Editor: Dear Doctors, Look for those small, uniquely special “In Between Patient Moments” and impress

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True Story | Personal File | Michael Tetreault | Editor-in-Chief | June/July

By Michael Tetreault, Editor-in-Chief

Have you ever sat across from a Patient, a loved one or maybe a family member during the holidays and heard their story about how they overcame an illness, cancer or seemingly impossible health crisis?

Usually they talk about the people and the individuals that were put into their path along the way.

“Then I met Dr. Smith … then she did this and this …” Or, “Then he introduced me to and told me to …”

We’ve probably never heard a story without a relational component. There’s always a mention of that Doctor, that specialist or that nurse.

How can more Doctors be fully present? How can Doctors with all of the weight you carry into the practice and into the exam room elevate and dignify [verb: make (something) seem worthy and impressive] the Patient relationship?

Patients Are Losing Hope In the Doctor-Patient Relationship, So They’re Turning to Apps, Urgent Care’s and Other Types of Providers

A Patient won’t come back because of function or process or location of your practice or the degree on your wall. Those things might be attractive on paper and convenient … but successful business understand that people, customers, yes, even Patients … choose to come back to brands, businesses, events and experiences because of how they or you [e.g. their Doctor] made them feel. Doctors are in the people business and you’ve got the potential to elevate the dignity of countless people every single day. Yet we’re still losing the caring and relational component of healthcare.

Example: Disney Found An In Between Moment to Impress Their Little Guests … Did You Know There Is A ‘Popsicle Hotline’?

Did you know that the Magic Castle at Disneyland has a cherry red phone mounted to a wall near the pool? When you pick it up and someone answers, “Hello, Popsicle Hotline.” You place an order, and minutes later, a staffer wearing white gloves delivers your cherry, orange, or grape popsicles to you at poolside. On a silver tray. For free!

Very Little Is Being Done To Make A Patient Feel Welcome At A Doctor’s Office. We Used To Do This … But It Stopped. We All Know Why. The Question Is, Why Aren’t We Doing More To Fix It?

Did you know that a Patient is more interested in being comfortable at a Doctor’s office and that they truly want to feel and know that you’re glad they are actually there? That might seem counter-intuitive because most of the time you’re treating symptoms and pain and that’s the reason they are there. Not so. Nothing about the majority of healthcare practices, offices and even hospitals or ERs today communicates to people who are paying them [e.g. the customer] that We’re glad you’re here.

EXAMPLE A: The DPC Journal and its sister publication, Concierge Medicine Today received this text from a Patient in February of 2019 … the Patient had went to see her long-time PCP of nearly 20-years and the Physician made her wait 111-minutes and visited with her in the exam room for 7- of those minutes. It should note, this Physician is not a DPC or Concierge Doctor but practices in what healthcare terms call “Hamster Wheel” healthcare.

So it’s no wonder Doctors are unhappy, burnt out and frustrated. You have an impossible job that you do every day.

Patients are as well … and the unfortunate part of that numbers equation is there are more and more patients leaving Doctor’s offices every day late, unhappy, frustrated and in even more debt than they were than when they arrived at your office.

Healthcare is already filled with terrifying in-between moments. How much is this going to cost? What does that mean? How long will that take? How long do I have? Etc.

We don’t have to tell you that healthcare today is one of the only businesses operating in America where the customer can wait 90-minutes in a practically unsanitary, unsafe, uncomfortable environment and is then expected, actually, demanded and tracked down by collection companies two to three months later to pay a lot of money for an experience, the time and the expertise that wasn’t all that caring in the first place.

When a Patient defines patient care these days, they describe and use phrases like ‘Sandpaper rubbing on my skin … I really don’t like my Doctor.’ Service in healthcare from staff is also a really raw topic these days too! Healthcare billing, the appeals process, billing errors, reading EOPs, incorrect addresses, wrong NPI numbers and even getting simple answers and a reply from a Doctor today is filled with so many, too many, customer-no-service moments that patients are frustrated too. And don’t even get me started on: contesting medical bills; Reading Chargemaster Spreadsheets from Hospitals by code and paying in advance of your treatment trend that seems to also be going around.

