Yes! It is true, I found love. It is so beautiful. Magical. Direct primary care.
Of course, I am trying to be humorous here. Before people lose their minds, yes, my wife, Arshia, is my other true love ;-). She manages it all and puts up with my crazy ideas. God bless her. I am still amazed how she agreed to support a scrawny kid waiving his old school medical bag and yelling "I'm mad at this health care system and I am gonna show people a better way to do it!"
2020 was a challenging year for all of us indeed. BUT, I always look at challenges as lessons. Sometimes in life we are not ready for the things we want to do and life throws challenges at us to get us ready for big endeavors. These lessons make us stronger, more creative, and more informed. In 2020, due to the Covid-19 pandemic, we saw millions of Americans turn to their tablets, phones, and computers to visit with their doctors. The country all of a sudden started practicing direct care! Medicare changed its rules and said use ANY video conferencing ability, including FaceTime to visit with your doctor. Use whatever!
Hmmm, I remember screaming this back in 2014 holding my rugged medical school bag, wearing roughed up scrubs, and doing house calls with this crazy idea!
I was already doing telemedicine visits prior to the pandemic and my patients and I became even closer this year. We struggled together. As an Internal Medicine physician and Hospital Medicine specialist, it is so rewarding to manage the chaos in the hospital. But, to take care of people through various settings including the outpatient clinic, long term acute care hospital, assisted living, and finally home is the most rewarding experience.
To see someone who was in the hospital for an acute COVID-19 pneumonia for more than 50 days with a trach and feeding tube come off the assistance of a ventilator and literally walk to their car on discharge day at our long term acute care hospital is the best feeling in the world!
At LiveActive Primary Care, we have accomplished something really significant. Direct Primary Care is a mindset, attitude, a philosophy. It is not just a way to practice medicine in an office and go home at night. No. It is more than that.
We take this attitude and mindset of preserving the sacred relationship between physician and patient and apply it to ALL settings of health care. We intend to show the world that direct primary care influences ALL aspects of care in our health care system. It means we do not allow third parties to dictate what care someone gets. It means we get creative. We tie loose ends. We create game plans. We communicate with the entire team of people who will help someone live their best quality of life. It means breaking down silos and leveraging each of our talents to serve our community at the highest level.
Our team has grown quite a bit in just a few months. We demand 2 things when we are approached by someone who wants to join our team. One, you have to smile and laugh...genuinely! Two, you have to have passion for what you do and be willing to take your talents to the highest level. No fear. Our organizational philosophy is that each one of us brings unique talents and experiences and we should respect that. If we allow it to thrive and be challenged, we all benefit from the exceptional service that is created. We do not allow any barriers to get in our way of providing the best care to our community.
So, going into 2021, we are preparing to take our attitude of direct primary care even further. Currently, we provide services in assisted living facilities, hospital, long term acute care hospital, our office, and at home. There is more work to be done. Why can't cardiology or pulmonary services provide direct care? Why not? Why can't we eliminate readmissions to hospitals for things that can be managed by hospital trained providers in the community? Can hospital services be done at home? Why not? Why are there soups of specialists in complex cases? Do we really need to have so many specialists involved? Are we treating to optimize quality of life or padding statistics or did we forget to even understand a patient's definition of quality of life before we even started a treatment plan? So much more to come...
If you or a loved one would benefit from our love for direct primary care, JOIN US! To enroll, click on the link - JOIN NOW.
A sincere thank you to all my wonderful family, friends, colleagues, dear patients and their families for your continued support and trust.
Here is to a blessed and healthy 2021!
Dr. Haseeb Ahmed
After months of fighting this virus in the hospitals, I cannot tell you how excited I am to see the amazing work our researchers have done since the start of this pandemic. You have to remember, this is a worldwide pandemic. So, we learned from one another across the globe. This experience demonstrates how we all are unified in this vulnerability.
