The Enable Blog

Saying Goodbye to 2008

Wed, 31 Dec 2008 19:00:42 -0700

It’s been a very tough year, hasn’t it?

We’ve made some tough decisions. One of those was to cancel our contract with Tricare. We have had to say goodbye to some absolutely wonderful families and retirees. Trust me, in our 6 years of business, this has been one of the hardest things we’ve had to do. I hope all of you have either been able to transfer to an insurance we accept, were able to find another physician, or will be seeing us on our cash plan. We hate saying goodbye.

With the exceedingly poor economy, we have seen many of our patients lose their jobs, transfer jobs, move out of town, and seen a decrease in their healthcare benefits. I predicted these changes in an Arizona Republic article about 2 years ago, and discussed the merits of the Health Savings Account. This program will allow people to make better choices about their healthcare, and become better “consumers”-- hopefully smarter about their health and making the right kinds of preventive choices. We hope to always offer the latest in evidence-based preventive care.

As regards that, we are now seeking accreditation by the NCQA (National Committee of Quality Assurance). This is our first attempt to seek accreditation by an independent organization rather than a healthcare insurance entity or licensing body. The NCQA helps to determine standards of care in such chronic disease states as asthma, diabetes, high blood pressure, and back pain. We will be seeking multiple different accreditations. As such, you may see more paperwork from our end. This is in hopes of capturing all of those things that we already think we do a great job at (such as diabetes screenings, etc.) and want to make sure we do an even better job.

I also will be looking at new ways to communicate with all of you. I am exploring the possibility of cell phone texting as a way of reminding you about appointments, providing cursory lab results, and helping you make quick appointments. We are also looking to institute electronic consultations. Of course these will need to be as secure as possible, which is the primary challenge. Also, these services are costly, and so there will be a charge associated.

I will now be expanding my availability to the Maricopa office. It has been a challenge to foster our growth in our Maricopa office, and we can no longer continue to see the large number of patients we see there with our current provider staffing. So I will therefore be slowly transitioning to a half time practice in Maricopa and a half time practice in Chandler.

This of course will necessitate a provider change. Barbara Regis, PA-C will continue her full-time practice in Chandler. If you need to be seen for an acute issue, you may be asked to schedule with her in my absence. We are hoping to add another physician in the next year. In 2008, we had nearly 15,000 unique patient visits. Among 3 1/2 providers (Dr. Shaw is a part-time physician), this has been quite a year. 2009 looks to be busier, and so we have a definite need for more providers.

Delivering healthcare in the changing market is a definite challenge. We believe we deliver exceedingly efficient care. But we do operate on a very tight margin. I would ask that you PLEASE pay your bill on the first statement. Unfortunately, we are looking at having to increase our administrative fees again because of our increasing costs. We know it’s a tough time for everyone. We hope you recognize the importance of your medical care, as well as the availability of a comprehensive and conscientious medical office. We can only continue to make ourselves available to you if we are paid for our services in a timely fashion. Please do everything you can to make sure your insurance pays your bill and/or you pay your balance on time. By doing this, we can continue to keep our costs down.

For our self pay patients, I want to extend our thanks for your continued support of our practice. We have been able to keep the office visit at $70.00 for 3 years straight now, and have not needed to increase it. We have also made arrangements with a new lab that now essentially cuts the lab fees in half from what we were paying previously. So should you need labs, we will be able to provide labwork at a fraction of the cost.

And thank you all for our best year ever. We appreciate the trust and faith you put in us as your medical care providers. We will never take that for granted.

--Dr. C

Correspondence with Triwest

Thu, 11 Sep 2008 20:03:40 -0700

I wanted to let you all know that I continue to ask for Triwest to be reasonable regarding their contract, but to no avail.

Letter Regarding Tricare.pdf is a correspondence I have had recently with Triwest’s network manager, which is Blue Cross Blue Shield of Arizona. I have blocked names and email addresses, for obvious reasons.

Again, I apologize for what’s going on. But as you can see, I have no control over how this insurance company decides to do business.

--Dr. C

Tricare Update

Sun, 24 Aug 2008 20:36:17 -0700

Many of our Tricare patients have approached our staff and our providers questioning why we decided to stop accepting the military health insurance program.

In short, it comes down to simple numbers. Tricare pays us 80% of the Medicare fee schedule. Now someone at the Triwest office needs to explain to me why they consider it okay to value the time I spend with a military veteran and their family at only 4/5th the value of the time I spend with a senior citizen. It’s the same amount of time, the same diseases, the same diagnostic consideration, the same office, exam tables, equipment that I use for both.

