Let’s hope for change in the medical world

imgresOn Friday night I started coughing about 9pm.  No idea where that came from but I was obviously getting sick.  Could be that I have run myself ragged the last month, it could be the change of weather, it could be a variety of things.  That night I woke up a few nights wheezing.  I was a bit concerned.  The next morning Fred said you were wheezing all night long.  Ugh.

We were out at the beach so I made sure I was the first person at the local clinic when it opened on Saturday morning.  It is a great clinic that I found out later has been run by several groups.  It is changing hands one more time in January and being run by the hospital in Southhampton.  It is hard to make money on the clinic and each group got tired of all the back end of running the business vs the real business at hand; treating patients.

Anyway, I got in quickly and saw a young energetic doctor.  She called in some meds and gave me a treatment while I was there.  It was really efficient.  We started to talk about how difficult it is to make money as a doctor and how these clinics, although great, are financial losers.  She was working at the clinic on the weekends and worked somewhere else practicing medicine during the week.

I told her about Captureproof.  Captureproof is HIPAA approved (which is key for doctors) so she could track and follow patients through the app after the initial visit which based on the results that CP has got it cuts down on the second visits by 80% and saves insurance companies almost 80%.  That is a win win for everyone.  The doctor wanted to understand how she would get paid on the second visit if it was through a photo and a quick message.  I didn’t know the answer but I am assuming that she will gets paid a co-pay based on the insurance.

This doctor has $300K in debt.  She went into medicine because she loved it and wanted to help people.  We need more people like her and yet our medical system remains a mess.  She is not only dealing with providing care she is dealing with the front end of a business to make sure she makes money.  That includes chasing down insurance companies for the co-pay.  It is utterly ridiculous.  We need to make doctors lives seamless so they can concentrate on what they set out to do and that is not being a business person.

I look at Captureproof, and have been part of the journey signing up hundreds of doctors including Blue Cross Blue Shield and Kaiser Permanente.  I hear the data that comes back to help make the medical world more affordable and seamless.  This is the beginning of a massive change that will happen over the next ten years.  Technology will hopefully allow doctors to be doctors and make sure that every one has access to preventive healthcare.  At least let’s hope so.

Comments (Archived):

  1. ellen sing

    Preventive healthcare is just a buzz word. Did you know that some health insurances pay for a colonoscopy if nothing is found, but if a growth is found then the copays and deductibles apply for that colonoscopy.”Preventive healthcare” is just jargon. If you get sick then you need real healthcare. One preventive doctor’s visit is not costing that much if something is found, it is the regular care coverage that is really important and what should be focused on.My husband is a heart failure survivor. There is a service that has been great. I take his blood pressure, oxygen, heart rate, and weight each morning and by dial up it goes to a monitoring service and they will email the nurse practitioner if there is an unhealthy change. The nurse practionioner must be alert to see the changes though. If no one reads the data it is useless. Of course I must be present to actually do the pressure etc. I love the backup but I will soon lose this service if I can’t come up with $250 a month out of pocket to continue. That isn’t huge but if you add up the copay of $630 for the zoll lifevest and their monitoring system and many other expenses plus the insurance premiums each month, this can become out of control.Remember when the bread winner gets sick there are still all of the same expenses but no regular income and then you must add the huge out of pocket cost for sickness even with a very expensive insurance plan.Captureproof sounds like a good additional tool, but there is nothing like actually evaluating the patient in your examining room to see exactly what is going on. I wouldn’t mind having a mini ekg that i could hookup and take a reading myself. That would be a big help too to the arsenal of things i do and watch for.

    1. Charlene Ngamwajasat MD

      Sorry to hear what you are going through. Home care can be very expensive & often a lot ends up coming out of pocket. Found a list comparing smartphone EKG devices so you don’t have to deal with buying paper and ink/all the wires involved when you use a traditional machine http://www.ndsu.edu/pubweb/

