Your input please

[Guest guest]

I have been trying to compose a letter to my patients to explain that

I am cutting back on my patient load (1700 or so) and instituting IMP

ideals. My reason is honest: to spend more time with my family,

especially my parents. I am also led by a desire to change the way

medicine is practiced and all that, but I don't want to get too wordy,

and I know that what really matters to them is if they are going to be

" cut " or not.

Honest feedback please:

Dear________,

Over the past year, I have been wrestling with some weighty issues

regarding my priorities, my time commitments, and the current status

of our healthcare system. This struggle has led me to make the choice

to significantly alter my practice. In a nutshell, I plan to make it

smaller and less hurried, following the " Ideal Micro Practice " model.

You can read further about this model at www.idealmicropractice.org.

I have been in either the pursuit or practice of medicine now for

almost 30 years. I love it, I'm fascinated by it, I hope to be

practicing for many more years. But if I continue on my current

trajectory, I believe I will face many regrets once I finally do

retire. The greatest is that I will have not been available to my

aging parents in their later years of life. I could not bear to

realize too late that I should have chosen time with them over working

late.

Consequently, I will be making changes that will unavoidably affect

each of you. These changes may mean that you move to another practice

that fits your needs. If that is so, please accept my thanks for the

privilege of having been your physician, and my apologies for the

disruption my choices create.

The three main changes come in the areas of Insurance, Technology

Fees, and Office Hours, as outlined below:

Insurance

As of 2/1/08, I will no longer be accepting any HMO insurance (this

means I will not be a provider for Hill Physician Medical Group).

I will continue to be a preferred provider for the following plans only:

All Medicare Fee-for-Service (ie: non-HMO) plans

Aetna PPO

United Health Care PPO

Great West PPO

Most Labor Union Self-insurance plans

Blue Cross

Blue Shield

All plans will be reviewed periodically with regard to reimbursement

levels and " hassle factor " . I will not guarantee ongoing

participation in any plans that fail to pay for my services

competitively.

If your insurance is not listed here, you will have the option of

paying at the time of the visit and submitting the bill to your

insurance plan. Your insurance will reimburse you using its

non-preferred provider rates.

For those of you who already pay at the time of service, there will

be no changes.

Technology Fees

The use of electronic records, email with patients, and other

applications of technology is the way of the future. It can boost

efficiency, provide important information at the point of care,

improve communication between patients and physicians, and help

prevent medication errors among other things. But it is not cheap.

Its use is encouraged but not mandated by payors, consequently it is

not rewarded financially either.

I will be instituting a reasonable " user fee " for these non-covered

services. It will be in the range of $10-15/month, paid quarterly.

Families with children and the very elderly will have a sliding scale.

Instead of charging for WebVisits on Relay Health, I think this fee

will more fairly reimburse me for my time and likewise encourage more

open communication online.

This fee applies whether you use email with me or not, since it is

not just for online communication but for all use of technology.

Office Hours

I plan to institute an " Open Access " schedule, which means that most

times a patient can be seen within 24 hours of contacting me for a

visit. Online visits will be available as well. However, I do expect

that I will be out of the office most afternoons in order to tend to

my family commitments. I will remain available by phone or email 24/7

however.