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Michelle Afrika Tucker

http://www.skyparkpfc.com/Form/sermon_version_6%20_3_.pdf

The short answer is that doctors go to school and train 100 hours a week getting straight As in the toughest curriculum immaginable for 11-15 years past high school accumulating an average of $250,000 in debt, forgoing 401K plans and a normal social life to enter practice in their mid thirties sincerely committed to the care of patients. Making large amounts of money was never our goal. We then discover they we have been forced to work for the wrong employer, that is government and health plans whose goal is to pay us as little as possible while expecting us to continue to work 100 hour weeks to keep the doors open. Physician and medical group bankrubcy has become common and many many doctors leave practice to do something else that is actually profitable. The talent and intelligence of a typical doctor can be put to many profitable uses beleive me. Both patients and doctors have been hurt baddly by the current “system” that extracts 40% of your premioum or tax money and returns you an unrecognizable product you cannot effectively and easily use. I invite you to read the link above for details.

Thomas W. LaGrelius, MD, FAAFP
President, SIMPD (formerly the Concierge Doctors Association)
Owner, Skypark Preferred Family Care http://www.skyparkpfc.com

Norman Rockwell got it right and his art truly illustrated the type of family practice physician care we know and love! Best Wishes to all physicians who are willing to “risk” to take control of their destiny and continue offering individualized quality health care to their patients.

1. A center for medical effectiveness essentially marries data doctors have, about efficacy of treatments, to data on the cost of those treatments, which we don’t have. By making patients and physicians consider not just the benefit but the cost of a given treatment, and by increasing copays for treatments judged to be cost ineffective, the study projects the single largest savings — $368 billion over ten years. This is essentially rationed health care; I do think it’s coming, and it’s not going to be popular.

2. By taxing sugar in sweetened drinks, the study projects savings of $283 billion, the next largest area of projected savings. Um, don’t bother. Obesity is by far the most important health care problem in the US. Effectively addressing it would save gobs of money. But any primary care physician will tell you the sugar in sweetened drinks is not even the tip of the iceberge that defines this problem. Obesity has to do above all with inadequate exercise, and that has to do with lots of things – depression, television, lack of discipline and abdication of personal responsibility, the burdens of working parents, the architecture of our towns and cities which abjure sidewalks for an extra lane on the road for cars, fast and processed food – I mean the list goes on and on. The consequences are devastating, including arthritis, diabetes, heart attacks, strokes, peripheral vascular disease, sleep apnea, insomnia and increased susceptibility to infection. The study is right to focus on this problem but wrong to suspect this feeble measure will make a difference.

3. The next most valuable benefit comes from changing the basis for reimbursement from office or inpatient visits to a disease based model, ie, you’re paid a single amount for a given illness, regardless of the number of visits required to address the problem. Bad idea:
a. there are already incentives to limit the number of office or inpatient visits, in the forms of copays and the inherent limitations of time available for both patients and physicians;
b. there’s no way this model would accurately account for the varied needs of patients and would therefore encourage pruning from our practices the sickest patients. For instance, I see one patient about every two weeks, in my office. She has multiple medical problems, has a niece who lives nearby but who works two jobs and can’t pay her aunt the attention she needs, and I’ve found from hard experience that seeing this woman less frequently – let’s say once a month – results in hospitalizations to deal with the accumulated problems that have gone unaddressed. Switch this patient to an “episode of care” model and she’s in big trouble.

4. Next comes a two dollar tax on cigarettes to reduce smoking, saving projected $191 billion. Good idea!

5. Finally comes reducing reimbursements in high cost areas based on national averages, saving $158 billion. This is just a cost cut to physicians. Good luck with that and get ready for the increased attrition of doctors willing to accept Medicare.

Overall, I think the study is discouraging and, from a primary care doctor’s perspective, all but ignores the single biggest area of potential savings – dealing with the awful consequences of our lack of daily sustained aerobic exercise – which by the way means an hour a day, seven days a week, on the treadmill, at four miles per hour or better. If you’re not doing that then stop fooling around, put on your sneakers and get going. And if you are doing that, guess what? You’re going to live a long healthy life, with relatively few incurred medical expenses.

So far, we haven’t started really marketing the practice. But we are getting some patient’s from jsut word of mouth. The area the practice is in is fairly affluent and people to have higher expectations of service, which is also a reason why I think my practice will eventually have demand. However, I agree with the people above… there isn’t a line waiting to join…yet.

Maybe next year I’ll be at the conference. I did attend last year and found it very useful. I made some good contacts, including you John.

John…would you add my blog, http://www.myconciergedoc.com to your blogroll

Dan Kowals, MD