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.

Click here to visit the article (excerpt below).

As an advocate of entrepreneurship, Quatre said that doctors should not lose hope on keeping their private practices afloat.

“When the owner of a practice has a vested interest in seeing the practice succeed, that’s an equation where incentives are alive in a way that has a real natural benefit to the community,” Quatre said.

There is still a place for more entrepreneurial practice owners in health care, he said.

“It’s not time to throw in the towel.”

Via: Physicians move out of private practice | Carolina Journalism Network.

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.

A culmination of the decade-plus vision of the project by its founder, Lou Castriota, Jr., the planning for the facility that will serve the rehabilitation requirements of more than 1,000 special needs children has been in the woks since 1997.  Funding has included $2.7 million raised by Castriota’s family, friends, and project supporters (including a state grant), and a $5.6 million loan.  A capital campaign is currently being considered in order to raise the additional funds necessary to secure the $10.4 million required to complete the project.

If you’d like to learn more about the project, or how you can help, visit Leg Up Farm online at www.LegUpFarm.org, or this article in the March 30th online edition of York Today.

I love to brag about our entrepreneurial clients, and PEG’s Group certainly is one of them.  PEG’s Group was founded by Kathy Gurland, and consists of an independent group of Cancer Navigation Consultants™, who provide personal education, guidance, and support for individuals affected by cancer in the New York City area.  PEG’s Group is a unique source of personalized support and guidance for persons and family members afflicted by a cancer diagnosis, and a group to whom you can turn to assist with the location of resources and options to make your encounter with cancer as successful as possible.

via Vantage Forums > Market Analysis 101 > Comparing Zip Code Data.

An article in the New York Times today titled, “More Doctors Giving Up Private Practices,” told the story of an increasing number of physicians who are finding their “bliss” through employed, salaried positions, rather than at the helm of their own private practice.  The reason – increased costs, decreased pay, and ultimately unhappier doctors in the private practice environment.  Again, I don’t buy it.

The article spoke of the increasing financial burden on physicians who, in order to keep up with the demands of today’s healthcare arena, must invest heavily into expensive electronic medical record systems (EMR) and practice management softare (PMS), along with the staff required to collect payment from a growing number of patients who lack the financial wherewithal to pay their bills.  Sure, the challenges are real, but it’s still bullhonkey.

The silver lining in this shift toward larger, safer, and inevitably more monopolized healthcare practice – if there is one – the article goes on to say, is the continuum of care that is far facilitated by larger, more integrated systems which employ large numbers of physicians from a variety of specialties.  Not convinced.

The Medical Group Management Association (MGMA) reports - according to the article - that in 2005 more than 67% of medical practices were physician owned, however three short years later this number had dropped to below 50%.  With admitedly disturbing facts such as this, and the industry knowledge that is near and dear to my heart – that private practice owners are, in fact, struggling in pockets across the country – how could I possibly scoff at the fact that an article in the New York Times suggests that quite possibly it is time to throw in the towel by the physician masses?

Because it’s short sighted, cowardly, and undermines the creative and entrepreneurial fabric from which many of our country’s greatest practices are woven.

In a nutshell, it’s the wrong way to go.

I’ve been around healthcare my entire life, and my professional career has known nothing else.  I care deeply about people, and understand that passion, freedom, autonomy, and creativity are the inspiration behind the greatest care that our country can offer.  I also understand that in order to attain autonomy, passion, freedom, and creativity requires risk, hard work, and often times, failure.

I’ve worked salaried positions and have spent much of my life in a risk averse bubble, looking fondly at the status quo and fearing anything that risked upsetting it.

But I’ve also lived the other side.  The side that guarantees nothing, but promises everything.  The side that allows me to be exactly who I’ve been created to be, and to relish in failure as it is a means by which I will improve my service to others.  It is this side about which I am passionate, and about which I know I can change my life, the lives of others, and through my current mission with Vantage Clinical Solutions, change healthcare.

I don’t think the healthcare industry is going to benefit from bigger companies who can promise the world to its salaried professionals, while placing handcuffs on the passion and creativity that comes only with the ability to chart one’s own professional course.  I don’t think the continuity of care is going to suffer if small town doctors have to refer to one another rather than down the hall in order to provide the specialty care that is needed of their patients.  And I don’t think that failure is inevitable to those who try to make it work.

There are challenges, yes.  We, at Vantage Clinical Solutions help private practice owners deal with them everyday.  We feel the pressures of the economy just like the next guy.  The difference is that we see the challenges as an opportunity to look to entrepreneurship, creativity, and innovation as the tool from which our problems will be fixed.

We understand that the “corporate” way which benefits from huge economies of scale and infrastructural efficiencies does indeed have merit – but more importantly we know that it is not the only answer.  We work with numerous private practice owners every day who are delivering healthcare their way, doing it profitably, and changing their patients’ lives in the process.

