Volume 3, Issue 3: Industry News


DoctorGlobe, America’s first and only domestic online hospital-shopping platform, has launched an innovative surgery case-management tool named “Surgerate”. Surgerate helps pre-certification, concierge, and case-management teams to seamlessly find the most efficient hospitals for their health plans’ participants in need of surgery.

San Diego, CA, 12/19/2017 – DoctorGlobe is excited to announce the launch of “Surgerate” to augment its first-of-its-kind cloud based Surgery-Shopping platform. The innovative new interface is dedicated for healthcare case-management, pre-certification, and patient-placement teams. With just a click of a mouse, Surgerate ranks performance of more than 120 surgeries, at 3,000+ U.S. domestic hospitals, by quality, price, and location, relative to every employee’s area of residence. Going forward, both the original (patient) as well as the new (case-management) applications will operate under the combined platform “Surgerate” brand.

“We realized that empowering case-management teams was essential to increasing patients’ utilization of our quality and cost transparency platform. Patient-placement team members have been forced to wonder among 5-6 different sites in order to find provider/procedure quality, price, and location information, while ranking their findings manually using spreadsheets. Surgerate will do the ranking for them with one click from now on,” stated Tibi Zohar, President and CEO of Doctor Globe, Inc.

DoctorGlobe’s initial focus was on direct patient engagement in online healthcare consumerism. The company introduced an incentive program that reimbursed employees for their out of pocket expenses, and awarded them a cash bonus based on a percentage of their employer’s savings. Accordingly, the patient interface displayed employees’ incentives (what’s in it for them) rather than hospitals’ procedure prices. Surgerate displays every hospital’s price for the specific procedure, relative to the average rate in every employee’s area of residence.

With the launch of Surgerate, DoctorGlobe reinforces its commitment to help employers and employees contain their healthcare costs. Backed by its proprietary algorithm, big data, and crowd wisdom, the company helps self-funded employers and employees to curb high health care costs and improve surgery outcomes. The company has also come up with a smart employee incentive benefit program that inspires plan participants to select premium care providers that offer better care for less.

Surgerate is the first and only platform that ranks US domestic hospitals from 1 mile to 4,500 miles. The hospitals are ranked based on the most important parameters considered by participants, while choosing the right hospital by distance, quality and price. With Surgerate, plan participants and case-management teams can find the ideal hospital based on the factors that matter the most, select the best suitable doctor at the chosen hospital, and reserve their care with their chosen providers.

“We help self-funded employers save millions on healthcare costs. Moreover, we assist them to solve the two most common challenges they face – lack of upfront quality and price transparency in healthcare, and the struggle to engage employees with innovative solutions. We provide employees with access to 3000+ hospitals and help their employers beat the challenge of quality and price transparency”.

For more details, please visit surgerate.com.



How the Growing LEP Patient Population is Increasing the Need for Remote Interpreting

By David Fetterolf

As a result of the ebb and flow of immigration, the most widely spoken languages in the United States have changed drastically in the last twenty years. Although the United States has always been known for its linguistic diversity, due in part to our “melting pot” mentality, census records show these changes are much more striking than in the past.

The steady increase in language diversity – and alternation of the most popular languages – has greatly impacted the demand for language access services in healthcare and beyond. Previously established language access plans have become obsolete due to a decrease in the use of some languages and a rapid increase in others. In addition, refugee resettlements and population concentrations of specific languages have contributed to this nationwide need for redefined language access solutions.

Language Patterns in the U.S.

Certain areas of the country tend to harbor specific language groups. These population concentrations are the result of chain migration influenced by points of entry into the United States and family connections. Over time, internal migration trends, employment opportunities and other family factors dictate language group hubs within the country.

In 2010, nine percent of the US population over age five was comprised of individuals with Limited English Proficiency (LEP). LEP individuals were primarily found in six states, traditionally known as the immigrant destination states: California, Texas, New York, Florida, Illinois and New Jersey. Each of these states had 1 million or more residents who spoke a language other than English at home and together harbored 68 percent of the total LEP population in the United States.

Although the majority of LEP residents were found living in the immigrant destination states, other states had high shares of LEP residents when compared to their total populations. In 13 states, the share of the LEP population in comparison to the total state population was equal to or more than the national average, including California, Texas, New York, New Jersey, Nevada, Florida, Hawaii, Arizona, Illinois, Rhode Island, New Mexico, Massachusetts and Connecticut.

