Physicians can Take Charge of Their Practice

Dear Friends and Colleagues:
Attached an article from Sunday's Miami Herald.
I have agreed to the story to demonstrate that we as physicians can take charge of our offices, if we are willing to embrace business principles, focus on customer care and patient satisfaction, competitive pricing and the utilization of medical information technology.
Don't get bamboozled by those who suggest that Electronic Medical Records are too expensive, too intrusive and allow the "government" to take over your office.Most of those critics don't even use such systems.
I am applying an EHR in my practice for 10 years now and have learned using it as a very sophisticated tool to assess the quality of care rendered, perform chronic diseases management and to connect to my patients.
Medicine has to move into the 21st century and information technology will play an important role in this transformation process.
Let me know your thoughts and I look forward to your comments which you can post on either one of my blogs (http://floridadocs.blogspot.com/ or http://takebackfma.blogspot.com/
Yours
Bernd

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Posted on Sat, Aug. 11, 2007
Dr. Wollschlaeger redefines care
BY JOHN DORSCHNER
Imagine getting sick, going online to see what time your doctor is available and booking an appointment for the same day. You might wait 5 or 10 minutes. Later, if you have a follow-up question, it can be asked and answered by e-mail.

This is the family practice of Bernd Wollschlaeger in North Miami Beach. What he is doing offers a window into the problems and prospects of primary care in America.

Is there a catch with his concept? Of course.

A growing number of doctors are offering such services as part of a concierge practice, in which patients pay an annual fee of perhaps $1,500 plus charges for the various visits.

That's not Wollschlaeger's model. He charges about $65 or $75 for a basic office visit. The catch: You have to pay in cash. He doesn't accept insurance, not even Medicare.

That eliminates a huge amount of paperwork and bookkeeping, allowing Wollschlaeger to work by himself in a storefront operation in a strip mall.

''He's an excellent doctor,'' says Chris Lamonica, a North Miami Beach resident who has been going to him for two years. ``He's very thorough, and he cares about his patients. I do all my appointments online, and it works out great. He's very hands on -- no assistants.''

A STEP BACKWARD?

In the medical community, Wollschlaeger is known as a progressive maverick, supporting universal healthcare and the movement to all-electronic medical records. But in avoiding medical insurance, he might seem in a certain manner to be returning to the 1940s, before employer-based health plans and Medicare, when nothing interferred with the doctor-patient relationship.

Wollschlaeger insists that's not the case with him: He's not being reactionary, but a pragmatist. ''I am adapting to a changing market environment,'' focusing on the ever-growing number of uninsured people, who account for about 75 percent of his practice. Most others have high-deductible policies or are foreigners whose insurance doesn't apply here.

''I'm not opposed to third-party payers,'' he says, if they pay a reasonable fee for performance without insisting on a lot of paperwork costs.

The problem is that insurers pay primary care doctors in South Florida about $40 to $60 for a basic office visit and insist on considerable justifying paperwork. Some doctors try to survive by hiring physician assistants and bookkeepers, and race between examining rooms seeing as many patients as possible to make the low pay work.

Wollschlaeger has gone the other way and simplified: ``I am surviving in a changing marketplace and waiting for a time when the pay structure has a reasonable price.''

After immigrating from Israel, Wollschlaeger did his residency in family practice at the University of Miami, was briefly the medical director of a homeless shelter and then went to work for a physician practices company that wanted to establish an office in Aventura.

That didn't work out. Wollschlaeger said the company didn't understand how long it took to build up a primary care practice. He bought the practice from the company. ``I didn't know how to run an office. I took management courses, read books.''

As both doctor and businessman, he believed the key question was ''how can I make medicine better? It's like asking how does Toyota make better cars.'' The answer, he decided: ``Pay attention to detail and pay attention to customers.''

SERVING THOSE IN NEED

While many physicians gravitate to upscale neighborhoods to get well-off clients, Wollschlaeger decided to move to a blue-collar section of North Miami Beach, to be closer to the under-served and the uninsured. He did, however, keep the name Aventura Family Health Center.

He sees 90 percent of his patients the same day they call up. ``Timely service with the right price -- there's nothing wrong with that.''

For him, better service often means the Internet, which he knows can often make communication faster and easier in answering routine questions and requesting refills of prescriptions.

If patients want, they can e-mail him through a highly secure server operated by Medem, a tech company ''connecting physicians and patients.'' For that, he charges $15 or $20.

But the vast majority of patients simply use regular e-mail, and for that he doesn't charge. Nor does he charge for sending a PDF file of lab results.

Underlying all these services is Wollschlaeger's belief in the absolute necessity for electronic medical records, which he has been keeping since the mid-1990s.

Electronic records can be sorted and measured in so many ways that he believes they take healthcare for a new level. When warnings went out on Vioxx, for example, he could do a simple sort on his computer to find patients taking the drug and alert them with e-mails or phone calls.

Gerard Anderson, a public health professor at Johns Hopkins, says many doctors are resistant to electronic records because they're required to take on all the costs while the insurers benefit the most, because of the ease of processing claims data. ``Buying the software, buying the computer and then there's the conversion from paper to electronic. That's a huge cost.''

`YOU CANNOT WHINE'

Wollschlaeger acknowledges there are expenses. Last year, he spent about $6,000 to update his computers and software. But he insists doctors need to do that. ''You cannot whine. To make money you have to spend money.'' Postponing electronic conversion -- and many doctors are postponing -- ``your practice only gets worse.''

He believes the costs of conversion from paper are exaggerated. ''Look at the banking industry,'' once based entirely on paper checks. ``They went to online payments, online facsimiles of checks. If they can do it, why can't we?''

He says healthcare is ''generally an ineffective and inefficient industry,'' but he's not trying to change it in order to make a ton of money.

''I did not choose medicine to get rich,'' he says. His gross adjusted income in 2005 was $121,000. He drives a Honda Accord with an Obama bumper sticker. ``I have a very satisfactory lifestyle.''