JUNE 2018, VOLUME 2 ISSUE 6 `200 INDIA MED TODAY
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RETHINKING DIAGNOSTICS: THE ESSENTIAL LIST How will WHO list of essential diagnostics paint the Ayushman Bharat canvas?
JUNE 2018
BIG DATA INNOVATION IS THE STREET OVER AND DIAGNOSTIC ERRORS VALUING THE FORTIS- RELIGARE HEALTH TRUST (RHT) DEAL?
IS PRIVATE HEALTHCARE VICTIM OF DIRTY POLITICS?
ANBAI TEACHERS DAY AWARDS 2018 in association with
National Board of Examinations
The National Board of Examinations (NBE) confers national awards to honor the contributions made by eminent medical teachers /professionals and institutions /hospitals to further the cause of medical education quality and excellence in the country. Last year the award ceremony was conducted by Association of National Board Accredited Institutions (ANBAI). This year NBE & ANBAI have joined hands and will be organizing the award ceremony together. The awards will be announced and distributed at the Teachers Day awards ceremony to be held at Bangalore on 22 September, 2018. We invite you to send nominations to email Id – bbharat@nbe.edu.in & anbaiindia@gmail.com in following categories for “National Award in Teaching and Clinical Excellence” by filling the relevant nomination forms latest by 15th July, 2018: Emeritus Teacher Award Eminent NBE Alumnus Award Distinguished DNB Teacher(s) of Excellence Awards Excellence in Teaching for DNB Programme- NBE Accredited Hospital Scroll of Honour-NBE Accredited Hospital The selection criteria for each category and the nomination forms are available on www.natboard.edu.in & www.anbai.org. A jury of distinguished experts will go through all nominations and select the winner. If you have any queries in this regard, kindly feel free to get back to us on anbaiindia@gmail.com.
CONTACT: ASSOCIATION OF NATIONAL BOARD ACCREDITED INSTITUTIONS Bangalore Baptist Hospital, Bellary Road, Hebbal – 560 024 Ph: 080-23330516 / 080 – 22024305 / 22024308 Fax No: 080-23437970 Email: anbaiindia@gmail.com
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Universal Health Coverage and the Private Sector THE PRIVATE healthcare delivery providers have been nudging the Indian government to re-think its ambitious Ayushman Bharat – National Health Protection Mission (AB-NHPM) rates. In a letter written by the Association of Healthcare Providers India (AHPI) to Indu Bhushan, CEO, AB-NHPM, states that overall the rates for the 1350 procedures are low and appear unviable, more so for tertiary care procedures. The letter further states that the rates put up under the scheme for the various procedures are unrealistic, abysmally low and untenable. The health minister on the other hand stating that the private sector’s participation is important for the implementation of the AB-NHPM, has frozen the lower rates and will go ahead with the launch. Addressing a press conference on completion of four years of the NarendraModi government at New Delhi, Nadda said that the private hospitals will join in this ambitious scheme. “Everybody will have to join. The private hospital had issues but when number of patients will increase, this will benefit the doctors and hospitals. Benefits from this scheme will be seen in long term,” he said.
The private hospital had issues but when number of patients will increase, this will benefit the doctors and hospitals In the current situation, where public healthcare system is grappling with many issues, most importantly of inadequate resources, with up to 40 per cent of health worker posts lying vacant in some states, the government has to partner with private providers to make this dream possible. On the other hand, to be able to provide cashless treatment, patients have to be the center of all planning. Maintaining continuum of care, through various delivery points should be of utmost importance for the success of treatment. Besides, the patients should have clarity on what is cashless and what part of the treatment has to be paid for, which treatments need authorization and how and where to get this authorization.Educating patients on the method of availing cashless treatment will save a lot of hospitals from mob violence and lynching. The model tender document released by the Ayushman Bharat secretariat says that preauthorisation will be mandatory for 636 out of total 1350 procedures. The patient needs to understand the process of approval else there will be massive chaos at the hospitals. Processing and approval of such claims cannot be done by machines and a huge investment in manpower will have to be done, even at the insurer or TPA side. The question is who will make this investment and who will pay for it?
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CONTENTS
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UPFRONT
26
PULSE
21
Is the Street Over Valuing the FortisReligare Health Trust (RHT) Deal? Kapil Khandelwal & Tapan Bhatt, Managing Partners, Toro Finserve LLP
COVER STORY
Rethinking Diagnostics: The Essential List
How will WHO list of essentialdiagnostics paint theAyushman Bharat canvas?
OPINION
Is Private Healthcare Victim of Dirty Politics Anas Wajid Director - Sales and Marketing at Max Healthcare Institute Ltd
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30
blood transfusions through genome sequencing
INNOVATE
Big Data Innovation and Diagnostic Errors Conceptual model for Symptom-Disease Pair Analysis of Diagnostic Error
INTERVIEW
“It has been a challenging, exciting and satisfying journey”
Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltd
June 2018
16 New era for NEWS ANALYSIS
Whole genome sequencing makes it possible to type hundreds of important blood type differences, enabling more precise matching for future blood transfusions
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03 Editorial 05 Letters 06 News roundup 35 Events EVENT REPORT 36 Symhealth 39 Diagnocon 41 Ask the expert
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’m writing to you about menstrual hygiene awareness. It is an issue that is severely underrepresented in this country, as demonstrated by the amount of women who still do not use proper menstrual hygiene products to manage their periods. Even amongst the 18%, they lack awareness of the importance of using clean sanitary napkins and not to reuse the product, which is why as part of our theory of change, we need to enrol existing menstrual hygiene product users and those who don’t in a supportive, taboo free environment to create an open forum for discussion and deliberation. With our Menstrual Awareness program, I am hopeful that we can inspire and motivate everyone to support the cause as I believe that we can all make a difference and break the taboo around menstruation by talking, educating and collaborating. Amar Tulsiyan, Founder, Niine Movement
I’m writing to you on World No-Tobacco Day. Imagine if you quit smoking a year ago today? What would that have changed for you? Would your health be better? Would you have saved money? Would you feel better? Consuming tobacco either by smoking or orally can affect nearly each and every organ, leading to many life-threatening diseases. With increased number of women taking up this habit, many are prone to a variety of long-term health complications. Nicotine and toxic ingredients in cigarettes can actually steal vitamins and minerals from the body adversely affecting the sense of smell and taste. Dr Gowri Kulkarni, Heads of operations, DocsApp I’m writing to you about long-term trend with respect to thyroid problems in women in India.Thyroid problems appear to be increasing in Indiaespecially in women. This may be due to the fact that now thyroid blood tests are easilyavailable in every nook and corner of the country at reasonable cost. More over the awarenessabout thyroid problems have increased considerably among doctors and public in the lastdecade. As thyroid disorders usually produce only subtle symptoms more people are screenedfor thyroid disorders when they have nonspecific symptoms such as tiredness weight gain etc.hence it is not clear whether this is an actual increase or better detection. Dr Usha Menon, Clinical Associate Professor, Centre forEndocrinology and Diabetes, Amrita Institute of Medical Sciences, Kochi
I would like to highlight the effects of smokeless tobacco on eye health. While it is a well- known fact that smoking can affect the health of our eyes, what many of us are not aware is that even smokeless tobacco can adversely impact. Unlike smoking wherein the tobacco and the chemicals in it are inhaled and reacts faster, the nicotine is absorbed slowly in case of chewable tobacco. In fact, the constant flow and higher dose of nicotine can induce damage to the retina, the part of the eye that converts the light into neural signals, and send these signals on to the brain for visual recognition. Some of the common conditions that chewable tobacco can cause are tobacco ambylopia and tobacco optic neuropathy. Both tobacco ambylopia and tobacco optic neuropathy can lead to irreversible blindness calling for quitting of tobacco consumption in any form. In fact, it is one of the best investment one can make for your eye and for self. Dr Amod Nayak, Medical Director, Dr. Agarwal’s Eye Hospital, Bangalore
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HMD LAUNCHES INDIA’S FIRST DISPOVAN INSULIN PEN NEEDLE Hindustan Syringes & Medical Devices (HMD) one of the largest manufacturers of Disposable Syringes in the World and the largest for Auto Disable syringes has today launched most revolutionary and pioneering, India’s First “Made in India” Dispovan Insulin Pen Needle” to provide better comfort for people with diabetes at the 4th Medical Expo Indore 2018. The Dispovan Insulin pen needle is a precision engineered, yet affordable sterile single use pen needle, which can be universally fitted on all international brands of Insulin Pens. With features like, ergonomic shape for improved skin contact and grip, extra thin wall, multibevel, tapered point, Dispovan Insulin pen needle is designed and manufactured by HMD with intent to offer a much less painful injection experience for diabetic patients. Founded in 1957, HMD (makers of DISPOVAN) is India’s leading medical device manufacturer with offices in USA and UK and has a annual turnover of approximately US$ 100 million. HMD is a trend setter and has pioneered innovative medical disposables to compete successfully with entrenched multibillion dollar MNC’s and became market leader of I.V.Cannulas, Syringes & Needles
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in India. HMD has seven highly automated plants employing over 3500 people and has a nationwide deeply entrenched customer base of over 5000 dealers. HMD’s primary international markets are USA, Europe and Middle East. All its ICMED certified products are manufactured as per ISO 9001, ISO 13485, and the European CE & US FDA standards. Besides being Jt. Managing Director of HMD, Mr.RajivNath is also Forum Coordinator of Association of Indian Medical Device Industry (AIMED), and a strong advocate for Make in India for Medical Devices According to Rajiv Nath, Jt. Managing Director of Hindustan Syringes & Medical Devices (HMD), “We are particularly excited about the prospects of our latest offering ”Dispovan Insulin Pen Needle” manufactured in our state of the art manufacturing facilities, which will end India’s import dependency and the monopoly of BD. Patients will now be able to access an affordable quality product, which they need not reuse because it is expensive. We have received excellent feedback and clinical acceptance from the end users of a comfortable injection and glad that our investments in high end technology are giving us a competitive edge.” “With the launch of ‘Dispovan Insulin Pen Needle’ we will contribute towards our ongoing commitment of making healthcare
affordable for common people in India” said Mr. PardeepSareen, Chief General ManagerMarketing of HMD . “Why reuse a pen needle”, he quipped “when Dispovan makes it affordable for single use? Reuse of a Insulin pen needle could increase the following : Bacterial growth on the needle – Risk of injection Experiencing pain when injecting Risk of lipohypertrophy (lumpy skin) occurring Risk of the very fine tip of the needle breaking off The above stated risks will grow with each re-use”, he adviced. Dispovan Insulin Pen Needle is manufactured at HMD’s Faridabad-Ballabgarh plant. The new plant is spread on an area of 5.5 acres and will have the capacity to initially produce over 100 million units per annum of ‘Dispovan Insulin Pen Needle’ to meet the rising export and domestic demand for its new technology. Every Needle point is checked online by a Digital Vision Camera System for a defective, blunt needle point and such needles, which can be potentially painful are rejected automatically on line, he explained. The proprietary dry silicon coating used by us makes the needle surface slippery to ensure comfortable injection.
