Today, July 15, is a really important day to me- for both happy and sad reasons. This day in 1993 is when I physically lost my best friend. My grandmother, Bella, was and is a large part of who I am as a person. She taught me about hard work, determination, unconditional love, and empathy. She is also the main reason why I not only became a Family Physician, but also why I left the insurance-based system behind for this new endeavor of Direct Primary Care. I knew people deserved better because I knew she always deserved better.

My grandmother was stricken by early onset dementia at the age of 62 and rapidly declined over the course of my high school years until her death in the summer of 1993 following my graduation. Although her death was a finality, it was also a blessing. She never wanted to live her life the way she was at that time, nor did she want to be a burden on anyone. My family struggled to get her approved for Medicaid after she worked her entire life. As a result, we were unable to get her coverage for a nursing home. We cared for her at home until it was simply unsustainable. As awful as it was, it taught me what people deserve when they are ill. It taught me that we treat our animals better than we do our loved ones. The system was screwed up even back then. So she lived in the nursing home until her money ran out after which she died peacefully in her own home with me by her side.

I have always used this experience to guide me through college, medical school, residency, and now my career. I miss her guidance and love every single day, but I know that I am finally happy as a physician because of her. I will always look back at her and my relationship with her, but I will never look back at a system that prevents doctors and physicians from caring for each other and does nothing to secure the sanctity of the physician-patient relationship. Is that not what medicine was based on in the first place? Hopefully she is fully resting in peace knowing that her only grandchild is happily doing the right thing and being the doctor she knew I could be.

Let me preface by saying that I can not and did not make this up. So after returning to work on Monday following the DPC Summit in KC this weekend, I went to check the mail and received this document from a Medicare Part D drug plan. (I did not include the image of the document here so as not to have the companies lawyers call me). This document is basically the 3rd party making sure that my patient is on the best drug regimen for his condition(s). Now on the surface this does not seem like a bad thing, but trust me when I say that what they are really looking for is a way to curb their costs.

So the comical part of this whole scenario is that they no longer have to worry about cost nor have they had to for the past 6 months. Why you may ask? Because that is how long this patient has sadly been deceased.

I would say that I’d be back next week at our regular scheduled time, but I am 99% sure something equally as asinine, if not more so, will come across my desk and/or mail in the next few days.

PS: I loved this patient and he would have had the exact same reaction. It would have been comical.

Yesterday I saw a long time patient who is on Medicaid due to disability. He is a great kid that is legitimately on aid due to mental illness. He has not had the best hand of cards dealt to him, but has a loving grandmother who has raised him as her own. She pays me directly because she knows I have his back and she values the relationship I have built with him. They trust me to always do the right thing for him and their loyalty to me is very much appreciated.

So yesterday he called first thing in the AM with a complaint of 4 days of abdominal pain with no appetite and low grade fever. Now this guy is very stoic and not a complainer so I always know that something isn’t right if he is complaining. We got him right in and evaluated him. He had some point tenderness right over McBurney’s point (where your appendix is) and had a low grade fever. He needed a CAT scan to rule out an appendicitis which Meghann, my LPN, scheduled for noon at our local hospital. For those who do not understand direct care, even though I do not take payment from Medicaid, the hospital would just bill Medicaid for the CAT scan and lab work etc etc. If he did indeed have appendicitis we would get him seen by surgery and all of his care would be billed to Medicaid- essentially the taxpayers in MA.

Well it took no less than a 20 minute phone call to get this scheduled, after which Meghann is told that Medicaid will not “approve/authorize” the CT scan because I am not a “Medicaid provider.” Now some readers may think I’m the jerk for not contracting with Medicaid and your entitled to your opinion, but this patient has paid me to work for him. (Maybe after you finish reading this you will understand why I dropped out.) Now we have a patient who is sick, a doctor that is trying to treat him expeditiously based on years of training, and indirectly you the taxpayer all at the mercy of insane, bureaucratic nonsense. My only choice was to have him go to the ER and be evaluated….again….by another physician in order to get a CAT scan of his abdomen (with contrast an abdominal CT is about 600-800 per the Healthcare Bluebook). So instead of just paying this amount, as his CT was fortunately negative, your state bureaucracy decided it would be better to add on the cost of an ER evaluation and 5 hour stay as well to the taxpayers bill.

Does this make any sense to anyone? If it does than maybe you took a different economics course than I did. So there is a story of a broken system that just cost you a few extra grand because the doctor was regulated. Wonder how the system worked when the Brady Bunch was on? Did Marcia need a “Prior Authorization” from an “in-network doctor” to have her nose looked at after she got smacked in the face with a football?

Off to Kansas City to the DPC Summit today to try to fix this mess and get people the care they deserve.