Re: coping with being all call 24/

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I’ve quit fighting it or getting mad.  Just have too many other things to get mad about and fight about.  I figure it’s just not fixable at this time.  Maybe when e-prescribing becomes full-proof. …. I can dream can’t I? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Walter V. KowtoniukSent: Sunday, January 22, 2012 4:02 PMTo: Subject: Re: coping with being all call 24/ I would concur with that 1/3. I would guess 1/3 of my prescription refills are redo’s before the original intended refills expire. Like lost socks in the dryer. What that means is that the “refill macro’s†are not predictable to be useful. At least not with my practice population. But, back to the issue, particularly with respect to these old people, how do you handle them so that the burden is not the physicians? Some are hopeless. If a 92 year old needs her amlodipine refilled on a snowy day two weeks after her last visit, it’s hopeless to do anything other than just do it. But, there has to be a non-illusive solution for the 76 yo still driving a cadillac but cheap on paying copays. WK From: Kathy Saradarian Sent: Sunday, January 22, 2012 3:54 PMTo: Subject: RE: coping with being all call 24/ Ditto.Or I refill at the OV and pharmacy puts it away because they didn’t come pick them up (as not due yet) and I have to redo it anyway. I think about 1/3 of my refills are redos.Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffingFrom: [mailto: ] On Behalf Of Walter V. KowtoniukSent: Sunday, January 22, 2012 3:29 PMTo: Subject: Re: coping with being all call 24/ I keep an electronic copy of every prescription I write. I refer to those copies all the time. You wouldn’t believe how often an old person says they need a refill when the electronic copy shows they have another 2 ninety day refills, but they say they don’t and the pharmacy says there are no more refills. What am I going to do? argue with them? That is pretty much a daily occurrence. Do you not have old patients on multiple meds? We have lots of them. they are tough. From: Sent: Sunday, January 22, 2012 3:18 PMTo: Subject: Re: coping with being all call 24/ Yep, the refill issues keep coming up, but that’s because there are so many permeations of them. 95% of refill requests are easy to deal with. 5% are tricky. What do you do about a medicare patient, as in elderly, who was just in a few days ago, you refilled 10 prescriptions for 90 days with three refills each, and they call back asking for two more that they forgot to ask for?then it s my fault that I screwe d up themed lis and I fix it IT will happen once and never again. you already spent an hour with them in the previous visit? How about the 85 yo guy that says “Doc, can you do me a favor? refill my prescriptions when I call? I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those? It really gets hard to keep track of?†That’s a pretty common scenario in our practice. Not any easier for him to do it when you call ,iSilly You do it at time of visit and explain why it is easier for him to have it DONE See --patietns do not understand that it isok to callthings in and nothave to pick them up Thats the missing piece Just add to your scripts a macro for hold til they call for it Itis then EASIER for Mr r 85 yr old with a old wife..Patietns aslo need education about the autoatedlines and refills and punching innumbers for new scripts but does not take long to teach ...PAtietns are our partners not our enemies How about a formulary change for the patient, non-medicare. Sometimes they come in sometimes I do it Personally, I like a prescription refill fee, but it won’t apply to the overwhelmed 80+ yo medicare patients.. Aw that's nickle and diming and makes more hassle for you ! The trouble is that Pennsylvania is a dead zone and primary care sucks.The problem is not the patietns ;but try doing all at visits you will find things get better really.That would be nice for you Walter. A littel breathing room You know there is alot of stuff that goes on that is time wasting crap that makes people need staff When we refine processes we do not need staff MAny of these jobs are job security for the armies of staff and if you KNEW what specialists demand multiple copies and so on you could refine processes to be efficient and have less staff and then less staff isl essoverherad and then you can go slower and breathe.I hope you can feel better soon,Walter WKFrom: magnetdoctor@... Sent: Sunday, January 22, 2012 2:37 PMTo: Subject: Re: coping with being all call 24/ FYI, we institued about 1 yr ago a fee for prior authorizations to patients for their meds. Although my insurnace trackers show that I Rx 85% generics, for some instances is isn't good enough or patient has already failed etc. I thought this would be a huge stink, 25$ per prior auth. Not a peep, and over the last year it generated almost 1200 in fees!. The answer for the fax, and phone call refills has been reviewed here many times, but now I am fully enforcing it. If you are out of medications( and you haven't had a insurance plan change where everything had to be reordered) it means it is time to come in. I have let this slide alot, but no more. That is poor care for them, money out of my pocket, and extra uncompensated time for the staff. If you're out, you come in or find another doctor. After following this thread for a couple days, I'm going to institue email visits for a fee, if you insist on a phone consult, and won't come in, there is email consult for X cost or go to the Urgent care. jly, I'm fed up. Most of the large hospital groups here are 30-50% medicare/medicaid, and run people through in 5-10min each, and are happily jumping on the medical home bandwagon. The doctors must see 28-30 to justify their salary, and the " STARS " are seeing 40/d. Of course the stars have huge Medical assistant turnover, and the patient's spend alot of time complaining to the receptionists and staff, but the big institutions DON " T care. There answer is " you don't have a choice " I think Dr Horovitz is right, there is a choice, but for now the system is broken, and I'm not willing to let it break me too. Make your choice, and Pay or go elsewhere. CCoteTo: Sent: Sunday, January 22, 2012 12:16:05 PMSubject: Re: coping with being all call 24/ Personally, I wish this stuff weren’t so annoying. I wish I/we could just figure out how to get paid for this stuff. If it were worthwhile for us, we’d jump for it, especially if it were well worthwhile, like most things. Heck, if calling in Septra at 6PM on a Friday gave me an extra $50, I’d do it in a heartbeat and feel good about. I’d welcome it. But for free, I hate it. Ditto for long e-mails. Ditto for prior auth’s. Ditto for incessant daily prescription refills. Ditto for phone call consults. If anyone can figure out these boundaries and systematize fairness into these things, I’d love to hear it. And yep, I am working on it. I have to. The money isn’t there anymore for universal charity and courtesy. -WKFrom: Myria Sent: Sunday, January 22, 2012 12:49 PMTo: Subject: Re: coping with being all call 24/ Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of " wolf " made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay. To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/  RE being available.Hmmmm...I had a pt call Friday evening, hematuria pressure.I knew her well.We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to. AND I made appt for follow up of the hematuria next week.Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.comPoint is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.Be available, be open to new solutions...Of course if the pt is not following up in other ways, different issues.Regards from open access heaven (and YES I still have pts going to Urgicares)Matt in Western PASolo since 2004FP since 1988 just need to express myself i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... sorry to intrude on your day as we all get too many emails to start=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools..com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools...com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com======= -- MD ph fax =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

I am checking my  dryer now! Few of them are hopeless Some do take longer!  Invovle family MAke them  bring someone else to a visit PUt  an office staff in charge of them on your team.Find out of they have money or pain or support They probably cannot hear you?

  It seems  that Wlater you are on the hamster wheel as you say  and the endless cycle

of you cannot help them /they are hopeless/ Pharmacies a re hopeless, etc  will go around and  around until you can have a relationship with  the patietn and figure out how they go about stuff Can;t  solve this stuff on a hamster wheel  You need breathing room  Yeesh!

 

I would concur with that 1/3.    I would guess 1/3 of my prescription refills are redo’s before the original intended refills expire.    Like lost socks in the dryer.    What that means is that the “refill macro’s†are not predictable to be useful.     At least not with my practice population.   

 

But,  back to the issue,  particularly with respect to these old people,  how do you handle them so that the burden is not the physicians?    Some are hopeless.   If a 92 year old needs her amlodipine refilled on a snowy day two weeks after her last visit,  it’s hopeless to do anything other than just do it.   But,  there has to be a non-illusive solution for the 76 yo still driving a cadillac but cheap on paying copays.  

 

WK

From: Kathy Saradarian

Sent: Sunday, January 22, 2012 3:54 PM

To:

Subject: RE: coping with being all call 24/

 

 

Ditto.

Or I refill at the OV and pharmacy puts it away because they didn’t come pick them up (as not due yet) and I have to redo it anyway.  I think about 1/3 of my refills are redos.

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 Walter V. KowtoniukSent: Sunday, January 22, 2012 3:29 PMTo: Subject: Re: coping with being all call 24/

 

I keep an electronic copy of every prescription I write.   I refer to those copies all the time.   You wouldn’t believe how often an old person says they need a refill when the electronic copy shows they have another 2 ninety day refills,  but they say they don’t and the pharmacy says there are no more refills.     What am I going to do?   argue with them?     That is pretty much a daily occurrence.     Do you not have old patients on multiple meds?      We have lots of them.    they are tough.  