Dispovan Insulin Pen Needle has needle gauge option of 31G & 32G with needle length of 5mm & 4mm respectively and comes in purple and green colour shade to enable visual recognition of needle size. The pricing of the Becton, Dickinson and Company (BD) pen needle is Rs.14 MRP whereas HMD has initially kept the MRP of its’ Dispovan pen needle for Rs.12. Dispovan pen needle is economical to patient by at least 15 %, as compared to imported pen needles. Unlike prices of imports that are volatile and linked to ever changing exchange rates and steady devaluation of Indian rupee that makes imports expensive, the made in India product has relatively stable pricing.
ECLINICALWORKS BAGS HMIS CONTRACT FOR 1,000-BED GCSMC HOSPITAL
eClinicalWorks®, recently announces that GCS Medical College, Hospital & Research Centre (GCSMC), a state-of-the-art multispecialty hospital in India, is transitioning to the eClinicalWorks Hospital Management Information System (HMIS) solution for its 1,000-bed hospital. GCSMC will utilize the eClinicalWorks inpatient and outpatient technology to create one unified medical record for its patients. “GCSMC was founded to offer medical education and create a continuous stream of trained medical professionals to provide diagnostic, therapeutic and preventive healthcare to the patients at an affordable cost,” said Neha Lal, Senior General Manager & Operations & HR, of GCS Medical College, Hospital & Research Centre. “GCSMC needed a HMIS technology that could meet our needs and allow us to provide the level of care our patients have come to expect. After working with three HMIS solutions, eClinicalWorks was selected because of its experience and commitment towards improving healthcare. We also felt the company would be an
ideal partner for the long term.” GCSMC and eClinicalWorks will collaborate to streamline and automate processes for a more effective patient treatment model. GCSMC will leverage the eClinicalWorks HMIS solution, which features a patient dashboard showing all clinical details for the emergency department, operating room, ICU, and inpatient units. The eClinicalWorks comprehensive solution also covers pharmacy, radiology, labs, and the ability to manage care by census lists. To better serve its patients, GCSMC is utilizing available eClinicalWorks features, including an integrated Central Sterile Service Department (CSSD) for a seamless flow of reusable surgical materials, dynamic multiple approval level for increased user accountability, and enhanced analytical capabilities through multiple dynamic reports.
4TH NATIONAL ORGAN RETRIEVAL WORKSHOP AT BANGALORE The 4th National Organ Retrieval workshop was held on May 4-5, 2018 at M.S.Ramaiah Advanced Learning Center, Bangalore. The course was attended by surgeons performing Liver, Kidney, Pancreas & Intestinal organ retrieval and transplantation and Cardiac surgeons with an interest in heart and lung transplantation. Organ donation in India has grown four fold in the last few years however, lack of organ retrieval protocol and experienced staff is limiting transplant of donated organs.
Safe organ retrieval is the cornerstone of successful organ transplant programs. There is a pressing need to train surgeons in the technique of deceased donor organ recovery, but this training is not part of any surgical curriculum at the present time. India does not lack skilled surgeons. Targeted training of identified surgeons to develop specific skill sets can be achieved with short and intense training courses with the appropriate curriculum. The National Organ retrieval course has been conducted for the past three years in partnership with NOTTO, ISOT, MOHAN Foundation and surgeons from Oxford University, and has been designed in collaboration with international leaders in organ transplantation to train aspiring transplant surgeons the tips and techniques for a safe organ recovery. This course has trained 115 Indian surgeons in this technique, of these half are from the public sector. This course has won the BMJ award for excellence in Medical Education 2017 for its high impact teaching. Dr AnandSubramanyam, Senior Consultant Cardiac Surgeon, Apollo Hospitals, Sheshadripuram, Bengaluru and Dr SonalAsthana, Consultant, HPB and transplant Surgeon, Aster CMI Hospital, are the course directors. There was a live webcast of a retrieval procedure on an anatomical specimen (cadaver model) by Dr. Isabel Quiroga, Clinical Lead for Organ Retrieval, Oxford University, Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom. This included heart recovery, abdominal organ recovery and renal recovery which was webcast from the MOHAN foundation, transplantationliver. com and the NOTTO websites live. Also, there was an entirely separate module for renal surgeons, and a new session on recovery for pancreas fortransplantation. This covers renal -only retrieval ( in situations where there are no abdominal surgeons toretrieve ). Renal surgeons also had an opportunity to perform renal
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NEWS ROUNDUP implantation on a cadaver.
A nine-member committee was set up five months ago to suggest the scope of profit margins on medicines and consumables. The committee comprised of members of Delhi Medical Council, Indian Medical Association and some bureaucrats in the health department. It is also reported that Delhi government will issue a policy based on the recommendation of the committee in next few days. “This will result in consumers access to medical devices at prices below inflated MRP. If this happens game over to artificially keep MRP at exhorbitant levels by any
HEALTHCARE GLOBAL ACQUIRES 12% STAKES IN STEM CELL RESEARCH FIRM
HealthCare Global Enterprises Ltd has acquired a 12% equity stake in International Stemcell Services Ltd (ISSL) – a stem cell and regenerative medicine research company based in Bengaluru. HealthCare Global, has acquired 10,860 equity shares of ISSL for Rs 56 lakh in an all-cash deal. HCG said that ISSL is a knowledge centric company in the space of stem cells and regenerative medicine. The developments in healthcare of late have established value of regenerative medicine, offering new found hope to patients. “There is synergy with the hospital in using adult stem cells in treating several conditions including cancer. The research activities with respect to stem cells and regenerative medicine carried out by ISSL would support HCG in the development of targeted therapies for cancer treatment,” HCG said.
NIGHTINGALES HOME HEALTH SERVICES APPOINTS NARASIMHAJAYAKUMAR AS CHIEF EXECUTIVE OFFICER Nightingales Home Health Services, an enterprise of Medwell Ventures and a pioneer in specialty home healthcare in India, announced the appointment of Narasimha Jayakumar as their Chief Executive Officer today. Medwell Ventures has received $21mn in Series B funding in 2017 led by Mahindra Partners & Eight Roads Ventures. In 2015 Eight Roads Ventures had led a $10mn round in the company. Narasimha joins the company to lead its next phase of growth beyond the cities of Mumbai, Bangalore, Hyderabad, Chennai and Pune where the company operates its multibranch model of speciality home healthcare
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Narasimha Jayakumar, CEO, Nightingale Home Health Service
services for chronic diseases. The company has a team of more than 1000 people across India. Narasimha brings to Nightingales rich and diverse experience across various consumer centric businesses. He was formerly the Chief Business Officer of 99acres.com, part of Info Edge India Limited which is India’s premier online classifieds company. Previously, Narasimha worked as COO, E-commerce for HomeShop18, India’s leading TV /web platform. His prior assignments also include Google India, where he was the business head for travel, local and media verticals. Narasimha holds a B. Tech (Computer Engineering, REC Surathkal), PGDM (IIM-Bangalore) and an MBA from the London Business School
AIMED APPLAUDS DELHI GOVT, IMA FOR ADVISORY ON CAPPING OF PROFIT MARGIN
An expert committee set-up by the Delhi govt. has suggested capping of the profit margin for drugs and devices at a maximum of 50% above the procurement cost or the manufacturers (MRP) price, whichever was lower.
of us manufacturers and importers as an inducement to push medical devices sales to hospitals.” said Mr. Nath. Of course lobbying forces for high priced medical devices suppliers will be worried as they will loose the competitive advantage of inducing procurement bodies based on higher margins as the cap becomes a leveller . This will bring back the focus to cost reduction and operational efficiencies by hospitals to remain competitive and profitable. Let’s hope other State Health Ministers follow this lead by Delhi Govt and NPPA and DoP consider this as a possible reform in the regulations for Price Controls of Medical Devices.
NMC PUSH FOR MIDLEVEL MEDICAL PRACTITIONERS (NURSE PRACTITIONERS)
Nurse practitioner will soon be a reality in India. Recently, a number of amendments to the National Medical Commission (NMC) Bill were approved by the Union cabinet, chaired by Prime Minister NarendraModi. The Amendment to the NMC Bill comes in the backdrop of its consideration in the LokSabha and subsequently being referred to the Department Related Parliamentary Standing Committee (DRPSC). The Government has considered the recommendations made by the Standing Committee in its report tabled in the House and general feedback, particularly the views of medical students and practitioners regarding certain provisions of the Bill.
One of the the amendments refers to mid-level medical practitioners. According to the new amendment, “The mid-level medical practitioners will get a limited license to practice specified medicines in primary and preventive healthcare settings and in other settings under the supervision of a medical doctor.� This amendment if implemented will open the doors to a new era of nurse practitioners that Indian healthcare industry has been waiting for. Nurse practitioners are a key part of healthcare delivery in USA, UK, Germany and many other developed countries. These nurses are equipped with additional educational qualification and the permission to function in an extended medical role. The government has been trying to raise a cadre of non-MBBS medical professionals in certain fields to address the lack of medical attention
arising from the shortage of doctors, especially in rural areas. The bill also provides for a separate register to list such mid-level medical practitioners with limited drug prescription rights. Other than the nurse practitioners, these mid-level medical practitioners will include pharmacists, physician assistants and optometrists. In 2016, Shri J P Nadda, Union Minister for Health and Family Welfare, launched two new Nurse Practitioner Courses, one in Critical Care and the other in Primary Healthcare in India. The Nurse Practitioner in Critical Care Program will be a two-year residential M.Sc degree in Nurse Practitioner in Critical care. On completion of the program Nurses will be qualified to assume responsibility and accountability for the care of critically ill patients. Whereas, the Nurse Practitioner in Primary Healthcare Program will be a one-year
residential Post Graduate diploma program.
GENETIC MUTATION CAUSING FAMILIAL ADENOMATOUS POLYPOSIS IDENTIFIED IN INDIA Researchers at the Bengaluru-based genomic diagnostics and research firm MedGenome Labs have discovered a never-beforeseen genetic mutation responsible for six members of a Gujarati family suffering from Familial Adenomatous Polyposis (FAP), a rare precancerous inherited condition accounting for 1-3% of cases of colorectal cancer. The mutation was also found in four other members of the family, leaving them highly susceptible to developing FAP later in life.