At the risk of belaboring my diatribe of a post, I do want to make clear that I understand that entrepreneurship indeed is not for everyone, and the thousands upon thousands of professional, caring, and excellent healthcare providers who do thrive in the corporate, structured environment, need not change a thing.  Indeed, consolidation and centralization is a viable solution to many of the challenges we face in the healthcare industry.

My point, however, is to suggest that it is not the only solution, and to those who’s fuel does come from a burning passion to create, be different, and deliver care in their own way – bear down and get after it.

The system that the NY Times article speaks of is not for you.

The goal of the SOL Santa Cruz website was to expand the SOL Santa Cruz online footprint by appealing to a diverse market consisting of the active, athletic, and injured within Santa Cruz county.  Attention was placed on emphasizing the strength of the SOL Santa Cruz brand, while allowing visitors to the site to have an interactive and intuitive online experience.

The SOL Santa Cruz online presence was not limited to the SOL Santa Cruz website however, and was carefully crafted elsewhere in the online world.  This was achieved by creating a branded presence within relevant social media platforms such as Facebook, Twitter, a themed Wordpress blog, and through the integration with online directories such as Google, Yahoo, Yelp, and more.  “The intent of the project was to focus on creating an online community for SOL Santa Cruz, rather than simply a website,” said Tannus Quatre PT, MBA, and lead of the project.  “We were very pleased with the extent to which we were able to help SOL Santa Cruz achieve their goals of conveying the diversity of services that makes their practice so successful in the Santa Cruz market.”

Tammara Moore, DPT, and co-owner of SOL Santa Cruz, stated, “Vantage has produced for SOL Santa Cruz a comprehensive and current website for our practice which has exceeded our expectations in every way.  Vantage knows private practice healthcare, worked hard to understand our specific needs, and ultimately helped us navigate this technical yet extremely important part of our business in a way that made sense both intuitively and financially.”

Located in Bend, Oregon and Denver, Colorado, Vantage Clinical Solutions has partnered with Smart Solutions (web development and search engine optimization) and Pixelsilk (content management system) to provide a powerful product specific to the needs of healthcare practices such as those within the physical therapy, medical, chiropractic, dentistry, and optometry domains. “The [healthcare] industry knowledge of Vantage Clinical Solutions combined with technical expertise and strategy of our developers and SEO team helped create the product that is truly great, and truly unique to the healthcare market,” said Wendy Roe, sales and marketing executive at Smart Solutions.

Vantage Clinical Solutions is going on it’s 4th year of healthcare management and marketing consulting within the healthcare industry, and is proud to provide solutions to companies such as SOL Santa Cruz through their entire suite of online services known as Vantage eSolutions.  If you’d like to learn more about Vantage Clinical Solutions, Vantage eSolutions, SOL Santa Cruz, Smart Solutions, or Pixelsilk, please visit the links below.

SOL Santa Cruz website
SOL Santa Cruz on Twitter
SOL Santa Cruz on Facebook
Vantage Clinical Solutions home
Vantage eSolutions (website management, social media, online listings, search advertising, and email marketing)
Smart Solutions (web development partner)
Pixelsilk (content management partner)

Q: On the financial production assumptions, my productivity is showing 236%. What does this mean?

A: Productivity is defined in this model as billed hours divided by total hours worked. If a PT bills out 4 hours in a day and worked 8, they would have a productivity of 50% for that day (4/8 = 50%). A clarification of this model is that productivity is not an “assumption,” it is a “metric.” In other words, productivity is calculated by the model (an output) and is not assumed prior to running the model (an input).

For a productivity of 236%, this means that your particular model is billing out 236% of the hours worked by your staff. This is not possible under a traditional 1:1 care model give current regulations surrounding 3rd party reimbursement. Again, the productivity is an output, so other inputs must be altered in order to achieve a productivity in an acceptable range (less than 100%). The most obvious input to adjust will be that of FTE’s, increasing to a number that places your productivity at appropriate levels. Remember though, that increasing FTE’s will also increase staff expenses, therefore decreasing profitability. And herein lies the iterative beauty of financial modeling!!

via Vantage Forums: Productivity Question.

Email marketing is a fantastic way to stay in front of your clients, and in a way that is helpful, inexpensive,…and not annoying. To find the fine line between helpful and annoying however, requires relevant content in bite-sized chunks, and at a frequency that is palatable.

So how often should you be sending email to your patients/clients? As with most things, there is no single answer, but the article below from Small Business Branding does a nice job of outlining the process for determining a frequency that works for you…and most importantly, your patients and clients.

http://bit.ly/9ZGmr7

via Vantage Forums: Email Marketing Frequency.