Zero Sum Game

This is what I tell my patients...

The world is changing for providers.  Heavily medicare weighted, the last few years have seen a proliferation of administrative paperwork.  When not overwhelmed with forms, we are hunched over computers inputting inane information like race and ethnicity.  What we are not doing, is taking care of patients.  We are not interfacing with those that we have sworn to care for.  The covenant I have so often written about is being replaced with vague ideas of community health and meaningful use.  In no uncertain terms, we are letting you (the patient) down.  This makes me ill.

A few months ago, I had a crisis of conscience.  I could no longer sign off on this willful subjugation of the doctor/patient relationship.  So I crunched the numbers.  What I found shocked me.  Most of the revenue from my practice comes from nursing home work.  In other words, all those hours spent in the office and the hospital did exactly one thing.  They paid the bills for that very office and all my employees. It's a zero sum game.  I would be better off economically if I finished each day at nine am in the morning.

So I decided to radically change the way I care for people.  I will continue to go to the nursing homes, but I am also opening a micro practice.  Trading in my two thousand plus patients for a few hundred.  In fact, I am mostly contemplating visiting people in their homes or places of business.  My patients will have my cell phone number and email address.  When they call the office they will get me, not some nameless, faceless employee. Care will be more proactive and patient centric.  Technology like skype and face time will bridge the gap.  I will once again be able to devote the time and energy necessary for every single soul under my care.  I will still be forced to do paperwork, but when your patient load is a tenth of the size, the time consumed is much less significant. 

Of course, there are drawbacks.  To support this micro practice I will charge a yearly fee that is not payed for by medicare or private insurance.  This fee will subsidize all those individualized services not covered by traditional models.  The doctors in my area generally charge X for this type of service.  I will also charge X, but I will see you in your home or place of business instead of the office. 

In a few months, you will receive a letter in the mail outlining the details of my venture.  I invite you in joining me in a revolutionary and patient centered model of health care.  For those who decide not to follow me in my future pursuits, your medical records will remain here and one of the doctors in the office will be happy to pick you up as a new patient.

Thank you for placing your trust in me.