ClickCare Café

Are Primary Care Doctors Being Replaced By Urgent Care?

Posted by Lawrence Kerr on Wed, Apr 11, 2018 @ 06:01 AM

filip-mroz-172352-unsplashThe time when each family had a family doctor isn’t long behind us.


When my parents were growing up, it was common for the family doctor to know your parents, kids, cousins, and neighbors; to make house calls; and to take your full situation (social, economic, cultural, familial) into consideration in treatment. Of course, payment might be made in dollars, insurance, or chicken eggs.

That time in medicine, of course, is gone. While some elements of this system are having a rebirth (like the dawn of the concierge family doctor), the structures that supported it have crumbled.

https://www.nytimes.com/2018/04/07/health/health-care-mergers-doctors.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=1&pgtype=sectionfront

Until recently, though, primary care doctors have been a core part of the healthcare system, and the foundation of most people's experience as patients. Primary care doctors, of course: 

  • Give continuity of care, remembering your last visit and your overall life situation, embedding their perspective in these elements 
  • Coordinate care, playing the role as the key intersection point among specialists and family and patient.
  • Tend to have long-term incentives, meaning their motivation is usually providing the right care over the long term, not necessarily providing a quick fix. 

Recently, as the New York Times investigates, urgent care and "minute clinics" have begun to supersede primary care doctors as the first place people go when they need medical care. There are 12,000 across the country and as visits increase, visits to primary care doctors have dropped. There are multiple factors that contribute to this, including the key advantages of urgent care or retail clinics: 

  • Expanded office hours, which often coincide with hours that busy working people are available.
  • Affordable, clear fees.
  • Perception of faster results and more streamlined treatment. 

There certainly is no replacement for a caring doctor who can truly care for you and understand the context of what you’re going through. Many in the healthcare field worry that outcomes will be worse from urgent care approaches, that antibiotics may be prescribed unnecessarily, and that key conditions or issues may be missed. Plus, fast isn’t always better — or cheaper. “None of the research has shown any of these approaches to delivering care has meaningfully addressed cost,” Dr. Werner said in the New York Times.

That said, even the best primary care doctor doesn’t eliminate the need for excellent care coordination and healthcare collaboration. For many years, the primary care doctor seemed like the panacea for coordinated, thoughtful care. But in reality, so much has fallen through the cracks for so long. And overloaded providers struggle to do healthcare collaboration and care coordination in the right ways. 

So much is lost when we transition from primary care doctors to urgent care clinics. But something might be gained as well. Perhaps, as the traditional structures of healthcare change, doctors and patients may begin to be more open to new solutions. Demands for speed and efficiency are exposing the weaknesses of the old system, certainly -- it's up to us whether we rise to the occasion and create better things to replace what's no longer possible to depend on. 

 

For more stories of how people are using telemedicine to move forward in healthcare, download our quick guide: 

ClickCare Quick Guide to Telemedicine

 

Tags: care coordination, emergency medicine, healthcare collaboration software, direct primary care

A Doctor Removed His Own Appendix and Here's What Happened.

Posted by Lawrence Kerr on Thu, Apr 20, 2017 @ 06:01 AM

Frozen-Snow.jpgThis American Life reports, "In 1961, a Russian doctor got appendicitis at a Soviet Antarctic station, and so he needed emergency surgery to remove his appendix or he would probably die. And he was the one doctor there, snowed in during a blizzard. And so he had to figure out what to do.

And so this Russian, a 27-year-old surgeon named Leonid Rogozov removed his own appendix and lived." In the end, he recovered fully and two weeks later, he was back on the job as a surgeon."

Ira Glass, from This American Life, interviewed Dr. Doug Smink, a surgeon and associate professor at Harvard Medical school, about the story.

Dr. Smink says, "Probably most impressive to me, though, is what is the mental aspect of this. And he obviously had the perfect personality to pull this off. And then to have the courage, but also the wherewithal to assemble a team and explain to them what they were going to do while he had appendicitis."

