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As reviewed in a recent JAMA article, the United States has the highest level of rural versus urban healthcare disparity among developed countries.Historically, there have been many reasons for this. Teaching hospitals tend to be located in larger cities. Their doctors and patients benefit from substantial case volumes, affiliated medical schools, research budgets, and fellowship programs. These factors help support more data-driven standards of care, in turn leading to better outcomes. However, as pointed out in the JAMA article, patients in rural settings enjoy advantages over their urban counterparts. For example, they often have healthier lifestyles, and are more likely to have regular primary care physicians.Thus, clinicians in different geographic settings have much to learn from each other. They and their patients will benefit from meaningful and continued collaboration. Circles are designed to foster this collaboration in a number of ways. For example:Musculoskeletal practitioners can easily work together across institutional and regional boundaries to develop and share clinical best practices in the use of orthobiologics for specific indications and patient cohorts.Physical therapists can develop and publish standards of rehabilitative care on the basis of large “n” datasets for specific injuries and post-surgical support.Dermatologists and plastic surgeons can jointly develop real-world evidence to support clinical decision-making in their regenerative aesthetics practice.Podiatrists can share with their patients regular post-intervention reports presenting individualized evidence-based progress against pre-clinical benchmarks, as well as against comparable patient populations across the country.Clinicians who completed residencies or fellowships in large academic centers, but are now in small practices, can continue to share learnings with former mentors in the context of jointly executed pragmatic studies.Circles are product-agnostic, built by clinicians for clinicians, minimally burdensome, and low cost. However clinicians collaborate, it is clear that doing so in a sustained and thoughtful manner is greatly to the benefit of their professional learning, and will drive better outcomes for patients in all regions of the country.Contact us to find out more.

Fellowship training is a pivotal part of many practitioners’ careers. Moreover, senior physicians consider mentorship to be among their most fulfilling professional activities. Also, hospitals invest heavily in personnel, recruitment efforts and strategic planning to implement a successful fellowship program. They, like the fellows themselves, look for a return on their investments.The benefits of fellowship are well-reported and manifold. They include clinical expertise, academic productivity, higher quality care, more time doing research, greater career satisfaction, higher success rates with grant proposals, publication, and career advancement.Unfortunately, a fellowship program lasts only one to three years. Once it is over, the realities of medical practice greatly reduce the opportunities for collaboration with peers, mentors, and researchers. It becomes much more difficult to keep up with advances in medical science and clinical best practices. For the fellows, their mentors, and the sponsoring hospitals themselves it is regrettable that the best attributes of fellowship training largely disappear once the formal program has concluded.This need not be the case. Modern platforms and processes enable efficient approaches to training, education, and collaboration across institutional and indeed national boundaries. Circles are designed and used to facilitate not only the continuation of fellowship benefits, but to build upon them for all concerned. Download our OneSheet on the topic, or contact us to learn more.

RegenMed has the pleasure of working with independent medical practices around the world. Many of these clients face challenges regarding finance, marketing, IT, personnel management, and other fundamental business elements. This is not surprising since business is rarely taught in medical school, even at an introductory level. Moreover, business courses by themselves do not constitute business experience and judgment. While medical students, residents and fellows benefit from clinical collaboration and mentorship of senior physicians, no analog exists for clinicians dealing with harsh business realities.These business deficits make it difficult for a private practice to reach its full potential – or even survive. The resulting diminishment of independent medical practices is highly regrettable. But its root cause – a lack of preparation for business realities -- has other serious consequences. These include non-physician leadership of medical institutions, inflated healthcare costs, less choice for patients, physician “burn-out” and reduced interest in a medical career among the “best and brightest”.RegenMed Circles are product-agnostic, but certainly not business agnostic. They generate financial as well as clinical value from the enormous amount of real-world data flowing daily through their medical practices each day. Examples of such value include honoraria, product discounts, investigator fees, superior patient engagement, new service lines, and professional advancement.One important approach to any business decision is return on investment. What will I receive and when, in exchange for what I put into a particular initiative? Staff hires, IT licenses, marketing spend, device purchases, rental agreements, ASC partnerships – each should be looked at through an ROI lens. Real-world data remain a major untapped asset of each independent medical practice. The cost and burden of capturing those data are negligible. The returns are manifold and substantial.Contact us to learn more.