  2. LE

    When I met my 2nd wife she had her first job out of medical school and residency. She was living hand to mouth (as a single mom with 2 kids) and after knowing and dating only perhaps 2 months she literally had no money in the bank. One day she was crying and upset and I asked her why. She said she couldn’t pay her rent. I gave her $2000 so she could pay her bills and rent. She had about 200k in medical school debt. She also had a ton of credit card debt. Yet with her job she was having money taken out for “retirement” which would be about 30 years away at that point!I said “why are you worried about retirement just use that money to pay off the credit cards!!”. So it was a combination of debt but also lack of financial common sense and not yet having a good paying job.Today of course (6 years later) things are much different. She earns a ton of money and has no problem at all paying back the loans that she has. Not only that but her job covers her healthcare as well as my kids healthcare as well (that’s worth about $1200 per month right there). [1]Also I would add that in my first business out of college I had to get equipment that at the time cost between 150k and 200k and had high priced loans at the time to pay for that. Yet I had no where the guarantee of income that a Physician has. The debt may very well be an issue for an attorney who can’t find a job for sure but from what I know (and I know quite a bit actually) it’s not a big issue for someone in medicine. They can pay the loan back over 30 years (at 3%). My loans were amortized over 5 or 8 years at perhaps 15% in the 80’s.[1] As a woman they tried to take advantage of her on contract renewal. They sent her a contract with no increase in wages but of course with my help we fixed that situation pretty quickly.

  3. LE

    She is not only dealing with providing care she is dealing with the front end of a business to make sure she makes money. That includes chasing down insurance companies for the co-pay. It is utterly ridiculous. We need to make doctors lives seamless so they can concentrate on what they set out to do and that is not being a business person.There are companies that do that for physicians. I had a tenant that was a member of a group that took care of billing, contract negotiations all of that. They charged 10% of billings and just raised that to 15%. At that point the physician has already let go their own staff so they are locked in. That’s a great business by the way. Physicians are typically clueless and don’t have the time, patience and knowledge to manage what is a fairly easy process actually. I could do that and play tennis at the same time (I don’t play tennis).I just spoke to another potential tenant the other day, a neurologist, who told me a group of 26 doctors in our area is forming what she called “a physicians union” where they will own the group and all be partners. The group will manage the back end and deal with insurance companies all of that. They hired an administrator to run the group as well. I don’t have all the details but it sounds like a decent concept and I’m sure it’s being done like that all over. The group mentioned in paragraph two above is a for profit group not owned by the physicians in contrast.I had a customer in the 80’s that managed physician practices.They even bought cars for the doctors and gave them other help (even with home affairs) so they could concentrate on medicine.

  4. pointsnfigures

    had lunch with her during TechStars Chicago. Great person. Glad she is doing well.

  5. Charlene Ngamwajasat MD

    I understand the situation. I went into medicine because I wanted to help people stay healthy and/or manage their health problems so they would be able to live their lives to the fullest extent possible.I left clinical practice when I saw that things really needed to change in terms of loss of autonomy, inertia, patient care, health policy and technology. It was hard to bring change about internally so I decided to leave to bring about change externally. Most docs carry 100K to 300K of debt. This article on KevinMD called “Dear Lawmakers, This is What It’s Like to Be a Doctor Today captures what many feel (prob one of the most shared articles on that site) http://www.kevinmd.com/blog…Doctors are trained to take care of patients, not to run a business, but that is disadvantageous because you need to know enough to keep the practice solvent. Sadly, many practices have closed due to insolvency or physicians leaving the practice of medicine to pursue other interests because of disillusionment or because they are retiring.I agree that tech can help docs manage their practices, their patients, and themselves. Docs also aren’t trained in tech which is also strange cuz they use it every day. Thing is until just a few years ago, there were no incentives for adoption & as more practices close and large health systems dominate, administrators will make more & more of those decisions. What I see with the digitization of healthcare is the migration of care from hospital to home. Policies are being written to facilitate that in terms of bills coming up for multi-state telemedicine licensure and re-imbursement for digital encounters. It’s time for incentives and payment to align with patient care and docs to get paid for work related to that. Your example illustrates that. Following up as described would be so convenient & helpful for patients but docs don’t get paid for that. A lot of times caring docs, in addition to mounds of info review, certification, licensure, & institutional requirements, paperwork (still) etc will do things in the care of their patients at the expense of their financial & social well-being, and then they burn out and close up at a time when there are severe physician shortages & the aging population needs them most. Things are changing, slowly but surely and I actually am hopeful.