Thursday, September 2, 2010

Family Medicine: Power Failure

The lights suddenly went out in the exam room where I had just handed my patient the documents to give to the person at the front desk.  The temperature outside was 92 degrees.  It was 12:15 PM.  I looked at the afternoon schedule hanging on the door listing my patients and those of our family nurse practitioner.  As I talked with our medical assistants, we pondered the cause of the power outage.  The office was getting warmer.

I noticed someone on the schedule who was a frail person over 90 years old.  Call her and everyone down to 2:30 and tell them about our power failure.  We'd like to reschedule them.  By 12:40 everyone was in receipt of a call, most to answering machines or voice mails.  Our phones didn't work, so we used personal cell phones to call the patients.  Three of them, as the afternoon progressed, did not know they had an appointment.  Very interesting.

The first three patients showed up and were treated in the one exam room with windows and in our conference room/ kitchen.  At 1:20, with the heat causing me to perspire, a maintenance man came into our building and turned off the lobby alarm, informing us that a car had struck a power pole causing the power outage.  He thought the power would be back on by 1:45.  It was.

When the power fails we have to consider our computer system which houses all our business information and patient lists.  We back it up regularly, so a total failure wouldn't wipe out our important information, like our ability to bill for services rendered and our knowledge of our patients.  We have an electronic health record, Praxis, on the system but we haven't started using it yet.

Refrigerable materials and temperature sensitive items also were high on our concern list with the power failure.  We have a back up site to remove the materials to if the temperature in the refrigerators rises too high. 

With the power back on and several patients canceled (not rescheduled since we need the computers to be able to schedule) we became sluggish for a couple hours.  We reviewed some things about procedures when the power fails and called some people back to reschedule them.  I remembered that I have some charts to review for legibility to send off to an insurance company.  Everything we write on Medicare patients is reviewed by a review nurse once we fax the chart to their company (we have to copy and fax these at no expense to the government contractor that does the review).  This is one of the painful aspects of relating to Medicare which has a huge hassle factor.  No other patient group requires as much scrutiny by regulators.

Congress allowed physician reimbursement for Medicare patients to be reduced by 21.2% four times in the last 9 months, but reversed the reduction each time, currently until November (after elections) when there's a fair chance they'll cut our reimbursement, endangering the very financial survival of thousands of family physicians.  Because of the flaky way Congress relates to Medicare, thousands of physicians across the nation have closed their practices to new Medicare patients (including my office since 1/1/2010).

There is no way that there is near enough capacity to care for the growing Medicare population with the dwindling primary care physician numbers and the repeated disrespect shown to primary care physicians by our health care non-system.  Five and one half family physicians have left my county in the last 16 months, leaving over 10,000 patients without a family physician.  So I fretted a bit about insurance companies and the plight of primary care during the power outage.  One could say that there is a power outage in our health care system much worse than the brief one we experienced in our office.

I gladly delayed the chart review since patients started to show up.  Soon we were back to our normal pace.

1 comment:

  1. I only hope that one day Family Medicine gets to "see the light." Great story, Dr. S.