Tuesday, June 29, 2010

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