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Saturday, December 1, 2012

First Hurdles : The Rajiv Gandhi Jeevandayi Arogya Yojna (RGJAY) implementation in Maharashtra

Pleas read this Mumbai mirror article first:
http://www.mumbaimirror.com/index.aspx?page=article&sectid=2&contentid=2012120120121201101329585a34b6329
Beautifully written by Ms Jyoti, a Journalist.


The Rajiv Gandhi Jeevandayi Arogya Yojna (RGJAY), covering more than 5 million families in Maharashtra,is poised to cover more than 80 million people. Based on the immensely southern success story "Arogyasree" health scheme. Within this scheme patient get cashless surgeries and other treament from empannel private and public hospitals. The state sponsors this at a highly discounted premium with TPAs / insurance companies.

Fall outs:
As mentioned in the story, there are bogus claims, unecessary treaments, and wrong escalated bills.
This was expected, and i did mention this is in one of my previous blogs / articles.

Reasons:
RGJAY does not follow in spirit the entire learnings of Arogyasree scheme.
Arogyasree does not involve any TPA or third party mediation.
The claim process has to be done with 24 hours. Any further delay leads to fraud and wrong claims and manupilation.
All interaction is with the insurance company without any TPA.
There is no variation in pricing and all hospitals have to follow the same pricing.
There are clinical processes and instructions on what tests, medicines and lenghth of stay and preconditions have to be followed mentioned by Arogyasree, which is left to the hospital here.
All centres are linked by common software and mandatory online MIS. You can actually see vacant beds and MIS online in public, making it transparent.
There is a large call centre and support by local health workers on implementation of this scheme.
There is on an avearge 15 day delay in TPA claim submission by hospital which leads to all the manupilations etc.

Way forward:
This work should be given to insurance companies directly without involving TPA.
The hospitals should follow a common cloud based / linked software for MIS and claim processing.
Clinical proccess should be laid down to prevent unnecssary treamtents.
hospitals whose claims have been found to be fraudulent should be banned /licence cancelled as an example.
Arogyasree scheme should be replicated in same essence and operations.

All this is necesary as the faith in medicine, and doctors will soon go away.
Such programs will not see the light of day if bad examples are reffered to.
Ethics Ethic Ethics. All doctors should be made to stand in line and made to read the hippocratic oath again.
Its High Time.

Author is social impact award winner & MD & CEO of EKohealth. Ekohealth has been fighting against referral fees, cut practice and striving to create a transparent health industry with cost comparisons and information to public to make them better informed.
 
Author:
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD,
Mumbai
Tel: 9820007137
Awardee, Ramanujan Bose Award 2012: http://www.ramanujan-bose-prize.org/#!2012-prize
Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
feature on CNBC Young turks chat with Dr Naresh Trehan : http://bit.ly/PeyPbN
Feature in Entrepreneur Magazine: http://scr.bi/HrBQSf
Feature in Business India Magazine: http://scr.bi/HltyQa
Feature on CNBC Awaaz: http://bit.ly/H9jdTF
Feature on National TV (DD) : http://bit.ly/TsFJ0s
---------------------------------------------------------------------------------------------------------------
EKOHEALTH website & blogs: http://www.ekohealth.in
Ekohealth @ Linked in : http://linkedin.com/company/ekohealth

Facebook : http://www.facebook.com/ekohealth

Twitter: http://twitter.com/ekohealthindia

Skype: akrajpal

Dr Akash Rajpal @ Linkedin : http://www.linkedin.com/in/akashrajpal



Saturday, November 24, 2012

Good intention

I was reading a fantastic article by professor Rodwin in New England Journal. Interesting perspective on the conflict of interest by medical practitioners who make investments in place they work. The primary objective logically will be ROI rather than patients interest. (Prof Rodwin's Article : http://bit.ly/U3mlIm)

When I shared this with my students & industry colleagues, some interesting arguments started.

Some practicing clinicians & hospital owners said that (sarcastically of course) that if Prof Rodwin is understood, then practicing medicine for fee itself is a conflict of interest. And I agree to that perspective too without any sarcasm.

Practitioners have been arguing since long time on why patients (consumers) just can't accept art of medicine & healing like any other profession & realize that like any other profession the care provider needs to earn a living too. Almost all surgeons have their own hospitals & physicians their own clinics. So the aspect of ROI (Return on Investment) & a commercial angle to seeing a patient always will arise. Afterall the hospital owners have their bills & salaries to pay. And some argue that offering costlier procedures for increased financial gains though is the norm today, is justified as it "apparently" offers significant advantages over the time tested older cheaper ones. Examples cited were minimally invasive laparoscopic surgery v/s open surgery. And the argument went on further that finally it is market forces which determine ones actions :) (me smiling)

No, I don't mind these responses. Actually, its an interesting argument.

