Is more technology really better?

I'm struggling a little with how to phrase this, so I'm just going to write and see how it goes...

Lately I've been noticing what I find to be an interesting dilemma for many specialists. As we develop technology, we talk about how it will improve someone's life. For a cardiologist, we are able to use CT to do a basic coronary analysis without an invasive procedure and rule out many patients that they would otherwise have to take to the cath lab. For the gastroenterologist, we are proposing the same thing with virtual colonoscopy.

The marketing pitch is easy, right? We tell the physicians this will make your life easier. You don't have to worry yourself with the routine procedures. You can get more patients through. Life is good. Or is it?

As a cardiologist or a gastroenterologist, yeah, it's great to have the challenging cases that allow you to stretch your thinking, perform an amazing procedure, and live up to the lofty views. But, it's the routine that puts the money in the pocket. A routine colonoscopy with no complications can take 30 minutes or so, and put 2-3x more money into the GIs pocket. Same with a routine angio. And, these are less likely to be met with complications, stress, etc.

When positioning to these customers, it is important to keep this in mind. As marketers, we want to tout all the time saving, risk saving that these cool and great technologies offer the physician and ultimately the patient. But it's also important to remember that we need to show them how to build a business around these new technologies. We need to become more consultative. For the GI guy, it's about helping him set up a practice that will allow him to boost screening by using virtual, which will in turn keep enough people coming through the door to keep the endoscopy suite packed. The same goes for helping the cardiologist get her practice established.

Ultimately, it's about helping them first embrace the technology as something to help them grow, showing them how to attract more patients/referrals, and really differentiating themselves from all of the other practices out there by truly catering to the different needs and desires of the end customer, the patient.

Virtual Colonoscopy; A Three Part Series - The Facility

After a short absense while I attended the Abdominal Radiology Course (great content for a future blog or two), I wanted to wrap up my discussion on the series of virtual colonoscopy by looking at the facility.

CTC should offer facilities a unique way to differentiate themselves from everyone else. There are many different places that could offer the procedure including hospitals and diagnostic imaging centers. But, the place that I want to focus is the physician's office, namely the GI office.

Right now, it seems that many gastroenterologists are fighting the idea of CTC. They don't want to take the scope out of their hands. But, they are missing a golden opportunity to market to the communities they serve, grow their business, and even make their work more enjoyable.

Here's an ideal scenario. As a practice they structure themselves to offer both VC and OC. They structure the facility so that the patient comes in and goes through the VC screening. If there are any questions or lesions, they are sent over to OC for a procedure. For the 88% that are clean, they are done, and they go home (the 88% is from the ACRIN trial where it was concluded that 88% of participants would not have had to undergo an optical colonoscopy based on the CTC findings).

As a facility, you can then market this concept to the physicians and patients in the area. Non-invasive screening, but the option for same day removal. One single prep. Go about your day, and feel good. What are the chances that the number of patients increases? Initial studies indicate it will be better than good.

Next, market this to insurance companies as a package. Say they pay one flat rate regardless of outcome. This means you win on VC, lose a little on OC, but end up ahead because you are doing far more VC than OC. Plus by covering screening, they are less likely to have to pay on the back end for the treatment of cancer.

Lastly, market to the physicians. To the GI guys, it's not about taking the scope out of their hands. Rather, it's allowing them to forego the mundane, basic, non-polyp colons and focus on more challenging cases and polypectomies, thus being more stimulating for them (the same thing is occuring with the cardiologists as they realize it's more "fun" to deal with the challenging cases and leave the basic, routine ones to CT). For radiologists, this allows them an opportunity to do some additional reading, or it allows teleradiology practices the opportunity to increase their workload.

All-in-all, if this is properly positioned, it should be a win-win for everyone. It is going to take some education of the parties involved, but in the end, I think the advent of VC is going to lead to increased screening, which will lead to increased survival rates and increased revenues for the GI facilities. Because, when we get right down to it, it's not about taking the scope out of their hands, it's the fear of taking the dollars out of their pockets.

What Gives you Credibility?