These internal migration trends demonstrate a steady influx of individuals who speak a language other than English into states that have not traditionally harbored high percentages of LEP persons. As a result, many of these states are faced with the daunting task of providing language access services for a rapidly growing population that greatly exceeds their current resources.

Diverse Language Needs in Healthcare

This is particularly evident in the realm of healthcare. Any facility receiving federal funds is mandated by Section 1557 of the Affordable Care Act (ACA) to provide qualified language services to LEP and Deaf/HoH patients at no charge. The mandate expressly prohibits the use of ad hoc interpreters, including family members, friends and untrained bilingual staff, barring extreme circumstances.

In addition, healthcare facilities are encountering less common languages on a regular basis. This shakes up traditional language access programs and, in many cases, calls for a new approach to providing medical interpretation. As a result, health care organizations are in search of more robust interpreting solutions that can adequately facilitate communication with an increasingly diverse patient population.

Remote Interpreting Expands Language Access in Healthcare

The use of both over-the-phone and video remote interpreting greatly expands language access in healthcare, providing non-English speaking patients with access to hospital interpreters qualified in a wide range of languages. In addition to greatly widening the scope of languages provided, the immediate, on-demand nature of remote interpreting eliminates both scheduling and travel time, resulting in faster access for the patient and reduced cost for the healthcare facility.

The two technologies each come with their own list of advantages and use-cases:


  • Video remote interpretation (VRI):
    • Combines the benefits of face-to-face interpretation with the on-demand nature of over-the-phone interpretation (OPI).
    • Is instant, mobile, and cost effective.
    • Patients are able to see and hear a qualified medical interpreter in their language with just the push of a button.
    • Interpreters are trained to pick up on nonverbal cues essential in ensuring meaningful communication is taking place.
    • Is often preferred for conversations of immediate need, as interpreters can be reached very quickly – typically in 30 seconds or less.
  • Over-the-phone interpretation:
    • Is easy to install and integrate into existing language access plans. Providers simply pick up the phone and dial a dedicated number to reach a telephonic interpretation service that provides qualified interpretation in a wide range of languages.
    • Interpreters are experts in consecutive interpreting, meaning they have the skill set to listen to the patient and provider, process and then convey the message into the target language without delay.
    • Is preferred for conversations that do not require visual cues, such as appointment settings and follow-ups.


With the significant increase of frequently encountered languages in healthcare, hospitals, health systems and other healthcare facilities are incorporating remote interpreting into existing language access plans. Remote interpreting enables hospitals to not only better serve their non-English patient population but also adhere to federal mandates that require the provision of language services.

About David Fetterolf

David leads the overall strategic direction of Stratus Video’s Language Services division. David brings over 26 years of experience working for healthcare information technology and service companies. Prior to joining Stratus Video, he was president and founder of MDeverywhere, revenue cycle management software tailored to the healthcare industry. In 2011 MDeverywhere made the coveted Inc. 500/5000 fastest growing companies list. Prior to MDeverywhere, David was a division president for Datamedic, a leading provider of computer-based patient records and business management software and services for medical practices and clinics. As division president, he was responsible for strategy and financial performance, which included leading the marketing, sales, implementation, support, and manufacturing and development teams. David has a Bachelor’s degree in Electrical Engineering from Cornell University and a Masters of Business Administration from The Wharton School at the University of Pennsylvania.



Inside the Global Race to Deliver a Vital Radioactive Isotope Used to Detect Cancer

By: Sarah Varney

Kaiser Health News

Khn.org — In a cornfield here, past the shuttered General Motors plant and the Janesville Terrace trailer home park, a facility not seen in the United States in three decades could soon rise: a manufacturing plant that will make a vital radioactive isotope used to detect cancer and other potentially fatal maladies in millions of people every year.

Nuclear medicine imaging, a staple of American health care since the 1970s, runs almost entirely on molybdenum-99, a radioisotope produced by nuclear fission of enriched uranium that decays so rapidly it becomes worthless within days. But moly-99, as it’s called, is created in just six government-owned nuclear research reactors — none in North America — raising concerns about the reliability of the supply and even prompting federal scientists to warn of the possibility of severe shortages.

Some 50,000 Americans each day depend on a strange and precarious supply chain easily disrupted by a variety of menaces: shipments grounded by fog in Dubai, skittish commercial airline pilots who refuse to carry radioactive material and unplanned nuclear reactor shutdowns, including one in South Africa when a mischievous baboon sneaked into a reactor hall.

