Several years ago, I was newly re-retired from a medical malpractice insurance company that I helped found and build, but I was not really ready to relax. Thanks to a bit of luck and lots of hard work in an earlier endeavor, I tried that route before, but my ADHDAttention deficit - hyperactivity disorder always kicks in. Plus, playing golf poorly all the time (which is how I play golf), is not a pleasant way to spend the last third of my life.
I volunteered at the Children’s Diagnostic Treatment Center in Fort Lauderdale, where I had been Medical Director of the High Risk Follow-Up Clinic many years earlier. I was able to observe and participate in the evaluation of children who were not developing typically and so sent to the Clinic by Child Find services. After witnessing scores of assessments by the psychologists and various therapists at the Clinic, I developed two important conclusions; 1) an epidemic of what we call ASDAutism spectrum disorder was emerging and 2) conventional medicine offered little in the way of etiologyThe study of causation or origination, accurate diagnosis, medical evaluation or treatment. I began to research about alternative interventions. There was the Internet, of course, reading books by CAMComplementary and alternative medicine practitioners such as Drs. Ken Bock or Bryan Jepson, and attending conferences and lectures by organizations such as Defeat Autism Now! (as it was named) and the National Autism Association.
One day, as a child who clearly suffered from the ‘gut’-type of autism was leaving our Clinic with only some tickets to an hour or two of therapy and a bunch of consulting evaluations, I ran after the family to tell them that I thought that I could help. That was my last day at CDTC, because I was reminded, “we don’t diagnose or treat, we refer.” So began the Child Development Center of America.
In spite of my M.B.A. degree (University of Miami), embarking on this medical practice was quite a daunting task. If it were not for the incredible support and work of my beautiful and patient wife, Jackie, or my friend and super-capable Practice Administrator, Karen Vossen, I would probably have gone back to shooting 94′s every day (I only get to do that once-a-week, now). I opened a small office in a medical professional building near the Dan Marino Center, and simply started to see patients who came by word of mouth.
Previously, as a pediatrician and neonatologist, I cared for hospitalized children who were very ill and quite unstable. The back office particulars were handled by financial professionals. My new practice had to make an early decision not accept payments from insurance companies. It takes hours to observe and evaluate a non-typically developing child, and the insurance reimbursement alone could not cover expenses such as malpractice insurance, office overhead and staff (Karen). More problematic is the fact that the alternative methods that are useful for reversing autism are simply not recognized by the conventional medical community. That means scrutiny and oversight by medical personnel who believe that doctors can’t fix autism in the first place, any therapy that we recommend can easily be denied, and novel protocols even open the physician to reprimands and licensure issues.
Thorough evaluation and close follow-up are the best means to get the greatest number of patients to improve and even recover from this childhood epidemic. Doctors practicing this type of care need to not only make diagnoses and treat patients, there exists a paucity of valuable research and literature upon which to base clinical decisions. I’m not uncomfortable or unfamiliar with this position, but when we were taking care of tiny premature babies or HIV-exposed newborns, I was part of a larger infrastructure. Although the conventional medical community may not have understood what was going on in those days, they were at least cordial. Private and public payors were obliged to provide reimbursement.
Individual practitioners are a dinosaur in today’s medical marketplace. We are trying to figure out how to take care of patients, pay the bills, and keep costs under control so that our care is somewhat affordable. That’s a tall order. Some doctors sell products, services or supplements related (or even unrelated) to the practice. But, that creates a moral hazard, as in, “Is the doctor selling me this product because it’s really going to help my child, or to pay for his Porsche?” (BTW, most DAN! doctors don’t have Porsches).
Some doctors choose to speak and lecture to patients and other professionals. That takes valuable time away from the practice. And, for me, it’s not a preferred activity, especially since that choice involves extensive travel (except for ‘webinars’, I guess). Other physicians have chosen the ’boutique practice’ route. That’s when the patient pays an up-front cost to assure that the practice never gets too large and so the physician can afford to take personal call and be more involved in patient care. I haven’t seen that in Child Development, but it seems to be a possibility.
Books and fame can provide additional revenue to the charming, good-looking and personable few.
I’m working on the book, but the goal is to help families and children, not personal aggrandizement.
The best model that I have envisioned is a company such as Cancer Treatment Centers of America – where a network of experts diagnose, treat, make recommendations and follow the patient with a holistic approach. ASDAutism spectrum disorder patients could get multi-disciplinary care; including supplements, traditional therapies, alternative treatment modalities, nutritional and dietary evaluations and support, in addition to the medical care that should lead the process. Reimbursement should be provided through insurance and other funded programs that understand the SAVINGS that are generated by early, precise diagnoses and effective interventions.
Currently, insurance companies and the government are basically not paying for any real help. There is no pressure to provide such reimbursement, which is seen only as a cost, not a lifetime of improvement and savings. It will take a prototype program that has the resources to evaluate funding and outcomes, and a pubic outcry, in order for such a service to become reality.
The present state of the ‘Autism Business’ is that it is not a business. It is the practice of medicine in it’s closest-to-pure state. Doctors from all over the globe are noticing the epidemic, studying it, and treating patients. I believe that many important breakthroughs will take place in the near future. In the meantime, I’ll do everything that I can to continue to keep costs in line, see as many patients as possible and let the world know how we are doing.
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