Tara Kiran’s Post

One of the reasons GPs in the Netherlands 🇳🇱 need to provide timely access: they are gatekeepers for the emergency department. (And yes, that is an empty ED wait room!) Most EDs will not accept patients who walk in. If they do walk in, they are told to contact their GP (or if between 5pm and 8am, the after hours service run by GPs). There is some flexibility with this, particularly in Amsterdam, where there are more people living at the margins. If someone is having a heart attack or something immediately life threatening, they would call an ambulance. Otherwise, they call their GP's office. GP offices also have a specific phone line for emergencies. If the practice assistant and GP think the person who is calling is having a life threatening event, they will call an ambulance. Otherwise, they will see the patient in the office and evaluate them. If a GP evaluates a patients and think they need ED care (e.g. if they require further workup or more specialized mgmt), they send a note electronically to the ED and call the ED physician to do a warm hand-off. So providing timely care during the day is critical as GPs are the first-line contact for everything that is not immediately life threatening. GPs also play the same role after hours — but they provide after hours care collectively in cooperatives that cover large regions (more on that later!). Timely access is facilitated by excellent triage algorithms developed by the Dutch College of GPs and used by practice assistants. These detailed algorithms allow assistants to resolve some issues independently and decide who needs to come in urgently and who can wait. GP contracts specify that a GP is responsible for care of their patients 24-7. But as far as I can tell, there are no specific requirements for timely access outlined in the GP contracts. Rather, it's an implied responsibility. There are checks and balances in the system, including many options for patients to voice their dissatisfaction e.g. if they cannot get a timely appointment. This could be by speaking directly to the GP; contacting the complaints officer associated with the practice (an affiliation that is required for GPs); approaching the disputes committee (another required affiliation for GPs); or at the most extreme, holding the GP accountable through disciplinary law. If there are a lot of complaints about the quality of care, a practice may also get investigated by the insurer contracting care or by the national health and youth care inspectorate responsible for quality & safety. But these are tools that are not needed for the vast majority of practices. From speaking with several GPs, it seems to me that providing timely care is just part of the professional ethos of GPs in the Netherlands. And, not surprisingly, Dutch ED waiting rooms are largely empty. 🙏 to Jettie Bont Eric Moll van Charante Rob Dijkstra Ralf Harskamp Tim olde Hartman and the many other 🇳🇱 GPs who patiently explained so much to me!

One of the reasons GPs in the Netherlands 🇳🇱 need to provide timely access: they are gatekeepers for the emergency department. (And yes, that is an empty ED wait room!) Most EDs will not accept patients who walk in. If they do walk in, they are told to contact their GP (or if between 5pm and 8am, the after hours service run by GPs). There is some flexibility with this, particularly in Amsterdam, where there are more people living at the margins. If someone is having a heart attack or something immediately life threatening, they would call an ambulance. Otherwise, they call their GP's office. GP offices also have a specific phone line for emergencies. If the practice assistant and GP think the person who is calling is having a life threatening event, they will call an ambulance. Otherwise, they will see the patient in the office and evaluate them. If a GP evaluates a patients and think they need ED care (e.g. if they require further workup or more specialized mgmt), they send a note electronically to the ED and call the ED physician to do a warm hand-off. So providing timely care during the day is critical as GPs are the first-line contact for everything that is not immediately life threatening. GPs also play the same role after hours — but they provide after hours care collectively in cooperatives that cover large regions (more on that later!). Timely access is facilitated by excellent triage algorithms developed by the Dutch College of GPs and used by practice assistants. These detailed algorithms allow assistants to resolve some issues independently and decide who needs to come in urgently and who can wait. GP contracts specify that a GP is responsible for care of their patients 24-7. But as far as I can tell, there are no specific requirements for timely access outlined in the GP contracts. Rather, it's an implied responsibility. There are checks and balances in the system, including many options for patients to voice their dissatisfaction e.g. if they cannot get a timely appointment. This could be by speaking directly to the GP; contacting the complaints officer associated with the practice (an affiliation that is required for GPs); approaching the disputes committee (another required affiliation for GPs); or at the most extreme, holding the GP accountable through disciplinary law. If there are a lot of complaints about the quality of care, a practice may also get investigated by the insurer contracting care or by the national health and youth care inspectorate responsible for quality & safety. But these are tools that are not needed for the vast majority of practices. From speaking with several GPs, it seems to me that providing timely care is just part of the professional ethos of GPs in the Netherlands. And, not surprisingly, Dutch ED waiting rooms are largely empty. 🙏 to Jettie Bont Eric Moll van Charante Rob Dijkstra Ralf Harskamp Tim olde Hartman and the many other 🇳🇱 GPs who patiently explained so much to me!

