Physicians

HEALTH PLANS/PHYSICIANS/TECH:Health care, the way it should be (or How to stop worrying and learn to love the bomb), by Pat Salber

Pat Salber writes The Doctor Weighs In. She is a doc, an ex-med director at California blue shield, and a Kaiser Permanente member. And she loves them. This is why, and it’s quite an advertorial for Kaiser and an indictment of how everyone else does it. So if this becomes the standard, and people find out about it (and with $80m of advertising budget a year behind it, they will find out) can the rest of the US system compete?

Health care, the way it should be or  (How to stop worrying and learn to love the bomb)

By PAT SALBER

I have to tell you again about what great health care I get from Kaiser Permanente Northern Cal. Drhealth (Yeah, I know, they screwed up on the transplant service).  But, they are doing a lot of the things we, the wonks, have been hollering about for years.  Read this.

Sunday night I noticed new “floaters” in the right visual field of my right eye.  They were different from the run of the mill floaters – those little dark circles — most of us have.  These were like long lines and they only moved on the right side of the visual field.  The next day, I started having sparkling lights, again in the right visual field.  Now, even an emergency physician knows this could indicate a retinal detachment (serious indeed).  So mid-afternoon, when I had convinced myself it would be stupid to miss my own diagnosis, I called KP.  The woman on the phone in the opthalmology department clearly had been trained.  When I talked about the sparkles, she put me on hold and got a nurse. 

The nurse tried her best to get me in the same day.  She had an appointment available, but being rush hour, there was no way I could make it. She carefully went over the symptoms of retinal detachment and compared them to what I was experiencing.  Together we decided it was OK to wait until the next am for an appointment.  She carefully explained that if certain symptoms occurred (e.g., a sensation of a curtain coming down over the eye), that I needed to go to the emergency department right away as that could indicate a retinal detachment.

The next day (today) I showed up at the opthalmology department.  The receipt I was given for my $15 co-pay listed the dates I had had all of my age/gender specific  preventive services and the dates the next ones were due.

There was no wait to see the doctor.  I was put in an eye exam room and saw a nurse right away.  She explained everything she was going to do.  She anesthetized my corneas,  she tested my vision (with glasses and with pinholes), she used the slit lamp to look at the corneal surface, and then she put in drops to dilate my eyes.

After about 15 minutes (waiting for the eyes to dilate), Dr. Prusiner, chief of the department came in to see me (he is the brother of Stan Prusiner, the Nobel Prize winner who discovered prions).  He did a very thorough exam of both retinas using a variety of techniques.  He explained that I had a vitreous detachment (annoying, but otherwise, no big deal).  He showed me a color picture of an eye with a vitreous detachment.  He answered all of my questions.  He did  not seem rushed (because the nurse had done a lot of the early work for him).

We were finished, he gave me a  4 x 6 piece of paper with his name, his photo and the URL of his home page.  Here’s the link  so you can see how nice it is.  This is, I think, the new KP Connect.  It also showed all of the stuff (by major categories) that he had on his home page.  He wrote down the diagnosis “vitreous detachment” on the paper and drew an arrow from it to name of the link where I would find the information he had chosen for his patients to read about this condition. He urged me to read it.  I went on the site, found the condition, and, lo and behold, everything he told me was what was on the site.

He then told me, in detail, what symptoms would require me to call or go to the ER right away.  But he assured me that the symptoms represented complications highly unlikely to occur.

By the way, he said as I was leaving.  Be sure to make an appointment with the optometrist.  I think we can improve the correction of your left eye.

I challenge you to find one single thing you would want that I didn’t get.  This is the way health care should be.

Livongo’s Post Ad Banner 728*90

Categories: Physicians

Tagged as: , ,

27
Leave a Reply

27 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
16 Comment authors
JustAboutDoneW/KPwindingupSuperplumscott lucasMaggie Mahar Recent comment authors
newest oldest most voted
JustAboutDoneW/KP
Guest
JustAboutDoneW/KP

Kaiser is fantastic!!! …as long as you don’t actually need to go in and be seen for anything!

windingup
Guest
windingup

Speaking of which, read this…
This story will enlighten all to Kaiser and their cost-cutting business model.
http://www.kaiserthrive.org/2006/09/13/yet-another-case-of-disappearing-evidence/
Also, how about this… this talks about Kaiser and their EMR…
http://www.latimes.com/news/printedition/front/la-fi-kaiser15feb15,1,5018956.story?page=1&coll=la-headlines-frontpage

