It Was the Best of Times, It’s Become Much Worse of Times

The knot in Holly's stomach wakes her at 5am. She can't shake the feeling that she forgot something really important yesterday. It wouldn't have been hard: she fell asleep at her computer again after putting the kids to sleep, trying to squeeze in a few more hours to document the day's events.

She really needs to start sleeping more than 5 hours per night. It's funny how often she gives this advice to her patients but completely ignores it herself. She might be the least healthy person she knows. Ugh, no time to think about that now: her first patient visit is at 8am, and she needs to squeeze in a staff meeting before that.

Chugging a coffee on the hurried drive to work, she imagines taking Saturday off to see Jonny’s little league game. At this rate, however, she’ll have to take her laptop with her or fall even further behind on her charting.

At the staff meeting, Holly's office manager mentions patient visits have been taking too long. Since the Smirf Network has been rejecting more claims this year, Holly will either have to see more patients or hire another billing assistant.

“I can’t spend less time with patients,” Holly says. “I’m down to 7 minutes already.”

Her office manager nods. “I know, but we also can’t afford another billing assistant’s salary.”

Holly looks at her watch and sighs: the day hasn’t even begun and it’s already depressing.

Minutes later, she musters a smile for the day’s first patient. It feels good: this is why she became a doctor. She finally gets to connect with him after three minutes of routine questions and tests, logging all the results into the computer so she can bill later. The patient asks about a cholesterol treatment he saw on TV. Questions race through her mind: diet, exercise, lifestyle. She opens her mouth but then the clock catches her eye. She’s already over time, so she orders more tests.

The patient frowns. “Don’t we already know I have high cholesterol? And doesn’t this drug help people with my condition.”

“Unfortunately it’s a lot more complicated than that, especially with drug side-effects,” Holly says. She checks his chart. “And it doesn’t matter anyway because your insurance doesn't cover it.”

After Holly's first patient, a series of blurry faces race past. Every patient with a worry gets referred to a specialist. While she could solve most of these issues herself, she doesn’t have time. She feels like she’s using her gut more than her brain. 'Why did I choose primary care?' she thinks to herself. 'An NFL quarterback has more time to make decisions than this!'

For lunch, she scarfs down a sandwich while catching up on paperwork. Due to falling reimbursements, the practice is struggling; so the financials are all riding on Holly's end-of-year "quality" bonus. The bonus worries Holly because she only receives it if her patients don’t end up in the ER, but ER visits are, of course, out of her control. 'I’m basically a professional gambler' she thinks.

She seriously considers playing the lottery as a revenue stream before realizing she's already late for her next visit.
Arriving home at 9pm, Holly has just enough time to reheat dinner and spend a few precious moments with her kids. While learning about their days, her follow-up work keeps bubbling to mind. She realizes tonight will be another 3am night.

At 3am the computer’s blue glow makes Holly feel zombified. She thinks back on her kids. They’re growing up so fast. 'Why do I feel like I’m missing it?'


Intermission: Is this real life?

Although it seems too dramatized to be true, these are the stories we hear from countless primary care physicians around the country every day. Overworked and underpaid, these unsung heroes leave it all on the field in their increasingly stymied efforts to improve the health and wellbeing of those entrusted to their care.

But it doesn't have to end here. Across the country, physicians like Holly are switching to Direct Care and taking back control of both their practice and their lives. To illustrate just how striking the difference is between these two models, let's take a look at another real-life story from a Direct Primary Care physician near you.

A New Hope: Direct Primary Care

Holly wakes up at 5am for a sunrise jog with her husband. She packs her kids lunch and drives them to school. She watches Jonny bang on his xylophone in the back seat and makes a mental note that he's showing an interest in music. Perhaps Bill, one of her patients who's also a concert pianist, could suggest an appropriate tutor.

Back at her practice, Holly's administrative dashboard confirms all accounts are in good standing and monthly revenue is on track. She makes a note to speak with Mr. Greenwich about updating his credit card during their visit today. She may need to walk him through the steps on her laptop, as he's not the best with technology. No worries, however: because she scheduled an hour for the visit, there will be plenty of time.

The first patient, Rose, arrives at 9am. Rose is recently divorced and moved cross-country to be closer to her daughter and grandchildren. Holly checks the results of Rose's recent blood test. Her cholesterol is skyrocketing! But Holly knows Rose, and she knows the cholesterol could be related to a bigger lifestyle issue. Rather than the traditional knee-jerk reaction of prescribing medication with dangerous side effects, Holly has time to investigate and creatively brainstorm solutions. During their conversation, she notices Rose is also showing signs of the onset of depression. Perhaps these two symptoms are related. Holly probes about Rose’s social life. Most physicians wouldn’t have time to ask, nor would insurance reimburse for this kind of care.

From a simple conversation, Holly learns that Rose hasn’t had a car since her divorce. Without reliable transportation, Rose is becoming a socially isolated homebody. She had a rich social network before her divorce, but now she feels trapped. Holly suspects this social history is the root of everything she's seeing. She steps out of the exam room to share a brilliant idea with her medical assistant:

"Would you teach Rose to ride the bus home, riding it all the way with her, and then take an Uber back to the office?" Holly glances at Rose's daughter reading a magazine in the waiting room. "Tell her she can go home -- we've got it covered. Also, on the trip, please make sure you show Rose the bus routes and schedules, especially the route that takes her to the library, where they have senior activities every week. Don't worry about leaving me, I can handle this place for an hour. Besides, we don't have another patient until noon." While most doctors don’t have a free minute all day, Holly keeps open time in her schedule to accommodate walk-in patients and emergencies.

Holly's medical assistant takes Rose for her 'treatment', and when Holly sees Rose again 4 weeks later the improvement is striking. She's in high spirits, a complete reversal from the looming depression. Holly orders another cholesterol panel, which she is able to draw right away in the office, and is not surprised to see the levels already falling back into normal ranges. She jokes to herself: 'what's the CPT code for “teaching a patient to ride the bus?”'

It feels great to finally be taking care of patients instead of throwing procedure codes at symptoms.


Further Resources

While this may seem too good to be true, we assure you the above story is both real and echoes the experience of doctors across the country who make the switch to Direct Care. More physicians are joining the movement every day, and our community is here to support them. Read more of their stories here on our blog, ask them questions on our community forum, watch their talks at the Hint Summit, and most of all: prepare to challenge everything you think you know about the future of healthcare. 


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