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Healthcare Company Proposes Way To Save Money On Health Reform

Making medical equipment available to patients could reduce costly visits to emergency rooms and hospitalizations


November 20, 2003
Copyright © 2003 CARIBBEAN BUSINESS. All Rights Reserved.

The Puerto Rico government’s Health Reform program could save money by making medical equipment available to patients, especially those with conditions that can require costly emergency room visits or hospitalizations, said a healthcare executive with businesses in Puerto Rico and Florida.

Raul Rodriguez, chief executive officer of Clinical Medical Services Inc. in San Juan, said medical equipment isn’t covered under the Health Reform, but insurance companies contracted to cover patients in the program are paying for it out-of-pocket on a case-by-case basis. He said patients could benefit from having medical equipment at home; for example, people with asthma could avoid a hospital visit if they had a nebulizer on hand to receive oxygen treatment.

"This type of equipment should be more of a preventive measure," said Rodriguez, who also runs All-Med Services of Florida Inc., a supplier of durable medical equipment, from basics such as canes and walkers to hospital beds, wheelchairs, and ventilators. It also provides respiratory and infusion services, which entails administering intravenous medical treatments to patients in their own homes.

Accredited by the Joint Commission on Accreditation of Healthcare Organizations, All-Med has managed-care contracts with companies such as Blue Shield and Blue Cross in South Florida. Rodriguez said the at-risk population for which All-Med is responsible in that part of the state numbers one million, but his company serves 18,000 active patients.

All-Med recently added a Tele-Med system for the telephonic monitoring of medical equipment in patients’ homes such as continuous positive air pressure machines (used by patients with sleep apnea, who experience brief interruptions of breathing while sleeping) and liquid oxygen. It allows All-Med to keep track of both the equipment and the patient, thus reducing unnecessary visits to the doctor.

Clinical Medical Services is the counterpart in Puerto Rico. Rodriguez said he has 3,500 active patients in Puerto Rico and contracts with Triple-S, Triple-C, the Automobile Accident Compensation Administration (ACAA), and the Veterans Health Administration. Infusion services are currently limited to inhalation medication but will soon include hydration, total parental nutrition, chemotherapy, and pain management, he said.

Rodriguez said he is trying to sell insurance providers participating in the Health Reform on the idea of contracting Clinical Medical Services to provide durable medical equipment on an exclusive, capitated basis—that is, a fixed payment each month per patient covered.

He has been involved in the managed-care business in the States since 1995 and likes working under this model because it reduces administrative costs, maintains continuity of care, and controls fraud. "My incentive is to keep people healthy," he said.

Frank Diaz, director in charge of providers and beneficiaries at the Health Insurance Administration, said insurers involved in the Health Reform aren’t obliged to provide medical equipment to patients but do so in individual cases.

Also, he said, patients in the Health Reform who are also covered by Medicare, approximately 200,000 people, can obtain medical equipment through the federal program.

According to Diaz, the coverage provided to patients on the island meets basic requirements set by Medicaid, which partially helps defray the cost of the Health Reform. Medical equipment doesn’t fall within those minimum requirements, he said, and any decision by the government to include such coverage would entail an added cost.

This Caribbean Business article appears courtesy of Casiano Communications.
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