Tag: health care

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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.

nyt-2023-06-15-the-moral-crisis-of-americas-doctorsDownload
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Double Down on Protection

When it comes to defense, does it get better than this?

Only if you have properly vaccinated against Influenza!!
(Come on, this is a medical website — bad jokes are inevitable)

Visit our Open House 10/17/19 and get protected!

We are excited to partner with MBs Pharma Care
in hosting our First Annual Flu Clinic
at the Thrive Adult Primary Care office
on Thursday 10/17/2019 from 9am – 5pm

This event is OPEN TO THE PUBLIC, and ALL INSURANCES are accepted
for coverage of your annual flu vaccine!

Yes, in the medical field we recommend annual flu shots for everyone.  We do this for a phenomenon called herd immunity, meaning that we aim to reduce the exposure of individuals who are susceptible to severe disease by immunizing everyone.  Influenza is not your typical cold virus.  It has been known to cause fatal outcomes in certain populations, generally the very young, the very old, and the chronically ill — that is, people whose immune systems tend to be weaker than average.  Healthy individuals with strong immune systems can contract influenza and have it manifest as nothing more than a really bad cold.  However these people are still contagious and therefore may potentially spread the virus to others who are at risk for a worse outcome.  I am typically pushier about advising someone to get the vaccine if they have regular contact with these susceptible individuals, all the more for someone who is one of them.

I have heard the argument that, “every time I get the flu shot, I get the flu.”  Let’s make it clear that it is impossible for this to happen with the injected flu vaccine.  In this formulation of the immunization, it is as if the virus particle has been broken in half before being introduced to the patient.  A broken virus cannot replicate and therefore cannot generate infection.  However the whole purpose of the vaccine is to activate your immune system to generate antibodies so that if the real flu comes along, your body will be prepared.  The activation of your immune system feels a lot like how it would feel when your immune system is trying to fight off the flu in the case of an actual infection.  So some people will potentially develop low-grade fevers, body aches, weakness and fatigue.  This should last no more than a couple of days, and be assured that it is not an actual infection with influenza.  The nasal flu vaccine (“Flumist”) does in fact contain a live virus, enough to trigger an immune response but rarely enough to cause infection.  For several years in a row, Flumist showed no protective benefit against contraction of the flu virus, and was not recommended for the 2017-2018 season, but for the 2019-2019 season, protection against H1N1 virus has been added to the nasal flu vaccine and is felt to be beneficial for appropriate individuals.

I do advise patients who are actively ill to avoid the flu shot.  Again, this is not because the vaccine can cause an infection with the actual flu virus, because it cannot.  However, when a person is sick, their immune system is already busy trying to heal them from their current illness.  Giving a flu shot under these circumstances only adds strain to the immune system when it has a job to do; as a result, it may both prolong the active illness and reduce the likelihood of developing an effective immune response against Influenza.

Rare adverse effects are possible with the flu vaccine.  Probably the scariest of these is known as Guillain-Barre Syndrome which is a type of short-term paralysis that starts in the feet and legs and may ascend to the upper body.  This is exceedingly rare, but of course anyone who has had this type of reaction to the flu vaccine in the past should avoid it in the future.  Also, the majority of available flu shots are prepared using eggs, so folks with an egg allergy should ask whether an egg-free preparation is available where they are planning to receive the flu shot.  In general, anyone who has been able to tolerate the flu shot in the past should have no problem with the shot this year, either.

Finally, on rare occasion a savvy patient will bring up the presence of a mercury compound in the flu vaccine. This is thiomersal, or thimerosal, which is a widely used antiseptic preservative that suppresses the growth and reproduction of common bacteria. It does metabolize the the human body to a form of mercury that can be toxic in significant amounts. However the quantity of thimerosal in a dose of flu vaccine is less than 2.5% of what is considered safe daily intake. Meanwhile a flu shot is needed only once a year. If you want to reduce your body’s exposure to toxic chemicals you would be better off monitoring your daily intake of sugar, salt, or artificial sweeteners. But that is a blog entry for another day. 😉

All of that said, recommendations are merely that. In medicine, we base our advice on the science of statistics. What we recommend IN GENERAL will offer protection against bad outcomes in the population. But each person needs to make a well-informed decision for his- or herself about what advice they will follow or decline. It is my goal to ensure that the decision you make rests on a foundation of solid information.  In all cases, my wish for you as a reader is that you STAY WELL this cold-and-flu season!

Oh, and feel free to check out the latest post from the CDC on flu as well:

https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm

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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!