What I Am Thinking About Today: Direct Care, a Missing Part of Health Care Reform

I believe widely dispersed smaller primary care medical practices hold a big part of the answer for a lower cost and access solution for America health care. A recent article lays out how the model for the physician and practice would work and IS working. The article presents in part Linnea Meyer, MD, a physician in Boston, who uses the direct pay model. Dr. Meyer states “This kind of practice is why I went into medicine, and that feels so good.” Quite different from what you usually read about physician’s unhappiness with contemporary medical practice. Dr. Meyer has patients paying her $25 to $125 a month depending on age to cover their primary care. It is called direct care and she gets to focus on the care of her patients. “Getting that third party payer out of the room frees me up to focus on patient care” she says.  A substantial part of the recent riveting health care debate focused on the costly nature of various government programs and also how to help all citizens have affordable primary care. Here is one part of a possible solution: 1) focus policy on enabling smaller primary care practices (not on encouraging ever larger physician – hospital group practices), 2) foster for those citizens meeting needs based criteria direct to physician financial payments made on the patient’s behalf.  Read:  In a Direct Primary Care Practice, It’s Just the Doctor and Patient, by Melinda Beck, 2/27/2017 Wall Street Journal

Evaluating the Dental Products Panel of the US Food and Drug Administration Scope and Effectiveness

On Friday March 10th at 7pm CST there is a webinar panel titled Evaluating the Dental Products Panel of the US Food and Drug Administration Scope and Effectiveness”  hosted by Loyola University of Chicago School of Law Institute for Health Law and Policy.  Blog Loyola WebinarI am moderating, the panel participants are:

  • Dean Joel Berg, University of Washington,
  • Professor Jon Suzuki, Temple University Kornberg School of Dentistry, and Chair of the Dental Products Panel, and
  • Professor Marjorie Jeffcoat, University of Pennsylvania Dental School and a Dental Products Panel member and past Chair.

Complementary CLE credit is being offered by Loyola for attorneys attending the webinar.

If you are interested, please register in advance. Webinar attendance is Freehttp://luc.edu/law/centers/healthlaw/events/seminar_series.html.

Login Information: Once you are registered the only information you will need to login on March 10th to the webinar is your name and e-mail address. Here is the link to use on March 10th for the webinar: http://tinyurl.com/loyolahlss . As a suggestion, you may find Firefox or Internet Explorer is helpful to log in.

You are welcome to message me or call 800-999-8121 if you have comments or questions.

Randall K. Berning, JD, LLM

China Potential Economic Downturn

Thought provoking Opinion page article in 8/17/2015 Wall Street Journal, A Global Recession May Be Brewing In China, by Ruchir Sharma. Many Blog-China Flagdoctors and their practices were significantly adversely impacted over the last 5-6 years of the economic downturn. Is another looming? In my view always better to be informed  prepared than not. Check out http://www.wsj.com/articles/a-global-recession-may-be-brewing-in-china-1439764500

Why Dentistry Will Always Trump Medicine

iStock_HELPIt is no secret that the practice of medicine is under attack, a national debate for years has spawned cost controls and a presidential initiative culminating in the Affordable Care Act. In case you missed it, or for future reference, here is the complete law, all 906 pages (381,517  words) as printed by the Government Printing Office. With an additional reported 11,000 pages of regulations or or 11,588,500 words. Oh, and there was a Supreme Court case about the validity of the Act that you might want to read, someday.

Okay, so physicians have gotten the message, cut costs, if possible. In an article The Team Can See You Now by Laura Landro, a description is provided of the concept and implementation of a team. The team basically divides up what used to be considered a doctor patient visit among a variety of non physicians reserving an actual visit with the doctor. Here is one telling quote, “Winning over patients to team based care can be a challenge. A 2012 survey of more than a 1000 low income people in California by the Blue Shield of California Foundation found that a majority preferred to be seen by doctors.” Imagine what those that are not low income would prefer?

And that is why dentistry will always trump medicine. Dentists and dental specialists see their patients, provide care to their patients and are usually available to discuss care with their patients. In my view, in dentistry the special aspect of the team is to support the doctor patient relationship not change, constrain or undermine it.

