Thoughts | Atlas.md | EMR Software for Concierge Medicine

Posted by: AtlasMD

October 18, 2013

A Third Of Med Students Aren’t Using EMR… Wait, Is That A Bad Thing?

A study published last year by the Alliance for Clinical Education found that just 64 percent of med school programs allowed future docs any use of electronic records. Oh, and of those that do, only two-thirds allowed students to actually write notes within the EHR.

Okay, so med schools are failing to fully prepare students for a future of potential bureaucratized headaches. But this is an interesting predicament, given the EMRs themselves are failing, too (just ask the doctors, the studies, etc.; no one is touting the current state of EMR as exemplary). However, there’s a relevant bit of knowledge here. Call it common, call it what you will, but we believe the best a person can be is well-informed, second to that is uninformed, because the worst spot to be in is misinformed. In this latter case, you not only are contaminated with bad information or insights, but you then have to unlearn what you know in order to move forward.

So, who thinks this finding is bad news? Not us. We’re more concerned with the two-thirds of students who were exposed to today’s kickback-savoring EMR. The same shoddy EMR we’re rejecting by launching our own practice management and EMR software specifically for direct care.

Posted by: AtlasMD

October 18, 2013

Michigan’s Reaction To Obamacare? Direct Primary Care.

We mentioned a while back that Michigan took precautionary measures in light of Obamacare. You can read “The Return of Direct Primary Care” on Sen. Patrick Colbeck’s personal website. He outlines the state’s legislation, SB 459 and 460, which underscore the key values of direct care. Colbeck also explains why his state is not blindly adopting the Medicaid Expansion component of Obamacare.

He’s landed some powerful punches with his rhetoric. If any of them ring true with you, tweet them to your followers. If there’s one thing we know about politics, the squeaky wheel gets the oil — and if there’s no oil, that’s because the government shut down.

Jokes aside, we’re staunch supporters of Colbeck’s vision of prioritizing direct primary care, reducing insurance dependency, and re-establishing the patient-doctor relationship.

“[Insurance] coverage does not equate to quality care.” – @pjcolbeck [CLICK TO TWEET]

“Anytime a budget increases by over $1.5B, it is difficult to make the claim that we are ‘saving money’.” – @pjcolbeck [CLICK TO TWEET]

Posted by: AtlasMD

October 17, 2013

Obamacare? Let CNBC Explain…

President Barack Obama has passed his landmark healthcare reform law. It’s referred to by several names—the Patient Protection and Affordable Care Act, or just the Affordable Care Act—but even the president uses the critic’s name: Obamacare.

Sure, the name is simple. But this is a complicated law. It wants to tackle two problems: first, it seeks to provide affordable health insurance to just about every American, and second, it wants to slow down the rate of inflation of healthcare costs, which account for nearly one-fifth of America’s economy (you saw John Green’s brilliant video, right?).

Okay, insurance for everyone sounds nice. We’re not going to argue with that sentiment, although the methodology might backfire. However, this second point sounds ludicrous.

“Add red tape to curb American healthcare costs? That’s like pouring gasoline on a fire because it’s liquid.” – @AtlasMD [CLICK TO TWEET]

Oh, and “the ACA will cost the government $1.36 trillion to implement over the next decade, according to estimates by the Congressional Budget Office,” says CNBC. Excellent. That’s just another tab that’s going to have to be picked up by someone, most likely someone who works and pays taxes.

Posted by: AtlasMD

October 17, 2013

Is Chris Dorster Allergic To Red Tape?

Yes, New York resident Chris Dorster suffers from occasional allergies, so he’s been known to sneeze a bit. However, there’s more than just pollen to sneeze at in his blog post. That’s because Chris currently doesn’t have prescription medication coverage. When his allergies flared up recently, he went in to see his doctor. There he was given a sample of a medication. The brand name nasal spray did the trick.

But the plot thickened. When Chris ran out of his sample he figured he’d pay cash for another tiny bottle of nasal spray. It can’t cost that much, he thought, maybe forty dollars?

Posted by: AtlasMD

October 10, 2013

AAFP Releases Detailed Projection Of Primary Care Physician Shortage

The AAFP reported on a recent study outlining the projected family doctor shortage that is facing our nation. According to the organization, “The projections rely on a combination of factors to gauge current and future workforce needs on a state-by-state basis, focusing heavily on increased patient demand that is likely to result from an aging population, overall population growth and coverage expansions due to the Patient Protection and Affordable Care Act.”

The projections are very specific. For example, according to the projection for Arizona, the state demands an additional 1,941 primary care physicians by 2030. This is 150 percent of the current number of doctors. According to the research, 1,466 primary care physicians are needed because of population growth, 360 because of increased utilization, and 115 because of insurance expansions that occur as part of the Affordable Care Act.

Posted by: AtlasMD

October 9, 2013

NPR Breaks Down Obamacare’s Effect on Insurance Rates

NPR published an article reviewing introductory rates on policies offered through state-run insurance exchanges. The report examined 36 different states. So what’s the verdict? A resounding “it depends.” In Oklahoma, premiums are going for as low as $96/month. Meanwhile, in Wisconsin, the lowest rate on a bronze plan is well over $300. The reporter echoed our direct care mantra, saying, “Competition equals lower prices.” They explained how in regions with only one insurance company selling through the subsidized exchange, the average monthly premium for a 21-year-old buying the lowest cost bronze policy is $186, before any subsidies are applied. However, in regions with 10 or more rival carriers, the average cost is $132 or less.

