Friday, October 9, 2015

A Chat with a Family Practice Doctor with A Less Complicated State of Mind

You must lie down with the daisies and discourse in novel phrases of your less complicated state of mind.

The meaning doesn’t matter. It’s only chatter of a transcendental kind.

Sir William Gilbert (1836-1911), Patience

I like to chat with seasoned doctors with a less complicated state of mind.

Today I discoursed with Donald Copeland, MD, who has practiced and taught in various family practice settings – solo, group, and academe – in North Carolina for over 50 years.

Dr. Copeland, a Southerner to the core, surprised me by declaring he was solidly behind Ben Carson, MD, the black neurosurgeon who is running for president.

Carson, Copeland maintains, has been there and done that and know health care inside-out and upside-down from a physician’s point of view.

Doctor Carson has an uncomplicated state of mind where national health care ought to go. At birth, give each person a birth certificate, an electronic medical record, and a health savings or health security record .

The health security record, a concept Copeland prefers, would allow every person to pay for care out of their own account using pre-tax money, and save for retirement. The term “Health Security Account” would tie in with the idea of Social Security with which most people are familiar.

Health Security Accounts, as originally proposed in 2003, would have a high deductible ($500 for individuals and $1000 for families) and would allow employers to contribute $2500 a year to worker’s accounts. It has been shown to lower premiums and save employers money.

When paying money out of their own accounts, consumers are more disciplined and sensitive to price. This cost-saving phenomenon is attributed to having “skin in the game.”

Obama acolytes are critical of HSAs because employers and workers are in control . HSAs, they contend, penalize workers with chronic disease.

Don also surprised me by saying that he thought the transition from the ICD-9 to ICD-10 coding system would be relatively smooth and painless. Just go to Google, he instructed me, and type in type in the clinical problem. For example, a patient has migraine, type in the Google search box ICD-10 Migraine, and the various codes for migraine will pop up. It gets more complicated with common conditions like diabetes, hypertension, and coronary artery disease, which have dozens of codes for the illness itself and its various causes and complications, but with a little practice, coding for common diseases is doable.

Dr. Copeland is a big fan of direct cash medicine, which is uncomplicated and avoids complicated regulations, coding, and asking for permission to do this or that. You can treat almost any patient, even if they are on Medicaid or Medicare, and you can spend more time with patients and less time with paperwork. For cash transactions, you do not need to be a concierge physician, although that is one way to go.

Finally, Don dwelled on problems stemming for hospitals employing and controlling physicians practice patterns. The problems include loss of autonomy, doubling of costs of patient visits, and compulsory referrals to hospital specialty units, where most hospital profits are.
It was a pleasure to chat with Dr. Copeland about such transcendental matters. Sometimes a chat with a clear-minded friend has a way of simplifying and clarifying complicated matters.
P.S. Here are 3 previous blogs I have written about Health Savings Accounts.

1. October 9, 2009, Interview with Don Copeland about Organization Overkill

2. July 17, 2011, Health Savings Accounts : A Return to the Obvious

3, February 13, 2013, Health Savings Accounts Tied to High Deductible Plans - The Essence of the Best in Consumer-Driven Health Care

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