Comments on: Fatal Error

By: Don

Don — Tue, 26 Aug 2014 03:39:11 +0000

Tasks include performing housekeeping work as well as assisting the patient in personal grooming and hygiene.
You probably didn’t know, but the American Red Cross has provided nursing assistant training classes for more than two decades.
You can check with the licensing authority of the respective state for the CNA certification renewal steps.

By: Chandresh Shah

Chandresh Shah — Wed, 09 Apr 2014 23:30:08 +0000

Didn’t you know of the ICD code H101? The ‘healthier’ the person (not patient), the higher the reimbursement?

By: hospitalist

hospitalist — Wed, 09 Apr 2014 13:08:24 +0000

I take care of hospitals for a living. I do not take care of patients any more, just the edicts from the hospital designed to take care of the hospital, paying lip service to the health of the patients.

The EHR costs…HUGE. No one want to admit the 4 millions being wasted on these meaningfully useless ordering and decision systems. OK, it is good to have lab data and imaging immediately available, when it works and does not misidentify the patients’ data.

Medical care has been invaded by HIT vendors and their consultants, who have co-opted hospitals with their touchy feely lines about capturing all charges and making care safer. NOT.

No soap box. Just the truth.

By: Trudy

Trudy — Tue, 08 Apr 2014 17:04:12 +0000

I have said for years that health “insurance” is a misnomer. I have auto insurance in case there is an accident. It does not cover routine maintenance, new tires, or a color change. I have homeowners insurance in case of some catastrope there but it does not cover new windows, a new roof or even reconfiguration of the layout should I medically/physically require it. I can even purchase travel insurance that would reimburse me for loss of expenses under certain circumstances. So what really is the purpose of “health insurance”? It really is illness cost reimbursement based on actuarials. Insurance is something you buy and hope you do not need. Not true for health care. And speaking of health care, is that really what we do? I guess it gets into the definition of health.

By: Perry

Perry — Tue, 08 Apr 2014 13:43:03 +0000

Dr. Rob,
At first you had me thinking something was wrong with MY computer!

It’s unfortunate that many will likely associate what you are doing with “concierge” or “boutique” medicine, when in reality this is even better than the old concept of seeing the doctor when you are sick and paying, to paying to stay healthy. This is what I would call real patient-centered care. The patient can see you and discuss problems and health issues that are pertinent to their own situation.
Government or third-party paid care demands quality measures that may or may not apply to every patient. For instance, my brothers-in-law recently saw a physician for a physical. He did a thorough history and physical, and then proceeded to discuss safety and health issues on everything from skating safety to gun safety. While I give him credit for being thorough, these guys neither skate nor have guns. When you rely on institutions for payment of medical care, there is a tendency to put everyone in a one-size
fits-all category.
Additionally with this type of practice, you can tailor discussions for testing and diagnostics to practical usage depending on risk factors, family history, etc.
I agree with Dr. Mike though, our current system has been based on third-party payors which dictate how we can practice medicine. Unless this type of model is somehow embraced and explored by the public and the politicians, we will continue this downward spiral with health care costs.

By: Rob

Rob — Tue, 08 Apr 2014 12:17:58 +0000

You are right. This is why I went to a direct care practice and no longer use a third party. I think true reform has to happen from the outside. When I am being paid by the patient I work for them. Their goals become mine.

By: Dr. Mike

Dr. Mike — Tue, 08 Apr 2014 03:56:18 +0000

I suspect that your patient’s reason for seeing you and your reason for having patients are not entirely the same. They pay your fees and become a “member” of your practice because they want you in case they get sick. They want you to guide them when they need tests, to reassure them when they have symptoms, to look for problems (i.e. sickness) so they can be nipped in the bud. They look to you to bring them back into health when they stray from health – i.e. when they are or might be sick. Although legally you would never want the term used, they look to you as insurance. If they had no perception of risk, I suspect your practice would dwindle. Why do you think insurers in almost all categories have to offer incentives to get the insured to change high risk behavior – the insured don’t naturally want to change, but they sure want the payments when they suffer a loss.
What you didn’t say directly (but I suspect you would agree with this) is that you can at least to some degree succeed in getting patients to focus more on health instead of sickness because there is no third party. That is key to a far greater degree than most are willing to see, much less admit. You can treat the blood pressure/diabetes/etc via email as long as they are compliant. Non-compliance equals office visits and more intensive work on your part which in extreme cases could lead to termination of membership. Carrot and stick. This only really works when there are two parties – patient paying you or insurance hiring you. Where there are three parties, then, for example, who’s to say whether one, two or three email visits are necessary between office visits? Or none? Surely if you get paid well, three is better, and if you don’t get paid well, the office visits will be preferred. One will always be pitted against the other when there are three. I know some will disagree and point to such and such examples, but in the real world away from the carefully controlled academic centers or grant funded experiments it is different.
So focusing on health is great and all, but I don’t see meaningful shift in this direction within the third party system. As a final example, who do you think uses their computer more meaningfully – a physician in a direct pay practice such as yours or a physician locked into third party payment? It’s no contest – the direct pay physician requires much less from his computer because the entire practice model accomplishes far more than the artificial measures in the third party model’s EHR that have to be implemented just to make it close.