As a physician, I remember feeling the pain the people and the health care workers were feeling in Italy, Brazil, UK, and of course here in the US. We lead the world in the total number of deaths due to COVID-19.
Personally, it has been exhausting. I have never signed so many death certificates in my 13 year career. I have never cried as much as I did while listening to someone's heart and lungs who was infected with COVID-19.
It is so hard to see a chest x-ray or CT chest of an infected patient who initially might be smiling and talking to you but deep down you know that in the next few days you will be battling a virus that will bring all its might against this same patient. So many sleepless nights have passed with worrying about people under my care and crying over those who I lost.
Many people may not know that as a physician who is treating a COVID-19 infected person in the hospital, you get to really know their family members and their stories as these cases require long hospital stays. Hearing the struggles of others whether it is economic, social, or other issues makes the whole situation even harder.
To say the least, it has been very difficult. I smile a lot so people may not ever know the pain or exhaustion I feel as I write this blog. But, I do this work because I am blessed to be in a position to heal. I am blessed with a team of nurses and nurse practitioners at LiveActive and all the team members we have at our assisted living facility, hospitals, and long term acute care hospital. Together, we have lifted each other when we were down, worked extra shifts when we could, and our families took on risks as we fight this virus.
Please thank the spouses of health care workers too! I feel that we do not recognize them. They are the ones who fear daily for their loved ones. It is they who may have had to make us smile, give us a hug when we needed it the most, or put their concerns on hold while they lend us their ear as we share our frustrations and stories.
BUT...we finally are getting close to vaccination! Here are some important points to remember. The CDC website is helpful, but I found it a bit much to navigate through and make sense of so here is my attempt to simplify it for you.
What the heck is a mRNA?
We are all familiar with DNA (deoxyribonucleic acid). This is the molecule that contains the genetic code for organisms. Remember, plants, bacteria, and many other organisms have DNA. So to get from the genetic code to actual protein synthesis, messenger RNA (mRNA) is needed to transcribe the code for production of protein.
So, how does a vaccine take advantage of this process?
COVID-19 mRNA vaccines give instructions for our cells to make a protein called “spike protein.” This protein is found on the surface of the virus that causes COVID-19.
Where do you inject the vaccine and how does it work?
Once it is injected in the upper arm muscle cells, our cells use the mRNA to make the “spike protein”. Our immune system then goes into action! It recognizes the protein as a foreign invader and starts to build an immune response and making antibodies. Not only will our body protect us from the virus this time but also against future infection.
How safe is the COVID-19 vaccine?
To answer this question, you must understand how a vaccine is developed. Here is a simple picture without getting too technical. At each phase, researchers assess safety while increasing the number of subjects involved in the studies.
In addition, the FDA also looks at the manufacturing of the vaccine to assure its safety.
Manufacturing companies must seek permission to market a vaccine for use in the United States. If the FDA approves it, there is continued monitoring for safety and effectiveness. There are various surveillance systems in place that assist in monitoring for safety and effectiveness.
The CDC website has some great information but it can be confusing. Here are some quick facts that is from their website: Facts about COVID-19 Vaccines (cdc.gov)
Which vaccines are currently in PHASE 3 Clinical trials? As of November 24th, here are the current vaccines in progress or being planned:
This sounds great, but how much is it going to cost me?
Per the CDC website, vaccines purchased with US taxpayer dollars will be given to the American people at no cost. Vaccine providers will be able to charge administration fees for giving or administering the shot to someone. This fee can be reimbursed by the patients public or private insurance company. If uninsured, this fee can be reimbursed by the Health Resources and Services Administration’s Provider Relief Fund.
So, should I get it?
In my humble opinion, I think you should. I trust our country and our researchers. I trust the FDA process. I have faith that every study has been and will be conducted with the utmost care and thoroughness. The FDA is notorious for being complete and having a rigorous process when approving new treatments.
