Tuesday, May 23, 2017

Remaining Solo: 5 Strategies

1: Go micro: go super small.  One doc.  One staff or no staff.   EHR, patient portal, no phones.  No insurance.   Good option for family doc. 

2: Go concierge: charge extra fees.  No insurance.  Good option for family doc

3: Go super special: cosmetic, anti aging, infertility.  Easier said that done. Good for plastic surgeon and derm.

4: Go non par: take no insurance.  Bill at crazy out of network rates.   Good for neurosurgery, Ortho, general surgery

5: Go stupid busy: how the rest of us do it. Take everything.  See everything.  Work everyday, everywhere.   Not sustainable. 

For option 5: rethink contracts.  Get in with IPA. 

Any other options? PM me.

Thursday, May 18, 2017

5 Threats to Independent Care

Independent practice is under inexorable assault.  Here are the 5 latest threats.

  • MACRA/MIPS  This is a very complex endeavor.  No one who I have spoken to really knows precisely how to proceed.  It is also a zero sum gain: the bonus payments from successful practices come from the deductions from the unsuccessful ones.  
  • Cyber security  If you use any electronic resources, which includes electronic claims submittal, you are at risk for malicious cyber attack.  Protection in the form of best practice IT solutions and insurance cost $$$
  • Cost sharing/deductibles  Even for patients with insurance, the dollar amounts of deductibles have risen dramatically over the past 10 years, far outpacing wage increases.  This translates to fewer patient visits and more expensive collection efforts
  • Consolidation   Health care has become consolidated over the past 15 or so years.  In some markets there is only one payer. On the provider side there has been a major shift to employed models into larger and larger entities.  This means drying up referral networks combined with declining reimbursements to offices and increased premiums for employee health insurance.
  • Income inequality  The majority of increases in wealth, income, and standard of living have gone to the top 1%.  Most doctor practices cater to the lower 99%, who struggle to pay bills and as such, put off health care as long as possible.  
Sorry for the doom and gloom but it is what it is.  Solutions in next post.

Thanks for listening.

The IU.

Wednesday, May 17, 2017

The latest and greatest tools

Always important to have the latest and greatest tools. You know the saying: with the right tools any job is easy.  


Wednesday, May 10, 2017

I am back!

I could find my login for this blog but just remembered it. I am back. Sorry for the delay. I have nothing else to say.

Tuesday, November 03, 2015

Hiking the AT

Left today for my 50 mile AT trek.  As I lay here tonight in my tent, wide awake, I reflect on the day.   
My partners and I left the hotel at 8 or so to drop off one of the cars at the end point, a trekker hostle in TN.  
Then we returned to the start point to begin the hike, which started at 12:06 pm.   We were joined by 3 others, Jeff, Elena (husband and wife) and John, age 75, and the most experienced of us all.  

The hike began with a 1500 or so foot scent up to the ridge line.  Some of the views were amazing, see below:
but most of the day was spent in thick forest.  

We got to the campsite, the No Business Shelter, at about 4pm.  We had to locate water.  The stream was 0.3 miles away.  

Not so easy but I had the right equipment to get the job done.  

Through the rest of daylight, more hikers passed through and set up shop.  Everyone has been quite nice and an interesting mix: professionals, ex-military, a retired Reverend, a finance guy etc.  

This is bear country so we had to take precautions to protect ourselves and our food.  All food gets hung in the air far from the camp.  

I am sleeping in a tent.  I am warm and comfy.   Unfortunately, the ground here is slanted so I am having difficulty sleeping. Oh well.  Could be worse.   

Tomorrow we do 10 miles to Big Bald Shelter.  Should be fun. 

Am I glad I went: not so sure yet.   Will let you know.   

AT Day 4

16 + miles.  Too much.  Exhausted. Tomorrow last day.   Here are 2 pictures. 


Today is the last day.  As I write this, I am in a shelter 2/3rd of the way from last nights shelter and THE END.

We calculated yesterday's walk to be 17 miles.  Very tough indeed.   
I feel good today though have no appetite.  Zero.   Wonder if I have a parasite?   
Is raining today.   Pouring in fact.  I am dry. 
Already did 6.8 miles.  I have another 4 miles until comfort and safety.   
All in all did I enjoy it?  At the time of this writing: no.   I feel a sense of great accomplishment but who friggin cares.  

