Re: just need to express myself

[Guest guest]

Walter,I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with. I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ("and by the way, since there are many causes of fatigue, let's schedule an appointment"), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better. If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services.Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right?I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow. SetoSouth Pasadena, CA

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=======

[Guest guest]

, there’s the rub. I suppose I wouldn’t mind corresponding by e-mail if I were being paid, which as of now, I’m not. I have thought about instituting some sort of pay structure. It appears it is becoming more and more necessary to do so for the millions of do-dad services we provide in the face of decreasing reimbursement and increasing overhead. Like most doctors, we are gradually instituting charges for things like filling out forms and such. But it is challenging figuring out how to do so, what to charge for and what to continue to do for free, and how to draw boundaries, especially for old people of which we have a lot of. I’m all ears on how others handle these things.

I’m particularly sensitive to this overhead stuff because our revenues are down markedly thus far year to date – compared to past years to date. Not sure why. Patient flow is unchanged. We are 5010 compliant. Claims are clean and flowing. My impression is that payors are slowed down in payment while we have to keep our doors open as usual.

As for e-mails, I really don’t mind them if they are short communications. It’s the silly multi-paragraph stories that get old. And, no, most of the time I don’t read them until actually the patient comes to the office and then I read them in front of the patient and address them as necessary.

WK

From: Seto

Sent: Saturday, January 21, 2012 12:42 AM

To:

Subject: Re: just need to express myself

Walter, I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with.

I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ("and by the way, since there are many causes of fatigue, let's schedule an appointment"), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better.

If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services.

Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right?

I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow.

Seto

South Pasadena, CA

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=======

[Guest guest]

As far as I am concerned email is a gift from the gods1. It is a far better thing than the phone- I can get to it  when i want and- documents. 2 People will be inappropriate occasionally in any venue( its the person not the  medium)

 I have  been doing email for 5 yrs- three people have been inappropriate One went on at length with drama  and left th e  practice when, though I was seeing her for 5.00/visit through a local program she was paying cash from her rich  boyfriend to get liposuction and the plastic surgeon wanted me to order a lipid  profile I told him to order his own labs and she left. I reported her to the program  for  letting them think she had no access to money

 2 is a woman who is needy and I tell her to brief and then she is, then she gets  long again, then I answer in a less timely fashion and say less myslef ,I say email is best for appointment making and brief appointment's

 #3 is a guy who has incredible thalidomide type deformities and he just w ants me to document and I do. I say be brief and he tries but he is overwhelmed and it is not  a big deal I control the mail when I see it They have it i n writing and can reread it and I do not have to be on the damn phone where it is hard ot get off.

 I  would like to be paid differently and a lot  better but  even   evisits for whici I charge  annoy me-- the owrk to do  to do the receipt etc I would like money divorced from care at the time of the careMy patietns have my emails cellphone and home phone and alot of em know where i live Its fine

 Visits way off here Yesterday a new patient contact I really needed him Could not reach him for return call  x 2 So on my second return call I left him my email  Woke up to  his email  so now I have captured that patient Yay.( patient email is a differnt account that this personal one Occasionally someone shows up the wrong place and I move  em over)A long lost friedn of ours just  found us becasue I have a website with a patient email.

I conclude that Its not the email

its human beings and the structure of health carePrimary care really sucks right now in the  US of A. I am amazed you all get up and go to work every day/:)

 

I'm just getting started but have this in my policies: " There are two ways to communicate with me outside of office visits: email via the online contact form and phone. Email is the preferred route and will get priority over phone messages.

Email is most appropriate for:

Your intial contact with me;

Follow-up questions within 2-4 weeks of a visit;

Scheduling issues that cannot be handled by the online scheduler.

Email is not appropriate for:

Any emergency -- call 911 and /or go to the Emergency Room !!Seeking detailed advice for a new or old problem;Seeking any email medical advice if I have not seen you within one year;

Ordinarily there is no charge for brief emails. However, I reserve the right to charge for frequent or lengthy e-mail messages. For

multiple responses and/or for lengthy emails that require a lot of time

to compose or research, I will charge $55 per 15 minutes of time. " The problem is, I have yet to charge .... Perhaps I will take it up in their follow up visit. At least I have this policy to refer them back to should their emails become too much. And, if they read this, perhaps it will help curb their emails. Still, I much prefer email to phone calls. Will see..

