An insured patient checking out form the physician’s office paid $100 for just 10 minutes with the doctor.  What exactly this $100 covers? Why patients get shocked seeing this type of bill? Here is what that $100 is covering…

• First, doctor office schedules an appointment. It took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
• When the patient arrives, staff double checks the patient’s contact info and insurance details to make sure that it is updated on the file.  The nurse gets notification of the patient’s arrival.
• The nurse called the patient from the waiting area, measures blood pressure and weight.  And then patient goes into the exam room where nurse again takes vitals, make notes around the visit reason, medication, last visit, etc.
• The physician came in to see the patient, asked about any changes since last been seen, reviews history of present illness and examines the patient. He talks about the illness and the treatment plan and prescribed a medication. He updates patient’s medication list and makes a copy of the diagnosis form and hand it out to the patient for the records.  The patient goes to the check out desk.
• The physician refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled.  The chart was filed, and the encounter form was sent to the billing office.
• At the billing office the charges and any payment gets posted and the claim was filed.  If there is no problem with the claim, it electronically gets processed.
• If payment was not denied, the payment arrives at the billing office and would be posted.
• If patient did not pay at the check-out desk, the patient-responsible balance is billed to the patient.  If the patient pays on the first statement, it has taken 45 to 60 days to receive complete payment.

The 10 minute office visit involved the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller.  It took 8 people, and at least 45 minutes of work to make that appointment happen.  In addition, that visit paid the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.  We all want efficient and quality health care but it is not cheap.

Thanks to KevinMd for giving this useful insight.

The new survey by Wolters Kluwer Health shows that 46 percent of doctors frequently use sites like Google and Yahoo for treating, diagnosing or caring for their patients; 68 percent of doctors dig through professional journals and 60 percent of doctors seek their colleagues advice, 42 percent get their information from conferences and events,  and 42 percent say they use online health sites like the Mayo Clinic and WebMD and 46% use general browser such as Google and Yahoo as a frequent source of information.  Nearly 9 in 10 physicians feel that improved access to online medical information and resources has improved the quality of care at their practice

The survey findings also note that “63 [percent] of physicians report changing an initial diagnosis based on new information accessed via online resources/support tools,” researchers wrote in the survey report.  The survey involved responses from more than 300 doctors who are members of the American Medical Association; about half of the respondents were primary care doctors, and the other half were specialists.

In 2006, the British Medical Journal published a study showing that Google is a useful tool in doctors’ toolkits, especially when it comes to difficult-to-diagnose illnesses. In that study, doctors plugged three to five search terms into Google of 26 diseases that are notoriously hard to diagnose (including Cushing’s syndrome and Creutzfeldt-Jakob disease).

Researchers found that Google was right 58 percent of the time in diagnosing the diseases, though they acknowledged that the person doing the Googling needs to also have a wide knowledge base in order to know what to search for.  As the Wall Street Journal points out with regard to the most recent survey:  No one says Google and Yahoo don’t lead people to tons of useful info — just that it can be tough to sort the wheat from the chaff. Physicians, presumably, can assess the quality of the health information they dig up better than the average consumer.

Doctors aren’t the only ones Googling health info — a Pew study shows that 61 percent of Americans go online for information related to health. This new disruptive technology which is offering autonomy and access to information can help both patient and the physicians in achieving better clinical outcome. It would improve doctor-patient relationship as well as patients would get more if they show up at the doctor practice with little more planning and information.

Hospital emergency departments are turning to a number of strategies to reduce wait times, amid growing concern about patients who leave without being seen.  Leaving without treatment can lead to lost revenue for hospitals and health risks for patients.  The national average of those who leave without being seen was about 2.7% in 2007-08, according to the most recent government data available. This is up from 1.7% between 1998 and 2006, according to an analysis by Johns Hopkins University researchers

“People who walk out without being seen are a measure of how we are basically failing as a health system in our ability to deliver important care in emergency departments,” says Renee Hsia, assistant professor of emergency medicine at the University of California San Francisco.