RELATED STORY
More Medical Providers Ask Patients to Prepay — More Patients Required To Pay Their Share Of Treatment UpfrontNPR

An excerpt from Kaiser Health News recently

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Okla. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost.

His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care, I should be able to get it without having to afford it up front.”

At many doctors offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect the money up front. Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Mass., who works with hospitals on addressing financial barriers to care.

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act, a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of federal law.

Source: Kaiser Health News; via NPR; https://www.npr.org/sections/health-shots/2016/12/07/504589131/doctors-and-hospitals-tell-patients-show-us-the-money-before-treatment

Poor Form, Indeed. Murky, Absolutely. Goes against the intent if not actual wording, maybe. That’s for attorney’s to decide.

Patient Fatigue Has Set In … And It’s Far Greater In Numbers Than We Realize

Escalating & Compounding Medical Debt + Surprise Medical Bills + Increasing Billing Errors + Patient Frustration – Service and Respect = Patient Fatigue.

We’ve talked for year about Physician Burnout. What we’re seeing on the other side of the sliding glass window is just as bad. Medical debt is crushing families. Medical costs, yes, even in the U.S. are ridiculously high.

I recently had hand surgery and asked out of curiosity what the out-of-pocket, cash-pay price was for the four codes that I was given. You don’t even want to know how high it was … it would make your eyes roll … (at least it did mine).

With the declining memberships and medical associations finding new ways to attract Physician members … Doctors are increasingly becoming unsatisfied with their association and paying large and small society dues for little impact.

RELATED STORY | POLL | PHYSICIANS
Reader Requested POLL: How successful were societies and medical associations at meeting your practice needs?

Here’s a consideration however, if Doctors and their respective medical associations, chapter, societies and the like, really want to help make it right and course correct … one potential strategy could be to start by advocating for things that help patients related to surprise medical bills in their own state. Steps are being taken but even now, just today … as I write this article right now this news story came across the wire and my desk … Senate Panel Makes Surprisingly Fast Work Of ‘Surprise Medical Bills’ Package

Rachel Bluth of Kaiser Health News said It may seem as if the Senate, or at least certain key senators, have decided on a way forward to fix the nation’s “surprise medical bill” problem. But make no mistake: The door is still open to try another solution. At the markup hearing Wednesday, the committee took a step toward Cassidy’s preferred vision for fixing surprise bills. It passed an amendment from Cassidy that would require insurance companies to post accurate lists of who is in-network, so patients have a better chance of avoiding surprise bills.

“This bill is not as good as it should be,” Sen. Bill Cassidy (R-La.) said. “And I thank the chairman because he has offered to work between now and floor consideration on the surprise bills.”

What Are Patients/Customers & People Doing?

It’s all gotten to the point where now Patients are hiring claims assistance professionals or medical billing advocates who will look over their bills and vet them for errors. They’re available in more than half of all states in the country. Visit Claims.org or BillAdvocates.com to locate one near you and expect to pay between $30 and $50 per hour for their services. Consumer Advisor, Clark Howard said “Anyone who is uninsured and paying retail for expensive medical services should go this route. These advocates can significantly reduce what you owe by identifying errors, fraudulent charges and other ways the hospital may have taken advantage of you financially.”

Have we have hit rock bottom in customer service in healthcare?

The good news is, there are countless Doctors trying to improve their schedules, their care quality and really help patients feel that the care and service they are receiving is uniquely special. It won’t take long before Patients recognize it. Doctors can take the lead here and can turn around their practice and it starts with the little in-between moments.

Back At Your Practice

When was the last time you were a part of a Patient story worth sharing? I bet after pondering this question you can think of a person or a family that seemingly wasn’t any different than others in your daily routine … but had an almost providential impact on you. You look back on it now and see that you were and maybe still are a huge part of their healthcare journey towards recovery … or maybe, their alive because of you!

One such story worth sharing that comes to my mind was when we interviewed a Physician in Tennessee.

