I am pleased to post the following commentary from Dr. Steven Knope, an internal medicine specialist and concierge physician located in Tucson, AZ.  I had the pleasure of befriending Dr. Knope a few years ago, and since that time have enjoyed thoroughly Dr. Knope’s perspective on medicine, and vision for the future of healthcare.  Dr. Knope’s book, Concierge Medicine: A New System To Get The Best Healthcare, is an excellent read and an important lens through which our country’s current struggles with delivering the best healthcare can (and should) be viewed.

A true healthcare entrepreneur, it’s my privilege to post the following commentary from Dr. Knope titled, “Is Traditional Internal Medicine Dead?”
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Is Traditional Internal Medicine Dead?
by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system. Paraphrasing a recent story published in The New York Times, an internist in Massachusetts who practices under the new RomneyCare program said this: “Every time I see a Medicare patient, it is the equivalent of giving them a ten-dollar bill. I have a six month wait to see a new patient. I run from room-to-room. I can barely make my overhead. I’ve never felt so disrespected in my entire life.”

So is this all just whining and political hyperbole or is internal medicine really dying? The answer to this question was revealed to me by a colleague last weekend while I was at the hospital. I had been called to the ER for one of my patients who was hemorrhaging on the blood thinner, Coumadin. The ER doctor looked at me and said, “You are a dying breed.” I laughed and said, “Yes, I know…but why do you say this?” He responded, “See that list of 9 doctors’ names and phone numbers up there on the wall? You are one of the last of 9 doctors who still admits his own patients to this hospital when they get sick. All of the other internists and family practitioners have abandoned hospital medicine and limit their practice to the office.” I knew that this was a profound statement and it shocked me; but I did not fully digest its implications until I had stabilized my patient and started my drive home.

The hospital where I practice has over 700 doctors on staff. The fact that only 9 of us still take care of our own patients when they are hospitalized answered the question about internal medicine’s future. It is no longer an issue of whether traditional internal medicine can survive; the facts are – at least outside of the concierge model – internal medicine is already dead.

What are the consequences for patients? What happens to the average person in Tucson, Arizona when he or she gets chest pain, develops pneumonia or has a seizure? Can they reach their internist or family practitioner for a medical emergency? Most patients who call their primary care doctor for a medical emergency can’t even reach his staff during normal office hours. Instead, they will hear a recording on an answering machine, directing them to go to “call 911” for any medical emergency.

Once in the ER, the “doctorless” patient will be admitted to a hospital physician, who is unknown to them. This so-called “hospitalist”, who is a salaried shift-worker, will put in his 12 hours, and then go home. He is a doctor who knows nothing about the patient’s medical history. He has never met the patient. There will be no call from the hospital doctor to the primary care doctor in the office to get a thorough medical history. There will be no medical records transferred to the hospitalist. The hospitalist will attempt to get the best medical history he can from the patient, make some quick medical decisions, and then pass the patient off to one of his colleagues when his shift ends. And so it goes. No continuity of care, no understanding of the patient; the sick person now becomes a “case of pneumonia” or “the stroke in bed 3” to a group of unknown, rotating professionals.

As fewer and fewer young doctors go into internal medicine and family practice, and thousands of primary care doctors retire early due to financial pressures, the primary care shortage will only worsen. Not only will there be no primary internists to take care of their own patients in the hospital, there will be fewer internists available to see patients in the office setting. This inevitable vacuum of internists and family practitioners (traditional diagnosticians) will be filled by nurse practitioners and medical assistants; people with far less training and expertise than an M.D.. If you are fortunate enough to have a good nurse practitioner, you will eventually be referred to an appropriate specialist, who will treat one of your medical problems. If you are not so lucky, a nurse or medical assistant may miss an uncommon or rare diagnosis; he or she may misdiagnose the “headache” that is actually an aneurysm, the “flu symptoms” that turn out to be meningitis, or the “gallbladder problem” that turns out to be a heart attack. Bad things will inevitably happen when doctors are replaced by medical assistants. It is simply a matter of statistics. All doctors make mistakes, but those with less training make more.

