Re: emails from patients

June 11, 2007

first I lOVE email with patients

so many thigns are easy with it

I put a tikcler in to e mail Bruce with progress and I do and I get back

a spread sheet!! on exercsie bs and wt

I make appointmetns

I sned labs

I get follow up- how is Tucker's diarrhea today?

However this kind of message would get a response like " There are several

thigns to talk about here I can see you today after 3 or tomorrow anytime-

You prefer am or pM? "

Annie did my favorite pateitn show up yet 9 yo Kaitlyn H just moved there

She cannot believe that she is going to get a docotr with a horse she is

beside herself!! YOu will love this kid and her mom. Dad is alittel more

neurotic but still sweet!

emails from patients

This is an actual email that I got from a patient. I do not have an

" e-visit " policy per se, and have not jumped on putting one in place

because local insurers are not paying anything on " virtual visits "

anyway, but more and more I get this sort of thing. How are you guys

handling this? Do you just tell everyone they need a visit? Do you

answer the emails with a link to something like the Mayo Clinic website

and say " come to the office if that doesn't answer your question "

I'm currently getting one like this every few days and it's getting out

of hand.

Hi Dr. Skaggs ~

My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM

this January and had since lost 50+ lbs.

My mother thinks all of us need to be on daily aspirin therapy like Jim

is now. I have had iron-poor blood in the past, and wondered if the

aspirin would affect that. I only know this because they wouldn't let me

donate blood a couple of times. Anyway, I told mom I was going to check

with you. My last checkup was December 21st.

Thanks ~ Kim Xxxx

June 11, 2007

For me, it depends on the patient. If it's someone I work with often and I

have a " good handle " of, I'd likely give her a suggestion or two just as

my RN in the former practice would have. I would take about 2-5 minutes to

read and respond.

If however the patient is someone I don't know well or haven't seen for a

while, I'd say something like, " thanks for the update of family history.

It's important to know that and consider a variety of risk factors before

deciding on treating with aspirin or other medicines. Let's meet and

review your risks. What days of the week and times of the day are

generally good for you? Are you free today at 4pm? I could see you then. "

Then I consider the email as part of the HPI of the appt.

I do use RelayHealth but I don't charge for email or webvisits. Instead, I

consider them as triage for my patients and appts.

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

>

> This is an actual email that I got from a patient. I do not have an

> " e-visit " policy per se, and have not jumped on putting one in place

> because local insurers are not paying anything on " virtual visits "

> anyway, but more and more I get this sort of thing. How are you guys

> handling this? Do you just tell everyone they need a visit? Do you

> answer the emails with a link to something like the Mayo Clinic website

> and say " come to the office if that doesn't answer your question "

>

> I'm currently getting one like this every few days and it's getting out

> of hand.

>

> Hi Dr. Skaggs ~

> My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM

> this January and had since lost 50+ lbs.

> My mother thinks all of us need to be on daily aspirin therapy like Jim

> is now. I have had iron-poor blood in the past, and wondered if the

> aspirin would affect that. I only know this because they wouldn't let me

> donate blood a couple of times. Anyway, I told mom I was going to check

> with you. My last checkup was December 21st.

> Thanks ~ Kim Xxxx

>

June 11, 2007

My take on this exactly mirrors Tim. If it was a patient I knew

well and had a good handle on, no problems-I would answer the

question. I also use relay health.

However, this is an example of why I want to be paid in a different

fashion than just face-to-face. (And I'm not talking about

reproducing a previously tried, broken capitation system).

By the way, this type of thing does get easier, more comfortable and

more natural the longer you practice and the better you know your

patients.

>

> For me, it depends on the patient. If it's someone I work with

often and I

> have a " good handle " of, I'd likely give her a suggestion or two

just as

> my RN in the former practice would have. I would take about 2-5

minutes to

> read and respond.

>

> If however the patient is someone I don't know well or haven't

seen for a

> while, I'd say something like, " thanks for the update of family

history.

> It's important to know that and consider a variety of risk factors

before

> deciding on treating with aspirin or other medicines. Let's meet

and

> review your risks. What days of the week and times of the day are

> generally good for you? Are you free today at 4pm? I could see

you then. "

>

> Then I consider the email as part of the HPI of the appt.

>

> I do use RelayHealth but I don't charge for email or webvisits.

Instead, I

> consider them as triage for my patients and appts.

>

> Tim

>

> --

> Malia, MD

>

> Malia Family Medicine & Skin Sense Laser

> 6720 Pittsford-Palmyra Rd.

> Perinton Square Mall

> Fairport, NY 14450

>

> (phone / fax)

> www.relayhealth.com/doc/DrMalia

> www.SkinSenseLaser.com

>

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole

use of

> the intended recipient(s) and contains confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the

intended

> recipient, you may not use, disclose, copy or disseminate this

> information. If you are not the intended recipient, please contact

the

> sender immediately by reply email and destroy all copies of the

original

> message, including attachments.

>

> >

> > This is an actual email that I got from a patient. I do not

have an

> > " e-visit " policy per se, and have not jumped on putting one in

place

> > because local insurers are not paying anything on " virtual

visits "

> > anyway, but more and more I get this sort of thing. How are

you guys

> > handling this? Do you just tell everyone they need a visit? Do

you

> > answer the emails with a link to something like the Mayo Clinic

website

> > and say " come to the office if that doesn't answer your question "

> >

> > I'm currently getting one like this every few days and it's

getting out

> > of hand.