I pay the same malpractice premium for senior citizens as I do for military personnel. Same for people who pay our cash pricing. My staff gets paid the same no matter who they’re rooming.

Add to that the fact that Tricare has never paid us the amount we pay for immunizations. We are always shorted by about $5.00-$10.00 per immunization. This can add up to a loss in many cases for us.

We could no longer afford to do it.

I have made many efforts to contact the Triwest network representative for our office. I have pleaded with them, as I have in years past, to sit down at the table with us to negotiate a fair contract. And you know what? They’ve never been willing to negotiate the contract.

I know many of you have made an effort to contact Triwest as well as your federal government representatives. We appreciate the effort. We too want to be able to continue caring for you and your families as we have for the past 5 years. But if Triwest doesn’t seem to be able or willing to face up to the realities of modern medicine--that inflation does affect the cost of healthcare delivery--then very soon they will find themselves with only the military bases as their healthcare delivery vehicles.

I hope at some point someone at that company will give me a call or email. To date that has not happened, and for that I say to my military families, I’m sorry we can’t keep doing this.

Triwest is in the middle of a bidding process to continue the Tricare contract for this part of the United States. I would encourage you to call those at the Tricare central office (not Triwest) to discourage Tricare from accepting the Triwest bid as they do not treat their clients (you, the patients) nor their providers with the respect that they deserve.

--Dr. C

Important Insurance Changes

Sat, 21 Jun 2008 17:50:37 -0700

Every year, we are forced to reevaluate our financials. Medicine is a business just like any other. And every year, we renegotiate insurance contracts, sign new ones, and occasionally cancel contracts that we can no longer afford to do business with.

After 4 years of caring for Military members, active and retired, as well as their families, we find we are no longer able to continue seeing Tricare patients. Tricare has never been willing to negotiate our contract. This year, they reduced the reimbursement for our most common services. They also have never paid us the actual cost of immunizations that we give to our patients. And so therefore, we have concluded that this year is the last year that we can continue to take Tricare.

Our contract will be cancelled with Tricare as of 12/31/08. Our Tricare patients will be receiving letters regarding this in the next month or so.

Another contract we are canceling is with University Physicians Healthcare Group of Arizona. That contract will end on 9/30/08. We have already sent out letters to those patients.

Finally, we will no longer accept Healthcare Connect. We have decided that our cash plan is sufficient for what we hope to achieve with our uninsured patients.

We continue to do business with the largest insurers in Arizona who pay a reasonable fee schedule, keep the amount of hassles with prior authorizations at an absolute minimum, and take comprehensive care of their clients--you, the patient. We are not willing to support insurers who do not deliver reasonable medical service for their clients.

We also urge our Medicare patients to call their federal legislators and urge them to repair the Medicare Payment System. A looming pay cut of 10% is set to start on July 1st. If that goes through, we will no longer accept new Medicare patients and may opt out come 1/1/09.

Saturday Acute Care Clinic

Mon, 14 Jan 2008 18:30:33 -0700

Starting January 19th, we will once again be offering Saturday morning office hours. We have not offered this since 2005, but due to demand, we have decided to reintroduce this to see if it might work.

These hours are for our existing patients only, but we will be willing to see direct family members of existing patients if they have not been seen in our office before.

These office hours are not meant to take the place of routine follow up. Due to the staff restrictions (I will be working the clinic by myself for at least the foreseeable future), I will not be able to see patients for routine follow-up. This includes follow-up on diabetes, hypertension, physicals, immunizations, etc. As the clinic becomes more popular and there appears to be continued interest, we will start adding support staff and may be able to accommodate routine visits.

So mainly, what I’d like to see you for would be things such as:
Acute illness (colds, flu, stomach bugs, strep)
Acute injury (sprains, strains, falls, etc)
Follow up on continued illness previously seen
Urinary tract infections
Other acute reasons

If you call, and there’s no answer on the phone during our Saturday 8am - 12 Noon hours, it may be because I’m in with a patient. I will of course welcome walk-ins during those hours, so you’re welcome to just come in.

And of course, our Maricopa patients are very welcome to come up to Chandler as well. Currently, we don’t have the volume or staff to start weekend hours at our Maricopa office, but that day may soon come!

--Dr. C