From:

Sent: Sunday, January 22, 2012 3:18 PM

To:

Subject: Re: coping with being all call 24/

 

 

Yep,  the refill issues keep coming up, but that’s because there are so many permeations of them.   95% of refill requests are easy to deal with.   5% are tricky.    What do you do about a medicare patient,   as in elderly,    who was just in a few days ago,  you refilled 10 prescriptions for 90 days with three refills each,   and they call back asking for two more that they forgot to ask for?

then it s my fault that I screwe d up themed lis and I fix it IT will happen once and never again. 

  you already spent an hour with them in the previous visit?   How about the 85 yo guy that says “Doc,  can you do me a favor?   refill my prescriptions when I call?   I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those?   It really gets hard to keep track of?â€Â Â Â Â  That’s a pretty common scenario in our practice.  

Not any easier for him to do it when you call ,iSilly  You do it at time of visit and explain why it is easier for him to have it DONE  See --patietns do not understand that it  isok to callthings in and nothave to pick them up Thats the missing piece  Just add to your scripts a macro for hold til they call for it Itis then EASIER for Mr r 85 yr old with a  old wife..Patietns aslo need education about the autoatedlines and refills and punching innumbers for new scripts but  does  not take long to teach ...PAtietns are our partners not our enemies 

  How about a formulary change for the patient,  non-medicare.   Sometimes they  come in sometimes I do it 

Personally,   I like a prescription refill fee, but it won’t apply to the overwhelmed 80+ yo medicare patients..  Aw that's nickle and diming and makes more hassle for you ! The trouble is that Pennsylvania is a dead zone and primary care sucks.The problem is not the patietns ;but try doing all at visits you will find things get better really.That would be nice for  you Walter. A littel breathing room  You know there is alot of stuff that goes on that is  time wasting crap that makes people need staff When we refine processes we do not  need staff MAny of these jobs are job security for the armies of staff and if you KNEW what specialists demand multiple copies and so on you could   refine processes to be efficient and have less staff and then less staff isl essoverherad  and then you can go slower and breathe.

I  hope you can feel  better soon,Walter 

WK

From: magnetdoctor@...

Sent: Sunday, January 22, 2012 2:37 PM

To:

Subject: Re: coping with being all call 24/

 

FYI, we institued about 1 yr ago a fee for prior authorizations to patients for their meds.  Although my insurnace trackers show that I Rx 85% generics, for some instances is isn't good enough or patient has already failed etc.  I thought this would be a huge stink, 25$ per prior auth.  Not a peep, and over the last year it generated almost 1200 in fees!. 

The answer for the fax, and phone call refills has been reviewed here many times, but now I am fully enforcing it.  If you are out of medications( and you haven't had a insurance plan change where everything had to be reordered) it means it is time to come in.  I have let this slide alot, but no more.  That is poor care for them, money out of my pocket, and extra uncompensated time for the staff.  If you're out, you come in or find another doctor. 

After following this thread for a couple days, I'm going to institue email visits for a fee, if you insist on a phone consult, and won't come in, there is email consult for X cost or go to the Urgent care.  j

ly, I'm fed up.  Most of the large hospital groups here are 30-50% medicare/medicaid, and run people through in 5-10min each, and are happily jumping on the medical home bandwagon.  The doctors must see 28-30 to justify their salary, and the " STARS " are seeing 40/d.  Of course the stars have huge Medical assistant turnover, and the patient's spend alot of time complaining to the receptionists and staff, but the big institutions DON " T care. There answer is " you don't have a choice "   I think Dr Horovitz is right, there is a choice, but for now the system is broken, and I'm not willing to let it break me too.  Make your choice, and Pay or go elsewhere.

CCote

To:

Sent: Sunday, January 22, 2012 12:16:05 PMSubject: Re: coping with being all call 24/ 

Personally,   I wish this stuff weren’t so annoying.   I wish I/we could just figure out how to get paid for this stuff.   If it were worthwhile for us,   we’d jump for it,  especially if it were well worthwhile,  like most things.     Heck,  if calling in Septra at 6PM on a Friday gave me an extra $50,  I’d do it in a heartbeat and feel good about.  I’d welcome it.   But for free, I hate it.    Ditto for long e-mails.   Ditto for prior auth’s.    Ditto for incessant daily prescription refills.    Ditto for phone call consults.   

If anyone can figure out these boundaries and systematize fairness into these things,   I’d love to hear it.    And yep,   I am working on it.   I have to.   The money isn’t there anymore for universal charity and courtesy. 

-WK

From: Myria

Sent: Sunday, January 22, 2012 12:49 PM

To:

Subject: Re: coping with being all call 24/

 

Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay.  Unfortunately her previous calls of " wolf " made me decide to wait to return her call.  That's stress for me.  I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay.

To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/

 



RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.

Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to.

AND I made appt for follow up of the hematuria next week.

Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.

We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that).  I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com

Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.

Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.

Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.

Be available, be open to new solutions...

Of course if the pt is not following up in other ways, different issues.

Regards from open access heaven (and YES I still have pts going to Urgicares)

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired...

sorry to intrude on your day as we all get too many emails to start

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[Guest guest]

Wow, 1/3? That is a lot of redo. I wonder if there is any redesign of the process to fill Rx that would help you guys not waste your time so much. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone " Don't ever let injustice go by unchallenged. " From: [mailto: ] On Behalf Of Walter V. KowtoniukSent: Sunday, January 22, 2012 4:02 PMTo: Subject: Re: coping with being all call 24/ I would concur with that 1/3. I would guess 1/3 of my prescription refills are redo’s before the original intended refills expire. Like lost socks in the dryer. What that means is that the “refill macro’s†are not predictable to be useful. At least not with my practice population. But, back to the issue, particularly with respect to these old people, how do you handle them so that the burden is not the physicians? Some are hopeless. If a 92 year old needs her amlodipine refilled on a snowy day two weeks after her last visit, it’s hopeless to do anything other than just do it. But, there has to be a non-illusive solution for the 76 yo still driving a cadillac but cheap on paying copays. WK From: Kathy Saradarian Sent: Sunday, January 22, 2012 3:54 PMTo: Subject: RE: coping with being all call 24/ Ditto.Or I refill at the OV and pharmacy puts it away because they didn’t come pick them up (as not due yet) and I have to redo it anyway. I think about 1/3 of my refills are redos.Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffingFrom: [mailto: ] On Behalf Of Walter V. KowtoniukSent: Sunday, January 22, 2012 3:29 PMTo: Subject: Re: coping with being all call 24/ I keep an electronic copy of every prescription I write. I refer to those copies all the time. You wouldn’t believe how often an old person says they need a refill when the electronic copy shows they have another 2 ninety day refills, but they say they don’t and the pharmacy says there are no more refills. What am I going to do? argue with them? That is pretty much a daily occurrence. Do you not have old patients on multiple meds? We have lots of them. they are tough. From: Sent: Sunday, January 22, 2012 3:18 PMTo: Subject: Re: coping with being all call 24/ Yep, the refill issues keep coming up, but that’s because there are so many permeations of them. 95% of refill requests are easy to deal with. 5% are tricky. What do you do about a medicare patient, as in elderly, who was just in a few days ago, you refilled 10 prescriptions for 90 days with three refills each, and they call back asking for two more that they forgot to ask for?then it s my fault that I screwe d up themed lis and I fix it IT will happen once and never again. you already spent an hour with them in the previous visit? How about the 85 yo guy that says “Doc, can you do me a favor? refill my prescriptions when I call? I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those? It really gets hard to keep track of?†That’s a pretty common scenario in our practice. Not any easier for him to do it when you call ,iSilly You do it at time of visit and explain why it is easier for him to have it DONE See --patietns do not understand that it isok to callthings in and nothave to pick them up Thats the missing piece Just add to your scripts a macro for hold til they call for it Itis then EASIER for Mr r 85 yr old with a old wife..Patietns aslo need education about the autoatedlines and refills and punching innumbers for new scripts but does not take long to teach ...PAtietns are our partners not our enemies How about a formulary change for the patient, non-medicare. Sometimes they come in sometimes I do it Personally, I like a prescription refill fee, but it won’t apply to the overwhelmed 80+ yo medicare patients.. Aw that's nickle and diming and makes more hassle for you ! The trouble is that Pennsylvania is a dead zone and primary care sucks.The problem is not the patietns ;but try doing all at visits you will find things get better really.That would be nice for you Walter. A littel breathing room You know there is alot of stuff that goes on that is time wasting crap that makes people need staff When we refine processes we do not need staff MAny of these jobs are job security for the armies of staff and if you KNEW what specialists demand multiple copies and so on you could refine processes to be efficient and have less staff and then less staff isl essoverherad and then you can go slower and breathe.I hope you can feel better soon,Walter WKFrom: magnetdoctor@... Sent: Sunday, January 22, 2012 2:37 PMTo: Subject: Re: coping with being all call 24/ FYI, we institued about 1 yr ago a fee for prior authorizations to patients for their meds. Although my insurnace trackers show that I Rx 85% generics, for some instances is isn't good enough or patient has already failed etc. I thought this would be a huge stink, 25$ per prior auth. Not a peep, and over the last year it generated almost 1200 in fees!. The answer for the fax, and phone call refills has been reviewed here many times, but now I am fully enforcing it. If you are out of medications( and you haven't had a insurance plan change where everything had to be reordered) it means it is time to come in. I have let this slide alot, but no more. That is poor care for them, money out of my pocket, and extra uncompensated time for the staff. If you're out, you come in or find another doctor. After following this thread for a couple days, I'm going to institue email visits for a fee, if you insist on a phone consult, and won't come in, there is email consult for X cost or go to the Urgent care. jly, I'm fed up. Most of the large hospital groups here are 30-50% medicare/medicaid, and run people through in 5-10min each, and are happily jumping on the medical home bandwagon. The doctors must see 28-30 to justify their salary, and the " STARS " are seeing 40/d. Of course the stars have huge Medical assistant turnover, and the patient's spend alot of time complaining to the receptionists and staff, but the big institutions DON " T care. There answer is " you don't have a choice " I think Dr Horovitz is right, there is a choice, but for now the system is broken, and I'm not willing to let it break me too. Make your choice, and Pay or go elsewhere. CCoteTo: Sent: Sunday, January 22, 2012 12:16:05 PMSubject: Re: coping with being all call 24/ Personally, I wish this stuff weren’t so annoying. I wish I/we could just figure out how to get paid for this stuff. If it were worthwhile for us, we’d jump for it, especially if it were well worthwhile, like most things. Heck, if calling in Septra at 6PM on a Friday gave me an extra $50, I’d do it in a heartbeat and feel good about. I’d welcome it. But for free, I hate it. Ditto for long e-mails. Ditto for prior auth’s. Ditto for incessant daily prescription refills. Ditto for phone call consults. If anyone can figure out these boundaries and systematize fairness into these things, I’d love to hear it. And yep, I am working on it. I have to. The money isn’t there anymore for universal charity and courtesy. -WKFrom: Myria Sent: Sunday, January 22, 2012 12:49 PMTo: Subject: Re: coping with being all call 24/ Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of " wolf " made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay. To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/  RE being available.Hmmmm...I had a pt call Friday evening, hematuria pressure.I knew her well.We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to. AND I made appt for follow up of the hematuria next week.Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.comPoint is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.Be available, be open to new solutions...Of course if the pt is not following up in other ways, different issues.Regards from open access heaven (and YES I still have pts going to Urgicares)Matt in Western PASolo since 2004FP since 1988 just need to express myself i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... sorry to intrude on your day as we all get too many emails to start=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools..com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools...com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com======= -- MD ph fax =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

