DOCTORS’ LOUNGE
lieve that heroin addicts fail in our current
abstinence-only based programs at a rate
of 80-90 percent per year. Speaking against
abstinence-only programs, in a culture that
values honest self-appraisal in living with
oneself without any crutches other than the
Twelve Steps, is very problematic in this
country. People who have achieved many
years of sobriety typically run residential or
group outpatient treatment programs. They
and Narcotics Anon leaders do not accept
such medications as Suboxone (Buprenorphine/Narcan combo) as valid ways to treat
addiction. “Drug free means just that,” they
say. Even though medical research clearly
supports the use of these medications as
supporting longterm sobriety in concert
with usual therapy, there are not enough
doctors working in treatment centers. Addicts are not referred to prescribers, and
there are not enough of us. In KY fewer than
3 percent of eligible doctors (all primary
care doctors are eligible) have undertaken
the certification to prescribe Suboxone or
plain Buprenorphine. Methadone clinics
have waiting lists, but also carry the stigma,
in the Twelve Steps world, of being for users, not abstainers. Dr Stuart Urbach, who
is a certified prescriber, reminds me of the
federal law that limits each doctor’s patient
list to 30 the first year, and 100 a year thereafter. Medicaid provides coverage, but with
the inevitable forms for pre-authorization,
etc. etc. Therefore, there is now a big black
market for the sale of Suboxone.
I think we doctors reason: inviting opiate addicts into our practices - is this wise?
And, why should we learn about this when
other people who don’t abuse things take
up all our time already? But if you have
room for 100 patients in your practice: they
need you. Heroin death and HIV: these are
deadly scourges, but we can look within our
ranks to help.
I believe it is time for us to follow the
selfless example of Dr Stuart Urbach, and
to take the Thirteenth Step. Learn about
the proper use of these medications; try to
arrange in your own group or with a referral
source a way to help steer the opiate-addicted into medical treatment that includes
both these medicines, and AA. Consider
being certified. Sometimes, 13 is a lucky
number.
Note: Dr. Barry practices Internal Medicine
with Norton Community Medical Associates-Barret. She is a clinical associate professor at the University of Louisville School of
Medicine, Department of Medicine.
NIRVANA FOUND
Boris Beckert, MD, MBA
M
ary Barry’s piece “Step Away From
the Vehicle” references a practice
where the doctor focuses just on
the patient and not on the documentation
mandated to feed the insurance and regulatory beasts as “Nirvana.” Dr. Barry goes
on to describe a model of care known as
“direct care” where the doctors have a patient panel of only 600, and states that the
direct care model cannot work with a panel
of sick patients who carry a high burden of
complex chronic diseases.
ucts. By investing in the health of the patient
up front, rewards are achieved over time.
Our Louisville centers— West Broadway,
Newburg, and Valley Station — provide
door to doctor transportation, in-house
pharmacy, on-site specialists and radiology. Most patients have no copay to see
their primary care provider. In addition,
the providers are compensated on outcomes
not production. The primary care panels
are capped between 400-450 patients per
provider.
By practicing smarter —JenCare has been
able to avoid the red tape associated with
meaningful use and patient centered medical home. We go beyond the minimum
requirements of the patient centered medical home by emphasizing frequent visits
leading to strong relationships between the
patient and the primary care provider as the
foundation for keeping our patients healthier, helping them avoid falling through the
cracks of the current, fractured healthcare
system, and achieving better outcomes.
What Dr. Barry may not be aware of is
that Nirvana exists in Louisville, and it targets precisely this elderly, complex cohort
of patients. This practice has achieved peer
review documented reductions in hospital
days and improved medication adherence,
and high patient satisfaction in this complex
population.1
Because JenCare has a global capitated
rate, the physicians don’t have to worry
about FFS billing. No billing means using
a much more clinically relevant, proprietary, electronic health record — no more
counting bullet points to achieve the next
level of service — simply document what’s
needed to care for the patient. As stated by
Dr. Barry — “see the patient, care for the
patient, and only write down what we think
necessary given the omnipresent threat of
the tort system.”
This creates better health for the patients,
lower cost to the healthcare system, and an
economically viable practice model.
JenCare, a division of ChenMed, specializes in caring for seniors with multiple
chronic complex health conditions who are
insured through Medicare Advantage prod-
Medical nirvana is possible, and can be
found in Louisville.
Craig Tanio and Christopher Chen. Innovations At
Miami Practice Show Promise For Treating High-Risk
Medicare Patients. Health Affairs, 32, no.6 (2013):10781
1082
Note: Boris Beckert, MD, MBA, is the Kentucky Market Medical Director for JenCare
Neighborhood Medical Centers.
MAY 2015
35