However my concerns:
For first time since last few batches, medical, dental seats are lying vacant to tune of 20 to 35%. 20 to 60 % of doctors & nurses don't clinically practice anymore (many of them are becoming administrators, & even changing industries :) I'm afraid the trend will continue. Fortunately you will see reduction in donation price & fees to fill seats in medical colleges. But over all there is huge competition from other industries like IT, offering better pay packets ( & for ethical work). Youth realize that.
Ethical Work? Yes, youth realise that every investment needs to have a return. The youth spends a fortune & almost a decade in becoming a doctor. With restriction on marketing & publicity, the hierarchy of sorts (of unethical nature) starts to work in healthcare. The hospital pays to family physician a referral fee to influence a patient to visit them. This comes at an ever increasing cost. The ROI will demand naturally more tests, treatment, expensive brands of drugs & so on which may even not be required by a patient. I still remember in disgust how a GP never prescribed antacids (or made patient aware) when prescribing chloroquine. The patient was forced to come back for a second consultation for treatment of acidity. ROI in classic play.

I'm afraid, healthcare is soon going to see a major setback across the globe & in India specially as we will see mass exodus of doctors & nurses to foreign shores for better pay packets. & potential doctors & nurses choosing other professions.

There is a serious introspection needed. This is the time to change & start having a good intention. Intention to see good of patient & sincerely honour hippocratic oath.

My argument on conflict of interest on fee for practice is that in other industries for any harm to an individual there are strict penalties & legal actions imminent (for example life imprisonment for murder, harm), but there is a huge relief given to medical practitioners for such outcomes (death for example) on account of a wrong judgement call. Why? Because we are playing with human lives & trust. The way we honour a soldier for killing in larger interest of the nation, similarly a lot of wrong doing & bad judgement calls are ignored by court of law so that the medical practitioner keeps practising & uses he prior bad experiences to save more lives. Alas that gets lost somewhere in the so called ' fee for practice', right to earn a living.

I remember Dr Naresh Trehan in an exclusive interview on CNBC with my company Ekohealth's Director Nehha Rajpal, said that for success in healthcare the most import thing required is good intention. Else one should choose any other industry. Therefore we have likes of Devi Shetty who come up once in a while as a breather.

If it was for me, I would have made healthcare akin to armed forces. Government spends on it being essential services (Obama trying to do the same exactly for same reason). And there are time tested good examples from past & present. Singapore is worlds most successful public health model followed by NHS. There the citizens prefer to visit a government hospitals, being so good. In such systems, all medicos are hired (there are better opportunities for governance due to low population too, but... Then you can have more centres & resources too) So no conflict of interest arises as patient don't have to pay. India is different, rest of world is different. This discussion is still an interesting argument.

Obviously government can look at a nicely IT enabled nicely monitored PPP delivery at fixed pricing with fixed clinical protocols (like arogyasree)
Obviously more clinical resources like doctors & nurses need to be created by removing red tapes, reasonable nationalistic rules governing medical/nursing colleges (3yr community professional course by govt is a right step. What can you do if doctors won't work even with bonds in villages. & bonds are not efficient & right way to keep doctors where they don't want to be)
OBviously everyone could be insured in the interim to pay for care.
Obviously all treatment should be free as matter of right of better living.

And I hope that day will come.

What is required is just a good intention.

Dr Akash S Rajpal
Author is CEO of Ekohealth (www.ekohealth.in)
He is a ramanujan bose awardee for social impact & is working against fee splitting (referal fee / cut practice)
Sent on my BlackBerry® from Vodafone

Tuesday, September 4, 2012

Singularity Summer


Dear all,
This blog perhaps is my most exciting blog ever.
I share my experiences at Singularity University at NASA Research Park, USA.



Singularity summer

Students and diversity
Peter & Ray & Firesides
Lectures and insight by various faculties
Site visits & Workshops
Team Projects
Fun
Concluding Remarks



Students and diversity
It was humbling to be among a highly diverse class with students from 35 countries. Women represent 40% of the class and that was positively a striking contrast to what I typically see back in India. It was good to know that I was selected among the 3000 odd applications and was one of the 20 global competition winners.




Average age being 35, most of the students are entrepreneurs; many of them have already started a company as early as 19 years of their age. Sharing experiences and knowledge being a learning experience every day, making you realize that ones achievement is not enough in comparison to the rich background of the class, and that much has to be done in life.
All share a common goal - of creating an impression on the global scene, and helping millions of people at the same time.

