A new kind of doctor’s office that doesn’t take insurance and charges a monthly fee is ‘popping up everywhere’ — and that could change how we think about healthcare – Business Insider

Interesting article after the previous post.

Direct primary care is a small but fast-growing movement of doctors who don’t accept insurance and instead charges a monthly membership fee.


The PA/RN/MD/DO will see you now. Consumer Reports

Good article demystifying the medical provider landscape. While I have some small issues with it, it is a good layman overview.  What they say about a seeing a P.A. “avoid relying on them for complicated procedures.” is quite off base. Many P.A.s work right alongside M.D.s in offices, doing all the same procedures that M.D.s do. It is more a matter of how long a P.A. has been working, and the background they came out of, just like any other professional, that determines there effectiveness on more complicated procedures. Some P.A.s came out of EMT work, and they are highly trained in some fields, some have spent extra years of education as orthopedic P.A.s. Some P.A.s have worked in the operating rooms for years, doing surgeries alongside the attending M.D. And the M.D. that they are assigned to is often relying on them to stand on their own and only bring them the more difficult issues. I’m sure there are many younger M.D.s who are still learning their craft and I wouldn’t want to take my complicated procedures to them either! I’d rather see an experienced P.A. than a brand new M.D. any day of the week!

It’s getting harder to see a doctor, but you can still get quality care from a host of other professionals if you know who’s who





Jefferson Healthcare Opens Express Clinic

Jefferson Healthcare has entered the new year with some positive announcements for primary care needs in the county. The Hospital district has announced a new Express Clinic, opening on February 5th. It will be open from 10AM to 8PM 365 days a year.

The goal is to provide same – day medical care for non-emergency health conditions, including minor cuts and injuries, mild respiratory, gastrointestinal and urinary symptoms. This is clinic is in addition to the normal primary care office.

The services provided will be billed at the same rate as your primary care clinic visits.

Patients will be seen in the order of their arrival and no appointments are available.

You do not need to be an existing patient of the primary care clinics to use this facility.  The announcement recommends that you call the standard clinic first, to determine whether you should go to the new express clinic or not. The new clinic will be staffed by Physician Assistants and Nurse Practitioners.  The hospital will phase out the old walk in clinic in favor of this new one.

This is all separate from the free standing Madrona Hill Urgent Care clinic that still exists on the first floor of the building at 2500 W. Sims Way, as you enter Port Townsend.

There is a huge shortage of Primary Care providers in both the U.S. and Canada. This is partially due to the fact that primary care Physicians make less than their counterparts in specialties so students often don’t follow that path. Insurance companies do not reimburse at rates that make the profession seem attractive. The push by government and insurance payers to reward the primary care physician for more wholistic patient health, while still refusing to allow the provider to attend to more than one issue at a visit is very frustrating to providers I’ve talked to.  It takes a dedicated young person to decide to choose that route, however it is in many ways extremely rewarding. It would be a very good idea for the government to offer incentives to students to go into primary care as well as revisit the issue of provider reimbursals, case loads and ability to investigate multiple issues at a visit.


Additionally, the hospital district has announced the addition of a husband and wife team of physicians. Chyrstal and David Schwartz have joined the staff.

Dr. Chrystal Schwartz has joined the Primary Care group and obstetrics. Dr. David Schwartz works at the Surgical Associates, specializing in general surgery and endoscopy.

This is not the first time husband/wife teams have been hired by the hospital.


Congress Is So Incompetent It Can’t Fund Health Insurance for Kids – VICE

The headline says it all. And the tie in to our local Hospital District is that this is likely to push us financially from black ink to red. And what were our local physician’s medical society doing about such a looming crisis, with more to come in the Medicare and Medicaid cuts? Were they coming out and deciding they were going to sound the clarion call and warn the population of the looming crisis? Ask them to call their legislators to ‘save the children’? Nope. They were getting together to  vote to endorse a man with no significant health care experience over a woman with a lifetime of policy and medical background. Just like the voters last year that voted for Trump, who is putting the local hospital in jeopardy by endorsing these cuts. Did these same physicians feel compelled to get together last year in the run up to the election to warn the population of the impending disaster that Trump likely would bring to healthcare at both the national and local scene? Nope. Have they ever endorsed a candidate before? Apparently not. But I digress, I’ll cover that tale of our local petty politics  in another post at a later date. Here’s our latest medical fiasco on the national level.

