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Are Primary Care Physicians Being Assimilated By The Borg?

If you live in a small town or rural area of the United States, you may have noticed that family doctors are becoming an endangered species. Private and public health insurance reimbursement rates are so low that survival as a solo practitioner (without the economies of scale of a large group practice or hospital system) is next to impossible. Some primary care physicians are staying afloat by refusing to accept insurance – this allows them the freedom to practice medicine that is in the patient’s best interest, rather than tied to reimbursement requirements.

I joined such a practice a few years ago. We make house calls, answer our own phones, solve at least a third of our patients’ problems via phone (we don’t have to make our patients come into the office so that we can bill their insurer for the work we do), and have low overhead because we don’t need to hire a coding and billing team to get our invoices paid. Our patients love the convenience of same day office visits, electronic prescription refills, and us coming to their house or place of business as needed.

Using health insurance to pay for primary care is like buying car insurance for your windshield wipers. The bureaucracy involved raises costs to a ridiculously unreasonable level. I wish that more Americans would decide to pay cash for primary care and buy a high deductible health plan to cover catastrophic events. But until they do, economic pressures will force primary care physicians into hospital systems and large group practices. My friend and fellow blogger Dr. Doug Farrago likens this process to being “assimilated by the Borg.”

Doug offered a challenge to his readers – to customize the definition of Star Trek’s Borg species to today’s healthcare players. I gave it my best shot. Do you have a better version?

Who are the Borg:

The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.

My attempt to customize the definition:

Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.

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To learn more about my insurance-free medical practice, please click here. We can unplug you from the Borg ship!


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4 Responses to “Are Primary Care Physicians Being Assimilated By The Borg?”

  1. Dan Ross says:

    Dr.Jones:

    I agree with you 100%. In fact, this model will become a cornerstone for large employer groups. (some will maintain employer-sponsored healthcare)

    Something you should consider is the need to transmit procedure/diagnostic/Rx data so your primary care services can be aligned with the care under the high-deductible plan. I believe primary care physicians will assume the direct role of providing physician-directed care for the sickest 5% of the population. This care is non-existent now. To assume these roles, doctors will need quick, roll-up access to all clinical care surrounding each patient.

    Thanks

  2. Alan Dappen MD says:

    Thanks for your excellent and wise words.
    I too have written on this topic using a “church of health” metaphor.
    http://getbetterhealth.com/leaving-the-organization-but-not-the-practice-of-medicine/2010.08.11#more-24821

    In today’s health care world, doctors are rapidly joining their “church of health.” Primary care physicians seem all to pleased to find their place within the safety of the Borg…for the right price.

    What we continue to lack as primary care physicians who have escaped “the matrix of the Borg” and left “the church of health” is a liberation theology platform and a unified place where we can unite, warn and welcome our peers who recognize that the Borg will fall far short of most of it’s stated purposes including cost effective, individualized, and individual controlled health care. Resistance is only futile if physicians (especially in primary care) fail to resist.

    I invite anyone interested in resistance to contact me and talk about what we can do together. United we stand and divided, we will become the Borg.
    Alan@Doctokr.com

  3. aaron says:

    “hive collective administrators” HCA – That’s too funny~!
    Similar topic but dealing with the challenges that specialist face because of the PCP practices being bought up by big hospital systems in this article http://goo.gl/AIK41

  4. doctorjay says:

    Sorry, I just couldn’t help riffing on the Borg thing:

    The {Accountable Care Organization (ACO)} Borg is a {dysfunctional health care bureaucracy} psuedo-race of {administrators and other individuals not qualified to directly provide health care services} cybernetic beings, or cyborgs. Their ultimate goal is the {gaining control over the maximum number of “covered lives”} attainment of “perfection” through the {recruitment of unwilling internists, pediatricians and family practitioners} forcible assimilation of diverse sentient species, technologies, and knowledge. No {autonomously practicing physician} truly self-aware individual truly exists within the {ACO} Borg Collective with the possible exception of thexecutive Director} Borg Queen, since all {ACO participants} Borg are {expressly prohibited from expressing opinions about the ACO and its policies} linked into a hive mind.

    The {Accountable Care Organization (ACO)} Borg Collective is served by {internists, pediatricians and family practitioners} humanoids referred to as {primary care providers (PCPs)} drones. Through the use of {a shared electronic medical record system, a process and outcomes registry, mandatory e-mail and interminable quasi-motivational meetings} thought-sharing cybernetic implants, the {PCPs} Borg interact. Upon {joining the ACO} assimilation, these innumerable {distractions from providing direct patient care} “voices” would overwhelm the {PCP} drone, stifling individual thought and resistance to the {ACO’s} Collective’s will. The {ACO} Collective is further populated by {midlevel practitioners, nurses, pharmacists, administrators, clerical personnel and persons from the IT, marketing, financial and insurance industries, and others who are unable to provide direct patient care} assimilated members of non-humanoid species, whose purpose is to enforce, direct and control the behavior of the {PCPs} drones in order to further the mission of the {ACO} Collective, as well as carrying out {economically punitive measures} termination on those {PCPs} drones who {advocate for the welfare of their patients over that of the ACO} exhibit independent thought and behavior.

    The {ACO mission} Borg philosophy is governed by a primary directive to add the {patients of non-ACO physicians} biological and technological distinctiveness of other species to that of the {ACO} Borg. In this manner, the {ACO} Collective seeks to achieve its definition of perfection; all other pursuits are deemed irrelevant. Accordingly, {PCPs} Borg drones {are not allowed to} do not engage in any {professional} activities except their {ACO-assigned tasks} duties and regeneration.

    In order to achieve the primary directive, the {ACO} relies upon the forcible and usually violent assimilation of {non-ACO physicians} other lifeforms and technologies to enhance the {market share} biological and technological distinctiveness of the {ACO}Collective. This is necessary for the {ACO}Borg to {provide a living for a substantial population of non-physician employees} innovate, adapt, and incorporate both the beneficial physiological and technological achievements of the assimilated species. This is the principal method of expansion; they are otherwise unable to {directly provide patient care} independently improve themselves and can neither understand nor mimic that which they do not {bind by restrictive contractual terms} assimilate.

    Upon {joining the ACO} assimilation, the {PCP}drone {either rapidly loses their hair or has it turn gray} ceases to grow body hair and develops an ashen, grayish skin coloration. {E-mail, EHR and Registry accounts are set up } cybernetic implants are either surgically attached to the body or grown internally by nanoprobes injected into the bloodstream. The resulting interfaces, connect them to the hive mind of the {ACO} Collective, and {stringent contractual terms precluding independent practice operation} cortical nodes render all {PCPs} Borg drones devoid of individual volition and causee them to work in unison and in constant contact with the {ACO}Collective, unencumbered by {concern for patient autonomy} emotion or autonomy. The {contract} cortical node also serves to ensure that any nascent emotions or emergent individuality would be minimized and, if necessary, allow termination of the {disobedient PCP’s membership} malfunctioning drone, ensuring complete unanimity and obedience to the will of the {ACO} Collective.

    {Economic coercion into membership} Assimilation frequently occurs on a small, individual scale but often comprises the assimilation of entire {group practices} species and/or worlds. The {ACO} Borg views the significant practical benefits conferred by {adding of physician members via threatened financial duress} assimilation as both desirable for themselves and the {prospective members} victim species; they seem to genuinely fail to comprehend what they see as the narrow-minded resistance shown toward {membership} assimilation and its attendant loss of individuality. Freedom, self-determination, and individual rights are viewed as archaic concepts necessary only to {outdated practice models} less advanced, authority-driven cultures, and thus, are not qualities worthy of upholding.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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