Peter & Ray & Firesides
Most amazing part of the Singularity Summer has been a close interaction with visionaries like Peter Diamandis and Ray Kurzweil. It’s an immense pleasure to see the aura of passion for technology-change for good in them, that it is nothing less than infectious.


Whether its listening to Ray talking about increasing life expectancy, not worrying about robots replacing human jobs, his predictions to the precise time and date in future and how his positive influence of his father on his childhood made him think the way he does was just an amazing experience. He however reiterated that technology changes would not be able to eliminate the influence of sex love and money. And he was serious about it.

While Ray’s passion reflects in his unique style of calmness, Peter Diamandis just exuberates with energy. Very approachable, and humble and it was an amazing experience interacting with him. While everybody worries about privacy and security due to Facebook and other social media sites, Peter has been positively insisting that such openness has been the biggest neutralizer to threat of security everyone being there, creating a more transparent community. He is a strong propagator of radical transparency and reflected the same in his fireside chat with Philip Linden of Second Life Virtual World.

The Fireside sessions in late evenings of Peter Diamandis where he invited many leading successful entrepreneurs for a close interaction is unforgettable.

Philip Rosedale AKA Philip Linden of Second Life and his out of box ‘commit to pay’ crowd source ventures like coffee&power, Eric Migicovsky of Pebble and how he raised 10 million dollars on Kickstarter site, Josh Kopelman’s marketing genius to rename a town to his company name ‘half.com’ which got sold to eBay later were amazing stories to listen to. It was encouraging to hear from Philip Linden say that great ideas sound crazy or of disinterest few years before they happen.

Lectures and insight by various faculties
The core strength of the Singularity summer was the faculty and invited guests to interact with the students. We had some amazing personalities interacting with us on various subjects including exponentials of Nanotechnology, Biotechnology, Robotics, Space, Health, policy law and ethics, Information Technology, and many more. While we were excited to gain an insight into the cutting edge technology, Marc Goodman reminded us of the dark side of the technologies - be it stealing a persons DNA, or 3D printing Guns. It was chilling to hear his work against terrorism & his insight on the technology used by terrorists in the Mumbai attacks.

Very approachable Salim Ismail discussed purpose of life, while Aubreyde Grey discussed curing ageing and longevity. Ever-spoken Vivek Wadhwa updated us with exponential technologies with his frequent Forbes articles and write-ups.

Eric Reis of Lean Startup encouraged us not to be insecure of ideas being stolen, and instead worry about execution, while Greg Maryniak told us about energy resources and future of energy. Bob Richards discussed multiplanatary civilization, and Navin Jain spoke about social enterprises. SR Das on economic modeling, Sushmita Gosh from Ashoka Foundation, Catherine Mohir's concern on gradually shifting agriculture land scape to developed countries, and Matt Ranen of GBN on forecasting future were among many lectures which helped us form a vision for our team projects which could help a billion people.

Hod Lipson introduced us to 3D printing allows printing customized implants, flexible batteries, bio cartilage, food using any material


India and Indian companies were frequently citied as good examples by many of the faculty.

Interaction with Hugo award winning science fiction writers like Verner Vinge, Greg Bear, David Brin, was very engaging, I specially being an avid science fiction reader.

Ben Goertzel on Genral AI via skype spoke about problems with the Turing's Test & wozniak cofee test and challenges to make AI better than humans.

Nano tech H2 fuel cells, terraforming desserts, supercomputing, early disease detection indicates that this is a Nano decade for sure.





Dan berry, astronaut and space faculty shared his passionate story of his desire to be an astronaut and how his persistence paid off.



The women at Frontier Event was organized by Singularity University which had inspiring speeches by women entrepreneur’s like Lakshmi Pratury of TED India and Kay Koplovitz founder of channel-SciFi.

Peter Schwartz predicting space travel by year 2200 & Bangladesh underwater by 2050, and exclusive revelation of Cambridge Decleration by Philips Tevenlow that Humans are not the only conscious beings, interaction with Dr Amy Lehman of Lake Tanganyika Floating clinic were other highlites.

Insight by Yasuyuki Motoyama of Kauffman FDN that VCs invest typically within 70KMs of their base was interesting to know.

An interesting coincidence observed though listening to all these technologies was that ‘something is happening at Global IT as an organism. Total transistors, web links are now similar to a human brain synaptics now. Whether a super AI brain in making was extensively discussed.