Please discuss your concerns with your primary care physician. Review the CDC website. Ask questions. Stay safe. We all have become stronger and more informed as a result of this terrible pandemic.
UPDATED 01/12/2021: With Missouri and Kansas in the initial phases of their vaccine distribution plans, some counties are allowing residents to sign up to be notified when they're eligible. This is a great new article that lists how to get on the Covid-19 vaccine list for certain counties: https://www.kcur.org/health/2021-01-12/kansas-city-heres-how-to-reserve-your-spot-in-line-for-a-covid-19-vaccine?fbclid=IwAR15z4Ni9FLxqrDbn8r_omTqYVUGcfUlFtT1jmz9F6Ec9tunLEO0xnF-Fv4
Hey guys! Nurse Heather here. For those who don’t already know, I am a licensed and registered dietitian. Yep, you read that right – nurse and dietitian. Weird, right? And to answer your question, no, it was not my original plan to take that career path.
I first obtained my bachelor’s degree in dietetics from Iowa State University and went on to complete my dietetic internship at the University of Iowa Hospitals and Clinics. After graduating and obtaining my license and registration, I worked in long-term care and acute-care settings. I loved interacting with and educating patients!
As time went on, I found myself wanting to do more for my patients than my degree allowed – I wanted to impact more than their nutrition, I wanted to provide hands-on care, and I wanted more opportunities to build a deeper connection with my patients. *Insert nursing school here.* One quick year later, I had my second bachelor’s degree, this time in nursing, from MidAmerica Nazarene University.
Long story short, I am grateful to be in a unique situation now where I get to utilize both my nursing and dietetics degrees. I do enjoy nutrition, and I believe it is the foundation to healthy living – that is why I am excited to start offering nutrition sessions to our members in the near future! As we work out the kinks, I plan to occasionally post nutrition-related tidbits here, so stay tuned for some healthy insights as we start navigating the holiday season!
Check out our nurse practitioner, Lisa's favorite pastimes!
Enough about my professional life, lets talk fun! I like knowing my providers on a personal level, so here is a look into what I enjoy doing in my spare time.
Top 10 Things:
My stepson is 18 and going to UCM with a double major in music technology and performance music focusing on guitar. My husband owns a remodeling company and is the laborer at home making our house more beautiful every day.
I began working towards my career as a nurse in 2009 as a non-traditional student. Nursing was a career change for me. I had always dreamed of taking care of people, but quitting my successful job in sales to go back to school felt irresponsible. When I was laid off during the downturn in the economy, along with several others, I jumped at the opportunity to fulfill my dream. With the support of my family, I applied to school at Saint Luke’s College of Nursing. During nursing school, I took a part-time job as a nurse intern at Saint Luke’s Hospital on the Plaza on the Pulmonary and CVICU floors. I loved every experience! Upon graduation, I took a full-time job in CVICU taking care of the sickest people in the hospital. After about a year, I realized how much I missed talking to my patients and developing a relationship with them (as most patients are sedated, on the ventilator and unable to speak in the ICU). Therefore, I decided to return to the pulmonary floor. I spent the next 8 years taking care of all types of illnesses: respiratory failure, kidney failure, GI bleeds, diabetes, alcohol and drug addiction, COPD, tuberculosis, flu, pneumonia, and a whole host of other viral and bacterial infections. It was hard work, but I enjoyed every minute of it because I learned something new every day. A couple of years after completing nursing school and working at the hospital, I realized I wanted to learn more and do more for my patients, so I decided to go back to school to become a nurse practitioner.