Just wondering, what would you do? 76 yo husband and wife come in for regular 2-3 month visits. She’s a nervous nilly and got her share of problems. He’s a CABG/endarterectormy patient. Normal people. I refill about six scripts for him – all routine. three for her. 30 day scripts 5 refills. two days laters, she calls and says she wants 90 day scripts because...

What would you do? besides fill them and get a bit frustrated and move on to the twist of refill request?

-WK

From:

Sent: Sunday, January 22, 2012 4:59 PM

To:

Subject: Re: coping with being all call 24/

I am checking my dryer now!Few of them are hopeless Some do take longer! Invovle family MAke them bring someone else to a visit PUt an office staff in charge of them on your team..Find out of they have money or pain or support They probably cannot hear you? It seems that Wlater you are on the hamster wheel as you say and the endless cycle of you cannot help them /they are hopeless/ Pharmacies a re hopeless, etc will go around and around until you can have a relationship with the patietn and figure out how they go about stuff Can;t solve this stuff on a hamster wheel You need breathing room Yeesh!

I would concur with that 1/3. I would guess 1/3 of my prescription refills are redo’s before the original intended refills expire. Like lost socks in the dryer. What that means is that the “refill macro’s†are not predictable to be useful. At least not with my practice population.

But, back to the issue, particularly with respect to these old people, how do you handle them so that the burden is not the physicians? Some are hopeless. If a 92 year old needs her amlodipine refilled on a snowy day two weeks after her last visit, it’s hopeless to do anything other than just do it. But, there has to be a non-illusive solution for the 76 yo still driving a cadillac but cheap on paying copays.

WK

From: Kathy Saradarian

Sent: Sunday, January 22, 2012 3:54 PM

To:

Subject: RE: coping with being all call 24/

Ditto.

Or I refill at the OV and pharmacy puts it away because they didn’t come pick them up (as not due yet) and I have to redo it anyway. I think about 1/3 of my refills are redos.

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 Walter V. KowtoniukSent: Sunday, January 22, 2012 3:29 PMTo: Subject: Re: coping with being all call 24/

I keep an electronic copy of every prescription I write. I refer to those copies all the time. You wouldn’t believe how often an old person says they need a refill when the electronic copy shows they have another 2 ninety day refills, but they say they don’t and the pharmacy says there are no more refills. What am I going to do? argue with them? That is pretty much a daily occurrence. Do you not have old patients on multiple meds? We have lots of them. they are tough.

From:

Sent: Sunday, January 22, 2012 3:18 PM

To:

Subject: Re: coping with being all call 24/

Yep, the refill issues keep coming up, but that’s because there are so many permeations of them. 95% of refill requests are easy to deal with. 5% are tricky. What do you do about a medicare patient, as in elderly, who was just in a few days ago, you refilled 10 prescriptions for 90 days with three refills each, and they call back asking for two more that they forgot to ask for?

then it s my fault that I screwe d up themed lis and I fix it IT will happen once and never again.

you already spent an hour with them in the previous visit? How about the 85 yo guy that says “Doc, can you do me a favor? refill my prescriptions when I call? I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those? It really gets hard to keep track of?†That’s a pretty common scenario in our practice.

Not any easier for him to do it when you call ,iSilly You do it at time of visit and explain why it is easier for him to have it DONE See --patietns do not understand that it isok to callthings in and nothave to pick them up Thats the missing piece Just add to your scripts a macro for hold til they call for it Itis then EASIER for Mr r 85 yr old with a old wife..Patietns aslo need education about the autoatedlines and refills and punching innumbers for new scripts but does not take long to teach ...PAtietns are our partners not our enemies

How about a formulary change for the patient, non-medicare. Sometimes they come in sometimes I do it

Personally, I like a prescription refill fee, but it won’t apply to the overwhelmed 80+ yo medicare patients.. Aw that's nickle and diming and makes more hassle for you ! The trouble is that Pennsylvania is a dead zone and primary care sucks.The problem is not the patietns ;but try doing all at visits you will find things get better really.That would be nice for you Walter. A littel breathing room You know there is alot of stuff that goes on that is time wasting crap that makes people need staff When we refine processes we do not need staff MAny of these jobs are job security for the armies of staff and if you KNEW what specialists demand multiple copies and so on you could refine processes to be efficient and have less staff and then less staff isl essoverherad and then you can go slower and breathe.

I hope you can feel better soon,Walter

WK

From: magnetdoctor@...

Sent: Sunday, January 22, 2012 2:37 PM

To:

Subject: Re: coping with being all call 24/

FYI, we institued about 1 yr ago a fee for prior authorizations to patients for their meds. Although my insurnace trackers show that I Rx 85% generics, for some instances is isn't good enough or patient has already failed etc.. I thought this would be a huge stink, 25$ per prior auth. Not a peep, and over the last year it generated almost 1200 in fees!.

The answer for the fax, and phone call refills has been reviewed here many times, but now I am fully enforcing it. If you are out of medications( and you haven't had a insurance plan change where everything had to be reordered) it means it is time to come in. I have let this slide alot, but no more. That is poor care for them, money out of my pocket, and extra uncompensated time for the staff. If you're out, you come in or find another doctor.

After following this thread for a couple days, I'm going to institue email visits for a fee, if you insist on a phone consult, and won't come in, there is email consult for X cost or go to the Urgent care. j

ly, I'm fed up. Most of the large hospital groups here are 30-50% medicare/medicaid, and run people through in 5-10min each, and are happily jumping on the medical home bandwagon. The doctors must see 28-30 to justify their salary, and the "STARS" are seeing 40/d. Of course the stars have huge Medical assistant turnover, and the patient's spend alot of time complaining to the receptionists and staff, but the big institutions DON"T care. There answer is "you don't have a choice" I think Dr Horovitz is right, there is a choice, but for now the system is broken, and I'm not willing to let it break me too. Make your choice, and Pay or go elsewhere.

