RE: tightening up the front and back end

August 22, 2008

All I can say is “yeah, I hear you.” That’s

why I can’t work it alone. Too many phone calls and other

stuff. And I actually had a Senior Rep at Horizon ask me why I would want

to close my panel and stop accepting new patients. Like, there is too

much work already? Does that make sense?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of drsof99

Sent: Friday, August 22, 2008 9:47 AM

To:

Subject: tightening up the front and back end

I am being bombarded by calls now. My MA and I

are both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement " attitude

of

some of the pts is driving me crazy!

August 22, 2008

some thoughts that may or may not apply have you closed your practices? If your supply of visits and work time is too great for the number of patietns you serve, then the work will never be do able If you see only HIV patietns you may need to have a smaller panel than if you see only well children....

what are all these calls about? Learning the nature shold allow you to forestall these-- refills? well then it is visit time Lab results?patietns should be educated what/how to expect results and docs should have a system to get them to patietns Email is a gift from the gods SOO much better than snail mail

appointmetns- do it online I do not, but I hear this goes over very wellprior auths?I gotta tell you I do not have insurances that make me do many of these I will do some Some are known to be needed- do it at the visit Sometimes if it is a med i tell the patietn the name of every say PI and say call up and find out which are OK and then i will do it. I say call up the number on the back of your card ,tell then to fax me a form. if i can do it ,i will .if it asks me al ot of question you may have to come in. Involving patietns never seems to go badly

sepcialist appointments?have the patietn call test s cheduling? fax the order and have the patietn set it up I will not use specialists if they do not let the patietn scheule I educate patietns " tell them to check theri fax machine tell them they have the paperwork "

CAn any of that help?Supporting 2-3 employees means there is very l ittel peanut butter left over for YOU.

All I can say is " yeah, I hear you. " That's

why I can't work it alone. Too many phone calls and other

stuff. And I actually had a Senior Rep at Horizon ask me why I would want

to close my panel and stop accepting new patients. Like, there is too

much work already? Does that make sense?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of drsof99

Sent: Friday, August 22, 2008 9:47 AM

To:

Subject: tightening up the front and back end

I am being bombarded by calls now. My MA and I

are both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement " attitude

of

some of the pts is driving me crazy!

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

August 22, 2008

You are right, there is little peanut butter left. And I don’t

know what the calls are but there are lots, and then they call again, and

again, and again because they just checked with the pharmacy and it wasn’t

done yet even thought they are told it won’t be done yet. Or they forgot

they need something else. Or they need this referral or please get a preauth

on that med you ordered or levsin isn’t available can we give hycocyamine

or I don’t like the new med I want to go back or I got my CT last week

what do you mean you don’t have results.

I would love to see less patients but then there would be no

peanut butter. You can’t reduce your size d/t complexity as you don’t

get paid any better for complex vs. simple. Making appts is the least of the

phone calls. I would love to take insurances that don’t require this

stuff but the worse insurance covers ½ the stat and can’t do without.

Just a bad day, covering another doctor who, apparently each and every one of

her patients is running out of meds today or in some kind of crisis. Paraplegic

with fevers, SOIB and congestion who just doesn’t feel like coming in so

will “ride it out.” Etc. That was 5 phone calls.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Friday, August 22, 2008 3:34 PM

To:

Subject: Re: tightening up the front and back end

some thoughts that may or may

not apply

have you closed your practices?

If your supply of visits and work time is too great for the

number of patietns you serve, then the work will never

be do able If you see only HIV patietns you may need to have a smaller

panel than if you see only well children....

what are all these calls about?

Learning the nature shold allow you to forestall these

-- refills? well then it is visit time

Lab results?

patietns should be educated what/how to expect results and

docs should have a system to get them to patietns Email is a gift from

the gods SOO much better than snail mail

appointmetns- do it online I do not, but I hear this goes

over very well

prior auths?

I gotta tell you I do not have insurances that make me do many of

these I will do some Some are known to be needed- do it at the visit

Sometimes if it is a med i tell the patietn the name of every say

PI and say call up and find out which are OK and then i will do it. I say

call up the number on the back of your card ,tell then to fax me a form. if i

can do it ,i will .if it asks me al ot of question you may have to come

in. Involving patietns never seems to go badly

sepcialist appointments?

have the patietn call

test s cheduling? fax the order and have the patietn

set it up I will not use specialists if they do not let the

patietn scheule I educate patietns " tell them to check theri

fax machine tell them they have the paperwork "

CAn any of that help?

Supporting 2-3 employees means there is very l ittel peanut butter left

over for YOU.