The Contented Retiring Doctor

When looking at retirement doctors can be pleased or disappointed as they look back. I see it all the time when handling practice transitions and succession planning for doctors because inevitably we talk about how the practice started and what happened over the years.  In the book Triumphs and Experience by George Vaillant, the good news is that people over many years continue to develop. They are increasingly refined is the way I look at. This book tracks the Harvard Grant Study that tracked 200 undergraduate men looking at their physical and emotional health. As one reviewer, Martin Seligman stated, "If you are preparing for the last quarter of your life, this is a MUST read." And I agree. In addition to the book you can check out a recent column A Way To Get Past Regrets by Diane Cole WSJ where she interviews Dr. Vaillant. Here is one excerpt, WSJ: Which of the participants in the study tend to have regrets later in life? Dr. Vaillant (provides an answer) then WSJ asks How did that compare with those people who tend to be more content? Dr. Vaillant: The latter had learned not to cry about spilled milk. The had learned to savor the things that had gone right." Which to me is great advice for any retiring doctor!   

Slap Down: Oral Surgery, Endodontics and General Dentistry

Writers in America’s top publications get lots of notice. No less than Joe Queenan, writer for the Wall Street Journal recently recounted in
Oral Surgery: A Real Kick In the Teeth, March 30, 2013 Moving Target column, his less than enthusiastic “endodontic subculture” experience. With characteristic snide humor he takes the reader on an unforgettable journey. Doctor, your patients no doubt will see this or an excerpt so better read it to be forewarned and so forearmed!


Communicate + Persuade = To Succeed

My experience is that Doctor CEOs who lay out their practice vision are half way to success. The other half is how they persuade their team the vision is attainable and that everyone is part of it. In our Smart Doctor CEO Interactive coaching newsletter for 2013 1st Quarter, I address how some people sabotage their changes for success and present a new book, Changeology: 5 Steps to Realizing Your Goals and Resolutions, by John C. Norcross. Here I would like to augment that book and our newsletter with another book that ties in nicely, Yes! 50 Scientifically Proven Ways to Be Persuasive, by Noah Goldstein, Robert Cialdini, and Steve Martin.  I believe you will find it a helpful perspective and it stresses in part that favorable results increase dramatically when we identify common ground with another person or group. Together the books are a great combination. I can confirm that in practices where Doctor CEOs communicate their vision for the practice clearly and persuasively success is at hand.

Politics In The Practice

What is a Doctor CEO to do? We are seeing it crop up in many conversations lately: doctors and staff that differ on political candidates or issues. Do you encourage a discussion or declare it off limits? Our view, after being through this a great deal is to choose, but what ever the choice have a policy that is clear. If it is no discussion in the practice, including with patients then that is it, no if ands or buts and that includes the Doctor CEO. If it is to encourage discussions then indicate that all discussions should be in good taste, no off color words, no impugning the intelligence of anyone, candidate or otherwise, and the operative phrase to be used is “we will agree to disagree” if there is no common ground. Good Luck whatever you choose and please encourage doctors, staff and patients to vote!

Moving Your World

Are you and your practice involved in your community? For many Doctor CEOs this question has a strong affirmative, yes! But surprisingly for many others, especially I am finding for some group practices, doctors are absent from participating in the life of the community. They may live in a different community, feel they do not want to be involved or find themselves too busy with personal and family matters. Yet these communities need the perspective that health care professionals bring. Doctor CEOs in our view should be among the most visible in helping to advance the general well being. Sometimes not easy, but very rewarding! We encourage you to help move your local corner of the world just by being involved!

Don’t Wait Around

No doubt many doctors are finding their practice performance less than desired, after nearly five years of a difficult economy. Yet, I continue to come across and consult with Doctor CEO’s that are positioning their practices aggressively and achieving significant performance. As one doctor said to me recently, “I can’t just wait around for an economic turn around!” What specifically is this doctor doing? Well, here is a taste of the items. First, the practice has narrowed its focus over the last few years and strives daily to be lean and efficient. Second, every aspect of the practice is performing based on stated objectives that are time bounded with a responsible person tagged to make the objective, whether marketing, collections, or personnel or whatever happen. Third, the objectives are part of an annual plan that is broken into quarterly performance units. Take a page from this doctor’s play book, Don’t Wait Around for things to change, act now and implement your planning! See our Smart Doctor CEO Interactive Coaching Newsletter web tools to help you implement your plans.