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.

Hospital admissions for elderly US patients with heart failure fell by nearly 30 percent over a decade, an analysis of federal Medicare data shows, a surprising finding that offers fresh evidence of progress in the battle against cardiovascular disease. The report, being published Wednesday in the Journal of the American Medical Association, is the first to document a decline in admissions in the US for the condition, an enormously costly and debilitating problem and the most common reason for hospitalization among Medicare beneficiaries.

The finding is based on data from more than 55 million patients in Medicare’s conventional fee-for-service program who were hospitalized for heart failure between 1999 and 2008. Researchers estimated there were 229,000 fewer admissions for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels.

As a result, the Medicare program saved $4.1 billion in hospital costs related to heart failure. Heart disease overall is still the leading cause of death in the US, and this latest research comes with caveats. For heart-failure patients who were admitted to the hospital, death rates one year after that hospitalization fell only slightly—to 29.6 percent in 2008, the last year of the decade covered by the study, from 31.7 percent in 1999.

Hospitalization rates also varied significantly by state, and the improvement for black men was smaller than that of other groups. But the gains, coming as the population ages and as obesity and diabetes—both risk factors for heart disease—are enormous public-health concerns, were a welcome surprise to some heart experts. Many attributed the improvements to better preventive measures and disease management, as well as a reduction in elderly patients’ rates of heart attack—a common cause of heart failure. About 5.8 million Americans are diagnosed with heart failure, according to the American Heart Association, which estimates that total costs for treating patients, including associated indirect costs, were $39.2 billion in 2010.

Source: Wall Street Journal, health industry

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

May’09 was a hectic month for DocAsap and for us. We graduated from Wharton and DocAsap product entered active beta testing. We grew our team, built new partnerships, formulated new processes, and are more and more close to our goal. Few more weeks and we would be live helping people get doctor appointments easily.

While we worked on finding ways to increase access to care, we found many amazing people who are successfully solving healthcare access problem.  One person clearly worth mentioning in Mr. Don Parker, CEO Atlanticare health services. Of many other things, Don is also a pioneer in creating urgent care model in the southern New Jersey area. The AtlantiCare Urgent Care Centers, located in Egg Harbor Township, Marmora, Little Egg Harbor and Hammonton, offer fast, quality care for non-life-threatening illnesses and injuries that occur after hours and on weekends and holidays. When doctors are not available as is many times the case, people can go to these urgent care centers and get needed care. Kudos to Mr. Parker. He has guided us in many ways over the last few months and we hope to get more insights on increasing healthcare access from him in the coming future.