Health IT, Hospitals, Startups

Palliative care meets telemedicine in physician entrepreneur’s startup

A 2008 study drew attention to a shortage of doctors with sufficient palliative care training […]

A 2008 study drew attention to a shortage of doctors with sufficient palliative care training to handle the anticipated demand from an aging population.

Physician entrepreneur Michael Fratkin has started a palliative care business Resolution Care. It uses telemedicine both as a way to give primary care staff and specialists palliative care training and as a way to check in on patients from their homes in rural areas where they don’t necessarily have access to hospice care.

Fratkin, an internist, decided to make the move to quit his day job with a hospital system in Humboldt County because he didn’t feel that he could deliver the level of care that his patients required at the volume that the health system required. He said he raised $137,000 in a crowdfunding campaign on Indiegogo in December to lay the groundwork for his new company’s launch earlier this year. In the next three months he plans to hire a nurse, community health worker, social worker and a chaplain.

So far, the four-month old business has focused on clinical work with telemedicine for 70 patients. Although many of his patients have cancer, he emphasizes that palliative care isn’t just for dying patients but for people facing a life threatening illness. It involves managing patients medications to control symptoms such as pain, nausea and breathlessness. It also involves helping them make decisions about treatment.

Although Fratkin continues to make house calls, his virtual house calls with patients through video conferencing isn’t covered by insurers in many cases. Patients pay a fee for the service. Fratkin contrasts the “incredibly depersonalized” feel of a clinic to checking in with patients in their home. They’re on a sofa with their cat drinking tea and are more relaxed and at ease. Fratkin sees that as a significant advantage at a particularly vulnerable time in his patients lives where so many things are beyond their control. He wants to be able to provide some patients iPads and hi-speed WiFi access to make it possible for more patients to connect with his practice.

Its educational component, Resolution Care Fund, licenses the project ECHO model from University of New Mexico. The program is intended to break down the divide between specialty and primary care by connecting specialist teams at an academic ‘hub’ with primary care clinicians in local communities. Through a video conference link, it will hold weekly clinics that function like a virtual grand rounds with primary care and oncology practices, as well as nursing homes and assisted living facilities. According to Fratkin, it is the only business applying the model to palliative care. It intends to work with up to 10 clinics twice a month for a year and plans to measure claims data to determine whether it has had an impact on the quality of care.

Fratkin said he expects the company to begin to generate revenue in September when it launches its first ECHO clinic. With no other companies providing dedicated services in the way that Fratkin is, he’s taking a bit of risk entering into this field before payers decide to reimburse for it. But if he can make it work, it could trigger wider adoption by hospitals and physician practices. He added that in addition to working with facilities in Norther California, it will be creating a palliative care program with groups in two other states.

A couple of companies have taken different approaches to using health IT to support palliative care. Medalogix uses predictive analytics to determine whether patients should be referred for hospice care. A social network for oncology nurses, called TheONC by United Business Media, has helped nurses share insights on palliative care.

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