Medicine-in-Motion FAQ's

How was this website created?

Web Pages That Suck (by Flanders and Willis) was used to gain understanding for the basics of web design. After I planned out the site, I used Microsoft FrontPage 2000 to assist with the coding. No "canned" themes were used in the creation of this site. Buttons were created using Microsoft Image Composer (part of MS FrontPage 2000), with clipart from Microsoft Publisher. The web servers are hosted by Hostway. Currently, Adobe Dreamweaver is used to update the site.

I have good insurance coverage for my medical care. Why won't you see me?

We CAN see you! However, we no longer participate in any insurance plans so you'll have to pay at the time of your visit. There's a good reason for this:

Medical care in America seems to have lost its way over the past nearly 40 years. It used to be simple. One went to the doctor, paid the doctor, and then submitted a "superbill" receipt to their insurance companies for reimbursement. No hassles at the front desk to verify insurance eligibilities and create frustrations.

There was transparency, too - I used to post all of my charges in the office waiting room so that patients actually knew what they would be charged in advance and could plan accordingly.

Then came the age of "managed"(some might say "mangled") care and all of that became lost...

With the advent of health maintenance organizations (HMO's), patients lost touch with the true costs of their medical care. All they knew were their office co-pay amounts - $5, $10, $15, $25, or $35. They were not aware that the medical office might actually be submitting their bills to the insurance companies for two or three hundred dollars for those visits. They'd only discover this months later when they received a denial letter from their insurance company and learn that they were responsible for possibly exhorbitant bills.

Why high bills? Offices would set their charges to cover the cost of extra employees to deal with the insurance companies (check eligibility benefits, submit and process claims, collections, etc), in addition to their overhead such as rent, utilities and equipment. However, the insurance reimbursement rates often covered only a percentage of their costs. In turn, physicians had to raise their rates in order to account for the insurance companies discounting their bills, so as to make ends meet and still earn a little profit.

By voluntarily withdrawing from "the system," we're able to keep our overhead low and pass the savings on to our patients. As an example, a first time 15 minute visit might be coded as a "99202" new patient visit. Per the Fair Health Organization website (https://www.fairhealth.org), the typical charge for this visit in the North County Coastal region would be $200. We charge $110 - far below what most offices and urgent cares would charge and certainly much less expensive than a visit to the local hospital's emergency department! Treating our patients like family; it's the right thing to do!

[NOTE: Most of our Medicare and PPO patients have no problem getting reimbursed from their insurance compaines as we provide our patients with the required diagnosis, visit codes, and other identifying information in the form of the aforementioned "superbill receipt." Be aware that insurance deductibles can come into play and some companies make the distinction between "in-network" and "out of network" provider deductibles. You'll have to investigate what works best for you. You should also note that, if a patient were to visit an "in-network" provider, but had not yet met their deductible, they'd be responsible for the entire bill and not just their coinsurance or co-pay amount. So, for the example in the preceding paragraph, if someone incurred a 99202 visit with an in-network provider, they may have been responsible for 20% coinsurance payment at the time of the visit ($40) and the physician's office would submit a bill to the insurance company for the balance ($160). BUT, if one's deductible had not yet been met, the patient would be billed for the balance and end up paying the entire $200 charge (versus our $110 charge).

What is our policy regarding specialty referrals?

We often field requests for referrals to specialists, e.g. dermatologists to look at acne or remove a skin cancer.

First, it is important to understand that family medicine is a specialty itself. The vast majority of family physicians are capable of taking care of a wide range of medical and minor surgical conditions without a need to refer out to a specialist.

Every physician should know his/her limitations. I, for example, have not delivered a baby in over 15 years. I gladly refer these cases to the local obstetricians. I do, however, perform well-woman exams, so these do not have to be referred out unless a patient truly prefers a particular gynecologist.

We have the capability to perform minor office surgical procedures such as biopsies and excisions of many skin lesions, as well as cryosurgery ("freezing" of pre-malignant and other benign skin lesions). We treat most types of common dermatitis and other skin conditions, as well. However, should a patient not observe appropriate improvement with my treatment, I would not hesitate to make a referral to one of our fine local dermatologists. These are but just a few common examples.

We do not make any referral decisions based upon insurance type or lack thereof! We simply try to do "what is the right thing" for our patient. If a specialty opinion is appropriate, I will make an appropriate referral regardless of coverage. When I ws part of the managed care system, I would never consider withholding or delaying a referral simply because someone had HMO coverage (this would be stupid, as well as unethical).

Incidentally, I always try to send my patients to those physicians to whom I would send my own family members. Be aware, though, that insurance plans have their own preferred panels from whom you must choose, should you decide to remain "in network."

How do HMO and PPO plans differ?

Preferred Provider Organization (PPO) plans provide freedom of choice with regards to your medical care. The costs of these plans has risen steadily over the years. In response to this fact, Health Maintenance Organizations (HMO) were created as an attempt to keep health care affordable for the average family. It accomplished this task, primarily through containment of costs and limiting panels of physicians.