Site visits & workshops
Google site visit was a beautiful experience, and I experienced up and close the great working environment it had. Interacting with teams behind Google car and Google maps was exiting.

We visited Autodesk, flew real aero models, had hands on with genetic sequencing during various site visits, built robots, moon rovers, programed circuit boards, and much more.
Team project workshops by external faculty, marshmallow challenge and an amazing session by Tom Wujeck & Maurice Conti was very helpful in preparing for our team project.
The students made Ignite presentations, and I did an ignite on use of the ‘Force Field’ as an answer to global grand challenges.

Team Project:
My team project was called as ‘CARE9’ and addressed Global Grand Challenge of Healthcare. The Team project integrates exponential technologies like Artificial Intelligence and sensors to make an artificial doctor to bridge the gap of inaccessible healthcare in remote corners. The application also has an extension to monitor falls and fainting for care of elders staying alone in developed world.
The team is strong and has diverse expertise from fields of sensors, artificial intelligence, public health and policy, Venture capitalists and others. Our team project already has got traction from companies like Genentech.
Our Care9 team project was rated as the best project with potential to reach 1 Billion dollar valuation in 10 years. We are working towards formation of a formal company and making a business plan to get funded.
Other exciting team projects in class included Zero G drones for economical lab experimentation, Artificial Womb and many others.

Fun
While were extremely busy, the diversity called for a lot of fun. We were invited to the Tony Robbins Motivation event, and many of us including me ended up doing the adventurous Firewalk. Tony Robbins also came for a exclusive one on one interaction at the Singularity University and it was very engaging.
We had various culture nights and the Asian/Indian culture night was very popular.
I got to participate in the annual San Fransisco Marathon, and had a lot of fun.
The class was very fun loving and ended up with a surprising flash dance to entertain the stressed staff and management. Video link -http://t.co/wQlEXKx6

We had various competetions which my team won including a 1000$ Android Application development opportunity, and other contests.
I got the opportunity to test various products including a foldable electric Bike ‘Yike Bike’






Concluding remarks.

The Singularity Summer has been a great unforgettable experience. Thanks to Ramanujan Bose Award that I could participate in this un-expectable journey of unique over whelming knowledge of exponential technologies called as ‘Singularity University’

My students in India have been following me and have insisted that I share my experiences when I return.

I plan to share such opportunities in schools and colleges as I feel the seed of exponential technology to help one billion people need to be sown in the young minds to affect in future.



Dr. Akash S Rajpal

- x -

Monday, May 14, 2012

Insurance dilemma and the outstanding billing issues.

In the United States the recent trends indicate that the uninsured population is rising and is at a high of 17 to 20% of population left uninsured. There the problems are very different and law suits against patients are common for un-paid bills which run in millions. Hospitals are also being sued by patients for aggressive payment collections methods for defaults and news articles are many citing incidents of payment sleuths from hospitals asking for money inhumanely in the emergency rooms from the uninsured.


Well the scenario is different here in India.


The insurance reach is less than 2%. And majority of payments are out of pocket.


However widespread grievance by a lot of INSURED patients is a little different.


They complain of jacked up prices when they informed the hospital that they were eligible for cash less services.


According to a recent survey as cited in Forbes, when the pricing for hospitalization was compared between insured and uninsured there was a striking upward billing of upto 40% for insured patients in comparison to cash paying patients.


This indicated obvious unethical billing and suspected collusion with many TPAs. This was bound to force many insurance companies to do away with TPAs and fixing certain costs of procedures.


The matter will only worsen over a period of time and will further lead to a disillusionment of patients from Insurance due to such instances and hassles, and the insurance penetration will not rise to a desired level.


With inflation and cost of health care rising, problems are going to worsen a lot leading to unutilized beds and non-competitive revenues and EBITAs. The problem of un-paid bills from TPAs to the hospitals and individual patients is on the rise. The reasons are many for the same but leads to a situation where either patients stay away from such hospitals, hospitals stay from such


TPAs and Patients stay away from getting insured.


However there is enough time to bring in trust among stakeholders:


Hospitals should look at long term solutions to acquire patients and not give into unethical referrals. Today majority of the hospitals pay 20% as referral fee, the competition will pay 30% tomorrow, and then how long will you up the scale? Effort based engagement with patients will build trust and cost of acquisition will be much lower. Leading to higher profit centres.


Hospitals should keep the tariff standardized for all kind of patients for the same class of beds. It should not change from opportunity to opportunity. The pricing for insurance too should not change.


