getting paid for paps Re: Re: Solo advice

[Guest guest]

My addition to the rant...Exactly right. That's why cash-only practices with a

blended

membership and simple fee per visit model make sense. My approach is $80 per

month

covers virtual visits, 24 hour direct access etc. If you do need to be seen - a

simple fee

schedule - $40, $80 or $120 (complete physical including gyn if necessary) based

upon

time and complexity. Simple to understand, disincentive for overuse but

appropriate

reimbursement to the doc for things that in an insurance environment wouldn't be

billable, no craziness. If someone needs an EKG - fine - we do it and we've

already been

compensated in the retainer or the visit charge. If someone needs a urinalysis

- no

stupidity about figuring out whether it's their diabetes ICD-9 code or their HTN

ICD-9

code that needs to be linked to the test in order to get reimbursed. And back

to the

original subject of this thread, if a woman needs a gyn exam - you do it because

it's the

right thing to do, without worrying about whether an insurance company is

willing to carve

it out of what would otherwise be defined as a complete physical under some

crazy logic I

don't care to try to understand. I remember when I was on faculty at Henry Ford

Hospital

in Detroit attending a Grand Rounds primarily focused on educating medical

students and

residents in which the entire talk was about how to be a good coder. I was

disgusted. I

couldn't believe we had lowered our educational mission to that point.

Now the caveat. I recognize it's easy to preach about the virtue of cash-only,

no-

insurance practices when you're starting a practice in a city of 6 million

people and you

only need to convince a few hundred to make it work. Most doctors don't

practice in areas

like that, so I feel for those of you who have to struggle for your patients

within the realm

that almost drove me away from clinical practice.

But ...the answer to your question is " very stupid. "

Chad

> >

> > 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.

> >

> >

>

> >

> >

> >

> ____________ _________ _________ __

> >

> From: chadcostley

> ...>

> > To: Practiceimprovement <mailto: >

> 1yahoogroups (DOT) com

> >

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

> > Subject:

> [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@ ...

> >

> >

> >

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

> >

> > Yahoo!

> Groups Links

> >

> >

> >

> > http://docs. <http://docs.yahoo.com/info/terms/> yahoo.com/

> info/terms/

> >

>

>

>

>

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

>

> Yahoo!

> Groups Links

>

> To visit your group on the web, go to:

>

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> yahoo.com/ group/Practiceim provement1/

>

>

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>

>

[Guest guest]

I think that the ICD9 system sucks, and offers no real

benefit. I can track any diseases I want to track with my EMR, and do

not use ICD9 for this.

ICD10 is much worse, but at least we have a temporary reprieve from

that for a few years.

dts

From:

[mailto: ] On Behalf Of Carla Gibson

Sent: Wednesday, December 10, 2008 9:13 PM

To:

Subject: Re: getting paid for paps Re: Re: Solo

advice

I wholeheartedly agree but in considering how to move the

system forward through change, one consideration for the " system "

is that without coding, there is no data on disease statistics, morbidity

etc... would you be willing to continue the current icd-9 coding system

in EMRs for reporting purposes only? Perhaps mandatory reporting to some

entity on a monthly basis? Maybe I'm off base, but as we re-design, I

think we have to consider the full impact of change and how to offset some of

the unintended losses.

Carla Gibson

From: chadcostley

Subject: getting paid for paps Re: Re: Solo advice

To:

Date: Wednesday, December 10, 2008, 4:37 PM

My addition to the

rant...Exactly right. That's why cash-only practices with a blended

membership and simple fee per visit model make sense. My approach is $80 per

month

covers virtual visits, 24 hour direct access etc. If you do need to be seen -

a simple fee

schedule - $40, $80 or $120 (complete physical including gyn if necessary)

based upon

time and complexity. Simple to understand, disincentive for overuse but

appropriate

reimbursement to the doc for things that in an insurance environment wouldn't

be

billable, no craziness. If someone needs an EKG - fine - we do it and we've

already been

compensated in the retainer or the visit charge. If someone needs a

urinalysis - no

stupidity about figuring out whether it's their diabetes ICD-9 code or their

HTN ICD-9

code that needs to be linked to the test in order to get reimbursed. And back

to the

original subject of this thread, if a woman needs a gyn exam - you do it

because it's the

right thing to do, without worrying about whether an insurance company is

willing to carve

it out of what would otherwise be defined as a complete physical under some

crazy logic I

don't care to try to understand. I remember when I was on faculty at Henry

Ford Hospital

in Detroit attending a Grand Rounds primarily focused on educating medical

students and

residents in which the entire talk was about how to be a good coder. I was

disgusted. I

couldn't believe we had lowered our educational mission to that point.

Now the caveat. I recognize it's easy to preach about the virtue of

cash-only, no-

insurance practices when you're starting a practice in a city of 6 million

people and you

only need to convince a few hundred to make it work. Most doctors don't

practice in areas

like that, so I feel for those of you who have to struggle for your patients

within the realm

that almost drove me away from clinical practice.

But ...the answer to your question is " very stupid. "

Chad

> >

> > 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.

> >

> >

>

> >

> >

> >

> ____________ _________ _________ __

> >

> From: chadcostley

> ...>

> > To: Practiceimprovement <mailto:Practiceimprovement

1yahoogroups (DOT) com>

> 1yahoogroups (DOT) com

> >

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

> > Subject:

> [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@ ...

> >

> >

> >

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

> >

> > Yahoo!

> Groups Links

> >

> >

> >

> > http://docs. <http://docs.

yahoo.com/ info/terms/> yahoo.com/

> info/terms/

> >

>

>

>

>

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

>

> Yahoo!

> Groups Links

>

> To visit your group on the web, go to:

>

> http://groups. <http://groups.

yahoo.com/ group/Practiceim provement1/>

> yahoo.com/ group/Practiceim provement1/

>

>

> Your email settings:

> Individual Email |

> Traditional

>

> To change settings online go to:

>

> http://groups. yahoo.com/

group/Practiceim provement1/ join

> <http://groups. yahoo.com/ group/Practiceim provement1/ join>

>

> (Yahoo! ID required)

>

> To change settings via

> email:

> mailto:Practiceimpr ovement

> <mailto:Practiceimprovement 1-digest@ yahoogroups. com>

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>

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>

>

>