> >

> > Hi Dr. Skaggs ~

> > My 52 year-old brother recently had a CVA. He had been dx'd w/

type 2 DM

> > this January and had since lost 50+ lbs.

> > My mother thinks all of us need to be on daily aspirin therapy

like Jim

> > is now. I have had iron-poor blood in the past, and wondered if

the

> > aspirin would affect that. I only know this because they

wouldn't let me

> > donate blood a couple of times. Anyway, I told mom I was going

to check

> > with you. My last checkup was December 21st.

> > Thanks ~ Kim Xxxx

> >

>

June 11, 2007

Annie,This is how I would reply if it was one of my patients:"Dear Ms. Xxxx,I'm sorry to hear about your brother's CVA and wish him a speedy recovery. It certainly sounds like there might be a genetic risk in the family for diabetes and stroke, and normally aspirin would be considered as possible preventive treatment of these conditions. However, as you know, aspirin can cause bleeding which would not be a good thing if you are already anemic. I recommend that you come in for an evaluation so I can check if you are still anemic and to check for diabetes and cholesterol. When would be a convenient time for you to come in?"Most of the time, I don't charge for e-mail communication because they are usually straightforward questions. Plus I don't think most patients are ready to pay for this kind of service -- yet. If I can answer via e-mail, often with a link to familydoctor.org or mayoclinic.com, then I'll do that. If I can't, I'll ask them to come in.Like Tim, I also have RelayHealth but don't push WebVisits but will accept them if patients want to use this service. I think twice I had patients try to use the WebVisit for something that I needed them to come in for, and I did not charge for the WebVisit since they were coming in anyways. But more and more insurance companies are covering for "online consultations" (including Blue Cross, Blue Shield, Aetna, Cigna, HealthNet) and RelayHealth has a mechanism for billing automatically. You could also record e-mail encounters in the patient record and send a claim for "online consultations" using CPT 0074T. SetoSouth Pasadena, CA This is an actual email that I got from a patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because local insurers are not paying anything on “virtual visits” anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say “come to the office if that doesn’t answer your question” I’m currently getting one like this every few days and it’s getting out of hand. Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

June 12, 2007

I do a lot of phone and virtual (online)

visits, and I would suggest doing this one in the office, or over the phone if

you know her well (and charge her for it, out of pocket). Online is too

restrictive for the back and forth communication you’ll need. I’d

lean heavily toward office visit if she hasn’t had labs done recently to

give you answers on pre-diabetes/diabetes, anemia, etc.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Annie Skaggs

Sent: Monday, June 11, 2007 10:26

AM

To:

Subject:

emails from patients

This is an actual email that I got from a

patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because

local insurers are not paying anything on “virtual visits” anyway,

but more and more I get this sort of thing. How are you guys

handling this? Do you just tell everyone they need a visit? Do you

answer the emails with a link to something like the Mayo Clinic website and say

“come to the office if that doesn’t answer your question”

I’m currently getting one like this every few days and

it’s getting out of hand.

Hi

Dr. Skaggs ~

My 52 year-old brother recently had a CVA. He had been

dx'd w/ type 2 DM this January and had since lost 50+

lbs.

My mother thinks all of us need to be on daily aspirin therapy like Jim is now.

I have had iron-poor blood in the past, and wondered if the aspirin would

affect that. I only know this because they wouldn't let me donate blood a

couple of times. Anyway, I told mom I was going to check with you. My last

checkup was December 21st.

Thanks ~ Kim Xxxx

June 12, 2007

I think I would say, "I think you should schedule an appointment so we can talk about this in more depth than is possible by email." If you have a good link, add it in, but I think really answering the question by email is asking an awful lot. Of course, if you set up actual evisits that people pay for, that might be another way to deal with it.Annie Skaggs wrote: This is an actual email that I got from a patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because local insurers are not paying anything on “virtual visits” anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say “come to the office if that doesn’t answer your question” I’m currently getting one like this every few days and it’s getting out of hand. Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because

they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

Be a better Heartthrob. Get better relationship answers from someone who knows.Yahoo! Answers - Check it out.

June 12, 2007

Online communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year. Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed. Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> "Annie Skaggs" 6/11/2007 9:25:44 AM >>> This is an actual email that I got from a patient. I do not have an â€œe-visitâ€ policy per se, and have not jumped on putting one in place because local insurers are not paying anything on â€œvirtual visitsâ€ anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say â€œcome to the office if that doesnâ€™t answer your questionâ€Iâ€™m currently getting one like this every few days and itâ€™s getting out of hand.Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

