Tag: flexibility

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Challenges of this Career

Special thanks to a kind and generous patient, Peter F, who shared this New York Times article from last week with me [see below], and regularly supports my practice with his trust and exploratory inquisitiveness.

It is with humility and regret that I will be raising rates once more for the services we provide here at Thrive Adult Primary Care. I have debated with myself fervently about how to ask patients to pay even more than they already do for their healthcare. The NYT article touches on those themes, which may manifest differently for doctors “in the system” compared with the handful of us who remain trying to keep our operations small and independent. But the end of this article actually reflects on that, too, which I greatly appreciate.

The bottom line is that United States Healthcare is deeply dysfunctional. I have been opining for years that it “is a behemoth structure of popsicle sticks held together by duct tape and Crazy Glue.” However, the pandemic necessitated and thereby introduced a severely wily network of sinews to uphold it, in the form of artificial intelligence engines, third-party-upon-third-party workflows, legislative edicts and revenue streams.

So it is not going anywhere anytime soon. “The System” as everyone calls it colloquially, is simultaneously indispensable and inefficient. And it is no longer only patients who suffer beneath its mutative, misshapen shadow. Rather, ALL stakeholders are being impacted by its weight and grasp, including and especially those who are in positions at the foundation of it all, obligated to prevent it from tipping and eventually crashing upon those it was supposedly designed to protect.

Anyhow, there I go again, unnecessarily waxing philosophical. Meanwhile, I suppose what I’m doing here is attempting to self-alleviate guilt over asking patients to help me keep my practice open. Costs have gone up — everyone sees it. This includes rent, gas (whereas I do plenty of home visits including at distances as far from the office as Wellesley, MA), utilities, various forms of insurance, and professional services that are essentially mandatory for operating a medical practice such as having a CPA, a business lawyer, payroll, hospital affiliation… and on and on.

As a reminder: yes, we “take Medicare.” But please be aware that this contributes progressively less and less to the revenue stream of the practice. Medicare is a shared resource among ALL citizens of the United States. The greater the population, the greater the needs, the greater the output without a synchronous increase of input… the less there is to go around. Each service we provide, for which billable claims are submitted to Medicare, has been DECLINING in dollar value through the years. Meanwhile, there is more work to do for each service rendered — more documentation, more forms to complete, more ancillary services to interact with… Imagine trying to run a contracting, plumbing, restaurant or other business in today’s economy where your resources consume more time, energy and cost while your own prices keep going down because you don’t control them. We have no say over what Medicare pays. Whatever they pay is all we get.

I will not be laying off employees to cut costs. We have MORE work to do (as just described), so they are each essential in their roles. I HAVE suspended my own salary so the practice can stay operational without debt. But with my own personal living expenses to pay, of course that can only go on for but so long.

The world has changed and I am praying my patients can understand. Please believe I have analyzed each case and calculated rate changes for active, loyal members in an effort to remain your doctor while upholding the margin that it takes to keep us operational, both this year and moving toward the uncertain future. And I am more than willing to have discussions on an individual basis for anyone who feels truly unable to financially keep up with the adjustments.

To cap it all off though, with an ear to the ground, we are shifting our goals and identity to remain relevant and sustainable in this ever-changing global atmosphere. We hope to be a federal 501c3 nonprofit by the end of the year, and creatively generating Healing, over “healthcare.”

It is a slow but steady and worthwhile climb. Stay tuned, and thank you for tuning in thus far.

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The Secret to Longevity is Pliability – and change is on the horizon

Despite having grown up in New York, I am a proud and mildly obnoxious fan of the New England Patriots and the intensely competitive while ever-classy Tom Brady.  I mean, what can we say: they’re awesome, no matter what you throw at them.  Kinda makes you want to emulate their habits.

My favorite lesson from my favorite Quarterback is one I’m not sure I’ve heard him say in so many words, but it is the title of this post.  Any fans who are paying attention will be aware that TB12’s new key word is “pliability.”  In other words: flexibility, the capacity to adjust and adapt.  As he keeps demonstrating through victories that defy age, the Fountain of Youth for athletes is not a rock-hard exterior, ironclad power, or even talents like speed or agility.  No, indeed: remaining competitive with young guns is all about rolling with the tide even when it comes after you like a tsunami.

I have come to two conclusions of my own based on this concept:

  1. There is always and only one standard worth achieving: BETTER.
    No matter how much or how little improvement has been accomplished, there is never a ceiling to how much further improvement can be achieved, and there is also no reason to dwell on shortfalls compared to an idealized goal.  As long as the average trajectory on any path moves upward –even if it moves down a little before moving up a little more– I believe it is safe to call it “the right track.”
  2. Pain is only relevant to the extent that it points to danger.  Once danger is eliminated from the equation, pain that is endured rather than eliminated leads to strength.
    Discomfort of any sort tends to lead to a hard stop for many, if not most, people who were otherwise on a journey towards personal betterment.  I’m going to call it a fortunate circumstance for myself to have grown accustomed to pain, depression and anxiety through various circumstances in life… fortunate, because despite some hard hits, I’m still here.  That simple fact opened up an opportunity to understand that even some unthinkable horrors thus far have not stopped me, until I came to a point of realizing I can CHOOSE to not be stopped, regardless of painful circumstances.

    I’ve learned this mostly from my new experiences with athletic performance doing CrossFit.  As long as the pain doesn’t point to some hidden threat, or as long as any potential threats are mitigated expeditiously (e.g., ice is applied immediately to a muscle or tendon strain), I keep on coming out stronger and stronger… more flexible… more capable… in spite of subjecting myself to the transient pain of the workouts.  Upon reaching this epiphany, I began to push myself harder, then developed acumen at understanding the limits beyond which I should not push lest I risk danger of injury, then rapidly identified the limits so as to practice nudging just a little more with each workout…

    Then my new epiphany was that I can do this in other areas of my life.  Mental and emotional discomfort became the new frontiers of limit-testing.  Until they have become the new frontiers of emboldening strength and endurance.

The ability to change when faced with challenges is the Secret to Longevity… The Fountain of Youth, if you will.

Well, change is on the horizon at Thrive Adult Primary Care.

First: a new website is under construction.  Please click here to check out our new Home Page.

Second: starting on October 1, 2019, we will be accepting Medicare!  This will continue to be the only health plan through whom we will process third-party payment for the foreseeable future.  This will mean lots of different things to different patients who carry Medicare plans, but for our active member patients whose insurance does not involve Medicare at all, NO CHANGES will be made to the current Direct Primary Care (DPC) memberships.  More info will be shared in the weeks to come.

Third: our DPC pricing plans will also change significantly starting October 1, 2019.  Once the rate schedule is finalized, information will be posted.  But our current published rates will only be valid through September 30, 2019.  So if you’d like to take advantage, contact us soon!