A Whole New World

 After a long sabbatical, I am writing my blog again.  My goal is to post monthly.  Welcome back to myself and all of you.  Recently as I have thought about how best to deliver patient care I have come to the realization that I cannot continue to function as I have.  The demands of primary care have increased greatly in the last five years.  More and more of our time is taken to process referral requests, obtain authorizations for medications, call insurance companies to obtain hospitalization approval, etc.  In addition, insurance companies including Medicare are beginning to change the whole structure of physician compensation.  In the past we would receive payments from insurance companies according to what transpired as part of a patient visit.  While that is still mostly the case, in the future, it seems clear that we will get paid to take care of a panel of patients, regardless of whether they come to the office or not.  We will receive compensation according to the severity of the health conditions that they have and how well they are cared for. 

As such, it is now necessary to create a system that can track high risk patients, watch over the most vulnerable ones, and improve communication between doctors as well as patients and their families.  It is quite apparent to me that I cannot do this on my own. It is all that I can do to take care of the patients that come through the door each day, let alone all those who are not present.  I view my choices as either entering “Boutique Medicine” which would limit my panel and require yearly supplemental payments of upwards of $2000 per patient, or of creating a team of health care workers to join together in maximizing the overall health of my patient panel.  I have personal and ethical problems with the first option.  I have decided to pursue the team approach. 

I have put a lot of thought and effort into this endeavor and I am quite excited about it.  It has rejuvenated my career and look forward to putting it into practice.  Let me introduce my team.

It begins with me.  You will not lose me as your physician.  You all know me.  I will keep a very hands on management style to your care.  Michelle has been my assistant for eight years and is invaluable  in helping me take care of you.  She has worked extremely hard.  She deserves more help and I am pleased to introduce the newer members.

Kym Jackson has been a very valued employee here at Associated Internists as a medical secretary for the last 16 years.  She will now be my team’s dedicated secretary. She will be verifying appointments, fixing my schedule, processing referrals, scanning documents as well as other duties.  We are very excited that she is now dedicated to my panel of patients.

I have also hired a nurse practitioner, Maria Motta, to assist me in seeing patients.  I asked her to write a paragraph, introducing  herself:

“I am a family nurse practitioner, a graduate from Maryville University.  I am so pleased to have an opportunity to get to know you all and have a chance to join with Dr. Fuller to provide excellent and compassionate medical care.     

I have been a nurse in the St. Louis community for the last twelve years and I have many years of experience in the field of sleep medicine.  Also, I have experience in the urgent care setting as well as family medicine.   Importantly, I have a special interest in the use of diet and physical activity to build physical and emotional health and will seek to promote these in our practice.”

Maria will be able to help see you for physical examinations as well as routine and sick visits.  She will be starting earlier than me, at 7:30 AM which will likely be a more convenient for many of you.  She, like me, has a passion for health and prevention.  I cannot be more pleased that she is joining with me.  She too will have an assistant to help in the office.  Her name is Rachel.  Please extend a warm welcome to them when you are in the office.  I would love to hear your feedback.  Let me know what questions you have.