Five long years later, I graduated from Kansas University Medical Center with my Doctor of Nursing Practice degree. Going to graduate school while working and taking care of a family was the most difficult, yet most rewarding, challenge I have ever taken on. I could never have accomplished it without the support of my loving husband and stepson pushing me every step of the way. My experience at the hospital gave me the opportunity to work with and get to know Dr. Haseeb Ahmed. I remember the day he told me about LiveActive Primary Care and his direct primary care practice. I was intrigued and followed his blogs over the years. When he called me after graduation, I was so excited for the opportunity to work with him and care for people in a way that allows providers to truly care for their patients. It reminded me of the way medicine used to be, where you get to know your patients and their families, and you spend more than 10 minutes in the exam room with them because you do not have insurance dictating how much your time is worth. I get to make old-fashioned house calls if they are needed. I have spent years working towards a career to care for people in a way all people deserve to be treated. I am so excited to be part of LiveActive Primary Care and I look forward to meeting you, my future patients.
Wishing You Health and Happiness,
Lisa Nelson, DNP
For some, moving your loved one into an independent or assisted living facility can be a challenging, guilt-ridden choice. It’s hard enough coming to terms with the idea your loved one is requiring more care. Now, you’re left asking yourself: Am I making the right decision? Will they be happy? Will they receive good care? What will their quality of life be?
First, know you are not alone. Millions of people face this same dilemma every year. Next, know your family at LiveActive Primary Care is here for you. Did you know our direct primary care services extend beyond the clinic? In addition to the clinic, we provide our services to hospitals and assisted living facilities. Most recently, we added a Long Term Acute Care (LTAC) facility to the list of health care settings where we provide our direct services.
What does this mean for you and your loved ones? This means your loved one can have the benefits of direct primary care at their independent or assisted living facility, and you can have peace of mind knowing your loved one is getting the best quality of care.
Here are just a few of the ways we will provide your loved one with the best quality of care:
If you have questions, are interested in our care, or if you would like to get to know us first, please sign up for a meet and greet on our home page.
Pictured: our nurse practitioner Dr. Lisa Nelson and nurse Cassie caring for our assisted living patients!
When you are admitted to a hospital, you will most likely be admitted by a Hospital Medicine physician. These physicians specialize in treating the complexities of hospitalized patients. The goal is to efficiently and effectively manage acute illnesses, reduce length of hospital stay, while maximizing patient experience. It is quite the challenge on a daily basis, but one that is very rewarding at the end of the day.
In modern medicine, it is absolutely fascinating how quickly we can reach a diagnosis, understand the physiology at play, launch a treatment plan, and get a unconscious or at times a person with no heart beat initially, walk out of the hospital in a matter of few days.
I have been doing this line of work for 10 straight years, holding various leadership positions, and one day realized that all the great work we did in the hospital can quickly become undone once the patient leaves the hospital.
Either the patient could not get a primary care follow up within 7 days of discharge, had too many specialist follow ups ultimately confusing the family and the patient, or cost of medications or lack of insurance was a barrier to follow up. Quite honestly, it really doesn't matter if they have insurance. The issue of access and cost is far greater than coverage. I also learned there was a lack of awareness of community resources from patients and physicians.
Picture this - you go to high school, college, medical school, then residency, then get employed by a large hospital system. So your understanding of health care becomes institutionalized and biased. The only community resources you know comes from who the health system partners with and THAT IS IT. You work too many hours to step outside the health system to fully understand the community you serve.
Having started a Direct Primary Care practice, forced me to get outside my comfort zone. I attended and joined multiple Chambers of Commerce, attended Rotary Clubs, shake hands with random people, drinking lots of damn coffee at coffee shops for one on one meets, and listen and learn from professionals who are doing incredible work in my community. These are small businesses that deliver quality personalized care. More importantly, you can feel their passion for what they do. A referral I made was not another number in their monthly quota. The referral was treated with special attention and an opportunity to build a relationship.
In addition to meeting amazing people in the community, as a Direct Primary Care physician who also works in the hospital, I started to understand how some of the education we did at discharge was overwhelming patients. For example, heart failure patients are aggressively educated to prevent readmission within 30 days to prevent loss of revenue for the hospital, so the checklist of items must be completed. In the process, someone with stable heart failure, discharges thinking the end is near for them. They would sign up with our practice overwhelmed with the medications and information they received at discharge, that it takes a 60 minute visit to walk them through it all. You start to see how financial incentives insurance companies, including Medicare and Medicaid, place on the practice of medicine affects patients utilization of health services and ultimately increasing the cost of care.