CCote

To: Sent: Sunday, January 22, 2012 12:16:05 PMSubject: Re: coping with being all call 24/

Personally, I wish this stuff weren’t so annoying. I wish I/we could just figure out how to get paid for this stuff. If it were worthwhile for us, we’d jump for it, especially if it were well worthwhile, like most things. Heck, if calling in Septra at 6PM on a Friday gave me an extra $50, I’d do it in a heartbeat and feel good about. I’d welcome it. But for free, I hate it. Ditto for long e-mails. Ditto for prior auth’s. Ditto for incessant daily prescription refills. Ditto for phone call consults.

If anyone can figure out these boundaries and systematize fairness into these things, I’d love to hear it. And yep, I am working on it. I have to. The money isn’t there anymore for universal charity and courtesy.

-WK

From: Myria

Sent: Sunday, January 22, 2012 12:49 PM

To:

Subject: Re: coping with being all call 24/

Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of "wolf" made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay.

To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/



RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.

Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to.

AND I made appt for follow up of the hematuria next week.

Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.

We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com

Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.

Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.

Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.

Be available, be open to new solutions...

Of course if the pt is not following up in other ways, different issues.

Regards from open access heaven (and YES I still have pts going to Urgicares)

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired...

sorry to intrude on your day as we all get too many emails to start

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools..com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

http://www.pctools...com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

http://www..pctools.com/?cclick=EmailFooterClean_51=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)http://www.pctools.com=======

-- MD ph fax

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

-- MD ph fax =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

Walter, I would recite my motto, which is " People lay awake nights TRYING to

think up ways to waste my time, " my husband/office manager would chide me for my

negativity, and I would redo the prescriptions...Sigh! At least it will be

easier with eRx than writing them all.---Sharlene

>

>

>

>

>

> That’s definitely the problem with blanket e-mail access. You get

stupid e-mails and then you feel obligated to respond. On the other hand,

with a phone/answering message that says if it’s an emergency go to the ER,

otherwise wait til Monday, you relax better because you put it in the

patient’s ball court, where it ought to be.

>

>

> I have given e-mail access to a handful of patients and I universally

regret doing so. Having done so, I have a problem to solve.

>

>

> WK

>

>

> From: Gordon

>

> Sent: Friday, January 20, 2012 4:50 PM

>

> To: practiceimprovement1

>

> Subject: just need to express myself

>

>

>

>

> i may be annoyed because friday is my early day and i've been at the

office since 715 but in the past 20 minutes i've had an email, a general voice

mail and now a call on my urgent line from someone wanting to know what to do

about their blood pressure being 135/80 and feeling tired...

>

>

> sorry to intrude on your day as we all get too many emails to start

>

>

>

>

>

>

>

> =======

> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

>

> http://www.pctools..com

> =======

>

>

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> =======

> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

> http://www.pctools.com

> =======

>

>

>

>

>

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> Email scanned by PC Tools - No viruses or spyware found.

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> http://www.pctools.com

> =======

>

>

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> =======

> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

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> http://www.pctools...com

> =======

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> http://www.pctools.com

> =======

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> Email scanned by PC Tools - No viruses or spyware found.

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> http://www.pctools.com

> =======

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> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

>

> http://www..pctools.com/?cclick=EmailFooterClean_51

> =======

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> Email scanned by PC Tools - No viruses or spyware found.

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> http://www.pctools.com

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> --

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> MD

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> ph fax

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> http://www.pctools.com

> =======

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> =======

> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

> http://www.pctools.com

> =======

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> Email scanned by PC Tools - No viruses or spyware found.

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> http://www.pctools.com

> =======

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> =======

> Email scanned by PC Tools - No viruses or spyware found.

> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

> http://www.pctools.com

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> --

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> MD

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> ph fax

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> http://www.pctools.com

> =======

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> Email scanned by PC Tools - No viruses or spyware found.

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> http://www.pctools.com/

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>

[Guest guest]

I don’t re-write them. I retrieve them electronically, change the numbers, print them, sign them. Re-send them by e-rx because of the quantity change. 3 for the wife. 6 for the husband. took about 11 minutes. Patient comes to pick them up. I keep electronic copies of the new scripts. I don’t even get terribly annoyed. It’s 11 minutes which isn’t a killer unless you do similar stuff a few more times throughout the day. Then it’s a business issue in an environment of decreasing revenue and increasing costs. Of course I accommodated my patients. But, was it fair to my office staff and me? and is it a sustainable business practice? Do I do it again for them? Do I do an odd refill call in for them in the future?

WK

From: sharkinn

Sent: Sunday, January 22, 2012 5:38 PM

To:

Subject: Re: coping with being all call 24/

Walter, I would recite my motto, which is "People lay awake nights TRYING to think up ways to waste my time," my husband/office manager would chide me for my negativity, and I would redo the prescriptions....Sigh! At least it will be easier with eRx than writing them all.---Sharlene> > > > > > That’s definitely the problem with blanket e-mail access. You get stupid e-mails and then you feel obligated to respond. On the other hand, with a phone/answering message that says if it’s an emergency go to the ER, otherwise wait til Monday, you relax better because you put it in the patient’s ball court, where it ought to be. > > > I have given e-mail access to a handful of patients and I universally regret doing so. Having done so, I have a problem to solve. > > > WK> > > From: Gordon > > Sent: Friday, January 20, 2012 4:50 PM> > To: practiceimprovement1 > > Subject: just need to express myself> > > > > i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... > > > sorry to intrude on your day as we all get too many emails to start> > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com/> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools...com/> ======= > > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www...pctools.com/?cclick=EmailFooterClean_51> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> =======> > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com/> =======>=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

The local, large group charges $10 to resend your rx's (change in qty or pharmacy). Not us, but we do 2-3 of these/day @10 mins each is 30 mins of uncompensated time. I suppose a $10 charge would be a reminder enough for some to make sure they get the right #/pharmacy to begin with.

Pratt

I don’t re-write them. I retrieve them electronically, change the numbers, print them, sign them. Re-send them by e-rx because of the quantity change. 3 for the wife. 6 for the husband. took about 11 minutes. Patient comes to pick them up. I keep electronic copies of the new scripts. I don’t even get terribly annoyed. It’s 11 minutes which isn’t a killer unless you do similar stuff a few more times throughout the day. Then it’s a business issue in an environment of decreasing revenue and increasing costs. Of course I accommodated my patients. But, was it fair to my office staff and me? and is it a sustainable business practice? Do I do it again for them? Do I do an odd refill call in for them in the future?

WK

From: sharkinn

Sent: Sunday, January 22, 2012 5:38 PM

To:

Subject: Re: coping with being all call 24/

Walter, I would recite my motto, which is " People lay awake nights TRYING to think up ways to waste my time, " my husband/office manager would chide me for my negativity, and I would redo the prescriptions....Sigh! At least it will be easier with eRx than writing them all.---Sharlene> > > > > > Thatâ s definitely the problem with blanket e-mail access. You get stupid e-mails and then you feel obligated to respond. On the other hand, with a phone/answering message that says if itâ s an emergency go to the ER, otherwise wait til Monday, you relax better because you put it in the patientâ s ball court, where it ought to be. > > > I have given e-mail access to a handful of patients and I universally regret doing so. Having done so, I have a problem to solve. > > > WK> > > From: Gordon > > Sent: Friday, January 20, 2012 4:50 PM> > To: practiceimprovement1 > > Subject: just need to express myself> > > > > i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... > > > sorry to intrude on your day as we all get too many emails to start> > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com/> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools...com/> ======= > > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www...pctools.com/?cclick=EmailFooterClean_51

> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> =======> > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com/> =======>=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com

=======

[Guest guest]

oh I dunno I  most frequently say prescriptions are done at visits  I throw in " Medicare requires face to face " .   The specialists expect people to come in  why wouldn't i?? I might do it  I dunno   I might say  great  remind at your next visit and we will get that set up for you

 I always do 90 day refills it is cheaper and easier for people I think the  problem is  your  hamster wheel I do not  see yet how we can rescue you WalterJean

 

Just wondering,   what would you do? 76 yo husband and wife come in for regular 2-3 month visits.   She’s a nervous nilly and got her share of problems.  He’s a CABG/endarterectormy patient.    Normal people.   I refill about six scripts for him – all routine.   three for her.    30 day scripts 5 refills.     two days laters,  she calls and says she wants 90 day scripts because...    

 

What would you do?     besides fill them and get a bit frustrated and move on to the twist of refill request?

