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Is Direct Primary Care the Solution to the US Healthcare Crisis? Print E-mail
Written by David H. Fater   
Thursday, 23 January 2020 11:19

Healthcare policy is often portrayed as a fight between government and insurance companies. But one of the most effective cost-saving measures is to cut out both and allow patients to deal directly with doctors. This can be accomplished in a variety of ways, one of which is referred to as Direct Primary Care (DPC), a concept that has been around for several years but is gaining traction. As with any facet of healthcare there are advantages and disadvantages and one has to understand the concept, as well as the benefits and the pitfalls. It also is important to differentiate Direct Primary Care from Concierge Medicine.  There are similarities but there are also significant differences.

Also, it should be kept in mind that many of these groups are pioneering next generation care models as well, incorporating nutrition, mental health and coaching services into holistic treatment plans that strike at the root of chronic disease. These integrated care teams design plans and wellness environments that are about as similar to traditional healthcare as Amazon.com was to Barnes and Nobles.

Let’s look at Todd Gibbons (Patient) from Any City, USA. When he has an aching shoulder or needs a physical, he can call and schedule an appointment on a day’s notice, maybe the same day. His physician is also available for phone consultations and even makes house calls. It all costs Mr. Gibbons $150 a month to cover his family of five. Costs are so low and coverage so good because the Gibbons family goes to PTC Direct Primary Care—a medical practice that treats patients for routine care and procedures for a monthly membership fee. Virtually every routine service—from electrocardiograms and pap smears to stitches and physicals—is included. There are no office-visit fees or copayments. All physician services and procedures offered at PTC are covered, and all without the use of health insurance.

Without third parties taking money and adding overhead, PTC can offer medications and lab tests not covered by the monthly fee at wholesale prices. A cholesterol blood test is $3.20 for a PTC member, but $22 at other in-network providers.  Drugs are cheaper. PTC buys directly from three national wholesalers, which compete to provide medications at the best possible price for any given patient, and PTC resells them at cost. A 30-day supply of the generic equivalent of 40 mg Lipitor for cholesterol is $3.30 at PTC. At Walmart it’s $9. Sildenafil, the generic for Viagra, is 37 cents a pill. The next cheapest option is Safeway at $2.13. Over-the-counter drugs are also cheaper and available in-house at PTC. Cetirizine allergy pills (the generic version of Zyrtec) are 6 cents a tablet at PTC, about half the Walmart price.

Costs are low and transparent. The monthly fee, whether paid by employer or individual, is predictable and easy to budget. It is important to bear in mind that patients still need high-deductible insurance or cost-sharing pools to cover nonroutine procedures and care. But complementing a direct primary care plan with one of those two options still can produce the cheapest coverage.

One of the negatives is that tax incentives currently discourage employers from switching to direct primary care plans. One possible fix would allow patients to use health-savings accounts to pay for membership. The IRS could make this change by redefining a direct primary care membership as an eligible HSA expense. Cutting the middlemen out of daily health care won’t solve all of the medical system’s problems. But altering the tax code to encourage employers to use direct primary care could help control or even shrink costs. Most important, it would improve the quality of care by letting doctors spend less time filling out paperwork for reimbursement and more time helping patients.

Direct primary care could be viewed as yet another in a long line of ideas to help reinvigorate primary care for both doctors and patients. Some view it as a panacea, others as snake oil. I am not sure what it is exactly, but I do know it is not a transformative innovation for making primary care more relevant, responsive, and affordable on a large scale. Simply put, direct primary care is a model for delivering primary care, and only primary care. The doctor charges each patient a monthly fee, generally ranging from $50 to $200, in return for timely, convenient access and a buffet-like menu of mostly basic primary care services. The amount of the monthly fee is presumably set in relation to the scope of services covered, though every practice may do it differently. For services that aren’t covered under the fee, like more extensive management of a chronic disease, the patient’s insurance — if it exists — must be billed to pay for the service or, in some cases, the physician or practice will charge the patient extra fees to cover those services.

On the physician side, direct primary care is appealing to a growing number of doctors. Many are burned out and dissatisfied working in traditional primary care practices, where the administrative hassles are high and physicians do not get to spend enough time with their patients. Many want to return to a time when Marcus Welby, MD practiced and the doctor-patient relationship was more central to the delivery of primary care. Many want greater predictability and control in their work lives.