A former associate of mine offered this excellent analogy:

Suppose that you want to go the shopping mall. You have two options to get there from your home: you may drive directly or take public transportation.

If you drive directly, you pay for the costs of your vehicle, the fuel, maintenance and upkeep, but you have the freedom to travel at the time of your choosing, as well as the route. (PPO)

Public transportation, on the other hand, will still get you to the mall. The monetary cost of the trip will be cheaper, however, it might not be as convenient - you might have to walk a few blocks/miles to the bus stop and the bus may have to make several stops along a long circuitous route, but eventually you will find yourself at the mall. (HMO)

With a PPO plan, you can usually choose the physicians that you like without need of a long referral process, so you can be seen faster in many cases. With the typical HMO plan, your choice of physicians within a particular community will be limited. It's quite possible that the best docs in the community might not even belong to the HMO.

In short, we get what we pay for. Convenience and quality has it's price.

[By the way, another term - IPA - frequently comes up in these discussions. IPA stands for Independent Physician Association. This is a contracting organization that serves as the go-between for practicing physicians and individual insurance companies. For example, Sharp Community Medical Group (SCMG) contracts with several HMO insurance companies (e.g. Secure Horizons, HealthNet) upon the behalf of practicing physicians.]

I hate magic! Do I have to be subjected to tricks and jokes when I visit Dr. Pearson?

Of course not! We recognize that some patients might not be in the mood, nor have the time, to be entertained during their visit. Simply tell the medical assistant that you'd like to politely decline any magic/joking/clowning at the time of your visit and we'll respect your wishes.

That being said, Dr. Pearson's philosophy closely correlates with that of Dr. Patch Adams' Gezundheit Institute. Most people do not like to go to the doctor's office. Good studies have documented the stresses and shame that is often associated with admitting a weakness (e.g. illness), especially men. After all, John Wayne wouldn't have gone to a doctor. He would have chomped on a silver bullet instead!

It's been oft quoted that "Laughter is the best medicine." Dr. Pearson uses humor in the form of jokes, improv, clowning, magic, etc to relax his patients and help them to forget that they're visiting a doctor. He is definitely NOT the stereotypical physician wearing a suit/tie who spends just 8 minutes with each patient. Rather, he cares enough to try and make his patients feel better spiritually, as well. Things can get silly at times (no matter what your age!) and you probably won't find worse puns than this office, but he really does listen to what patients tell him and the vast majority appreciate his efforts and feel better afterwards. [All in all, this practice is probably not a good one for patients without a sense of humor. There are plenty of other good docs in the area from whom to choose and we make appropriate recommendations if requested.]

I looked Dr. Pearson up on the internet [Healthgrades.com, Vitals.com, or some other physician-grading site). He apparently sucks. Why should I go to your office?

Unlike random surveys taken of large groups of individuals, the surveys that are posted on these sites are not scientifically valid. The few people who post on these sites often go there with a specific purpose: to either exalt or trash a particular physician. Some patients go to a doctors office with specific expectations for treatment, let's say, to obtain a narcotic pain killer such as Vicodin, an antibiotic for a persistent cough, or perhaps an MRI for typical acute low back pain. If the physician, in his or her opinion feels that these are not medically warranted, they will not be prescribed. Most patients will accept their learned doctor's conclusion and advice. However, a very small minority appear to take personal offense that the doctor did not do what they most certainly "knew was the right thing to do" and want to get back at the physician. These sites provide a mechanism for doing so.

This is not new information. Check out the following discussion regarding these doctor-rating sites: http://e-patients.net/archives/2008/11/how-good-are-doctor-rating-sites.html. To view the research article upon which this discussion was based, click here.

On the other hand, relatively large samples (from out of our thousands) of patients are contacted annually to participate in random anonymous patient satisfaction surveys by Sharp Community Medical Group (SCMG) and our malpractice insurance carrier, Cooperative of American Physicians (CAP). The following is a scan of one of the results from one of the most recent surveys regarding Dr. Pearson. It shows the typical questions that are asked, indicates the number of respondents, and how we ranked in comparison to other docs.

This particular survey was given to every patient who presented to the office during a particular 1-2 week period in August 2010. You'll note that Dr. Pearson scored very high, in marked contrast to what is found on some of the internet sites.

In addition to scoring a physician based upon the questions, patients are also given the opportunity to comment about their physicians. Thus, here are scans of the complete list of patient-submitted comments (unedited by us):

While the majority of the comments are good, one common theme involves the wait times to see the doctor. This represents a good news/bad news situation for patients. Unlike most family medicine offices that schedule "waves" of patients (e.g. 2 every 15 minutes resulting in 8 minute visits for all), we'd rather see fewer patients each day so as to be able to spend adequate time discussing our patients' concerns. Our scheduling reflects this.

None of the docs ever likes to run behind, but most of the time the circumstances are beyond our control. It's not uncommon for a patient to schedule an appointment for what they believe to be a simple condition and have it turn out to be something of greater significance warranting a longer than expected visit. Also, unexpected emergencies are a fact of medical life. That's the bad news.