 

-WK

From:

Sent: Sunday, January 22, 2012 4:59 PM

To:

Subject: Re: coping with being all call 24/

 

 

I am checking my  dryer now!Few of them are hopeless Some do take longer!  Invovle family MAke them  bring someone else to a visit PUt  an office staff in charge of them on your team..Find out of they have money or pain or support They probably cannot hear you?  It seems  that Wlater you are on the hamster wheel as you say  and the endless cycle of you cannot help them /they are hopeless/ Pharmacies a re hopeless, etc  will go around and  around until you can have a relationship with  the patietn and figure out how they go about stuff Can;t  solve this stuff on a hamster wheel  You need breathing room Yeesh!     MD         

ph    fax

[Guest guest]

I don’t need rescue. I need a lot of things – the list is long. One of those things is figuring out a fair manner to deal with call in requests including prescription refills and changes. I also do my share of 90 day prescriptions with 3 refills – a full years worth of routine meds. I bet less than 20% of those prescriptions make it to the end of the one year due to the various things discussed thus far including insurance changes/formulary changes.

I do like the refill / prescription change fee idea. How could it be implemented with respect to medicaid and medicare patients? I don’t think I would risk it on medicaid patients and I’m not sure I’d risk it on medicare either. My guess is that medicaid, if they heard of it, would go nuts and demand I give the money back to the patient under threat of discipline. My guess is that it would be below the medicare radar screen, but still not sure I’d risk it.

-WK

From:

Sent: Monday, January 23, 2012 6:25 AM

To:

Subject: Re: coping with being all call 24/

oh I dunnoI most frequently say prescriptions are done at visits I throw in " Medicare requires face to face". The specialists expect people to come in why wouldn't i?? I might do it I dunno I might say great remind at your next visit and we will get that set up for youI always do 90 day refills it is cheaper and easier for peopleI think the problem is your hamster wheel I do not see yet how we can rescue you WalterJean

Just wondering, what would you do? 76 yo husband and wife come in for regular 2-3 month visits. She’s a nervous nilly and got her share of problems. He’s a CABG/endarterectormy patient. Normal people. I refill about six scripts for him – all routine. three for her. 30 day scripts 5 refills. two days laters, she calls and says she wants 90 day scripts because...

What would you do? besides fill them and get a bit frustrated and move on to the twist of refill request?

-WK

From:

Sent: Sunday, January 22, 2012 4:59 PM

To:

Subject: Re: coping with being all call 24/

I am checking my dryer now!Few of them are hopeless Some do take longer! Invovle family MAke them bring someone else to a visit PUt an office staff in charge of them on your team..Find out of they have money or pain or support They probably cannot hear you? It seems that Wlater you are on the hamster wheel as you say and the endless cycle of you cannot help them /they are hopeless/ Pharmacies a re hopeless, etc will go around and around until you can have a relationship with the patietn and figure out how they go about stuff Can;t solve this stuff on a hamster wheel You need breathing room Yeesh! MD ph fax =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

You add it into your financial policy as a non-covered service.  A change of meds always requires an appt because you need to discuss the benefits, side effects, etc (unless you talked about it at the previous appointment & it's already documented).  If you want to be really passive-aggressive, you could wait to do those refills for 2 days (unless it obviously is a threat to patient safety to not do so).  Make it a policy that it takes 2 business days for refills.  If a patient changes pharmacies, the new pharmacy should be able to transfer over the rx's from the previous pharmacy.  Let them do the work - they are the ones benefitting, not you.  

If the patient should still have refills left, direct them to call their pharmacy for a refill.  It doesn't take too many of those calls, and the patient will get used to looking at their bottle to see if they have refills left.  No refills means it's time for an appt.  Even if they " forgot " to get their labs done, we will do a 30 day refill, but they must schedule an appt. If they cancel the appt, then they will likely get a 7 day refill and must come for an appt.  Most people don't want to pay a copay for only 7 days of meds, so they will find a way to come in.  Formulary/insurance change requires an appt.  Gotta discuss the new med in person.  Oh, and if the patient (not you) decides that they want something that requires prior auth, that is a forms completion fee.  We waive this if it's a med that the MD is requiring and the patient has been in.  But for things like propecia, Viagra, and sleeping pills, we definitely charge.  If the patient asks why, we explain that there is a form or questions that require us to review their chart in order to answer.  No one complains when we tell them that.  They think all we have to do is call the insurance and tell them we are prescribing it and then they will ok it.  We all know that to not be true!

We aren't charging the refill fee.  But it doesn't take us much time to deal with these because of e-rx.  If it were becoming a burden, we probably would (which is why we implemented the forms completion fee).  Also, many of them come in on our voicemail after hours or thru the Portal,so we aren't taking the phone calls.

If you have staff, it will take some retraining of staff as well so that you aren't the only one dealing with this.  The majority of those calls can be redirected by an MA or receptionist so that all you have to deal with are the true refills.

Pratt

 

I don’t need rescue.   I need a lot of things – the list is long.   One of those things is figuring out a fair manner to deal with call in requests including prescription refills and changes.    I also do my share of 90 day prescriptions with 3 refills – a full years worth of routine meds.    I bet less than 20% of those prescriptions make it to the end of the one year due to the various things discussed thus far including insurance changes/formulary changes.  

 

I do like the refill / prescription change fee idea.    How could it be implemented with respect to medicaid and medicare patients?    I don’t think I would risk it on medicaid patients and I’m not sure I’d risk it on medicare either.    My guess is that medicaid, if they heard of it, would go nuts and demand I give the money back to the patient under threat of discipline.   My guess is that it would be below the medicare radar screen,  but still not sure I’d risk it.       

 

-WK

From:

Sent: Monday, January 23, 2012 6:25 AM

To:

Subject: Re: coping with being all call 24/

 

 

oh I dunnoI  most frequently say prescriptions are done at visits  I throw in " Medicare requires face to face " .   The specialists expect people to come in  why wouldn't i?? I might do it  I dunno   I might say  great  remind at your next visit and we will get that set up for youI always do 90 day refills it is cheaper and easier for peopleI think the  problem is  your  hamster wheel I do not  see yet how we can rescue you WalterJean

 

Just wondering,   what would you do? 76 yo husband and wife come in for regular 2-3 month visits.   She’s a nervous nilly and got her share of problems.  He’s a CABG/endarterectormy patient.    Normal people.   I refill about six scripts for him – all routine.   three for her.    30 day scripts 5 refills.     two days laters,  she calls and says she wants 90 day scripts because...    

 

What would you do?     besides fill them and get a bit frustrated and move on to the twist of refill request?

 

-WK

From:

Sent: Sunday, January 22, 2012 4:59 PM

To:

Subject: Re: coping with being all call 24/

 

 

I am checking my  dryer now!Few of them are hopeless Some do take longer!  Invovle family MAke them  bring someone else to a visit PUt  an office staff in charge of them on your team..Find out of they have money or pain or support They probably cannot hear you?  It seems  that Wlater you are on the hamster wheel as you say  and the endless cycle of you cannot help them /they are hopeless/ Pharmacies a re hopeless, etc  will go around and  around until you can have a relationship with  the patietn and figure out how they go about stuff Can;t  solve this stuff on a hamster wheel  You need breathing room Yeesh!     MD          ph    fax

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com

=======

[Guest guest]

Walter,Are you doing e-fax or true e-prescribing?I found MUCH less was lost after I switched to e-prescribing. 

Just a thought. Sharon McCoy

www.sharongeorgemd.comwww.impcenter.org

 

I don’t re-write them.  I retrieve them electronically,  change the numbers,  print them,  sign them.   Re-send them by e-rx because of the quantity change.    3 for the wife.   6 for the husband.   took about 11 minutes.    Patient comes to pick them up.   I keep electronic copies of the new scripts.      I don’t even get terribly annoyed.   It’s 11 minutes which isn’t a killer unless you do similar stuff a few more times throughout the day.   Then it’s a business issue in an environment of decreasing revenue and increasing costs.    Of course I accommodated my patients.   But, was it fair to my office staff and me?   and is it a sustainable business practice?   Do I do it again for them?    Do I do an odd refill call in for them in the future?    