Five Factoids About Direct Primary Care
 
1. DPC physicians foster an enduring doctor-patient relationship
Developing an enduring doctor-patient relationship through adequate appointment time is a hallmark of Direct Primary Care. A typical Direct Primary Care practice has about 600 patients, compared with 2,500 patients for an average fee-for-service primary care practice. Instead of seeing up to 30 patients or more a day, Direct Primary Care providers typically see less than 10. Many physicians believe a lot of medicine can be done electronically. It should be noted that most Concierge Medicine practices limit their patients to 600 as well; However, the Concierge Fee is greater than the Direct Primary Care fee-ranging from $2,000-$2,500. (Interestingly enough, if you add up 12 payments of $150, you are close to the Concierge Fee-but recognize the Concierge physician does not have a "Family Plan).

Additionally, Direct Primary Care physicians profess that they know their patients by name and have time for them. These longer appointments in the DPC model allow time for discussions between a physician and patient that encompass lifestyle choices with the aim of long-term health and well-being.What everyone really needs to know is that patients do get better care when their doctor is more satisfied with what they are doing. And that takes time. That is what the [fee-for-service] system cannot provide -  time with the patient.

2. DPC is growing and DOs are joining in
In the past decade, the DPC model has grown from just 21 practices to over 1,000 practices in 49 states that care for an estimated 500,000 patients, according to the Direct Primary Care Coalition (DPCC), an advocacy group. The movement has been particularly popular among DOs who estimates that 30-40 percent of the group’s members are DOs, osteopathic residents and medical students.The high level of interest in DPC by DOs may be attributed to an already higher percentage of DOs practicing primary care- But DOs also tend to be a bit more entrepreneurial and independent and their training includes some additional non-traditional treatment techniques.

3. Efforts are underway to enhance DPC
The American Osteopathic Association supports the DPC model, and has urged Congress to support a Primary Care Enhancement Act (PCEA) that includes a DPC model which would allow physicians to provide health care to the full extent of their scope of practice, including providing diagnostic services and dispensing prescription drugs. Currently, the IRS views DPC as a type of health insurance and bars the use of health savings account funds to pay for DPC. The PCEA would allow patients to use the funds from their HSA to pay for DPC. One of the downsides of direct primary care is that it can be challenging to find patients who can afford their membership dues, particularly in medically underserved areas.

4. DPC offers upfront pricing
DPC practices offer transparent pricing upfront. A monthly membership fee (typically under $100 per member, often with family discounts) covers unlimited primary care office visits and services. Patients are encouraged to buy a complementary insurance plan, such as a high deductible health plan, to pay for any complex or catastrophic medical services outside of primary care.While both concierge and DPC charge a periodic membership fee to the patient, most DPC physicians don’t accept insurance. Concierge practices, on the other hand, typically still bill insurance and often add an annual retainer fee that is usually higher than the DPC annualized membership fee.

5. DPC embraces the ‘quadruple aim of medicine’
The triple aim of medicine—to enhance the patient experience, improve population health and reduce health care costs—is well-documented and embedded in the triple aims promulgated by the ACA. DPC providers are focused on “the quadruple aim of medicine” which acknowledges that improving the work-life balance of physicians is necessary in order for the other three aims to happen.

Direct Primary Care will continue to evolve (as will Concierge Medicine). It probably will not be the solution to our broken healthcare system but it does provide some interesting alternatives both for physicians and patients. Primary Care Physicians should consider this concept to include in their practice as the crisis continues to evolve; but this will also entail a change in the mindset of physicians.
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Mr. Fater is CEO, Alda & Associates in Delray Beach, FL.

Last Updated on Thursday, 23 January 2020 12:17
 
What are the Differences Between Home Health Aides (HHA) and Certified Nursing Assistants (CNA)? Print E-mail
Written by AHHC News   
Thursday, 16 January 2020 09:43

If you have disabled or elderly patients who are in need of assistance, there are many things to consider. You may wonder what kind of help they need and how much help they require. You may know that you want to get your patient a home care aide, but you might be unsure which home aide is best suited for him/her: a home health aide (HHA) or a certified nursing assistant (CNA). While home health aides and certified nursing assistants perform some of the same tasks and have similar responsibilities, their roles are not quite the same.