So, I'm breaking from the VC topic prior to the 3rd part in the series because there is something that bugged me a little bit yesterday.

Does who you work for and what you do for a living increase or decrease your credibility?

I would say that if you are expressing an opinion regarding your industry, it should count for something right? My friend Andy is a partner in a consulting company that specializes in social media marketing. So when he talks about social media marketing, he is more credible even if he is trying to sell me his service than say my sister who is a teacher.

What you do and who you work for should enhance your credibility in your field as it is what you do on a daily basis. For Andy, his credibility is enhanced in a discussion involving social media marketing. His opinions should be more relevant and matter more in these discussions.

So why do I bring this up? The other day I read a post by a family practice physician that was against reimbursement for VC. So, I challenged his position by pointing out studies that indicated it was more effective than he gave it credit for as well other procedures that are reimbursable but have a lower sensitivity than VC. Rather than make a counter argument, he simply dismissed my comments because I work for a company that produces a VC product!! How does this make sense? I've spent the better part of a month researching and trying to understand the validity of this procedure, where the benefits lie, and why it would make sense. Yes, I want to see it approved because it is good for my company. But at the same time, my argument was based on research, patient care, etc. Doesn't this qualify me as having some credibility to my argument?

When you are talking to people, what they do can lend a lot of credibility to an argument, even if they are trying to eventually sell you something. People that are trying to sell actually spend a lot of time understanding their products and services, thus bolstering their credibility. Plus, people try to find things that they enjoy to do, enjoy learning about, and enjoy talking about. You definitely shouldn't dismiss those people.

Virtual Colonoscopy; A Three Part Series - The Patient

Let's switch gears a little from a discussion of Health Care reform, and get to understand Virtual Colonoscopy from the perspective of the customer, or as they are known in the medical world, the patient.

Imagine for a minute that you are in the at-risk population and should be screened for colorectal cancer (for anyone reading this over 50, this probably isn't much of a stretch). Odds are you feel fine other than some of the general ailments that tend to present themselves once you cross the half-century line. You meet with your doctor and he recommends that you get screened for CRC. You think, no big deal, it's just a blood test right? Then your doctor starts describing your options.

Option #1: Optical colonoscopy. Basically what you will have to do is find a GI and make an appointment. You will have to go through this process to cleanse the colon. Not great, but you can do that. Then you have to take a day off work, and find someone to drive you to the doctor. Why do you need someone to drive? Because you are going to be sedated. Once sedated, the doctor is going to spend 30-60 minutes looking for any polyps or lesions. Then you get to go home to recover.

Option #2: Stool DNA Testing. Let's just say you have to send a bowel movement to a facility to be tested.

While there are many other options, they really aren't as effective as you would want.

As you leave the office, you are thinking, "I really feel fine, do I need to go through all of this?". You then tend to put it off because you don't have any symptoms.

This happens more often than not. With all of the different screening options out there, less than 50% of the at-risk poplulation gets screened. What does this mean? Basically that over 50,000 people will die this year of colorectal cancer. By the time you start experiencing systems, it's too late.

However, if the doctor told you that you had another option, a virtual option, what would think? Yeah, you still have to go through the prep, but then you go to the facility, get scanned, and go about your day? Are you now more likely to get screened?

For the patient it's about having choices. Some people will elect the traditional colonoscopy as it is the gold standard, and they want only the best. Some will elect virtual for their various reasons. And some will elect to do nothing. When it comes down to it though, as a patient, I want to have different options. Let me choose which method I want to be screened by.

I think that we will see a significant increase in the number of patients being scanned by simply offering a virtual choice, even if some have to pay for it themselves.

Virtual Colonoscopy; A Three Part Series - Healthcare Reform

If you had asked me a year ago what my thoughts were about colonoscopies, I may have given you a blank look and quickly turned my attention to something sports related.  Now however, colonoscopies, specifically virtual colonoscopies (also known as CTC) occupy a good part of my thoughts throughout the day.  As such, I thought it would be an interesting topic to try and get this little blog up and running.

