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Reimbursement and Practice Management

Fish Story

By: Dale Moss

This is a fish story that's mostly true - really! - and its lessons can apply to the new face of healthcare delivery in America. Picture the boy, about 10, a towheaded blonde, skinny and just a bit active. It's summertime in the 60's in the Land of 10,000 Lakes. The "ride" is a big red Hawthorne bike, with the dual cross bar and about 2" too big (important later on in the story). The bike was too big because he'd "grow into it" ("too big" like every pair of shoes he'd ever owned until he was a teenager).

The boy had decided he was going fishing the next afternoon – the 'CCO radio forecast had sounded pretty good.

  • Getting ready – checking weather, best time of day, right bait, tackle box with the right tackle – extra hooks, fishing line, lures…
  • Getting the all chores done first, "no questions asked" – the Mom-Mandate!
  • Patience – a true test of a fisherman – repeated casting and reeling with the Zebco rod and reel with the medium sized Daredevil (red and white spoon shaped with a treble hook that got caught in the weeds often enough to be really annoying) – 20# test line
  • The distractions – butterflies along shore, leopard frogs, mosquitoes the size of small planes (mostly not true) or anything that caused a ripple in the water
  • Ready to pack it up, the dinner hour would soon be upon him – and then an amazing event.
  • The water erupts, the line goes screaming out of the Zebco reel and the boy gets a glimpse. It's big. It's really big. It's huge. It's a lunker fish and it's well hooked!
  • Get it right. Yep, Dad's direct talk on landing the big one was coming back quickly. It was all about playing it right – letting out the right amount of slack at the right time. Then working the tension to reel 'em in. Wet, muddy, sweaty, excited, heart racing and loving every moment – this is a big moment for a small boy.
  • No net (oops factor) – didn't think he'd get one this big. New plan – wade on in past the knees to get into position for the pending grab! This one just couldn't get away… to truly become just another fish story.
  • The fish is caught – it's a huge Northern. It's magnificent. What a beauty. It's flopping and flailing furiously. Forget the stringer he's got to get this home so he can show Dad when he gets home from his busy day at the office with computer hardware the size of buildings.
  • The bike ride on Big Red leaves the boy a bit bruised in the mid-section – no matter. The tackle box was forgotten lakeside – no matter. There may have been a Chevy Camaro SS with glass-packs passing by on the ride home – no matter. The boy pedaled home in record time.
  • The fish bucket was hastily filled with cold water from the garden hose. Big problem – the fish is TOO BIG for the bucket. So a basement laundry tub is the next best BIGGER option. (Thankfully he didn't consider Mom's pride and joy - the Maytag washer.)
  • So, the fish really was BIG and it was admired by the whole neighborhood (they had party lines back then), the relatives and all of Dad's work buddies for a very long time. We weighed it and measured it – making sure the tail was fully extended – for sure.
  • And, with the expert assist of dear Dad it was cleaned, fileted and was a fine feed for the family and neighbors!

A Bigger Fish Story – The HCR Wish Story

Thinking about the fish story got me wondering. Wondering if there could be some of the same great energies, preparations, passions and patience for the new face of healthcare delivery in America? A requisite healthy dose of skeptical thinking was required for sure. But what about those essential components of the "fish story"? Could there be a lesson there? Could it be "mostly true"?

  • Something exciting – Finding better ways for my Dad, my daughters, your Mom, your cousins, the favorite uncle, a best auntie – to access better specialty medical care. Even better than today. And maybe even ways to make it all easier. Now that does sound exciting.
  • Time of change – We are in the nebulous time of "health care reform" – maybe aptly dubbed "health pay reform". What things are we doing to get ready? Improving data collection systems, measuring outcomes, knowing costs of providing care, fine tuning specialty measures of quality…
  • Something new – Maybe an emerging therapy, new technology or a new way to put clinical services together in a patient-focused coordinated way.
  • Getting the basics in place – doing the chores first. Making sure the current care is its best & the infrastructure to support the patient care is optimized.
  • Preparations – tackle box, weather reports. Clinical data access, EMR, data gathering & data analysis. Oh, and that adage "garbage in – garbage out" truly does mean getting the right data into the systems accurately
  • Patience – casting for a couple of hours. HCR delays, payer policy changes
  • Distractions – frogs, flies and such. Politics – institutional, practice-based, local and national, nay-sayers…
  • Readiness for the moment – check the weather. Prep for potential political storms, cold economic fronts…
  • Being in the moment – wading in knee deep. "Just Do It", ready-fire-aim, get in the game – collecting outcomes, putting business and services excellence at the forefront of the care experience, reaching out to provide care efficiently with SoMe and web-based applications.
  • Contingencies – Perhaps a partnership with another specialty or multi-specialty group, maybe new health system relationships, putting an exit strategy into the business plan.
  • Measuring success – scale, tape measure. Deciding what outcomes data is meaningful – and measuring it (i.e. functional measures, ADLs, QOL, RTW, medication use, mood&hellip).
  • Sharing success – fish fry. Letting others know what worked via networking, publishing successes.
  • Celebrating "what's right" – celebrating moments. Taking time to celebrate system improvements, patient successes, achieving satisfaction and quality thresholds.
  • And preparing to do it all again – preparing for the next fishing trip and hoping to catch another BIG fish! HCR changes, new business models, new care delivery models, mobile medicine… What might be next?

Even though I now live not far from that same lake I fished as a young skinny towheaded blonde kid, I haven't been back. The memory is fond and it really is mostly a true story – yet today I think there might be some "bigger fish to fry" – Or are there?

What are some of the lessons from your life that you can you apply to today's challenges of making sure the "right patient gets to the right doctor for the right therapy at the right time"?

United States