Will the Verizon iPhone be an LTE Phone?

December 2, 2010 Leave a comment

Much has been said and written about when and how an iPhone will appear on the Verizon network. It may be remembered that way back in ancient history Steve Jobs said that Apple would never do a CDMA iPhone. While this was sometimes ascribed to the fact that Apple had an exclusive contract with AT&T, there may have been technical reasons why Apple felt that this combination might not be ‘insanely great’. It could be speculated that there might be battery life, temperature, or other power consumption issues on CDMA that would impact the user experience, a killer for the Apple folks.

Now Verizon has announced that their next generation LTE network is about to launch on December 5 in 38 metropolitan areas, it is attractive to speculate that sometime next year this network would provide the platform that Apple would find attractive enough to make the combination something new and powerful. The CEO of Verizon, Ivan Seidenberg, has said “If the iPhone comes to us, it’s because Apple thinks it’s time. Our interests are beginning to come together more but they have to take steps to align their technology with ours.”

The pieces are coming together. Seems to make sense to us.

Categories: Uncategorized

Credit Cards and Medicare Savings

September 29, 2010 2 comments

I live in New York. Last week my daughter in Chicago called to say that a five dollar charge had been refused at a local coffee shop. My credit card company had identified an unusual pattern of purchases, and had put a hold on the card.

No similar process exists for the Medicare system, where cost savings could be realized by systems that identify unusual patterns of charges and outright abuse by providers of medical services and equipment. A single basic change in the way the system operates has the potential to both save money and improve the care of patients.

When a Medicare patient has a service provided, the service is billed after it is done. A physician, for example, may bill a charge to Medicare one hour, one month, or one year after it is performed. There is no approval at the time of the charge, as there is with the credit card. Take the example of a 70 year old woman who sees her primary physician in New York for a regular visit. As part of his/her preventive practice, an ultrasound of the carotid arteries may be performed to assess her risk for stroke (no comment on whether this represents appropriate practice). The result is normal. Several months later, spending the winter in Florida, she sees a physician for monitoring of her blood pressure. Another Doppler study is performed. Who will get paid for performing the Doppler study, the first or second physician, or both? Well, it may depend on who bills the charge first, and several other factors.

A Credit Card for Medicare

If the Medicare card were like a credit card, the service would need to be approved before the charge was billed. And sophisticated software, such as the fraud detection systems used by credit card processors, could be utilized to identify duplication of services and potential patterns of fraud.  Both ethical and political opposition to such a change would be significant.

Changing the system to have Medicare charges approved before the service means sometimes saying ‘NO’ to a patient that is already at their doctor. Any hint of curtailing Medicare benefits has led to violent reactions (‘death panels’) by the opponents of such change. And the public may be justifiably fearful of choices made by committees or bureaucrats who have no knowledge of Medicine. Is there any way to make this work?

Doctors Need to Step Forward

Physicians know their business. Professionals in every medical field and specialty are aware of what their colleagues are doing, and where savings can be achieved without harm to patients. Patterns of abuse by sellers of durable medical equipment (wheelchairs) are recognized. But there has never been any reasonable incentive for physicians to lower costs. Doctors, after all, are paid for the services they perform.  And the legal environment makes it dangerous at times to withhold services.

Medical societies in each specialty should create groups to analyze practice patterns, and suggest ways to identify potential savings. A percentage of the cost savings must then be returned to establish and increase reimbursement to physicians for direct contact with patients. This would include an increase in payment for office and hospital visits, and payment for telephone communications and emails. This would be a win-win for patients, physicians, and the society.

A credit card company such as MasterCard or American Express could easily handle the processing of Medicare charges. Card reading devices are standardized and ubiquitous, and they have experience with sophisticated fraud detection systems.

It is time for creative ideas that originate from the providers of healthcare, and not from government or insurers. The real partners in the healthcare system are patients and providers. They need to work together to improve systems of care.

Categories: Healthcare Tags:

Should Patients Adjust Blood Pressure Medicines?

August 22, 2010 Leave a comment

We are no longer surprised when a patient is asked if they take their blood pressure medicines every day, and we are told “it depends”. Yes, it can be amusing to hear how one member of a couple decides that they know more than their physician, and makes decisions based on home blood pressure measurements. Sample quotes may include “she thinks she is a doctor”, or “I decide what to give him/her after I take the pressure”. This can not only be amusing, but frustrating to the physician attempting to achieve blood pressure control in order to reduce the risk of heart disease and stroke, among other conditions.

