All right, pencils out, notebooks at the ready! Quiz to follow! Here is Part II of Resuscitating Primary Care. At our last session, we noted the primary care was indeed a “code-blue/COR-0″. As promised, I will apply my laser sharp focus to “fixing” this problem.
You are a shrink. This is another unavoidable issue. You must learn effective ways to help these patients, which make up a large part of medical practices. In our medical school and residency programs there needs to be a greater emphasis on psychiatry, as mental illness is so pervasive. As to your own practice, several things will help: learning and using the counseling codes, scheduling enough time for these patients, and having on hand the cards of your favorite psychiatrists, psychologists, and social workers. Also, you must become well versed in the plethora of antidepressants out there. Key point: you have limits too, and remember that most mental health professionals have the phrase down, “I’m sorry, but our time is up. When should we schedule our next visit?”
Insurance companies make life miserable. We must fight back! As group, we physicians have laid down and played dead! From a macro level, we physicians need to lobby for appropriate reimbursement and STOP accepting what ever insurance companies offer. (See related post: “Entering the Lions Den”.) At a practice level, your job is to ensure that your coding, billing and collections are top notch. That means knowing which insurers are paying in a timely fashion, at an appropriate rate. It means dumping the ones that aren’t! It also means negotiating for the reimbursement your work deserves. It means having a strong stomach, and realizing that this problem is not going to go away unless you make it go away!
It’s not good mind candy anymore. Ahh, to find the random pheo and look like a hero! The reality is we are managers of chronic disease, cheering patients on when they lose weight, lower their A1-C and actually exercise. Yes, you will still make the occasional brilliant diagnosis, but your focus will be on medical coaching. You need to learn how to coach, and find joy in it. Another avenue to explore would be group sessions, which can be energizing and exciting. Next, you could market your practice as “the practice for the seriously ill” — meaning you WANT complicated medical patients. This has ramifications for billing/collections, but could be a viable model. (Note: I haven’t run the numbers, but remember, you will code higher for more complicated patients. If you really market your practice to get these patients, it may be fairly interesting. Any one out there have a practice like this?) Lastly, consider leaving slots open for urgent care visits. There is no reason to give this business away to Urgent Care clinics, and these visits can be fun and interesting. (Yeah, I know, you will see a lot of URIs, but you will also see the occasional thyroid storm and aplastic anemia! Been there, done that!)
The environment is hostile. But you don’t have to be! If you are on time, sit down, look AND listen to the patient a lot of hostility will vanish. We have perpetrated some of this, and it is completely fixable by physicians! Bedside manner, (Marcus Welby, not House!) is where it’s at. Please, do not hide behind your computer. Yes, use that high falutin’ super expensive EMR, but set it up so that you can look at the patient and type. For pity’s sake DO NOT write notes and type them in later! Talking about a huge time waster!!! Make your exam room and waiting room comfortable, and a friendly receptionist and nurse are a must. Sourpusses need not apply!
Not everything is fixable. Yup. However, our mind set must be that our job is to guide patients toward health, and that there are no quick fixes. Part of the job is to move patients towards this mind set as well.
Key point of this post:
Make it fun!
We spend too much of our time at work not to have fun. Have a good time with your patients and staff. When the end of the day comes, I think the one that had the most fun, wins! Hang in there, send comments on how to make it better, lobby for change, and keep doing the good work!
PS: I will put up a page with a resource list in the next few days.