As a concierge physician, people often ask me how this move toward a government-run healthcare system will affect me professionally. Speaking honestly, I tell them that it will help my practice, but I do not think this is good news for the country. As an independent concierge doctor, I am not subject to the rules or fees set by Medicare or Medicaid, nor do I deal with third-party insurance carriers or HMOs. I work for my patients, not a third-party with a conflicting financial agenda. As someone who practices full-service internal medicine, the demand for my services will continue to increase. However, this outlook about my own practice does not make me happy. I have small children. I am concerned about their future. I am concerned about what the changes in primary care will do the future of American medicine; what will happen if the art of internal medicine is completely lost. I am worried about what it will mean to the efficiency of medicine as a whole, to have no diagnosticians and clinicians to treat the majority of problems that do not need a specialist.

I have found a unique niche in medicine, which allows me to truly practice what I was trained to do. For most of my colleagues, however, this is no longer the case. They too were trained to care for patients from the office, to the hospital, to the ICU. Now, they no can longer afford to take care for their patients when they develop life-threatening illnesses. They are now “clinic doctors.” Their hospital skills have atrophied. They will never practice comprehensive medicine again. For them, the game is already over. For them, internal medicine is already dead. For their patients, and the society as a whole, this is a great loss.

Among features included in the improved website are Medicare benefits summaries, coverage options, rights and protections, and answers to many of Medicare’s FAQ’s.

Take a look at the new Medicare website here.  I actually kind of like it.

http://bit.ly/dwZqg1

via Vantage Forums: iPhone App Improves Patient Satsfaction.

As we quickly approach the end of October, today marks just 70 days until calendar year medical benefits will reset for many of your patients.  Renewed deductibles, expiration of existing insurance plans, and the zeroing of health savings accounts will — in very short order — mean more money out-of-pocket for your patients.  As you’re aware, this has a tendency to accompany the delay of non-urgent care, resulting in decreased volumes and revenues for healthcare practices shortly after the first of the year.

This cyclical nature of medical benefits should come as no surprise, as it is something we see year in and year out.  The fact that there is something that can be done about it now is something that many practices neglect to realize however, leaving opportunity out on the doorstep even in light of this predictable, annual occurrence.

So, what do you do about it?  The answer is simple – remind your patients.  This is a busy time of year, and while patients also realize that their medical benefits will be resetting in just a few short months, day-to-day life often trumps important details like this that can result in the savings of hundreds, if not thousands of dollars in out-of-pocket healthcare expenses.

A simple form letter sent out by mail merge, a mass email distribution, individual phone calls, or in-office reminders can all be acceptable ways to remind your patients that if they anticipate the need for medical, physical therapy, or dental services in the next few months – now is the time to act.

A gentle reminder to your patients may go a long way toward saving them money, ensuring their health, and making them appreciate that you’re looking out for them in more ways than one.  If you’d like some ideas on how to communicate this important message to your patients, along with examples of sample letters, don’t hesitate to contact us for more information.

H1N1, or “Swine Flu” is on just about every television channel and every news broadcast, so your patients are really thinking about germs right now.  Anytime you have everyone focused in the same direction on a topic like this, it becomes much easier to be relevant and current with your clientele by responding responsibly.  Your patients will likely appreciate your thoughtfulness in offering the simple option of keeping their hands clean as they are in your presence, and you might just kill a germ or two.

Oh, and racking your brain over your next promotional giveaway at an upcoming event?  You guessed it – give people something they will actually use – small, travel hand sanitizers with your logo proudly displayed on the bottle.

A blog can be a powerful way to get a hospital’s message out to the public, says Mark Whitman, vice president of digital marketing at Ohio-based brand consulting firm Northlich. “A big advantage of blogs is that information can be shared quickly among all stakeholders,” he says. “Quick response and sharing of information can help stop misinformation and rumors that can be very damaging during times of crisis.”

via Hospital Blogs Can Help During Times of Controversy | www.healthleadersmedia.com

A patient enters the waiting room and is greeted warmly by her personal navigator, who hands her a tablet-sized computer preloaded with her personal demographic information and health records. She answers a series of questions and the computer compiles a list of possible diagnoses for her physician.

In his office, the physician is reading an e-mail from a patient who has forwarded an interesting study about his particular medical condition. The physician forwards the study to the rest of the patient’s care team, including the patient’s acupuncturist.