A recent study she led that was published in the Annals of Emergency Medicine shows the left-without-being-seen rate in California ranged as high as 20.3%. Visitors to hospitals serving a high proportion of low-income and poorly insured patients were far more likely to leave without being seen.

Hospitals are tackling a costly side effect of emergency-room overcrowding and long wait times by turning towards “lean” management techniques to speed patients more efficiently through the ER. Following are some effective measures:

1. Posting wait times online or in the waiting rooms at different facilities so patients can chose the shortest option. Akron General Health System in Ohio went one step further last year and began providing live streaming of wait times on highway.
2. Streamlining the traditional methods of triage and reserving beds for only the sickest patients, abandoning the longstanding rule that every patient gets a bed.
3. Staffing the ER with less-costly providers such as nurse practitioners and physician’s assistants, so more expensive ER doctors can focus on care and not on paperwork and discharge plans.
4. Allowing incoming ER patients to be quickly identified and tagged with a bar code linked to a new medical record. Rather than try to create a full medical record, patients were directed to the nearest available emergency room bed immediately after they were triaged as mentioned by Dr. Ted Chan, who works in the ED at the University of California, San Diego, Medical Center, where the average wait times for emergency patients hits two hours during peak demand periods

In addition to aforementioned measures, new protocols such as qTrack designed by department of emergency medicine at New Orleans-based Ochsner Health Systems relies more on providers like physician’s assistants for less-ill patients. Unlike traditional triage, which might take 10 minutes, qTrack has nurses giving a “quick look” evaluation to get basic information in three to five minutes.

A similar program, Door to Doc, which includes a model hospitals can use to match staffing levels to peak-demand periods, was developed by Banner Health, which cut the rate of patients who left before being seen to 0.5% from 8% in 2007.

A new form of E.coli (Escherichia coli-STEC) is causing lot of trouble in Germany, so far 17 people have died and several got infected.   It is causing bloody diarrhea and affecting Kidneys and considered to be “highly infectious and toxic”

As recorded by BBC, Dr Dilys Morgan from the Health Protection Agency says the E. coli outbreak is “alarming, it mainly affects young children and older adults, but what we’ve seen is predominantly young females getting this condition. It’s a very rare organism that’s causing this and it’s thought it has particular properties where the toxin it produces is particularly virulent and therefore is affecting this population more than we would normally expect.”

Professor Hugh Pennington, a microbiologist from the University of Aberdeen, said: “This outbreak is unusual in that it doesn’t seem to be targeting young children, usually children under five have had a very hard time with this kind of bug in the past, they seem to be escaping it, maybe just due to the nature of the food that’s causing the problem.”

According to the Centers for Disease Control and Prevention, to prevent Shiga toxin-producing E. coli (STEC) infection, you should just follow these simple things:

• Wash your hands thoroughly after going to the bathroom or changing diapers
• Wash your hands thoroughly after handling animals, animal bedding, or any material contaminated with animal fecal matter
• Eat only thoroughly cooked ground beef, pork, sheep meat, or sausage.
• Cook ground meat products to an internal temperature of 160ºF
• Avoid drinking unpasteurized milk and juices
• Wash fresh fruits and vegetables thoroughly before eating raw
• Prevent cross contamination in food preparation areas by washing hands, counters, cutting boards, and utensils after they touch raw meat.
• Keep raw meat separate from ready-to-eat foods

As long as you are doing aforementioned, you shouldn’t worry too much.  Ask your physician if you have any more concerns around this.  Just remember prevention is the key to a good health!

Use DocAsap for timely appointments. 