Medicine advances by questioning standards of care. However, many such standards today are based on expensive and product-specific clinical trials which only well-capitalized for-profit companies can afford.Meanwhile, the need for broader-based improvements in healthcare delivery is becoming more acute. Medicine is increasingly specialized while, paradoxically, the systemic nature of pathologies and treatments alike is increasingly apparent. For the modern clinician, it is easy to be daunted. There is not too little information; there is too much.But we arguably live in the most exciting time in the history of medicine. Those individuals who today combine the courage, inventiveness, persistence, and scientific rigor of past medical trailblazers will stand on their shoulders.It is not a matter of money, nor of access to the latest laboratory equipment, nor of “big data” and complicated algorithms. It is a matter – as it always has been – of careful observation, following one’s informed intuition, scientific methodology and willingness to make mistakes.At RegenMed, we have the honor of working with clinicians and scientists around the world who seek to verify accepted “knowledge”, attempt to make sense of their own observations, believing that they can improve standards of care for their patient panels. They collect and examine real-world evidence, and go where that evidence takes them – whether a tentative confirmation of their hypothesis, a serendipitous correlation or a dead-end. They seek out peers with whom to collaborate. They are willing to publish and otherwise share their hypotheses and data.Circle Members include department chairs, sole practitioners, medical research directors and others. Many, on the basis of their work, began as attendees at medical conferences, and are now invited speakers. Others are receiving industry support while maintaining full control over their studies.To quote Hippocrates, “science begets knowledge; opinion, ignorance.” The building blocks of science are found in the “real world”, where the application of science finds its greatest value. We applaud those modern trailblazers who, using their own powers of observation and professional judgment, strive to advance medicine for the greater good. Modern technology, efficient yet inexpensive, can be a great aid to them.Please contact us to find out more.

AbstractPatient Reported Outcomes Measures (PROMs) have been used since the 1960’s, with some of the earliest in the field of mental illness. Today, there is a large and increasing number of PROMs across virtually all medical specialties.PROMs continue to be used principally for research purposes. However, there is growing recognition of their potential to assist in clinical decision making, value-based medicine and sustained patient engagement. PROMs can thus be a useful vehicle for addressing some of the larger challenges in modern healthcare.However, the design and use of PROMs present serious challenges for the busy clinician. These include selecting or designing the PROMs most relevant to a specific practice, execution, cost, personal health information protection, patient enrollment and continuing engagement, data verification and audit trail, adequate data to generate statistically significant correlations.Fortunately, modern tools now allow clinical groups of any size to generate clinical and financial value from PROMs.PROMs: The Theory And The RealityCapturing longitudinal outcomes data is essential to evidence-based medicine. Thus, standardizing PROMs constructs and scoring systems for all categories of clinical interventions and patient cohorts is a worthy goal. Many medical societies, for example, develop PROMs in the context of their registries. Other organizations publish free and licensed PROM’s. Other groups analyze the strengths and weaknesses of various PROMs.On the one hand, there typically exist multiple PROMs for any pathology. On the other hand, the busy clinician will find it daunting to select PROMs which drive clinical and other value in his particular context. Moreover, PROMs for the same condition can be in part contradictory, duplicative, incomplete and/or confusing. Well intentioned attempts at standardization of PROMs have been unavailing.PROMs As Tools In The Clinical SettingPROMs can play an important role in two major trends in modern healthcare — value-based medicine and clinical decision-making.Value-Based MedicineAs stated in the New England Journal of Medicine:Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.This approach is found in accountable care organizations, narrow networks, and many other clinical intervention revenue models. Capturing and analyzing outcomes in a systematic, longitudinal manner are essential elements of value-based medicine.However, efforts to derive useful correlations for value-based medicine from EMRs, claims databases, patient registries, and other traditional data sources have been disappointing. These sources often reflect only partial data, poor clinical context, challenges in verifiability, and other weaknesses. Of particular note, there is usually a paucity of outcomes data, and wide variation and discrepancies in what little exists.Meeting these challenges with respect to PROMs begins at the clinic. The treating clinician must select/design the proper PROM construct for each patient cohort. For example, what exactly is the PROM intended to measure – pain, function, quality of life etc. – in the context of a particular class of clinical intervention? Only then, will the outcomes data truly support value-based medicine.Clinical Decision MakingMedical science is advancing ever more quickly. Clinicians must learn to deal with concepts not even mentioned during medical school, as well as new equipment, medications, and diagnostic tests. Modern communications channels offer practitioners and their patients good and bad information on any topic – both good and bad.Despite these oceans of information, or perhaps because of them, the informed judgment of the experienced clinician remains central to accurate diagnoses and safe, efficacious treatment protocols.PROMs As The Foundation of Patient-EngagementAn attractive website, efficient front office, well-lit reception area, testimonials and five-star reviews are only the beginning of patient engagement in the 21st century.Yes, patients are consumers; but they are first and foremost patients. They have a patient story, one or more specific conditions, outcomes objectives, perhaps disappointments with past treatments. Patients have often already researched their conditions and options. They want to be heard, and to be a part of their recovery. Moreover, listening to patients from the initial consult and then throughout their treatment journey can be critical to successful outcomes.PROMs can represent an excellent tool for intermediating the respective “languages” of the patient and the clinician. Properly designed and executed, they make clear to the patient that her doctor is genuinely interested in the success of the long-term outcomes they both are seeking.Removing The Burden; Generating The ValueAs indicated, PROMs have significant potential clinical, patient engagement and financial value. For them to be a realistic part of the active clinician’s armamentarium, however, they must have several key characteristics:Impose minimal burden on the clinician, her staff, and patients.Conform in their constructs to the indications, treatment protocols and other aspects of the clinician’s everyday practice.Comply with patient data privacy and security laws.Real-time mapping of outcomes against a variety of clinician-selected treatment factors.Generate statistically and clinically significant correlations.Allow easy collaboration within peers within and across institutional and national boundaries.Circles enable all of the foregoing. Start or join one today. Or contact us to find out more.