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NEWS ROUNDUP The first-of-its-kind genetic study, conducted in collaboration with Kailash Cancer Hospital & Research Centre (KCHRC) in Goraj, Gujarat, involved a 52-year-old patient, Paresh (name changed), and his immediate and extended family of 25 people. When the patient approached KCHRC with health issues including weight loss and changes in bowel movement, doctors conducted a colonoscopy which confirmed the presence of multiple polyps (an abnormal growth that could become cancerous) in his colon, an indication of FAP. On further investigation, it was found that five of Paresh’s family members, aged 35-60 years, were afflicted with FAP. The presence of benign polyps, between 100 to 1,000 in number, appear in the colon and rectum of patients in their teenage years. If left untreated, the polyps gradually turn malignant giving rise to aggressive and often fatal colorectal cancer by the age of 40-50 years. Since FAP is an inherited condition, MedGenome Labs together with KCHRC collected clinical data and blood samples from twenty five members of Paresh’s immediate and extended family ranging in ages 6-60 years. Genetic analysis of their blood samples revealed a neverbefore-reported mutation in the Adenomatous polyposis coli (APC) gene, not only in all six FAP-diagnosed family members, but also in four young individuals (ages 6-23 years) who have not yet been diagnosed with FAP. This observation has important clinical repercussions, as the four young individuals have a strong predisposition to developing polyps in later years and must therefore be kept under observation. They have thus far been counselled by MedGenome genetic counsellors and regular colonoscopies for early detection of polyps have been recommended. This approach involving genetic analysis, is vital not only in the early diagnosis and subsequent treatment of FAP, but could also be leveraged to play a role in cancer prevention.
INTUITIVE SURGICAL TO BEGIN DIRECT OPERATIONS IN INDIA 10
June 2018
In support of the company’s commitment to India, Intuitive also named Mandeep Singh Kumar as its general manager. Mandeep will direct and implement Intuitive’s in-country strategy and commercial operations. He has more than 20 years of global business experience in health care, pharmaceuticals, medical devices, and advertising. Most recently, Mandeep served as the chief commercial officer for GE Healthcare, India and South Asia. “It is a privilege to be part of Intuitive’s journey in India, and we are committed to working with surgeons across the country to bring the
Intuitive Surgical, Inc., (Nasdaq:ISRG) recently announced that it has begun direct operations in India, following seven years of doing business in the country through a distributor, Vattikuti Technologies Pvt. Ltd.Intuitive Surgical has also announced the joining of Mandeep Singh Kumar as general manager in India. Intuitive pioneered, and continues to be a global leader in, the field of robotic-assisted, minimally invasive surgery with the creation of its da Vinci surgical system more than two decades ago. Now on its fourth-generation system, the Silicon Valley-based company has seen more than five million robotic-assisted surgical procedures performed worldwide, and the da Vinci surgical system benefits explored in more than 15,000 peer-reviewed scientific publications to date. “The adoption and advancement of roboticassisted surgery has been enabled by critical contributions from health care professionals from India,” said Intuitive CEO Gary Guthart. “As Intuitive continues to grow to serve patients, surgeons, and hospitals in India, we look forward to deepening our support of, and work with, health care professionals in their pursuit of the clinical and economic benefits robotic-assisted surgery offers.”
benefits of robotic-assisted surgery to their patients,” said Mandeep. Intuitive’s sixth international office will be headquartered in Bengaluru, where employees in sales, marketing, field service engineering, and business operations will be based to support customers throughout the country. More than 65 da Vinci surgical systems are currently in use in India, with surgeons performing robotic-assisted procedures in urology, gynecology, thoracic, and general surgery. “Our customers can expect a smooth transition and even deeper collaboration opportunities between Intuitive and India’s surgical community,” said Jeroen van Heesewijk, senior vice president of global distribution at Intuitive. “We look forward to welcoming our new colleagues to the Intuitive team, as well.” More than 60 former Vattikuti employees became a part of Intuitive India’s business. Terms of the deal were not disclosed. Intuitive Surgical, headquartered in Sunnyvale, Calif. is the pioneer in roboticassisted, minimally invasive surgery. Intuitive develops, manufactures and markets the da Vinci surgical system. The Company’s mission is to make surgery more effective, less invasive and easier on surgeons, patients and their families. There are several models of the da Vinci surgical system. The da Vinci surgical systems are designed to help surgeons perform minimally invasive surgery. Da Vinci systems offer surgeons high-definition 3D vision, a magnified view, and robotic and computer assistance. They use specialized instrumentation, including a miniaturized surgical camera and wristed instruments
(i.e., scissors, scalpels and forceps) that are designed to help with precise dissection and reconstruction deep inside the body.
APOLLO HSPITALS ADOPTS IBM WATSON FOR ONCOLOGY AND GENOMICS
IBM and Apollo Hospitals – one of India’s largest specialty hospital systems – today announced that Apollo will adopt Watson for Oncology and Watson for Genomics. The two IBM cognitive computing platforms will help physicians provide patients with personalized, evidence-based cancer care. This agreement is the first-of-its kind Watson for Oncology & Watson for Genomics deployment in India. Apollo Hospitals will build on its long legacy of clinical excellence with dedicated cancer care hospitals in India by implementing Watson for Oncology and Watson for Genomics across ten of its 64 hospitals. Watson for Oncology will be available at the Apollo Chennai and Delhi hospital from April 2018, followed by Hyderabad, Mumbai, Kolkata, Ahmedabad, Bhubaneshwar and Madurai over the next few months. Watson for Genomics will become available across the same locations in the
following months. The Watson for Oncology and Watson for Genomics solutions will help oncologists at Apollo surface relevant data to bridge disparate sources of information and identify treatments that are personalized to each unique patient. IBM Watson for Oncology, trained by Memorial Sloan Kettering (MSK), complements the work of oncologists, supporting them in clinical decision-making by enabling them to access evidence-based, personalized treatment options from more than 300 medical journals, more than 200 textbooks, and nearly 15 million pages of text providing insight and comprehensive details on different treatment options, including key information on drug treatment selections. IBM Watson for Genomics analyses massive bodies of genomic, clinical and pharmacological knowledge to help uncover potential therapeutic options to target genetic alterations in a patient’s tumour. Using this genomic analysis, Watson produces a report for physicians, which identifies genetic alterations that are actionable based on literature as well as drugs and clinical trials that target those alterations. Watson for Genomics has been tested and validated at more than 20 leading cancer institutes worldwide. Watson Health is
a business unit of IBM that is dedicated to the development and implementation of cognitive and data-driven technologies to advance health. Watson Health technologies are tackling a wide range of the world’s biggest health care challenges, including cancer, diabetes, drug discovery and more.
MFINE RAISES $4.2 MILLION IN SERIES A mfine, an app-based on-demand healthcare service, announced it has raised $4.2 million in Series A funding. Prime Venture Partners led the round alongside existing investors, Stellaris Venture Partners and healthcare entrepreneur, MayurAbhaya. The company will use the fresh funds to build the hospital network across cities, and further strengthen the technology team. The company is planning to achieve over One Lakh consultations by the end of 2018 and also partner with more than 50 top hospitals across the country. Within the first five months of launch, mfine has clocked more than 10,000 consultations.mfine’s platform ensures that patients can reach the doctors on the network within 60 secsand start the consultation. Users get access to the same doctors and other
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11
NEWS ROUNDUP
Opening of AstraZeneca GMD center in Bangalore by Chief Guest, Klas Molin, Swedish Ambassador to India and other dignatories
integrated experiences as visiting a hospital, virtually and when they need. mfine will soon launch additional services such as monitoring of vitals, collection of sample for lab tests and medicine delivery at home. mfine has built an AI-powered technology system that improves doctors’ efficiency & effectiveness dramatically. The system is built on the foundation of standard medical ontologies and protocols and is able to learn and replicate high quality diagnosis and treatment methods. The system takes care of structured data collection, reminders for follow up based on signs/symptoms and execution of care protocols for chronic conditions, thereby building a platform that’s unique and globally competitive. mfine was founded in February 2017 by AshutoshLawania (Myntra co-founder) and Prasad Kompalli, a former business head at Myntra. The founders were later joined by Ajit Narayanan, ex-Myntra CTO, ArjunChoudhary,
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June 2018
ex-Myntra head of growth marketing and Dr. Jagadish Prasad, an interventional neuroradiologist, and founder of Femiint Health, a hospital in Bengaluru. Including the current funding round, the startup has raisedover $6 millionand has 50 employees in Bengaluru.
CHINESE MEDTECH COMPANY LEPU MEDICAL LAUNCHES INDIA OPERATIONS
Lepu Medical Technology (Beijing) Co., Ltd., Chinese medical device company, forays into Indian medical devices and equipment market with an overseas subsidiary company, Lepucare (India) Vascular Solutions Pvt. Ltd., which is the Fifth overseas subsidiary of the company, globally. At a press conference at Hyderabad vice president, Lepu Medical Aaron Lin, announced
Lepu Medical’s India entry and their plans for the country. Harrison Wang, managing director; Victor, GM, and Jitendra R Kulkarni, director sales, were also present at the event. Established in 1999, Lepu Medical specialises in developing, manufacturing and distribution of high-tech medical devices, equipment, mobile medical service and pharmaceutical. It is dedicated to reach its state-of-the-art technologies and services to patients and doctors, through its global foot print. Lepu will set up a fully functional operation organization with 95% Indian employees. It will be launching the whole range of PCI products and bring its the structure heart products and others’ in the near future in a staggered manner. The products being launched will be made available across the length and breadth of the country. “India has grown into one of the prime
markets for medical devices and equipment, the demand here will far outstrip that of the current leading markets in America and Europe. Our entry into India, we consider is at an opportune time and will ensure arrival of the most innovative technology while making the market highly competitive through our affordable products,” said Aaron Lin. “Our products are world class and reliable, while being within the affordable reach of the Indian patient. Our India office will be located in New Delhi and will set up branch offices in other cities depending on the operational requirement,” said Jitendra R Kulkarni. Lepu Medical, which is a global player in the medical devices and equipment market, has four other overseas subsidiaries companies in United States, Netherlands, France and Turkey. It has presence with products in all major medical specialties including cardiovascular, neurovascular and peripheral vascular interventions, structural heart diseases, surgical cardiology, cardiac rhythm management, anesthesia and critical care, in vitro diagnostics and general surgery.
ASTRAZENECA EXPANDS ITS GLOBAL MEDICINES DEVELOPMENT (GMD) CENTRE IN INDIA
Global science-led biopharmaceutical company AstraZeneca officially opened its new Global Medicines Development (GMD) Centre in Bengaluru, India today. This unit is one of AstraZeneca’s nine GMD centres around the world that transform breakthrough molecules into medicines and monitor their use and safety. With this opening, India will now play an even bigger role in AstraZeneca’s global operations. Globally, GMD works with AstraZeneca’s two biotech units – Innovative Medicines and Early Development (IMED) and MedImmune – and the Global Portfolio and Product Strategy (GPPS) organisation to understand where there is unmet medical need, to shape AstraZeneca’s therapy area strategies from early development through to commercialisation.