At the same time, practicing Direct Primary Care, allows you to look behind the game. You start to understand and see the real cost of health services. It is infuriating and almost a crime. The greed is sickening. You become bold, confident, and walk a little taller because you are armed with knowledge and experience. Most physicians have no idea what the true cost of care is and shrug their shoulders when you ask them. Most of them are too burnt out or have not had time to really learn the system - but I do not like that excuse of not having time.
We all make time for anything we prioritize. We all are busy, but if we prioritize something or make it necessary, it will be done.
To truly impact the health of our nation, physicians are going to have to get uncomfortable, grind, get out of their comfort zone, fight, speak, yell, do everything and anything we can to change policy. If this sounds like too much, then medicine is not for you. Being a physician is a responsibility. You are responsible for the health of our world. In this global economy and world of social media, we all are interconnected. We are one people, each with individual talents, skills, experiences, and backgrounds. To heal, means to understand the human spirit and seek opportunities to improve health through better housing, better jobs, innovative treatment options, prevention, counseling, and simply listening. That is what makes this profession so beautiful.
Wishing you all great health and happiness,
There are over 62 million Americans over the age of 60 with continued expected growth over the next several years. In fact, people around the world are aging at increasing rates. This rapid growth demands health systems around the world to adapt by embracing innovative solutions to manage the health conditions that may come with this growth.
Beyond the health conditions, there are multiple stakeholders involved in care delivery. Therefore, it becomes critical to have a true "quarterback" that is managing this type of complex care. This is the role of primary care. This is the value of direct primary care in elder care.
Centers for Medicare and Medicaid (CMS) is pushing for a shift from fee for service care to value based care. Thus, the goal is to reimburse physicians for care coordination. Currently, physicians are not reimbursed for their time spent on care coordination. However, how realistic is it for a traditional primary care physician who is seeing 20-30 patients in the office to be 24/7 available? This is impossible. The solution many health systems have for this is to place mid level providers, like Nurse Practitioners or Physician Assistants, to respond to patient needs. But, how does this facilitate continuity of care or building long lasting relationships? There are call schedules and so forth that prohibit the same physician responding to the same patient on a 24/7 basis. This is where the lapses in communication and continuity of care fall short.
Why do older Americans join direct primary care practices?
You should really ask them! What you will see is a sweet smile and a look of "are you seriously asking me this question?!" From accessibility to affordability, many patients older than 60 years old will tell you that they join these practices for simply the peace of mind. One doctor in charge. Family members love to have access to that "quarterback" who they can contact to know exactly what is going on with their loved one. House call at their independent living facility or assisted living facility is a huge value for the patient, the facility staff, and family members.
In addition to be able to manage and discuss multiple issues during a single office visit, family meetings are more feasible. Understanding ones definition of quality of life is better understood. More importantly, that definition is the lens by which any future health care services will be recommended. This assures the patient and their family members that everything will be done to protect and secure their right to live a high quality of life.
Most membership fees range from $70-100 per month that include many free office procedures and no copays when they visit the office. Medications, imaging, and labs can be purchased using their Medicare or supplemental insurance. BUT, at a direct primary care practice, they can see what the cash price is for the service before deciding to use their insurance. This is true consumerism in health care delivery.
Many do not realize how insurance companies delay echocardiograms, stress tests, other imaging studies, and other services by having a horrific prior authorization process. These delays lead to medical complications and delayed care. At least at a direct primary care practice, you can bypass this chaos and pay discounted cash prices for the services and prevent any further headaches.
