River City Rheumatology

I wanted to put some thoughts together in one place so that you can get a more detailed, behind the scenes look regarding what is happening with me and my medical practice. 

I have been in medicine for nearly 30 years.  During that time there have been a number of challenges and changes in the field of medicine, and in my life as well.  In medicine, a disturbing trend has been a move away from local, private practice delivery of health care toward centralized, system-based care.  This migration has many causes, but a primary driver has been the overwhelming influence of third party payors (government or insurance company plans) to determine and assign the value of medical services. This reality, coupled with incredible licensing and certification requirements has made it nearly impossible for local, private, independent providers to make it without becoming completely jaded and burned out.

While in the practice of medicine I have worked in nearly every health system imaginable including large tertiary university hospitals, community hospitals, academic centers, private practice, free clinics, and in missionary medicine overseas.  In all these settings my goal has been to remain faithful to basic principles of care. The Hippocratic Oath calls on physicians to “first do no harm”. This means that a good doctor will make decisions and recommendations in a thoughtful and considerate way to ensure the lowest likelihood of hurting someone. This takes technical and scientific expertise, but also requires attention to detail and avoiding snap judgments (too common in today’s productivity-based model of health care). Secondly, I try to follow the “Golden Rule”, which is to do to others as you would want them to do to you. In other words, I am committed to treating my patients the way I would want to be treated.  

All of this has led to where I am now. My determination to focus on patient centered care and to make sure all people are given a fair hearing has led to some difficulties in satisfying the demands of a health care industry which is increasingly focused on productivity and profitability. In one of the letters announcing the termination of the University of Michigan Health-West Rheumatology clinic, rheumatology was referred to as a “broken” specialty nationwide.  This characterization has a nugget of truth to it, but is somewhat misleading. The “broken” parts of the specialty do not reside in the practice of rheumatology, but in the valuation, or reimbursement of it.  

Rheumatologists care for some of the most challenging conditions that a person can acquire or develop. These conditions are frequently misdiagnosed, as they evolve erratically over time, and they rarely have simple tests to help make a diagnosis. For these reasons and more, people who present with rheumatic or autoimmune diseases often have seen multiple specialists and have been dealing with symptoms for years. These conditions persist for a lifetime in many or most cases. Therefore, it stands to reason that the evaluation and management of autoimmune disease takes time and consideration. However, our health care reimbursement system does not value time. It values procedures and numbers.  Many procedures which take little thought and minimal time to perform are reimbursed at much higher rates than what rheumatologists can charge for the long-term diagnosis, care, and management of  complex autoimmune and inflammatory diseases. It is in this way that the specialty is “broken” and helps to explain why so few physicians go into the field, adding to the trouble many people have getting in to see a rheumatologist in the first place. 

With all of this in mind, and understanding the challenges before me, I am trying out a different practice model. By opening River City Rheumatology, along with River City Wellness and Integrated Care, I am committing to the comprehensive health and wellness of my current and future patients. My goals are to maintain my basic principles of care and to sustain a viable independent practice. As part of this I want to be able to offer an open clinic for all, and I do not wish to exclude patients on the basis of insurance quality. At the same time, I want to be able to offer extra time and access for those with the desire or need for increased education or management review. Part of the success of this philosophy will be dependent on having income from a variety of sources, and I will therefore be establishing a hybrid approach to the clinic with traditional and direct payment options. Traditional payment is exactly what my current patients are used to: generous office visits at regularly scheduled intervals with either myself or one of my mid-level providers, billed to insurance.  

A second option will be an annual membership program that will allow patients more time during appointments, as well as on demand, same-day or urgent virtual or office visits with a provider outside their routine scheduled appointments. A focus of this plan will be the integration of holistic aspects of wellness into the appointments, including diet, sleep, exercise, and stress management along with yearly comprehensive medical evaluations. This design is in no way intended to implement a “two tiered” care model. Every one of my patients will continue to be valued and cared for in the way they deserve. I believe this model recognizes the differing needs and desires of individuals, and also helps keep the entire practice accessible to all.   

This endeavor will be aided by highly qualified and compassionate physician extenders such as nurse practitioners and physician assistants.  As always, my goal is to have the entire support staff of my practice share a common vision—which is to provide high quality, compassionate, patient-centered care to every single person who comes through our doors.

We are also pleased to be offering infusion therapy on-site for those who need it. And we anticipate expanding our services to include physical, exercise, and nutrition therapy, as well as other specialists on-site interested in the management of autoimmune disease. 

The need for patient centered, comprehensive care for autoimmune and inflammatory disease is overdue. This vision extends well beyond my own little corner of the world. I hope that by partnering together we can prove this model of care to be successful and that management of chronic illness doesn’t demand a high volume, productivity-based approach, but can be comprehensive, integrated, and truly holistic.  If you would like to partner with me, I look forward to working with you and I appreciate your encouragement and support. I know rheumatology well, but the intricacies of launching a business on a short timetable is a steep learning curve, so I covet your prayers and your patience (and your advice!) as I navigate these new waters. Philanthropic opportunities may also exist as we explore ways to expand this vision.

Feel free to reach out  if you have any other questions or concerns and we will do our best to respond in a timely manner.

The new office number is 616-320-5330.

Sincerely,

James Birmingham, MD (Jamey)