In the long run Insurance companies will prefer such hospital who do competitive and standardized billing.  Many hospitals now doing away with bed class wise exponential billing and only charge extra for the room type and not the services. This makes all stakeholders happy.

Hospitals should invest time in making good all-inclusive packages with no variable. Its not that it can't be done. This will increase trust and competitiveness.


Hospitals should list their prices transparently and on all its communication channels including the website.


Hospitals should not take legal action against any patient. This will be like axing ones own foot. It will only lead to bad publicity. A gesture of good-will shall create a word of mouth to compensate for your loss if any.


Train your staff, specially the billing and customer care. A nice gentle but persistent followup with patients or relative every day reminding of their outstanding will sort out billing issues in majority of cases.


It is advisable that a tactful dedicated team (depending on the size of hospital) be assigned for such tasks.


Focus on 'Customer satisfaction'. That is what will make you survive in the business of healthcare.


Remember patients are only becoming more educated and informed.

 

 
Sincerely,
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD,
Mumbai
Awardee, Ramanujan Bose Award 2012: http://www.ramanujan-bose-prize.org/#!2012-prize
Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://scr.bi/HrBQSf
Feature in Business India Magazine: http://scr.bi/HltyQa
Feature on CNBC Awaaz: http://bit.ly/H9jdTF
---------------------------------------------------------------------------------------------------------------
EKOHEALTH website & blogs: http://www.ekohealth.in
Ekohealth @ Linked in : http://linkedin.com/company/ekohealth

Facebook : http://www.facebook.com/ekohealth

Twitter: http://twitter.com/ekohealthindia

Dr Akash Rajpal @ Linkedin : http://www.linkedin.com/in/akashrajpal


Tuesday, April 17, 2012

Gold out of dust

This is in reference to the recent government action against Kokilaben Dhirubhai Ambani Hospital to recover 175 crores just because they changed the trust constitution & ran some few innovative non health earning centres within the premises. http://m.thehindubusinessline.com/industry-and-economy/government-and-policy/article3324975.ece/?page=1

My take:
I guess unless govt is healthcare provider friendly there will not be many takers for creating a good quality health setup. Govt seems to become greedy when a pvt setup creates gold out of dust. The case seems to be duplicated in almost all professionally run centres now - seven hills, fortis vashi & others whoa re all in some trouble even with agreed MOUs. Govt needs to realize that no pvt setup will be there without profits for self sustenance even if it is a trust run centre. All prudent establishments who don't want to run on donations will want a self sustenance model. Govt should be happy that its city has such brilliant health setups catering to their obligation towards its citizens of providing excellent health facilities which they fail to do on their own.

Dear Govt, please be supportive of all who want to provide a brilliant setup &, please hand hold them. Make it un-bureaucratic, attractive, & un interfering so more private enterprises show willingness to invest in great quality health setups & ultimately providing world class healthcare to all with investments & maintainence from government.
Dr Akash S Rajpal
MD & CEO
Ekohealth Management Consultants PVT LTD

Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://lnkd.in/PwN4H4
Feature in Business India Magazine: http://www.scribd.com/doc/82435630/
Feature on CNBC : http://youtu.be/Nh5vpH_SErE

Website:
www.ekohealth.in
Linked in :
http://in.linkedin.com/in/akashrajpal
Facebook :
http://www.facebook.com/ekohealth
Twitter:
http://www.twitter.com/ekohealthindia

Sent from a Blackberry Device.
This communication is for intended recipients only. Standard confidentiality and nondisclosure clauses applicable.

Monday, April 16, 2012

Is marketing a healthcare provider ethically also 'ethical?

