nzou.com

Finding a primary care physician you can trust and get along with is a daunting task. Many people do not seek out a primary care physician until they develop a medical condition that needs immediate attention, often leading to rushed or blind decisions about where to seek care. As a healthcare provider and a healthcare consumer, here are a few tips for finding a new doctor.  It’s a challenging process that might take a few attempts.

1. Interview your friends and find out who has a good reputation. This is especially helpful if you have a physician friend to query, because they often have a insider’s perspective.

2. Check online reviews of physicians in your area.

3. Check the physician’s licenses and credentialing online. Most state medical licensing boards have a website where you can check a physician’s credentials and see if they have any disciplinary action or judgements against them.

4. Make an appointment and go see the doctor.  This visit is necessary to see if you’re going to “click” with the doc and the staff.  Be honest with yourself in your review of your visit and make sure you don’t “settle.”

The Happy Hospitalist has proposed a solution to correct underpayment by Medicare.

“Medicare should role into town once every two years with a silent auction to set rates. Providers bid on the CPT rate schedule for the next two years. The lowest CPT bid gets to set that CPT rate for all other providers within that regional district. But here’s the kicker. The winning provider gets a 25% bonus for that procedural code for ONE OF THOSE TWO YEARS, as a reward for coming in with the lowest bid.”

Happy’s suggested price-setting scheme pits doctor against doctor, and leaves all physicians in a region vulnerable to just one physician’s (group’s) business strategy.  In general, physicians are poor business people.  The majority of physicians in this bidding war would be at the mercy of the few who do have business sense.  

The winning (lowest) bidder gets a 25% bonus the first year, which is equal to a 12.5% bonus for two years.  What if just one physician (or physician group) decides to bid at 12.5% below overhead costs on all CPT codes.  The winning bidder would then be able to able to drive the other groups in the region into the hole by 12.5% per year.  One of the following results would likely occur:

• the losing group(s) are forced to move out of the region or face bankruptcy
• the losing group(s) are forced to stop providing needed services/procedures resulting in an even more severe shortage of healthcare services in a region
• the winning group is able to force a merger with one or more losing group in a ”hostile takeover” of sorts
• the losing group opts out of medicare/medicaid, sets higher prices and becomes the provider of choice for the white-collar and private-insurance patients and ends up making more money than the winning group.  If this happens, we’ll find physicians/groups in many areas actually wanting to be the losing bidder in the medicare lottery.

I think the need for competition between physicians is real, but that competition has to be fair.  Giving one group the chance to cannabalize the other groups is not fair.

Mr. Mac’s untimely death will perhaps serve to remind the public that pneumonia is not a benign condition.  Pneumonia can strike fast and hard and certain types of pneumonia have kill rates of 50% or more.

Mr. Mac was one of those rare comedians with a sense of obligation to decency and a desire to inspire greatness in young people.  He’ll be missed!

Dr. RW has recently addressed the patient-centered care model of medicine.

I think patient care has to be patient-centered.  I think we (physicians) are obligated to explain treatment options and present the supporting evidence.  There are very few patients who want to know or who would be able to utilize statistics like NNT and ARR or ARI.  In the end, patients want to know what is wrong, what the options are to fix it, what the risks and benefits are for those treatment options.  Even more than that, they really want a doctor who listens to them and who appears to care about their well-being.  These are totally reasonable expectations on the part of the patient.  If a patient walks out of our clinic confused, we’ve failed them.

I’m fairly new to the medical blogosphere, and would like to comment on commenting. 

First, let me say that I think comments are a wonderful way to discuss issues and to learn to look at problems from different perspectives.  That said, there are three, bothersome things that I’ve noticed in the comment sections of various medical blogs.

1.  Some comments contain personal attacks.  This is childish and totally unnecessary.

2.  Comments often contain words that are flippant and disrespectful - again, unnecessary.

3.  I realize that anonymity has it’s place and purpose, but I think that anonymity does little to promote meaningful discussion.  I find it much more beneficial and interesting to know who the the commenter is and what type of work they do. 