June 12, 2007

Dr. Scherger,I have admired your foresight for a long time. You seem to be ahead of the game again.I think the wave of the future of family medicine is with prepaid services. The overhead is minimal, and with either electronic payment or a drop box with a bank, payments can be done effortlessly. Integrating email with an EMR with cut and paste, and of course archiving the original, is also easy. Then, as you say, visits can be done much more leisurely, with more personal attention.Despite the thinking of the AAFP, AMA, and other organizations--and Presidential candidates--government and insurance are not the way, they are IN the way. When we deviated from pay as you go to bill someone else, primary care lost the edge, as we sought to see more patients to increase income. Who got short-changed? The

patients did. Now with fixed fees and high overhead, who suffers? We do. Patients have to regain control of their own care. We are in the century of customer service. The IMP concept is revolutionary to many, yet it attempts to return to a more simple time. Marcus Welby was the TV star who took time with his patients, rather than the hurried characters found in Grey's Anatomy, Scrubs, and ER, who now set the value standard for today's medical school graduates.Please continue your innovative approach to family medicine, as we all learn to shift the paradigm of family medicine and who we really are. Ramon Parrish, M.D. "You never change things by fighting the existing reality. To change something build a new model that makes the existing model obsolete"- Buckminster Fuller Re: emails from patients

Online communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year.

Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed.

Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards.

Joe

ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> "Annie Skaggs" 6/11/2007 9:25:44 AM >>>

This is an actual email that I got from a patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because local insurers are not paying anything on “virtual visits” anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say “come to the office if that doesn’t answer your question” I’m currently getting one like this every few days and it’s getting out of hand. Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

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Check out fun summer activities for kids.

June 12, 2007

Wonderful comments Ramon. Thank you. I also use the same Buckminster Fuller quote! One comment about EMRs and cutting and pasting emails. That is great with an EMR which does not have a "patient portal" built right into. Many of the EMRs (better called EHRs, and even PHRs with the patients having access) now have secure imbedded patient portals for online communication which are then automatically saved and part of the record. I know these EHRs are the more expensive ones. Many hospitals are now subsidizing these for their docs to build loyalty, and the IRS has even said this is legal for a not-for-profit hospital to do! An IMP physician may no longer do hospital work, but if you refer to a specific hospital and have some level of privileges, this may be an option. Another lower cost alternative to such an EMR is to use a secure email service like eDocLocal or Relay Health and have a secure patient portal built right into your practice website. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> Ramon Parrish 6/12/2007 4:08 AM >>>Dr. Scherger,I have admired your foresight for a long time. You seem to be ahead of the game again.I think the wave of the future of family medicine is with prepaid services. The overhead is minimal, and with either electronic payment or a drop box with a bank, payments can be done effortlessly. Integrating email with an EMR with cut and paste, and of course archiving the original, is also easy. Then, as you say, visits can be done much more leisurely, with more personal attention.Despite the thinking of the AAFP, AMA, and other organizations--and Presidential candidates--government and insurance are not the way, they are IN the way. When we deviated from pay as you go to bill someone else, primary care lost the edge, as we sought to see more patients to increase income. Who got short-changed? The patients did. Now with fixed fees and high overhead, who suffers? We do. Patients have to regain control of their own care. We are in the century of customer service. The IMP concept is revolutionary to many, yet it attempts to return to a more simple time. Marcus Welby was the TV star who took time with his patients, rather than the hurried characters found in Grey's Anatomy, Scrubs, and ER, who now set the value standard for today's medical school graduates.Please continue your innovative approach to family medicine, as we all learn to shift the paradigm of family medicine and who we really are. Ramon Parrish, M.D. "You never change things by fighting the existing reality. To change something build a new model that makes the existing model obsolete"- Buckminster Fuller Re: emails from patientsOnline communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year. Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed. Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JSchergerucsd (DOT) edu>>> "Annie Skaggs" <askaggsfayettefamilymed> 6/11/2007 9:25:44 AM >>> This is an actual email that I got from a patient. I do not have an â€œe-visitâ€ policy per se, and have not jumped on putting one in place because local insurers are not paying anything on â€œvirtual visitsâ€ anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say â€œcome to the office if that doesnâ€™t answer your questionâ€Iâ€™m currently getting one like this every few days and itâ€™s getting out of hand.Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim XxxxGot a little couch potato? Check out fun summer activities for kids.

June 13, 2007

ï»¿

RE paying for access--

they won't but i will

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

Re: emails from patients

Online communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year.

Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed.

Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards.

Joe

ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> "Annie Skaggs" 6/11/2007 9:25:44 AM >>>

This is an actual email that I got from a patient. I do not have an â€œe-visitâ€ policy per se, and have not jumped on putting one in place because local insurers are not paying anything on â€œvirtual visitsâ€ anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say â€œcome to the office if that doesnâ€™t answer your questionâ€

Iâ€™m currently getting one like this every few days and itâ€™s getting out of hand.

Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

June 14, 2007

'Another lower cost alternative to such an EMR is to use a secure email service like eDocLocal or Relay Health and have a secure patient portal built right into your practice website.' This is a quote from one of my list-serve buddies. This is the sort of thing I am refering to when I say 'secure'.

Lynette I Iles MD 214 South Iowa Ste 3 Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

June 14, 2007

Sorry, trying to send this to the gal doing my web-site ;-).

'Another lower cost alternative to such an EMR is to use a secure email service like eDocLocal or Relay Health and have a secure patient portal built right into your practice website.' This is a quote from one of my list-serve buddies. This is the sort of thing I am refering to when I say 'secure'. Lynette I Iles MD 214 South Iowa Ste 3 Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer. -- Lynette I Iles MD 214 South Iowa Ste 3 Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

June 14, 2007

Wow, “access fee”….

