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	James L. Holly, M.D.

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Letters - What Kind of People “Hang Out” in a Doctor’s Office January 29, 2015

A friend of SETMA state, “My apologies Dr. Holly,” in reference to a question about “What Kind of People Hang Out in a Doctor’s office.” I sent the following private message on Face Book.

I think an apology is not required. This link is to the healthcare providers who "hang out" in SETMA's seven clinic locations. http://jameslhollymd.com/about-setma/setma-provider-portrait in the same section of our website are portraits of SETMA's partners, executive management, accreditation team, nurse practitioners, nurse home team, hospital care team and Diabetes Center of Excellenceed team.

I am intrigued by the issue of "who hangs out" in our offices. Number one if you have a virus, antibiotics are useless. It is possible to get a secondary bacterial infection on top of a virus but with out that virus are not affected AT ALL by antibiotics. In fact, national standards of care, which SETMA tracks our providers' performance on, specifically address not using antibiotics in Acute Bronchitis and other conditions. We do have fairly effective anti-viral medications which, if taken early enough in the illness' course, can mitigate the symptoms.

But, back to the issue of "who hangs out," SETMA is the only practice in America -- true fact -- that is accredited for excellence in ambulatory care and patient-centered medical home by all four agencies which evaluate practices. Only 18% of primary care physicians are accredited by one of these agencies. This does not mean that we are perfect for we are not, but it does mean that the “creative tension” which is the difference between our “reality” and our “vision or passion” drives us daily to improve.

In order to allow the poor and elderly to “hang out” in SETMA’s offices, who often are the ones who need to, and for them to do so without having to chose between healthcare and food, SETMA went to the principle HMO with which we work and said, "We want to reduce the co-pay for an office visit to a primary care provider to zero." We were told, if you do that, you will be inundated with patients abusing the privilege of coming to your office at no cost.

SETMA was confident of the responsibility of our patients and we pressed the point achieving the goal of our patients being able to see us without any cost if they are on Texan Plus. We have kept records of patients who have wanted to "hang out" at our office since they did not have to pay anything. After twelve years, the following is the list:

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There are NO names on the list and no one has abused the privilege. However, many people with chronic and serous illnesses have been able to access care as frequently as they need in that it costs them nothing. It is our experience that patients are responsible and that most will not incurred a debt which they cannot pay. That means that they often will not come to the doctor because they cannot afford even a five-dollar co-pay. Without a co-pay, they get the care they need. Often that care keeps an illness at bay or decreases the danger it represents to the patient. Through data analytics we have proved that our HMO patients have better out comes than our Medicare Fee-for-Service patients who are equally honorable but who have to pay their 20% of usual and customary charges. In that many of them cannot afford that, they stay away from “hanging out” and they get sicker.

We infer that the reason for HMO patients receiving better care is because there is no financial barrier to them receiving care. That pleases us.

So, if you need to “hang out” at the doctor’s office, do so.

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

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