Latest Advanced Access post "Culture Change" AKA Phase I complete!
Tuesday, April 22, 2008
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Kishore Visvanathan
Trying to improve my medical practice. Also, various random thoughts.
Kishore Visvanathan
Welcome to Plain Brown Wrapper!
PBW is a scrapbook of my attempts to improve my medical practice. Also, various random thoughts.
Why "Plain Brown Wrapper"? Because I hope you'll find something exciting and provocative inside...
Why "Plain Brown Wrapper"? Because I hope you'll find something exciting and provocative inside...
Contributors
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- Communication (46)
- Quality Improvement (19)
- What's wrong with this picture? (19)
- Advanced Access project (13)
- Office practice (10)
- Safety (10)
- Electronic health records (7)
- Presentations (7)
- Patient survey (5)
- tech notes (4)
- Pharmaceutical industry (3)
- Prostate Cancer Education Project (2)
2 comments:
fantastic data Kishore! When we went to digital referrals that was the default so we never had any way to prove that the system worked better (or to put a value on it). We create a digital "referral" note in the scheduling system and one of the drop down lists is "provider". Beside that is a check-box marked "only". If left on the system forces you to book with that provider only. Thanks for allowing us access to the data.
Access, Progress, then regress and stress….
Kishore, it so phenomenal to see your progress in access to specialist care. Your effort is not getting the recognition it deserves. Too bad it is still restricted to the geographical area you practice in, as referrals seemingly has to go by region, and only if specialists in your own area are not accessible – then you can refer to “out-of region”.
But there is a more disturbing trend, right at the “grassroots” level. At the family physician level. Two things that will make Hippocrates turn in his grave. The first one is “meet and greet” The second is “one complaint per visit”.
Meet and greet: a visit, supposed to be paid by the patient, as there is no code in the billing book for the visit. A visit where the physician can decide whether the patient is an acceptable risk to take on as a new patient. This seems to be the trend in cities, where family physicians are aplenty. Emergency room access is unlimited. After hour visits is not the responsibility of the family physician. The world is a good place and everyone lives happily ever after.
Unlike the rural areas where there is no choice – neither for the patient, nor for the physician. The physician gets what presents to the office or the ER. The patient sees the only physician in the area. If need be the patient gets referred to the available specialist, not unlike your “pooled referrals”. Universal, accessible health care, for everyone.
“One complaint per visit”: How do you manage this principle? Can you treat a patient to the best of your ability by maintaining this attitude? Once again – does your patient have access to any other physician to treat the remaining problems? How does this compare to your rural colleagues? Do they have any choice but to accept and treat all the complaints the patient presents with?
Bottom line is that this is about money. The 5B billing is the same, does not matter if the consult deals with one or eleven complaints. The meet and greet is to minimize complicated conditions and after hours visits.
This is the exact opposite of what you are trying to achieve with you advanced access. We will not make any progress this way.
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