Board certified in pediatrics.
In private practice for 40 years.
Education: University of Kentucky College of Medicine (Residency, Pediatrics); University of Chicago Pritzker School of Medicine (Medical School)
Medical News: Why did you become a doctor?
James Hedrick, MD: I have a degree in nuclear physics and my wife said she would not marry me if I was going to build bombs. I always knew I wanted to be a doctor. My uncle had a PhD in chemistry and he was Dr. Hedrick. From the time I was five, I knew I would be a Dr. Hedrick just like my uncle.
MN: Over the last 40 years, how has the practice of medicine changed?
JH: Medicine used to be very personalized. For example, if the patient came in and couldn’t pay, you’d loan them money, or you would give them free care. The biggest change is the insurance and the tremendous amount of paperwork. You must code everything correctly.
Electronic Medical Records (EMRs) have changed how things work. We used to have paper charts, which had their own set of problems, however, if you needed information, you could get it quickly, that is if you didn’t lose the chart. With EMRs, the idea is to communicate with all specialties, but it doesn’t always work out. For example, if we get a record, we print it, scan it, upload it, convert to a pdf file. This is a lot of steps. Another problem is that some hospitals have two different EMR systems. One for the emergency room and one for the admissions.
Also, if you send your child to an immediate care center, we have no record of that visit. We don’t know how many ear infections a child has had because they don’t send data back to the primary care physician. To complicate matters, a patient will say, “My child needs to see a specialist because he’s had an infection ten times.” However, we only have record of two times.
Vaccines have changed our pediatric practice drastically. We used to do spinal punctures for meningitis once a week in our office 30 years ago. We also used to have around three children, per doctor, a year die from meningitis. We also saw a lot of pneumonia. Vaccines have eliminated those problems. We hardly see meningitis and we haven’t done a spinal tap in about 15 years. We also see much less serious pneumonia than we used to see.
When I started, pediatrics was a sub-specialty of infectious disease with two thirds of our business being illness related. Today, one third of our business is illness related and two thirds is behavioral health related (ADHD, depression, school problems) with a good bit of time spent on well visits and anticipatory guidance.
MN: How does your practice work to address social determinants of health?
JH: Social determinants of health is huge – it’s the biggest driver of poor health in the U.S. We see many patients affected by drugs, with one in ten being raised by grandparents or foster parents. Because of financial hardship or drug abuse, children come second, out of necessity. Because we are in a rural area, transportation is problematic. Many patients don’t have a car, or the car breaks down and we don’t have TARC or taxi service in Bardstown.
MN: Tell me about the clinical trials you conduct in your practice.
JH: We have done clinical trials since 1986 and began with antibiotics for ear infections. We became well known because we were the first to report resistant pneumococcus for the middle ear.
We also are well known for vaccine trials. I’ve given numerous talks around the world on this and serve on advisory boards of several drug companies. Doing the research and clinical trials has been beneficial because of the prestige it brings. Even if a parent declines to participate, they at least are aware that our practice is on the cutting edge.
MN: Describe your relationship to Passport.
JH: I got involved with Passport 20 years ago when UofL, Norton and Jewish, formed a Medicaid MCO for the 15 surrounding counties. We were nervous about it because we accepted many Medicaid patients and had a meeting with Passport to discuss our concerns.
To alleviate our anxiety, they put me on the board, along with Bill Wagner of Family Health Centers. We are the two longest serving board members.
Passport has always been receptive to provider concerns. They may not give us what we want, but they do listen, often coming out in person. I’ve never seen an actual person from other MCOs. Insurance wants primary care providers to be the gatekeepers. We are supposed to oversee your care and refer you to specialists. However, they don’t pay us enough to be a gatekeeper.
For example, insurance companies grade us over the use of antibiotics for colds because the CDC says don’t give antibiotics for colds. However, urgent care centers aren’t graded, even though they might dispense antibiotics at higher rates. It counts against us as far as our quality because our patient got an antibiotic. We are held responsible. Passport understands this and is trying to address it.
MN: What are the challenges of being a physician in Kentucky?
JH: I’m 70 years old and I often say, “I love my retirement!” which confuses people. I say that because I enjoy my job, I get to travel, and I get to see my 30,000 grandchildren.
The frustration is the insurance regulations, with the Medicaid waiver being especially challenging.
Philosophically, I’m not opposed to what they are trying to do because there is tremendous incentive for people not to work, to rely on Medicaid. If you are able bodied, you need to be doing something to improve your life.
However, as a provider, it’s going to be a nightmare. For example, a $3 co-pay will be expected for an office visit. They likely won’t have the co-pay, but we’ll of course, see them regardless. After the patient leaves, we will be expected to bill them for the co-pay three times before we write it off. This takes time and money to process those bills when they only reimburse us at $36 per visit to begin with.
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