The GMD Bengaluru team will focus on supporting AstraZeneca’s medicines, which covers treatments across a range of therapy areas, including oncology, respiratory and cardiovascular and metabolic diseases. GMD Bengaluru plays a key role supporting 51 of AstraZeneca’s mature brands which are used by patients around the world. During the last year, the team has recruited scientific experts in the fields of regulatory science, clinical, and patient safety, and has grown from 30 to 70 people. The expansion will see a further increase to more than 100 specialists. AstraZeneca India Private Limited (AZIPL), is a private entity, established in 1986, covering AZ’s Global Technology Centre (GTC) in Chennai with a workforce of more than 2400 employees. It also includes AstraZeneca’s science unit – Global Medicines Development Group (GMD), the clinical operations unit and the digital unit I.e. Global Commercial Operation within Global Business SThe new GMD offices are situated in Manyata Business Park, Outer Ring Road, Nagawara, Bengaluru.
WHO RELEASES LIST OF ESSENTIAL DIAGNOSTIC TESTS Recently, WHO published its first Essential Diagnostics List, a catalogue of the tests needed to diagnose the most common conditions as well as a number of global priority diseases. “An accurate diagnosis is the first step to getting effective treatment,” says Dr Tedros Adhanom Ghebreyesus, WHO DirectorGeneral. “No one should suffer or die because of a lack of diagnostic services, or because the right tests were not available.” The list concentrates on in vitro tests – i.e. tests of human specimens like blood and urine. It contains 113 products: 58 tests are listed for detection and diagnosis of a wide range of common conditions, providing an essential package that can form the basis for screening and management of patients. The remaining 55 tests are designed for the detection, diagnosis and monitoring of “priority” diseases such as HIV, tuberculosis, malaria, hepatitis B and C, human papillomavirus and syphilis.
Some of the tests are particularly suitable for primary health care facilities, where laboratory services are often poorly resourced and sometimes non-existent; for example, tests that can rapidly diagnose a child for acute malaria or glucometers to test diabetes. These tests do not require electricity or trained personnel. Other tests are more sophisticated and therefore intended for larger medical facilities. “Our aim is to provide a tool that can be useful to all countries, to test and treat better, but also to use health funds more efficiently by concentrating on the truly essential tests,” says Mariângela Simão, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals. “Our other goal is to signal to countries and developers that the tests in the list must be of good quality, safe and affordable.” For each category of test, the Essential Diagnostics List specifies the type of test and intended use, format, and if appropriate for primary health care or for health facilities with laboratories. The list also provides links to WHO Guidelines or publications and, when available, to prequalified products. Similar to the WHO Essential Medicines List, which has been in use for four decades, the Essential Diagnostics List is intended to serve as a reference for countries to update or develop their own list of essential diagnostics. In order to truly benefit patients, national governments will need to ensure appropriate and quality-assured supplies, training of health care workers and safe use. To that end, WHO will provide support to countries as they adapt the list to the local context. The Essential Diagnostics List was developed following an extensive consultation within WHO and externally. The draft list was then considered for review by WHO’s Strategic Advisory Group of Experts on InVitro Diagnostics – a group of 19 experts with global representation. WHO will update the Essential Diagnostics List on a regular basis. In the coming months, WHO will issue a call for applications to add categories to the next edition. The list will expand significantly over the next
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NEWS ROUNDUP few years, as it incorporates other important areas including antimicrobial resistance, emerging pathogens, neglected tropical diseases and ad.
IMPACTGURU RAISES US$2MN IN SERIES A BY APOLLO HOSPITALS GROUP AND VENTURE CATALYSTS ImpactGuru.com, India’s leading healthcare, nonprofit and personal cause donation crowdfunding platform, has announced a Series A round of$2 million (Rs 13 crores) coled by Apollo Hospitals Group and Venture Catalysts India’s first integratedincubator. ImpactGuru.com was incubated at Harvard Innovation Lab in 2014. Singapore based VC fund, RB Investments, an existing investor, also participated in the round along withCurrae Healthtech Fund, India’s largest healthtech fund by number
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June 2018
of deals. Otherkey investors include various family offices and Indian diaspora from US, Southeast Asia, and the Middle East. The capital raised will enable ImpactGuru. com to scale crowdfunding in India by ramping up sales and marketing as well as technology development including artificial intelligence, machine learning, big data, and vernacular language support. ImpactGuru.com, a fintech company, is India’s largest crowdfunding platform for medical expenses, personal causes and nonprofits. The company was incubated at Harvard Innovation Lab in USA in 2014. Impact Guru has offices in Mumbai, New Delhi, Singapore, and San Francisco. Healthcare crowdfunding is an alternative method of raising funds online for medical expenses, with the patient or his/her friends or family primarily relying on social media networks to mobilise donors to finance the relevant medical bills. Crowdfunding as a next generation financing method to pay for healthcare is particularly relevant for India’s 25 crore strong middle class population as
80% of India’s population doesn’t have health insurance (NSSO), access to credit is limited, and the culture of generosity is increasing rapidly in India. ImpactGuru.com will now be the preferred crowdfunding platform for all Apollo Hospital Group’s patients nationwide effective immediately. Apollo Hospitals Group’s strategic investment into ImpactGuru.com will help it to increase the level of awareness of crowdfunding as a solution to make healthcare affordable for all – particularly cancer, transplant, and pediatric cases. Piyush Jain, Co-Founder & CEO of ImpactGuru.com said, “ImpactGuru.com is thrilled to receive the backing of Apollo Hospitals Group, Venture Catalysts, Currae Healthtech Fund, and RB Investments to scale crowdfunding in India and make healthcare affordable for all. Every social cause deserves a chance to succeed. The potential to use technology to crowdfund for help is limitless in the face of India’s accelerating smartphone, internet, and digital payments penetration.”
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NEWS ANALYSIS
New era for blood transfusions through genome sequencing Whole genome sequencing makes it possible to type hundreds of important blood type differences, enabling more precise matching for future blood transfusions Author: Brigham and Women’s Hospital
MOST PEOPLE are familiar with A, B, AB and O blood types, but there are hundreds of additional blood group “antigens” on red blood cells - substances that can trigger the body’s immune response - that differ from person to person. Each year, up to 16 deaths reported to the Federal Drug Administration are attributed to mismatches in red blood cell antigens that are not related to differences in A, B and O blood groups. Currently, no method is available that can determine all blood antigens. But as whole genome sequencing becomes routine for patients, it may be possible to modernize therapy by identifying both rare donors and at-risk recipients before blood transfusions. In a new study, investigators from Brigham and Women’s Hospital and Harvard Medical School, as well as from the New York Blood Center have leveraged the MedSeq Project - the first randomized trial of whole genome sequencing in healthy adults - to develop and validate a computer program that can comprehensively and cost-effectively determine differences in individuals’ blood types with more than 99 percent accuracy. The team’s results are reported in The Lancet Haematology.
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June 2018
Blood transfusion complications are common in patients needing chronic transfusion, but with current technology it is not cost effective to do blood typing for all antigens,” Dr William Lane, director of Clinical Laboratory Informatics & assistant director of the Tissue Typing Laboratory, BWH Department of Pathology “Blood transfusion complications are common in patients needing chronic transfusion, but with current technology it is not cost effective to do blood typing for all antigens,” said first author William Lane, MD, PhD, director of Clinical Laboratory Informatics and assistant director of the Tissue Typing Laboratory in the BWH Department of Pathology. “But the algorithm we have developed can be applied to type everyone for all relevant blood groups at a low cost once sequencing is obtained.” Blood transfusions are one of the most common procedures in medicine with more than 11 million units of blood transfused in the U.S. each year. Complications from blood transfusions can be life-threatening. When the body encounters foreign antigens on the donor cells, it can stimulate production of antibodies that can destroy the transfused donor cells. From birth, people have antibodies unique to their ABO blood type, but other antibodies against specific blood antigens can be stimulated during pregnancy from exposure to fetal cells or exposure to donor cells when receiving multiple blood transfusions. “This approach has the potential to be one of the first routine clinical uses of genomics for medical care for patients needing blood transfusion,” said co-first author Connie M. Westhoff, PhD, at the New York Blood Center. “It could prevent serious or even fatal complications because once patients are sensitized they have a life-long risk of hemolytic transfusion reactions if blood transfusion is
needed in an emergency.” Today, most testing for blood donors and patients include only ABO and Rh matching, but more than 300 red blood cell antigens and 33 platelet antigens are known. To create a way to cost-effectively type many people for these antigens, Lane teamed up with scientists directing the MedSeq Project and experts in blood group genetics at the New York Blood Center to build a database and develop a computer software algorithm, known as bloodTyper, that could rapidly and accurately predict an individual’s blood group antigen profile from genomic sequences. Lane, Westhoff and colleagues validated the software by comparing it to traditional, and more laborintensive, methods. bloodTyper was more than 99 percent accurate when typing from the MedSeq Project participants’ genomes. Lane notes that this work would not have been possible without access to samples from the MedSeq Project, and close collaboration with MedSeq’s principal investigator, Robert Green, MD, MPH, and coinvestigator, Heidi Rehm, PhD. “This report demonstrates a previously unanticipated use case and benefit that will accrue as whole genome sequencing become a routine part of medical care,” said Green, one of the senior authors on the study, director of the Genomes2People Research Program at BWH and professor of medicine at Harvard Medical School. “Genome sequencing can now identify potential transfusion recipients who need rare blood types and the individuals who can safely provide them.”
The Genomes2People Research Program at Brigham and Women’s Hospital, the Broad Institute and Harvard Medical School is directed by Robert C. Green, MD, MPH and conducts empirical research in translational genomics and health outcomes. NIH-funded research within G2P seeks to understand the medical, behavioral and economic impact of using genetic risk information to inform future standards for implementing genomic medicine. The BabySeq Project is recruiting families of both healthy and sick newborns into a randomized clinical trial where half will have their baby’s genome sequenced. The MilSeq Project is examining sequencing within the military. The MedSeq Project has conducted the first randomized clinical trial to measure the impact of whole genome sequencing on the practice of medicine. REVEAL Study has conducted several randomized clinical trials examining the impact of disclosing genetic risk for a frightening disease. And the Impact of Personal Genomics (PGen) Study examined the impact of direct-to-consumer genetic testing on over 1000 consumers of two different companies. Funding for this work was provided through the Clinical Sequencing Exploratory Research Consortium of the National Human Genome Research Institute and National Institutes of Health, Doris Duke Charitable Foundation, NHS Blood and Transplant, National Institute for Health Research, and Wellcome Trust. With inputs from Brigham and Women’s Hospital.
