Back in the Day

Remember the good old days? Back when you could see patients, take your time, learn about them and their families, and really understand some of the actual things that affect their health (and not only the measurable metrics of lab values, BMI, and vital signs)?

Remember when you didn't have to decide if a visit was a 99213 or a 99214, and what modifiers to use? And a diagnosis was described using words, not numbers?

Remember when there were paintings on the wall, instead of big signs that say "Copay is expected in advance of your visit" and "Referrals require 72 hours notice. NO EXCEPTIONS."?



Imagine, a life without billing codes, prior authorizations, referral paperwork. Imagine a day where all the patients were entitled to the same treatment, without having to ask permission from a third party. Then add a staff that is dedicated and comes to work expecting nothing in return, (you don't even have to ask them to make decaf, they remember that's what you drink!!). And this staff, they care what happens to the patients. They pay attention to the individual. They do what they can to help them get what they need.



Then, add the fact that the patients have no insurance and very little money. So their visits are free. And the other cool thing about this staff, they work for free.



So there's no money exchanging hands. Just good sound medical advice, lots of patient advocacy, and a whole lot of generosity of time and spirit.



That's VIM, my new job. I'm the brand new medical director of the Volunteers in Medicine Clinic in Cape May Courthouse. It's a volunteer and local donation based clinic for people without insurance who live or work in Cape May County who are unable to afford healthcare. (There's a income limit formula). It started in 2002, open just 2 half days a week, and has grown rapidly to a now 5 day a week clinic for primary care, with dedicated clinic days for eye care, psychiatry, and GI and ortho. VIM has relationships with several other area specialists as well.

I'm still learning about the many ways VIM helps the patients. The staff there works hard to make sure that patients have access to hospital care and services through Charity Care, and they have a computer program to enter every patient's demographics and financial data to apply for Prescription Assistance from the major Pharmaceutical Companies. And what meds are not covered by prescription assistance (or samples), VIM is often able to use their funding to buy patients their meds from the local Acme pharmacy. Can you imagine? Patients getting their meds, without insurance or money? Without begging for authorization, or waiting for approval.

Of course, there are always things that need to improve. Chart flow and communication between the many providers and staff are high on my list. Going between my tiny practice with me and 2 part time non-clinical staff to a practice with providers that may have never met and different volunteer staff on different days of the week presents a whole new set of challenges. It is exciting to me to get to look at all the issues I've looked at for the past 10 years from a completely different perspective. I'm thrilled to be able to challenge myself in this way. And I'm thrilled to be able to explore another system that's outside the "insurance model".

The VIM logo says "Neighbors helping Neighbors". The time I spend at VIM confirms my belief that all people deserve access to quality health care. And that at least in one place in Cape May County, other people believe it too, and are doing something to make a difference.

"Never doubt that a small group of thoughtful, committed citizens can change
the world. Indeed, it is the only thing that ever has." -Margaret Mead

Learning the hard way.

So right around Labor Day I got pneumonia. Big nasty 'right lower lobe infiltrate with temps of 104, shaking chills, and hypoxia if I walked up the steps' pneumonia. I didn't leave my bed for four days, except to go to the ER and get xrayed. My mom took me. So its clear that I was Really Sick.
Now during this illness, once I was no longer solely focused on breathing, and after i finished all four Twilight books, I had some time to think, about many things related to healthcare, my job, and my life. Examples include the fact that despite a prescription plan, antibiotics are very costly; and the fact that I opted to have some of my testing done at the outpatient lab rather than while I was in the ER, because my insurance covers it at a higher rate if it is done at an outpatient facility, even though it was a participating hospital.
But I learned something more important while I was sick, and much more unexpected. I learned that somehow, in the last 18 months, I have started to develop some balance. Five years ago, when my daughter was born, I was back in the office when she was 5 days old, and I was getting called by the office while I was in labor. When I was sick in September, I was out of the office for an unprecedented 8 consecutive days. Five years ago, it took me about a year to make up financially for my maternity leave. When I came back from being sick in September, I was able to pay my staff paychecks that day and rent when it was due the following week. I didn't pay myself much for that week, but I didn't pay any bills late. I had enough buffer spaces in my schedule to fill in the people that I had to cancel while I was out, and still to work lighter days while I was recovering.
No one died, I don't even think anyone left the practice. And many many of the phone messages I got while I was out of the office were expressions of concerns and well wishes. I even got get well cards from my patients.

Being sick is a little scary. Not just the mortal fear of lack of oxygen, but there is a significant dread from loss of business, loss of income, and overwhelming medical expenses. But to come back to work, still recovering, and have a practice that is still viable, and patients that are still loyal, and a schedule that allows for emergency, and a small financial buffer that allows the bills to get paid close to on time, is huge. If I hadn't made the changes in my practice that I made back in October of 2008, I am certain I would have still been in the mill of overbooked and underpaid, scraping by to pay bills late and cramming as many patients as possible into a day.

So, the two most important things that I learned:
1. I can take a day off without losing my livelihood.
2. It really does take four to six weeks to recover from pneumonia.


After about a month, I walked up my steps one day and didn't get short of breath. I felt like I got my life back, and even better than before, because I am now a little wiser. I went back to the gym, and since then have run in two 5k runs. I've taken a short vacation and at least one personal day a month. (not including snow days). I am in the office less than two Saturdays a month. I took a day off to go to New York City with my mom before Christmas. We didn't have to hire anyone to do our leaves this fall. We painted the outside of the house ourselves.
I'd write more, but its a school holiday, so the kids and I are going skating...