Posted by: AtlasMD

October 31, 2013

We Hate To Say We Told You So…

But we kind of have to say we told you so. Here’s a “stop-what-you’re-doing” type of article from Forbes-contributor Avik Roy. Let’s start with the title, “Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare” and then some telling quotes:

“Obama administration knew that Obamacare would disrupt private plans…”

“Mid-range estimate: 51% of employer-sponsored plans will get canceled…”

You know our stance. We’re not here to be political. But if ever there was a time to take the leap of faith and start offering cash-only medicine, now is it. There’s all sorts of wrenches in our healthcare system. We have the government jeopardizing the free market, forcing people out of insurance plans they liked, for something that is in certain cases more restrictive and more expensive.

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Posted by: AtlasMD

October 30, 2013

Direct Care Prescription Dispensing By State

Direct Care Prescription Dispensing By State

In case you’re wondering, here’s the list of prescription dispensing laws by state. The rules vary, but only four states have banned dispensing outright — Montana, Texas, Utah and New York. We’ve extolled the benefits of dispensing meds for your direct care patients. First off, it gives your practice a kind of Costco-esque appeal. Now, the $50 monthly fee is giving them access to seriously discounted meds. We’re talking penny on the dollar in certain cases. Secondly, it adds a convenience factor. It’s one more thing for a patient to worry about when they see you and then have to go wait for a prescription. And it’s one more thing for you to do, either calling in or faxing over the order (or handing a piece of paper to your patient to deal with). But when you can dispense yourself, the visit becomes a very complete experience — a personal one, and a satisfying one.

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Posted by: AtlasMD

October 29, 2013

Red Tape Puts Insured Californians in a Bind

Fox News conducted a hard interview with a doctor in California. All things considered, we’re aware of the network’s general political leanings, and we’re not politicians at Atlas MD (we’re doctors). However, it’s very difficult to argue with the fact that paying subscribers have been kicked off of existing plans in California, and forced into Obamacare programs. Regardless of whether one plan is better than the other, one thing has been eliminated, and that’s the power of choice.

Had we been invited to the program we might have added that the insurance doesn’t guarantee quality care. Quality care is something that takes time and experience. The more fee-for-service doctors deal with insurance to get paid, the less medicine they actually practice. In a perfect world, there’d be MORE doctors, not more red tape. Ironically, as we add more bureaucratic influence, albeit well intentioned, we run the risk of running doctors out of medicine entirely.

Sadly, the government imagines medicine like this — insure everyone, problem solved. But what happens when all the doctors are occupied, and there’s no one to see all these insured patients?

Posted by: AtlasMD

October 26, 2013

Prepare Yourself for the Fork in the Road

Prepare Yourself for the Fork in the Road

We found a great blog post from The Happy MD that clarifies a schism that’s likely to develop here in the American healthcare system. With an influx of patients gaining insurance through Obamacare (assuming those exchange websites finally work), primary care docs have essentially two directions they will be pushed in:

  • One group of docs will be part of the patient mill, who due to the inherent volume of patients coming through a clinic will only see the very sick; here the doctor will spend a majority of time in a management position, overseeing nurses and physician assistants who actually interact with patients.
  • Another group of docs will be part of the concierge medicine/direct care movement, and will see all of their patients for longer durations; here the doctor will free up this time by removing the red tape and operating their practice with limited assistance.

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Posted by: AtlasMD

October 23, 2013

A Burnt-Out Doctor Decides To Quit

A Burnt-Out Doctor Decides To Quit

Diane W. Shannon, M.D., MPH, is now solely a freelance writer. That’s because primary care burned her out of practicing medicine entirely. She’s not burnt out on the industry, though, instead focusing on what she calls “performance improvement in health care.”

Dr. Shannon is exactly the doctor we refer to when critics mention that direct care might exacerbate a doctor shortage. To reiterate, every doctor in America doesn’t get to cut the red tape and instantaneously practice insurance-free medicine. No, direct care is about doctors cooperating collectively and acting independently to circumvent the administrative forces that swallow doc’s time, stress them out, and prohibit them from forming strong relationships with patients.

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Posted by: AtlasMD

October 23, 2013

A Doctor Reminds Us that Patients Are in Control

We had to share this harrowing story of Dr. Annie Brewster, who is both a physician and patient. See, she suffers from MS, and in dealing with her condition, she’s gained amazing insight into what it’s like on the other side of the gurney. She explains:

“Being on the patient side has changed me as a doctor. Now, I see more clearly that no medical decision is simple. While my job is to make recommendations to patients based on my medical knowledge, there is no one answer.”