$30 per month. I can’t

imagine anyone paying that. On

average, my patients expect to have to be seen in the office no more than twice

per year, and they expect eleven free services between visits.

Does anyone actually research what people

value, what they will pay for? “$30

a month for 1000 patients”… at least twice a month I have to calm

down someone who is irate about not getting their phone in refill: “I’m sorry I upset you, Ms DiamondsAreaGirlsBestFriend. I would love to be able to do everyone

favors, but did you know that if every one of my patients wants only one

special favor a year, that is still two favors a day, every day, 365 days a

year. And I haven’t taken a

single day off since 2004”

Do they care? Not a bit.

There will have to be WAY more of a

shortage of primary care docs before I get any kind of “access fee”

Annie

Re:

emails from patients

Online communication is the new

" platform " of communication with patients. I started giving my

email to all my patients in 1997 and have not looked back. I answer

online health questions every day for Revolution Health and eDocAmerica.

It makes access to health care communication continuous for our patients.

You should have an access fee to cover this service. Remember, $30 a

month for 1000 patients is $360,000 a year.

Don't do anything by email that

should be done in person, or even over the phone. Email is a nice way to

set up telephone appointments (again, get paid for this). I predict in

the near future we will handle more than 60% of our daily patient

communications online, reserving time for relaxed and professional visits and

telephone calls as needed.

Mimi Doohan, an model IMP in Santa

Barbara, has just set up " eDocLocal " through eDocAmerica to add this

service. That way it is done through a secure website meeting recommended

HIPAA standards.

Joe

ph E. Scherger, MD, MPH

Clinical Professor

University of California, San Diego

Medical Director, AmeriChoice

8840 Complex Dr. Suite 300

San Diego, CA 92123

Phone:

Fax:

JScherger@...

>>> " Annie Skaggs "

6/11/2007 9:25:44 AM >>>

This is an actual email that I got from a patient.

I do not have an “e-visit” policy per se, and have not jumped on putting one in place because

local insurers are not paying anything on “virtual visits” anyway,

but more and more I get this sort of thing. How are you guys

handling this? Do you just tell everyone they need a visit? Do you

answer the emails with a link to something like the Mayo Clinic website and say

“come to the office if that doesn’t answer your question”

I’m currently getting one

like this every few days and it’s getting out of hand.

Hi Dr.

Skaggs ~

My 52 year-old brother recently had a CVA. He had been

dx'd w/ type 2 DM this January and had since lost 50+

lbs.

My mother thinks all of us need to be on daily aspirin therapy like Jim is now.

I have had iron-poor blood in the past, and wondered if the aspirin would

affect that. I only know this because they wouldn't let me donate blood a

couple of times. Anyway, I told mom I was going to check with you. My last

checkup was December 21st.

Thanks ~ Kim Xxxx

June 14, 2007

Agreed.

Acess fee ONLY IF "PERCEIVED" shortage of doc access

Sorry, but appears to be more "ivory tower" idea to me, not realistic in my area

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: emails from patients

Wow, “access fee”…. $30 per month. I can’t imagine anyone paying that. On average, my patients expect to have to be seen in the office no more than twice per year, and they expect eleven free services between visits.

Does anyone actually research what people value, what they will pay for? “$30 a month for 1000 patients”… at least twice a month I have to calm down someone who is irate about not getting their phone in refill: “I’m sorry I upset you, Ms DiamondsAreaGirlsBestFriend. I would love to be able to do everyone favors, but did you know that if every one of my patients wants only one special favor a year, that is still two favors a day, every day, 365 days a year. And I haven’t taken a single day off since 2004” Do they care? Not a bit.

There will have to be WAY more of a shortage of primary care docs before I get any kind of “access fee”

Annie

-----Original Message-----From: [mailto: ] On Behalf Of ph SchergerSent: Tuesday, June 12, 2007 1:40 AMTo: Subject: Re: emails from patients

Online communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year.

Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed.

Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards.

Joe

ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JSchergerucsd (DOT) edu>>> "Annie Skaggs" <askaggsfayettefamilymed> 6/11/2007 9:25:44 AM >>>

This is an actual email that I got from a patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because local insurers are not paying anything on “virtual visits” anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say “come to the office if that doesn’t answer your question”

I’m currently getting one like this every few days and it’s getting out of hand.

Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

June 14, 2007

Agreed.

Acess fee ONLY IF "PERCEIVED" shortage of doc access

Sorry, but appears to be more "ivory tower" idea to me, not realistic in my area

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: emails from patients

Wow, “access fee”…. $30 per month. I can’t imagine anyone paying that. On average, my patients expect to have to be seen in the office no more than twice per year, and they expect eleven free services between visits.

Does anyone actually research what people value, what they will pay for? “$30 a month for 1000 patients”… at least twice a month I have to calm down someone who is irate about not getting their phone in refill: “I’m sorry I upset you, Ms DiamondsAreaGirlsBestFriend. I would love to be able to do everyone favors, but did you know that if every one of my patients wants only one special favor a year, that is still two favors a day, every day, 365 days a year. And I haven’t taken a single day off since 2004” Do they care? Not a bit.