 

WK

From: sharkinn

Sent: Sunday, January 22, 2012 5:38 PM

To:

Subject: Re: coping with being all call 24/

 

 

Walter, I would recite my motto, which is " People lay awake nights TRYING to think up ways to waste my time, " my husband/office manager would chide me for my negativity, and I would redo the prescriptions....Sigh! At least it will be easier with eRx than writing them all.---Sharlene> > > > > > Thatâ s definitely the problem with blanket e-mail access. You get stupid e-mails and then you feel obligated to respond. On the other hand, with a phone/answering message that says if itâ s an emergency go to the ER, otherwise wait til Monday, you relax better because you put it in the patientâ s ball court, where it ought to be. > > > I have given e-mail access to a handful of patients and I universally regret doing so. Having done so, I have a problem to solve. > > > WK> > > From: Gordon > > Sent: Friday, January 20, 2012 4:50 PM> > To: practiceimprovement1 > > Subject: just need to express myself> > > > > i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... > > > sorry to intrude on your day as we all get too many emails to start> > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com/> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools...com/> ======= > > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www...pctools.com/?cclick=EmailFooterClean_51> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> =======> > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com/> =======>=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)

http://www.pctools.com

=======

[Guest guest]

I am using true e-rxing via Surescripts. it works. except sometimes. Just enough times in my neighborhood for me to give hard copies plus e-rxing just to keep from dealing with the occasional call backs. I have not developed that comfort level yet to rely on Surescripts, even though it costs $ 500 per provider X 2 providers which is about equivalent to the otherwise 1% penalty.

-WK

From: Sharon McCoy

Sent: Monday, January 23, 2012 6:56 PM

To:

Subject: Re: coping with being all call 24/

Walter,

Are you doing e-fax or true e-prescribing?

I found MUCH less was lost after I switched to e-prescribing.

Just a thought. Sharon McCoy www.sharongeorgemd.com

www.impcenter.org

I don’t re-write them. I retrieve them electronically, change the numbers, print them, sign them. Re-send them by e-rx because of the quantity change. 3 for the wife. 6 for the husband. took about 11 minutes. Patient comes to pick them up. I keep electronic copies of the new scripts. I don’t even get terribly annoyed. It’s 11 minutes which isn’t a killer unless you do similar stuff a few more times throughout the day. Then it’s a business issue in an environment of decreasing revenue and increasing costs. Of course I accommodated my patients. But, was it fair to my office staff and me? and is it a sustainable business practice? Do I do it again for them? Do I do an odd refill call in for them in the future?

WK

From: sharkinn

Sent: Sunday, January 22, 2012 5:38 PM

To:

Subject: Re: coping with being all call 24/

Walter, I would recite my motto, which is "People lay awake nights TRYING to think up ways to waste my time," my husband/office manager would chide me for my negativity, and I would redo the prescriptions....Sigh! At least it will be easier with eRx than writing them all.---Sharlene> > > > > > Thatâ s definitely the problem with blanket e-mail access. You get stupid e-mails and then you feel obligated to respond. On the other hand, with a phone/answering message that says if itâ s an emergency go to the ER, otherwise wait til Monday, you relax better because you put it in the patientâ s ball court, where it ought to be. > > > I have given e-mail access to a handful of patients and I universally regret doing so. Having done so, I have a problem to solve. > > > WK> > > From: Gordon > > Sent: Friday, January 20, 2012 4:50 PM> > To: practiceimprovement1 > > Subject: just need to express myself> > > > > i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... > > > sorry to intrude on your day as we all get too many emails to start> > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com/> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools...com/> ======= > > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www..pctools.com/?cclick=EmailFooterClean_51> ======= > > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6..19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> ======= > > > > -- > > > > MD> > > ph fax > > > > > > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com> =======> > > > =======> Email scanned by PC Tools - No viruses or spyware found.> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> http://www.pctools.com/> =======>

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)http://www.pctools.com=======

[Guest guest]

I just sent out the following in a newsletter to my patients. It has been very well received. I was a bit surprised at how well, in fact. Now the question will be whether I will stick to my new boundaries or cave to my first inclination to not charge for something that really doesn't take much time in and of itself but adds up to hours of unpaid time collectively. But, my patients are very supportive and are now reminding me to bill them or they are asking what they owe for the phone call or whatever and saying they will send a check.My next step is to move to an option that is a blend of a NCBF and Dr. Horvitz' model for those who would like more seamless care without the "per visit/interaction" fragmented payment system. As Dr. Horvitz said, I won't know

until I try it but either way, I won't be feeling resentful for giving away so much of my time.I also formally announced that I'm implementing the "Antonucci refill model" - I just wasn't making headway trying to implement it one on one- but now its a breeze as the patient is expecting it. And in less than one week, people are already self-scheduling for their refill visits.I will have all patients sign a copy of the formal policies as they come in, but the newsletter format has worked well. I did my best to put the onus on myself rather than on my patients- and in truth, it belongs on me. It is not their fault that they accept what I give and then expect more when they perceive that I minimize the value of it by not charging appropriately. And, as I've learned in reading about marketing, perceived value is somewhat dependent on what you have to pay for something. Giving away care to the

point where I become resentful is doubly damaging.Here is what I sent out:Dear X:I

am updating several office policies and am listing the highlights in this newsletter. Some of these simply clarify aspects of how the office does business and some are significant new changes. I

have a vision of the primary care relationship that is both old-fashioned and somewhat radical/cutting-edge. In trying to achieve my

vision, I've been stymied in finding the balance between your needs, my

needs, and the requirements of the insurance companies. I have realized that if I am going to keep the practice going, I have to hold myself to some new boundaries. I

think you will find these new boundaries reasonable. If not, I really would like you to share your thoughts with me. There is a link to a feedback form at the bottom of this newsletter if you want to do so today. Sincerely, Carla Gibson

Financial Policies

Here are highlights of financial policies for the office. New changes are in bold print:

Copays are due at the time of service. If your insurance plan requires a "copay" rather than "co-insurance", the copay is due at the time of service per your agreement with your insurance company. Discounts

are available when paying in full at the time of service without billing insurance. These rates are posted on the website and are subject to change at any time. By requesting the discount, you are requesting that insurance not be billed. Receipts for these visits are not appropriate for sending to insurance on your own, but should be adequate to obtain reimbursement from Flex Plans and HSAs. Remainder

balances (the percentage of the charge that you are responsible for after insurance has paid their part) are due within 15 days of the date of the first statement. When

an account cannot be paid in full within 15 days, a FORMAL payment plan

is required. When a formal payment plan is not in place, each subsequent statement that carries a balance forward will incur a $5 charge to cover the cost of statement management. Formal Email and Phone visits are available and accessible through the website as Virtual Visits. I encourage you to utilize the formal system through the website so that my time is reimbursed appropriately. If you choose not

to utilize the structured access to these visits available through the website, I reserve the right to bill for a visit when I have done the work typically contained in a visit. These type of visits, whether billed as a visit or not, incur malpractice liability risk and require the same type of time-consuming documentation as an office visit. In reality, it takes more skill to safely conduct a virtual visit than an office-based visit. If you utilize the formal access to a Virtual Visit and I determine that the extent of the visit does not meet

my criteria for a visit, there will be no charge and, if needed, I will

refund any payment you have made. Most

insurance plans do not cover these visits. It is your responsibility to understand your coverage. If you ask me to bill your insurance company for an email or phone visit and your insurance company indicates

this is a non-covered service, there will be a $5 billing charge applied to your account. There is information on how to check regarding your insurance coverage on the website Virtual Visit page. I

now charge for completion of forms, pre-authorization phone calls, and writing letters on your behalf when not done during an office visit. These charges are not covered by insurance and will be direct billed to you. Charges vary depending on amount of time spent. Refills

for medications requested outside the time of an office visit will incur a charge of $10- see the section on Prescription Refills further on in this newsletter. Preventive care vs Problem oriented care: I'm

finding there is a lot of confusion about billing for preventive care now that more insurance plans are reimbursing for this care, often without any out of pocket expense to you. Preventive care is basically for screening and counseling about how to stay healthy. It is NOT care or advice that deals with a problem. For example, coming in for a breast exam and pap is a preventive care visit. If you bring in your lab results from a workplace screening and we review those and find them

to be normal, it's still a preventive care visit. But what if the results are abnormal? In

a preventive care visit, the abnormal results would be identified as a problem and the appropriate "preventive" advice would be to return to the office for a problem visit to discuss treatment and recommendations.

