I'm sweltering in Las Vegas amid a mass of humanity swarming the hotels and streets, getting ready for an exciting day.

I'll be listening to my fellow healthcare bloggers as they speak abut their work and beliefs at The Healthcare Blogging Summit, and I'll be doing my bit as a panelist discussing the topic, Creating a Presence - Plan and Develop Your Blog.

The most fun part of this experience is realizing that my blog and website went live exactly nine months ago today - on August 29th 2006, I had zero readers other than dutiful family and friends, and I had no name recognition at all. Today, three quarters of a year later, I am speaking at the conference simply because I have become "a little known", and I have a wide readership, many of whom either comment or write me emails, and I have a stream of new business.

All because of the power of some writing that I manage to get to two or three times a week!

Last night, I attended a dinner for the speakers and had the pleasure of schmoozing with fellow bloggers, Toby Bloomberg of the lively Diva Marketing Blog, Matthew Holt of the popular and rambunctious The Health Care Blog (never afraid to have an opinion!), Enoch Choi MD of medmusings, Carol Kirschner of the thought-provoking Driving in Traffic blog and Tom Eng, CEO of Healia, the "google" of healthcare search engines.

What was so remarkable to me was that I had forged many of these relationships in cyberspace, before we ever met.. And what was even more striking was the energy and passion in the room - it seems that there is no person more filled with conviction and persuasion than a happy blogger!

I'll share what I learned in today's conference as it is starting to look like, unless you have absolutely nothing to offer, nothing to sell and nothing to say, that developing a sound blogging strategy may be just the ticket you're looking for to being noticed, promoting your "brand" and bringing in new streams of revenue. At least, I'm convinced!

By now, you might have realized that I am fascinated by all the shapes and sizes and variation that contemporary medical practices represent. And I am realizing that so much of the innovation is being driven by a strong physician desire to 1.) enjoy a higher quality of life, and 2.) serve patients in a way that feels much more like what they had aspired to originally, as fresh-faced medical students.

So I enjoyed reading this article yesterday in the Canadian National Review of Medicine, about the move towards "micropractices" (I especially love all the new terminology).

The article describes the practice of family physician Dr Gordon Moore (also a researcher with the Institute for Healthcare Improvement) as follows:

"In many ways this is a Norman Rockwell practice with a 21st century technological backbone," muses solo FP Dr Gordon Moore of his Ideal Micropractice vision ......

.......... Imagine answering your own office phone and giving out your email address and cell number to patients. Throw in some same-day booking and 30 minute patient visits and you start to get an idea of how things work in Dr Moore's office. But there's a method to the madness — in fact it was his IHI research that led him to hang out his micropractice shingle. Well, that, and the pressure to see more than 30 patients a day at his former group practice in a big HMO.

Just what is a micropractice?

In an article in Modern Medicine, it's described as "a low-volume, highly efficient solo practice that uses cutting-edge technology to keep overhead low and free up time for more doctor-patient interaction."

It's a practice that has gone on a serious diet, and lost the fat of grumbling back-office staff, mumbling receptionists, mislaid paper charts, impersonal answering services, bossy office managers and crowded waiting rooms. It puts the patient squarely in front of the physician, with no buffers in between!

Dr. Moore is apparently the pioneer who has been promoting this concept. With the support of the Physicians Foundation for Health System Excellence (a Boston-based non-profit organization that provides grants to improve the quality of care delivered in physician offices), he has created a website, Ideal Micropractice, geared to creating a community of like-minded physicians, and providing them with resources.

A successful micropractice depends on:

• the use of low-cost but powerful technologies, such as electronic medical records integrated with billing and coding software, and even self-scheduling software
• reliable physician-patient interaction
• convenient and timely access for patients
• the ability to control overhead expenses
• the willingness to provide consistent, reliable clinical care

Some of the challenges include:

• a decreased earning potential (in exchange for a vastly improved quality of life on the job)
• the ability to think like a business person and "wear many hats"
• the need to become techno-savvy and keep your tech support costs down
• the ability to finance your own start-up costs
• the lack of collegiality and hallway consults if you are going it alone

In exchange, according to most of the "micropractitioners" (see - there's a new word!), you can expect to get:

• lower overhead
• better efficiency
• more time for patient visits
• enhanced physician and patient satisfaction
• the joy of being your own boss (just make sure you don't land up working for the worst boss in the world!)

I'd love to hear from anyone considering this move, or who has actually made it.

Entrepreneurship is alive and well in the Nevadan desert!

A couple of weeks ago, I interviewed James Egidio, a co-founder of HouseCall Doctors which is a Las Vegas-based business that teaches physicians how to establish "mobile medical practices". In addition to providing the education and start-up knowledge, the business also supports its licensee physicians by:

• Providing a recognizable and marketable name
• Offering complete marketing and advertising consulting services,including website design, graphic arts, and desktop publishing
• Providing medical billing services 
• Offering discounted medical supplies, printed materials such as letterhead, envelopes, business cards, brochures, vehicle signage, and even logo-laden business attire
• Offering practice accounting services utilizing Quick Books
• Providing assistance with malpractice and insurance credentialing.

