Local Physicians Respond to “Taking the Temperature of Healthcare.”

Over the past several weeks, RiverTown Multimedia published a 5-Part series, titled “Taking the Temperature of Healthcare” in which a reporter interviewed administrators in the western Wisconsin region. As Family Medicine specialists who see and care for patients daily in the exam rooms, the Healthcare Providers at Vibrant Health Family Clinics felt it was important to share perspectives from that vantage point.

This series follows the same format as the pieces published by RiverTown Multimedia.

Whether you are purchasing health insurance for your employees, buying your own insurance privately or on the government marketplace, participating in a healthcare sharing ministry, or opting not to purchase health insurance, it has become a frustrating, stress-inducing experience. The blatant politicization of the health care system holds consumers hostage leading to anxiety and uncertainty.

Even with insurance, practically every health care decision today has also become a financial decision and that makes people more than a little uncomfortable. Patients can pay thousands of dollars for care and barely benefit from their insurance.

Are we approaching a point where the cure is becoming worse than the disease?

Recently, RiverTown Multimedia asked the CEO’s of four local hospitals to answer five questions about the state of health care in western Wisconsin.

Responses to this question were submitted by the doctors at Vibrant Health Family Clinics in a letter to the editor.

To read the Vibrant Health Family Clinic’s letter to the editor, click here: Vibrant Health Letter to Editor

Dr. Kerith Lijewski - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Kerith Lijewski, MD, Family Medicine:

I think my fellow primary care physicians would be as surprised as I was to find long-time patient-physician relationships described as “nearly impossible to find”. While there have been significant changes in health care, the importance of having a primary physician that you trust has not changed at all. There are still many physicians who are in independent practices, and many more physicians who are still able to put their patients first regardless of what health care group they work for. While hospital care is now usually provided by physicians who only work in hospitals, more and more care is focused on outpatient care, and less and less in the hospital. Primary care clinics have teams set up to assist with providing care between visits, to help manage chronic diseases, and to make sure that we are available when acute illness arrives.

At nearly 15 years of providing family practice in this community, I am still a relative newcomer compared to many of the physicians who have been in practice in this area.  While there are areas in our country where getting same day care with your primary physician is hard to achieve, in this area patients have access to primary care seven days a week including evening hours.

It is true that insurance companies and their contractual relationships with health care systems often leave patients feeling like their needs are not being put first.  Primary care physicians spend significant portions of their day completing forms and making phone calls to make the case with insurance companies to cover necessary medications and tests for our patients. The cost of health care – from medications to clinic costs to costs for procedures and imaging – needs to be more transparent so that patients can work with their primary care provider to make the choice that best meets their needs.

Dr. Gregory Miller - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Greg Miller, MD, Family Medicine:

Health Care is changing all the time. However, Family Physicians are still present in this area.

I have had the privilege of practicing Family Practice since 2000 in River Falls. I have had the opportunity to get to know many individuals and families over that time.  It has been humbling the concerns people have entrusted me to help them with over the years.

As a Family Physician my goal is to help make medical care be as affordable as possible as it is a much more affordable option than emergency rooms. I have always been concerned about the cost and look for ways to make tests available to people.

Insurance companies, electronic health record companies, health systems and the government all present challenges on our time providing care which impacts the cost of healthcare. Those entities are more concerned about checking boxes as opposed to listening and taking care of people. I am working hard to make healthcare affordable despite all these difficulties.

Dr. Amber Morgan - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Amber Morgan, Pediatrician:

The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Our society is a mobile one.  Many young families today have to move where the jobs are.  That may mean across state lines, in some cases further. However, in our community we also are lucky enough to experience the opposite- families that have lived in the area for generations.  With this, we have the luxury of physicians who have lived in the area for their entire careers.  Our local physician patient relationships still tend to be life-long and so far have not been greatly influenced by corporate medicine.

Medicine is becoming more and more corporate as we speak. Once a patient is in a health system- through delivery or insurance, it is in that systems best interest to keep them there.  The rules are made by those who stand to benefit the most, and this leaves the physician and patient tied to whatever system they are working in.  Insurance companies decide which treatments to cover, which doctors are in network, and how much they are reimbursed.  Large hospital systems often dictate which type of doctors are available; and where they are located, and when a patient can be seen.  The physician and patient are left to figure it out together what makes the most sense for their particular situation.  It reinforces the importance of that long- term relationship and benefits from having it.