I’d usually describe myself as a grateful person.  But, today, I’m feeling especially grateful… probably because I’m sitting 50 feet from and spent several hours snorkeling in the pristine waters of the Caribbean.  It’s days like today that truly recharge my batteries and give me a renewed vigor for life.  As a healthcare professional, I get tired and even cynical at times.  Today I’m reminded of the importance of taking time away from work to regain a healthy perspective on life.  Regardless of the business and politics of medicine, the practice of medicine still boils down to the therapeutic interaction between patient and provider.  I feel strongly that we must not sabotage that interaction by neglecting our own mental, physical and emotional health - and no, I’m not just saying that to justify my next trip to the beach, or the next trip , or the next trip…

It seems the insurance companies are convinced that money talks.   In this little $400,000 experiment, the patients have a 1/10 chance per day to win $10, and a 1/100 chance per day to win $100, that’s about (36.5 x 10) + (100 x 3.65) gives you a minimum of $730 a year (if the stats play out) just for taking your medication as prescribed.  Not a bad deal at face value, however, there are at least two BIG problems with this simplistic approach to patient compliance.

1. This is not enforceable.  I could pop a pill in my mouth and spit it out later.  People have been doing this for years.

2. If patients were put on a medication that gave them side effects and stopped the medication, they’d likely get penalized and cry foul.  “No” you say, “the side effect would just have to be reported to the insurance company and the patient wouldn’t get penalized.”  Right… we all know that would mean another form per patient per medication for the doctor to fill out…  not gonna happen!

If Aetna needs some help figuring out how to spend $400k a little more wisely, I’m sure they have several million customers who would be happy to offer more reasonable suggestions.

“Nzou” is the Shona word for elephant.  Shona is one of the two main indigenous languages of the country of Zimbabwe (Africa).  My grandparents were life-long missionaries in the country of Zimbabwe (41 years), and adopted the name nzou as their totem or clan name.  It was their way of adapting to the culture of the people that they served.

I registered nzou.com because I thought it would be a neat way for me to celebrate my grandparents’ legacy.

Zimbabwe is a beautiful country, with beautiful people.  Unfortunately, it is on the brink of economic collapse.  The average person is starving and the general population is dying at an unbelievably high rate from HIV/AIDS.

http://www.zimbabwe911.com is an organized effort to send a container of supplies over to an orphanage for the children of AIDS victims.  Many of the orphans have HIV themselves.  I really hope that the customs agents in Zimbabwe let this container go through without pilfering it.

The ever-thoughtful Dr. Leap has posted Grand Rounds addressing one of the most fundamental questions for healthcare workers - “Why Do I Do It?”

 Enjoy!

Yes, you read it right, I want to talk about junk mail.  Junk mail is a topic worthy of discussion because physician’s offices receive so much of it.   The time that it takes you and/or your staff to sift through the junk mail actually costs you money. 

For example, if a front office staff member spends 15 min per day at $10/hr or $2.50 per day x 5 days/week x 52 weeks (junk mail comes year-round) you’ll spend $650 + taxes or approx $750 on having your mail sorted and opened. 

If you spend 15 min per day sorting mail at $300/hr or $50 per day x 5 days x 52 weeks, you’ll lose out on $13,000 of gross income per year.  That’s a chunk-o-change.  So, here are a few suggestions:

1. Use your work address for everything related to doctoring.  People who send out junk mail are trying to make a profit, so they LOVE to send it to people with money - i.e. you.  Every government office, every medical organization, every store you shop at is going to sell your soul address to some marketing firm and BOOM, your mailbox will explode with junk mail.  If you can limit the amount that gets sent to your house, you can avoid having to spend your time (after hours) sorting and shredding junk mail.

Shred every piece of mail that has your home address and references the fact that you’re a doctor or MD.  That includes pre-populated credit card offers, magazine prescription offers, e.t.c.  Someone will dig through your trash and try to steal your identity at some point during your career - don’t help them.

2.  Designate one person in your office to sort your mail and recycle junk mail.  Give that person a list of journals that you’d like to keep.  Don’t sort mail yourself - you can’t afford to use yourself as the mail sorter.

3.  If you’re so inclined, reply to junk mail from professional organizations and ask them to remove your address from their mailing lists.  Better yet, have your office staff write those letters for you.