I wanted to look at the idea of virtual colonoscopy, and the recent memo issued by CMS stating that they would not reimburse for the procedure, from three different aspects.  The first is general health care reform as some state this is the beginning of changing times (more on this in a moment).  The second is through the perspective of the patient.  The third is through the perspective of the provider.  The latter two will have a much more marketing perspective to them.

Last month the Centers for Medicare and Medicaid Services (CMS) issued a memo stating that they would not be reimbursing for Virtual Colonoscopy as a screening method for Colorectal Cancer.  Many different articles and editorials, such as this one from the New York Times, suggest that these type of decisions are "fundamental to any successful health care reform effort".  The author goes on to say that "Eliminating unproven procedures and reducing needless costs is necessary if the nation is to improve the quality and lower the cost of care over all."

Now, I don't disagree with this sentiment, per se.  However, are we really going about this the right way?  Currently there are other "screening" tests that are reimbursed by CMS, such as Fecal Occult Blood Test, that have been proven to be far less effective than CTC.  Wouldn't it make more sense to review current procedures that are reimbursed as to their efficacy?  Or do we leave them because at one point they were the gold standard, but as technology has advanced, it would be too much of a hassle to reevaluate these antiquated methods?  

Taking this a step further, shouldn't it also be important to look at the types of procedures that are being reimbursed?  By this I mean screening, diagnostic, treatment, monitoring, etc.  When looking at it from this perspective, preventative medicine is far less expensive than treatment of a disease.  Just ask anyone that has had an overnight stay in a hospital, or a surgical procedure.  And how much of that is paid for by Medicare and Medicaid?  By simply preventing the disease in the first place, how much money would be saved?  I don't have the answer to this, but I would assume it is quite a bit. 

So, let's return to the case for Virtual Colonoscopy.  Why is this become a hot topic?  Colorectal cancer is the second leading cause of cancer death in the U.S. annually (nearly 50,000 deaths per year), but is one of the most treatable if caught early.  Unfortunately, less than 50% of the at-risk population (adults over the age of 50) are screened using any method including those that are less effective.  Not only do there exist numerous studies that indicate that this procedure is as effect as optical colonoscopy (the current gold standard) at identifying lesions of 10 mm and greater, but there are additional studies that show the at-risk population is more likely to be screened using this method.  On top of this, the numbers indicate that 80% of those that are screened do not have lesions that need to be removed, thus saving additional time and money (no anesthesia and CTC costs less per procedure than optical).

In my opinion, this decision by CMS concerning Virtual Colonoscopy is a short-sighted view that could affect access to an proven procedure, and is at best a veiled attempt at reform without really digging deep and asking some tough questions about the entire system.  Are all currently reimbursable procedures still adequate?  Can money be saved by removing older, less effective, but still reimbursable procedures?  What types of procedures are being reimbursed?  Can money be saved in the long-term by putting more emphasis on screening procedures?  It won't be until CMS begins looking at things from this perspective that we will see actual reform begin to take place.

Here we go again

So, I figure it's time to jump into the world of blogging, to find a place to express my thoughts, and to build a little bit of a knowledge base. Right now, I'm not entirely sure what this blog will be. I anticipate read and respond from the world of Healthcare, random musings on things going on in the world, day by days of my conferences and tradeshows, all with a marketing twist.

I had started a blog a couple years back with the goal of writing about sports 2 times a week. 5 posts in it faded and died. It wasn't from lack of material or thoughts, but more a lack of any internal reason to keep it going. I hope that this time it will be different.

I'm not sure where this is going to go. I anticipate that the the first posts will be rough, the writing not so fluid, and the ideas maybe a little muddy. But I hope through time and practice, this encourages me to continue reading about the world around me and expressing my thoughts, and slowly rounds into something fun and coherent.

So here it is, my first post of hopefully many. We'll see if I can keep this going, if I can develop a readership, and if I can take it somewhere. This time, I'm not approaching it simply as a "creative outlet", but rather an opportunity to build my personal brand, and develop myself professionally. As Seth Godin says "Google never forgets", so I hope to give it good things to remember.