Last Saturday, Congress failed to reauthorize the Children’s Health Insurance Program (CHIP), jeopardizing systems that provide low-cost insurance for almost 9 million kids and hundreds of thousands of pregnant women in families that make too much money to qualify for Medicaid but still need assistance. Legislators failed to renew other safety net programs as well. But missing the window on CHIP was a particularly egregious fumble, and one of the clearest signals to date of how desperate this Republican-led Congress is.


Health care mergers often driven by patient access – Kitsap Sun

Good short article detailing the problems facing independent medical practitioners today. This is the state of medicine we are in. Jennifer Hanscom is the CEO and executive director of the Washington State Medical Association.

When I began my career at the Washington State Medical Association in 1996, 38 percent of physicians were in solo practice; today that number has plummeted to less than four percent. For comparison, during that same period only 18 percent of physicians were in practices of 100 or more physicians and a good percent of those practices were large independent clinics. Today, over 61 percent of physicians practice in groups of more than 100 physicians, with most employed by integrated systems.


Swedish CEO resigns in wake of Seattle Times investigation – Seattle Times

After a damning series of articles about Swedish this comes as not much of a surprise. The next question is, “What will they do about the issues that were brought into the open about the surgeon that is the cause of this mess?”

Swedish Health Services CEO Tony Armada has resigned, days after a Seattle Times investigation examined turmoil and troubles inside Swedish’s premier neurosurgery institute.

The story is still unfolding.


Reassessing the Jefferson Healthcare & Providence relationship

Now that the Seattle Times has brought out a truly shocking series of articles (see other posts on this site)  on the neurosurgery unit of Providence/Swedish, the question is “What should Jefferson County’s hospital do about this?” We have a working relationship with these hospitals. From what I understand they send us doctors for certain shortages we face from time to time and we also are tied to their electronic records systems, called EPIC.

I have discussed with a number of medical professionals who have read the articles and they were in  agreement that this is more than a simple story that can be easily brushed over. To them it’s a deeply concerning one. Some of them said, “Yes, it’s been understood for years that the implementation of a numbers based goal for surgical units is going to drive more surgeries.” Jefferson Healthcare themselves uses the system, and evaluates their doctors on these units.

That the neurosurgery unit of Swedish Cherry Hill has been run like a machine on overdrive, churning through questionable surgeries for the sake of racking up maximum reimbursable value for the hospital and doctors themselves, should force us to discuss the future of the relationship with the Seattle hospital system with which we have allied ourselves. Would you want to see yourself or any loved one of yours sent there after reading this damning expose that took over a year to uncover?

I have a personal dog in this hunt. My best friend was in the neurosurgical unit at Cherry Hill during the last half of 2016, fighting multiple brain cancer sites and a chest tumor. He and his partner went through a great deal of stress over the pressures that the staff were putting on him to undergo more brain surgeries after he was deemed terminal. I told them to push back and discuss with the staff the quality of life issues that he would face one way or the other.They  finally found a doctor at the hospital  who sided with them against the surgical teams. Apparently there were heated words in meetings with the patient present about the choices being made. My friend died at home in January without undergoing further surgeries.

The Jefferson County Healthcare CEO Mike Glenn and the Hospital Board of Commissioners needs to take some time, but come forward and help us understand that they are concerned about this state of affairs and questions need to be asked as to whether our hospital should continue sending patients to Providence and Swedish Cherry Hill.

More thoughts on this issue will be forthcoming.