Delays that pose an inconvenience for other commercial goods are existential threats in the daily global relay race of medical isotopes that disappear hour by hour. “It’s like running through the desert with an ice cream cone,” said Ira Goldman, senior director of global strategic supply at Lantheus Medical Imaging in North Billerica, Mass.

But that race may soon be shortened. Propelled by persistent supply problems and fears that terrorists could seize American uranium en route to foreign facilities, President Barack Obama signed legislation in 2013 prodding American companies into the medical-isotope business.

The $100 million Janesville plant, in the hometown of Rep. Paul Ryan, speaker of the House, is the first construction project to pass through the labyrinthine nuclear regulatory approval process since 1985 and is being built by SHINE Medical Technologies with $25 million in federal funds.

Greg Piefer, the company’s founder and a nuclear engineer (he drives a Tesla with the license plate “NEUTRON”), has big plans for the cornfield: a plant that could manufacture up to 50,000 doses of imaging agent a week. “Ryan called me out of the blue and he said, ‘We really want you here,’” Piefer said.

Still, it could be years before moly-99 is manufactured in the United States. SHINE still needs more money to complete its manufacturing plant, and investors are wary of the many problems that can arise during construction. Already, construction deadlines promised by SHINE have come and gone. Other competitors, meanwhile, that received tens of millions of dollars in federal grants to build their own moly-99 manufacturing plants have been thwarted by protracted drug approvals and nuclear regulatory hurdles, and some have given up.

European rivals have also cautioned the American upstarts. At industry presentations, Goldman said, the producers have warned, “This is more difficult than it looks. You can’t come up with a fancy slide that says, ‘I’m going to be producing moly-99 in a couple of years.’”

Birth Of An Isotope

The radioactive isotope injected into the veins of potential heart attack victims or bone cancer patients begins its journey in the heavily guarded American nuclear stockpile.

The Department of Energy’s National Nuclear Security Administration ships Cold War-era uranium overseas, where the containers — sought by terrorists for dirty bombs — are secretively trucked to government-owned nuclear research reactors in the Netherlands, Belgium, Czech Republic and Poland. (South Africa and Australia also use American uranium to produce moly-99 in research reactors.)

Private companies rent time in the reactors to irradiate enriched uranium targets, producing an atomic alphabet soup. Nearby processing facilities fish out the moly-99, and the radioactive material is loaded onto commercial airline flights bound for the United States in protective containers.

Three companies dominate the American market for moly-99 — Lantheus, Curium and GE Healthcare. They distribute the material to specialized pharmacies around the country, where technicians process it into a diagnostic imaging agent called technetium-99. The companies work against a ticking clock: Because of its short half-life, just 66 hours for moly-99 and six hours for the imaging agent, the material must be quickly delivered to hospitals and administered to patients.

“The whole industry is like a duck going on a fast-flowing river,” said Kevin Charlton, an analyst at the Organization for Economic Cooperation and Development’s Nuclear Energy Agency in Paris. “On the surface, it looks like things are going very smoothly, but under the water, their legs are going really fast.”

Countless things can go wrong, starting with the first step.

The worldwide supply of moly-99 relies on a fleet of government-subsidized nuclear research reactors built mostly during the Khrushchev-Eisenhower era.

Regular maintenance and major repairs can shutter the reactors, sometimes for months, and so-called scrams — caused by anything from a hiccup in a reactor’s cooling system to an errant lightning strike — frequently halt production. “It’s a nuclear reactor,” Charlton said. “The only thing you can do is shut it off.”

Even the Mayo Clinic in Rochester, Minn., a prestigious cancer treatment center, can be left waiting for shipments of the generators that contain the imaging agent. “We’ve had days when no generator comes in at all, or it’s been cut in half,” said Andrew Paulsen, supervisor of the clinic’s radiopharmaceutical laboratory.

And the ephemeral nature of moly-99 always looms. On a recent afternoon, inside a locked laboratory at Stanford Hospital’s nuclear medicine department in Palo Alto, Calif., a technician held a lead-lined, plastic cylinder containing a syringe of fragile atoms that had traveled around the globe.

Once the imaging agent is injected into a patient’s body, it emits gamma rays that can be detected by gamma cameras that look like X-ray machines. The radioactive tracer lights up on a computer monitor wherever the heart’s blood vessels are blocked or bones are riddled with potentially cancerous tumors. The imaging agent was first used in medical applications in the 1960s because its short half-life meant that patients were getting less exposure to radioactivity than from other diagnostic tracers.

