Presentation at the AACE Pediatric Practice Management Workshop
On Friday, March 7, 2003, I had the pleasure of serving as lunchtime keynote speaker at the AACE Pediatric Practice Management Workshop, held in Washington, D.C. I looked at this as an opportunity to share my thoughts about how type 1 diabetes should be managed in kids with a group of pediatric endocrinologists. A couple weeks earlier I had sent an e-mail to the parents mailing list, asking for suggestions that I could incorporate into my presentation. The result was a 30-minute speech on the benefits of insulin pump therapy, how diabetes changes family life, how any food is OK, and a bunch of humorous tidbits.
The meeting began with breakfast. I sat at a table with six pediatric endocrinologists, all of whom had come to the workshop in the hopes of learning how not to go out of business. Everyone seemed to be struggling with serious financial problems, including declining reimbursements, untold hours of work that can't be billed, and even worse -- the very real threat of an insurance company audit that could result in being required to pay back thousands or tens of thousands of dollars for work that was questioned by insurance companies. The more I listened to their stories, the more I began to understand why pediatric endocrinology is in such trouble across the United States.
One of the biggest frustrations expressed by all of the doctors was the enormous amount of work they do for which they can't bill. They can only bill for "face to face" time with a patient, so every phone call, form that needs filling out, downloading of meter data, review of blood sugar data, call to a pharmacy to refill a prescription -- all the stuff that we parents and patients take for granted -- is done essentially for free by the doctors. Add to that the fact that they underbill for fear of being accused of fraud by the insurance companies or US government and you have a recipe for disaster. Doctors can't continue to practice if they lose money on every patient.
As the morning sessions progressed, I came to appreciate the challenges that each of these doctors faced as they struggled with a reimbursement system that was never geared for caring for people with a chronic illness, especially one like diabetes that involves a lot of non-face-to-face time. It became clear to me that only by changing the way the reimbursement system works, either through the insurance companies or through legislation, will the problem be remedied.
Joining me for lunch were Natalie Bellini and Rick Philbin from Animas, and Marisa Schmidt, a CWD mom who lives in northern Virginia. Even though I found myself a bit choked up a couple times, I believe the speech was well received. Natalie kindly jumped in to help during the question-and-answer sessions that followed my presentation.
-- Jeff Hitchcock
Download the Presentation
My thanks to everyone who shared their ideas, and to everyone who contributed their humorous tidbits. I hope I quoted you correctly.
10 March 2003
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