There will have to be WAY more of a shortage of primary care docs before I get any kind of “access fee”

Annie

-----Original Message-----From: [mailto: ] On Behalf Of ph SchergerSent: Tuesday, June 12, 2007 1:40 AMTo: Subject: Re: emails from patients

Online communication is the new "platform" of communication with patients. I started giving my email to all my patients in 1997 and have not looked back. I answer online health questions every day for Revolution Health and eDocAmerica. It makes access to health care communication continuous for our patients. You should have an access fee to cover this service. Remember, $30 a month for 1000 patients is $360,000 a year.

Don't do anything by email that should be done in person, or even over the phone. Email is a nice way to set up telephone appointments (again, get paid for this). I predict in the near future we will handle more than 60% of our daily patient communications online, reserving time for relaxed and professional visits and telephone calls as needed.

Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal" through eDocAmerica to add this service. That way it is done through a secure website meeting recommended HIPAA standards.

Joe

ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JSchergerucsd (DOT) edu>>> "Annie Skaggs" <askaggsfayettefamilymed> 6/11/2007 9:25:44 AM >>>

This is an actual email that I got from a patient. I do not have an “e-visit” policy per se, and have not jumped on putting one in place because local insurers are not paying anything on “virtual visits” anyway, but more and more I get this sort of thing. How are you guys handling this? Do you just tell everyone they need a visit? Do you answer the emails with a link to something like the Mayo Clinic website and say “come to the office if that doesn’t answer your question”

I’m currently getting one like this every few days and it’s getting out of hand.

Hi Dr. Skaggs ~ My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM this January and had since lost 50+ lbs. My mother thinks all of us need to be on daily aspirin therapy like Jim is now. I have had iron-poor blood in the past, and wondered if the aspirin would affect that. I only know this because they wouldn't let me donate blood a couple of times. Anyway, I told mom I was going to check with you. My last checkup was December 21st. Thanks ~ Kim Xxxx

June 14, 2007

Hmmm.... I pay much more than this per month for my satellite TV,

TiVo. I also pay about $400 per year to have my heating ventilation

and air-conditioning obtain biannual inspections and have it so that

they will respond quickly to any problems.

>

> Wow, " access fee " .. $30 per month. I can't imagine anyone paying

that.

> On average, my patients expect to have to be seen in the office no

more

> than twice per year, and they expect eleven free services between

> visits.

>

> Does anyone actually research what people value, what they will

pay for?

> " $30 a month for 1000 patients " . at least twice a month I have to

calm

> down someone who is irate about not getting their phone in

refill: " I'm

> sorry I upset you, Ms DiamondsAreaGirlsBestFriend. I would love

to be

> able to do everyone favors, but did you know that if every one of

my

> patients wants only one special favor a year, that is still two

favors a

> day, every day, 365 days a year. And I haven't taken a single day

off

> since 2004 " Do they care? Not a bit.

>

> There will have to be WAY more of a shortage of primary care docs

before

> I get any kind of " access fee "

> Annie

>

> Re: emails from patients

>

> Online communication is the new " platform " of communication with

> patients. I started giving my email to all my patients in 1997

and have

> not looked back. I answer online health questions every day for

> Revolution Health and eDocAmerica. It makes access to health care

> communication continuous for our patients. You should have an

access

> fee to cover this service. Remember, $30 a month for 1000

patients is

> $360,000 a year.

>

> Don't do anything by email that should be done in person, or even

over

> the phone. Email is a nice way to set up telephone appointments

(again,

> get paid for this). I predict in the near future we will handle

more

> than 60% of our daily patient communications online, reserving

time for

> relaxed and professional visits and telephone calls as needed.

>

> Mimi Doohan, an model IMP in Santa Barbara, has just set

up " eDocLocal "

> through eDocAmerica to add this service. That way it is done

through a

> secure website meeting recommended HIPAA standards.

>

> Joe

>

> ph E. Scherger, MD, MPH

> Clinical Professor

> University of California, San Diego

> Medical Director, AmeriChoice

> 8840 Complex Dr. Suite 300

> San Diego, CA 92123

> Phone:

> Fax:

> JScherger@...

>

> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM

> >>>

>

> This is an actual email that I got from a patient. I do not

have an

> " e-visit " policy per se, and have not jumped on putting one in

place

> because local insurers are not paying anything on " virtual visits "

> anyway, but more and more I get this sort of thing. How are you

guys

> handling this? Do you just tell everyone they need a visit? Do

you

> answer the emails with a link to something like the Mayo Clinic

website

> and say " come to the office if that doesn't answer your question "

> I'm currently getting one like this every few days and it's

getting out

> of hand.

> Hi Dr. Skaggs ~

> My 52 year-old brother recently had a CVA. He had been dx'd w/

type 2 DM

> this January and had since lost 50+ lbs.

> My mother thinks all of us need to be on daily aspirin therapy

like Jim

> is now. I have had iron-poor blood in the past, and wondered if the

> aspirin would affect that. I only know this because they wouldn't

let me

> donate blood a couple of times. Anyway, I told mom I was going to

check

> with you. My last checkup was December 21st.