I

personally don't like fragmenting care like that and it is often inconvenient for you. Thus, I usually try to cover the problem during the preventive visit. But

how many 'problems' should be covered in a preventive visit before a problem visit is also billed? The general rule of thumb is that if the amount of time spent on the problem extends the typical time spent by the average provider doing a preventive/wellness visit, then a problem visit should be billed in addition to the preventive visit. So, if a patient comes in for their once a year visit wanting their breast exam and pap, but also wanting to deal with knee pain, high cholesterol, and insomnia.... that clearly is going to require extra time and a problem visit will also be billed. Please

be aware that when we try to lump several problems into a preventive visit, it is not possible to do it all. A preventive visit alone takes about 30 minutes when done properly in my opinion. One simple problem usually takes about 15 minutes.. you can see how quickly we run out of time! The

change in my practice to take note of is that I will now be consistent in billing for problem visits in addition to preventive visits when the guidelines for both are met during one visit. You will see two charges for the date of service. Most insurances allow this billing practice. You will be responsible for the copay or co-insurance portion that insurance does not cover. To: Sent: Sunday, January 22, 2012 11:16 AM Subject: Re: coping with being all call 24/

Personally, I wish this stuff weren’t so annoying. I wish I/we could just figure out how to get paid for this stuff. If it were worthwhile for us, we’d jump for it, especially if it were well worthwhile, like most things. Heck, if calling in Septra at 6PM on a Friday gave me an extra $50, I’d do it in a heartbeat and feel good about. I’d welcome it. But for free, I hate it. Ditto for long e-mails. Ditto for prior auth’s. Ditto for incessant daily prescription refills. Ditto for phone call consults.

If anyone can figure out these boundaries and systematize fairness into these things, I’d love to hear it. And yep, I am working on it. I have to. The money isn’t there anymore for universal charity and courtesy.

-WK

From: Myria

Sent: Sunday, January 22, 2012 12:49 PM

To:

Subject: Re: coping with being all call 24/

Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of "wolf" made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay.

To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.

Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to.

AND I made appt for follow up of the hematuria next week.

Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.

We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com

Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.

Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.

Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.

Be available, be open to new solutions..

Of course if the pt is not following up in other ways, different issues.

Regards from open access heaven (and YES I still have pts going to Urgicares)

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired...

sorry to intrude on your day as we all get too many emails to start

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools..com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

Wow, very informative and detailed. I wish I have patients reminding me to bill them... Keep us posted please,Carla. Thank you for sharing your process. Wen

 

I just sent out the following in a newsletter to my patients. It has been very well received. I was a bit surprised at how well, in fact.  Now the question will be whether I will stick to my  new boundaries or cave to my first inclination to not charge for something that really doesn't take much time in and of itself but adds up to hours of unpaid time collectively.  But, my patients are very supportive and are now reminding me to bill them or they are asking what they owe for the phone call or whatever and saying they will send a check.

My next step is to move to an option that is a blend of a NCBF and Dr. Horvitz' model for those who would like more seamless care without the " per visit/interaction " fragmented payment system.  As Dr. Horvitz said, I won't know

until I try it but either way, I won't be feeling resentful for giving away so much of my time.I also formally announced that I'm implementing the " Antonucci refill model " - I just wasn't making headway trying to implement it one on one- but now its a breeze as the patient is expecting it. And in less than one week, people are already self-scheduling for their refill visits.

I will have all patients sign a copy of the formal policies as they come in, but the newsletter format has worked well.  I did my best to put the onus on myself rather than on my patients- and in truth, it belongs on me. It is not their fault that they accept what I give and then expect more when they perceive that I minimize the value of it by not charging appropriately. And, as I've learned in reading about marketing, perceived value is somewhat dependent on what you have to pay for something. Giving away care to the

point where I become resentful is doubly damaging.Here is what I sent out:Dear  X:I

am updating several office policies and am listing the highlights in this newsletter. Some of these simply clarify aspects of how the office does business and some are significant new changes. I

have a vision of the primary care relationship that is both old-fashioned and somewhat radical/cutting-edge. In trying to achieve my

vision, I've been stymied in finding the balance between your needs, my

needs, and the requirements of the insurance companies. I have realized that if I am going to keep the practice going, I have to hold myself to some new boundaries. I

think you will find these new boundaries reasonable. If not, I really would like you to share your thoughts with me. There is a link to a feedback form at the bottom of this newsletter if you want to do so today.  Sincerely, Carla Gibson

Financial Policies 

 Here are highlights of financial policies for the office. New changes are in bold print:  

Copays are due at the time of service. If your insurance plan requires a " copay " rather than " co-insurance " , the copay is due at the time of service per your agreement with your insurance company.   Discounts

are available when paying in full at the time of service without billing insurance. These rates are posted on the website and are subject to change at any time. By requesting the discount, you are requesting that insurance not be billed. Receipts for these visits are not appropriate for sending to insurance on your own, but should be adequate to obtain reimbursement from Flex Plans and HSAs.    Remainder

balances (the percentage of the charge that you are responsible for after insurance has paid their part) are due within 15 days of the date of the first statement.    When

an account cannot be paid in full within 15 days, a FORMAL payment plan

is required. When a formal payment plan is not in place, each subsequent statement that carries a balance forward will incur a $5 charge to cover the cost of statement management.    Formal Email and Phone visits are available and accessible through the website as Virtual Visits. I encourage you to utilize the formal system through the website so that my time is reimbursed appropriately.

If you choose not

to utilize the structured access to these visits available through the website, I reserve the right to bill for a visit when I have done the work typically contained in a visit. These type of visits, whether billed as a visit or not, incur malpractice liability risk and require the same type of time-consuming documentation as an office visit. In reality, it takes more skill to safely conduct a virtual visit than an office-based visit. If you utilize the formal access to a Virtual Visit and I determine that the extent of the visit does not meet

my criteria for a visit, there will be no charge and, if needed, I will

refund any payment you have made.  Most

insurance plans do not cover these visits. It is your responsibility to understand your coverage. If you ask me to bill your insurance company for an email or phone visit and your insurance company indicates

this is a non-covered service, there will be a $5 billing charge applied to your account. There is information on how to check regarding your insurance coverage on the website Virtual Visit page.   

 I

now charge for completion of forms, pre-authorization phone calls, and writing letters on your behalf when not done during an office visit. These charges are not covered by insurance and will be direct billed to you. Charges vary depending on amount of time spent. Refills

for medications requested outside the time of an office visit will incur a charge of $10- see the section on Prescription Refills further on in this newsletter. Preventive care vs Problem oriented care:

I'm

finding there is a lot of confusion about billing for preventive care now that more insurance plans are reimbursing for this care, often without any out of pocket expense to you. Preventive care is basically for screening and counseling about how to stay healthy. It is NOT care or advice that deals with a problem. For example, coming in for a breast exam and pap is a preventive care visit. If you bring in your lab results from a workplace screening and we review those and find them

to be normal, it's still a preventive care visit. But what if the results are abnormal? In

a preventive care visit, the abnormal results would be identified as a problem and the appropriate " preventive " advice would be to return to the office for a problem visit to discuss treatment and recommendations.

  I

personally don't like fragmenting care like that and it is often inconvenient for you. Thus, I usually try to cover the problem during the preventive visit. But

how many 'problems' should be covered in a preventive visit before a problem visit is also billed? The general rule of thumb is that if the amount of time spent on the problem extends the typical time spent by the average provider doing a preventive/wellness visit, then a problem visit should be billed in addition to the preventive visit. So, if a patient comes in for their once a year visit wanting their breast exam and pap, but also wanting to deal with knee pain, high cholesterol, and insomnia.... that clearly is going to require extra time and a problem visit will also be billed. Please

be aware that when we try to lump several problems into a preventive visit, it is not possible to do it all. A preventive visit alone takes about 30 minutes when done properly in my opinion. One simple problem usually takes about 15 minutes.. you can see how quickly we run out of time! The

change in my practice to take note of is that I will now be consistent in billing for problem visits in addition to preventive visits when the guidelines for both are met during one visit. You will see two charges for the date of service. Most insurances allow this billing practice. You will be responsible for the copay or co-insurance portion that insurance does not cover.

To:

Sent: Sunday, January 22, 2012 11:16 AM Subject: Re: coping with being all call 24/

 

Personally,   I wish this stuff weren’t so annoying.   I wish I/we could just figure out how to get paid for this stuff.   If it were worthwhile for us,   we’d jump for it,  especially if it were well worthwhile,  like most things.     Heck,  if calling in Septra at 6PM on a Friday gave me an extra $50,  I’d do it in a heartbeat and feel good about.  I’d welcome it.   But for free, I hate it.    Ditto for long e-mails.   Ditto for prior auth’s.    Ditto for incessant daily prescription refills.    Ditto for phone call consults.   

 

If anyone can figure out these boundaries and systematize fairness into these things,   I’d love to hear it.    And yep,   I am working on it.   I have to.   The money isn’t there anymore for universal charity and courtesy. 

 

-WK

From: Myria

Sent: Sunday, January 22, 2012 12:49 PM

To:

Subject: Re: coping with being all call 24/

 

 

Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay.  Unfortunately her previous calls of " wolf " made me decide to wait to return her call.  That's stress for me.  I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay.

 

To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.

Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to.

AND I made appt for follow up of the hematuria next week.

 

Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.

 

We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that).  I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com

 

Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.

Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.

 

Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.

 

Be available, be open to new solutions..