He had been treating the wife and each time she came in, I believe her husband was usually there to accompany her. Sweet couple, right? The Physician and even the staff at the office grew to adore this elderly couple, bonded and eventually they created a close friendship with them.

One day, the wife passed.

A few days after the funeral, I believe, the Physician called the husband.

He said “NAME, how are you doing today?”

The widowed-husband replied “Not good.”

Then the Doctor, said something so remarkable in this seemingly insignificant but monumental moment.

The Doctor replied, “Can I come over … and get a cup of coffee?”

The husband replied, “Yeah, I’d like that very much.”

As I write and re-read this story I get tears in my eyes. I just hope I remembered the details correctly.

Key Takeaways

Example B.

That’s a perfect example of what we mentioned earlier (above) … A Patient won’t come back because of function or process or location of your practice or the degree on your wall … Doctors are in the people business and you’ve got the potential to elevate the dignity of countless people every single day.

How exactly is this accomplished? How can this possibly be implemented in your practice?

Baby steps. Try something small. See how it works. Then, rinse and repeat. You can put this into practice by starting to look at what some call those In Between Moments in patient care. It might be the moment you leave the room and pop your head back in by surprise and say … “Happy Birthday by the way, Bill!” with a smile.

I know several Doctors who send $5 gift cards for coffee shop whenever a new patient joins as a result of a current patients referral. They’ve built these gift cards into their budget as a line item expense and it only costs them $500-$700 per year. That remark-worthy or remarkable in-between moment leaves an impression. Or maybe it’s the moment you hear that a loved one passed during a patient exam. Later that day you write a hand-written note of bereavement and mail it (hand-written) to the patient noting that you’re sorry for their loss and that their family is in your thoughts during this time of grief.

Here are some additional questions that might help as well. In your practice today, ask yourself these questions:

  • Am I making it easy to see the Doctor?
  • Is my team/staff equipped and forthright about what and where they see we can improve?
  • Have I given my team/staff permission to show me where we can improve?
  • How can we better navigate and serve Patients through the IN-BETWEEN moments in our practice?
  • Have I given my staff permission to look for those in between moments and act upon them?
  • How can we make our practice safer? (e.g. less germs; improved lighting; local artwork)
  • How can we make our office more predictable? (e.g. Schedule; time spent waiting; etc.)
  • IN A TRADITIONAL, PLAN-REIMBURSED Medical Office, Typically, your staff are the bookends [e.g. first and last people a Patient encounters] how can you make the “Farewell” more significant? Here’s a thought/consideration … —What if … “I (the doctor) were the bookends … e.g. being the first and last person my patients see.” ?
  • If I am looking for unique ways to improve … is it really going to be better and what would make that change unique?

Regardless of how threatening or impossible this idea of finding in between moments is to you or inconvenient in your daily schedule, it’s an indicator of how open you are to new ideas. It is virtually impossible for all of us to look in the mirror and see how we can do things better. Good leaders in the business of providing great customer service and thrive in the hospitality sector tell us a secret if we’ll listen … and that is — It’s not enough to lead well, you have to be seen leading well. They [the customer] has to catch you. 

Catch your patients attention in those in between moments. Be a part of a Patient’s story worth sharing? Approach each day (getting a little better one day, and a little better the next …) until one day being more relational is a natural habit and occurrence in your practice. Your staff will even see it and pick up on your new habits.

Be a part of seemingly small stories … look for those in between moments to make a small impression. Remember, “Then Dr. Smith said … and then she did this and they did that …”

Understanding and applying these tips is a great start towards being successful in this thing called Subscription-based Medicine or DPC.

If you apply what you’ve learned … I think you’ll be pleasantly surprised by the feedback you’ll receive from staff and Patients. Again, these are just some of the ideas you must have in order to crack open the door towards being a great DPC Doctor. If you recognize rather than resist good ideas … you will begin to understand what it will take to be successful in this space.

Perhaps you have your own in between moments you’d like to share … leave them in the comments below or email us at editor@directprimarycare.com.

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