At one point, Glass asks Dr. Smink whether he could have done the surgery on himself.

He paused. It was clear that the interviewer was expecting an answer of "Likely not." But the surgeon ended up saying, "I'd like to think I could, if given no other option."

Like many healthcare providers, I have performed minor surgery in a cave and in a restaurant. I've given people turning purple the Heimlich maneuver on the airport tarmac.

So many of us work in adverse conditions every day. And because we take our oath so seriously, in some ways it's not anything special -- it's just what we do.

This really is an amazing story of discipline, courage and ingenuity. But to me, it is a story that highlights the everyday discipline, courage, and ingenuity of all medical providers -- demonstrated so strikingly by the doctor in Antarctica. As Doctor's Day passes, I'm taking a moment to applaud what healthcare providers do everyday. They're not lauded as heroes for it; but they are heroes, nonetheless.

 

For more stories of heroism and medical collaboration, get our Quick Guide:

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: emergency medicine, good medicine

Why Community Paramedics are the Next Big Thing You've Never Heard Of

Posted by Lawrence Kerr on Tue, Nov 29, 2016 @ 10:13 AM

olderwoman.jpgWe are passionate about thoughtful, effective medical care, especially new models that work in complex situations. That's why we are big supporters of WOCNs. It's why we love these Long Term Care programs. And it's why we started ClickCare.

As we all know, long term care and care for chronic conditions is only increasing as a percentage of the total medical field. So solutions that don't treat chronic problems as acute but rather treat them as the holistic, long-term conditions that they are -- have a lot of potential to be transformative.

A new example of this kind of out-of-the-box thinking caught our eye recently, for just these reasons. It's a model called Community Paramedics or "mobile integrated health care." The model is structured to avoid frequent trips to the emergency room by folks who could be better treated at home. So when an emergency call is made, and paramedics respond, the paramedics are trained to connect with physicians via tools like videoconferencing on an as-needed basis. That usually means additional training, a team approach, and an emphasis on preventing unnecessary transport.

The New York Times quotes Dr. Karen Abrashkin, one of the leads in a Community Paramedics program, as saying, “A lot of what’s been done in the E.R. can safely and effectively be done in the home... the hospital is not always the safest or best place to be.” So the Community Paramedics programs focus on treating patients with at-home visits by paramedics, avoiding E.R. visits.

The justification is pretty simple. Emergency rooms often lead to readmissionsincreased length of stay, deconditioning, rehab and physical therapy to regain mobility, hospital-acquired infections, and delirium. These things are true with most populations, but especially true for patients with complex problems or those who can be treated/triaged instead of becoming super-utilizers of emergency rooms. 

For the patients, the consequences of this kind of emergency room visit can be deadly or contribute to a decreased quality of life. Of course, on "another side of the table", these issues also put hospitals -- especially in a pay for performance system -- under huge amounts of financial pressure.

Community Paramedics challenge the typical thinking of "we need to do this just to be safe." But "just to be safe" can kill. So we think this kind of thoughtful approach could be hugely impactful as a model. 

We would argue that videoconferencing in these situations is ultimately not the best way to go, since it necessitates physicians to be immediately available, makes the flow of treatment with the patient more challenging, and cannot be used later as a teaching case. We believe that especially when you are working with teams across the continuum of care, it's really important that consults can be done asynchronously using a healthcare collaboration tool like hybrid store-and-forward telemedicine.

It makes financial sense and it keeps people in their homes, healthy and mobile, longer.

 

Learn more about how healthcare collaboration tools can support innovative models like this one:

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Tags: long term care, emergency medicine, emergency first responders, care coordination, healthcare collaboration

Dental ER Visits Are Rising But Care Coordination is a Fix

Posted by Lawrence Kerr on Mon, Apr 11, 2016 @ 07:30 AM

firetruckemergency.jpg

 

As a company, and as doctors, we've always had a close relationship with dentists and dentistry.