I was at Raipur & Korba, Chattisgadh last few days to promote 'Ekohealth' through road shows. I had interesting interactions with the medical fraternity & other stakeholders. A lot of them were surprised when I told them that Ekohealth will not take any 'cut' from them if Ekohealth patients come to them.
I said that someone had to begin ethical medical practice as unethical practice of referral fees is degrading the competence & faith in such a lovely profession.
On this many practitioners put forward their pain points on how difficult it is to get patients without referral fees.
Obviously, much of medical establishment is driven by doctors turned owners. Almost all of them are uncomfortable working for 'others'.
This creates a problem. Almost none of them get time to write about their good work, give adequate attention to patients & this leads to a degrading practice over a period of time. Such doctors who were busy earlier are find lesser patients coming to them in many centres. They never invested in themselves.
They never took opportunity to 'brand' themselves through publishing articles, creating patient forums, taking customer feedback & thus loosing an opportunity to act on it for appropriate course correction.
This also leads to a desperate 'spegheti' marketing & advertisement which is unethical in a lot of ways, but also unfruitful. So I have always propagated my belief of handholding your patient as a 'customer' who expects 'satisfaction' like any other purchase of a product. Today customer is smarter than before & therefore the patient too, as they both are the same.
One elderly gentleman during my interaction pointed out that in this case even writing articles, telling people how many amazing surgeries you have done, clinical outcomes etc is also 'marketing' & is therefore unethical. And he was very uncomfortable with patient being termed as 'customer'.
On this I deliberated that doctors are themselves to blame for it. They made patients customer the day they started encouraging a 'referral fee'. This ultimately made costs higher & patient started counting value for the buck. This also paved way for more professionally run corporate setups.
I told him that its absolutely fair that one's achievement be known to patients, else how would he know?
And unless you write on internet or contribute to various publications sharing your research outcomes, & learnings from the experience how would your peers & patients know you exist. Writing well would increase confidence among all stakeholders & create ethical peer referrals & direct patients.
I think he was convinced in the end.
Dr Akash S Rajpal
MD & CEO
Ekohealth Management Consultants PVT LTD

Feature on Young Turks-CNBC: http://t.co/hkzEzeDY
Feature in Entrepreneur Magazine: http://lnkd.in/PwN4H4
Feature in Business India Magazine: http://www.scribd.com/doc/82435630/
Feature on CNBC : http://youtu.be/Nh5vpH_SErE

Website:
www.ekohealth.in
Linked in :
http://in.linkedin.com/in/akashrajpal
Facebook :
http://www.facebook.com/ekohealth
Twitter:
http://www.twitter.com/ekohealthindia

Sent from a Blackberry Device.
This communication is for intended recipients only. Standard confidentiality and nondisclosure clauses applicable.

Wednesday, January 11, 2012

Marketing your medical centre for free & get 20% more patients

Dear Readers,

Wishing you and your family a great 2012.

Well the above mention was nothing but a small gesture of welcoming you to my world of blogs. 

Well similarly, the same is expected of a medical centre. Just putting a smile, doing a namaste and welcoming a patient into your premises is the least bit any medical centre can do. This elicits a response - positive mind frame, and let's the patient open up to you in a more receptive way.

Background: I was invited as a panelist at a conference on ways to improve patient productivity (turnaround) in Nagpur recently.

It was pleasure to share the dais with luminaries of the industry like Mr VP Kamath COO of Wockhardt hospitals, Dr Vedprakash Mishra - Pro chancellor of Datta Meghe Institute of Medical sciences, Dr Mr & Mrs Gode, Dr V Ranjan- Director at HMI KEM hospital Pune, and of course, interact with bright energetic hospital management students -  the leaders of tomorrow.

So, taking the insights forward, this blog post shall highlight some key ingredients to increase productivity in a medical centre - be it a hospital, nursing home, day centre or even a diagnostic centre. And the best part is - one can improve productivity by almost 20% and more by just doing the things below which does not cost anything. No advertisements required, no publicity, no unethical cut practice. Just sheer WILL and PATIENCE.

1. Greet all customers: But the catch is - the greeting should be felt from within and should show on face. There is no language barrier to greet. A simple namaste does the trick. In all areas this gesture should be followed. Be it a nurse caring for patient, or doctor examining, housekeeping cleaning the room or security frisking you. This however needs to match your action. Just plain greeting is not enough. Your gesture to welcome indicates that patient is a guest and you will take good care. So if there is a problem then it should be immediately 'looked into' without being defensive. (Discussed later in blog)
The best way to inculcate this habit is the initiative starting from ceo/trustees directly. They should start greeting even the housekeeping boys, doctors, nurses etc themselves. This shock of a gesture will embarrass all into following the same habit.

 2.  Take complains very seriously: To begin with you should have a strict command chain which makes it mandatory to collect feedback from 'all' patients. Though difficult, but needs to be done. An internal objective number of feedback's collected can increase month on month and can be linked to performance appraisals. Start off with a small sample size. All feedback forms should reach CEO 'after' root cause analysis and action taken. This process though has to be very prompt. CEO should create a environment among his employee to do this. The pretext of all complains should be handled with philosophy that ' All customers are right. And if customer is wrong, you led him to be that'

3. Display internally created publications: Well always remember one thing. Patient does not want to come to a hospital. Its a unavoidable need. So patient is not looking to be entertained there. He just wants to be treated, and well. So avoid keep entertainment magazines in your premises. On the contrary the only publication which should be there for people to read is your own. Why should you promote anyone else other than your organization and people in your own premises without getting paid

Create a monthly news letter or magazine which has poetry's written by your own staff(including housekeeping), disease articles by your doctors (one which you can handle and not some procedure which only your competitor can do), patient management processes and stories by your nurses, administrative hassles (ways you are overcoming wait times etc) by your admin staff, billing trends by your front office, lab/imaging trends/info etc. All should of your own hospital. Promote all department's salient offerings, explain in detail what you can do. Highlight one department of the month and introduce all staff members with group photo etc. Include their travel woes and their dedication to work. Best employees, awards etc, NEWS article copies of your hospital's mention. Write about the experience and back ground of your doctors, nurses, admin staff etc over a period of time in various issues.