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OPINION
Private Healthcare Victim of Dirty Politics Anas Wajid, Director - Sales and Marketing at Max Healthcare Institute Ltd
OF LATE politicians of various hues have been paying a lot of attention to the private healthcare sector in the country. Sadly, most of this attention is rather unhealthy, based on their own populist electoral agenda and completely partisan. Let us look at two recent examples. We have had the Prime Minister talking about capping of stent prices and the like, while speaking some time back in London and then more recently we had the health minister of the government of Delhi announcing a slew of measures that the government plans to implement to curb “profiteering” by the private healthcare players in the National Capital Region. Financial Results Even a casual glance at the financial results of private healthcare players in the
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June 2018
country will establish the simple fact that far from profiteering, most of them are struggling to make a decent profit on their investments. The EBITDA margins for most of the hospitals are in the range of7-15 per cent and the return on capital employed (ROCE) is mostly in single digits even after a decade of hospital operations. The investors, who set up these hospitals as “for profit” businesses, would probably be far better off if they had just chosen to keep their money idle in a bank or may be invested in some other business. Pricing War The government and the pricing authority (NPPA) tend to look at hospital profitability through a completely distorted lens. Media stories inform readers that hospitals are making jaw-dropping profit margins on things like syringes, gloves and other sundry drugs and medicines. While these
items are always sold on the MRP, the hospitals have also been baselessly accused of colluding with the manufacturers of these items in inflating the prices. Even if for a moment one assumes this is true, the simple fact is that a hospital’s profitability cannot be judged from the profit margins on sundry consumable items. Cost of Healthcare The profitability of a hospital has to be established by looking at the revenue that it earns
Cashless Claims Even on the revenue side, private hospitals are required to cater to patients such as those covered under the CGHS and the ECHS schemes
Media stories inform readers that hospitals are making jawdropping profit margins on things like syringes, gloves and other sundry drugs and medicines
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OPINION Who Will Bear the Cost? On one hand, we as consumers continue to demand more from our healthcare service
Political Hysteria Politicians whipping up unnecessary hysteria by claiming that hospitals make huge margins on say a cotton swab and then presenting themselves as knights in shining armor out to protect the general public from the depredations of unscrupulous private sector hospitals is just playing to the galleries. It is actually the
20
June 2018
they will end up destroying private healthcare in India. With no hospitals and sub-quality treatment people will be forced to seek treatment outside India. And that truly would be a very high price for all of us to pay. (The views expressed are personal)
Even on the revenue side, private hospitals are required to cater to patients such as those covered under the CGHS and the ECHS schemes of the government
COVER STORY Author: Dr Sanjay Sarin, Country Head, Foundation For Innovative New Diagnostic (FIND)
RETHINKING DIAGNOSTICS: THE ESSENTIAL LIST How will WHO list of essential diagnostics paint the Ayushman Bharat canvas?
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June 2018
COVER STORY
D
iagnosis is the first step on the path to treatment and serves as the foundation of disease control and prevention. As William Osler, sometimes described as the father of modern medicine, said in 1892: “There are three phases to treatment: diagnosis, diagnosis and diagnosis” . Without diagnosis, medicine is blind. Diagnostic tests guide clinical decision-making and improve the efficiency of health care spending by helping to ensure the use of appropriate treatments.
Ayushman Bharat The Government of India under the leadership of Honourable Prime Minister, NarendraModi has announced the ambitious National Health Protection Scheme (NHPS) – Ayushman Bharat, which will cover over 10 crore poor and vulnerable families based on Socio Economic and Caste Census 2011 (SECC) database, providing coverage up to INR 5 lakh per family per year for secondary and tertiary care hospitalization. The scheme envisages to cover ~50 crore beneficiaries comprising nearly 40% of the Indian population. Under the scheme, government will set up 1.5 lakh wellness centres across the country by 2022 that will leverage on comprehensive primary health care for preventive, promotive and curative care. It is expected to have a substantial impact on reduction of Out of Pocket (OOP) expenditure by providing coverage for pre and post-hospitalisation expenses and all pre-existing conditions. This in turn would eventually increase cost-effectiveness in healthcare delivery because of improved patient outcomes, improvement in various healthcare indices associated with communicable and noncommunicable diseases, reduction in the economic burden and improved quality of life.
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June 2018
Essential Diagnostics As the government plans the overall strategy and implementation plan for universal health coverage via NHPS, it is critical to give due consideration to “diagnostics”, in terms of nature and type of diagnostics to be offered, technology selection, manpower capacity, quality control
The scheme envisages to cover ~50 crore beneficiaries comprising nearly 40% of the Indian population. Under the scheme, government will set up 1.5 lakh wellness centres across the country by 2022
and appropriate pricing, more sonow in view of the NPPA’s (National Pharmaceutical Pricing Authority) analysis showing that patients paynearly 16% of their hospital charges on just diagnostics. To achieve equitable access to quality diagnostics across the country, the first and foremost step is to define the type of lab investigations to be offered and the associated level of technology required for conducting these diagnostic tests at various levels of healthcare. These investigations once definedin such a manner can constitute the Essential Diagnostics List (EDL) for the country WHO List The World Health Organization (WHO) has just published the first edition of the Model List of Essential In Vitro Diagnostics (EDL) in May 2018. The EDL is a catalogue of the tests needed to diagnose the most common conditions as well as several global priority diseases. It contains 113 products: 58 tests are listed for detection and diagnosis of a wide range of common conditions, providing an essential package that can form the basis for screening and management of patients. The remaining 55 tests are designed for
The EDL is a catalogue of the tests needed to diagnose the most common conditions as well as several global priority diseases the detection, diagnosis and monitoring of “priority� diseases such as HIV, tuberculosis, malaria, hepatitis B and C, human papillomavirus and syphilis. The list also provides links to WHO Guidelines or publications and, when available, to prequalified products. The primary aim behind the EDL is to provide a tool that will allow the health funds to be utilised more efficiently by focusing on essential tests . Benefits of EDL The WHO guidance document on EDL recognises that diagnostics are essential to advance universal health coverage, reduce cost of quality
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COVER STORY
mechanisms for increasing access to modern diagnostic technologies including leveraging the technology and trained capacity available in the private sector, more so for a country like India where >80% of the population seeks access to healthcare in the private sector. Implementation is the Key It is heartening to note that the NHPS already envisions engagement of both the public and private sector as part of its modus operandi. Development and implementation of an EDL will also help in standardization of healthcare delivery across the various tiers in pubic and private sector.
.
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June 2018
for POC and lab based tests), level of proficiency required for conducting the particular diagnostic test using a particular technology which in turn will help define / refine the training needs and occupational standards at the national level. Impact of EDL To maximize the impact of an EDL, it is imperative to ensure uptake and appropriate use
adoption and uptake. This may be because of numerous reasons such as: ďƒŒ General lack of integration between medicines and diagnostics and hence: Essential
It is heartening to note that the NHPS already envisions engagement of both the public and private sector as part of its modus operandi
To Conclude As India goes about implementing its free diagnostics initiative in 29 states, there is a window of opportunity for India to set an example to other countries by developing and implementing a national EDL aimed at
EDL are thus unique and quite in line with what is expected from the NHPS thus further underlining its need from a universal health coverage perspective.
Under the National Health Mission (NHM), `649.29 crorehave been approved for 24 States/UTs in 201617 for implementing NHM Free Diagnostic Service Initiative. Theministry had developed the guidelines for operationalising the Free Diagnostics Initiative which have been shared with the States two-years back.
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25
PULSE
Is the Street Over Valuing the FortisReligare Health Trust (RHT) Deal?
Kapil Khandelwal & Tapan Bhatt, Managing Partners, Toro Finserve LLP
WHEN I was invested in an asset-lite chain of day-care surgery centers in India investors were giving a premium valuation to healthcare assetlite business models as it provided high Returns on Capital Employed (ROCE). The same investors today, are in a race to acquire Fortis and are looking to fund Fortis’ acquisition of Religare Health Trust (RHT), a Singapore REIT vehicle for Fortis’ hospitals, at a premium valuation. Why this googly? As India’s first dedicated Healthcare Infrastructure Fund, Toro Finserve LLP believes that the investors on the street are blind slighted by what is coming! In the Beginning For the sake of clarity, lets roll back in time. In October 2012, in the first of it’s kind deal for an Indian healthcare operator, Fortis announced that it will spin-off its hospital assets into a Singapore listed business trust, RHT.
Fortis announced that it plans to re-acquire the entire portfolio of Singapore-listed RHT for `4,650 crs 26
June 2018
crs / ~USD 255 mn) and for investments in Subsidiaries. Exactly what one would expect from the Company to do with the Funds raised.
Exchange Rate at Listing (from INR)
43.55
RHT INFORMATION
SGD MN
52.8 INR MN USD MN
Portfolio Valuation at Raise
719.3
31,327
593.3
Cash proceeds from Listing - FHL
520.7
22,677
429.50
Projected 1YF Rent
102.3
4,454
84.4
Implied Rental Yield
14.2%
14.2%
14.2%
G-Sec Yield – India
9%
9%
9%
Spread over G-Sec
5.2%
5.2%
5.2%
In return for receiving the money from RHT, Fortis would have to pay fixed + variable hospital service fee (rent). As a yield seeking investor, RHT should have been a very attractive investment opportunity.
So What’s New Where have we heard this before? While one rationale is for a spin-off
has become popular among most investors? We feel that there is something amiss. In Addition Recently, Fortis Healthcare International Limited, a wholly owned
The Current Scenario Back in the present, in a complete u-turn, in early November 2017, Fortis
aims to raise equity and leverage from Banks / issuance of debentures.
Additionally, a quick web search revealed that Mahaesh Udhav Buxani
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27
PULSE also holds 1.91% of Religare Enterprises Limited, a related company of the erstwhile promoters of FHL! The transaction is classified in the filings as non-related party transaction, but is it really?
Improving Profitability So what if the debt goes up? Asset value is also going up and profitability is going up you might say. Based on the first-quarter service fee, Fortis has said it can be
Why the Turn-around Let’s take each of the reasoning point by point: Improving Balance Sheet: How is Fortis financing the RHT p.a. for the debt against the hospitals they acquire. SGD MN
INR MN
Service Fee Savings
55.7
2,700.0
41.5
Allied Interest Servicing Savings
14.4
700.0
10.8
Total Savings
70.1
3,400.0
52.3
SGD MN
INR MN
USD MN
Debt Assumed
234.3
11,362.7
174.8
New Debt / Debt-like instrument
629.6
30,537.3
469.8
Total New Debt
863.9
41,900.0
644.6
Interest Rate
9.50%
9.50%
9.50%
82.1
3,980.5
61.2
INCREMENTAL DEBT
transaction, there will be significant increase in debt from `1799 crs to `5989 crs (Current Debt + New Debt + Assumed debt from RHT). This SGD MN
INR MN
USD MN
USES Total Consideration for RHT (From RHT filing) SOURCES Assuming existing debt (from RHT Presentation) Cash Balance (from Fortis filings) Equity Raise
958.8
46,500.0
715.4
SGD MN
INR MN
USD MN
234.3
11,362.7
174.8
94.8
4,600.0
70.8
-
-
-
Debt / Debt-like instruments
629.6
30,537.3
469.8
Total Sources
958.8
46,500.0
715.4
should be of a concern to most investors. In this case, the balance sheet worsens significantly. So what happens when new investors infuse equity? The new investors are expected to infuse anywhere from `1500 crs to `2000 crs in Equity and dilute existing investor’s equity. The rest of the transaction value being financed by debt. So in the best-case scenario, the debt goes up by INR 2,650 crs or to INR 4,449 crs. Improving the balance sheet? Not so much.