Day 3 AT

Too bad I only post at night, when I am cold and tired.  Today was nothing short of spectacular.  The day began with a hike to the top of Bald Mountain where we had amazing views.
There was even a couple that braved the winds to camp on the peak.   
Then we descended a couple thousand feet through forest of several varieties. 

Ultimately we hit Sam's Gap, which bisects I 26.   I saw a cab.  I can't say I was not tempted to haiil it and head to Asheville, given my exhaustion and the change in weather for the worse.   

Now it is raining lightly but we have a nice fire.  
Tomorrow we do a 14.7 miler.  I am nervous but have been assured it is not too hard.   Yeh right.  The remaining 2.5 miles to tonight's area was very tough.   Of course, it was up hill for ~1000 feet.   

On balance, has been great.   As we stand here this minute, I'd like to be home.  Miss my family.   Oh well.  Tuesday it is.  

Monday, November 02, 2015

AT over and out

Got off the trail at 1:35 and re-entered civilization shortly thereafter.   Wow!  I can just go into a convenience store and get food and water.   Trash cans: I love you.  I no longer need to carry my trash everywhere I go.   Indoor plumbing: marry me!  Civilization: I ain't leaving you anytime soon.  
How would I rate my experience?   Awesome and amazing and life-changing and reaffirming all at once.  But also, the experience was exhausting and frightening and lonely (at times).    We walked 6 miles on day 1, 11 on day 2: 10.2 on day 3, 16 on day 4, and 10.8 on day 5.  Elevation changes were as folllows: day 1: 1800 to 4200.   Day 2: 4200 to 1800 then back to 5000.  Day 3: 5000 to 5600 then to 1800 then back to 4200.   Day 4: 4200 to 4600 then down to 1800 then back up to 4900.  Day 5 4900 down to 2000.  
Getting water was an ordeal in itself. Water sources, or streams, were either encountered 0.3-0.7 miles from shelters/camp sites or encounter but water needed to be carried and filtered prior to drinking.  On day 2 I made the mistake of filling up in a terrific steam at 2000 ft then had to carry the water up to 5000 ft. Water was 2.2 lbs per liter and I had 3 extra liters that day in my bag.   Many sections of the trail require bordering.  This is a slow process and it requires tremendous concentration and energy expenditure.  Downhill, easy right?   Wrong.  The trail has many wet leaves that are treacherous. They not only cover rocks and roots, but they are slippery.  Treading here required enormous energy expense as well.   Until day 5, I averaged 1.5 to 2 miles per hour. 

I found a great deal of the experience to be either stressful or downright scary. One slip or bad fall could result in a fracture.  Most of our locations were remote and lacked any cell phone reception.  Simple medical emergencies like ankle fracture could prove fatal.   
The trail is well marked and easy to follow  yet at times I had difficulty finding markings and felt lost.   The area is so vast that getting lost would be terrible indeed.   But wasn't I with my friends?   Not usually.   Everyone hikes at a different pace.   On the trail, they say that everyone must do their own hike.  I guess that is true in life as well.  Still sometimes I found it scary and stressful.   

Lonely: see above.  Plus I missed my family terribly. 

What did I like about the experience?   
The views are spectacular.  The  physicality required was amazing.   The challenge comquered: how can my words describe that. To do this justice I'd need to be poet.   

So on balance how would I rate this experience?   Friggin amazing. 

Min parting I'll leave you with some photographs.   Enjoy,
The IU


Saturday, October 31, 2015

AT day 2

Awoke at 7:30 am.  Had to take a big dump.  Have never dumped outside before.   Not fun. Not easy.   But I survived. 
Hike stated at 9:30.  Stunning views.  Easy walk for first few hours.  

 Absolutely delightful.   
And then the afternoon hike hit.  1800 foot to 5000 foot climb with 37 lb pack.   Brutal.  If it was beautiful, I never noticed as I was too tired.  Had a nice lunch though at 4200'feet.   
From this point it took me another 3 + hours of challenging hiking to the shelter.  
Now all is good.  Had a nice meal.  Then a good fire.  

Temp tonight will be high 20s.   Hopefully I'll stay warm.   
So far so good.