Tag Archives: Hospital

Making a Bigger Leap after Coronavirus the New Age of Primary Care and Telehealth

I have been watching our country and the world as we struggle with this pandemic, a truly eye-opening experience for all of us.  May we rapidly slow the spread and heal the sick.

As we consider the longer-term implications, there are a lot of areas (I’ll steer clear of the Government, its response and the politics that we all saw, as well as its major impact) that need work including:

  1. Our public health infrastructure
  2. Our lack of resources
  3. Our disjointed system
  4. Our use of just in time supplies
  5. Our lack of manufacturing and production capabilities here in the United States for basic supplies and medicines
  6. Our focus on revenue generation by elective procedures
  7. Our overall health literacy and many, many more.

While all these issues has been influencing our response, our doctors, nurses and other healthcare professionals and staff, who are truly on the front lines, have been doing amazing work with what they have and risking their lives for us.

What I’d like to discuss is the issue of Telehealth/Telemedicine and its potential to radically transform our care delivery system.

When hospitals and clinics were told to stop doing any elective or non-emergency work, many procedures and visits were cancelled.  Primary care doctors and other specialists are now rapidly running out of cash to keep their offices open because no one is coming in and they are generating less revenue.

A few weeks ago, an email was sent by my provider group notifying me that a follow-up visit with a specialist scheduled for early May, may be done virtually.  I was happy to hear this as my wife, an RN, had recommended that I contact the clinic and cancel it, because there were other more urgent matters that the doctor might need to see.

If we consider that this visit, a post-surgical follow-up could be done virtually and then also in particular looked at the primary care system, how many of these could be done without the need to be seen face to face?  And think of the potential universe of visits with the addition of remote monitoring devices and tools.

While everyone recognizes the need for Telehealth and is rapidly embracing it, the majority of implementations have been similar to our experience with Electronic Medical Records, which was:

Take the paper chart and digitize it. 

So now we take the office as it is and add Telehealth.

But lets think more broadly, imagine the amount of resources that a redesigned practice around Telehealth could free up, from built offices, to exam rooms, to front desk staff, the MA to walk you back to the room, waiting room space, to supplies (wash your hands between seeing each patient), throw that paper towel away, replace the paper on the exam table, to cleaning the room, heating/cooling the space etc.

The net savings and efficiencies of moving to a modified virtual/face to face delivery system are potentially enormous; let alone the reduction in risk to the physicians, other clinicians and staff and those in the waiting rooms that they may bring in or catch an infection from someone else.

These changes would also prepare us for the next pandemic or disaster when we are once again home bound.

This new Telehealth/face to face approach should be the front end and major component of a healthcare system built for the 21st century.  A new primary care approach and a new specialty care approach.

Doctors and patients will have to learn new ways to do things, but it can work, freeing up money and allowing for the built infrastructure to be designed and capable of handling those requiring more critical services; without using that built infrastructure for non-critical needs. It also ensures that services continue, and providers can practice during crises like this.

This is but one of the many changes we should make that include addressing the other issues listed above so this type of situation never happens again.

Rahm Emanuel said, “Never let a good crisis go to waste”. By moving to a hybrid Telehealth/face to face approach we can improve healthcare from a quality, operations, cost and satisfaction perspective, let’s start with Primary Care.





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A Letter from Dr. Shetty and the Costs of Care

Sometimes we here in the United States, me included, when dealing with all the problems we face with our healthcare system need to step back and understand why we are really here. In the end, it is about the patient, the person needing help.

If I had my druthers I would do nothing but work in Medicaid.  After spending almost 20 years providing disease management services to Medicaid programs and running a Medicaid health plan, the joy of helping this population improve their health has always felt like the pinnacle of my work.

While much of what we have done and continue to do is laudable, there are many flaws with our healthcare system, we spend too much, get too little, and are constantly looking for new solutions to the unique problems the system we created, creates. It seems as if we harp on the negative, but is it really negative to harp on the waste, inefficiencies, fraud and abuse, to point out these wrongs in an effort to fix them?

Recently I received a copy of a letter written by Dr. Devi Shetty. He is a world-renowned heart surgeon, but more importantly he is a heart surgeon who says about healthcare:


   “If the solution isn’t affordable, it’s not a solution,”


“For 92 per cent of people living on this planet, heart surgery is a distant dream,”

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My Patient Portal and Meaningful Use – for Whom?

After my last physician office visit, I got invited to sign into the patient portal for the health system that the physician is affiliated with.  This is a very large health system in Jacksonville, FL and many would say its the premier hospital. My primary care physician who I have been seeing for a number of years is part of this system as are the specialists.

The Portal is really the most minimal of implementations, although I believe their EMR is from one of the big guys.  The main page shows:

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