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June 2018
USD MN
Incremental Interest Cost
The above table clearly illustrates that Fortis will be worse off on PAT
the best-case scenario for Fortis investors, which again is not a great outcome. Also, some street analysts were of the opinion that Fortis listed RHT at ~14% rental yield in 2012, which was very expensive and that’s why FHL needs to unwind this deal. We believe that many of these analysts have forgotten that the Indian 10-Year G-Secs in 2012 were trading at ~9% and that some of the hospitals in the portfolio transferred to RHT were non-stabilized / under development and warranted higher yield be-
cause of that. Today, to unwind that deal they want to buy the hospital at 7.3% rental yield (340/4,650) when the Indian interest rates have bottomed out and there is only way that the rates are going to move and that’s up. This is nothing but a perfect case of buy high and sell low. Consolidate holdings for better valuation In short, by acquiring these hospitals for `4,650 crs, the valuation impact for Fortis is higher than that. In normal circumstances that would mean, RHT is not being priced correctly in Singapore and for some reason Fortis can find certain “synergies” to push the valuation up. Clearly, there are no synergies here and we believe the current Enterprise Value of RHT
It is basically assuming that investors don’t understand what they are buying for the investment they have made In the above example, Apples gets valued at `2000 crs whereas Oranges gets valued at `1,600 crs when there is only one difference i.e. Hospital
very expensive. MARKET VALUATION
SGD MN
INR MN
USD MN
Market Cap
634.9
30,790
473.7
Net Debt as of Dec 17
234.3
11,363
174.8
Enterprise Value of Transaction
869.1
42,153
648.5
Rent as of Dec 17
70.1
3,400
52.3
Implied Rental Yield for the Transaction
8.1%
8.1%
8.1%
Enterprse Value per Occupied Bed (2,779)
0.31
15.17
0.23
Enterprise Value per Installed Bed (3,603)
0.24
11.70
0.18
So why does Fortis think they can get better valuation? One of the street analysts told us that given that EBITDA will improve by `340 crs (service fee saving), applying an industry wide EBITDA multiple of 20x,
is basically assuming that investors don’t understand what they are buying for the investment they have made. Let’s take a small example to make our point. There is an Apples Hospitals, which is an asset-heavy operator i.e. it holds the hospitals on its balance sheet and there is an Oranges Hospitals, which is an asset-lite and rents the hospital and does not hold the hospital on its balance sheet. Both Apples and Oranges are running similar operations with similar bed capacity, revenues and operational efficiency. Their P&L and valuation would look as follows: APPLES HOSPITAL Profit & Loss `
Heavy
Lite
200
200
Operating costs
100
100
100
80
EBITDA EBITDAR Valuation 20x of EBITDA Value of Asset
In the End We believe that the street is failing to see how this transaction negatively impacts the balance sheet with increased in leverage, profitability is worse as there is no real service fee savings when you compare it to incremental
ORANGES HOSPITAL
Revenues Rent
Now let’s apply this Apples and Oranges example to Fortis-RHT deal. If we believe that `4,650 crs is fair value that Fortis is paying for RHT, then the current EV should go up by `4,650 crs (as there is no synergies or mis-pricing to take advantage of).
20 100
100
2000
1600
400
Nil
Street’s notion of valuing Indian healthcare companies moving forward, with Healthcare REITs coming into India, needs to shift else, risk capital will be scarce to come by for the healthcare operators in India.
www.indiamedtoday.com
29
INNOVATE
Big Data Innovation and Diagnostic Errors IMT Team
DIAGNOSTIC ERRORS are common. In fact, experts say one in 20 adults experiences diagnostic errors which may lead to delayer or alteration in treatment, gaps in disease management, unnecessary procedures or even result in death. Indeed, diagnostic errors are an important patient safety concern. So much so that the ECRI Institute named diagnostic errors the number one concern on its 2018 Top 10 Patient Safety Concerns for Healthcare Organizations list. New research Various research studies reveal that an estimated 12 million Americans are affected each year by diagnostic errors, with one in three errors leading to serious patient injuries, including disability or death.”We know diagnostic errors are a big problem, but we currently have no way of operationally measuring them,” says Dr David Newman-Toker, Director of the Armstrong Institute Center for Diagnostic Excellence. In an effort to reduce
patient misdiagnoses and associated poor patient outcomes from lack of prompt treatment, a Johns Hopkins Armstrong Institute for Patient Safety and Quality researcher is helping to lead the way in providing hospitals a new approach to quantify and monitor diagnostic errors in their quality improvement efforts. Other researchers involved in this study include Dr Ava Liberman, vascular neurologist, The Stern Stroke Center, Montefiore Health System and assistant professor of neurology, The Saul R. Korey Department of Neurology,Albert Einstein College of Medicine. SPADE The approach, called Symptom-Disease Pair Analysis of Diagnostic Error, or SPADE, is featured in a
Credit: Johns Hopkins Medicine
interventions are making a difference,” Newman-Toker says. Big Data at Work Many current methods of measuring diagnostic errors rely on labor-intensive medical record
Conceptual model for Symptom-Disease Pair Analysis of Diagnostic Error (SPADE)
30
June 2018
performance dashboards. “Using SPADE, we can
measure how often a patient comes to the hospital
“And being able to do that using big data is an important innovation for diagnostic quality and safety.” Improved Outcomes Newman-Toker also believes SPADE, in turn, will lead to improved patient outcomes.“Many quality
measures will matter to patients,” he says. Range of Disease SPADE will work best with acute and subacute diseases for which a misdiagnosis that leads to
In the Future Thinking toward the future, Newman-Toker understands that physician and hospital leadership “buy-in” relating to tracking diagnostic errors may take time. However, he believes
“We know diagnostic errors are a big problem, but we currently have no way of operationally measuring them”
deaths?” Newman-Toker says. “And that is a step towards patient empowerment in diagnosis that has never existed before.” With inputs from Johns Hopkins Medicine
Dr David Newman-Toker Director of the Armstrong Institute Center for Diagnostic Excellence
of disability and death from diagnostic error: vascular events, infections and cancers.
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31
INTERVIEW
“It has been a challenging, exciting and satisfying journey”
Suresh Vazirani Chairman & Managing Director, Transasia Bio-Medicals Ltd
32
June 2018
RECENTLY, TRANSASIA Bio-Medicals Ltd. , India’s Leading In-vitro Diagnostic Company, was awarded the ‘India Medical Devices Export Company of the Year’ by the Ministry of Chemicals & Fertilizers, Government of India. Founded in 1979, Transasia Bio-Medicals Ltd., India’s Leading In-vitro Diagnostic Company offers products and solutions in Biochemistry, Hematology, Coagulation, ESR, Immunology, Urinalysis, Critical Care, Diabetes Management, Microbiology and Molecular Diagnostics. It is the first Indian company to manufacture and export blood analyzers and reagents, in the 1990s. Today, Transasia’s indigenous research has resulted in development of state of the art, ‘Make in India’ products and technologies, enabling its products to be among the best in the world. Transasia has animpressive install base of more than 65,000 equipment in 35,000 laboratories across India. What’s more, it has a vast network of the more than 250 service engineers, 400+ sales and marketing team, 21 zonal offices and 350+ distributors spread across India, catering to the needs of its clients. Headquartered in Mumbai, Transasia is a part of the global Erba Diagnostics Mannheim GmbH Group. The Erba –Transasia Group has spread its footprint across USA, UK, Germany, Czech Republic, France, Italy, Russia and Turkey through various acquisitions.
Erba’s production sites in India, Czech Republic and USA and R&D centres in France, UK, India and Czech Republic form a hub for indigenous manufacturing of world class deliverables.Today, the Erba -Transasia Group serves millions across 110 countries. Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltdspeaks to IndiaMedToday about his entrepreneurial journey and future plans. You started Transasia in 1979 with a capital of Rs. 250 and today it is an over Rs. 1000 cr company. Tell us how things have changed during these 38 years for you as a businessman and a medical device manufacturer? When we started off, almost all medical and diagnostic equipment were imported and thus we provided the necessary after-sales support. Thereon, we decided to cater to India’s need for affordable and reliable diagnostic systems by manufacturing in India. And today, with 14 overseas acquisitions in nine countries, we cater to the needs India and of the emerging countries. It has been a challenging, exciting and satisfying journey! Over the last four decades, with the mushrooming of stand-alone laboratories, chain labs andcorporate and government hospitals, there has been an increase in the demand for
diagnostic equipment. Nowadays, laboratories play a very important role in the proper diagnosis and treatment. This has led us to innovate and introduce the latest technologies that are affordable and easily accessible.In the last decade, we have focused on our R&D expertise and expanded our manufacturing base. Besides, aftersales service and application support has been our forte. We have widened our reach to cover the length and breadth of the country. The size of the Indian medical device industry was USD 2.16 bn in 2006* and in little over a decade, it has more than doubled to reach USD 5.2 bn by 2017.** Though the growth has been promising, our dependency on imports still overhauls the sector. Even today 70-80% of our medical equipment is imported. Transasia is one of the few domestic manufacturers and developers of diagnostic systems. As a manufacturer of diagnostic instruments, for me the direction in which the industry is
moving is very exciting! It has steadily grown at a CAGR of 15.8%. As per industry estimates, the Indian medical devices market will grow to USD 50 billion by 2025. Currently, India is counted among the top 20 global medical devices market and is the 4th largest medical devices market in Asia after Japan, China and South Korea. What has been the effect of the recent government’s ‘Make in India’ policy on the medical device sector? Our Hon’ble Prime Minister’s ‘Make in India’ initiative has been welcomed by the Indian IVD industry too. However, sadly not much has changed in reality. We are still facing issues like inverted duty structure, government hospital’s love for ‘phoren’ products even from unknown countries, poor infrastructure, no preferential market access, etc.