One of the reasons GPs in the Netherlands 🇳🇱 need to provide timely access: they are gatekeepers for the emergency department. (And yes, that is an empty ED wait room!) Most EDs will not accept patients who walk in. If they do walk in, they are told to contact their GP (or if between 5pm and 8am, the after hours service run by GPs). There is some flexibility with this, particularly in Amsterdam, where there are more people living at the margins. If someone is having a heart attack or something immediately life threatening, they would call an ambulance. Otherwise, they call their GP's office. GP offices also have a specific phone line for emergencies. If the practice assistant and GP think the person who is calling is having a life threatening event, they will call an ambulance. Otherwise, they will see the patient in the office and evaluate them. If a GP evaluates a patients and think they need ED care (e.g. if they require further workup or more specialized mgmt), they send a note electronically to the ED and call the ED physician to do a warm hand-off. So providing timely care during the day is critical as GPs are the first-line contact for everything that is not immediately life threatening. GPs also play the same role after hours — but they provide after hours care collectively in cooperatives that cover large regions (more on that later!). Timely access is facilitated by excellent triage algorithms developed by the Dutch College of GPs and used by practice assistants. These detailed algorithms allow assistants to resolve some issues independently and decide who needs to come in urgently and who can wait. GP contracts specify that a GP is responsible for care of their patients 24-7. But as far as I can tell, there are no specific requirements for timely access outlined in the GP contracts. Rather, it's an implied responsibility. There are checks and balances in the system, including many options for patients to voice their dissatisfaction e.g. if they cannot get a timely appointment. This could be by speaking directly to the GP; contacting the complaints officer associated with the practice (an affiliation that is required for GPs); approaching the disputes committee (another required affiliation for GPs); or at the most extreme, holding the GP accountable through disciplinary law. If there are a lot of complaints about the quality of care, a practice may also get investigated by the insurer contracting care or by the national health and youth care inspectorate responsible for quality & safety. But these are tools that are not needed for the vast majority of practices. From speaking with several GPs, it seems to me that providing timely care is just part of the professional ethos of GPs in the Netherlands. And, not surprisingly, Dutch ED waiting rooms are largely empty. 🙏 to Jettie Bont Eric Moll van Charante Rob Dijkstra Ralf Harskamp Tim olde Hartman and the many other 🇳🇱 GPs who patiently explained so much to me!

I was still fighting with an ambulance company after my dad had been dead for a year ... so this article caught my eye this morning. 🚑 🏥 💰 A few things stood out to me... Knowing this geographic area, airplane (not helicopter) vs ground travel seemed peculiar because I couldn't imagine it was any faster. But I kept reading because...sick baby for crying out loud. I still have questions. The parents have a $97,000 bill and The No Surprises Act doesn't protect them because it wasn't deemed medically necessary. While they knew the family was insured, the medical facility arranged the flight without attempting to use the in-network option. And now it's against their policy to help the parents appeal Cigna's denial. 🤯 Most days I'm optimistic about training the next generation in our industry. But this morning, I've got a bit of a throbbing headache. In addition to everything else they're juggling, how do client service colleagues educate employees on what to do in similar situations? Can they fiercely advocate for Cigna to pay this bill and still contain the employer's costs? Navigating and negotiating claims with such a significant dollar amount requires skills outside the boundaries of traditional client service. I don't see evidence that the frequency of similar claims will decrease, so firms need to think about how they'll respond when it happens to one of their clients. Thoughts on this? Let me know in the Comments. ✍🏻 Day 13: Daily LinkedIn posts in April and May about how high-performing client service teams help insurance brokers grow. #letsgetreal GenuineShift We build client service teams to help insurance brokers grow. Clients hire you to be led.™ #insurancebrokers #insuranceindustry #womenininsurance #employeebenefits https://lnkd.in/gMn2yfqz

I was still fighting with an ambulance company after my dad had been dead for a year ... so this article caught my eye this morning. 🚑 🏥 💰 A few things stood out to me... Knowing this geographic area, airplane (not helicopter) vs ground travel seemed peculiar because I couldn't imagine it was any faster. But I kept reading because...sick baby for crying out loud. I still have questions. The parents have a $97,000 bill and The No Surprises Act doesn't protect them because it wasn't deemed medically necessary. While they knew the family was insured, the medical facility arranged the flight without attempting to use the in-network option. And now it's against their policy to help the parents appeal Cigna's denial. 🤯 Most days I'm optimistic about training the next generation in our industry. But this morning, I've got a bit of a throbbing headache. In addition to everything else they're juggling, how do client service colleagues educate employees on what to do in similar situations? Can they fiercely advocate for Cigna to pay this bill and still contain the employer's costs? Navigating and negotiating claims with such a significant dollar amount requires skills outside the boundaries of traditional client service. I don't see evidence that the frequency of similar claims will decrease, so firms need to think about how they'll respond when it happens to one of their clients. Thoughts on this? Let me know in the Comments. ✍🏻 Day 13: Daily LinkedIn posts in April and May about how high-performing client service teams help insurance brokers grow. #letsgetreal GenuineShift We build client service teams to help insurance brokers grow. Clients hire you to be led.™ #insurancebrokers #insuranceindustry #womenininsurance #employeebenefits https://lnkd.in/gMn2yfqz