In the exam room, a specialist and patient sit together in front of a computer—the physician is showing the patient which sites have the most reliable medical information that she can use to learn more about her recent diagnosis. Next door, a physician is talking to a patient who has unusual symptoms; the doctor consults her PDA, which is loaded with a decision-support application.

Down the hall, an employee e-mails to a prospective patient a detailed, itemized list comparing the costs of hip replacement surgery at a number of area hospitals.

And, by the way, everyone in the waiting room is fit and trim. Nobody smokes anymore. People with diabetes check their blood sugar regularly. Everyone shows up for their colonoscopy appointments. People are knowledgeable about their health, empowered to participate as partners in their care, and engaged enough to comply with their physicians’ directives.

Patients are searching for doctors, medical practices and hospitals via search engines, like Google, so whether or not you’re found on the first page can make a significant impact on the number of patients you see.

Furthermore, it’s in your best interest to have some control on how your name or practice comes up on search queries. Because if you don’t, it’s likely that negative news items or other unsavory information will be associated with your name instead.

There are many good sources to learn SEO to apply to your practice’s web site, however, we believe that it is worth the money and time to have an SEO specialist work their magic for you.  SEO has gotten more complex and more competitive over the last several years.  Let someone else handle this complexity so that you can focus on patient care and running your business!

Taken literally, I suppose a signature really is no big deal. I mean, signatures can be forged, they can be easily reproduced into various forms of media, and everyone has one – so it really isn’t in their rarity that their value is created. It’s who and what a signature represents that is important, and why the meaning behind signatures has such deep implications for our personal and professional lives.

In health care, the “what” and the “who” behind the care that is delivered are tremendously personal, extremely important, and are rarely taken lightly by either the provider or the recipient of the services – and it’s the reason that I believe the signature goes far beyond pen and paper in our world.

My entry into the health care industry was as an athletic trainer. Most people who follow sports to any extent know that athletic trainers provide a number of first aid, rehabilitation, and injury prevention services to athletes in a variety of sports and settings. Most notable of the athletic trainer however, is one role that few other professions master in quite the same way – the taping of an ankle.

Every single athletic trainer on the face of this planet can tape an ankle. The reason is simply that it is one of the hallmarks – or “signatures” of the athletic trainer regardless of who you are or where you practice. Athletes that have spent any time at all in sports are able to identify good athletic trainers from bad, and their first glimpse into the trust and respect that they can hold for the athletic trainer comes with the application of the first strip of adhesive placed on the ankle.

When I was training to become an athletic trainer, my mentor told me very bluntly, “Your tape job is your signature. Everything from the time it takes you to complete the tape job, to the tension that you apply to the tape, to each and every wrinkle that exists when you are done, will be the ‘sign’ of your work. And this is what will bring athletes back to see you, or make them look for someone else.”

This really stuck with me, as I immediately recognized that taping an ankle was actually quite a bit more than a repetitive act that I would be performing dozens of times per day. It was a distinct trademark that I was stamping on each athlete that I encountered, and was a representation of my quality of work, my training, and my expertise. It was, in essence, me in a nutshell – my signature.

And this is just one example. In health care, I believe we can dissect each and every one of our daily tasks into a number of “signature” products and services that we are known for. It could be the grip of our handshake, or the way our receptionist answers the phone that makes our patients feel warmly received into our care. On the flip side, it could be that we always take more than a day to respond to a phone inquiry, or the fact that we forget to tell our patients how much we care about them that causes them to wonder if they are our priority.

In health care, signatures exist far more commonly than the mere scribble that may be found at the end of a SOAP note or insurance contract. Our signatures are everywhere, and they carry great meaning to those that evaluate these symbols as representations of who we are and what value we provide.

In an increasingly competitive market, the representation of our value is of paramount importance – much more so I would argue, than the fear I once had of leaving an athlete dissatisfied with the way I taped their ankle. The implications of our signatures have powerful qualitative and economic ramifications, and we are wise to understand those elements that create the signatures that represent our work each and every day.

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website by clicking here.

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Bridget Morehouse PT, MBA is a consultant with Steffes and Associates, a rehabilitation consulting firm based in Wisconsin.