Even today 70-80% of our medical equipment is imported. Transasia is one of the few domestic manufacturers and developers of diagnostic systems
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33
INTERVIEW What are your views on the FDI policy in the medical device sector? To scale up the domestic capabilities, Indian government is providing 100% FDI for Greenfield operations under automatic route and 100% FDI for Brownfield operations via the Foreign Investment Promotion Board (FIPB). For medtech companies this is a simple process to infuse funds to set-up a new plant. The campaign is expected to attract global companies to set up manufacturing base in India which will in turn build up the components ecosystem and enhance the manufacturing capabilities. However, inspite of such open door policies, not much FDI has come into the medtech sector, as it is still unattractive for ‘Make in India.’ Is the recent preferential pricing policy helping device manufacturers? The ‘Preferential Pricing Policy’ (PPP) and ‘Buy India Policy’ are strategic drivers that can, not only positively impact domestic growth but also benefit the consumers as well as stakeholders. However, the policy remains only on paper and needs reconsideration, as the following points have not been considered:
Preferential pricing for domestic manufacturers based on World Bank norms which allow 15-20% price preference. Preference for Indian Certification for Medical Devices (ICMED) /ISO certified manufacturers to boost quality. Preference for Design India Certified Manufacturers to boost indigenous development. Timely payment against government supplies. Penal provision against hospitals that keep exclusionary compliance clause of USFDA certification in tender specifications. Incentives for R&D and innovative indigenous product development. All these will help achieve long-term sustainability and access to low cost, affordable and high quality devices under the Make in India programme. These will also result in employment generation and foster innovation and competition in the medical devices sector.
Transasia has been a pathfinder for Indian device manufacturers, receiving awards and accolades galore. What are the next milestones Transasia wants to achieve? The medium-to-long term growth strategy is to keep the focus on technology through our global R&D especially in the fields of immunology and molecular diagnostics. On the other hand, in the field of Molecular testing, Transasia is working on combining special technology that makes molecular diagnostics less complex and introduce products that are customized to Indian needs for detection of TB, dengue, malaria, chikungunya, etc., so that these diseases can be treated faster with products that are affordable and accessible. Sources: *http://www.ijph.in/article.asp?issn=0019557X;year= 2013;volume=57;issue=4;spage=203;epage=207;aulas t=Chakravarthi **http://www.nishithdesai.com/fileadmin/user_ upload/pdfs/Research%20Papers/The_Indian_ Medical_Device_Industry.pdf
34
June 2018
EVENTS NBE-ANBAI TEACHER’S DAY AWARDS Date: September 22, 2018 Organiser: NBE & ANBAI Venue: Bangalore, Click: www.anbai.org, www.natboard.edu.in Contact: bbharat@nbe.edu.in&anbaiindia@ gmail.
T
/hospitals
to
further
and excellence in the country. Last year the award ceremony was conducted by Association of National Board Accredited Institutions (ANBAI). This year NBE & ANBAI have joined
National
Examinations national the
institutions
the cause of medical education quality
hands and will be organizing the award
com
he
and
Board (NBE)
awards
contributions
of
confers
to
honor
made
by
ceremony together.
The awards will be
announced and distributed at the Teachers Day awards ceremony to be held at Bangalore on 22 September, 2018.
eminent medical teachers /professionals
WORLD CONGRESS ON CARDIAC SCIENCES Date: November 28 - 29, 2018 Organiser: Biogenesis Health Cluster Venue: J.N.TATA Auditorium, IIS City: Bengaluru Click: www.cardiacsciencesconference.com Contact: Ms. Radhika, +91-9886327807
W
orld Congress On Cardiac Sciences - 2018 “International Conference on Cardiology” is designed on the theme: “Building and Beating to the Future of the Heart” that focuses to share novel approaches related to Cardiology field and exploring the challenges concerning excellence in Cardio research and advancements. The motive of the event is to generate awareness that will keep medical professionals abreast of the problems affecting the prevention, diagnosis and treatment of cardiovascular diseases.The scientific program will feature live workshops, interactive education sessions, B2B meetings, round-table discussions apart from the conventional plenary sessions, featured symposia, breakout sessions and oral presentation sessions for abstracts and challenging cases. In addition, the World Congress On Cardiac Sciences - 2018 “International Conference on Cardiology” will feature live cases and interventional courses in an interactive format throughout the conference. Our endeavour is to provide a stimulating and thought to provoke scientific program. “We sincerely hope that the blend of pleasant weather, warm hospitality and revitalizing social evenings will make the scientific environment richer.”
MEDICALL 2018 Date: July 27-29, 2018 Organiser: Medexpert Business Consultants Pvt.
Venue: Chennai Trade Centre, Chennai, India City: Chennai Contact: Mr.KSundararajan, 91-7305789789 Click: info@medicall.in
M
edicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approx. 750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, but also biomedical engineers, sales people, decision makers, consultants and hospital owners, are represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer the fair mainly serves as a platform to exchange knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complement the event.
EMCON 2018 Date: November 15-18, 2018 Organiser: The Society for Emergency Medicine India (SEMI)
Venue: The LaLiT Ashok Bangalore City:Bengaluru
Click:http://emcon2018.org Contact:emcon2018@gmail.com, +91 9880880682, 9632602928
T
he Society for Emergency Medicine India(SEMI) is organizing its prestigious 20th Annual Event on Emergency Medicine – the flagship conference EMCON 2018 at Bangalore, Karnataka India under the SEMI Karnataka Chapter from November 15th to 18th 2018.15th November 2018 will be for the Pre Conference Workshops and the Scientific fiesta with various research projects from 16th to 18th November 2018. The theme of the conference is Consensus, Advances and Innovations. It aims to bring in the field of Emergency Medicine an agreement for universal emergency care by bonding our unique needs with the progresses made. The Conference aims to provide participants working in Emergency Medicine a platform to come together and corroborate to evolve the National guidelines and to stay ahead in our knowledge and skills to match the International standards and thereby aiming to provide universal agreement of guidelines in India in Emergency Medicine
MEDICAL FAIR INDIA 2019 Date: Feburary 21 - 23, 2019 Organiser: Messe Düsseldorf India Pvt. Ltd. Venue: PragatiMaidan New Dehli, City: New Dehli, India Click: http://www.medicalfair-india.com/ Contact: Love Bhardwaj, BhardwajL@mdindia.com
M
EDICAL FAIR INDIA is held alternately at venues in Mumbai and New Delhi every year. Focal ranges include: medical products and medical device technology, laboratory technology and diagnostics, equipment and furnishings plus furniture for hospitals and health centres and the global trend areas of Health IT and Mobile Health solutions, to name but a few themes. The target group encompasses decisionmakers from the medical field (such as physicians and medical professionals), hospital managers as well as representatives from the medical trade and industry. Due to its spectrum of topics covered the event is equally attractive for architects and building planners, for enterprise consultants or for the scientific and research community.
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35
EVENT REPORT
Edifying Symbiosis Conference SYMHEALTH 2018, a National Conference on Interdisciplinary Approach to Healthcare, organized by the Faculty of Health & Biological Sciences (FoHBS), Symbiosis International (Deemed University), was held on May 3-4, 2018 at the university’s Lavale campus, Pune. Around 1200 healthcare professionals, from across the countryparticipated in this event.
Standing true to its promise, the multi-disciplinary conference underscored the importance of applying integrative strategies to the theory and practice of health sciences. The conference forged new dialogues amongst various stakeholders of the healthcare community, bringing in new insights and perspectives from other fields and offered a platform to foster intellectual fellowship amongst all stakeholders.
Inauguration ceremoney
36
June 2018
Valedictory Ceremony
The Inaugural ceremony was graced by Air Marshal PawanKapoor, AVSM, VSM (Retd), Former Director General Medical Services (Indian Air Force). The ceremony was also graced by Dr VidyaYeravdekar, Pro Chancellor, SIU and Dr RajaniGupte, Vice Chancellor, SIU.Dr Rajiv Yeravdekar, Dean, Faculty of Health & Biomedical Sciences, SIU, welcomed the dignitaries and spoke on the emerging concept of interdisciplinary approach to healthcare, whereby in this era of globalization & knowledge explosion, the shackles of tubular approach must be broken. He described SYMHEALTH 2018 as a confluence of important stakeholders involved in optimum healthcare delivery. Dr Gupte remarked that healthcare is on the horizon of a radical change with evolving technologies making inroads such as artificial intelligence in diagnostics. She mentioned telebehavioral health which creates, promotes, and maintains access to behavioral health services through technology. Telebehavioral health offers aid by eliminating traveltime and expense for both providers and consumers. DrVidyaYeravdekar announced the opening of Symbiosis Hospital & Research Centre, a standalone hospital made to cater to nearby 23 adopted villages in MulshiTaluka which are currently poorly served by healthcare facilities. She also mentioned about
the Symbiosis Health Science & Technology Park where innovation will be the focus and which will make the Lavale campus of Symbiosis as the university campus of 21st century. Air Marshal Kapoor addressed the audience by appreciating the efforts taken by Symbiosis & was impressed by the service given by Symbiosis to the community. He observed that India is the leading producer of generic drugs and it is the need of the hour to harness technology to ensure that the 4 A’s of healthcare are fulfilled i.e. accessibility appropriateness, approachability & achievability to all. He further quoted that every year in India; millions of people above the poverty line go below the poverty line because of a health event. The factor that puts this problem in a vicious circle is the lack of affordable and adaptable health insurance policies. He also mentioned the requirement of a Swasth Bharat Abhiyaan on the same grounds as Swacch Bharat Abhiyaan. The first session of the day was on digital healthcare by TirupathiKarthik, CEO, Napier Healthcare Solution. He spoke about the biggest challenge plaguing healthcare in current scenario- poor accessibility.Dr H.P Singh, Chief of Medical Administration, Indian Spinal Injuries Centre, Delhi, spoke on managing standalone super specialty center.Following that, Anthony
D’Costa, Product Manager, Halyard Health India, Pvt. Ltd.discussed performance standards of medical textiles.Shishir Gupta, National Manager- Strategy &Innovation, Roche Diagnostics, expressed his views on changing landscape of diagnostics in India. Dr Rajeev Boudhankar, Chief Executive Officer, Bhatia Hospital, Mumbai spoke on Healthcare quality & patient safety. The session on achieving operational excellence in healthcare was conducted by Dilip Jose, MD &CEO Manipal Health Enterprises. He said that healthcare personnel must actively participate in performance improvement efforts and must be open to changes. He also explained how change management & process improvement are two important factors that assist organizations in achieving organizational excellence. The other proceedings of day were two parallel sessions. The first session was chaired by Dr NilimaKadambi, Executive Director, Pharma division, Belle Sante, Bengaluru, India. The speaker for this session, Dr GeetaBhardwajGMOperations, MD India Healthcare Services Pvt. Ltd., addressed the gathering on Health Insurance: Dynamics of Cancer Care Economics.The second parallel session was on plagiarism in clinical trials by Dr VirajSuvarna, Medical Di-
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37
EVENT REPORT rector, BoehringerIngelheim, Mumbai. The day concluded with sessions on healthcare associated infections by Dr RohiniKelkar Director Laboratories, Professor and Head, Dept of Microbiology, Tata Memorial Centre, Mumbai; and India: An ultimate destination for medical value travel? byAnuravRane, Founder & CEO- Plan my medical trip. Day 2 of SYMHEALTH opened up with an invigorating talk on Home healthcare by Dr GauravThukral, Executive VP, Health Care at Home India Pvt. Ltd.The second session of the day was an engaging talk on Healthcare startupopportunities & challenges by Dr. Shyam Vasudevrao, Founder and Director Forus Health, Renalyx and Rx DHP.Dr. RajendraPatankar, COO, Nanavati Hospital, Mumbai discussed on the sensitive topic of managing consultants in tertiary care hospitals.Meghraj Gore, Vice President – Operations, Fortis Healthcare Limited spoke on Financial planning for sustainable
MARCH 2018, VOLUME 2 ISSUE 3 `200 INDIA MED TODAY
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FIRST-EVER EX UTERO INTRAPARTUM TREATMENT FOR VENTRICULAR PACING DONE
NEW CLINICAL TESTING SEGMENTS TO WATCH OUT FOR IN 2018 HOW SOCIAL FRANCHISING IS CONTRIBUTING TO MATERNAL & CHILD CARE
Can India Capitalize on
MARCH 2018
9BILLION USD Medical Value Travel OPPORTUNITY
hospitals where as DrRakeshVarma, Managing Director, Falcon Skills spoke about on training & development for healthcare professionals. Later, Dr Sanjay Gupte, Former President, The Federation of Obstetric and Gynecological Societies of India gave the audience food for thought with his discourse on Legal aspects of healthcare delivery. The event concluded with a valedictory ceremony and was graced by ShriGirishMahajan, Minister for Water Resources & Medical education, Govt. of Maharashtra, Dr Ravi Wankhedkar, National President, Indian Medical Association, Dr S.B. Mujumdar, Chancellor, SIU, Dr RajaniGupte and Dr Rajiv Yeravdekar. GirishMahajan in his speech said that good education, physical and emotional fitness is a need of the hour especially for doctors and every zilla should have medical college so that there are more doctors to take care of the needs of the common man.