So, if you want the best for your loved ones or yourself, consider a direct primary care practice. From your residence, the office, to hospital care, direct primary care physicians will be at your side to take care of you. We will give you everything we have to offer to make your health care experience the best, while optimizing your definition of quality of life. This is our promise.
To a life filled with happiness and peace,
In this final blog post as part of this series, I feel the need to start with illustrating the difference between Direct Primary Care and Concierge Medicine. It is very important for my readers to understand the terms we are using in explaining how Direct Primary Care in combination with the Affordable Care Act (ACA) is the best solution for our healthcare system.
In addition, I refer to direct primary care as well as direct medical care in general. I strongly believe, as many specialists, surgical centers, and endoscopy suites do as well, direct pay for medical services is less expensive than billing to insurance companies.
So, in summary, Direct Primary Care:
In order to really understand the economics of health care spending on a national level, think about this: We spend about 25% of the national budget on four health insurance programs — Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) marketplace subsidies. How efficient are we with our tax dollars? What is the return on our investment? We spend 17.2% of our GDP on healthcare; more than any other nation in the world. Take a look at the graph below. We spend 49% from public funds on health care. The reason for inefficiency all of a sudden becomes more clear.
What happens when direct care and health insurance programs work together?
It is estimated that about 80-90% of all health issues can be resolved or prevented in the primary care setting. Yes, you read that right, a significant majority of issues can be managed and prevented in the office. Urgent cares, stand alone ER, and now the new trend of small hospitals are feeding off the need for accessible care. Large health systems are trying to reach more patients with multiple "footprints" across the region to bring in more people into their system. People find comfort in that all their information is "in one place."
But, we tend to forget that when physicians are on medical staff or teach at various hospitals, we have access to the EMR and able to coordinate hospital care, like the "old" days. I would argue, when your patient panel is smaller (less than the traditional 6,000 patients) then it becomes easier to coordinate and provide hospital care.
Economics of direct medical care
A. Consumers save and decrease out of pocket expenses
By saving $0.40 on the dollar, practices are able to offer more services, use technology to make themselves available to their patients, while keeping the cost of their services low. The consumer's out of pocket expenses are drastically decreased as majority of direct primary care practices do not charge co-pays or any additional costs for in clinic procedures. In addition, the discounted imaging, labs, and medications are drastically lower than with insurance.
B. Health insurance premiums will decrease drastically
When we take insurance companies out of the outpatient world: all primary care practices, specialty office visits, imaging, laboratory, physical therapy, occupational therapy, speech therapy, and some outpatient procedures, then the insurance companies are purely covering inpatient care and catastrophic care. A large component of insurance premiums are to cover these services. So eliminating the outpatient services will significantly reduce these premiums.
The medical offices, imaging centers, laboratory facilities, and many procedural suites save big when they don't have to bill insurance by reducing their staffing, paperwork, and resubmitting of claims. Thus, the cost of their services will come down and the market is open to competition. Accounts receivables have minimal to zero balance; leaving liquid cash in the bank to offer more services.
Please note, many endoscopy suites, surgical centers (like Surgery Center of Oklahoma) specialty offices, imaging centers, laboratory facilities, and of course primary care offices are moving to a direct model because of these benefits.
C. Cost of hospital care and need for more services will decrease
With accessible and affordable primary care, studies have shown that not only do people visit with their primary care doctor more, but their risk for admission to a hospital is drastically lower (see diagram below from our friends at Qliance). Hospitals have an opportunity to embrace a direct model as seen around the world and surgical centers where there is no insurance billing. But, I fear this will take some more effort and health insurance lobbyists are quite powerful. So, I will push the envelope towards at least getting the outpatient world out of the grasps of health insurance.
D. Federal health spending and taxes (Federal and State) will decrease
Medicare and Medicaid are government sponsored health insurance programs that will also be focusing on inpatient and catastrophic care in this new model. Folks who are paying lower premiums can fund their Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to pay for direct medical services. These are pre-tax dollars and funding them is more realistic as the consumer will be paying less out of pocket for their health insurance premiums.