This will not only motivate the staff, reduce attrition, but entice patient's confidence and bring them closer to your staff. Increase the confidence further by highlighting you clinical and administrative indicator statistics with benchmarks like infection rates, UTI rates, ALOS, YOY productivity in various departments, etc). 

And always print testimonials and positive patient remarks from feedback, etc(with patients permission, of course)

4. Publish or perish: Well a saying which is centuries old has still got relevance. Our Indian doctors are the busiest in the world. The kind of patients and experience we gain cannot be compared by anyone in this world. We all know that at times we see about 200 to 300 patients a day, each. In government setups this number is per hour.
Only problem - the treasure of experience gained, the unique cases seen, the amazing outcomes achieved are rarely shared with the world by my Indian colleagues. The Indian doctors kill an opportunity everyday to become famous and share the global dais among their western counterparts. 

'Their' OPDs are 'full when they see about 30 patients a day. Their single patient research gets accolades world wide and then patients from across the globe hoard to see them. Then why not us? I have though argued the other side of the story too (defending the non publishing friends of mine) that India is a developing country and we all are eager to create a financial security first than fame. That's ingrained into our mindsets. Western worlds have social security, population is less - so internal competition for work is less, so it leaves them time to publish what ever they see. But I guess its time to think again, as competition is increasing, patients are becoming more learned, word of mouth is the best source of reference and Internet is the best source to search for talent.

So if your article and paper is not there for world to see, and is not there in an indexed journal (at-least begin with a simple article every month online on free sites like slide share or Facebook or blogs) work done by you will not be noticed and you will not be able create a word of mouth among your referring fraternity and net savvy patients.

5. Internally cross promote your departments: Well as I said earlier, a patient never wants to come to a hospital. So the chances are that he will rush to your specific department, get treated and rush back. He would not know about some other great things you offer in your hospital. 

Though waiting time is a bane, you can convert that into boon by highlighting services offered in other departments. 

For example, if your patient is in imaging centre you should definitely highlight what services you offer in imaging. He may have only come (maybe through reference) for USG, but now you should ensure he also knows that you carry out dental OPG, CT etc. You just marketed your services to this patient which may go out as a word of mouth to other friends of his who may need that service apart from him. That recall will be there. This should be further extended by highlighting salient services of other departments (in this example - non imaging like dental, physic therapy, cardiac unit etc) and create foot falls for those departments too and vice a versa in all departments.

You will be surprised to know that many times even the local patients are surprised to know of a service which may have existed for months in your centre. 

You may offer some promotional attractions to visit the new department (eg. Free consultation - show your bill from previous visit in another department)

6. Track all patients/Capture all registration data: The patients who have visited you are a rich treasure of opportunity for repeated acquisition to sustain your business. A healthy hospital is the one which has about 70 % existing patients who come again and again, and 30% new patients. Have you calculated this figure? Please do that today itself. A large number of new patients means that you are depending too much of referred patients and is a danger to business sustenance (the case may be a little different for centers of excellence like dancer institutes etc where patient come from all over the country). The data of phone number, email etc which you capture can be a channel for you to keep on communicating with your patients to offer discounts, disease awareness, promoting new department, wishing them on their birthdays (but with with caution) etc. This will help you get the same patients again and again and improve your revenue.

7. Last but not the least - signages: Have good signboards and signages. They should not be dirty, should be in language which is understood by majority of your visitors, and should easily direct the patients to the relevant location within the centre. Its a great turnoff for a patient to keep on asking for directions. The worst is when your staff is not trained well to guide further. Imagine your security saying 'nahi maloom'. Signages are the first reflection of the 'brand' and are the first aspect in marketing oneself. If one can invest (and therefore my last mention in this post), one should have good signages both internally and externally. If you are at a location which can provide opportunity for a large floating population in the vicinity to see that big signboard, one should invest in a large distantly visible signage(neon etc). This will give you free publicity and recall. Your external signage itself can become a landmark for many addresses.