On Fri, Aug 22, 2008 at 1:43 PM, Kathy Saradarian

wrote:

All I

can say is " yeah, I hear you. " That's why I can't work it

alone. Too many phone calls and other stuff. And I actually had a

Senior Rep at Horizon ask me why I would want to close my panel and stop

accepting new patients. Like, there is too much work already? Does

that make sense?

Kathy

Saradarian, MD

Branchville,

NJ

www.qualityfamilypractice.com

Solo

4/03, Practicing since 9/90

Practice

Partner 5/03

Low

staffing

From: [mailto: ]

On Behalf Of drsof99

Sent: Friday, August 22, 2008 9:47 AM

To:

Subject: tightening up the front and back end

I am being bombarded by calls now. My MA and I are

both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement " attitude

of

some of the pts is driving me crazy!

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

August 22, 2008

I'm reminded of what they do with computer suppprt.

You pay for 4 hour response times, 1 hour telephne response, or next

business day email support etc.

Pity you can't ask patients to pick a response plan for medical support.

> You are right, there is little peanut butter left. And I don't know what

> the calls are but there are lots, and then they call again, and again, and

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

August 22, 2008

I agree with Jean’s comments below, but would also address

the issue of “entitlement” attitudes of some patients, and would

simply explain to them that because you are a small practice that is trying to

work on a low-overhead model so that more quality time can be spent with

patients, you are simply not able to meet their expectations, and that they

would be best served by going to a high-volume practice that has the staffing

to do the extra things they expect.

The “20-80” rule usually applies to these

situations, where “20% of the patients result in 80% of the calls,”

and “20% of the insurance companies result in 80% of the lengthy preauth

calls.” Figure out who those 20% patients are and which

of the insurance companies are causing the biggest problems, and take an appropriate

action.

How many active patients do you have? Depending on the

illness burden in your patient population, it might be very hard to have more

than a few hundred elderly patients with multiple chronic diseases, while one

could probably manage up to 1,000 young healthy patients with no chronic

problems with only one staff. I personally have about 700 patients, and would

rapidly get burned out if I took any more. I do have one staff, my “volunteer”

wife, and would need to cut my patient load down to 500 or less if she were not

able to help.

dts

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Friday, August 22, 2008 12:34 PM

To:

Subject: Re: tightening up the front and back end

some thoughts that may or may

not apply

have you closed your practices?

If your supply of visits and work time is too great for the

number of patietns you serve, then the work will never

be do able If you see only HIV patietns you may need to have a smaller

panel than if you see only well children....

what are all these calls about?

Learning the nature shold allow you to forestall these

-- refills? well then it is visit time

Lab results?

patietns should be educated what/how to expect results and

docs should have a system to get them to patietns Email is a gift from

the gods SOO much better than snail mail

appointmetns- do it online I do not, but I hear this goes

over very well

prior auths?

I gotta tell you I do not have insurances that make me do many of

these I will do some Some are known to be needed- do it at the visit

Sometimes if it is a med i tell the patietn the name of every say

PI and say call up and find out which are OK and then i will do it. I say

call up the number on the back of your card ,tell then to fax me a form. if i

can do it ,i will .if it asks me al ot of question you may have to come

in. Involving patietns never seems to go badly

sepcialist appointments?

have the patietn call

test s cheduling? fax the order and have the patietn

set it up I will not use specialists if they do not let the

patietn scheule I educate patietns " tell them to check theri

fax machine tell them they have the paperwork "

CAn any of that help?

Supporting 2-3 employees means there is very l ittel peanut butter left

over for YOU.

On Fri, Aug 22, 2008 at 1:43 PM, Kathy Saradarian

wrote:

All I

can say is " yeah, I hear you. " That's why I can't work it

alone. Too many phone calls and other stuff. And I actually had a

Senior Rep at Horizon ask me why I would want to close my panel and stop

accepting new patients. Like, there is too much work already? Does

that make sense?

Kathy

Saradarian, MD

Branchville,

NJ

www.qualityfamilypractice.com

Solo

4/03, Practicing since 9/90

Practice

Partner 5/03

Low

staffing

From: [mailto: ]

On Behalf Of drsof99

Sent: Friday, August 22, 2008 9:47 AM

To:

Subject: tightening up the front and back end

I am being bombarded by calls now. My MA and I are

both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement " attitude

of

some of the pts is driving me crazy!

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

August 23, 2008

Don't be ruled by the phone! You might want to try one of these online appointment scheduling systems for starters. This will at least cut back on phone calls to schedule appts---and you still get the appointment.