How will Obamacare’s varying premium rates affect direct care practices?

Actually, there are two wins happening. If you’re a doctor looking to move to open a cash-only clinic, you’ll bode well in regions with only one insurance plan offered through the exchange. Lower competition tends towards higher insurance rates, meaning that wrap-around plans and your direct care offering can add tremendous value. Secondly, in areas with fewer insurance plans offered on the exchange, there is another effect: increased premiums for existing subscribers. In this case, because of the lack of competition, and the fact that Obamacare is forcing insurance companies to expand their offerings, rates might reach an exorbitant level for the subscriber. This is another patient who would benefit greatly from switching to a wrap around plan (remember, Obamacare means that insurance plans can’t raise their rates for pre-existing conditions) and enrolling in your direct care clinic.

Posted by: AtlasMD

October 9, 2013

Direct Care is Not the End of Empathy

If you’re currently running an insurance-based fee-for-service primary care facility, and planning to switch to direct care, you should read this op/ed from the Wall Street Journal. Jerald Winakur practiced internal and geriatric medicine for 36 years and is a clinical professor of medicine at the University of Texas Health Science Center at San Antonio. His cousin Irene, a 90-year-old woman living in Queens, was recently notified that her internist was joining the concierge medicine ranks.

Winakur’s thoughts are less than enthusiastic about profit-focused decision making. But, they actually don’t contradict our own belief in Atlas MD-style of direct care. Why is that? Because concierge medicine is not the same as direct care. According to Winakur:

“What Irene learned was that her internist was converting her fee-for-service office into a ‘concierge practice.’ For a yearly retainer of $2,200 (in addition to the usual charges that would still be billed through Medicare and supplemental insurance), Irene would receive “value-added” services. These include same-day appointments, electronic access to her medical records and lab reports, shortened waiting times, and other ‘frills’ that Irene said her doctor always provided anyway.”

Posted by: AtlasMD

October 9, 2013

Preserving Doctors Means Preserving the Patient-Doctor Relationship

David Bornstein is making a career of empowering, thought-provoking articles on the emotional state of healthcare. In his New York Times op/ed “Medicine’s Search for Meaning” he advocates that as the patient-doctor relationship vanishes, so too will the doctors. He says, “Medicine is facing a crisis, but it’s not just about money; it’s about meaning.” Adding that, “As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressure to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship.”

Bornstein’s piece is powerful, weighing in on the manner with which we doctors handle grief. In his opinion, med school is where the doctor burnout is first felt. Students are pushed to absurd extremes–losing sleep, and being trained to approach medicine in a distant, compassion-less manner, even reprimanded if they break down and cry in the presence of a patient. So is it okay to cry in the presence of a patient? You have to decide for yourself. However, reprimanding a student for doing so is pure Vulcan, cold. But, according to Bernstein, almost half of medical students get burned out during their education. He claims that, “medical education has been characterized as an abusive and neglectful family system.” It places unrealistic expectations on students.

Posted by: AtlasMD

October 8, 2013

Direct Care & Doctor Shortages Are Related, But Not How You’d Think

David Bornstein recently reported on doctor burnout, something we’ve been following over the last few years. This concern isn’t falling on deaf ears, instead half of the nation’s medical schools are reacting, by including a course called The Healer’s Art (this course was created by physician Rachel Naomi Remen, and according to Bornstein, helps “doctors and students discover and reconnect to the deep meaning of their work and maintain their commitment for it.”) His article caused a commotion on the Web, with hundreds of readers — patients, medical students, doctors and spouses and children of doctors among them — expressing their personal experiences. After we reviewed a host of comments, we noticed something missing in the conversation: direct care…

We’re all running out of time
One reader from New York writes, “I am a primary care doctor who started idealistic, and am disillusioned and dejected. By far, the biggest barrier to being a compassionate healer in our current working environment is time. We simply don’t have the time we need to do our jobs well. And we all lose.”

Posted by: AtlasMD

October 7, 2013

Hold On To Your Highbrow Hats: Rand, Rock, Greek Gods and Direct Care…

We came across an academic paper highlighting attention paid to Rand in the works of contemporary scholars and intellectuals. Prog Rock (especially Rush songs penned by Neil Peart, drummer extraordinaire), Greek Gods (Dionysus and Apollo specifically), and Randian libertarianism intersect in this curious research from NYU.

It might seem off topic, but this paper stirred up thought on our end — how do we rectify a healthcare system comprised of people? Yes, people — doctors, patients, providers, pharmacists, politicians, insurance agents, the whole lot of parties all wrapped up in one complex machination. Given that we know most problems are people oriented, and that our industry ensures the health and longevity of people, it seems like we’re in for a perpetual rollercoaster ride. On one hand, we consistently talk data and numbers, especially money, and how bureaucracy misallocates it. This is a more Apollonian argument, one based in reason and logic. We support direct care because we want services to be rendered more efficiently. It’s easier to pay us $600 for a year’s worth of unlimited service than it is for people to pay an insurance agent for a premium with copays and deductibles so that they can find a doctor within their network who will hand their insurance information over to a third party biller who will go back to the original insurance company to request a payment in part that will then go back to the provider who also has to bill the patient for a copay that varies depending on their deductible…

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