Wednesday, April 1, 2015

Patient-Powered Care Drives New Relationship With Physicians

You fought hard to get that health insurance card, whether it is through the affordable care act, medicare, medicaid or another source..  Perhaps you pay cash or belong to a direct payment model primary care practice.  Or perhaps you are still among those who could not afford health insurance even with the subsidies calculated from the Affordable Care Act's website.

Whether your present that card with a zero-dollar copay or zero dollar deductible, you have only just begun your new patient career in the future of medical care.

Even for patients who have had a consistent uniform policy through an employer based or group based coverage most patients find the true story is only known when you present that card to the receptionist or admission clerk.  Many get a surprise when they learn how their 'old policy' has changed, with new rules, copays, deductibles, and other caveats.  Your own physician probably does not know what is in your 'card' let alone your wallet.  The card is swiped, the computer screen blinks several times and the truth will out you. God forbid it says 'declined' are relegated to the status of a non-citizen in the digital health sphere.  Go to start, and revert to old fashioned cash. (some are still bogged down or never left that niche)..

More likely the computer screen  will display what insurance is in effect, deductibles, copays, prior authorization requirements and much more.  The clinic EHR system is most likely connected directly to multiple insurance companies, billing agencies, hospitals and now to a nationwide health data exchange to increase transparency, and improve efficiency (when and if it is working).

Doctors, go back to your patient rooms, this stuff is not for the faint of heart and you will need all of your energy, commitment and discipline to do what you know best for your patients. Cardiac arrests, CPR, seizures, gunshot wounds are all trivial in the face of a 17% carve out of the U.S. GDP for health costs. Should you want to know more about the business of medicine you would have to have been in medical practice for at least 20 years, and have had several near misses at practice insolvency and you will need to get an MBA. 

It used to be that having an M.D. degree was the end all. Not so anymore. Many young physicians in training or early practice are enrolling in an MBA program,  perhaps on one of those MOOCs , through Coursera  or taking evening courses at the local college.  Some have learned by OJT working through the ranks of managing their clinic departments or managing their own practice in years gone by.

For more about Paient Powered Care:

Rx: A Quiet Revolution
An Interview With Cardiologist Turned Documentary Producer Jennifer Mieres
Bob Harrington interviews Jennifer Mieres about the PBS documentaries Rx: The Quiet Revolution and Rx: Doctors of Tomorrow, on innovative models for practicing and teaching patient-centered care.

PBS Documentary Champions Patient-Centered Care
Airing on April 2, 'Rx: A Quiet Revolution' turns aside from the usual discontents of medicine to show how reviving the physician-patient relationship can help Americans cope with chronic illness. 

Expert Reviews
Primary Care Models: Not One Size Fits All
A Perspective From Reid Blackwelder, MD, Board Chair, AAFP

Healthcare As It Is, or As We Want It to Be?
Professor of medicine Mark Williams reflects on the meaning of healthcare models shown in the PBS short film.

A PCMH Model That Works
Brad Fox, MD, a practicing family physician, reflects on the success of the PCMH depicted in an Alaskan practice described in the PBS film.

Transforming Primary Care, One House Call at a Time
Kenneth Lin, MD, discusses how a new documentary demonstrates the value of house calls in primary care, and why they should be reimbursed for that value.

Diabetes in the Delta: Helping Patients Meet Goals
Dr Dace Trence reviews an upcoming PBS documentary that addresses a Mississippi program for diabetes patients.

Rx: The Quiet Revolution: Heart and Soul Meet Modern Medicine
After so many doom-and-gloom healthcare documentaries, Seth Bilazarian is pleasantly surprised to find Rx: The Quiet Revolution to be both representative of his experience and insightful.

Healthcare Is a Team Sport; Nurses Are Key Players
Ken Miller, president of the American Association of Nurse Practitioners, explains how healthcare has also become a team effort, as highlighted by the PBS documentary.

Transforming Medical Education
Emotional Education in PBS's Rx: Doctors of Tomorrow
Medical student Alexa Mieses reviews the PBS documentary Rx: Doctors of Tomorrow. The program focuses on an innovative medical school that highly values empathy and emotional experience

Providers must be aware that illness can severely impair patient judgment and the ability to be self empowered during acute and some chronic illnesses.   Patient advocacy will become even more important as  providers and hospitals may fail to discharge their duties toward patients. It's all in the small print.

So let's not abdicate our position of leadership in caring for patients and monitoring just how well or not our 'allied' staff performs.

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