getting paid for paps Re: Re: Solo advice

[Guest guest]

the S code pays well for BCBS many commercial carriers

> >

> > 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 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. yahoo.com/ info/terms/

> >

>

>

>

>

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

>

> Yahoo!

> Groups Links

>

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

>

> http://groups. 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

>

> (Yahoo! ID required)

>

> To change settings via

> email:

> mailto:Practiceimprovement 1-digest@ yahoogroups. com

>

> mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com

>

>

>

[Guest guest]

In discussing the continued use of traditional codes if we were to go to patient as payer for primary care services, what I was wondering about is how the general "public health" data would be available if we did not have some central reporting system such as how many individual diabetics we see, how many diabetic visits per year, meds being used for diabetics etc.. where do those statistics come from now? Insurance companies? Beyond HYH how do we measure public health outcomes if our data sources no longer exist? I am not well educated on this topic- thus I'm asking. And in any healthcare re-design, some of these "small points" could become stumbling blocks.

Carla Gibson FNP

From: chadcostley <chadcostley@ mac.com>Subject: getting paid for paps Re: [Practiceimprovemen t1] Re: Solo adviceTo: Practiceimprovement 1yahoogroups (DOT) comDate: 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> 1-digest@> yahoogroups. com > > mailto:Practiceimpr ovement> <mailto:Practiceimprovement 1-fullfeatured@ yahoogroups. com>> 1-fullfeatured@ yahoogroups.

com> > >