The good news is that this also reflects the fact that we really do spend time with our patients, rather than try to rush them back out the door in clinic fashion. Our patients recognize that although they may have to wait a little longer, we do not shortchange them when it's their turn to be seen. Considering that most of the patients that visit us are seen the same day that they called, the wait becomes a moot point for many of them as they are happy to be seen when they are acutely ill rather than being forced to wait a few days and feel miserable at home.

Our staff really works hard every morning to correctly estimate how much time an individual patient might require while scheduling appointments. However, the reality is that something will always come up. Whenever possible, we try to let our patients know when we are running behind. We hope that, with the addition of our 3^rd doctor and extending office hours on Mondays and Tuesdays, the wait times will be less.

On another topic, be aware that every physician has a different style of practice and personality. A particular physician might not be a perfect fit for a particular patient. Fortunately, we offer three excellent docs from which to choose. Do not feel shy about requesting one of the other physicians if you feel uncomfortable with one of us.

Finally, while we certainly appreciate the degree of thoughtfulness of some of the suggestions, we regret that we do not anticipate offering shrimp cocktails, Margaritas, nor "tea and crumpets" anytime soon... :)

How can I get a copy of your mom's fabulous tabouli recipe?

Click here!

I just hurt my (choose one or more: back, ribs, ankle, knee, toe, etc). Why didn't you perform an x-ray? (Don't you need the money?!)

Quite simply, a good doc does not order a test unless it's going to change his/her treatment. While this might not be such a big deal when ordering cheap tests (do these really exist?), it becomes a significant issue when it comes to the more expensive technologies such as magnetic resonance (MR) scanning (MRI scans may easily exceed $1000).

There are numerous studies demonstrating the extraordinary amounts of money wasted on unnecessary radiographic examinations. For example, physicians in Ottawa, Canada, looked at the vast numbers of plain x-rays that were ordered for typical injuries to the knee, ankle, and foot. They observed that while most patients who arrive at emergency rooms with an ankle sprain are sent for an X-ray, less than 15% actually have a fracture. These physicians developed the Ottawa Ankle Rules, a set of guidelines that can help doctors avoid ordering unnecessary X-rays simply by observing how patients walk and by feeling their feet. These rules were recently validated, yet again, by a Swiss study that concluded that they "can rule out ankle fractures with almost 100% accuracy and cut down on thousands of needless X-rays every year." As a sports med doc, I've used these rules over the years and have yet to miss a clinically significant fracture.

There are occasions where the diagnosis of a fracture simply doesn't make any difference in the subsequent treatment. Fractures of the toes and ribs are probably the most common examples of these. All common toe injuries are treated by "buddy taping" the affected toe to the adjacent one, whether a sprain or simple fracture. In the case of ribs, they are composed of bone and cartilage, the latter of which cannot be visualized with routine x-rays. Rib studies are notorious for missing rib fractures. For example, I cared for a patient involved in a motor vehicle accident who complained of left rib and flank pain. Plain films obtained by the emergency room physician were interpreted as being negative for fracture. When I saw him, I was concerned for a possible spleen injury so I ordered a CT scan of the region which revealed the presence of 7 broken/fractured ribs! Regarding their treatment, we do not apply casts to chests for rib fractures as this would compromise breathing (we even try to avoid rib belts, if possible, for this reason). Hence, painful ribs are treated with analgesics ("pain killers"), ice and then heat, etc - whether they are broken or merely contused (bruised). Bottom line: no need for rib x-rays unless we clinically suspect a more severe injury such as a pneumothorax (and then the radiographic study of choice is a chest x-ray looking at the lungs, rather than a rib series).

I could go on forever on the subject of imaging the acute (fresh/new) low back injury. The fact is that out of 100 back injuries, less than 5 will ever require surgery, including many disc herniations. Plain x-rays cannot visualize muscles, discs, nerves, or ligaments, nor can they identify facet subluxations (the "kinks" that patients commonly present with in the office). MR imaging can identify the majority of disc herniations/protrusions, but we would only order MR examinations if surgery was being considered because, as just noted, the majority of patients with acute disc injuries get better without surgery. The natural course of acute low back pain is well-recognized, as are the treatment options. Early imaging studies do not add anything to the management of the typical case of acute low back pain. Of course, exceptions may exist and there are some "red flags" in the patient's history that we look for in order to identify who might really have an underlying condition warranting further investigation. The National Guideline Clearinghouse (U.S. Government) has published it's guidelines for the evaluation/management of low back pain or sciatica in the primary care setting. (They may be found here.) Finally, a brief summary of the treatment of low back pain may also be found at the Quackwatch site here. [And don't forget to read my patient education handout on the treatment of acute injuries elsewhere on this site!]

Oh yeah, could we use the money? Sure, but we have to live with ourselves ethically and do what's right for our patients. Bummer.....

Frequently Asked Questions (FAQ's)

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