Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Mark Gettleman, MD is the founder of Goofy Gettwell Pediatrics, an independent practice that recently opened in Scottsdale, Arizona. He offers house calls via the GoGo Gettwell mobile, as well as phone, video, and e-mail consultations. Patients can also take advantage of Gettleman’s proprietary, online Electronic-Rash Identification service, which enables parents to securely send images of ailments to Gettleman for consult. Gettleman considers the practice to be a startup business, one with very little overhead thanks to relationships with vendors like PayPal and other HIPAA-compliant business associates. He does not accept insurance and is not participating in the Meaningful Use incentive program. His mobile practice typically sees six to eight patients a day, while his bandwidth for video, phone, E-RID, and e-mail consultations has yet to be reached, though he notes the upcoming cold and flu season may alter that.
You started Goofy Gettwell Pediatrics after spending 18 years at a brick and mortar practice. What led you to move from that type of business to this one? Was there a final straw that prompted you to make the switch?
I came out of medical school as far from the typical, idealistic, wide-eyed newbie doctor as you could be. I had no ambitions to change the world or cure cancer. I just wanted to do my thing in my small corner. After working for someone for three years, my frustrations with his management style led me to start my own practice. I was managing partner of a thriving, economically successful practice for 15 years. But, I was becoming more and more despondent over the medical system. I hated this triangular model where the provider, the patient, and the payer are all pulling for different purposes. The patient, without knowing it, had given the power of the purse away and was left with little influence.
Then I read the ACA (Obamacare) and I realized how bad the system was going to get. The cost-containment feature would be entirely up to the secretary of health and human services, and implemented as metrics and bundling through the government and accountable care organizations. I realized that Washington was now going to control what I was allowed to do in the exam room.
Under the ACA law, well visits (preventive medicine) are fully covered, or free to patients. The natural repercussion of this was an increase in sick visits not being covered until deductibles were met. This new model sent shockwaves through our billing department, and unsuspecting patients become irate and hysterical when we tried to collect. It was a nightmare.
In addition, issues that the government didn’t deem preventive were not allowed to be discussed. If a question about asthma or allergies came up in a well check, I was obligated to code the visit accordingly, which kicked it out of the preventive category. Hundreds of dollars of immunizations would then no longer be covered and patients were forced to pay these huge fees, or I was left to cover the costs. Some practices were audited, charged with fraud, and forced to pay huge fines for not following the guidelines.
The last straw had to do with the metrics. The public “rating” of the physician, which is tied to the reimbursement, had to do with fulfilling a few dozen criteria, from doing certain tests to patient survey results. While most were reasonable, many should be directed by the situation. For example, one metric insists that I discuss and screen for STDs like chlamydia with all patients 13-years old and above. While this is appropriate for many of my patients, some are prepubescent, immature, and still playing with their Barbies. I would not dream of venturing into a discussion about STD and therefore sex until a parent and I had decided the timing was right.
Would you consider your business model to be concierge? Has healthcare IT better enabled you to operate in this fashion?
I’m not sure about the monikers. Concierge, direct primary care, fee for service, private physician … I just took a step back, thought about what patients would like and what I could do for them. I can not charge a lot, because in pediatrics people are young and just starting to build wealth. I can keep my overhead very low by offering home visits, but I can only see a limited number of people per day. The IT component allows me to see more patients and help greater numbers of kids more quickly and efficiently.
How have your patients reacted to this type of business model? What do they appreciate most about the technologies you offer?
They have LOVED it – mostly the convenience of not having to leave their homes. I’ve treated kids on Easter; via e-mails; and with photos from a smart phone, which saved long waits in the ED. I saw a three-day old who was feeding poorly and was able to alleviate the tremendous fears of the parents on a Saturday morning. I did a video visit with one mom during which we discussed issues related to autism and behavior without needing to upset the child with the new and strenuous stimuli of an office visit. These parents are thrilled with the service.
How do you foresee your practice adapting to the wants and needs of an increasingly savvy patient/parent population, especially considering the speed at which digital health is bringing healthcare onto phones and tablets and into the home?
Many of my patients are still leery about using IT. We need to walk a few through the steps. As patients get used to it, they love the system. I envision extending to many more programs as technology becomes both more accepted and affordable. The thought of using heart, lung or blood pressure monitors over a smart phone, or using a picture of the tympanic membrane to diagnose an Otitis Media excites me.
What best practices or advice can you offer physicians looking to take their practices to the next level of healthcare IT?
Don’t be afraid. There are tons of reasons to not to do things, but when push comes to shove, it is up to you. If you, as the physician, lead the way, the patients who trust you will come along. As Steve Jobs once said, “People don’t know what they want until you show it to them.”