Now British physicians have published a study in a prestigious medical journal, The Lancet. Their study, Telmonitoring and Self-Management in the Control of Hypertension (TASMINH2) was reported in July. They showed for the first time that patients adjusting their medications according to rules specified by their physicians could do a better job of controlling blood pressure. This study was well designed, and included several key elements.

Patients were first trained in how to adjust medicines, and which ones to adjust. The schedules for measurement and adjustment were agreed upon with their physicians. The blood pressure was only measured for one week per month. If the readings were above a target blood pressure on two consecutive months, an adjustment could be made.  Blood pressure readings were transmitted to the physicians conducting the study.

What has happened here is very important. It demonstrates the power of educating patients, and of giving them responsibility for their own care. With the correct type of patient, this is a powerful way to improve care. It may not apply to every patient, however. More work will be done to see how these techniques can apply to people of various educational levels and ethnic backgrounds. These studies are in progress.

The health care system will need to change in order to support physicians and nurses that are ready to implement these changes, and involve the patient more closely in their own care.

Categories: Healthcare

The Coming Tablet Wars: The Contenders

June 1, 2010 1 comment

The early success of the iPad, and the hype surrounding its introduction may have given the impression that Apple will once again dominate this product category the way they did MP3 players with the iPod. While this may yet be the case, there will be real competition this time, making the future of this product category much more interesting. If we understand the iPad as more than hardware, we can see what Apple has done, and what others are up against.

Taking a look back to the Blackberry and iPod is useful in understanding the tablet environment. With the Blackberry, RIM showed early on that hardware was only the start of the story. It was the integration of the device, its operating system, and software that created such a useful device for its intended users. By running Blackberry email through their own servers, they added a continuous revenue source. With the iPod, Apple took an established piece of hardware, the MP3 player, and gave the user a superior software experience. Then they created a model to produce revenue with the iTunes store and their desktop software. The device itself was only the beginning, content became at least as important.

The iPhone took the iTunes model of selling content and brought it from music to computer software. But software developers need tools to create products, and Apple provided that, and the App Store gave independent developers and Apple the opportunity to share revenue. Apple was not the only one to understand this time. Before the iPhone was introduced, Google purchased Android in 2005 to give them an operating system and software development platform for mobile devices. And Palm had the right idea with webOS and the Pre, but could not execute their plan.

The iPad puts it all together in a tablet, using the established foundation. Apple added some of their own applications, bought a company that made low power ARM based microprocessors, and created a compelling package. They did a great job once again. We can complain about a few things (closed platform, Flash support etc) but in general it is a winning design.

Who can compete with the iPad?
No shortage of hardware companies that can build tablets, from Lenovo to ASUS to Acer to Fujitsu. Some of these have actually built Windows based tablets for primarily vertical market use. But there is very little to differentiate tablets running Windows, so it is no different from the PC business of selling boxes.

Google has been very successful with Android. Although they have a hardware product of their own (Nexus One), most Android devices are produced by other companies. Android now has a large catalog of Apps, a store, and a development environment. It is an open platform compared to Apple’s, and has a lot of momentum among software developers. Android will be running on tablets from multiple manufacturers. This is more like the Microsoft model, with the revenue of applications added.

HP until a few months ago was showing prototype Windows tablets, including one displayed by the Microsoft CEO at the consumer electronics show in January. But they have been paying attention to realize that it was worth over a billion dollars to buy Palm. Now they have their own modern operating system designed for mobile devices, that can run on phones and tablets. And they have the development tools and a store to sell Apps. All the pieces in place.

Nokia has been neglected by some, but they have been putting the pieces together, and it looks like they have a plan. They have a lot of experience building mobile devices, and have had their own operating system, Symbian, under continuous development. They are also, along with Intel, developing a Linux based operating system that can be used for tablets known as Meego. And in 2008 they bought a company named Trolltech that makes a software development tool, Qt. Nokia has modified Qt so the same applications can be developed for phones and mobile computers. And Intel has a new generation of low power Atom chips that will be supported by Meego.

Two companies in the smartphone business have not made the list, as you have noticed. RIM is still struggling with touch screen interface and will only have a modern browser in their next major OS release. They are a great company, so we will be watching. And of course, we wonder about Microsoft. When it comes to mobile devices we have been wondering about Microsoft for too long.

Categories: Tablets