> Thanks ~ Kim Xxxx

>

June 14, 2007

Yes,

yes, yes…. And I know my patient’s pay similarly for services and

products that they value. Personally, I don’t have satellite

or cable and have to do pay-as-you-go thing for HVAC repair…Last year, when

Medicare didn’t pay me for 6 months, we did without AC until August

because we didn’t have the money for repairs….

I wish we could do some real research on

human behavior in regard to this subject.

You and I can argue all day that it is only fair that we be paid fairly,

that people obviously have money if they can pay $90 per month for cable (what

a patient told me he pays the other day)or they can

drop $250 cash to take their dog to the doggie Urgent Care Clinic, or they pay

$80 for a visit to the hair salon…. So it seems that paying for medical care

should not be that big a deal, but reality: IT IS LIKE PULLING TEETH. There is something that makes otherwise

reasonable people believe that it is somehow WRONG for them to have to pay

money when they come to see me. Or

for service that doesn’t involve coming in. Very few people are willing to pay anything

beyond the copay and coinsurance, and they make me

wait months for the coinsurance. I stayed late at the office last night writing

letters to about 20 medicare patients who are now

>90 days on their deductibles that they owe me.

I seriously would like to research this

somehow…

One interesting observation: Recently I

bought 100 copies of that little HSA book “Healthcare Happily Ever After”,

the price was subsidized (by Farm Bureau I think) on the condition that the

books NOT be resold. OK, fine, I’m

not selling them. But I put 3 or 4

in the waiting room at a time and several people have asked if they could have

one. It’s a small trade

paperback of 88 pages. In a store,

I would expect to pay $4.95 for something similar. I, and my office helpers, have told people

quite plainly that they aren’t for sale, but we would really appreciate a

small donation of a dollar or two to offset the fact that I did have to pay for

them. But if they feel that a

dollar is too much, they can have one for free. This

just floors me, but 100% of people have declined to take one at all,

free or for a buck…and this conversation take place while they are

pulling a $5 out to tip the valet driver when they get their car.

Similar experience last Christmas: I make some killer toffee, and after

they tasted it, a number of workers in my office building asked if they could

buy batches from me to give a Christmas gifts. Fine, I sold a bunch to office

employees. I thought, maybe patients would also buy some. Similar product from mail

order company sells for $15/lb.

I priced mine at $5 for 12 oz and packed it up in little gift baskets. Although patients would stand at the

front desk and eat the entire plate of samples, exclaiming the whole time how

delicious it was, NOT A SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal

bought, the drug reps (and I don’t even see reps) bought, the janitors

bought. But patients….they’d

take all the free samples I put out, but they would not pay a penny to buy in my office. WHY IS THAT???

What are we missing about human behavior?

Annie

Re: emails from patients

>

> Online communication is the new " platform " of communication with

> patients. I started giving my email to all my patients in 1997

and have

> not looked back. I answer online health questions every day for

> Revolution Health and eDocAmerica. It makes access to health care

> communication continuous for our patients. You should have an

access

> fee to cover this service. Remember, $30 a month for 1000

patients is

> $360,000 a year.

>

> Don't do anything by email that should be done in person, or even

over

> the phone. Email is a nice way to set up telephone appointments

(again,

> get paid for this). I predict in the near future we will handle

more

> than 60% of our daily patient communications online, reserving

time for

> relaxed and professional visits and telephone calls as needed.

>

> Mimi Doohan, an model IMP in Santa Barbara, has just set

up " eDocLocal "

> through eDocAmerica to add this service. That way it is done

through a

> secure website meeting recommended HIPAA standards.

>

> Joe

>

> ph E. Scherger, MD, MPH

> Clinical Professor

> University of California, San Diego

> Medical Director, AmeriChoice

> 8840 Complex Dr. Suite 300

> San Diego, CA 92123

> Phone:

> Fax:

> JScherger@...

>

> >>> " Annie Skaggs " 6/11/2007

9:25:44 AM

> >>>

>

> This is an actual email that I got from a patient. I do not

have an

> " e-visit " policy per se, and have not jumped on putting one in

place

> because local insurers are not paying anything on " virtual

visits "

> anyway, but more and more I get this sort of thing. How are you

guys

> handling this? Do you just tell everyone they need a visit? Do

you

> answer the emails with a link to something like the Mayo Clinic

website

> and say " come to the office if that doesn't answer your

question "

> I'm currently getting one like this every few days and it's

getting out

> of hand.

> Hi Dr. Skaggs ~

> My 52 year-old brother recently had a CVA. He had been dx'd w/

type 2 DM

> this January and had since lost 50+ lbs.

> My mother thinks all of us need to be on daily aspirin therapy

like Jim

> is now. I have had iron-poor blood in the past, and wondered if the

> aspirin would affect that. I only know this because they wouldn't

let me

> donate blood a couple of times. Anyway, I told mom I was going to

check

> with you. My last checkup was December 21st.

> Thanks ~ Kim Xxxx

>

June 14, 2007

Yes,

yes, yes…. And I know my patient’s pay similarly for services and

products that they value. Personally, I don’t have satellite

or cable and have to do pay-as-you-go thing for HVAC repair…Last year, when

Medicare didn’t pay me for 6 months, we did without AC until August

because we didn’t have the money for repairs….

I wish we could do some real research on

human behavior in regard to this subject.

