Re: Solo advice

[Guest guest]

also Chad the original article that G wrote said something like , if you share space , rent a chaperone staff member occasionally.(ask someone else who works there if occasionally you could borrow them, and then pay them.)

Good luck with the new practiceJean

Chadjust as starters, here's a link to the wiki section about chaperones from both male and female perspectivehttps://idealhealth.wikispaces.com/Chaperone

and if you look in the group archives, I think Tim Malia? posted a while back about this ( hope that's right Tim ) and I remember thinking what he said sounded rightMy sense of it from listening to the males in the group is that it is very doable.

Personally, no one has ever asked me for a chaperone, but sometimes they bring their partners for sensitive exams.Also the lab that I share space with, most of the phlebotomists are trained as medical assistants and they've volunteered, should I ever need anyone to some over (doesn't work after hours obviously).

LynnTo: From: chadcostley@...

Date: Tue, 25 Nov 2008 10:40:32 +0000Subject: Solo advice

I need some advice. I am opening my cash-only practice in January and given the economy

am realistic about how fast it will grow. I am absolutely convinced it can be successful, but

the ramp up will surely be slower than it would have been a couple of years ago. Therefore,

I'm getting very serious about controlling overhead so I can make it through the lean months,

and perhaps years, it will take to get the practice where it needs to be. I've not been overly

excited about practicing with no support, but the economic realities may force that decision.

So the question - how can a male provider realistically practice solo-solo without a

chaperone available for gyn exams, or focused cardiac exams for that matter? How are

others solving this?

Thanks -

Chad Costley

chadcostley@...

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[Guest guest]

Most of the patients in my practice followed me from my old office. So there was

inherent trust already. But, after almost three years, I also have many new

patients.First, it's good issue to consider. That in and of itself

suggests respect for the issue of privacy and patient comfort. I work with the idea

that each patient may have been exploited at some time in his/her life even if

they've never told me.Second, I actually don't think the cardiac exam is

a significant problem as the stethoscope is often placed down the shirt and my hand

doesn't directly tough skin but holds stethoscope through the shirt. Even when my

hand is directly holding the stethoscope, I usually keep the hand off the patient's

skin (male or female). Also, I try to ask the patient to hold open the shirt

(front or back) which I once heard at a lecture can be helpful for patients who have

been raped -- consider someone of authority (doctor) grabbing a shirt to get a hand

onto the body rather than patient holding shirt after a polite pause by the doctor

and gentle request to hold shirt -- life is all about self-empowerment.Third, for private female exams (pap, breast check, rectal exam) I have set a

policy that someone else must be in the exam room, and I offer all women two

options. They can bring someone they want to be there, or they can ask me and we

schedule the appt so my wife (home full-time) can be the chaperone. Then I leave it

to the patient to choose. The final option is to see a different doctor of course --

they have joined the practice aware of how I work things.Now, legally,

this is not the best choice as a spouse is not a good witness in court (5th

amendment works for spouses as well as the accused) which my brother-the-lawyer

pointed out to me. But I look it not as a legal issue but as a professional issue --

I think my responsibility is to set a safe environment and offer patients options

they are comfortable with .Other docs do other things, so watch for

other ideas.It has not been a problem, and, surprisingly, I actually

believe a higher percentage of my female patients have their gyn care with me now

than they did in my old office (but I can't be sure about that, it's just an

estimate).Tim > On

Tue, November 25, 2008 5:40 am EST, chadcostley wrote:> > > I need some advice. I am opening my cash-only

practice in January and given the> economy> am realistic about how

fast it will grow. I am absolutely convinced it can be> successful, but> the ramp up will surely be slower than it would have been a couple of years

ago. > Therefore,> I'm getting very serious about controlling

overhead so I can make it through the> lean months,> and perhaps

years, it will take to get the practice where it needs to be. I've not>

been overly> excited about practicing with no support, but the economic

realities may force that> decision.> So the question - how can a

male provider realistically practice solo-solo without a> chaperone

available for gyn exams, or focused cardiac exams for that matter? How>

are> others solving this?> > Thanks -> > Chad Costley> chadcostley@...> > >

------------------------------------> >

[Guest guest]

Then there are the female physicians alone with the men for cardiac and genital exams. I have never had a chaperone in with me. Some may say that is stupid/dangerous/naive. I have done procedures on men in "sensitive" areas, and my female MA has assisted on some, but I have never had a problem. Rarely, a female S.O. of the patient is present. I judge the guy, how well do we know each other, what am I doing and take it from there. A new patient with "HATE-KILL" tatoos (oh, no, here we go again with the tatoos!), you better believe my husband (5th ammendment and all) would be in the room. I may even forego the exam and send to a male urologist, don't know, never came up against the situation.