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June 2018
EVENT REPORT
DIAGNOCON 2018 ORGANIZED BY AMEN, one of India’s most successful Healthcare Conference Managers, and Thyrocare, the World’s largest Diagnostic center and Pathology lab, DIAGNOCON 2018 held on the 27th of April 2018 at Bengaluru, turned out to be a huge success with participation from various labs, diagnostic centers and related businesses from across the country. The conference, as expressed by a few of the delegates, was a much needed initiative to bring people from the diagnostics business on one platform. Speakers and panelists from across the country shared immense knowledge on various topics and issues related to the diagnostics business. Dr A Velumani, Creator, Thyrocaredelivered the keynote address. In a very interesting talk he captured the audience attentionwith his story and the making of Thyrocare. “If you have not seen poverty, you have not seen life”, he said. “In 1982 I did not know where the Thyroid was located. In 1992 I finished my MSc and PhD in Thyroid Biochemistry. In 2002 I am running the world’s largest Thyroid testing laboratory,” he revealed while elaborating on his Topic ‘Focus gives Success’. “I focused on the 15 gram gland in the human body and built a brand around the gland,” he quipped. Kishor Joshi, Global Head – BD & Sales, Teleradiology Solutions spoke on Teleradiology& Emerging Technologies - A pathway for a distributed Diagnostics in a connected World. “300 million is the expected geriatric population in India by 2050 and nearly 270 million Indian’s will be ‘middle class by 2020”, he said, while talking about why diagnostics will grow. “Sub-specialty Tele Radiology reporting, Tele 3D Services for Radiology, Tele-Echo Services to Children’s hospitals in India, Artificial Intelligence in Radiology & other Diagnostics etc. are some of the Emerging technology areas within Tele-diagnostics”, he added. “Customer focus drives success and is the Key to win, not price alone”, saidBharathUppiliappan, COO, Dr LalPathlabs, while speaking on
“An ideal platform for facilitating a faster shift from unorganized to organized diagnostic industry” Dr A Velumani, Creator, Thyrocare Pathology Business : Patient Focus. “The diagnostics’ Industry is geared up for INR 600 billion boom driven by increase in evidence based treatment, focus on preventive disease and wellness and demand for services for lifestyle diseases “, he added. He also enlightened the audience on the growth story of Dr LalPathLabs and their future plans. Following this Rahil Shah, CEO, NM Medical, Mumbai threw light on Innovation & Technology in Diagnostics’ Management - Latest Trends & Strategies. He spoke about the challenges in today’s diagnostic procedures and how they can be tackled effectively with technology. “The Key Trends in the next three years would be; Interplay between all disciplines (AI powered precision medicine); Standardization, Productivity, Efficiency (Automa-
tion in Lab & Imaging, Remote Control Cockpit, AI to make Radiologist job easier); Diagnopeutics (Hybrid imaging & therapy); Collaboration & Planning (3D Printing & Mixed Reality) ; Patient powered healthcare & OPD Insurance (Digitization - Healthcare 4.0)”, he said. Next,Laxman T L, Alumni-IIMB, presented his thoughts on marketing labs & diagnostic centers- branding strategies, challenges and ethics. Speaking specifically about challenges and ethics, he stressed on the recently released National Healthcare Policy - 2017 by the government which emphasized on the need to increase regulatory supervision in the sector. He also shared details of branding and marketing strategies implemented by various Labs and Diagnostic Chains and centers across the country and their impact on business development.
“We are absolutely thrilled with the success of this Conference and extremely motivated and excited to announce our next edition in 2019” Paniel, Founder & Chief Strategist, AMEN
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39
EVENT REPORT In addition to talks and presentations by experts, the conference also had threepanel discussions by almost fifteen industry experts. Moderated by SubhashiniSathyanarayan, Director - Hospital Strategies, K-Arogia Healthcare, the first panel discussion was on the ‘Quality Management, Accreditation and related challenges in Diagnostics’. Panelists included Achala Mohan, Consultant- System Certification and Accreditation Centre for Management of Quality and Innovation, Bengaluru; Col. Dr SudiptaDatta, (Formerly) Senior VP - Quality Assurance & Lab Services , Columbia Asia Hospitals, Dr. NiveditaJayaram, Lab Director and HOD- Clinical Biochemistry, Strand Life Sciences Pvt. Ltd. and Dr. S K Saran, Consultant, SKS Health Management Advisors. The second panel was focused on Law & Medico Legal Issues in Diagnostics’ Management. Dr. S V JogaRao, Advocate & Medico Legal Expert, Legalexcel, Bengaluru; Dr. SantoshSaklecha, Director Santosh Diagnostics & Group of Institutions Bengaluru and Dr. LeenaAppicatla, Technical Head - South, SRL Diagnostics, Bengaluru formed the group of panelists for this power packed session moderated by Dr. U K Ananthapadmanabhan, Director, Tenxhealth Technologies, Chennai. The session included discussion on how ethical practices, good patient- doctor communication, documentation standards, regulations, accreditation and technology can help minimize medico legal complications. The role of NABL in minimizing medico legal complications was also discussed. The third panel ‘The Future of Diagnostics in India -Labs in 2025’, was moderated by N J Gowri Shankar, Chief Consultant, HSB Consulting, Chennai. Panelists for this session included :SumanKatragadda, Co-founder & CEO, K-Arogia Healthcare, BharathUppiliappan, COO, Dr. LalPathlabs, Dr. S P Ganesan, Medical Director, Hitech Diagnostic Center, Chennai, Dr. BabliDhaliwal, Director & Technical Head, Central Lab, Bengaluru and S V Satyanarayana, Strategic Advisor - Healthcare. In addition to Thyrocare, the Conference was also supported by Dr LalPathLabs, MedReach Events, K-Arogia Healthcare, Actify Data Labs, Benson Medical, FQI – Foundation for Quality in India, and Live Health.
40
June 2018
Panel1 Quality Management, Accreditation and related challenges in Diagnostics
Panel 2 Law & Medico Legal Issues in Diagnostics’ Management
Panel3 The Future of Diagnostics in India -Labs in 2025
Q&A
ASK THE EXPERT
Running a private medical practice in India comes with the risk of lawsuits and property damage. As a medical professional, you are probably well aware of the devastating effects of legal cases and security threats that await doctors who face the blunt of an angry patient. We encourage you to share your queries and concerns regarding legalities of practicing medicine in India to learn more about legal framework, legal cases and the experience of fellow doctors
Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com
Q: Do doctors charge a lot in India, is it cor-
vate hospital, if I resign from the hospital.
rect?
Dr TanuSatija Ans: You can only be relieved of your duties in case of resignation when You discharge your patients and they leave hospital. Care of your patient is transferred to other doctor who takes over before your relieving order is signed. Only after you get relieving order, your medicolegal liability stands finished but you still remain liable for earlier care provided by you
Ans: The following is fee structure of doctors of allopathy in India In tier 3 cities - Rs 100 per consultation including medicines In tier 2 cities- Rs 300 per consultation that may include medicines in some cases In tier 1 cities – Rs 400 per consultation In metropolitan cities- MBBS doctor charge Rs 500 per consultation Specialist charges - Rs 1200-2000 per consultation Maximum charge - Rs 3500-3500 per visit I have yet to come across any doctor who charges Rs 10,000 per consultation.While I know a lot of High court / Supreme Court lawyers who charge Rs 10000 / per consultation. Do we doctors charge a lot? Average doctor earns more than average lawyer but a good lawyer earns 10 times more than a good doctor.
Q: I am running a small nursing home as a single proprietor of the nursing home.I am having Professional Insurance for myself .I am an Orthopedic Surgeon with M.S. ortho. Now my son also an orthopedic surgeonhas joined me in my practice and is being given a salary for his services.Now do I get him an insurance in individual capacity or get my nursing home insured.If I get the nursing
Q:
What is my medico-legal liability for
patients admitted under my care in a pri-
home insured do I need to get myself insured separately?
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Ans: You should take insurance for your nursing home too. Your insurance is not applicable for claims against nursing home. Recommended is atleast 1-2 crores.You should ask your son also to take separate insurance as he may work in other places too but if he is working on salary basis in your nursing home, he need not take separate insurance as he would be covered in nursing home insurance. Q:
Is it essential to keep record of OPD
prescriptions?
Should
we
give
new
prescription everytime when patient comes
state to another state with NOC from the previous sate and now practicing in a the new state ,can the medical council of the previous state call me up for PE committee on any incident involving me many years back during my stay in the previous state ? Does it fall under their jurisdiction to ask a doctor to come and face quarries?
Ans: Yes , previous medical council can call you on any incident when you were working in that state.Please remember that there is no time limit fixed for filing complaint against doctors in medical council.
for follow up?
Ans: It is not essential legally to keep record of OPD prescriptions , there is no need also to issue new prescription when patient comes for follow up. You can write on same prescription paper again.But it is always better to keep records . It can be easily done if you issue it from computer. Doctors should be tech friendly now. Q:
If I have changed my state medical
council number of all my degrees from one
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June 2018
Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.