Thursday, January 31, 2013
Questions and answers
Things have been crazy. It's much, much more difficult to build a new practice than I expected. I opened up sign-up for my patients, getting less of a response than expected. This, along with some questions from prospective patients has made it clear that there is still confusion on the part of potential patients. So here is a Q and A I sent as a newsletter (and will use when marketing the practice).
About My New Practice
Q: When will it open?
A. My office will open in January, 2013, but the exact date is still not set. I had initially hoped to be already seeing patients, but things always are harder than they seem.
Q: How much will it cost?
A. I will charge only a monthly payment which depends on the age of the patient:
$40/month for children under 3
$30/month for people ages 3 to 29
$40/month for people ages 30-49
$50/month for people ages 50-64
$60/month for people 65 and up.
There is a $50 charge for the first month for people under 40, $100 for those 40 and up.
There is a $150/month family maximum ($200 maximum for 1st month).
Q: Are there other charges?
A. As of now, there are none. All office visits and any procedures done in the office are covered by the monthly fee.
Q: How can I afford to do this?
A. I have greatly decreased my overhead by not accepting insurance and keeping my charges simple. My goal is to have 1,000 patients paying the monthly fee, which will limit the number of staff I need to hire.
Q: What will patients get for the monthly fee?
A. In addition to office visits, patients will get:
--direct access to me via phone,
--access to me through secure messaging,
--a personal health record, a health summary customized for each patient giving detailed information to help with care outside of my office,
--a personal care plan summarizing scheduled care done, due now, and due in the future,
--regular review of the personal health record and care plan to assure it is up to date,
--enhanced coordination of care with specialists, hospital physicians, and
--a health library of information for patients to answer questions when they come up.
Q: Why did I do this?
A. I get to be a doctor again (perhaps for the first time). I got tired of giving patients care that wasn't as good as it could be. I got tired of working for a system that pays more for bad care than for good. I got tired of forcing patients to come in for care I could've given over the phone. I got tired of giving time that should be for my patients to following arduous regulations. I got tired of medical records not meant for actual patient care, but instead for compliance with ridiculous government rules. Making this change gives me the one thing our system doesn't want to pay for: time devoted for the good of my patients.
Q: What makes this better for patients?
A. The main advantage is that I am finally able to give them the care they deserve: care that is not hurried, not distracted by the ridiculous complexity of the health care system, and not driven by the need to see people in person to give care. This means:
--I don't ever have to "force" people to come to the office to answer questions. This means that I will let people stay at home (or work) for most of the care for which I would have required an office visit in the past.
--I will be able to give time people deserve to really handle their problems.
--I won't have to stay busy to pay the bills, so I can take care of problems when they happen (or when they are still small), rather than having to make people wait to get answers.
--Patients won't get the run-around. They will get answers.
--I won't wait for patients to contact me to give them care. I will regularly review their records to make sure care is up to date.
--I will help my patients get good care from the rest of the system. Avoiding hospitalizations, emergency room visits, unnecessary tests, and unnecessary drugs takes time; I will have the time to do this for my patients. This should more than make up for my monthly fee.
Q: What's the advantage of patients having their records?
A. Health care is disjointed, with little communication occurring between different locations of care. Care is often done blindly, not knowing the overall picture of the patient's care done elsewhere. This means patients repeatedly answer questions about their care, care they often don't understand or remember.
My patients will have an accurate summary of their care which they can print out or bring up on their computer, phone, or tablet when information is needed. I will work with them to keep this summary up to date and as useful as possible. While others may be afraid of the consequence of patients seeing their records, I am far more afraid of the uninformed care they get when those records are not available.
Q: Will this mean patients will need to come in more often to "get their money's worth?"
A. There certainly is a risk of this happening, but my intent is to empower my patients, not coddle them. The ideal for every patient is that they spend as little time dealing with doctors and hospitals as possible. My goal will be to use my time to give my patients tools to make good decisions and stay healthy.
My old business (and the rest of the health care system) depended on people being sick or uninformed to pay the bills, but my new system has no such motivation. I can finally have the same goal as my patients: their health. I think this will ultimately save them a lot of money, and (most importantly) keep them healthy, informed, and away from doctors.
Q: What are my future plans?
A. If the business is successful, my hope is to add staff to offer more services. I hope to hire a dietician to educate my patients about their diets. I hope to hire a social worker to deal with the non-medical burden many of my patients carry. I hope to hire nurses to visit complicated patients to make sure they are taking medications properly, or to deal with small problems before they become big ones. I hope to hire a counselor to improve the emotional welfare of my patients. This will enable me to grow the size of the practice without becoming overly busy.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
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Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
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Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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