Home Health Aides

The main purpose of a home health aide is to provide clients with personal care and they usually work at the patient’s home. This means HHAs will assist with everyday tasks: bathing, grooming, restroom use, getting dressed, meal preparation, transportation, laundry, light housekeeping, running errands, and more.

With the training they’ve received, HHAs are great helpers and companions to seniors. But HHAs have limited medical training. That said, they rarely provide their clients with medical assistance, cannot provide nursing care, and do not offer medical advice. However, HHAs will monitor their clients’ condition and remind them to take their medication.

Depending on the state you’re in, HHAs need to be certified, which comes after completing the correct courses at a college or vocational school. HHAs can receive national certification from the National Association of Home Care and Hospice, but they do not need to have a college degree or a high school diploma.

Certified Nursing Assistants

CNAs have the same personal training as a home health aide does, so they can assist clients with many of the same tasks that home health aides do, such as eating and hygiene care. In addition to providing direct care, they can also help clients switch positions in bed for comfort and assist them from their wheelchairs to their beds and vice versa.

CNAs work in a wide variety of settings including nursing homes, hospitals, rehabilitation centers, and more. But they also have additional medical training and work under the supervision of either a licensed practical nurse (LPN), a licensed vocational nurse (LVA), or a registered nurse (RN).

With this medical training, CNAs will monitor patients’ health, take vitals, track their symptoms, and can speak with clients about health concerns. Furthermore, they will report their findings to their supervising nurse.

To become a CNA, one has to receive proper training from a certified program — which is offered by community colleges, hospitals, and online programs among others — and then pass a competency exam. The exam consists of a written exam and a practical exam. After receiving a CNA license, one can keep the license active by doing 48 hours of continuing education every two years.

HHA or CNA?

When deciding whether your patient requires a home health aide or a certified nursing assistant, consider their needs and what kind of assistance he/she would benefit from the most. If you determine that an elderly relative could use everyday, non-medical assistance, then hiring a home health aide is a good choice.
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At Assisting Hands, serving Miami-Dade County, FL, we offer a variety of senior care services in which we provide clients with a home health aide for anything they need. We have home health aides who can provide part-time help or full-time help, live-in care or 24-hour care, and more. At Assisting Hands, we will work with clients and their families to develop a care plan customized to your elderly loved one’s needs. Learn more at www.AssistingHands.com/Miami.

Last Updated on Thursday, 16 January 2020 09:56
 
What's the Hardest Part of a Physician's Job? Print E-mail
Written by Rada Jones, MD | KevinMD   
Tuesday, 07 January 2020 17:35

I work in the ER. It's not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think. Years ago, when I declared I was going into emergency, she looked at me askance. She didn't ask why. She looked at me with her wise old eyes. "Let me tell you about ER," she said. "I know all about it. I watch every show." She was politely dismissive and actively unimpressed. Worried about the staff having sex in the closets maybe? Or she didn't think that my hair or my style could stand up to the job. She was right. Not about the sex. I don't know how the folks in the movies find the time. Or the interest. I struggle to find time to pee. And the closets? Really? You get turned on by dirty mops and bleach perfume? She was right about the hair. It's still not worth mentioning. And my style - what style? I eventually got used to people questioning my career choice. Patients ask me when I'm going to specialize. My best friend - a computer maven - asked me why I choose to work triage. "Can't a nurse do that? Shouldn't you be treating people, instead?"

 
What are the 7 ADLs? Print E-mail
Written by AHHC News   
Wednesday, 04 December 2019 15:49

Activities of daily living, ADLs for short, are essential everyday tasks that people do to live healthy, safe, independent lives. ADLs are used in the caregiving industry to assess an individual’s ability to function on their own. This evaluation then helps determine whether an individual requires home care and assistance.

If you have elderly loved ones or care for the elderly, then it is important to know what the different activities of daily living are. You may be concerned about your elderly relatives or patients living on their own at home and feel they may need daily care. By evaluating their ability to perform ADLs, you can get a better, more accurate idea of whether they are in need of caregiving services from a home care agency. Your senior relatives or patients may also be eligible for government help depending on their ability to perform ADLs. For some elderly individuals, only part-time home care is needed. For others, full-time home care is required in order for them to maintain their health and well-being. Read the following information to learn more about the different activities of daily living and their importance.