Anne

 

,   there’s the rub.    I suppose I wouldn’t mind corresponding by e-mail if I were being paid,  which as of now, I’m not.   I have thought about instituting some sort of pay structure.   It appears it is becoming more and more necessary to do so for the millions of do-dad services we provide in the face of decreasing reimbursement and increasing overhead.   Like most doctors, we are gradually instituting charges for things like filling out forms and such.   But it is challenging figuring out how to do so,  what to charge for and what to continue to do for free,  and how to draw boundaries,  especially for old people of which we have a lot of.  I’m all ears on how others handle these things.  

 

I’m particularly sensitive to this overhead stuff because our revenues are down markedly thus far year to date – compared to past years to date.   Not sure why.    Patient flow is unchanged.   We are 5010 compliant.  Claims are clean and flowing.   My impression is that payors are slowed down in payment while we have to keep our doors open as usual.  

 

As for e-mails,  I really don’t mind them if they are short communications.   It’s the silly multi-paragraph stories that get old.  And, no,  most of the time I don’t read them until actually the patient comes to the office and then I read them in front of the patient and address them as necessary.

 

WK

From: Seto

Sent: Saturday, January 21, 2012 12:42 AM

To:

Subject: Re: just need to express myself

 

 

Walter, I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with.

 

I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ( " and by the way, since there are many causes of fatigue, let's schedule an appointment " ), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better.

 

If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services.

 

Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right?

 

I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow.

 

Seto

South Pasadena, CA

 

 

 

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=======

--      MD          ph    fax

[Guest guest]

We charge for forms completion, but it is not the Medicare patients that need forms filled out.  It is the young, healthy, insured patient whose insurance will only allow him/her to go to a certain lab, or requires a certain drug be used in formulary.  For forms, we charge $20.  There might be more of this as Medicare Advantage plans become more popular, but our Medicare patients are a little more willing than our commercial insurance patients to try the formulary or use the right lab than not.  

For phone visits (which go on the schedule just like an office visit), we charge by time.  I think our lowest charge is $45 for up to 20 mins.  Those are becoming more frequent because patients like the convenience.  Once I explain that it might not be covered by insurance, and that they would be responsible for payment, they think about it ($45 is more than most copays), but the convenience factor (patient last week has 3 young kids and would have had to pay not only her $20 copay, but hires a sitter for $15/hr) draws them in.  I still bill it to insurance, and then invoice the patient for the balance since I haven't done enough of them to figure out which plans pay and which ones don't.

Revenues for us are always down in January because of the lag time for deductibles.  Most of our contracts require us to send the claim and wait for EOBbefore we can bill the patient.  And my PT front desk person would not be able to figure it out. So less work for me this way, just delays payments.  February is always higher thanJanuary because we start to get those deductibles, and by March we start to even out again. 

We don't do straight email because of Steve's irrational HIPAA Police fear.  So we use a Patient Portal.  Patients have to log in, but it comes straight into our EMR and is automatically documented in their chart (before we had to copy and paste and remember to do so) and works like email on our side, just on the internal EMR email.  We don't charge for the portal because it is less work for us than phone calls :-)

Pratt

 

,   there’s the rub.    I suppose I wouldn’t mind corresponding by e-mail if I were being paid,  which as of now, I’m not.   I have thought about instituting some sort of pay structure.   It appears it is becoming more and more necessary to do so for the millions of do-dad services we provide in the face of decreasing reimbursement and increasing overhead.   Like most doctors, we are gradually instituting charges for things like filling out forms and such.   But it is challenging figuring out how to do so,  what to charge for and what to continue to do for free,  and how to draw boundaries,  especially for old people of which we have a lot of.  I’m all ears on how others handle these things.  

 

I’m particularly sensitive to this overhead stuff because our revenues are down markedly thus far year to date – compared to past years to date.   Not sure why.    Patient flow is unchanged.   We are 5010 compliant.  Claims are clean and flowing.   My impression is that payors are slowed down in payment while we have to keep our doors open as usual.  

 

As for e-mails,  I really don’t mind them if they are short communications.   It’s the silly multi-paragraph stories that get old.  And, no,  most of the time I don’t read them until actually the patient comes to the office and then I read them in front of the patient and address them as necessary.

 

WK

From: Seto

Sent: Saturday, January 21, 2012 12:42 AM

To:

Subject: Re: just need to express myself

 

 

Walter, I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with.

 

I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ( " and by the way, since there are many causes of fatigue, let's schedule an appointment " ), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better.

 

If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services.

 

Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right?

 

I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow.