Even the $50 monthly fee for direct primary care can become difficult for some Americans. This is where practices should be given a tax incentive to provide free charity care. The more they do, the more they save. Currently, tax laws place a cap on how much they can claim as charity care. Each practice can also be allowed to set up a charitable foundation and reduce the complexities of forming of 501(c)(3) organization. This will enrich a community feel of delivering health care and bring all Americans together in providing quality care for one another.
States can expand Medicaid without having to increase their state taxes as much. The IRS and the ACA must agree on terms, as they currently have different definitions for HSA and FSA as to what qualifies as a medical service. This will happen soon, but in aligning the definitions, this will incentivize more development of direct medical practices across the country.
So, what does it look like for the consumer purchasing medical services?
To answer this question, lets put ourselves into the shoes of a imaginary 40 year old man named Tommy.
Tommy is a car parts salesman and recently took over his fathers business. He is very energetic and overweight. He has diabetes, heart disease, and some kidney disease. He starts searching for a direct primary care doctor in his area. After spending time meeting the doctors and their staff at different practices, he settles on one. We can call it LiveActive Primary Care www.liveactivepc.com
He then looks for a health insurance product that has his hospital of choice in their network and co-incidentally his new direct primary care doctor also provides hospital care at that same hospital. What a find! His premiums are much lower and he gets a plan with a HSA account so he can fund his card with pre-tax dollars.
His first visit with his direct primary care doctor is 60 minutes where all his health issues are discussed and a plan of care is developed. He walks out with all his labs done for less than $35, medications that are significantly less, and plans to see his kidney specialist soon.
Since his kidney specialist does not bill insurance, they are able to see him same day or next day. All his doctors are a text message away. When he arrives at the kidney specialists office, his case has already been discussed by his primary care doctor and the specialist. This is a real possibility as both of these doctors have the time to discuss cases instead of seeing 30 patients a day with unnecessary paperwork. They discuss the case and he is on his way home with a plan.
When Tommy goes to the hospital, both of his physicians come to take care of him. The nurses and hospital staff are ready to take care of him upon his arrival.
How about the consumer with no health issues?
So for this part, we meet Elon. He researches a direct primary care practice just as Tommy did and signs up. His health insurance product is just as cheap as Tommy.
Elon is playing with electric cars and hurts his hand. He texts his direct primary care doctor with a picture of his swollen hand. His doctor takes a look at the picture and calls him to discuss his symptoms via video chat. After assessing his mobility, Elon is told to get a hand X-ray, which costs less than $40. Elon walks into the imaging center, gets his X-ray done, and within minutes his direct primary care doctor calls him to say that they saw the images and he needs a cast placed. Elon is told to come the office that same day and a cast is placed for $40. Elon goes back home to play with rockets.
How will hospitals save money in this health care system?
The ACA attempts to improve quality of care by penalizing re-admission rates, in hospital infections, and pushes for a medical home model. With the development of various direct care practices, the consumer is able to create their medical home: pick their direct primary care doctor, pick which specialist they like, and hospital. The hospitals should see less readmissions as the care in the outpatient setting is more accessible and affordable. There is a reduction in risk for hospital acquired infections with decrease length of stay.
The Emergency Rooms will not be overflowing as patients are able to be seen by their direct primary care doctor quickly or in their home as needed. If someone does have to go to the ER, then the process is much more efficient. The primary care doctor and the ER physician have already talked about the case so upon arrival of the patient, care is started immediately.
The ACA has more than 33,000 pages of regulations. Remember this famous photograph in the Washington Post:
But there are several benefits that should be continued:
Changes that need to be made to the ACA:
Now, this solution is a key ingredient in decreasing our national expenditures quickly. But, it is not complete on its own. We must make continued efforts in reducing pharmaceutical cost as well as medical devices. This will take some aggressive regulations and encouragement of free market. As the insurance companies remain involved in hospital care, long term care, and some other services under the model, there must be efforts to make billing more efficient and decrease the amount of waste we produce as discussed above.
