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Why Our Medical Practice Won't See Nursing Home Patients

Our practice will no longer see nursing home patients in our office.  If a nursing home patient is already established with us, then we will see him; but, we have decided not to accept new patients. Of course, we believe that these individuals – like the rest of us – deserve medical care.  This demographic not only deserves care, but has the greatest need for medical services.  Our practice will see every person who wants to see us, including the uninsured.  Why, then, would a welcoming practice like ours close our door to new nursing home patients?  We just couldn’t take it anymore. These patients, who often have serious physical and mental challenges, would typically arrive to our office accompanied by a driver, who naturally has no medical knowledge.  The patient often had no awareness of the reason for the visit.  The ‘medical record’ consisted of a nearly indecipherable list of medications of uncertain accuracy.  Typically, no reason for the visit was documented, or ther

Quality Indicators in Colonoscopy - A Three-pronged Test for your Gastroenterologist

One thing that gastroenterologists know about is stool.   But, I’m not referring to that kind of stool in this post.   Follow along . When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool.    This metaphor illustrates that the three legs must be equally strong or the stool will not stand.   The three pillars of support that a colonoscopist needs include: Knowledge Skill Judgment All 3 Legs Needed As the gastroenterologist guides the colonoscope along your long and winding colon, he may discover a lesion.    He needs knowledge to identify the intruder.   Is it a cancer or a benign polyp?   Could it be Crohn’s disease or some other form of colitis?   Is it a normal structure that simply appears atypical? Obviously, the more experienced the gastroenterologist is, the more likely he will be able to identify the abnormality. But, every gastroenterologist, regardless of experience, confronts lesions

Medical Practice Hassles Torture Patients and Doctors

We do most of our colonoscopies in our ambulatory surgery center (ASC), which is attached to our office.  We are proud of the work that we and our staff do every day and are grateful for the outstanding feedback that we consistently receive from our patients.  Some insurance companies will not cover procedures in our ASC so these patients must get ‘scoped’ at the hospital instead.  For many of them, this means required blood tests a few days in advance of the procedure, which we would not have required for an ASC procedure.   On the procedure day, the patient and the driver will enjoy spending hours in the hospital for parking, checking in, interviews with various medical personnel, the procedure and the recovery period.  And, since it is a hospital, delays are inevitable.  Not only does this experience take hours longer than it should, but we are mystified that an insurance company would take on the expense for a hospital test that we could do more efficiently and cheaper in our ASC.

Insurance Company Denies Coverage for Drug - Part II

Last week, I related a vignette where a routine medication refill was denied by a patient's new insurance company.  The patient had developed symptoms 2 weeks after he ran out of the medication. I surmise that 100% of gastroenterologists surveyed would have agreed that refilling the medication was the next step. So, even though the best medical option was to refill the medicine that we know has worked, the new insurance company won’t cover it and the patient cannot afford to pay retail for the drug.  (As a separate point, I challenge anyone including those with PhD's in economics to explain retail drug pricing.)   The patient did his best to navigate the insurance company’s website and found a colitis medicine that is covered, but it is medically inferior.   Should we just cave and prescribe it to save money and a hassle?  Is this an issue that we want on our sick patients' agendas?  How would you like to face surgery and be told that the newer clamps and scalpels are o

Insurance Company Denies Coverage for Drug

A patient came to see me recently with a suspicion that his colitis was recurring.     In general terms, colitis describes a condition when the large intestine is inflamed or irritated.   Typical symptoms are diarrhea, abdominal cramping and rectal bleeding.   This patient was concerned as his last 3 bowel movements were diarrhea.   He had been on a medicine called mesalamine, a safe and effective treatment for colitis, but he ran out of it 2 weeks ago.   While he was taking the medicine, he felt perfectly well.   So, his bowel change developed 2 weeks after he ran out of his medicine.   For readers who like to play doctor, choose among the following options: Schedule an urgent colonoscopy to verify that nothing has changed since his colonoscopy 6 months ago. Observe the patient without any treatment to give him time to heal himself. Recommend probiotics to restore his digestive health. Refill the mesalamine at his usual dosage. Request a 2 nd opinion because the case is

Blockchain

First there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking.   (Wasn’t the Titanic said to be unsinkable?)    We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago. My own state of Ohio will now accept Bitcoin as payment for commercial taxes.   And, of course, there are many other cryptocurrencies mushrooming around us.   In my life, many innovations seem to be solutions in search of problems.   I don’t find my current methods of transacting business – cash and credit cards – to be so onerous that I am screaming for a new way to conduct commerce.   But, I will admit that I have security concerns about my credit card number and other highly personal data being ‘safely stored’ all over the internet.   Some years ago, I enjoyed the thrill of being a victim of identity theft,

Hospitals Seek Donations from Patients

Many organizations solicit private donations from benefactors and philanthropists.   Is there a stadium in the country that does not bear the name of a prominent donor?   There are also anonymous donors who are not cursed with egos that require their names to be emblazoned in giant font on a building’s façade.   But, most donors want recognition which is often used as an incentive when soliciting the donation. Donors understandably receive perks and privileges that ordinary folks will never be offered.   If you give a ton of money to a theater, you might receive prime season tickets as a gift.   If you make a sizable donation to a symphony orchestra, you may be invited to a private event to meet the conductor and leading musicians.   If you make a robust financial contribution to your city’s art museum, you won’t have to worry about competing for limited tickets to view the visiting Picasso exhibit.   You may very well have your own private tour. There is nothing venal about