You and I can argue all day that it is only fair that we be paid fairly,

that people obviously have money if they can pay $90 per month for cable (what

a patient told me he pays the other day)or they can

drop $250 cash to take their dog to the doggie Urgent Care Clinic, or they pay

$80 for a visit to the hair salon…. So it seems that paying for medical care

should not be that big a deal, but reality: IT IS LIKE PULLING TEETH. There is something that makes otherwise

reasonable people believe that it is somehow WRONG for them to have to pay

money when they come to see me. Or

for service that doesn’t involve coming in. Very few people are willing to pay anything

beyond the copay and coinsurance, and they make me

wait months for the coinsurance. I stayed late at the office last night writing

letters to about 20 medicare patients who are now

>90 days on their deductibles that they owe me.

I seriously would like to research this

somehow…

One interesting observation: Recently I

bought 100 copies of that little HSA book “Healthcare Happily Ever After”,

the price was subsidized (by Farm Bureau I think) on the condition that the

books NOT be resold. OK, fine, I’m

not selling them. But I put 3 or 4

in the waiting room at a time and several people have asked if they could have

one. It’s a small trade

paperback of 88 pages. In a store,

I would expect to pay $4.95 for something similar. I, and my office helpers, have told people

quite plainly that they aren’t for sale, but we would really appreciate a

small donation of a dollar or two to offset the fact that I did have to pay for

them. But if they feel that a

dollar is too much, they can have one for free. This

just floors me, but 100% of people have declined to take one at all,

free or for a buck…and this conversation take place while they are

pulling a $5 out to tip the valet driver when they get their car.

Similar experience last Christmas: I make some killer toffee, and after

they tasted it, a number of workers in my office building asked if they could

buy batches from me to give a Christmas gifts. Fine, I sold a bunch to office

employees. I thought, maybe patients would also buy some. Similar product from mail

order company sells for $15/lb.

I priced mine at $5 for 12 oz and packed it up in little gift baskets. Although patients would stand at the

front desk and eat the entire plate of samples, exclaiming the whole time how

delicious it was, NOT A SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal

bought, the drug reps (and I don’t even see reps) bought, the janitors

bought. But patients….they’d

take all the free samples I put out, but they would not pay a penny to buy in my office. WHY IS THAT???

What are we missing about human behavior?

Annie

Re: emails from patients

>

> Online communication is the new " platform " of communication with

> patients. I started giving my email to all my patients in 1997

and have

> not looked back. I answer online health questions every day for

> Revolution Health and eDocAmerica. It makes access to health care

> communication continuous for our patients. You should have an

access

> fee to cover this service. Remember, $30 a month for 1000

patients is

> $360,000 a year.

>

> Don't do anything by email that should be done in person, or even

over

> the phone. Email is a nice way to set up telephone appointments

(again,

> get paid for this). I predict in the near future we will handle

more

> than 60% of our daily patient communications online, reserving

time for

> relaxed and professional visits and telephone calls as needed.

>

> Mimi Doohan, an model IMP in Santa Barbara, has just set

up " eDocLocal "

> through eDocAmerica to add this service. That way it is done

through a

> secure website meeting recommended HIPAA standards.

>

> Joe

>

> ph E. Scherger, MD, MPH

> Clinical Professor

> University of California, San Diego

> Medical Director, AmeriChoice

> 8840 Complex Dr. Suite 300

> San Diego, CA 92123

> Phone:

> Fax:

> JScherger@...

>

> >>> " Annie Skaggs " 6/11/2007

9:25:44 AM

> >>>

>

> This is an actual email that I got from a patient. I do not

have an

> " e-visit " policy per se, and have not jumped on putting one in

place

> because local insurers are not paying anything on " virtual

visits "

> anyway, but more and more I get this sort of thing. How are you

guys

> handling this? Do you just tell everyone they need a visit? Do

you

> answer the emails with a link to something like the Mayo Clinic

website

> and say " come to the office if that doesn't answer your

question "

> I'm currently getting one like this every few days and it's

getting out

> of hand.

> Hi Dr. Skaggs ~

> My 52 year-old brother recently had a CVA. He had been dx'd w/

type 2 DM

> this January and had since lost 50+ lbs.

> My mother thinks all of us need to be on daily aspirin therapy

like Jim

> is now. I have had iron-poor blood in the past, and wondered if the

> aspirin would affect that. I only know this because they wouldn't

let me

> donate blood a couple of times. Anyway, I told mom I was going to

check

> with you. My last checkup was December 21st.

> Thanks ~ Kim Xxxx

>

June 14, 2007

The research has been done I believe. We humans don't make financial

decisions based on facts but rather by emotions. Cable TV is " romantic "

in a way and " adds something " to our lives -- at least that is what people

believe in their heart, if not in their heads, from watching commercials.

But healthcare is not " romantic " and trying to avoid it can mean someone

is " healthy " (even if we know so many people really are avoiding the facts

about their health)... so they'd prefer not have to pay.

And the toffee... wrong person selling it. Same product, higher price,

not their doctor, buy it up in an instant. People do not buy things for

quality but by the emotion they relate to something. And because no

patient would think of buying a food from a doc, few if any will buy your

toffee. Human nature really.

.... And it's a big part of my concern for the " consumer-driven " healthcare

movement. Some parts of it seem good, but wow does it have some major,

major risks once natural human behavior starts messing up individuals'

decisions!

