High-tech Care with Old-Fashioned Values

How to Make Money in Practice

As we have been looking at the need for the practice to grow the driving issue is revenue. Actually it is the difference between expenses and income! There are only so many patients you can safely seen in an hour and as you approach that number your income stream flattens out. You either find ways to increase the income or you become content with it. There are several ways offices do and can increase revenue. First and foremost you can grind more people through the mill. This can be done several ways but the most common is to find reasons for people to come in for "routine" followup of conditions we used to see less often. You could tell women that they need a "yearly PAP" when the research would suggest that low risk monogamous women who have had normal PAP's for 3 straight years need only be tested every 3 to 5 years. (There goes the car payment). Or patients could be convinced by their doctor or industry that they are sick and need pills which, unfortunately, could cause liver damage. This means they need to come in more frequently for lab work (some of which can be done in the office generating lab fees). You could advocate routine "physicals" for all adults which have been shown to be of limited value. You could hold "health fairs" where you hope to identify early disease that could be a source of income. You could order many in-office lab tests based on symptoms because insurance will pay (sore throat = strep test) rather than take a history and use that to identify only those who might benefit from the test. Finally you could raise a generation of patients who don't want responsibility for their health and know that every ache is dangerous, every stress needs treatment. You could tell them that you have a pill to fix most things they do to themselves or imagine they do to themselves. And if you are luck those pills need monitoring!!

I have to admit that most of the above makes me very uneasy. Sure, there are times when followup and testing are the right approach but too often the temptation is there to get as much revenue from each patient as possible. The problem is that insurance companies don't pay well for listening to your patient and working on behavior change. They do pay well if you "do something". I don't know what the answer is but our patients should know how uncomfortable I am with unneeded tests and exams. You should assume we are looking out for your money. On the other side of the coin patients seem more and more reluctant to come in for needed care if they have a $15 or more co-pay. I get calls every day from folks who decline same day appointments for something and request I "call in something for me." Many then get angry if we suggest that might not be the right way to go. I don't know the answer so until then I guess I'll just keep working 2 jobs!

I have been going to a new church in White Pine and have been pleased and blessed by the way God has chosen to help me during a very trying time. I LOVE hymns and could be in church and just sing them for the whole service. This church has not had me crack a hymnal yet! I was very concerned about this approach (and still worry that hymns will die out) but today when the entire congregation was singing a simple chorus from the heart with tears on our faces it hit home how often I use structure to limit God. With the hymn book in hand I can look at the chord progression, the next verse, the next page etc. With a chorus I just belt out the song from my heart. I hide behind structure in other ways. Maybe it's when I use medical words to shorten the conversation with a talkative patient. Maybe its when I don't spend the time with a lonely older widow who comes in just to have someone touch her hand and smile. Maybe it's with my friends when I fail to break out of routine and see who they really are, who they are becoming. I just know that today a simple song brought me face to face with the Holy Spirit in our church and it was good. I hope you all had good experiences today in church and, if not, look at your own reasons for limiting contact with God.

Recent thougts

I have been a bit out of the loop as far as access to the machine where I blog and upload my web pages so I'm sorry for the stale site. A lot of things have been going on in the past few weeks and I have a lot of thoughts to put down in the first entry.

I met a young man recently who was depressed and upset over a relationship currently on the rocks. As we explored his feeling and history he related a your spent without any male role models as they were ALL in prison. He had been on the streets and in prison himself and had moved to the area in part due to a relationship and to get away from that past. He now had a steady job and had been doing well but had difficulty knowing how to act as a father and a partner and the relationship was stressed. I was amazed at the story and told him that I could not imagine trying to be a doctor without training or role models. He had done exceptionally in the past months in just that situation. I urged him to reframe the "failure" he felt into hope and pride that he was on the right track. He also needed to be in church (and he needed to contact his mother for support). I am praying that this life can be turned around with Christ's power.

A second thing that happened recently is that a local paper did a profile on our practice. I hate doing those things (though I have a big ego like most doctors) and having to have a picture taken was even worse. But it did give me an opportunity to talk about some of my "quirks" and, hopefully, to let folks know about our spiritual bent. The response has been tremendous. We have had dozens of calls asking to join the practice and that affirmation of our values is gratifying.

