A Pathfinder in Wireless Healthcare Says Reimbursement, Not Innovation, is the Critical Factor for Startups Today

Within the span of a few months, it seems as though wireless healthcare has come into focus as an emerging area of innovation and technology convergence.

That has been especially true in San Diego, where the Gary and Mary West Foundation committed $45 million at the end of March to create the West Wireless Health Institute. Yet the institute actually represents the culmination of years of work behind the scenes by representatives of Qualcomm, the San Diego wireless industry giant, Scripps Health, Johnson & Johnson, and a handful of other key players.

As the opportunities for innovation become more apparent, San Diego’s James Sweeney is gaining broader recognition as an industry exemplar. As Xconomy’s Juha-Pekka Tikka recently reported, Sweeney founded CardioNet (NASDAQ: [[ticker:BEAT]]) a decade ago to create wireless technology that helps doctors diagnose irregular heartbeats by allowing them to continuously monitor a patient over three weeks. Following CardioNet’s successful stock market debut last year—a notoriously bad year for IPOs—the company currently has a market valuation of more than $430 million.

Which certainly helps justify Sweeney’s introduction as “the first grandmaster of wireless health in the business world” when he took the stage yesterday as a keynote speaker for the Wireless-Life Sciences Convergence Summit in San Diego

Sweeeney’s key point, which he repeatedly emphasized, is that technology innovation alone is not sufficient to create a successful business in wireless healthcare. “In the world we’re moving into, more than ever, if you can’t justify the cost benefits, then you will fail,” Sweeney said. “In my view, getting the FDA’s approval is not nearly as hard as getting the CPTs and insurance reimbursement approvals.” (He’s referring to codes for Current Procedural Terminology established by the American Medical Association to facilitate billing Medicare and health providers.)

Sweeney said healthcare represents the largest industry on the planet—a $3 trillion juggernaut with an estimated $600 billion wasted every year. Eliminating even a small part of that waste can lead to an extraordinarily successful business in healthcare. But “you are not going to get paid for cool ideas,” Sweeney said. “You are not going to get paid for saving lives. You are not going to get paid for anything unless you can prove that you can save them money.”

In a wide-ranging discussion, Sweeney offered other advice to aspiring wireless healthcare entrepreneurs:

—“I encourage you to think of really big ideas,” Sweeney said. “This is the most exciting time I’ve ever seen in healthcare, and there are unlimited resources available even in this economy for the right idea.”

—India recently unveiled plans to build 5,000 hospitals throughout the country over the next 10 years. “I think that could be an easier testbed for some of these incremental changes,” in technology, Sweeney said.

—Because the recession has caused a sharp drop in philanthropy, hospitals are “almost paralyzed” when it comes to approving new capital outlays, Sweeney said. So it’s easier to propose innovative technology as a service that hospitals can pay out of their operating budget.

—The physician still is key to developing a successful business. So you have to get a leading physician who really believes the innovation you are bringing to market is something that will benefit patients.

—“Physicians want to do the right thing. They want to improve medical care for their patients. And they want to make money—and not necessarily in that order,” Sweeney said. “It’s much easier to get them to change their behavior if you can improve the care for their patient—and make them money,” and making them money includes saving them money.

—“Every venture capital firm I talk to today says, ‘We’re only involved with late-stage companies and we’re only involved in companies with positive cash flow,’ ” Sweeney said. “And I say, ‘I know three companies that meet that criteria. So what are you doing with the rest of your money?'”

Author: Bruce V. Bigelow

In Memoriam: Our dear friend Bruce V. Bigelow passed away on June 29, 2018. He was the editor of Xconomy San Diego from 2008 to 2018. Read more about his life and work here. Bruce Bigelow joined Xconomy from the business desk of the San Diego Union-Tribune. He was a member of the team of reporters who were awarded the 2006 Pulitzer Prize in National Reporting for uncovering bribes paid to San Diego Republican Rep. Randy “Duke” Cunningham in exchange for special legislation earmarks. He also shared a 2006 award for enterprise reporting from the Society of Business Editors and Writers for “In Harm’s Way,” an article about the extraordinary casualty rate among employees working in Iraq for San Diego’s Titan Corp. He has written extensively about the 2002 corporate accounting scandal at software goliath Peregrine Systems. He also was a Gerald Loeb Award finalist and National Headline Award winner for “The Toymaker,” a 14-part chronicle of a San Diego start-up company. He takes special satisfaction, though, that the series was included in the library for nonfiction narrative journalism at the Nieman Foundation for Journalism at Harvard University. Bigelow graduated from U.C. Berkeley in 1977 with a degree in English Literature and from the Columbia University Graduate School of Journalism in 1979. Before joining the Union-Tribune in 1990, he worked for the Associated Press in Los Angeles and The Kansas City Times.