You can also use secure messaging for people to request renewed referrals and lab results. Send them a message and a brief explanation of the lab result. They can come in for followup if they want or need a more detailed explanation (or treatment).

tightening up the front and back end

I am being bombarded by calls now. My MA and I are both on the phone or with patients and I have a answering machine on that picks up while we are busy. I am finding it more difficult to pick up the messages from the machine. Whenever we think we are done, there is another message. I am also finding it more difficult to be able to get to the practice management stuff...following up on claims, sending bills,etc. My nurse is trying her best but she too is being stuck with referrals and pre-auths from insurance companies, along with the faxing of stuff and pt stuff.I am torn. I am busy enough to warrant a PT recpetionist, but am trying to keep my costs down. Quite honstly all this extra work and phone calls is burning me out and I know my nurse is feeling it too. I deperately need help streamlining things-the "entitlement" attitude of some of the pts is driving me

crazy!

August 23, 2008

"Entitlement patients" may need to be set up with once a month visit or even every 2 weeks then wean them to monthly and then every other month.....or keep them on monthly if needed. Many of these patients don't trust doctors and are scared they haven't been heard about their needs. It takes time to build that trust. Office visits is the time to use. I've even built a "contract" with patients to limit phone calls or letters or e-mails or whatever is overwhelming. This in effect helps the patient learn how to prioritize without fear of not having needs met. Once that trust is established the phone calls drop off completely in most of these patients. Make a check off list for the patient: refills check, referral check, explaination about A1C check. They can start a new list for the next monthly visit.

All I can say is "yeah, I hear you." That's why I can't work it alone. Too many phone calls and other stuff. And I actually had a Senior Rep at Horizon ask me why I would want to close my panel and stop accepting new patients. Like, there is too much work already? Does that make sense?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypr actice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of drsof99Sent: Friday, August 22, 2008 9:47 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] tightening up the front and back end

I am being bombarded by calls now. My MA and I are both on the phone or with patients and I have a answering machine on that picks up while we are busy. I am finding it more difficult to pick up the messages from the machine. Whenever we think we are done, there is another message. I am also finding it more difficult to be able to get to the practice management stuff...following up on claims, sending bills,etc. My nurse is trying her best but she too is being stuck with referrals and pre-auths from insurance companies, along with the faxing of stuff and pt stuff.I am torn. I am busy enough to warrant a PT recpetionist, but am trying to keep my costs down. Quite honstly all this extra work and phone calls is burning me out and I know my nurse is feeling it too. I deperately need help streamlining things-the "entitlement" attitude of some of the pts is driving me

crazy!

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

August 23, 2008

I think this general advice is all great. But sometimes

you just have a bad day and that was what we were having yesterday. Each

call was a unique problem and a unique patient. But this time of year

people have sudden “emergencies” like needing a sports physical or

just having the form signed by the school physician who is on vacation and you

are covering them.

Part of the problem was that I was covering another doctor and

everything had to be done yesterday as we were leaving for 1 weeks vacation,

then only coming back for 2 days and gone again. The guy who just

developed Guillan Barre was released from the hospital and needed referrals to

a neurophthalmologist. Another lady was told by the wound care center that

she should have a graft be in the hospital for 1 week and then in rehab and she

wanted to talk it over with me as she trusts me. Thing is she is a 400 lb

agoraphobic and hard to get out of her house and her kids have to bring

her. Trying to get Levmir Flex Pens for diabetic starting insulin.

Denied by insurance so now call in insulin and syringes. Been playing

phone tag for weeks. Fax machine was down so finally got that up and

running Thursday, crush of issues. Pharmacy faxes back the prescriptions

and calls to say he has the Flex Pen and which is it going to be we have to

straighten this out and they didn’t get it for him and now he has

appt for diabetic teaching and doesn’t have his insulin (I don’t

know why they need to have 4 days noticed to get Levemir, that in and of itself

is ridiculous. Order med on Medicaid patient and guess what, it

requires a preauth. Home health aid of quadriplegic patient calls at end

of day on Friday that patient is sick. WE offer to add her to end of day

and she doesn’t feel like leaving the house. Another patient LPN

calls while I am in with last patient that yesterday, when she was driving, her

face suddenly got red, itchy and swollen and her eyes swollen and she has been

taking Advil and thinks it’s an allergic reaction but what should she

do? Meanwhile, patient that I have already referred to GI whom she is

seeing for complications from choledocodudenostomy comes in with severe attack

of pain (walk in, patients backed up 4 deep already) Sent to ER.