To: chadcostley@...; practiceimprovement1 Sent: Tuesday, November 25, 2008 9:04:59 AMSubject: Re: Solo advice

Most of the patients in my practice followed me from my old office. So there was inherent trust already. But, after almost three years, I also have many new patients.First, it's good issue to consider. That in and of itself suggests respect for the issue of privacy and patient comfort. I work with the idea that each patient may have been exploited at some time in his/her life even if they've never told me.Second, I actually don't think the cardiac exam is a significant problem as the stethoscope is often placed down the shirt and my hand doesn't directly tough skin but holds stethoscope through the shirt. Even when my hand is directly holding the stethoscope, I usually keep the hand off the patient's skin (male or female). Also, I try to ask the patient to hold open the shirt (front or back) which I once heard at a lecture can be helpful for patients who have been raped -- consider someone of authority (doctor) grabbing a shirt

to get a hand onto the body rather than patient holding shirt after a polite pause by the doctor and gentle request to hold shirt -- life is all about self-empowerment.Third, for private female exams (pap, breast check, rectal exam) I have set a policy that someone else must be in the exam room, and I offer all women two options. They can bring someone they want to be there, or they can ask me and we schedule the appt so my wife (home full-time) can be the chaperone. Then I leave it to the patient to choose. The final option is to see a different doctor of course -- they have joined the practice aware of how I work things.Now, legally, this is not the best choice as a spouse is not a good witness in court (5th amendment works for spouses as well as the accused) which my brother-the- lawyer pointed out to me. But I look it not as a legal issue but as a professional issue -- I think my responsibility is to set a safe environment and offer

patients options they are comfortable with .Other docs do other things, so watch for other ideas.It has not been a problem, and, surprisingly, I actually believe a higher percentage of my female patients have their gyn care with me now than they did in my old office (but I can't be sure about that, it's just an estimate).Tim> > > > I need some advice. I am opening my cash-only practice in January and given the> economy> am realistic about how fast it will grow. I am absolutely convinced it can be> successful, but> the ramp up will surely be slower than it would have been a couple of years ago. > Therefore,> I'm getting very serious about controlling overhead so I can make it through the> lean months,> and perhaps years, it will take to get the practice where it needs to be. I've

not> been overly> excited about practicing with no support, but the economic realities may force that> decision.> So the question - how can a male provider realistically practice solo-solo without a> chaperone available for gyn exams, or focused cardiac exams for that matter? How> are> others solving this?> > Thanks -> > Chad Costley> chadcostley@ mac.com> > > ------------ --------- --------- ------> >

[Guest guest]

That doesn't work for me. The whole concept is comprehensive care, and creating

a list of

things I " don't do " both hurts the model and makes practice less interesting.

I'm actively

seeking to add to the list of things I do so that patients can stop getting

bounced around

our healthcare system. Also, I believe the trend toward OB/Gyns being the

primary source

of routine gyn exams is dangerous for women. The reason is that a lot of women

consider

getting their annual gyn exam and mammogram as sufficient preventive healthcare.

When

Ob-Gyns, surgeons by training, pretend to be equipped to provide " preventive

healthcare "

for women things get missed. Colon cancer screening, HTN control targets, etc.

all have

poor performance measures in women in part because a lot of women consider

" their

doctor " to be the OB-Gyn who does their annual gyn exam. There's a reason that

the

system is better at screening for cervical cancer in women with very low risk

for the

disease than it is at preventing heart disease - the number one killer of women.

If by

becoming " micro-practices " we limit our range of services, I think we risk

missing the

point.

>

> Don't do gyn exams.  When my sister stopped doing them, it really saved us

alot of

headaches.  But I do understand that as cash only, you may want to offer

it--maybe as

part of the annual?  We are trying to slowly convert to cash only and are

re-thinking the

issue.

>

>

>

>

> ________________________________

>

> To:

> Sent: Tuesday, November 25, 2008 5:40:32 AM

> Subject: Solo advice

>

> I need some advice.  I am opening my cash-only practice in January and given

the

economy

> am realistic about how fast it will grow.  I am absolutely convinced it can be

successful,

but

> the ramp up will surely be slower than it would have been a couple of years

ago. 

Therefore,

> I'm getting very serious about controlling overhead so I can make it through

the lean

months,

> and perhaps years, it will take to get the practice where it needs to be. 

I've not been

overly

> excited about practicing with no support, but the economic realities may force

that

decision. 

> So the question - how can a male provider realistically practice solo-solo

without a

> chaperone available for gyn exams, or focused cardiac exams for that matter? 

How are

> others solving this?

>

> Thanks -

>

> Chad Costley

> chadcostley@...

>

>

> ------------------------------------

>

>

[Guest guest]

That doesn't work for me. The whole concept is comprehensive care, and creating

a list of

things I " don't do " both hurts the model and makes practice less interesting.