Dr. Gregory Goblirsch - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Greg Goblirsch, Family Medicine:

I have been in practice in River Falls for almost twenty five years with many patient-doctor relationships of twenty plus years.  Children I delivered early in my career are in college and still see me on a regular basis.  I disagree with the demise of the traditional doctor patient relationship.  I would say the relationship has changed with the compartmentalization of medicine.  Large hospital systems have forced this with hospitalists (doctors who only see patients in the hospital) and requiring emergency room physicians to be board certified in emergency medicine.  The days of having your family physician see you in the hospital, emergency room and the clinic have gone away.  This has led to fractured, less efficient care and most times, more costly care.  A universal medical record that follows the patient has been touted as a replacement for this type of relationship.  It certainly has helped but at increased cost and decreased efficiency.

Our society’s desire for convenience has also affected the doctor-patient relationship.  Having medical care delivered in the local grocery store may be convenient, but is not the same has seeing a doctor who has known you for 15 years.  Many primary care practices have designed their scheduling processes so same day visits are available with a doctor who knows your name and is familiar with your health.  There is no doubt that the delivery of healthcare is fragmented.  The integration of hospitals, primary care and specialty care appears to be more efficient but it has increased cost and decreased patient choice.

Dr. Dan Zimmerman - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Dan Zimmerman, Family Medicine:

The insight about healthcare being delivered through a system I believe is true.  It is still possible to see a specific doctor or a specific group.   Chosen well, this doctor will give you options and advice on your care that day as well as referrals.   Also a good physician will seek the best for you whether it is in the interest of the system or hospital with which they have an affiliation.  Admittedly in some systems, the consequences to the physician can be significant when not following the corporation’s line of service.  It does require significant understanding and sophistication to navigate through health care needs.

Dr. Chris Tashjian - Response to Part 1

PART 1: The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of “independent” practitioners. For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

Dr. Chris Tashjian, Family Medicine:

In the “Taking the Temperature of Healthcare” series printed by River Falls Journal, the writer began with the opinion that “The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today,” and asked the hospital administrators to respond to the question of how the integration of hospitals, insurance companies and physicians has affected healthcare.

As an independent primary care physician who has served the Ellsworth community for more than 25+ years, I’d like to respond by stating that you can still find an independent primary care physician in our community and there are plenty of benefits to doing so.  The main advantage is that you have a personal relationship with someone who knows your health related issues and treats you like a person rather than an invoice.  Further, Vibrant Health is open on weekends so you don’t have to use the emergency room for non-emergent problems. We work with insurance companies to find the best value for prescriptions, referrals or procedures.  We are available 24 hours a day, seven days a week for phone calls.

And in our case especially, it is objectively better medicine.  While massive healthcare systems tout their coordinated care, our Vibrant Health clinic was recognized by the CDC as one of the first two clinics in the country to provide measurably better care.  Isn’t that why people go to a doctor: to make them well when they are sick, and to help prevent them from getting sick?  The facts speak for themselves.

In some ways, the changes in modern healthcare are like the local hardware store that was pushed out of business by a big box retailer with the promise of offering more for less.  The problem is, there is no one at the big box who is responsible for or dedicated to actually helping you solve your problem.  And after the competition is squeezed out, they raise their prices to whatever the market will bear.  Who hasn’t experienced a substantial increase in health insurance?  More of my patients have insurance only to find they can’t use it due to the high deductibles. Prescription prices have skyrocketed… even for generics.

We love medicine and we love our patients.  Over the past 25 years, I personally have had the privilege of helping my patients through good (birth deliveries) and hard (illness and death) moments in their lives.  We know them on a first-name basis; we talk to them when we see them around town; and care for them like family.  Now more than ever people need a trusted partner to help them with the ever

Dr. Kerith LIjewski - Response to Part 2

Taking the Temperature of Healthcare Question #2

There is a fair amount of anxiety well before you even make a health care decision these days because of the financial implications of those decisions. People who were just settling into the Affordable Care Act (ACA) and understanding that the basics of healthcare, important preventative procedures like physicals, mammograms, colonoscopies, were going to be covered, question that assumption now. Politics have introduced uncertainty into the equation and it is no longer clear that the basics will be covered, or for how long they will be covered, or whether subsidies will continue to help people afford Insurance. How does that uncertainty impact the provider side of the equation?