Has a dilated duct. I say to call gastro, he won’t admit only

consult. She has no other medical problems for me to treat. That is

bull kaka. Get another call from Caremark for 3 month renewal of BP

med I already called in to local pharmacy 2 weeks ago because he ran out and is

4 months late making an appt. People call for refills I gave them

last month at their OV, or Caremark files them but still sends patient a note

that they are out of refills because they can’t handle getting them

before those last 2 weeks. I have not been able to figure out why this “refilling

at the OV” stuff doesn’t work. Pharmacy always says “we

didn’t get it” but they did. It’s not just one pharmacy

either though some are worse than others.

You just can’t anticipate days like this, you can’t

prepare, you can’t fire every patient who decides to have a bad day on

the same day. You have to deal with it. It’s not people

trying to get appts, mostly it’s people refusing to make appts.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Myria

Sent: Saturday, August 23, 2008 9:06 AM

To:

Subject: RE: tightening up the front and back end

" Entitlement patients " may need to be set up

with once a month visit or even every 2 weeks then wean them to monthly and

then every other month.....or keep them on monthly if needed. Many of

these patients don't trust doctors and are scared they haven't been heard

about their needs. It takes time to build that trust. Office visits is

the time to use. I've even built a " contract " with patients

to limit phone calls or letters or e-mails or whatever is overwhelming.

This in effect helps the patient learn how to prioritize without fear of not

having needs met. Once that trust is established the phone calls drop

off completely in most of these patients. Make a check off list for the

patient: refills check, referral check, explaination about A1C check.

They can start a new list for the next monthly visit.

All

I can say is " yeah, I hear you. " That's why I can't work it

alone. Too many phone calls and other stuff. And I actually had a

Senior Rep at Horizon ask me why I would want to close my panel and stop

accepting new patients. Like, there is too much work already?

Does that make sense?

Kathy

Saradarian, MD

Branchville,

NJ

www.qualityfamilypr

actice.com

Solo

4/03, Practicing since 9/90

Practice

Partner 5/03

Low

staffing

From: Practiceimprovement

1yahoogroups (DOT) com [mailto:Practiceimprovement

1yahoogroups (DOT) com] On Behalf Of drsof99

Sent: Friday, August 22, 2008 9:47 AM

To: Practiceimprovement 1yahoogroups (DOT) com

Subject: [Practiceimprovemen t1] tightening up the front and back end

I am being bombarded by calls now. My MA and I

are both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement " attitude

of

some of the pts is driving me crazy!

--

If you are a patient please allow up to 12 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

August 23, 2008

We're (poorly) paid for visits, not health care, so we're forced by the

payment policies to make patients come in to the office for a visit when

the issue may have easily been addressed by phone or email.

It's not the patients, it's not greedy docs - it is a fatally flawed

system of policies that push volume of care not health care. Keep

hammering this message with your patients and in any public venue to

which you have access.

The foundation of a less expensive and logical health system is effective

primary care. Our system won't fund adequate primary care, choosing

instead to pay for piece-work as if we were making toasters, then

layering on an untenable burden of administrative trivia that diverts us

from patient care as we argue nuances of medicine with denial

clerks.

Don't let the system drive a wedge between you and your patients - of

course people can be unreasonable at times, but the bulk of our burden is

not our patients but the outrageous policies that leave tens of millions

Americans with no health insurance, tens of millions more with out of

pocket charges they can ill afford, added to a Byzantine array of trivial

nuances of coverage that changes with every insurer, every employer, and

every year.

The health care structure of the US is fatally flawed and must be

fundamentally changed. Keep the message simple and positive:

We can beautifully serve our patients if we are given adequate resources

to do so and if we are unshackled from crushing burden of administrative

denials and trivia.

Gordon

At 06:28 AM 8/23/2008, you wrote:

I think this general advice is

all great. But sometimes you just have a bad day and that was what

we were having yesterday. Each call was a unique problem and a

unique patient. But this time of year people have sudden

“emergencies” like needing a sports physical or just having the form

signed by the school physician who is on vacation and you are covering

them.