But at Stanford’s nuclear medicine department that day, a patient had missed his appointment. This meant the dose — which cost the hospital an irretrievable $500 — had decayed and was now useless. The technician threw the syringe in the trash.

The supply chain’s vulnerability, acutely felt during a severe worldwide shortage in 2009 and 2010 when two reactors shut down unexpectedly, has led some doctors to shift to more dependable, but more toxic, imaging agents. “For cardiac imaging, we had to shift to a more expensive agent and expose patients to more radiation,” said Dr. Andrei Iagaru, chief of the division of nuclear medicine at Stanford Health Care.

After the worldwide shortage, the volume of nuclear medicine tests went down, and stayed down. “It definitely had an impact on the way many practices run their cardiac stress tests,” Iagaru said.

Depending On Other Countries

American patients consume nearly half of the world’s supply of moly-99. And despite plans to ramp up production in Australia, reactor construction is notoriously tricky. In addition, reactors that are converting for security reasons to low-enriched uranium have lower yields and more waste, according to nuclear scientists.

Concerns about moly-99 shortages heightened in October 2016, when the Canadian government mothballed a reactor in Chalk River, Ontario, that supplied about 40 percent of the American market. The government’s decision to shutter the plant was, in part, due to frustration that Canada had had to spend $70 million in 2009 to repair the facility — in effect, subsidizing the American health care industry. That is a complaint of European governments as well.

William Magwood, director of the Nuclear Energy Agency in Paris, said that moly-99 production at Chalk River “went from being incidental to being the only reason to operate the reactor.”

“Canadians didn’t want to continue to operate a high-cost reactor to sell isotopes to the U.S.,” he said.

Some European governments have begun charging moly-99 producers higher rates to rent reactor time, and prices are expected to rise sharply when governments strip for-profit companies of subsidies originally meant to support academic research.

“How much will get passed on to the health care providers?” said Leah Gannon, senior portfolio executive of radiopharmaceutical distribution sourcing for Vizient, a company that negotiates contracts for hospitals. “Probably almost all of it.”

With no source of moly-99 anywhere in North America, American nuclear medicine specialists appointed by the National Academies of Sciences, Engineering and Medicine warned in a 2016 report commissioned by Congress of a more than 50 percent likelihood of another severe shortage in the coming years.

Moly-99 suppliers refute the report’s findings, a position echoed by the Nuclear Energy Agency, which has fostered closer ties among producing nations. Reactor operators, the suppliers say, work closely to stagger maintenance shutdowns to minimize shortages and respond to disruptions in production, and producers have increased the number of uranium targets.

“We’re describing a glass that is half-full,” Charlton said, “whereas the National Academy of Sciences sees the glass looking half empty.”

Still, nuclear medicine physicians and nuclear pharmacists charged with filling patient orders each day say the supply remains fragile, especially for smaller pharmacies where the moly-99 imaging agent can account for 95 percent of their business. “It is inconceivable to believe that an outage will never occur on any of these old reactors in the future,” said Dr. Joseph Hung, director of radiopharmaceutical operations at the Mayo Clinic and a member of the government committee.

Wendy Galbraith, a clinical associate professor at the University of Oklahoma College of Pharmacy in Oklahoma City who runs the university’s pharmacy, said she frequently doesn’t know if moly-99 is going to be available until the wee hours of the morning. Even when there are no major outages, she said, “it’s a scramble.”

That uncertainty means delays and on-the-fly triage for patients. “If we have a patient who can wait two days for their cardiac stress test, we’ll put them off,” Galbraith said.

Suppliers want to tamp down fears about reliability, physicians and pharmacists say, to dissuade them from seeking alternative imaging methods when possible, like positron emission tomography, a costly and complex type of medical scan.

“It’s hard to stay relevant in an environment when things are not available every now and then,” said Iagaru at Stanford.

Even more troubling, critics say, is the lack of redundancy in the supply chain. Of the four global suppliers, two rely on a single reactor. “If anything goes wrong with the reactors in South Africa and Australia,” Dr. Hung said, “it will be déjà vu again like in 2009.”

The Wisconsin Project

If the United States is to grow a domestic moly-99 supply, it will probably rise from the corn and soybean fields in America’s Dairyland.

Rock County, Wis., has become the unexpected home to two of the three companies vying for control: NorthStar Medical Radioisotopes in Beloit, which has been awarded $50 million in federal grants, and SHINE, or Subcritical Hybrid Intense Neutron Emitter, in Janesville.