My Dad was a dentist (and was even President of the American Dental Association in 1979); my brother is a dentist. One of our most important investors and advisors is a dentist (and colleague.) Also, as a reconstructive surgeon (doing a lot of work with cleft palates), dentists have always been valued and respected colleagues in the creative work of caring for these complex patients.

Dentists face unique challenges and opportunities in the world of medicine, though. When we talk about the isolation and siloing of medical providers, dentists often face the worst of it. So many of the ClickCare customers we've had who are dentists have said that the biggest benefit is care coordination.

We see one manifestation of this challenge that dentists face with care coordination in the data showing a steady rise in ER vists (many unnecessary) for dental issues.

This well documented report highlights the need of access of care. Dentistry is not alone, but the report clarifies nicely that access to care is a fundamental reason that the expensive, time wasting, inappropriate use of the emergency department is a problem. Not coincidently over 40% of this use of the emergency room is for the patient who is labeled “self pay”.

This report is worrisome for us at the patient level, the populational level, and as evidence that there is more work to be done when it comes to making the coordination of care possible and effective. Underlying the technology -- and more importantly the mission -- of ClickCare is our drive to facilitate access to care for the patient, collaboration for the providers, and education of colleagues, medical students (of all kinds), patients, and families.

Given that these ER visits will not stop immediately, and given that there are other places that could be called “originating sites”, would it not make sense to use Hybrid Store-and-Forward telemedicine to help the patient get the right care at the right time without burning out the providers and the system? Access doesn't have to mean in-person visits with every provider -- and telemedicine (especially a platform that works on your existing hardware or smartphones) can be an economical way to improve access and prevent last-ditch emergency visits.

If nothing else, medical collaboration helps with provider burnout. Decreasing telephone calls about unknown patients with unclear descriptions is important. (Home many of you know where the distal part of a tooth is?)

Finally, education about disease alone, is important, but also, educating each other about our roles, expertise and importance is, in the end, maybe more important.

The ultimate goal of care coordination is prevention -- prevention of disease, provention of unnecessary costs, prevention of conditions that could have been treated more simply in the office rather than later, in the ER. 


Are you a dentist interested in using telemedicine in your practice? You can try iClickCare for free by clicking here.

 

Tags: telemedicine, hybrid store and forward medical collaboration, provider burnout, care coordination, medical provider burnout, emergency medicine

Telemedicine Study in California Shows ROI of 200%

Posted by Lawrence Kerr on Tue, Jun 09, 2015 @ 07:30 AM

telemedicine_roi_sm.jpg

 

Many states are wisely removing barriers to telemedicine. You can see in the American Telemedicine Association's ranking of states' friendliness to telemedicine technologies that places like Virginia and New Mexico are making it easier for reimbursement and care to happen using telehealth.

Of course, some states (and some organizations) are battling these changes. For instance, the Texas state medical board recently challenged the use of telemedicine in the state (it appears the challenge may have been overturned.) All of which seems a little misguided when you hear stories of just how impactful telemedicine programs can be. Stories and data abound about their impact, excellent care, and cost savings.

Among the many (just as one example), we recently came across a great study of a pediatric telemedicine impact and savings. The University of California Davis Children's Hospital did research on the costs of implementing and maintaining a telemedicine program and compared them to 8 rural emergency medicine departments over the course of 6 years.

The researchers found that the telemedicine program improved quality, safety and patient satisfaction. In terms of costs, they found a $1.96 return on investment (ROI) for each dollar spent on telemedicine.

So it's not tough for us to see that telemedicine is worth it, especially when it's implemented in thoughtful ways. And we laud all of those pioneers who are "making the path by walking" as the data emerges to support their work.

 

If you're looking into telemedicine ROI at your organization, get your free guide to the options here:
 
 
ClickCare Quick Guide to Telemedicine

 

 

 

 

 

Photo used under Creative Commons rights from lowercolumbiacollege on Flickr

Tags: telemedicine, telemedicine roi, regulatory issues, emergency medicine, rural medicine

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