The Government’s vision to create a Health Information Exchange (HIE) has the potential to provide a comprehensive patient history at the point of care. In addition to this data exchange, Internet and “meaningful use” of electronic health records will have a positive and significant impact on the delivery of healthcare and its associated costs. This new arrangement will improve the collaboration among providers and health facilities.  The integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and University of Pittsburgh Medical Center are extensively utilizing technology to improve access.  These big groups are combining doctors, clinics, hospitals and often some insurance and capturing the financial savings from electronic health records.

However, despite all the benefits, adoption of technology is slow in most of the small practices.  It is surely a change in “status-quo”, and as such small practices do not get financial incentives to use computerized medical records and for some practices it is very time consuming process to convert paper records into electronic records.

“And there are privacy and patient centered concerns as well” said Dr. Donald Tavakoli; a Philadelphia based Psychiatrist. “Obviously for psychiatrists, mental health issues and therapy notes raise a major concern of “discoverability” and differ from the rest of medicine (at least in some people’s minds).  Not to mention, typing with a patient in front of you, which happens a lot with electronic systems, takes away from the doctor patient relationship.  On the other hand, legibility, access to records, and streamlining for billing purposes can increase efficiency and decrease redundancy in testing etc.”

Dr. Tavakoli said “technology being incorporated into practice is a good thing as it increases access (as DocAsap proves), increases efficiency, and decreases risk of errors.  And at the end of the day, it is inevitability.  Increasingly, I’m hearing about things like Ipad’s being considered as notepads for clinicians, which could offer simply touch screen checklist items to mark off during evaluations, this not only reduces medical error but healthcare costs as well.  And it is possible increased technology and Electronic record systems dovetails with increased “checklist” medicine.  The big concern is that in healthcare, sometimes the art of medicine can have immeasurable value, and the doctor patient relationship is crucial (and mental healthcare tops that list, especially with psychotherapy, but it is true in all of medicine).”

Please check Dr. Tavakoli’s profile at DocAsap

We recently came across an interesting article that discusses the challenges of locating the right information to help select a primary care physician.  Some interesting points:

• Determine if your insurance is compatible with the doctor’s practice.
• What is the doctor’s hospital affiliation? Is the doctor affiliated with a reputable, nearby hospital?
• How convenient is the doctor’s office to your home?

In the coming weeks, DocAsap will be launching with primary care, allowing you to find this information, and more, with ease.

An interesting NYT poll indicates that America’s growing frustration with the rising cost of care is driving them to support government-based solutions rather than those from private insurers.  Many prominent voices in healthcare seem to agree that the existing pay-per-procedure insurance model does not promote efficiency, providing proverbial wind to the Obama administration’s reformist sails until the Congressional Budget Office released costly estimates on the universal health plan.

HealthBeat argues that the government can provide universal access to care in way that does not jeopardize the country’s financial health or raise overall health care costs.  If the Obama administration can get doctors and insurance companies at the same table to emphasize efficiency-based rather than volume-based compensation, maybe the cost of care in the U.S. can decrease over time.  Still, major efficiencies will take time to materialize, necessitating tax increases to pay for the plan.

The NYT poll shows that Americans’ willingness to shoulder higher taxes is largely partisan, with Democrats supporting them and Republicans more mixed.  If tax increases are indeed necessary to bankroll universal health access in the short-term, we are likely in store for a long battle in Washington on this issue.  Stay tuned.

Health Affairs made available an article entitled “Take Two Aspirin and Tweet Me In the Morning”, which concerns patient empowerment via social media technologies.  It’ll be interesting to see how social media uniquely evolves in healthcare, as privacy issues loom and doctors might not buy in to it unless economic and clinical value is clearly evident.  Firms like Kaiser and Hello Health that are giving patients better access to care and more information are ones to watch, though the article also alludes to the nascent nature of such endeavors.   Furthermore, pure online treatment will likely only ever be an add-on to traditional offline doctor relationships, as you can’t take a shot, get a root canal or perform surgery via the internet (at least not now!).  Still, getting more information about and communication with doctors might radically improve access to care, something DocAsap is passionate about.