Backed by $25 million in federal support, Piefer, SHINE’s chief executive, has promised to build a nuclear accelerator and produce moly-99 by 2020. (The previous deadline was 2015.) In early 2017, the company opened its headquarters in Janesville above the Time Out Pub & Eatery and down the street from a fishing tackle shop and Speaker Ryan’s district office.

Nuclear engineers have moved en masse to Janesville in recent months, decorating their cubicles with hand-painted signs with sayings like, “Think like a proton, stay positive.”

Piefer zips along Highway 90 in his Model S Tesla between Janesville and Monona, a Madison suburb where his research lab, Phoenix Nuclear Labs is located. There, engineers have built a ghostly particle beam that looks like a giant, purple lightsaber.

Eight particle accelerators have been designed for the Janesville plant, which the Nuclear Regulatory Agency approved for construction in 2016. Piefer still needs to raise considerable private capital, a challenge with eager entrants like NorthStar and Nordion, an Ottawa-based company also with aggressive plans to enter the Moly-99 market.

“If we don’t have significant production soon, we will continue to export highly enriched uranium,” Piefer said. “And the National Nuclear Security Administration will have failed their mission.”

The city of Janesville is banking on Piefer. Its economy reeling from the closing of the General Motors plant in 2008, the City Council aggressively pursued SHINE with a generous economic development package, besting two other Wisconsin cities.

In 2011, over the objections of some residents opposed to a nuclear facility in the town, the council authorized $1.53 million to buy 84 acres of farmland, which it has agreed to turn over to SHINE for $1. The city has also agreed to pay $345,000 to extend utilities to the site, provide $2 million in forgivable loans and co-sign a bank loan with SHINE for up to $4 million that it would have to pay should the company fail, a first for the city.

Gale Price, economic development director for the city of Janesville, said that although it was unusual to put public money into a startup, the city expected to recoup its investment within 10 years. “That’s how we measure whether we’re giving away the farm,” he said.

Ryan has championed the project and spoke at a celebration marking nuclear regulatory approval. But Piefer said, except for the initial phone call urging him to come to Janesville, Ryan has played no part in the federal grant and construction approvals.

SHINE jumped at the chance at federal money for the private plant. But Piefer isn’t solely focused on the need in American hospitals. The company has already announced lucrative deals to ship moly-99 to Chinese hospitals.

But first, it needs to start producing.

“You cannot just open a shop down the street and start nuclear medicine,” said Iaragu, of Stanford. “The public comes with an expectation that if my oncologist wants me to get a bone scan, it’s not big deal. But the truth is, it’s a big deal.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

To view the original article, click here.



San Diego banking on medical tourism

By Marlene Y. Satter

Benefitspro.com — Ah, San Diego—sun, sand, beaches… and hospitals.

report in Stat News says that San Diego is betting on converting plain old tourism into medical tourism, hoping to attract patients to its hospitals with the city’s other attractions serving as icing on the cake, so to speak. A philanthropist has actually funded a marketing campaign pitching the city that way to patients in need of care, but simply advertising the city as destination does not medical tourism make, according to Maria Todd, a business consultant who focuses on health tourism strategy.

To view the original article in its entirety, click here.


Specialists, Not Just PCPs, Are in Short Supply: Report

By Ken Terry

Medscape.com — A new white paper from Merritt Hawkins Associates, a leading physician recruiting firm, argues that specialists such as pulmonologists, psychiatrists, and dermatologists are in just as short supply as primary care physicians (PCPs) are, and that the situation is getting worse. One reason frequently offered for the high cost of healthcare in the United States — contrary to the paper’s results — is that the physician workforce here includes far more specialists than PCPs; in contrast, the numbers of PCPs and specialists are roughly equal in other advanced countries that spend less on healthcare than the US does.

To view the original article in its entirety, click here.


Why UnitedHealth is betting big on South America

by Leslie Small

fiercehealthcare.com — For UnitedHealth Group, already the largest health insurer in the U.S., the next frontier for growth is in South America.

On the company’s quarterly earnings call on Tuesday, UnitedHealthcare CEO Steve Nelson said the expansion opportunities in South America are “reminiscent of the opportunities in healthcare markets in the U.S. two decades ago,” when both Medicare Advantage and Medicaid managed care were in their infancy.

“We expect opportunities for growth in these markets to advance, as they have in the past two decades or more in the U.S.,” he added.

To view the original article in its entirety, click here.

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