Doctor Kara's Blog

Medicare Regulations and Absurdities: Tidbit #1

doctorkara@doctorkara.com — Tue, 05 Feb 2008 05:00:00 GMT

Recently I have taken on Medicare insurance so I can provide home visit services to those who are homebound and cannot get to a medical provider's office. While learning the terrain of "Medicare Regulations", I stumbled upon what has to the be the most ridiculous regulation known to mankind. As a Nurse Practitioner, I am licensed to diagnose, prescribe, and supervise my own medical treatment plans for patients who visit my private office. When I was a registered nurse, I was responsible for delegating nursing activities and supervising the outcomes of the activities of licensed practical nurses, student nurses, and nursing assistants. Medicare even pays me for the services I render to home bound patients. HOWEVER, as a Nurse Practitioner, I am not allowed to sign the home health agency document (called the "485") that summarizes the treatment plan for the home-bound patient, not even to direct a nursing assistant to give a patient a daily bath! Apparently only an MD has sufficient brain power and authority to tell the home health agency that it is okay to give a patient a bath when he or she needs one. Other examples of what the "485" does may include: directing an RN to do wound care dressings, check blood pressures or blood sugars, etc---all the things I did as an RN and can still do as an NP---but Medicare regulations will not allow me to tell a fellow nursing colleague to perform an activity that is nursing care because I am not an MD. I think several factors are at play here: a very powerful American Medical Association Lobbyist group that continues to put legal barriers in the way of the profession of nursing, and the failure of legislators to pass regulations that are consistent within general Medicare guidelines. On what planet it is acceptable to tell an NP she can be paid for services she personally renders, but that signing documents that allow even simple things like directing a CNA to bathe a patient or for an RN to change a wound dressing are prohibited and can be only handled by an MD? I wonder if this absurdity makes any one else laugh as I did the first time I heard it? I only laughed the first time because when I found out this absurdity is really true, I got angry and wrote this blog. My next step is to contact my congressional leaders and complain like hell until its changed. And I believe you should too if you don't have something else to do at this very moment.

When Some One Else Says It Better Than I Can--

doctorkara@doctorkara.com — Thu, 25 Oct 2007 04:00:00 GMT

Article written by Ron Paul about Free Market Medicine

So What's the Deal with Having Your Appointment Book Online?

doctorkara@doctorkara.com — Thu, 06 Sep 2007 04:00:00 GMT

Online access to my appointment book is one of the core service features of the Doctor Kara, P.C. Family Clinic. It is a direct result of my personal frustration as a patient in trying to get an appointment with my primary care provider. I doubt I am not alone in this frustration. Having to wait for an office to open to talk to a receptionist—only to find out the office is booked solid for 4 weeks—and all I needed was my annual visit to refill my Zyrtec for my spring allergies. Well, it all seemed a bit silly in my opinion.

That’s when I started looking for a software company that could custom build me a program so my appointment book could be available 24/7. Isn’t technology great?! Because I make house calls and house calls to employment sites, I'm not always in the office and available to answer the phone. If I'm with another patient in the office, you don’t have to worry about waiting for a return call just to schedule an appointment. That was another pet peeve of mine as a patient—waiting for that return call that never came or was 3 days later.

Most of my patients use the online appointment book for reserving an appointment because they find it convenient and they have computer access. I am still happy to receive phone calls and manually schedule patients who do not have computer access.

The benefits of online scheduling are that it is very convenient, but highly secure. The software company maintains secure servers and encrypts the information. For those occasions when talking to a receptionist about the reason for your visit would be embarrassing, you have complete privacy when you use the online appointment book. The only person who sees your “reason for visit” comments is Dr. Kara.

One of the new benefits soon to be available at the Doctor Kara, P.C. clinic is a “Patient Portal” system which has a scheduling feature. So those of you who are already familiar with online scheduling will see a new program. The portal has many more features and will offer even better access and convenience. All of the patients who have financially supported Doctor Kara, P.C. in the first year of business have made this added convenience possible. Thank you to all my patients who put their trust in me and made it financially possible to add even more conveniences to the clinic. Every one of you are the reason I love to serve.

Welcome and Introduction

doctorkara@doctorkara.com — Mon, 09 Jul 2007 04:00:00 GMT

Hello!
Thank you for stopping by to browse and see what's new in this small corner of the world. I'm Dr. Kara Diersing Clapp and I am a Family Nurse Practitioner with a PhD--hence the "doctor" in Doctor Kara, PC. I own and operate a small family medical clinic in beautiful Sandy, Utah. I've been a registered nurse for 14 years and an APRN (advanced practice registered nurse) for 11 years (10 as a CNS and 1 as an FNP). I started this blog as a way to share my opinions and insights that are difficult to package in a professional-based website like the one I maintain for the clinic. Sometime I just like to say things in plain English and with lots of passion. I think most people who enjoy reading blogs are well aware that blogs can be full of emotions that are best placed in a blog as opposed to a website that maintains a sometimes drier business-like tone. I tend to write in a conversational style, so I hope none of you are disappointed that I choose not to pull out the $20 high-brow words I learned in my doctoral program.

If any of my readers have the misfortune (just kidding!) of meeting me in person, you'll easily recognize that I follow the WYSIWYG philosophy--"what you see is what you get". You'll recognize the same tone of voice and ease that you saw when you sat with me in my office and talked with me or when you heard me speaking at a public event. This year I will be 45 years of age and with those wrinkles and flabby bits comes a certain freedom to live and be exactly who you are, so this blog will be no different.