Egidio is a smart, restless entrepreneur who realized early on that a traditional educational path didn't suit his needs. En route to becoming a Physician Assistant, he was struck by the idea for the business. One of his early steps, a few years after starting the business and partnering with Dale Harelik, was to write a book - a task that took him two and a half years. In 2004, he completed A Physician's Guide to a Successful House Call Medical Practice, published by their own company, Hippocrates Publishing.

It seems there is sound logic for considering starting a "mobile" house call practice. According to Egidio and Harelik, there are at least ten good reasons:

1.) No managed care or HMOs
2.) Lower overhead
3.) Increased reimbursement for medical house calls by Medicare and other insurers
4.) Aging Baby Boomer population
5.) Have more free time; Work part-time and earn a full-time income
6.) Flexible scheduling
7.) Lower malpractice premiums
8.) Utilize medical house calls as an expansion to your office-based practice
9.) Have the edge over your competition
10.) Enjoy a fee-for-service practice

Given the prevalence of mobile diagnostic services -- labs, radiology services, ultrasound, EMG, EKG and ancillary services such a Physical Therapy, Occupational Therapy and Speech Therapy -- it's not a difficult argument to make that the limitations imposed by the old-fashioned house call are no longer present.

This house call interview brings to mind a story from my childhood in South Africa with our beloved general practitioner. At about the age of 3, my youngest brother suffered a severe attack of croup one night. I am quite sure we did not have Emergency Rooms available (this was in about 1963), so my mom placed a call to our GP's home (also no answering services back then!). He arrived very shortly thereafter with his black version of the above bag, and rummaged around for a tongue depressor. Not finding one, he asked my mother - and this was my highlight memory - to fetch him a teaspoon from the kitchen to inspect my brother's throat. He sat all night with my brother in a steam-filled bathroom, and only weeks later confessed that he was minutes away from performing a tracheostomy!

But, back to the topic. It seems that several physicians have discovered the joy of a "house call only" practice. And Egidio's business is not unique. Back east, in New Jersey, Visiting Physician is having an impact on the lives of the physicians and the community patients. And in Atlanta, GA, Mobile Medicine is bringing not only conventional medicine to your living room OR your office (for the busy executive), but also integrative medical services.

The movement towards increased in-home care has spawned a professional association, The American Academy of Home Care Physicians, whose mission is to:

"serve the needs of thousands of physicians and related professionals and agencies interested in improving care of patients in the home. Academy Board member volunteers and members work to reduce barriers and enhance practice education. Notable successes include: fostering increased reimbursement, sponsoring multiple educational and scientific seminars, and providing the practice community with a variety of helpful publications."

I continue to be fascinated by the ingenuity of the entrepreneurial mind and spirit!

I received an email today from a company from which I had purchased some prior products.

What struck me about this email was how simple the technology is behind it and how easy it would be to implement in a busy and streamlined medical practice.

This is what it said (with some bolding of what caught my attention, and adjustments so as not to bore you with my personal details!):

In a recently published review of studies, in Medical Care (the journal of the American Public Health Association), it seems that excellent doctor-patient communication can confer some real health advantages to patients.

According to ScienceDaily, where I spotted the report of the article:

Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

........ "From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time," said Dr. Frankel. "It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants."

Now this is pretty interesting to me because I have long been a proponent of giving doctors some coaching skills training.

I learned this personal lesson well when I began my coaching training. Somewhat arrogantly, I assumed that my coach training would be a mere formality, as I had already been through a family practice residency program with a strong emphasis on doctor-patient communication. Boy, was I humbled.... by the end of the first weekend of coach training!

I learned to listen in ways I had never imagined before, and I learned to place the client's agenda (substitute "patient's agenda") foremost in our relationship. If the client wasn't willing to follow suggestions, no matter how eager he or she appeared to please me, it wasn't going to happen!! Even if the suggestions came from the client! Remember, patients are as eager to please, or as stubborn, or as forgetful as you or I. 

This article also makes me wonder how an astute physician, who is aware that he or she is a skilled verbal communicator, can use this information to set him- or herself apart from the crowd. If you realize that physicians check in with their patients for their understanding only about 1.5 percent of the time, imagine the power of doing that even just 20 percent of the time.

Even a harried physician can develop a habit of asking: "Now, Mrs. S, I'd like to make sure that what I said was nice and clear to you. Can you tell me what you understood from our conversation today?"

Pretty simple marketing tactic, wouldn't you say?

What would that do to your practice's bottom line in a Pay-for-Performance environment?