We have spent several months now with difficulty in getting payments from Medicare. Since this is a large part of the practice, the financial strain has been huge. At the same time many unforeseen expenses suddenly came up. Meanwhile I have been learning about tests in our lives. Last week we studied Abraham's "sacrifice" of his son. Several points were made:
1) Your trials have your name on them: they are areas of weakness seem to be courage, patience and letting go of control. These recent tests are right on target!
2) Your greatest trials will involve your greatest loves (this one really hits home with me)
3) The greatest trials will have the most wide ranging impact on you and your world. I can only hope that the current stress will be used to produce great growth in me and praise to my Lord.

Finally a bit of wonder. A local church women's group held a "fashion show" for mothers and daughters. The underpinning was to show young women how to dress "righteously" not provocatively. Moms wore some funny fashions and daughters were the real models. Nice concept, right? Here's the wonder of it. The women also used this idea and went a step further, they shared their faith using fashion as the object lesson. Before the night was through 8 people made first time decisions to given their lives to Christ and 4 more rededicated themselves to that decision. I was humbled when I heard that news. We often think we need to do dramatic or "church" things to share our faith. God is not limited by that approach and these women knew that and did a wondrous thing.

Careful what you read

With great fanfare the NEJM had a press announcement prior to today's presentation at a national meeting about a new drug for osteoporosis. I will not go into the details but I would like to talk a bit about how research is now done. The press release touting the drug and the decrease in death highlighted by the study as being groundbreaking. Read a bit further and you find: 1) The major drug company sponsored the research 2) the same company pays the lead researcher 3) The researcher and company have the press conference and make statement over the top about praise. 4) the research is released the next day.

The research showed approximately a 2.5% reduction PER YEAR in fractures and 1/2 that in deaths. In a nutshell women over 74 who had already had hip fractures (high risk frail women) were given placebo or the drug. Over 2 years the small differences were found in repeat fracture and deaths and the decrease in deaths was not fully understood.

This is either groundbreaking OR industry sponsored media hype show a very small improvement with no clear biological explanation which also could be statistical manipulation. By the time we would find that out the stock would be out the roof and the public clamoring for the drug. In the end we again buy the Madison Avenue/Big Pharmaceutical alliance that has been so successful in the past 20 years in this country. THE BOTTOM LINE IS ARE WE GOING TO BE A SIGNIFICANTLY MORE HEALTHY PEOPLE BECAUSE OF THIS? I THINK NOT.

We are ready

I wrote about our web portal a few weeks ago. Well, it is up and available. In order to become a "web-enabled" patient you must either come to the office or call us so we can give you a user name and login password. With these in hand (after a few hours so the upload can occur) you will be able to log into the portal and look around. There is a lot of neat things. We will have forms logged into the site to fill out from time to time, you can email us. You can look for labs. You can update your information. All of this is more secure than going through the email. This is an exciting way to build a health community and I am hoping to learn a great deal about how the be a "web doctor". Many have already made use of the email and it has proven helpful. I am excited about this. We will have some handouts soon to show you what you can do on the site. These should be available at our practice.

As you know we have been short-handed (pun intended) at the office but I am grateful that Holly is recovering well and back in her usual place helping my patients with their problems. You don't think about your health care professionals getting sick and we are some of the worst patients in the world. I know that I often don't practice what I preach but that is fairly typical for doctors. I hope the problems contacting us during this time of ill health has not been too problematic.

I am working on developing a presence at the local hospitals and hope to soon be more active in the White Pine community. I feel this is important and know that many of you have voiced that to me. Thank you for your support through this transition. I should be more available by cell phone after hours so you will not get as many voice mailbox messages. I also hope to clear up a problem with access to a computer on which to blog regularly. I use a iMac for this and hope to have a machine readily available soon that will allow me to blog on a more frequent basis.

Finally I need ideas for a newsletter topic. I have been on hiatus with the newsletter but with the web portal I will be able to send it out to registered users who have given us their email address. This has me energized to work on it again. Let me know.