DMHC Enhances Its Subspecialty Expertise

With Addition Of Superstar Neurologist,

Professor Cheryl L. McNeil, M.D.

DMHC is proud to announce that neurology luminary Cheryl L. McNeil, M.D. will join our practice starting August 15th after serving for ten years on the teaching faculty of two world-class academic institutions.

Dr. McNeil was attracted to DMHC because of her passion for providing care to complex, underserved patients - the focus of DMHC's pioneering practice. "I want to work where I'm needed and appreciated," says McNeil. "I always thought my highest contribution would be in academia, but DMHC changed my perspective. It gives me the opportunity to take on new challenges while also achieving a better balance between professional and personal commitments - a goal that was particularly important to me at this point in my career," she admits. "I can even continue my teaching activities, thanks to the cooperative arrangement Dr. Alan Kronhaus, the CEO of my new practice, worked out with the Chair of my Department at UNC."

A Triangle native, Dr. McNeil did her undergraduate studies at UNC-Chapel Hill, then continued at Wake Forest University for medical school and her residency. Consistent with her zeal for scholarship, Dr. McNeil also completed a Neuro-Oncology Fellowship at the University of California, San Francisco. With this outstanding training and Board Certification in Neurology and Psychiatry, Dr. McNeil accepted a prestigious faculty appointment at Wake Forest University, where she directed the Outpatient Neurology Department.

After living in Winston-Salem for five years, Dr. McNeil decided it was time to come home. In 2006, she accepted a faculty appointment in the Department of Neurology at UNC-Chapel Hill, where she became heavily involved in teaching neuroscience to medical students and neuropathology to residents, while supervising clinical activity in the outpatient neurology clinic.

In recognition of her teaching accomplishments, Dr. McNeil was awarded the Hyman Battle Teaching Award and the Neurology Resident Teaching Award in 2010. When she announced her decision to join Doctors Making Housecalls, her Department Chair cajoled her into continuing her teaching activities by promoting her to Associate Clinical Professor. Dr. McNeil is delighted to be able to keep one foot in academia while spending the majority of her time seeing patients as the Neurology Consultant to DMHC's 23 primary care clinicians.

According to Dr. Kronhaus, "having Dr. McNeil on our clinical team will enhance our status as the nation's "gold standard" in home medical care. It will also improve our ability to bring the best medicine has to offer to our patient's in their own environment. By improving access to such high-quality care," Kronhaus continues, "we can function in a more proactive, prevention-oriented fashion, instead of reacting when a patient deteriorates."

Dr. Kronhaus contends that crisis-oriented care leads to unnecessary ER visits and hospitalizations, which are all-too-common these days. "There's a ton of evidence," Kronhaus contends, "that we serve our patients better by keeping them out of the hospital and emergency room. Unnecessary admissions not only drive up the cost of care, but also put patients at risk for untoward events," he says. "When we can keep patients living at home, on an even keel, everyone wins."

Dr. McNeil cherishes the time she spends with her husband and two young children at home as well, but also needs to be practicing medicine. "There's nothing more important to me than family, but I have to be taking care of patients to feel truly fulfilled."    

Questions Raised About

Accuracy of Office-Based

 Blood Pressure Readings 

Writing in the Annals of Internal Medicine, researchers report that "white coat syndrome" is real and may lead to the overtreatment of hypertension in some individuals.  They define the "syndrome" as the temporary elevation of blood pressure caused by aggravations associated with the office or clinic experience itself -- like languishing in the waiting room, sitting in a cold exam room glad in a skimpy paper gown, trying to grab enough time with the overworked physician.     

The report raises the perennial question of how best to measure blood pressure -- an important question considering that 30% of the U.S. population is deemed "hypertensive," and hypertension is an eminently treatable condition.  Moreover, the consequences of under-or unrtreated hypertension account for untold billion in health care expenditures. 

If we can't agree on how to measure blood pressure (BP), we will will be in trouble when it comes to deciding what level of BP is "abnormal" and how aggressively to treat patients defined as hypertensive. 

According to the report's lead investigator, "Blood pressure normally fluctuates from hour to hour, and from day to day . . . even knowing this, we were surprised to see how big the differences were between clinic and home readings."

Because hypertension is almost always asymptomatic, it is generally goes unrecognized and untreated until discovered during a trip to the doctor's office for some other problem.  Therefore, office-based blood pressure measurements become the standard by which "hypertension" is defined.  However, this research suggests that overly-aggressive treatment of the problem may be also be an problem if physicians rely on BP levels that are "artificially elevated" by the environment in which BP is measured.

This research "supports recent calls for increased use and reimbursement for home blood pressure monitoring," according to Dr. Powers, the study's principle investigator. By shifting from clinic-based to home-based blood pressure monitoring, we could explore new practice models and create new efficiencies in care."

Dr. Taavoni, Chief Medical Officer of Doctors Making Housecalls, agrees with Dr. Powers, and suggest that patients would be better served in many ways if physicians cared for them at home.  "We get a more accurate picture of our patients when we see them at home" says Taavoni. "They're more at ease and forthcoming with information that is clinically valuable.  Once you become accustomed to seeing patients the way we do, it's hard to imagine practicing any other way."   

Concierge Practice:

What's Your Perspective?

 The Debate Continues

A recent Medscape article about concierge medicine deemed the practice model "unjust."  The argument goes as follows:

There aren't enough primary care providers around to begin with. We all know that we have too many specialists, not enough generalists, and not enough primary care providers in the United States. If you take a significant number of them out of the pool available to every patient and make them available only to people who can pay additional fees, it results in a bigger workload for the rest of the providers who are doing primary care. No matter how you look at it, if you allow providers to buy out, you are going to leave other patients with lower-quality care, and you are going to burden the remaining primary care practitioners (who don't take the concierge route) with more work. 

Concierge practices are considered unjust in part because they foster a "two tier" system of care that many the U.S. view as ananthem.  Yet many would suggest that disparities in the quality of care already exist and can be dramatic, the level of customer service provided by different health care organizations the amenities already exist, as well as

How does this argument resonate with you? Is concierge practice a "legitimate," understandable solution to a broken system, or a way for doctors to avoid the full force of their obligation to serve, and the  priviledged to buy their way to better service? 

Please convey your thoughts on the blog area of our website.  DMHC believes it provides all the benefits and advantages of concierge medicine, without an annual fee.  As such we have some resentment about practices which do.  Our goal is to be as affordable as possible, but still financially viable.  If our unique practice model is not financially sustainable, we will not be around to help anyone. 

Physicians made a "Faustian bargain" when they agreed to accept government insurance.  In exchange for "patient volume," we agreed to accept whatever the government decides to pay. Those payment decisions have forced physicians, and even mid-level practitioners, to opt for specialties that pay multiple times more than primary care. 

These days, it's not a matter of greed, it's a matter of survival.  Plumbers and electricians earn about as much as primary care physicians who have invested 11 years more in their education, and accumulate an average of $135,000 in debt by the time they start their first real job.  Over the past couple of decades, the cost of practicing medicine has increased inexorably, while the pay rate of primary care physicians has barely budged.   

So those are the facts and a bit of the backdrop to the debate over the concierge practice model. We are most anxious to hear what our patients, constituents, and friends of the practice have to say about that form of practice.  Please let us know.

Alan Kronhaus, M.D., CEO
Doctors Making Housecalls