I am Dr. Rob and this is my blog. It could be called “The blog previously known as ‘More Musings (of a distractible kind)”, but that would get me sued by Prince. I want to avoid that.
http://distractible.org/ - Dec 20, 2012 10:26:46 AM - Dec 5, 2004 9:22:04 AM
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 PracticeQ. 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 1000 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.
- 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 patientsabout 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.
Big stuff has been happening over the past few days: I agreed to the construction plan and will begin on the renovation of the office as soon as possible. My initial thought was that I’d be open for business in December, but that’s not seeming very likely now. I am screaming on the inside, but [...]
Thoughts of an odd, but not harmful primary care physician.
I should be encouraged. I was asked to talk on public radio last week about my new practice, then I was on a panel of “experts” in Washington DC on Monday. Everywhere I talk about what I am doing I get positive reactions. I get very positive reactions, actually. I was approached by someone wanting to work with me “when I get my practice running” to help roll it out to other physicians.
But these words don’t seem to encourage me at all; in fact, they seem to have the opposite effect. The reason? I am building a practice, not a practice model. I am going to work with people, not ideas. This is reality, not theory. Real patients are going to put their real lives in my care. The closer I get to practicing once again, the more time I must spend out of the world of “good ideas” and in that of hard work.
And what I am doing is a lot harder than I thought. There are so many loose ends that must be addressed before I can even see my first patient, that it feels like I am juggling Jell-o. I have a physical office that is being renovated, an EMR system to learn, patients to sign up, staff to hire, bills to pay, licenses to get, regulations to obey, care plans to make, details, details, details.
Even with all of that work done, I have to hope I haven’t missed anything. I have to hope the people I hire are right for the job. I have to hope I haven’t left out important details, or missed any deadlines. I have to hope I can make disparate computer systems work together to accomplish my goals. I have to hope enough patients sign up to pay the bills. I have to hope I stay healthy, that I have no major family crisis, or that I don’t make bad choices in my personal life.
The attention I’ve gotten through my writing, my radio appearance, and my speaking appearances have actually made this harder. It’s the difference between being an underdog and an overwhelming favorite. It’s the difference between being the #1 choice in the draft and a late-round choice. When expectations are for overwhelming success, even partial success is a disappointment. Peyton Manning and Ryan Leaf both had high expectations, but only Manning could translate that into success. The next few months will determine if I am a Manning or a Leaf.
This reality underlines another thing: the weakness of words. When the medium for my craft is writing or speaking, the measure of my success is my persuasiveness. The NPR segment held me up as a doctor who is dealing with our system in a radical way. The “experts” who were on the show to give their opinions about the Affordable Care Act (“Obamacare”) viewed my practice with skepticism. Some of my family wondered if I was frustrated at my inability to respond to their dismissiveness toward what I am doing. It was actually what I expected. I see it all the time, as my writing is posted on my blog and the others that republish what I say. I get agreement and praise when I state my case well, but get arguments or dismissiveness when I don’t. The weapons in this battle are words, and the one with the best words wins. But I have something that others don’t have: the chance to prove myself right. The best argument against “it won’t work” is not “oh yes it will,” it is “look: it works.” Success silences critics. There aren’t any people who doubt Peyton Manning can be a success in the NFL.
I guess the moral of the story is this: be careful what you say. It’s far easier to say than to do. Being good with words and convincing in arguments can lead to praise and even fame, but it also increases pressure. I can win the war of words, but that victory does nothing to help my patients. All my patients care about is if I can make it work. And that takes for more work than words.
Big stuff has been happening over the past few days:
- I agreed to the construction plan and will begin on the renovation of the office as soon as possible. My initial thought was that I’d be open for business in December, but that’s not seeming very likely now. I am screaming on the inside, but am trying to meditate those screams away since there’s nothing I could’ve done differently. Thanksgiving and Christmas also get in the way of getting things done quickly, so I’ve just got to accept what is.
- I’ve made a brochure which will mail out next week to former patients and which I will hand out with evangelical zeal.
- I’ve started the process of interviewing people to work with me.
- I changed the name of this blog from “More Musings” to the old name of “Musings of a Distractible Mind.” I have imported the old posts to this blog and will begin the process of redirecting traffic from “distractible.org” over to this blog. More changes will soon follow.
- I’ve filled out a bunch of paperwork to do such amazing things as dropping out of Medicare, getting contracts with labs, and being able to run labs in my office.
- I was contacted by the producer of the NPR radio show/podcast Science Friday about possibly being on a show about the future of health care. While I am not sure how scientific my part will be, it’s a show I’ve listened to a lot and should be fun to be on. It’s a live show, so the pressure will be on me to not screw up too badly. Perhaps you could make a drinking game based on how many times I say “you know” (which I realized I do a lot after listening to my last live appearance on a show). I will be on the show between 2 and 2:30, and it probably won’t be all that long. Go here if you need to figure out how to listen (live or recorded). Ira Flatow is the host, which means I am one of the few people who’s been interviewed by the holy pair of public radio Iras (having spoken with Ira Glass on This American Life a couple of years ago). Do I get some of award for that? Perhaps they’ll put money in my IRA.
- Am making final preparations for my trip to Washington DC to speak at the mHIMSS mobile health summit on Monday.
- I’ve gotten dirty looks from my wife who is afraid I am getting a big head.
- My hats don’t fit me any more, but I think that’s just a coincidence.
- I wonder if Ira Flatow had a penguin named “Bucky.”My New Practice4
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