 

Seto

South Pasadena, CA

 

 

 

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

=======

[Guest guest]

I charge 30.00 I used ot charge 25  but foudn it was all too annoying do upped it Bear in mind I live where noone has money  and money is  a very touchy subject  ALso I think about what I would pay  I would not pay to email my doc to get an appointment when that is easier for both of us  than the phone, I would never pay a NCF as I pay through the nose for   insuracne that gets me nothing ,  but 30.00  to take care of a UTI sinusitis etc   to not have to t go in wait sit there  tale time away- sure  reasonable value  God I wish I could  have pap  smears by email

sorry haha

 

I have been mulling this idea of charging for emails via a patient portal.  How much are people charging per person for emails?  Ideally I would like most all of my patients to use secure email to contact me, but I don't want to make it mandatory. So, I am debating what to charge so that most of my patients will sign on to use this feature.  Any advice would be appreciated on this topic.

 

Lee

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=======

--      MD          ph    fax

[Guest guest]

Walter,I can see why you don't like e-mail if they are uncompensated and really long. Even with my Non-covered Benefits Fee, I have charged patients extra for really long e-mails or for managing a new problem. For example, if I have to prescribe a new medication for someone because of a new e-mail message (like for acute conjunctivitis or simple UTI), I'll charge a $30 e-mail consultation fee. CPT code 99441 but I don't bother submitting it because insurance doesn't pay anyways. I tell patients this at the time and they are fine with paying because it saves them a trip to the office. For really excruciatingly long e-mails, I've charged $50 per 15 minutes of time it takes me to read and respond. But how to institute a fee? I think there are 2 strategies I've seen:1. Per use fee2. One all-inclusive feeThe rationale for the per use fee is that it is more fair because not everyone sends e-mail. People get charged for whatever they use, and if they don't use it, they don't get charged. The problem with that is that some patients will feel they are being nickel and dimed, so this may damage your reputation. Would you charge per actual e-mail message, or by conversation thread? And logistically, you would have to keep track of who to charge. Plus how would you collect the money? Send a statement right away or add it to their account? Ask for a credit card, or keep one on file? That is why I chose to institute an annual Non-covered Benefits Fee (NCBF). Some practices charge a fee by the month. Other practices have called their fee by other names, such as a Technology Assessment Fee. I was told that you can't call it an Administration Fee because technically the insurance companies consider the rates they pay to include compensation for administration of patient visits, so they would consider an Administration fee to be double dipping. But with my annual fee, I don't have to worry about charging the patient every time they send an e-mail, and I don't feel like I am doing uncompensated work. The downside is that you will lose some patients who don't want to pay extra for something they either don't use or have been getting for free. The upside is that you end up with patients who really appreciate and want this kind of service. I had questions about the compatibility with a NCBF and Medicare, so I chose to opt out of Medicare at the time I instituted my NCBF. But Gordon charges his NCBF and takes Medicare and has not had any problems, right? I think it depends on how you word the NCBF agreement as to what the fee pays for. Obviously it should not pay for anything that Medicare already covers. SetoSouth Pasadena, CA

, there’s the rub. I suppose I wouldn’t mind corresponding by e-mail if I were being paid, which as of now, I’m not. I have thought about instituting some sort of pay structure. It appears it is becoming more and more necessary to do so for the millions of do-dad services we provide in the face of decreasing reimbursement and increasing overhead. Like most doctors, we are gradually instituting charges for things like filling out forms and such. But it is challenging figuring out how to do so, what to charge for and what to continue to do for free, and how to draw boundaries, especially for old people of which we have a lot of. I’m all ears on how others handle these things.

I’m particularly sensitive to this overhead stuff because our revenues are down markedly thus far year to date – compared to past years to date. Not sure why. Patient flow is unchanged. We are 5010 compliant. Claims are clean and flowing. My impression is that payors are slowed down in payment while we have to keep our doors open as usual.

As for e-mails, I really don’t mind them if they are short communications. It’s the silly multi-paragraph stories that get old. And, no, most of the time I don’t read them until actually the patient comes to the office and then I read them in front of the patient and address them as necessary.

WK

From: Seto

Sent: Saturday, January 21, 2012 12:42 AM

To:

Subject: Re: just need to express myself

Walter, I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with.

I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ("and by the way, since there are many causes of fatigue, let's schedule an appointment"), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better.

If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services.

Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right?

I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow.

Seto

South Pasadena, CA

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=======

[Guest guest]

,RelayHealth is an online portal that I used to use, and their default fee for a WebVisit was $30. This is how much I charge for any e-mail or phone consultation where I have to call in a new prescription for someone. But you should charge what you feel is a fair price. You could see if anyone else in your area does this and see what they charge, maybe? SetoSouth Pasadena, CA

I have been mulling this idea of charging for emails via a patient portal. How much are people charging per person for emails? Ideally I would like most all of my patients to use secure email to contact me, but I don't want to make it mandatory. So, I am debating what to charge so that most of my patients will sign on to use this feature. Any advice would be appreciated on this topic.

