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Retaking Control from Specialists

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Retaking Control from Specialists

Do cardiologists really need to be managing patients’ blood pressure long-term?

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No patient wants to hear that the next available appointment for them to be seen is in three months.

This is the predicament we often find ourselves in as our practice has grown, and the demand for patients to be seen has increased.

And the providers we refer to for subspecialty care are similarly stretched thin.

We’ve noticed a dramatic decrease in the availability of appointments, open spaces on our schedules to see our own patients and new patients, which seems to have been exacerbated over the past years as fewer and fewer providers in the community take insurance plans, and more and more patients have been enrolled under the Affordable Care Act.

Taken together, less access.

Often, when we ask a new patient what brings them here to see us, they say their prior physician no longer takes X (insert name of any insurance company).

As providers, we’ve all been faced with this dilemma, the challenge when patients need to be seen, and we all get creative when it comes to fitting them in.

We’ve all done the workarounds to deal with limited access.

Every few days, I get called by a colleague within our institution, asking me for a favor, if I can see a patient of theirs right away, often with the promise of, “Don’t worry, he’s a lovely guy, he won’t be any trouble at all.”

Lots of patients get overbooked onto our schedules, hoping that we are going to be able to get through the day, either because of a certain built-in level of no-shows, or the desperate hope that there be no clinical surprises in store for us that often leave us an hour or more behind schedule.

And when our patients are told that the wait time to get in to see the cardiologist/pulmonologist/gastroenterologist that we selected for them is much much greater than they were hoping, they often call, email, text, or send messages through the patient portal asking if we can intervene on their behalf.

“Dr. Smith’s assistant said if you were to call and tell them that you really want me to be seen by her sooner, then maybe she’d be able to see me sooner.”

It shouldn’t be this hard.

So, since we are all in the getting-patients-seen business, maybe there are better ways to improve access.

Not longer hours, not weekends, not double- and triple-booking.

If we had more efficiencies of scheduling, if our patients could reach us on the phone to either schedule or cancel appointments, if our electronic medical record allowed patients to put themselves directly onto the schedule, maybe there wouldn’t be such a problem with high no-show rates and the mismatch between supply and demand.

We are also hopeful that our new telehealth initiative will decompress some of the challenges of access, by getting patients the care they need in a much timelier manner.

A sick visit to the doctor may no longer require an hour-long commute to get there, the 30-minute wait in the waiting room, the seven-minute office visit, and then the long return home.

If we can take care of that patient in just a few minutes on a remote link through a video call, maybe even with new technology allowing us to get some real-time biometric information and maybe even remote physical examination on the patient, then we will suddenly become freed up to see more patients in the office.

As I said before, none of us are going to do this extra telehealth care without making sure the time and effort is compensated in a manner similar to what we would get from office visits, otherwise this is just using technology to figure out yet another way to give the doctors and others providing care more work that they don’t get paid for.

Another idea that we’ve been trying to sell to our colleagues, specialists and subspecialists alike, is the idea that they should work towards sending our patients back to us, not necessarily continuing to follow them for fairly basic issues that should return to the primary care doctor for long-term management.

We all have patients who have high blood pressure being followed by a cardiologist, COPD followed by a pulmonologist, reflux followed by a gastroenterologist, diabetes followed by an endocrinologist.

If we are all going to work in a truly patient-centered model of care, building an efficient collaborative system, then we all have to practice up to our licenses, and hopefully these specialists will help us, the primary care team, get most of their problems under control and then let us retake control.

The simple bread-and-butter from each of their separate fields should be taken off of their plates and returned to us, where we are ready and willing to handle it, then they’ll be available, truly available, when we need them to see the tough cases, the ones who we are having trouble figuring out what to do.

We all know that it’s easier to see the patient you’ve taken care of for a long time for the same issues over and over again, but there’s no reason for most of these cases for the specialist to still be involved longitudinally.

It’s nice to have them around in case that patient decompensates, or if we have new questions, but if not, let us take it from here.

My hope, my belief, is that we will need to return to a more consultative model, where these subspecialists see patients for one to a few visits, then pass them back to us.

This will open them up to be free when we need them.

In return, we promise we’ll see the patients you need us to, those seeking primary care, needing an internist, presenting with issues that you as a subspecialist are not prepared to handle.

Then access will truly go both ways, better for us, better for our patients.

2018-01-04T16:36:51-0500
Comments

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At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Retaking Control from Specialists

Do cardiologists really need to be managing patients' blood pressure long-term?

MedpageToday

  • by

No patient wants to hear that the next available appointment for them to be seen is in three months.