Personal Hygiene

Personal hygiene concerns bathing, showering, oral care, grooming, nail care, and other activities that help one remain clean. Personal hygiene is important in order to maintain your health, well-being, and even personal appearance. However, some of these tasks can be especially difficult for elderly individuals, making it tough for them to maintain their personal hygiene. Knowing this, pay attention to your elderly loved one’s/patient's hygiene habits and grooming as their inability to maintain or perform such tasks should be of concern.

Continence Management

Continence management concerns toileting and one’s ability to control their bowels and bladder. If an elderly individual has continence problems, their incontinence can significantly affect the individual’s ability to live their life. Because of their lack of control, seniors may require incontinence care at any moment, so they have a great need for a caregiver who will help them clean up and change after incidents occur.

Eating and Feeding

Getting proper nutrients helps people stay healthy, and eating daily meals gives us the necessary energy to get through the day. This is why it’s so important to be able to feed yourself. If you have an elderly relative or patient who isn’t eating enough, then it may be a sign that they have trouble feeding themselves and require assistance. If this is the case, help is a necessity. Otherwise, your loved one may end up skipping meals due to their inability to eat on their own.

Dressing and Undressing

Getting dressed and putting on clothing seems like a simple enough task, but it’s not easy for everyone to do, especially elderly individuals. If seniors cannot change their clothes, then they will be left wearing the same dirty clothing items and will be unable to get properly dressed for various occasions. That said, it’s important that people are able to dress themselves or get the assistance needed to change outfits.

Ambulation

Ambulation refers to one’s ability to walk from place to place independently. If you have an elderly loved one or patient in a wheelchair or who requires the assistance of a walker to safely move about, then care services would likely be beneficial for your relative or patient. If they need help walking, then they may be more at risk of suffering from falls while moving about. This risk can be minimized significantly with someone present to help them move around their home.

Transferring

Transferring is similar to ambulation but concerns a person’s mobility. Examples of this include getting up and into bed and standing up after being seated. Struggles with transferring can also be potentially hazardous because a senior’s difficulties with transferring can lead to accidents. Knowing this, assistance would be of great benefit to your loved one or patient.

Memory

Memory problems can be especially troubling to encounter in your elderly loved ones and patients, because it may be an indicator of Alzheimer’s disease or another form of dementia. Although there is no cure for dementia of any sort, early diagnosis is best with such conditions, so be wary of frequent forgetfulness and memory lapses in your elderly relatives and patients.

If you find that your elderly loved ones or patients struggle with any of the aforementioned activities of daily living, then you should get them part-time or full-time help from a home care agency. Home health care services will allow them to remain within the comfort of their own homes while still receiving the care they require.
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Assisting Hands Home Care can provide assistance with senior home care services to elderly individuals in need. We can provide professional, well-trained, qualified caregivers who will help with any ADLs that may be difficult for seniors. We will also help with other important activities such as transportation and meal preparation. The caregivers we employ are trained to conduct CPR and first aid, so you can have some peace of mind knowing that your loved ones are in the hands of our caregivers.

Last Updated on Wednesday, 04 December 2019 16:15
 
Some of the nation's largest health systems want to care for patients in their homes Print E-mail
Written by FHI's Week in Review   
Monday, 25 November 2019 17:27

Samantha Liss reports for Healthcare Dive on Nov. 21, 2019:
Some of the nation's largest hospital systems are turning to a startup to help them deliver at-home hospital care to patients who otherwise would have been admitted...It's a move that may seem at odds with the traditional business model of hospitals, but it's one way providers are trying to get ahead of the curve as pressure mounts to reduce the cost of care and as reimbursement is increasingly tied to quality. It also fits the trend of care moving out of the pricey hospital setting.
"This is the first instance I have seen where a hospital system is attempting to intentionally reduce patient census in favor of lower cost care being provided out of the hospital," states David Fater, CEO at ALDA and Associates International in Boca Raton "This may indicate that we are approaching the tipping point and <witnessing> a new breed of hospital CEO," he adds.

Read more in the current issue of Week in Review>>
 
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