Monday, November 18, 2013

When We Empower Patients to Pay for Expertise

"I know what you're thinking, punk. You're thinking "did he fire six shots or only five?" Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you've gotta ask yourself a question: "Do I feel lucky?" Well, do ya, punk?

Harry Callihan (played by Clint Eastwood) in "Dirty Harry"
Today, Alivecor accounced the launch of their AliveInsights(TM) EKG interpretation service where patients decide with their own dollars and sense, who interprets the single-lead EKG generated by Alivecor's EKG iPhone case. If the patient feels fine with a technician and wants a response in 30 minutes, they can get their answer if they elect to pay $2. If that same patient wants a "Board Certified" US cardiologist to interpret their tracing and are are willing to wait up to 24 hours, they can elect to cough up $12 instead.

Gee, which would you take?

My bet is that Alivecor's guessing people will accept the cheaper alternative. But will prescribing doctors?

It is an interesting model. I learned from Dr. Dave Alpert, the inventor of the Alivecor iPhone case, that "board certified" cardiologists get to keep $10 of the interpretation fee for providing the service - no insurance forms to fill out, no worry about a technical fee for the patient - just a plain ol' cash payment model.

Perhaps what is most interesting to me is how incredibly disruptive this model is to our current medical model.

But there are other concerns for doctors who might elect to "prescribe" an Alivecor case to their patients.

If the patient elects to pay $2 and a "technician" mis-reads the EKG, is the prescribing physician legally responsible for adverse outcomes that might occur? Who is responsible if a cardiologist mis-reads the transmitted EKG - the prescribing physician or the interpreting physician (presuming they are not always the same individual)?

These are interesting questions to ponder as this service launches. Certainly other issues are likely to arise where the lines of patient responsibility become blurred. Still, I like the fact that Alivecor is moving head-on into this space. It sets an exciting opportuntity for patients to have more control over their health concerns, and if this helps them, then all the better.

So as Harry Callihan said, "Feel lucky, punk?"


1 comment:

Gary M. Levin said...

I am only an ophthalmologist, however, a single lead EKG ? How many things can be missed? I hesitate to venture an opinion. Almost as good as making an eye diagnosis with just a visual acuity. If I were a cardio I would stay away from this no matter how much the"model" pays. Ask Obama ?