As you look ahead, what do you envision? If you’re like most people, you are probably eager to stay healthy and enjoy your life in the most vibrant, vigorous way possible. No magic pill or secret potion can deliver a long, healthy life. To some extent, your genes are responsible however, abundant research shows that the actions you take today matter the most. Simple lifestyle choices — what you eat, how active you are, whether you smoke — have an enormous impact on your longevity and quality of life.

A 2007 study in the American Journal of Medicine focused on adults who adopted a healthier lifestyle during middle age. The researchers followed ~15,000 adults (ages 45+) for a decade and noted that 970(~9%) of these people embraced a healthier lifestyle by the sixth year of the study. These individuals ate five or more daily servings of fruits and vegetables, worked out at least two and a half hours per week, didn’t smoke, and avoided obesity. Benefits appeared quickly. Just four years later, the group of individuals who made these four changes had a 40% lower rate of death for any reason and 35% fewer cases of heart disease compared with the participants who made fewer of these changes. No matter what your age or stage of life, you have the power to change many of the variables.  Actions you can take to increase your odds of a longer and more satisfying life span are really quite simple:

1. Don’t smoke.
2. Enjoy physical and mental activities every day.
3. Eat a healthy diet rich in whole grains, vegetables, and fruits, and substitute healthier monounsaturated and polyunsaturated fats for unhealthy saturated fats and Trans fats.
4. Take a daily multivitamin, and be sure to get enough calcium and vitamin D.
5. Maintain a healthy weight and body shape.
6. Challenge your mind. Keep learning and trying new activities.
7. Build a strong social network.
8. Follow preventive care and screening guidelines.
9. Floss, brush, and see a dentist regularly.
10. Ask your doctor if medication can help you control the potential long-term side effects of chronic conditions such as high blood pressure, osteoporosis, or high cholesterol.

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 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.

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

DocAsap’s primary goal is to help patients get appointments as quickly as possible.  Given delays after scheduled doctor appointment times average 20 minutes, and that Americans in total spend 847 million hours per year waiting in doctor office lobbies for care, DocAsap has some tips to help you get out of the waiting room ASAP:

• Schedule your appointments first thing in the morning or immediately after lunch since the doctor won’t have a backlog.  Also, schedule appointments midweek to avoid typical Monday and Friday rushes. (via eHow)
• Visit open-access urgent care centers for non-emergency same day care, as this BusinessWeek article states that they are more likely to provide care without a wait.
• Encourage your doctor or dentist to message you if they are experiencing long delays, either via email or text message, so you can show up later.

Since office waits will never completely disappear, DocAsap obviously recommends bringing good reading material, or homework if you’re a student like us, to fill your time.  We’re eager to hear more time-saving advice, so please share your own tips below.

This sure is an extreme statement. However, I firmly believe that open access to doctor booking systems would provide significant value for both doctors and patients.

Years ago, people who needed to see a doctor simply walked in, “took a number” and waited for their turn. At that time appointment scheduling was a welcome change as it brought order to the chaos. However, the results did not meet expectations. Appointment systems became complex and frustrating. Despite proper scheduling, the appointments were rarely honored. Double and triple booking by doctors to mitigate no-shows resulted in the same old wait-your-turn system.

Not just this, the need for timely access pushed more and more patients to emergency room care. Studies show that more that 50% of HMO patients would have preferred a day or two wait for their primary care instead of going to an ER. It’s just that the receptionist telling them “come next week” led them to an ER.

Open access eliminates most of these issues.

Wouldn’t it be great if you could be sure that when you call your doctor, he/she would see you either today or tomorrow instead of making you wait for weeks?

In the book, Strategic Management of Health Care Organizations, the authors talk about one such open access scheduling system – developed as part of idealized design of clinical office practice IDCOP – in Jefferson County, Alabama. The system required the doctors to provide for same day appointments. When implemented the results were startling:

• Contrary to popular belief, physicians were fine with the guarantee of same day appointments
• Revenue increased by almost 10%
• After 6 months average appointment wait time was reduced from average 46 days to 5 days
• No show rates reduced from 56% to 19%
• New patients per month increased from 78 to 95

Needless to say, the results were so amazing that Jefferson County adopted the same-day scheduling system.

Clearly, medical practices can create considerable value by enabling patients to see the doctor promptly by improving existing appointment scheduling systems. I believe DocAsap would prove to be a prominent open access mechanism that would create value for both doctors and patients.

While seeing a doctor has never been fun, it is about to get a lot easier.  DocAsap.com helps you instantly choose and book the best doctors in your area.  No more long waits.  No more flipping through the yellow pages to pick a doctor.   Just convenient doctor appointments.

We started DocAsap.com because of the frustration we felt in making doctor appointments, and we know we’re not alone.  A 2007 McKinsey Quarterly study found that 66% of patients would switch doctors for better ease of scheduling and 77% would switch for timely appointments.  By making it easier to schedule convenient appointments, we hope to make America (and ourselves) healthier by getting patients in to see doctors more frequently.

Over the next few months, we at DocAsap.com will continue to progress on our mission to bring convenience to U.S. healthcare, and we will start implementing our solutions in a doctor’s office near you.  We hope that you’ll continue reading this blog to hear about product updates and our thoughts on healthcare in America, and we encourage you to share your opinions, ideas and advice in this space as well.

Vince and Puneet
Co-Founders
DocAsap.com