And for the internal signages, you can begin with nice economical printouts from your computer printer, and use a economical acrylic standees which will be cheap to acquire and install.
Please ensure there is no grammar or spelling mistakes. PLEASE DON'T USE MEDICAL TAPES OR CELLOPHANE TAPES. ITS A BIG TURN OFF. AND DO NOT JOT ANY PHONE NUMBERS ON THOSE SIGNAGES. Do invest in professionally made internal sign ages also over a period of time.


So get going and make patients happy, and profit from it.

Warm Regards,
Dr Akash S Rajpal
Founder, MD & CEO of Ekohealth.

Looking forward for any particular topics that I should write on? Do write in. Reply on my blogs or leave a comment.

Press, media, management schools and others can use my articles and blogs without permission. Kindly just give due credit and inform me of the inclusion. 
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About Ekohealth:
(Watch the CNBC feature on Ekohealth at http://youtu.be/Nh5vpH_SErE)

Ekohealth facilitates discounts for the medically uninsured.
There are many patients in this country who do not get medical
insurance even if they wanted to. Health Insurance does not cover
senior citizens, and those with pre existing diseases like Diabetes,
cancer, etc, and such patients end up with huge medical bills. These
patients are the ones who have to get blood tests done more
frequently, visit doctors more often, and get admitted more
frequently.

Ekohealth strives to help such patients numbering between 100 and 200
million in this country.

Ekohealth has tied up with various hospitals, clinics, diagnostic
centres, chemist shops, dental clinics, cosmetic centres and ambulance
services. Ekohealth members can avail from 5 to 50 % of discounts on
various services at these centers. Ekohealth has tied up with Bombay Hospital, Saifee Hospital, Yash Birla group of medical centers, Nova Day care, Life care, 1298 ambulance, Nirmaya, Rajpal geriatric nursing care, and many more.

There is no age limit to become a member and any person with any
disease or otherwise can join ekohealth. There is no limit on using
the membership card and can be used any number of times.

Youngsters who are insured can also benefit with ekohealth membership
as they can now avail services in OPD like dental care, maternity care
etc at discounted rates. Insurance does not cover OPD expenses like
executive health checks, Maternity child birth etc.

Corporates can buy ekohealth memberships for their employees to extend
an existing insurance scope and reduce expenses on medical
reimbursements. They can also extend this facility to the parents of
the employees who are normally not covered any corporate insurance.

Ekohealth becomes a single corporate like setup for individual
patients who can collectively bargain for better rates for common
ailments.

Insurance will be the biggest beneficiary as they will not have to run
around to get hospitals to offer discounts and their reimbursements
will be lesser saving them millions in cash payouts to patients.

To know more about Ekohealth write to me, call our toll free number
1800 2094 356 or email at benefit@ekohealth.in


Tuesday, January 3, 2012

Short sighted governance

I refer to the recent issue in Jharkhand where heated arguments over bio waste disposal have begun between Jharkhand State Pollution control board and the private hospitals. http://telegraphindia.com/1120103/jsp/jharkhand/story_14955191.jsp

The state pollution control board of Jharkhand wants all big hospitals to setup their own incinerator infrastructure to treat the biowaste. This is a very short sighted approach, and will only lead to further pollution of the neighboring areas and cause lot of health problems to the citizens nearby.
Incernerators also need Diesel (considering the poor power situation there) and will be a great fire hazard as loads of diesel would need to be stored on premises.
Plus the capital costs will only worsen the existing poor ROI of the hospital.
Jharkhand government authorities cites lack of funds for land acquisition and capital funding issues as main reasons.

This is classic example of concerned agencies not planning with all stakeholders. If a land crunched and expensive real estate location like Mumbai and Navi Mumbai can have a great arrangement of a centralised bio waste disposal then why not Jharkhand? 

Such arrangements necessarily need to be done on a a PPP model, and needs farsightedness and willfullness on behalf of the governance.

Problem which still lingers with the government is that they are not still willing to let go its micro involvement in - everything. They should act (as I have always deliberated) as facilitators and create a environment of inviting all stakeholders for a simple solution. Let the private bodies do such things, offer them great incentives, and just supervise from time to time.

I hope the new year sets some great PPP examples and cites landmark benchmark in good governance.

Wishing all a very happy new year.

Warm regards & best wishes.
 
Sincerely,
Dr Akash S Rajpal
MD & CEO,
EKOHEALTH Management Consultants PVT LTD

Watch Dr Akash S Rajpal Speak on CNBC.  http://youtu.be/Nh5vpH_SErE
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