According to Dr. Brewster, what is ultimately “right” is based on a multitude of factors and we may not have the precise answer within our reach. Now she tells her patients when she suggests any treatment, “You are in charge.” Being as we were just reading about a healthcare future that’s been Walmart-ized and might have machines dictating our treatments, this seems especially relevant. What do you think happens if primary care physicians are to be replaced by software algorithms and nurses? Would patients be less stubborn? Would they be even less likely to listen to their own intuition?

Again, these are ambiguous, difficult issues to discern. But regardless, it’s humanizing to remember that in spite of all our education, training and experience, we are not the final call. Really, it’s up to the patient to trust us and follow a treatment plan that works for them. Our job is to take the time to make sure we’re offering the most sound advice within our own reason and skill set.

READ DR. ANNIE BREWSTER’S PATIENT-PHYSICIAN PERSPECTIVE

Posted by: AtlasMD

October 22, 2013

Will Medicine Be Walmart-ized?

In his new essay, David M. Cutler prognosticates an intriguing, yet impersonal healthcare future. He says, “the idea that technology will change medicine is as old as the electronic computer itself.” And we agree with his proposal.

However, there’s a lot of information out there, and for the most part, it’s not made available at the right time. Think about it: how many times do we hear about a patient receiving an incorrect dosage or a drug that causes an allergic reaction? And, as more docs “get wired” and adopt EMRs, there will be even more parties contributing to the collective consciousness of medicine. Just look at the numbers. Since the 2009 American Recovery and Reinvestment Act created the HiTech program, billions of dollars have been allocated for doctors and hospitals to purchase EHR software/systems. According to Cutler, “Since the program was enacted, rates of ownership of such systems have tripled among hospitals and quadrupled among physicians.”

Okay, but what happens when all of medicine gets connected?

Cutler says healthcare will be delivered in a more standardized fashion, with less overall cost, but less of a personal touch.

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Posted by: AtlasMD

October 21, 2013

The Direct Care Doctor Will See You Now

Thanks to @jsgoldmd20 who linked us to a relevant Huff Post story. Ann Brenoff’s “The Doctor Will See You … When Her Boss Says She Can” documents her experience with an overly commodified fee-for-service doctor. It’s not the same old story, of long waiting rooms, harried visits, obscene fees, and dodgy insurance claims… Well, it does have the long waiting room, but for a different reason: Brenoff’s doctor refuses to spend less than 30 minutes with her patients, even when the company she works for demands she book appointments every 10-15 minutes.

The problem, though, is that patients back up in the waiting room. Even when her appointments are booked four weeks in advance, Ann Brenoff is forced to wait over an hour to see her doctor. Recently she got fed up and tried to take her business elsewhere. Her time was too valuable. She couldn’t be made to wait.

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Posted by: AtlasMD

October 20, 2013

Even The New York Times Is Suggesting Catastrophic Insurance Plans

In his new New York Times healthcare piece, “Driving a New Bargain on Health Care,” Tyler Cowen spells out the hard truth of Obamacare failings. Based on his prognosis, a lack of states extending Medicaid coverage will leave millions uninsured. This isn’t something that should excite anyone. However, it’s leading to wake up calls from top journalists. In his assessment Cowen offers a reaction to this shortcoming:

“At the same time, I’d recommend narrowing the scope of required insurance to focus on catastrophic expenses. If insurance picks up too many small expenses, it encourages abuse and overuse of scarce resources.”

As you know, we’ve been suggesting this for years now. When we as a nation can’t provide care for our own, that’s failing. But when we know something isn’t working (health insurance as health maintenance, for one) and we keep doing it, that’s even worse. So yes, while we’re nowhere near a solution, we’re moving towards a society that recognizes one thing: coverage is not care. It’s a point worth mentioning, because to many people, the idea that EVERYONE is insured sounds like utopia. For now, we’ll be the squeaky wheel reminding you that this isn’t really the case.

READ THE FULL NEW YORK TIMES ARTICLE HERE

Posted by: AtlasMD

October 20, 2013

WATCH: Dr. Lee Gross Explains His Direct Care Success In Florida

Check out this YouTube video of Dr. Lee Gross, MD, a family physician practicing in Florida. He presents Epiphany Health, his direct primary care plan, to medical students attending the AMSA national conference on October 12, 2013 at Rowan School of Osteopathic Medicine. His talk was sponsored by the Benjamin Rush Institute, a non-profit organization dedicated to protecting the doctor-patient relationship and preserving freedom of choice in medicine.

Just a heads up, it’s a long video, clocking in around 35 minutes. To help you out, we highlighted a few key segments.

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