Lee

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=======

[Guest guest]

I recently got up the courage to start charging for telephone and e-mail visits,

since I decided that I would lose too many patients if I instituted a

non-covered benefits fee. I set my price at $20 for less than 15 minutes of

total work time (which my husband/office manager argued was too low), and I will

only do very simple stuff over the phone. Unfortunately, I felt obligated to

run it through the patient's insurance, and my local Blues covered it, but

allowed only $15!!! A dollar a minute. GREAT. We really can't win!---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 <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 <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 <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 <http://www.pctools.com/?cclick=EmailFooterClean_51>

> =======

>

[Guest guest]

Let me correct that. We can't win within the insurance system. I guess I'll

keep considering that NCB fee! (MUST NOT LET LEARNED HELPLESSNESS OVERWHELM

ME!)---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 <cygnusdave@>

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

> > =======

> >

>

[Guest guest]

Okay so let me get this straigth, you have no NCF yearly fee, patients too poor, but they will pay for one time emails? Do all the patients have access to your email, but only get charged if it is a certain length or what?

I am floored, I live in a pretty affluent rural community, where people work for Microsoft, Paccar, Alaska Airlines, and Boeing. I surveyed patients about 100-150 in October about what they would be willing to pay for.

Email access: overwhelmingly NO.

NCBF for same day access, 24 hr phone calls, longer appts, what I am doing now, duh. again overwhelmingly NO. Not even 75/month.

Their feeling I think was they pay alot for their insurance and should get everything with just that. Not reality I know.

So I scrapped even offering limited email to those who were willing to pay.

But as I sit here, 5010 denials( their end not mine), slow Jan, and snow closure for a week, means next wk I have no income to pay my bills. For 2 yrs at least BOTOX has been subsidizing my medical practice. Medicine is no longer paying it's share of the overhead, and I am in the process of notifying patients that things are changing as far as appointments, that is no longer get to do 6 problems in 1 visit, etc. Maybe I should also implement email for those willing to pay.

I have only been doing phone visits for people who have no insurance, and no ability to f/u appropriately for starting on SSRI's. Only charging $25 for it, because it is people who can't afford it anyway. But perhaps I do need to even charge more for those.

To: Sent: Saturday, January 21, 2012 11:37:44 AMSubject: Re: just need to express myself

I charge 30.00 I used ot charge 25 but foudn it was all too annoying do upped it Bear in mind I live where noone has money and money is a very touchy subject ALso I think about what I would pay I would not pay to email my doc to get an appointment when that is easier for both of us than the phone, I would never pay a NCF as I pay through the nose for insuracne that gets me nothing , but 30.00 to take care of a UTI sinusitis etc to not have to t go in wait sit there tale time away- sure reasonable value God I wish I could have pap smears by emailsorry haha

I have been mulling this idea of charging for emails via a patient portal. How much are people charging per person for emails? Ideally I would like most all of my patients to use secure email to contact me, but I don't want to make it mandatory. So, I am debating what to charge so that most of my patients will sign on to use this feature. Any advice would be appreciated on this topic.

Lee

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=======

-- MD ph fax

[Guest guest]

I hear you. They gush but money is the real talker. That with the perception that doctors are rich, rich, rich! and a sense of entitlement "I already pay 600/month for my insurance, etc."

To: Sent: Saturday, January 21, 2012 8:00 PMSubject: Re: Re: just need to express myself

Yes, I am still considering it. On my most irritable days, I say "let the ones who don't like it GO", but then I get scared that they all will, even though they gush about how I'm not like "other doctors", yeah right I'm working 2 -3 jobs, not like other doctors to support this venture.

To: Sent: Saturday, January 21, 2012 2:36:10 PMSubject: Re: just need to express myself

, I'm not surprised that they responded to your survey that they would be unwilling to pay extra. We all want to get the best deal possible, for everything. It's human nature. If the affluence was there in my patient panel, I would just start charging the NCB fee and see what happens. Many will grumble and some will leave, but some of those will come back when they are reminded what it's like out there...Sharlene > > <blockquote>> >  > >  > > > 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 > ======= > Â > > > Â > > > > > ======= > 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 > ======= > > > > </blockquote>> > > > > </blockquote>> > > > > </blockquote>> > > </blockquote>> > > > -- > > > >    MD >    >    > ph   fax > >

[Guest guest]

HI Dave,

  I know how you feel.!!

Deb

 

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