Part of the problem was that I was covering another doctor and everything

had to be done yesterday as we were leaving for 1 weeks vacation, then

only coming back for 2 days and gone again. The guy who just

developed Guillan Barre was released from the hospital and needed

referrals to a neurophthalmologist. Another lady was told by the

wound care center that she should have a graft be in the hospital for 1

week and then in rehab and she wanted to talk it over with me as she

trusts me. Thing is she is a 400 lb agoraphobic and hard to get out

of her house and her kids have to bring her. Trying to get Levmir

Flex Pens for diabetic starting insulin. Denied by insurance so now

call in insulin and syringes. Been playing phone tag for

weeks. Fax machine was down so finally got that up and running

Thursday, crush of issues. Pharmacy faxes back the prescriptions

and calls to say he has the Flex Pen and which is it going to be we have

to straighten this out and they didn’t get it for him and now he

has appt for diabetic teaching and doesn’t have his insulin (I don’t know

why they need to have 4 days noticed to get Levemir, that in and of

itself is ridiculous. Order med on Medicaid patient and guess

what, it requires a preauth. Home health aid of quadriplegic

patient calls at end of day on Friday that patient is sick. WE

offer to add her to end of day and she doesn’t feel like leaving the

house. Another patient LPN calls while I am in with last patient

that yesterday, when she was driving, her face suddenly got red, itchy

and swollen and her eyes swollen and she has been taking Advil and thinks

it’s an allergic reaction but what should she do? Meanwhile,

patient that I have already referred to GI whom she is seeing for

complications from choledocodudenostomy comes in with severe attack of

pain (walk in, patients backed up 4 deep already) Sent to ER.

Has a dilated duct. I say to call gastro, he won’t admit only

consult. She has no other medical problems for me to treat.

That is bull kaka. Get another call from Caremark for 3 month

renewal of BP med I already called in to local pharmacy 2 weeks ago

because he ran out and is 4 months late making an appt.

People call for refills I gave them last month at their OV, or Caremark

files them but still sends patient a note that they are out of refills

because they can’t handle getting them before those last 2 weeks. I

have not been able to figure out why this “refilling at the OV” stuff

doesn’t work. Pharmacy always says “we didn’t get it” but they

did. It’s not just one pharmacy either though some are worse than

others.

You just can’t anticipate days like this, you can’t prepare, you can’t

fire every patient who decides to have a bad day on the same day.

You have to deal with it. It’s not people trying to get appts,

mostly it’s people refusing to make appts.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[

mailto: ] On Behalf Of

Myria

Sent: Saturday, August 23, 2008 9:06 AM

To:

Subject: RE: tightening up the front and

back end

" Entitlement patients " may need to be set up with once a month

visit or even every 2 weeks then wean them to monthly and then every

other month.....or keep them on monthly if needed. Many of these

patients don't trust doctors and are scared they haven't been heard about

their needs. It takes time to build that trust. Office visits is

the time to use. I've even built a " contract " with

patients to limit phone calls or letters or e-mails or whatever is

overwhelming. This in effect helps the patient learn how to

prioritize without fear of not having needs met. Once that trust is

established the phone calls drop off completely in most of these

patients. Make a check off list for the patient: refills check, referral

check, explaination about A1C check. They can start a new list for

the next monthly visit.

All I can say is " yeah, I hear you. " That's why I can't

work it alone. Too many phone calls and other stuff. And I

actually had a Senior Rep at Horizon ask me why I would want to close my

panel and stop accepting new patients. Like, there is too much work

already? Does that make sense?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypr

actice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

Practiceimprovement

1yahoogroups (DOT) com

[

mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of

drsof99

Sent: Friday, August 22, 2008 9:47 AM

To:

Practiceimprovement

1yahoogroups (DOT) com

Subject: [Practiceimprovemen t1] tightening up the front and back

end

I am being bombarded by calls now. My MA and I are both on the phone or

with patients and I have a answering machine on that picks up while we

are busy. I am finding it more difficult to pick up the messages from

the machine. Whenever we think we are done, there is another message.

I am also finding it more difficult to be able to get to the practice

management stuff...following up on claims, sending bills,etc. My nurse

is trying her best but she too is being stuck with referrals and

pre-

auths from insurance companies, along with the faxing of stuff and pt

stuff.

I am torn. I am busy enough to warrant a PT recpetionist, but am trying

to keep my costs down. Quite honstly all this extra work and phone

calls is burning me out and I know my nurse is feeling it too. I

deperately need help streamlining things-the " entitlement "

attitude of

some of the pts is driving me crazy!

--

If you are a patient please allow up to 12 hours for a reply by

email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

August 23, 2008

Kathy. Ouch. i undrstand- i have days like that of course .but not the energy to type it all.I thought though that caca was spelled with a c ? " bull kaka "

I think this general advice is all great. But sometimes

you just have a bad day and that was what we were having yesterday. Each

call was a unique problem and a unique patient. But this time of year

people have sudden "emergencies" like needing a sports physical or