Part 2: Enough is Enough

I think going back to Virginia and seeing some of my old patients, and how they were doing so well, supported my previous thoughts that the Florida market was not following the model. Our model is focusing on primary care and prevention to keep patients healthy, with less sick days (less days in the hospital), and living longer.

Here are some examples of how the model was not being followed:

–Patients did not bring their medications to each visit. How are we supposed to perform medication reconciliation after a hospitalization? How do we monitor medication compliance? How do we reduce polypharmacy?

–Hospital discharge appointments are ineffective. Patients are supposed to follow up with their PCP but the front desk keeps putting them with non-PCPs due to ‘availability’. The entire purpose of this appointment is to prevent them from going back to the hospital, who better to do that than their PCP that knows them well. Also, often there are no records from the hospital so we don’t even know what happened to them while they were there. Let’s just say the re-admission rates are high in this market.

–Patients are being scheduled randomly. The entire model focuses on the PCP and patient relationship. Total hospitalization rates are high in this market because patients do not have an established relationship with their PCP. This means when they are sick they go straight to the hospital instead of notifying their PCP. Patients shouldn’t see a non-PCP unless it’s a walk-in or their PCP is on vacation.

–HEDIS measures are not being done. As I have been seeing other PCP’s patients, I noticed that most of them do not have HEDIS measures done and it is the end of the year. Aren’t we supposed to be focusing on primary prevention, recommending mammograms, screening for depression, and starting them on a statin if they are diabetic etc?

Some other red flags: the social worker was asked if she could do a home visit on a suicidal patient and she said no. Apparently that was ok. Another instance was when I suspected a patient to have a DVT and approached his PCP, who recommended the patient go to the hospital. The patient declined going to the ER and I asked the PCP if he wanted to speak to the patient for a bit (since he had more of a relationship with the patient than I did), and the PCP said no. Apparently that was ok as well.

In response to the medical directors email, I wrote back to him with my concerns that we were not following the model but he never responded. I wasn’t surprised, since he never replies to any of our emails. Nor is he present to have an actual conversation with. I then realized that there was no leadership/management in this market, which is the primary root of the problem.