Finally, as a country, each American must make a commitment to improving their health. We can open several doors for the American people, but as many direct primary care physicians will tell you, despite all these resources and at times FREE medical services, we still have trouble maintaining compliance in some of our patients. This must change.
It will take comprehensive effort to improve our national health care. President Obama, despite your opinion of his presidency, has ignited the push towards better health care for all of us. It is on us to keep pushing, improving, and supporting programs that have intentions of providing accessible and affordable care for all.
Dedicated to my beloved fellow Americans,
This is part 2/3 of My prescription for better health care for ALL Americans.
With the new president-elect nominated by the American electoral college, there are increasing worries about repealing the Affordable Care Act (ACA). Is it possible to repeal such significant legislation of our time? Will millions of Americans lose their insurance coverage?
Since its inception in 2010, an estimated 20 million of the estimated 47 million uninsured Americans gained health insurance coverage with surveys pointing towards many satisfied customers not only with their plan but also their chosen doctors. Studies, as cited by the Common Wealth Fund, also suggest an improvement in quality of care as a result of ACA implementation. In the last 6 years, there has been increasing interest in multi-payer initiatives to promote quality primary care by reimbursing physicians a set fee per member of their practice (sounds like the government likes direct care but won't admit it).
All this sounds great, right? So what is all the fuss about?
Well lets look at what this "coverage" means for the average ACA enrollee:
Think about this: When a person gets admitted, the hospital staff runs them through a myriad of exams and tests quickly to maximize their revenue (initial evaluation is highest paid with decreasing reimbursement for follow up visits), and then discharge them to the clinic setting where the wait times are long and the patient has little time with the doctor. The social workers and case managers will be the first to tell you there are several moments during a hospital discharge, we can predict someone will likely come back (called LACE score). To add to all this chaos, add the fact that the insurance companies will deny medications that at discharge might be needed or imaging that is needed for follow up. Hey, but I have coverage, right? Delay in care with prior authorization and denial of medications is what only the American who experiences this in some way truly understands.
Health care is a $3 trillion industry. Each change in policy means millions of dollars worth of changes in staffing and organizational structure for hospitals. Like any other business, these costs will need to be recovered in some way. Thus, the rising hospital bills, avoiding certain payers completely, and entertaining providing services in a cash basis without involving insurance; it's so much cheaper!
Health insurance adds about 5 staff members for each physician with denial of claims about 15-20%. Accounts receivables increase as the facilities await payment while continuing to pay for billing services to resubmit and submit new claims. This is the single largest cost and waste in our health system. From direct costs of paper, printing, software and hardware, billing services, to indirect costs of time wasted, prior authorizations, insurance denials and requests for more forms, less patients seen due to paperwork, and burn out. This is the foundation for the need to see 20-30 patients daily to capture a reasonable revenue stream to keep the business running. More on this in the final blog post.
Enter direct care.
The American Academy of Family Physicians (AAFP) proudly supports direct primary care and holds the single largest conference in Kansas City, MO every year. This single event has grown from a few 100 to over thousands of attendees, including physicians, medical students, medical residents, technology vendors, and others who are eager to partner with direct care practices across the nation.
Their tremendous support stems from the growing national shortage of primary care physicians, increasing prescription medication costs, poor access to care, and unaffordable medical care despite insurance coverage.
The American College of Physicians (ACP) has also written a white paper on practices contracting with their patients instead of insurance companies. This paper has increased the conversation differentiating direct primary care from concierge care. A social media storm was lead by yours truly. Sorry ACP, but I cannot tolerate poor research prior to writing a paper.
Here is the reality:
How would this new health system look like? I discuss this in my final blog post for this 3 part series.
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."