I do not go out of my way to offend people, but I do speak the truth with kindness as I see the truth to be. Like many older nurses who have been a nurse for awhile, I grew up in nursing at a time where compassion was king and service was really service. My early career was spent giving back rubs to hospitalized patients as I passed out the evening and bedtime medications. Yes it's hard to believe, but nurses really did those things in the 1980's. The point is that I'm not running for office and I don't have to be a politically correct type when stating my viewpoint on things. My view points are like everyone else's--you know that saying, so I won't finish it.

What you can count on in this blog is a decently informed opinion and some food for thought when it comes to serious things like health care, health care service, and the state of nursing as an art and science. In regards to my hobbies, don't count on anything but the ramblings of a person who does not take herself seriously when she is having fun.

Like all good researchers, I love to learn and if you have more information that I should consider when stating my views, I welcome it--as long as it is stated in a polite, respectful manner. And speaking of that-----

I have reserved the right to review all postings of readers because this blog is maintained on my professional website and there will also be children involved with this blog. I do reserve the right to choose not to post comments that are simply disrespectful and in extremely poor taste or not suitable for a child's viewing. I have been around the world wide web long enough to know that--just like in real life--there are folks out there who are hateful and disrespectful to others and who love to spew hateful comments because of the anonymity they believe they have on the web---but, rest assured, God sees all things. I ignore those folks in real life and will do so here as well. Hateful people and their comments will not be welcomed here, nor will their postings be of any worth to publish in my blog. Only comments that are designed for fruitful discussion, food for thought, or simply to add a splash of goodness in the world are worthy of posting and will be posted with the blessings of my cheerful heart.
So again, thank you for visiting and I hope you will continue to visit my blog because you find it amusing or helpful or both.

Why Did I Choose to Start a Clinic of My Own? (sometimes I wonder about that too!)

doctorkara@doctorkara.com — Fri, 06 Jul 2007 04:00:00 GMT

I love being a nurse. I love my career--it turned out much better than I could ever imagined. Like many nurses who became nurses at a young age. I was only 17 when I entered my first nursing program. I was a person who tended to be soft-hearted and caring about others. All of us inherit different capacities and personality traits. Mine happened to be "other-oriented", so a career in nursing was a great fit for me. Over the years my curiosity about being able to offer "the best" of what I knew became the driving force to return to school for another 4 nursing degrees. A little bit of boredom with small town life in Idaho directly influenced my decision to return to school for another 6 years. The additional benefit of earning a PhD meant that I would have credibility and doors would open that were currently closed to me. I was going to be older in 6 years anyway---why not do something fun like return to school and put in 70-80 weeks for those 6 years? It certainly cured me of my boredom problem.

During the last year of my NP (nurse practitioner) residency, I was involved in patient care in the office setting across a variety of clinics. As graduation got closer and closer, my sense of dread grew bigger and bigger. I just wasn't able to do what everyone else was doing. I was very dissatisified with having to “turn around” an office visit in 15 minutes or less---and less was the expectation of any new boss. It felt awful to rush through visits and I couldn’t do it.

That's when my wonderful husband, Glenn, told me to suck it up and start my own clinic. He couldn't understand why I would be so worried about something that was never meant to be--I wasn't meant to be employed by a physician. Plus, you really don't want to hear about the disappointing experiences I've had in sitting down with a potential physician employer only to have the conversation never move away from "why did I get a PhD?" question and being told I was overqualified for the position and no job offer was forthcoming from any physician. I was meant to be self-employed so I could provide health care services differently than every one else!

That was the beginning of Doctor Kara, PC. By the way, The PC stands for "professional corporation" and not for personal computers. Apparently the 411 folks misdirected several customers who needed personal computer repair my way because of the "PC" part of the clinic title. In Utah any person who must hold a special degree and licensure in order to practice in their field (ie, nurses, doctors) must form a PC instead of an LLC when forming a corporation.

So the day after I passed by board exam, I sat down and started writing a business plan and deriving the concepts of the "DK" (Doctor Kara) model of health care service. It wasn't as hard as you might think. I simply thought about all the things I had seen and heard over the years of my nursing career, my strengths and weaknesses as a person and as a professional and the DK concepts emerged pretty rapidly. Many of the key DK concepts would never work in the generic clinic setting we all know and often hate. I thought about the amount of time many people spend waiting for health care services, how rapidly a patient is cycled through a visit, how dissatified everyone felt about what was happening or what they were doing, the survival mentality of the nurses and doctors I worked with over the years, the lost hope, the resignation, the indignity, the malpractice, the accidental harm, the avoidable mistakes, the string of phone calls that are made to find a clinic who takes uninsured patients, the extra amounts of money the uninsured paid at traditional clinics, etc.

From all those experiences, the key concepts of DK emerged: on-time appointment keeping, house calls, visits that are personalized and attentive, soft music and lighting in the clinic, snacks and drinks for visitors, but most of all---the insurance companies were not invited--so they can't control how I choose to serve patients. Having a small clinic to run all by your lonesome is definitely not fun and games. It's a lot of serious hard work for which you will be the last to be paid---yes, I have been without a pay check for 18 months now and it will probably be another 18-24 months before I take home my very first dollar to my husband, but the rewards are well worth the sacrifice. I serve people and their health needs to the very best of my ability and under the best possible circumstances---all based on what their individual needs and wants--that is priceless in my book.