Doctor / Patient / Staff Re-Education
in the Age of Managed Care

We, the doctors and staff of 201 East 65th Street, want you to feel satisfied with the quality of care and the kind of service you receive when you decide to become a patient in our practice. Because we have experienced two major transitions over the past few years (first, the change-over for most patients to managed care and, more recently, "The Move" to a new and much larger office), this has meant a lot of adjustment, and often, a lot of stress on us all. Some things are out of our control (for example, the huge increase in paperwork demanded by the unwieldy bureaucracy of managed care rules). Others can be addressed, and made to run far more smoothly. We need your help to make this happen. Here's how:

Managed Care  puts quality healthcare within the reach of many more people.

The first reality of the managed care system is, that while it is a good thing because theoretically, it puts quality healthcare within the reach of many more people, the individual physician can only stretch himself/herself so far. In an ideal world, no one should be denied medical care when they need it. Alas, in the real world, cost effectiveness has to be considered. It is simply unrealistic to expect the doctors to spend as much time with each individual patient, as they were able to do in the past. Hence, when you call for an appointment, please understand that unless you are calling for a physical, a special procedure, or consultation about a long-standing or complex medical problem, routine visits may be scheduled with one of our

Even in the Age of Managed Care, it is possible to have a rewarding doctor/patient relationship of care and mutual trust.

highly competent and trained physician assistants, or an associate physician. This does NOT signify inferior care or second-class citizenship! If seen by an assistant first, one of the physicians will be called in to review advice/treatment plan and answer any other questions you may have. The merit of proceeding in this manner is that it conserves doctor's time by allowing him/her to concentrate on the essentials and not get bogged down with lengthy note-taking, drawing blood, giving routine shots etc.

An internal medicine practice does not work the same way as a specialty practice. Although we work in both capacities, the role of "generalist," which includes serving as primary care provider, requires that choices MUST be made about time allocation to a multiplicity of tasks. Naturally we put patient welfare at the top of the list, but you, as patients, need to realize that every request you make cannot be treated as equally urgent. We pride ourselves on a very open and generous policy of accessibility to the doctors by phone at all times. An enormous amount of office-time is expended in dispensing advice and prescriptions over the phone because we recognize that patients with work pressures or other commitments cannot always come in when they are ill.  May we point out that accommodating patients in this way is the exception rather than the rule for most medical practices around the country? If we are to continue this policy, we need your help in the following ways:

1. When you first sign up for a medical plan, please take the time to read the accompanying brochure of rights and responsibilities you have as a member of that plan. This saves much time and misunderstanding later, about exactly what services you are entitled to and at what cost. One of your obligations is to make your co-payment at the time of service.

2. A medical practice provides a human service, not a commodity. However, the service professions are no less costly to run than any other business. Just as you would not expect to go into a store to buy an article without paying, why should paying for medical services be viewed any differently? Since most co-payments are a very modest amount, we would appreciate them being offered as a matter of course at the time of service.

3. If you are calling to get a prescription refill on a medication you regularly take, please have the following information ready before you make the call: a) Correct name and spelling of drug; b) Strength (how many mgs.etc.) if applicable; c) How many times a day taken; d) Quantity normally dispensed by your physician.  We simply do not have the staff to pull out 500 charts on a daily basis in order to look up this information, then call you back, then call the prescription in to the pharmacy. You tell the secretary what you need, wait till she gets the doctor's approval, and then ask you pharmacy to call us. If this procedure is consistently followed, nobody feels aggravated, least of all the pharmacist who doesn't want to be put on hold indefinitely any more than you do.

4. If you are calling for authorization to get a procedure done, or to see a specialist on your plan, please try to give as much time as possible to the referral staff to get your request processed. This means allowing enough time for you to receive it in the regular mail, or if that is not possible, arranging to have it picked up from the office. It is unreasonable to expect that you can call up the day of your appointment, or from the specialist's office, and demand a fax be sent instantly because no one will see you without the necessary authorization. We employ a full-time referral staff of four, all working to capacity, to accommodate your referral needs. It is not fair to expect them to routinely drop everything they are doing, several times a day, in order to write and then fax you a referral for a follow-up appointment, consultation, or procedure that you knew you needed several weeks or days in advance (e.g. routine mammogram or chest X-ray, dermatology check-ups, eye check-ups etc.) Of course we understand that any or all of these might be necessitated by a medical emergency, in which case we will make every effort to make your request a priority. However, we serve many patients in our practice, and while most requests might be medically justifiable, not every request can receive equal priority. Our estimate is that staff, phone, mail and fax costs for processing almost 600 referrals per week costs 120 man-hours and us about $4,000. We do not get reimbursed for this!

5. When you call the office to request something, e.g. a doctor's note, a written prescription, a copy of lab tests or other information in your chart, please get the  name of the secretary you spoke to, so that if any problem ensues, we know who to follow up with. (Staff members too are instructed to volunteer their names when they undertake to follow up on a request). Allow sufficient time for the request to be carried out.

We know our services are not perfect and there are still many kinks that need ironing out. We are striving to do this. With understanding and mutual effort on all sides, we feel certain that even in the Age of Managed Care, it is possible to have a rewarding doctor/patient relationship of care and mutual trust. Help us to achieve this!