I'm actively

seeking to add to the list of things I do so that patients can stop getting

bounced around

our healthcare system. Also, I believe the trend toward OB/Gyns being the

primary source

of routine gyn exams is dangerous for women. The reason is that a lot of women

consider

getting their annual gyn exam and mammogram as sufficient preventive healthcare.

When

Ob-Gyns, surgeons by training, pretend to be equipped to provide " preventive

healthcare "

for women things get missed. Colon cancer screening, HTN control targets, etc.

all have

poor performance measures in women in part because a lot of women consider

" their

doctor " to be the OB-Gyn who does their annual gyn exam. There's a reason that

the

system is better at screening for cervical cancer in women with very low risk

for the

disease than it is at preventing heart disease - the number one killer of women.

If by

becoming " micro-practices " we limit our range of services, I think we risk

missing the

point.

>

> Don't do gyn exams.  When my sister stopped doing them, it really saved us

alot of

headaches.  But I do understand that as cash only, you may want to offer

it--maybe as

part of the annual?  We are trying to slowly convert to cash only and are

re-thinking the

issue.

>

>

>

>

> ________________________________

>

> To:

> Sent: Tuesday, November 25, 2008 5:40:32 AM

> Subject: Solo advice

>

> I need some advice.  I am opening my cash-only practice in January and given

the

economy

> am realistic about how fast it will grow.  I am absolutely convinced it can be

successful,

but

> the ramp up will surely be slower than it would have been a couple of years

ago. 

Therefore,

> I'm getting very serious about controlling overhead so I can make it through

the lean

months,

> and perhaps years, it will take to get the practice where it needs to be. 

I've not been

overly

> excited about practicing with no support, but the economic realities may force

that

decision. 

> So the question - how can a male provider realistically practice solo-solo

without a

> chaperone available for gyn exams, or focused cardiac exams for that matter? 

How are

> others solving this?

>

> Thanks -

>

> Chad Costley

> chadcostley@...

>

>

> ------------------------------------

>

>

[Guest guest]

That doesn't work for me. The whole concept is comprehensive care, and creating

a list of

things I " don't do " both hurts the model and makes practice less interesting.

I'm actively

seeking to add to the list of things I do so that patients can stop getting

bounced around

our healthcare system. Also, I believe the trend toward OB/Gyns being the

primary source

of routine gyn exams is dangerous for women. The reason is that a lot of women

consider

getting their annual gyn exam and mammogram as sufficient preventive healthcare.

When

Ob-Gyns, surgeons by training, pretend to be equipped to provide " preventive

healthcare "

for women things get missed. Colon cancer screening, HTN control targets, etc.

all have

poor performance measures in women in part because a lot of women consider

" their

doctor " to be the OB-Gyn who does their annual gyn exam. There's a reason that

the

system is better at screening for cervical cancer in women with very low risk

for the

disease than it is at preventing heart disease - the number one killer of women.

If by

becoming " micro-practices " we limit our range of services, I think we risk

missing the

point.

>

> Don't do gyn exams.  When my sister stopped doing them, it really saved us

alot of

headaches.  But I do understand that as cash only, you may want to offer

it--maybe as

part of the annual?  We are trying to slowly convert to cash only and are

re-thinking the

issue.

>

>

>

>

> ________________________________

>

> To:

> Sent: Tuesday, November 25, 2008 5:40:32 AM

> Subject: Solo advice

>

> I need some advice.  I am opening my cash-only practice in January and given

the

economy

> am realistic about how fast it will grow.  I am absolutely convinced it can be

successful,

but

> the ramp up will surely be slower than it would have been a couple of years

ago. 

Therefore,

> I'm getting very serious about controlling overhead so I can make it through

the lean

months,

> and perhaps years, it will take to get the practice where it needs to be. 

I've not been

overly

> excited about practicing with no support, but the economic realities may force

that

decision. 

> So the question - how can a male provider realistically practice solo-solo

without a

> chaperone available for gyn exams, or focused cardiac exams for that matter? 

How are

> others solving this?

>

> Thanks -

>

> Chad Costley

> chadcostley@...

>

>

> ------------------------------------

>

>

[Guest guest]

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@... > > > ------------------------------------> >

[Guest guest]

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@... > > > ------------------------------------> >

[Guest guest]

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@... > > > ------------------------------------> >

[Guest guest]

So I will have patients come in once for the physical and 6 months later for the Pap. Hopefully that will get me paid.

Subject: Re: Re: Solo adviceTo: Date: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling

overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

So I will have patients come in once for the physical and 6 months later for the Pap. Hopefully that will get me paid.

Subject: Re: Re: Solo adviceTo: Date: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling

overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

So I will have patients come in once for the physical and 6 months later for the Pap. Hopefully that will get me paid.

