{"id":1205,"date":"2020-04-01T08:43:03","date_gmt":"2020-04-01T15:43:03","guid":{"rendered":"http:\/\/danschmidtforsenate.com\/blog\/?p=1205"},"modified":"2020-04-01T08:43:03","modified_gmt":"2020-04-01T15:43:03","slug":"progress","status":"publish","type":"post","link":"https:\/\/danschmidtforsenate.com\/blog\/?p=1205","title":{"rendered":"Progress"},"content":{"rendered":"\n
\"\"
Clunkiest Cell Phone<\/figcaption><\/figure>\n\n\n\n

Last week I saw all my patients (except one) by phone or\nonline visit: telehealth. Thanks to our global pandemic us old doctors are\nhaving to learn new tricks. <\/p>\n\n\n\n

It was telling that the telehealth, online visits were\nmostly with younger patients, and the older ones used a phone call. The patient\nhas to download an \u201capp\u201d so I can talk to them through a secure video feed.\nMany folks my age, my wife included, wonder just what the heck is an \u201capp\u201d. And\ndownload isn\u2019t about moving freight. But maybe we all will learn some things.<\/p>\n\n\n\n

Many of the staff in our clinic are busy talking to people to advise them whether they should come in to the clinic or not. The default setting is \u201cnot\u201d, but we make some exceptions. And we have made these telehealth visits common and easy. Since I am in the high-risk group for this novel corona virus (over 60) I will be doing all my patient visits from home for the foreseeable future. \u00a0It took an hour of two to get the laptop set up but I\u2019m ready for a busy day tomorrow.<\/p>\n\n\n\n

But I want you to imagine a business where you advise the\ncustomer to stay away. Doctors are used to being paid to \u201cdo things\u201d, and often\npatients expect it. We charge for the office visit, but we get paid more if we\ntake off a mole or some procedure, or prescribe something or order a test.\nPaying office medical staff to advise the patient to stay home may serve the\npublic welfare, but it doesn\u2019t make the payments on the lake cabin.<\/p>\n\n\n\n

But this is the way health care needs to be transformed.\nAnd, here in Idaho and all across this country, it is. <\/p>\n\n\n\n

When I first joined my group in this small town, they notified\nme the telephone company would be running a dedicated line to my house. You\nhave to understand, this was before cell phones. When I was on call, I stayed\nlate in the clinic and when the receptionist left after the last patient she\nflipped a switch. That switch routed all clinic calls to the phone by my bed. My\nline at home had a switch too. I had to remember to flip the switch on when I\ngot home, and flip it off when I went in to round in the morning.<\/p>\n\n\n\n

Our clinic goal was to keep our patients out of the hospital\nemergency room. We had late night (until 8PM) and weekend clinic hours. The on-call\ndoc would listen to all manner of night time complaints, offer advice and\nrarely advise a night time trip to the ER. <\/p>\n\n\n\n

As technology progressed, we moved to beepers, and even adopted\nthe earliest, clunkiest cell phone. But we never bothered to measure whether we\nwere doing a good job keeping our patients out of the ER. We didn\u2019t have the\ndata.<\/p>\n\n\n\n

But I\u2019m pretty sure insurance companies knew the numbers.\nOne year I sat in on negotiating what an insurance company would pay our clinic.\nThey wanted to pay us less because we weren\u2019t hitting their goal for getting\nwomen mammograms. I asked them, \u201cHow are we doing on ER utilization?\u201d They said\nthey don\u2019t consider that data in their contract negotiations. \u201cOK,\u201d I said, \u201cbut\nyou must know how we are doing.\u201d The representative smiled. He said we had the\nlowest ER utilization of any practice they contracted with. But they wouldn\u2019t\npay us for it.<\/p>\n\n\n\n

This is what is going to have to change. We are going to\nhave to reward doctors, providers and hospitals for keeping communities\nhealthy, for keeping costs down, and providing good care. I believe the numbers\nare out there; we just have to build a system that aligns these incentives. And\nthis pandemic is disrupting the comfortable status quo. We badly need the change.<\/p>\n","protected":false},"excerpt":{"rendered":"

Last week I saw all my patients (except one) by phone or online visit: telehealth. Thanks to our global pandemic us old doctors are having to learn new tricks. It was telling that the telehealth, online visits were mostly with … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[19],"_links":{"self":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1205"}],"collection":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1205"}],"version-history":[{"count":1,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1205\/revisions"}],"predecessor-version":[{"id":1207,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1205\/revisions\/1207"}],"wp:attachment":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}