This is the predicament we often find ourselves in as our practice has grown, and the demand for patients to be seen has increased.

And the providers we refer to for subspecialty care are similarly stretched thin.

We've noticed a dramatic decrease in the availability of appointments, open spaces on our schedules to see our own patients and new patients, which seems to have been exacerbated over the past years as fewer and fewer providers in the community take insurance plans, and more and more patients have been enrolled under the Affordable Care Act.

Taken together, less access.

Often, when we ask a new patient what brings them here to see us, they say their prior physician no longer takes X (insert name of any insurance company).

As providers, we've all been faced with this dilemma, the challenge when patients need to be seen, and we all get creative when it comes to fitting them in.

We've all done the workarounds to deal with limited access.

Every few days, I get called by a colleague within our institution, asking me for a favor, if I can see a patient of theirs right away, often with the promise of, "Don't worry, he's a lovely guy, he won't be any trouble at all."

Lots of patients get overbooked onto our schedules, hoping that we are going to be able to get through the day, either because of a certain built-in level of no-shows, or the desperate hope that there be no clinical surprises in store for us that often leave us an hour or more behind schedule.

And when our patients are told that the wait time to get in to see the cardiologist/pulmonologist/gastroenterologist that we selected for them is much much greater than they were hoping, they often call, email, text, or send messages through the patient portal asking if we can intervene on their behalf.

"Dr. Smith's assistant said if you were to call and tell them that you really want me to be seen by her sooner, then maybe she'd be able to see me sooner."

It shouldn't be this hard.

So, since we are all in the getting-patients-seen business, maybe there are better ways to improve access.

Not longer hours, not weekends, not double- and triple-booking.

If we had more efficiencies of scheduling, if our patients could reach us on the phone to either schedule or cancel appointments, if our electronic medical record allowed patients to put themselves directly onto the schedule, maybe there wouldn't be such a problem with high no-show rates and the mismatch between supply and demand.

We are also hopeful that our new telehealth initiative will decompress some of the challenges of access, by getting patients the care they need in a much timelier manner.

A sick visit to the doctor may no longer require an hour-long commute to get there, the 30-minute wait in the waiting room, the seven-minute office visit, and then the long return home.

If we can take care of that patient in just a few minutes on a remote link through a video call, maybe even with new technology allowing us to get some real-time biometric information and maybe even remote physical examination on the patient, then we will suddenly become freed up to see more patients in the office.

As I said before, none of us are going to do this extra telehealth care without making sure the time and effort is compensated in a manner similar to what we would get from office visits, otherwise this is just using technology to figure out yet another way to give the doctors and others providing care more work that they don't get paid for.

Another idea that we've been trying to sell to our colleagues, specialists and subspecialists alike, is the idea that they should work towards sending our patients back to us, not necessarily continuing to follow them for fairly basic issues that should return to the primary care doctor for long-term management.

We all have patients who have high blood pressure being followed by a cardiologist, COPD followed by a pulmonologist, reflux followed by a gastroenterologist, diabetes followed by an endocrinologist.

If we are all going to work in a truly patient-centered model of care, building an efficient collaborative system, then we all have to practice up to our licenses, and hopefully these specialists will help us, the primary care team, get most of their problems under control and then let us retake control.

The simple bread-and-butter from each of their separate fields should be taken off of their plates and returned to us, where we are ready and willing to handle it, then they'll be available, truly available, when we need them to see the tough cases, the ones who we are having trouble figuring out what to do.

We all know that it's easier to see the patient you've taken care of for a long time for the same issues over and over again, but there's no reason for most of these cases for the specialist to still be involved longitudinally.

It's nice to have them around in case that patient decompensates, or if we have new questions, but if not, let us take it from here.

My hope, my belief, is that we will need to return to a more consultative model, where these subspecialists see patients for one to a few visits, then pass them back to us.

This will open them up to be free when we need them.

In return, we promise we'll see the patients you need us to, those seeking primary care, needing an internist, presenting with issues that you as a subspecialist are not prepared to handle.

Then access will truly go both ways, better for us, better for our patients.

2018-01-04T16:36:51-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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Dr Irfanullah Khan Born: 15th July,1994 in Khagram,Dir Upper KPK Pakistan. Others names:Doctor Irfo,Peshoo Education:Pharm-D Scholar Graduated from Abasyn University Peshawar. Occupation:Clinical Pharmacist,Doctor,Entrepreneur. Home Town:Dir Upper Height: 6 feet. Website:Iukmedonline.com

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