Subject: Re: Re: Solo adviceTo: Date: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling

overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

Myria,

Been there and done that too. The only thing it got me were complaints from patients that I was gouging them, costing them time from work and more copays. And, as an Internist, it is very, very rare for me to have a patient who only needs a Pap. Most need to return in 6 months anyway for their lipid or bp checks. Tack that time onto the GYN and you'll not get paid for those either.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

Myria,

Been there and done that too. The only thing it got me were complaints from patients that I was gouging them, costing them time from work and more copays. And, as an Internist, it is very, very rare for me to have a patient who only needs a Pap. Most need to return in 6 months anyway for their lipid or bp checks. Tack that time onto the GYN and you'll not get paid for those either.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

Myria,

Been there and done that too. The only thing it got me were complaints from patients that I was gouging them, costing them time from work and more copays. And, as an Internist, it is very, very rare for me to have a patient who only needs a Pap. Most need to return in 6 months anyway for their lipid or bp checks. Tack that time onto the GYN and you'll not get paid for those either.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

Yikes! But they will go pay the GYN? That sounds backwards doesn't it? Thanks for the heads up. Since I'm rural I think folks will still come here rather than traveling and waiting and waiting. (I'm haing the greatest time NOT using my waiting room! Patients complain --- it's so comfortble and I didn't even get to sit down!) Thanks again.

From: leslie <lstrouseinsightbb (DOT) com>Subject: Re: [Practiceimprovemen t1] Re: Solo adviceTo: Practiceimprovement 1yahoogroups (DOT) comDate: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling

overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

Yikes! But they will go pay the GYN? That sounds backwards doesn't it? Thanks for the heads up. Since I'm rural I think folks will still come here rather than traveling and waiting and waiting. (I'm haing the greatest time NOT using my waiting room! Patients complain --- it's so comfortble and I didn't even get to sit down!) Thanks again.

From: leslie <lstrouseinsightbb (DOT) com>Subject: Re: [Practiceimprovemen t1] Re: Solo adviceTo: Practiceimprovement 1yahoogroups (DOT) comDate: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling

overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >

[Guest guest]

But most plans cover a GYN with no copay...I never collect a copay for GYN and patients are rarely billed...

To: Sent: Monday, December 8, 2008 12:12:06 PMSubject: Re: Re: Solo advice

We had a nice little "speech" we'd give the patient. Something along the lines of "This is done as a service for patients who prefer to see the same doctor for everything if possible. But we can't do it at the same visit as a physical because of the time involved. So it is a separate visit with a separate copay just as if you were going to a gynecologist. " They usually accepted that once we came up with it. At first , though, we got the angry response and charges of gouging "to get that extra copay" just like we get now when we require diabetic or hypertensive or depresses/anxiety patient to come in for a visit to renew an Rx.

From: Myria <myriaemenyyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Friday, December 5, 2008 12:09:12 PMSubject: Re: [Practiceimprovemen t1] Re: Solo advice

Yikes! But they will go pay the GYN? That sounds backwards doesn't it? Thanks for the heads up. Since I'm rural I think folks will still come here rather than traveling and waiting and waiting. (I'm haing the greatest time NOT using my waiting room! Patients complain --- it's so comfortble and I didn't even get to sit down!) Thanks again.

From: leslie <lstrouseinsightbb (DOT) com>Subject: Re: [Practiceimprovemen t1] Re: Solo adviceTo: Practiceimprovement 1yahoogroups (DOT) comDate: Thursday, December 4, 2008, 5:52 PM

Wayne,

I agree with you 100%. I am going to stop doing GYN exams as well because I am tired of not being paid for them. Most of the big insurers in my area bundle the GYN exam with the rest of the annual exam fee. I have begged, I have pleaded and I have cursed but nothing changes. I do not do Paps on men and I get the same reimbursement for their annual exams as I do for the women on whom I do Paps and I do not have to collect specimens, clean and sterilize equipment, review test results and call men about their results. So, from now on, most of my women will just have to take another day off work and go to a gynecologist and pay another copay to get their Paps done. I am done.

[Practiceimprovemen t1] Solo advice> > I need some advice. I am opening my cash-only practice in January and given the economy > am realistic about how fast it will grow. I am absolutely convinced it can be successful, but > the ramp up

will surely be slower than it would have been a couple of years ago. Therefore, > I'm getting very serious about controlling overhead so I can make it through the lean months, > and perhaps years, it will take to get the practice where it needs to be. I've not been overly > excited about practicing with no support, but the economic realities may force that decision. > So the question - how can a male provider realistically practice solo-solo without a > chaperone available for gyn exams, or focused cardiac exams for that matter? How are > others solving this? > > Thanks -> > Chad Costley> chadcostley@ ... > > > ------------ --------- --------- ------> >