NEW @ THCB PRESS: Surviving Workplace Wellness. Spring 2014. Al Lewis and Vik Khanna. e-book edition. # INNOVATION: PCORI APP Challenge

Physician business models

It has always been my assumption that my new practice will be as “digital” as possible. No, I am not going into urology, I am talking about computers. [Waiting for the chuckles to subside]

For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s and spirometry reports appear to most folks). Since this has been obvious from the early EMR days, the interfaces between medical devices and EMR systems has been a given. I never considered any other way of doing these studies, and never considered using them without a robust interface.

Imagine my surprise when I was informed that my EMR manufacturer would charge me $750 to allow it’s system to interface with a device from their list of “approved devices.” Now, they do “discount” the second interface to $500, and then take a measly $250 for each additional device I want to integrate, so I guess I shouldn’t complain. Yet I couldn’t walk away from this news without feeling like I had been gouged.

Gouging is the practice of charging extra for someone for something they have no choice but to get. I need a lab interface, and the EMR vendor (not just mine, all of the major EMR vendors do it) charges an interface fee to the lab company, despite the fact that the interface has been done thousands of times and undoubtedly has a very well-worn implementation path. This one doesn’t hurt me personally, as it is the lab company (that faceless corporate entity) that must dole out the cash to a third-party to do business with me.

Doing construction in my office, I constantly worry about being gouged. When the original estimate of the cost of construction is again superseded because of an unforeseen problem with the ductwork, I am at the mercy of the builder. Fortunately, I think I found a construction company with integrity. Perhaps I am too ignorant to know I am being overcharged, but I would rather assume better of my builders (who I’ve grown to like).

Yet thinking about gouging ultimately brings me back to the whole purpose of what I am doing with my new practice, and what drove me away from the health care system everyone is so fond of. If there is anywhere in life where people get gouged or are in constant fear of gouging, it is in health care. Continue reading “Rob’s New Economics of Practice Management”

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Finally.

I can finally see progress in what I am doing.  Above is a photo of the front page of my new practice website (visit http://doctorlamberts.org).

There still is a little “Lorem ipsum” here and there – like having labels you missed on a shirt you are wearing – but I am very happy with the look.  The pictures of the sepia photos with the iPad making it color were the genius of my web developer (with some suggestions from me), giving a perfect image of the use of technology to accomplish “old-fashioned care made new.”

I’ve spent good portion of the past few days writing the content (replacing most of the “Lorem ipsum”).  Of what I’ve written, the strongest was in the section “Why It’s Different,” where I compare life in a traditional practice to what I intend to do.  Here are a few examples:

“I Need an Appointment”

Traditional Practice

· Call the office, hear a message about calling 911, get placed on hold or leave voice message (after navigating automated attendant).
· Get called back to find out the reason for your appointment.
· Appointment is made around what is open for the doctor.
· Take time away from your schedule to meet doctor’s schedule.

Our Practice:

· Log on to portal and directly make your own appointment to fit your schedule.
Or
· Call the office and tell a human being that you need an appointment.

Continue reading “Progress”

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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. 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. 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. 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.  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:

  1. 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.
  2. I will be able to give time people deserve to really handle their problems
  3. 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
  4. Patients won’t get the run-around.  They will get answers.
  5. 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.
  6. 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.

Continue reading “Questions and Answers”

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