Superplum
Guest
Superplum

If Kaise is so fantastic, why must patients sign an anti-suit waiver (along with their permission for treatment) upon entrance to the ER? Why do certain Kaiser physicians tell patients “I’m only allotted a certain number of MRI’s each year, and after that I’ll have to pay a premium out of my own paycheck?” Why won’t the Kaiser review board let patients seek care from outside surgeons who have ACTUALLY PERFORMED their intended procedure? Why, after a Kaiser surgery has been botched, does the review board change their tune and allow patients to be transferred to us for clean-up neurosurgery?… Read more »

scott lucas
Guest

The doctors service should not change because he works for Kaiser. A doctor should provide the best service he can because he is in business and his business depends on customer service.

cyberpunk
Guest
cyberpunk

Just for those of you who don’t know, the British Health Service has come out on at least two occasions to visit Kaiser leaders, looking for advice about how to better run their own health programs

Marc
Guest

The reason health care costs are rising so rapidly is because of the high rate of uninsured, and the free care that hospitals and doctors have to provide. Someone has to cover the costs, and that comes out of the pockets of those that have insurance, that is private insurance as well as Medicare and Medicade, or from those who can pay for medical care on their own. And the reason there is so much corruption in the medicaid and medicare arenas, is because every year reimbursements go down from the government, and fraud or running unnecessary tests etc. is… Read more »

Maggie Mahar
Guest
Maggie Mahar

First, regarding Medicare and Medicaid– yes, their costs are increasing faster than inflation–but not as fast as the cost of health care in the private sector. Going back to Kaiser, when compared to other health plans, patient satisifaction is high: in regions of the country where Kaiser is well-established, the annnual voluntary turnover rate (the rate at which members leave the program when given the opportunity each year) is less than 3 percent. When I was writing “Money-Driven Medicine,” Dr. Jack Mahoney, director of health care benefits at Pitney Bowes told me: “People are incredibly loyal to Kaiser. We couldn’t… Read more »

Barry Carol
Guest
Barry Carol

Jason, I remain a skeptic regardiing socialized medicine. I note that Medicare and Medicaid continue to increase in cost significantly faster than the sum of inflation and (eligible) population growth while fraud is a serious issue in both programs. I also note that many large employers self-insure and contract with insurers for administrative services only or so-called ASO contracts. Perhaps one of the brokers on the blog could provide some insight into how much administrative services cost per member per month on average and what that comes to as a percentage of the client’s total dollars spent on employee healthcare.… Read more »

jason d
Guest
jason d

Barry, I would bet it compares favorably to America at large, but would compare very UNFAVORABLY with socialized medical nations in Canada and Europe from a cost standpoint. Those systems operate without any middle man like Kaiser skimming money off the top. I think the fed govt should take some of KP’s practices like EMR and build a socialized medical model that eliminates all the middle man insurance companies, just like Europe operates. Of course, KP and the rest of the insurance industry would go out of business overnight, so they would fight it severely. The powerful insurance lobby is… Read more »

gadfly
Guest

Matt – I propose you rename your blog “The Astroturf Blog”.

Barry Carol
Guest
Barry Carol

Since Kaiser has over 8 million members (greater than the population of some countries with national health insurance), I wonder if it has made any data available regarding average life expectancy, inpatient hospital days per 1,000 members, etc. and how their stats compare to the U.S. population at large. Has electronic medical records and evidence based medicine reduced costs and medical errors? How does their malpractice payout experience compare to non-Kaiser doctors within a given specialty? There should be a lot of useful data to be mined here.

cyberpunk
Guest
cyberpunk

I think that when you compare the private practice model to the Kaiser model, Kaiser is doing it right. The provide evidence-based healthcare that’s integrated. Nobody else can provide that. In addition, Kaiser has and is well ahead of the competition in its IT systems–they have a functioning emr and an amazing patient driven web site that allows patients to email their doctor, check lab results and book appointments online. Prevention of disease is their goal and doctors get to focus on this instead of insurance reimbursements or enticements by pharma to prescribe their latest, most expensive drugs (KP Norther… Read more »

RW
Guest
RW

Some of you folks don’t seem to get it. This is about how medicine should be practiced, not premiums and lost laptops. KP physicians work in a system that allows them to focus on medicine. Not business, not paperwork for reimbursement, not staffing, not malpractice insurance, or any number of other distractions that every other onesy-twosy doctor (aka “independent business person/entrepeneur”) has to worry about. Kaiser has a system designed around allowing physicians to practice medicine. They have the systems and supports to allow them to focus on providing good care. Not to mention support for CME, quality initiatives, a… Read more »

gerovital
Guest

Very nice job

gadfly
Guest

Kaiser may be trying to PR-bury this, as well:
http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2006/07/24/daily47.html
What makes me raise my eyebrows about health care professionals who preface their praise with “I don’t work for Kaiser, but I love them…” is that they are speaking from a position where they want to keep their options open in the future. Kaiser is a very comfortable professional destination for people at the top.
In speaking of professional parachutes, does anyone know where David Brailer landed?