Dr. Keri Lijewski, Family Medicine:

From a provider standpoint, the changes in the financial implications for patients is something that primary care providers face every day. We have noticed that as deductibles and out of pocket expenses rise for patients, they are more hesitant to come in to clinic and are looking to avoid visits. Primary care providers have to work to balance the best interest of the patients, and we likely need to continue to work on educating patients about when they need to seek medical care and where they should be seen. We see patients wanting potentially complicated conditions to be treated over the phone, and patients with relatively minor symptoms that could be managed at home coming in to be seen. In addition, there are times when patients have severe or life-threatening conditions best managed in an emergency room, but come instead to the clinic because of concerns for cost.

As a family doctor, I see a significant portion of my role is to help patients navigate the complicated system and help them have all of the information to make the best decisions for themselves, which includes considering cost. I heard a news story about a woman who had her entire health savings account wiped out when her dermatologist office prescribed a very expensive topical treatment for a toenail fungus. Neither the dermatologist office nor the patient’s pharmacy told the patient that the medication cost thousands of dollars. When interviewed, staff at the dermatologist office was quoted as saying that their policy was to provide the best treatment for the patient without considering the cost. The problem with that mindset is that the patient was now stuck trying to figure out how to pay for her medication for her high blood pressure because the money she had set aside had been wiped out treating a minor cosmetic issue. I believe it is a cop out for physicians and other health care providers to fail to consider cost when recommending treatments for patients. That said, the entire system needs more transparency so that we can all better understand what is covered and what is the cost to the patient.

 

Dr. Amber Morgan - Response to Part 2

Taking the Temperature of Healthcare Question #2

There is a fair amount of anxiety well before you even make a health care decision these days because of the financial implications of those decisions. People who were just settling into the Affordable Care Act (ACA) and understanding that the basics of healthcare, important preventative procedures like physicals, mammograms, colonoscopies, were going to be covered, question that assumption now. Politics have introduced uncertainty into the equation and it is no longer clear that the basics will be covered, or for how long they will be covered, or whether subsidies will continue to help people afford Insurance. How does that uncertainty impact the provider side of the equation?

Dr. Amber Morgan, Pediatrician

As a pediatrician, the uncertainty of coverage affects everything I do.  Before the ACA, I carefully worded every note, as to ensure there were no implicit pre-existing conditions that could be extrapolated from my words by a future insurance company to prevent a patient from obtaining insurance.  Now with the ACA, I worry much less about pre-existing conditions and my patient’s future ability to obtain insurance.  I think even with some political uncertainty, Congress has rejected that the ACA will be repealed in its entirety.  When this was up for a vote, I personally was writing letters to our representatives asking them to keep the ACA as it is critical to access for care for my patients.  I encourage anyone reading this to do the same in the future if needed.  In pediatrics we are in the business of prevention, and our preventative physicals or well child visits are key to promoting health and wellbeing in this population.  Insurance coverage should not be a barrier to obtaining vaccines for preventable disease or for checking in on a child’s developmental, social and emotional wellbeing.  Thankfully the ACA has helped with this.  However, with the rising high deductibles that families are faced with, acute visits are where I see hesitation and anxiety.  As a provider, I am acutely aware of the cost of care and the anxiety it can provoke.

 

Dr. Gregory Miller - Response to Part 2

Taking the Temperature of Healthcare Question #2

There is a fair amount of anxiety well before you even make a health care decision these days because of the financial implications of those decisions. People who were just settling into the Affordable Care Act (ACA) and understanding that the basics of healthcare, important preventative procedures like physicals, mammograms, colonoscopies, were going to be covered, question that assumption now. Politics have introduced uncertainty into the equation and it is no longer clear that the basics will be covered, or for how long they will be covered, or whether subsidies will continue to help people afford Insurance. How does that uncertainty impact the provider side of the equation?

Dr. Greg Miller, Family Medicine:

At Vibrant Health Clinics we have been anticipating this change in health care and have been working hard to develop relationships that help patients find good quality and affordable health care. There are many non profit organizations and health care systems that do not necessarily have the best interest of the patient in mind. Instead some organizations are looking to maximize revenue at patient expense. Family Physicians are well positioned to help patients figure out whether or not tests are necessary and then the best place to get them.

Taking the Temperature of Healthcare

Five-part series on the cost of health care in western Wisconsin published by RiverTown Multimedia:

PART 1: The doctor patient relationship
PART 2: Decisions, decisions
PART 3: Skepticism & mistrust
PART 4: Placing Blame
PART 5: A cash hospital?