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> Yes, yes, yes.. And I know my patient's pay similarly for services and

> products that they value. Personally, I don't have satellite or cable

> and have to do pay-as-you-go thing for HVAC repair.Last year, when

> Medicare didn't pay me for 6 months, we did without AC until August

> because we didn't have the money for repairs..

>

> I wish we could do some real research on human behavior in regard to

> this subject. You and I can argue all day that it is only fair that we

> be paid fairly, that people obviously have money if they can pay $90 per

> month for cable (what a patient told me he pays the other day)or they

> can drop $250 cash to take their dog to the doggie Urgent Care Clinic,

> or they pay $80 for a visit to the hair salon.. So it seems that paying

> for medical care should not be that big a deal, but reality: IT IS LIKE

> PULLING TEETH. There is something that makes otherwise reasonable

> people believe that it is somehow WRONG for them to have to pay money

> when they come to see me. Or for service that doesn't involve coming

> in. Very few people are willing to pay anything beyond the copay and

> coinsurance, and they make me wait months for the coinsurance. I stayed

> late at the office last night writing letters to about 20 medicare

> patients who are now >90 days on their deductibles that they owe me.

>

> I seriously would like to research this somehow.

>

> One interesting observation: Recently I bought 100 copies of that little

> HSA book " Healthcare Happily Ever After " , the price was subsidized (by

> Farm Bureau I think) on the condition that the books NOT be resold. OK,

> fine, I'm not selling them. But I put 3 or 4 in the waiting room at a

> time and several people have asked if they could have one. It's a small

> trade paperback of 88 pages. In a store, I would expect to pay $4.95

> for something similar. I, and my office helpers, have told people quite

> plainly that they aren't for sale, but we would really appreciate a

> small donation of a dollar or two to offset the fact that I did have to

> pay for them. But if they feel that a dollar is too much, they can have

> one for free. This just floors me, but 100% of people have declined

> to take one at all, free or for a buck.and this conversation take place

> while they are pulling a $5 out to tip the valet driver when they get

> their car.

>

> Similar experience last Christmas: I make some killer toffee, and after

> they tasted it, a number of workers in my office building asked if they

> could buy batches from me to give a Christmas gifts. Fine, I sold a

> bunch to office employees. I thought, maybe patients would also buy

> some. Similar product from mail order company sells for $15/lb. I

> priced mine at $5 for 12 oz and packed it up in little gift baskets.

> Although patients would stand at the front desk and eat the entire plate

> of samples, exclaiming the whole time how delicious it was, NOT A

> SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal bought,

> the drug reps (and I don't even see reps) bought, the janitors bought.

> But patients..they'd take all the free samples I put out, but they would

> not pay a penny to buy in my office. WHY IS THAT???

>

> What are we missing about human behavior?

>

> Annie

>

> Re: emails from patients

>>

>> Online communication is the new " platform " of communication with

>> patients. I started giving my email to all my patients in 1997

> and have

>> not looked back. I answer online health questions every day for

>> Revolution Health and eDocAmerica. It makes access to health care

>> communication continuous for our patients. You should have an

> access

>> fee to cover this service. Remember, $30 a month for 1000

> patients is

>> $360,000 a year.

>>

>> Don't do anything by email that should be done in person, or even

> over

>> the phone. Email is a nice way to set up telephone appointments

> (again,

>> get paid for this). I predict in the near future we will handle

> more

>> than 60% of our daily patient communications online, reserving

> time for

>> relaxed and professional visits and telephone calls as needed.

>>

>> Mimi Doohan, an model IMP in Santa Barbara, has just set

> up " eDocLocal "

>> through eDocAmerica to add this service. That way it is done

> through a

>> secure website meeting recommended HIPAA standards.

>>

>> Joe

>>

>> ph E. Scherger, MD, MPH

>> Clinical Professor

>> University of California, San Diego

>> Medical Director, AmeriChoice

>> 8840 Complex Dr. Suite 300

>> San Diego, CA 92123

>> Phone:

>> Fax:

>> JScherger@...

>>

>> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM

>> >>>

>>

>> This is an actual email that I got from a patient. I do not

> have an

>> " e-visit " policy per se, and have not jumped on putting one in

> place

>> because local insurers are not paying anything on " virtual visits "

>> anyway, but more and more I get this sort of thing. How are you

> guys

>> handling this? Do you just tell everyone they need a visit? Do

> you

>> answer the emails with a link to something like the Mayo Clinic

> website

>> and say " come to the office if that doesn't answer your question " I'm

>> currently getting one like this every few days and it's

> getting out

>> of hand.

>> Hi Dr. Skaggs ~

>> My 52 year-old brother recently had a CVA. He had been dx'd w/

> type 2 DM

>> this January and had since lost 50+ lbs.

>> My mother thinks all of us need to be on daily aspirin therapy

> like Jim

>> is now. I have had iron-poor blood in the past, and wondered if the

>> aspirin would affect that. I only know this because they wouldn't

> let me

>> donate blood a couple of times. Anyway, I told mom I was going to

> check

>> with you. My last checkup was December 21st.

>> Thanks ~ Kim Xxxx

>>

>

June 14, 2007