After a decade of treating children in rural Campbell County, Shahid Hasnain, MD, expanded into the Farragut area earlier this year. And while his patients there may come from a different social dynamic than those he sees elsewhere, he says that there are lessons that he, and insurance providers, can learn from both settings.
The offices of Pediatric Professionals Jacksboro and Pediatric Professionals Farragut both feature bright walls for fretful children waiting to see the physician, but the similarities often end at the waiting room. In Jacksboro, Hasnain and his staff see children whose diet often leaves much to be desired, and who get very little in the way of basic medical care due to a lack of good insurance. In Farragut, the population is wealthier, so the patients tend to have a higher starting point in terms of their day-to-day health regimen.
That said, Hasnain says he hopes to showcase the differences between the two in educating TennCare and other insurance providers about the need to reexamine how, and when, they reimburse for certain types of procedures. He also hopes to use that information as a starting point to bring more varied services into the state's less populated, and usually socially underserved, regions.
"Campbell County is a rural, underdeveloped area, and so there's not a great infrastructure there, medically speaking," Hasnain said. "We handle a big portion of the county's children and don't see much support from outside the clinic for those we are taking care of. We often get children who have very complicated cases. That's a lot of extra paperwork for which we get zero reimbursement, and it's why a lot of doctors are not taking TennCare."
Continued Hasnain, "Recently, a patient who is physically and mentally challenged joined our practice after his primary care doctor refused to continue to treat him. The father told me that the previous doctor clearly stated that he cannot afford to take care of the stack of paper work from the Home Health. This particular patient happens to be on more than a dozen medicines. Basically, TennCare has unreal expectation for clinics and it is a nightmare making the two ends meet."
When he opened the Jacksboro office in 1998, it was the latest move in a career that had focused on pediatric medicine early on. Hasnain did his residency at the University of Tennessee Medical Center in Knoxville, at which time he was chosen to be chief resident. He came to UT after receiving a full scholarship by USAID to do his master's degree in public health (MPH) from the University of Alabama at Birmingham, which was followed by an internship in New York. The Campbell County practice came about at the behest of his studies chairman in Knoxville, who wanted an affiliate clinic there and asked Hasnain to run it, he said.
"Operating the clinic has given me lots of confidence, and the fact that many patients from the Farragut area actually came to Campbell County to see us was really the positive reinforcement we needed when we were looking at a second site," he said. "That really was the encouragement we needed."
Hasnain shuttles between the two sites, and since opening the Farragut location, he has added a second nurse practitioner as well as other support staff. The dual operation means lots of driving, but a passion for children and their welfare makes the constant commute worthwhile.
"In simple words, pediatrics is my life and my passion," Hasnain said. "I am so glad that I chose this profession, this specialty. It has changed a lot as the economics of the medical industry and the health industry has changed, but it's still something that drives me to do well every day."
Like physicians everywhere, Hasnain bemoans the insurance industry's perpetual changes in coding, and the extra time it takes to double- and triple-check submissions to avoid denials. That, and dealing with various private- and public-health bureaucracies, aren't things that were taught in medical school, but have had to be learned in order to have any success at all, he said.
"We are mixing our clinical practices with this business aspect, this coding and billing, and I don't know how good we sometimes are at these things," he said. "But its part of our job now and it's something we have to do even if it's not a very comfortable situation."
That said, he is emphatic about continuing to be involved with TennCare and its enrollees.
"If everybody refuses TennCare children, who will accept them?" he asked. "Every doctor has a kind heart; it's why we're in this profession. What I have seen over the last ten years is the need for some kind of structure to be built, so that all of these children can not only have a place to go, but to also get the social situation they are in looked at as well. Campbell County doesn't have many social workers, so our patients don't get the help they need. It would be wonderful if some of these state officials could come out and do rotations in the rural clinics, to see how the industry works in these situations."
That's why he hopes to get parents talking to reach others, and pushing their local officials to add to existing programs, and revamp outreach efforts to benefit the region's youngest residents.
"It is my personal feeling that people designing the healthcare structure should enrich themselves with real experience and inside stories by spending some time in these clinics," said Hasnain. "They need to get firsthand knowledge and information as to what goes on a typical day and how this noble profession gets bruised from time to time."
Added Hasnain, "It is about time that practicing pediatrics once again should become rewarding—spiritually, emotionally and financially."