Many years ago I joined forces with Dr. Iden, who had been practicing in the small town (pop. 3000) of Berryville, Virginia. He had been practicing over 40 yeas at the age of 70. The office was a wonderful relic of the “golden Age” of medicine. A true PCMH…..The staff knew everyone, there were no appointments except for physicals. If the waiting room was full in the morning you came back after lunch. If you were too sick to come in, we went to your house. We saw the retired judge and we saw the migrant apple pickers. The nursing home was just a few blocks away and we even did Occupational Medicine for several manufactures in the area. I once used a screw driver from under the sink to remove a screw from a workers’ finger. Doc Iden’s doctor-father did not retire until he crashed his car into the wall in the hospital parking lot at the age of 90. Every year, Randy and his wife, the pharmacists gave us a whole cooked Virginia ham for the holidays. (You have to be from Virginia to know what a cured Virginia ham is all about). The other pharmacy in town was one of the last old time pharmacies in the country and when that guy retired, the new pharmacy school that opened nearby packed up the entire shop and installed it as a museum in their building.
Half the medical charts were still kept on index cards stapled together. The note for a visit might read “11/15/1985, Pneumonia, Erythromycin”.
Whether the patient had insurance or not, the entire family’s leger was kept on a yellow card in a file box. Charges and payments were listed for the entire family without explanation whether it was an insurance or patient payment or for whom the charge or payment was entered! After I convinced my boss we needed to modernize ( and spend a lot of money to do it) he agreed with skepticism. I took it upon myself to computerize the office so that we could submit bills electronically and stop completing the infamous HCFA 1500 forms by hand. I knew my shiny new Apple computer and the program inside out. I was the IT department. I could walk the office through restoring a crashed system by phone. I remember pulling all-nighters to set things up, fix bugs and do updates.
My next venture was my own start up office with 6 providers and a staff of about 15. Hiring and keeping a staff seven days and 4 nights a week can be exciting. Doing the HR stuff, providing insurance as rates are skyrocketing, doing peer review and making sure nursing and everyone else is credentialed, insured and had flu shots is…….interesting. While ‘learning the business” as you go was a fun challenge for me, it was made more so by having to pay the bills, which meant seeing a full load of patients and more. Now in 2016, my own doctor is struggling to keep their office independent. His latest disheartening challenge is MACRA.
Getting this far with my missive, I realize it is Thanksgiving week. I am thankful to work for CHC, Inc. that does all those things for me. My biggest worry now is the patient. I know bugs in ECW happen but IT is there to fix it. Insurance goes up but someone else researches the best options. I may be rushed and cut corners to get though the day, but I am pushed and prodded to “check the boxes” . My family gets sick and I can call out without anxiety about rescheduling all those patients.
I also know that we are leaders…on the cutting edge of innovation in a transformed and ever-changing world of medical care. At a meeting of FQHC leaders a while back, I went to seminar after seminar where innovative ways of providing services were presented. Over and over I found myself saying, “We do that! We do that already! We do that too!” It made me kind of proud to represent CHC.
What I do everyday is challenging. I see patients. I am doing what I signed up to do a long time ago. I like it.
By: Hartmut A. Doerwaldt, MD