 

Of course if the pt is not following up in other ways, different issues.

 

Regards from open access heaven (and YES I still have pts going to Urgicares)

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired...

 

sorry to intrude on your day as we all get too many emails to start

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

 

 

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools..com=======

 

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com

=======

[Guest guest]

I wouldn't make it a habit of waiving copays.  It is against your contract with the insurer and you are committing insurance fraud.  Often times, the copay is less than allowable, so for patients with a high copay, you may have to issue refunds.  Please don't sell yourself short by waiving copays....

Pratt

 

Yeah! I had a new patient call me to say she called her insurance yesterday to ask they why they haven't paid me for the first two visits!  She said I better call because she didn't really get an answer she understood.  I rebilled it as I left off the 00 for the patient ID number but without the reminder I would have missed it.  Will be so glad when Amazing Charts gets their practice managment released.  I have two or three who get their EOB before I do and come pay me.

I have started charging nurse visits for every UA, BP recheck my nurse does.  Since my patients would not return for 3 months til the refill run out I waive the co-pay for those.  It may help.  I will start charging for sending records as everyone else is. 

I think I will update my policies as well.

Great work Carla! I may borrow portions of it!

To: Sent: Wednesday, January 25, 2012 1:26 AM

Subject: Re: coping with being all call 24/

 

Wow, very informative and detailed. I wish I have patients reminding me to bill them... Keep us posted please,Carla.

Thank you for sharing your process.

Wen

 

I just sent out the following in a newsletter to my patients. It has been very well received. I was a bit surprised at how well, in fact.  Now the question will be whether I will stick to my  new boundaries or cave to my first inclination to not charge for something that really doesn't take much time in and of itself but adds up to hours of unpaid time collectively.  But, my patients are very supportive and are now reminding me to bill them or they are asking what they owe for the phone call or whatever and saying they will send a check.

My next step is to move to an option that is a blend of a NCBF and Dr. Horvitz' model for those who would like more seamless care without the " per visit/interaction " fragmented payment system.  As Dr. Horvitz said, I won't know until I try it but either way, I won't be feeling resentful for giving away so much of my time.

I also formally announced that I'm implementing the " Antonucci refill model " - I just wasn't making headway trying to implement it one on one- but now its a breeze as the patient is expecting it. And in less than one week, people are already self-scheduling for their refill visits.

I will have all patients sign a copy of the formal policies as they come in, but the newsletter format has worked well.  I did my best to put the onus on myself rather than on my patients- and in truth, it belongs on me. It is not their fault that they accept what I give and then expect more when they perceive that I minimize the value of it by not charging appropriately. And, as I've learned in reading about marketing, perceived value is somewhat dependent on what you have to pay for something. Giving away care to the point where I become resentful is doubly damaging.

Here is what I sent out:

Dear  X:

I am updating several office policies and am listing the highlights in this newsletter. Some of these simply clarify aspects of how the office does business and some are significant new changes.

 

I have a vision of the primary care relationship that is both old-fashioned and somewhat radical/cutting-edge. In trying to achieve my vision, I've been stymied in finding the balance between your needs, my needs, and the requirements of the insurance companies. I have realized that if I am going to keep the practice going, I have to hold myself to some new boundaries.

 

I think you will find these new boundaries reasonable. If not, I really would like you to share your thoughts with me. There is a link to a feedback form at the bottom of this newsletter if you want to do so today.

 

 

Sincerely,

 Carla Gibson

Financial Policies 

 Here are highlights of financial policies for the office. New changes are in bold print:  

Copays are due at the time of service. If your insurance plan requires a " copay " rather than " co-insurance " , the copay is due at the time of service per your agreement with your insurance company.   

Discounts are available when paying in full at the time of service without billing insurance. These rates are posted on the website and are subject to change at any time. By requesting the discount, you are requesting that insurance not be billed. Receipts for these visits are not appropriate for sending to insurance on your own, but should be adequate to obtain reimbursement from Flex Plans and HSAs.    

Remainder balances (the percentage of the charge that you are responsible for after insurance has paid their part) are due within 15 days of the date of the first statement.    

When an account cannot be paid in full within 15 days, a FORMAL payment plan is required. When a formal payment plan is not in place, each subsequent statement that carries a balance forward will incur a $5 charge to cover the cost of statement management.    

Formal Email and Phone visits are available and accessible through the website as Virtual Visits. I encourage you to utilize the formal system through the website so that my

time is reimbursed appropriately.

If you choose not to utilize the structured access to these visits available through the website, I reserve the right to bill for a visit when I have done the work typically contained in a visit. These type of visits, whether billed as a visit or not, incur malpractice liability risk and require the same type of time-consuming documentation as an office visit. In reality, it takes more skill to safely conduct a virtual visit than an office-based visit.

If you utilize the formal access to a Virtual Visit and I determine that the extent of the visit does not meet my criteria for a visit, there will be no charge and, if needed, I will refund any payment you have made. 

 

Most insurance plans do not cover these visits. It is your responsibility to understand your coverage. If you ask me to bill your insurance company for an email or phone visit and your insurance company indicates this is a non-covered service, there will be a $5 billing charge applied to your account. There is information on how to check regarding your insurance coverage on the website Virtual Visit page.   

 

I now charge for completion of forms, pre-authorization phone calls, and writing letters on your behalf when not done during an office visit. These charges are not covered by insurance and will be direct billed to you. Charges vary depending on amount of time spent. 

Refills for medications requested outside the time of an office visit will incur a charge of $10- see the section on Prescription Refills further on in this newsletter.

Preventive care vs Problem oriented care:

I'm finding there is a lot of confusion about billing for preventive care now that more insurance plans are reimbursing for this care, often without any out of pocket expense to you. Preventive care is basically for screening and counseling about how to stay healthy. It is NOT care or advice that deals with a problem. For example, coming in for a breast exam and pap is a preventive care visit. If you bring in your lab results from a workplace screening and we review those and find them to be normal, it's still a preventive care visit. But what if the results are abnormal?

 

In a preventive care visit, the abnormal results would be identified as a problem and the appropriate " preventive " advice would be to return to the office for a problem visit to discuss treatment and recommendations.  

 

I personally don't like fragmenting care like that and it is often inconvenient for you. Thus, I usually try to cover the problem during the preventive visit.

 

But how many 'problems' should be covered in a preventive visit before a problem visit is also billed? The general rule of thumb is that if the amount of time spent on the problem extends the typical time spent by the average provider doing a preventive/wellness visit, then a problem visit should be billed in addition to the preventive visit. So, if a patient comes in for their once a year visit wanting their breast exam and pap, but also wanting to deal with knee pain, high cholesterol, and insomnia.... that clearly is going to require extra time and a problem visit will also be billed.

 

Please be aware that when we try to lump several problems into a preventive visit, it is not possible to do it all. A preventive visit alone takes about 30 minutes when done properly in my opinion. One simple problem usually takes about 15 minutes.. you can see how quickly we run out of time!

 

The change in my practice to take note of is that I will now be consistent in billing for problem visits in addition to preventive visits when the guidelines for both are met during one visit. You will see two charges for the date of service. Most insurances allow this billing practice. You will be responsible for the copay or co-insurance portion that insurance does not cover.

To:

Sent: Sunday, January 22, 2012 11:16 AMSubject: Re: coping with being all call 24/

 

Personally,   I wish this stuff weren’t so annoying.   I wish I/we could just figure out how to get paid for this stuff.   If it were worthwhile for us,   we’d jump for it,  especially if it were well worthwhile,  like most things.     Heck,  if calling in Septra at 6PM on a Friday gave me an extra $50,  I’d do it in a heartbeat and feel good about.  I’d welcome it.   But for free, I hate it.    Ditto for long e-mails.   Ditto for prior auth’s.    Ditto for incessant daily prescription refills.    Ditto for phone call consults.   

 

If anyone can figure out these boundaries and systematize fairness into these things,   I’d love to hear it.    And yep,   I am working on it.   I have to.   The money isn’t there anymore for universal charity and courtesy. 

 

-WK

From: Myria

Sent: Sunday, January 22, 2012 12:49 PM

To:

Subject: Re: coping with being all call 24/

 

 

Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay.  Unfortunately her previous calls of " wolf " made me decide to wait to return her call.  That's stress for me.  I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay.

 

To:

Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.

Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to.

AND I made appt for follow up of the hematuria next week.

 

Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you.

 

We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that).  I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com

 

Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.

Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way.

 

Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway.

 

Be available, be open to new solutions..

 

Of course if the pt is not following up in other ways, different issues.

 

Regards from open access heaven (and YES I still have pts going to Urgicares)

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired...

 

sorry to intrude on your day as we all get too many emails to start

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