Re: just need to express myself

January 20, 2012

The answer is: “Yeah and now mine is 150/90 because of these nonemergent phone calls”. Probably not even your patient, right? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of GordonSent: Friday, January 20, 2012 4:51 PMTo: practiceimprovement1Subject: 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

January 20, 2012

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=======

January 21, 2012

I don't think giving patients email or phone access is a problem at all--so long as you retain the privilege of billing/charging appropriately for the convenience and service that you provide by monitoring and answering such communications.Ken

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=======

January 21, 2012

Actually my experience is more in line with ’s. When we opened and operated our first site I started giving out my cell phone number and e-mail with some trepidation I must confess (e-mail not such a problem because most of my patients are too poor to have internet connection at home). My approach was if it gets too crazy I will simply change my number and that is that. To my surprise most my patients were very respectful of the use of the phone and the calls I got, except for my super anxious pt that though he was having an MI every other day, were very appropriate. By the way I did stop my anxious pt form going to the ER more often than not. As we open our second site (long story to be told off line to save you some time) in one week I plan to give my phone number and e-mail address to all my patients with explicit instructions of when to text and when to call (I even have a hand out explaining it in English and Spanish). Given the population I serve (very low income low literacy individuals) I will not be able to add the fee for this service but… se la vie Anyway these are my two cents on the subject… and I am sorry to hear your Friday was less than stellar J Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone " Don't ever let injustice go by unchallenged. " From: [mailto: ] On Behalf Of SetoSent: Saturday, January 21, 2012 12:42 AMTo: 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. 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 PMTo: 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=======

January 21, 2012

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=======

January 21, 2012

Let me add that I agree with and and others and think that email is the greatest thing in the world. I couldn't even have my practice without it. I have pounded in my patients head that email is my preference. I would say 90% of my patient communication is by email and that 10% is primarily folks that don't even have email access. For those that have email, nearly all use it with me. I think it is preferable for many reasons. First, is the asynchronous communication. What a waste of time trying to track someone down on the phone. Next is that for many issues, it's so much nicer to explain things by email and then a patient can go back and refer to it. I think it's especially good for lab results and review of medication lists. Finally, it's a way patients can feel comfortable asking a quick question that in other practices they wouldn't even have asked. I think my patients are much better educated because they ask more questions. I would say I see extremely few upper respiratory infections in the office now because most people email symptoms and most just need reassurance that it's a simple cold and review of symptomatic measures.

Like , I use an NCBF in the office and thus feel compensated for all the email work I do. Without the fee, I would still agree with all those benefits but I wouldn't have a practice (or be able to pay my mortgage for that matter) so the point is moot there.

In my anecdote yesterday, I wasn't the least bit annoyed that someone bothered to email about feeling poorly and their BP up from their baseline, even though there was nothing concerning. The patient in fact would have likely gone to the ED if I wasn't available which of course was unncessary. Anytime I can reassure someone and help them avoid ED visits (or even unneeded office visits) I think it's a great thing. What does get my goat is the concepts of repeat calls and emails. I don't understand why people feel that repeat emails/calls makes their issue more important, especially when my norm is responding to most everything with a matter of hours. Again, just a little pet peeve on an already tiring Friday but no way a black mark on the use of email in my practice

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

=======

January 21, 2012

I got it! When I am covering my co-covering doctor, I will often get a voicemail “marked as urgent”. Usually it’s a much need refill of a schedule 3 drug. Or similar to yours, I have a headache and my BP is high it’s 130/80…..And I’m thinking – this is my “urgent” call number already, so any call I get after hours is supposed to be “urgent” and you have to mark it urgent and ….it’s not even worthy of a weekend call as far as I am concerned. As many times as it happens, it still bugs me. B-R-E-A-T-H-E. Have a relaxing weekend! Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of GordonSent: Saturday, January 21, 2012 11:11 AMTo: Subject: Re: just need to express myself Let me add that I agree with and and others and think that email is the greatest thing in the world. I couldn't even have my practice without it. I have pounded in my patients head that email is my preference. I would say 90% of my patient communication is by email and that 10% is primarily folks that don't even have email access. For those that have email, nearly all use it with me. I think it is preferable for many reasons. First, is the asynchronous communication. What a waste of time trying to track someone down on the phone. Next is that for many issues, it's so much nicer to explain things by email and then a patient can go back and refer to it. I think it's especially good for lab results and review of medication lists. Finally, it's a way patients can feel comfortable asking a quick question that in other practices they wouldn't even have asked. I think my patients are much better educated because they ask more questions. I would say I see extremely few upper respiratory infections in the office now because most people email symptoms and most just need reassurance that it's a simple cold and review of symptomatic measures. Like , I use an NCBF in the office and thus feel compensated for all the email work I do. Without the fee, I would still agree with all those benefits but I wouldn't have a practice (or be able to pay my mortgage for that matter) so the point is moot there. In my anecdote yesterday, I wasn't the least bit annoyed that someone bothered to email about feeling poorly and their BP up from their baseline, even though there was nothing concerning. The patient in fact would have likely gone to the ED if I wasn't available which of course was unncessary. Anytime I can reassure someone and help them avoid ED visits (or even unneeded office visits) I think it's a great thing. What does get my goat is the concepts of repeat calls and emails. I don't understand why people feel that repeat emails/calls makes their issue more important, especially when my norm is responding to most everything with a matter of hours. Again, just a little pet peeve on an already tiring Friday but no way a black mark on the use of email in my practice 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. WKFrom: Seto Sent: Saturday, January 21, 2012 12:42 AMTo: 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. 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 PMTo: 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=======

January 21, 2012

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=======

January 21, 2012

,

I think our community is similar - fairly affluent, but not willing to pay extra. I had a patient (who is transferring care to another PCP) complain just this week that we charge $20 for records. I bet his salary is double what Steve is making (not to mention that I work as an unpaid volunteer!). Somewhere along the line, many people have come to the conclusion that they should get everything for free because they pay insurance. Again, same thread that we have hashed over and over on this list of insurance getting in the way of real patient care.

We are also beginning to think about limiting the number of diagnosis per visit. We are getting pounded with Medicare RAC audits because we do a lot of 99214's. They are all justified because of complexity and/or time, but the fact that we have to take time to justify each one is onorous.

I have found that patients are willing to pay on a case-by-case basis for phone visits. Even if it costs more than their copay, it takes the patient less time to answer the phone and talk to the MD for a few minutes than it does to drive in, check in, have the MA take vitals, see Steve, and the drive home or back to work. We stopped doing evisits last June (I think Steve had done 3 in 6 years).

I hope you have a busy week this week!!!

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 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

-- Pratt

January 21, 2012

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?All patients have access to email I would say less than half can use email/a computer They have access for brief questions or making appointments Longer than that, I redirect .It is no differnt than the phone and a damn sight easier for me

Th e poorer ones on medicaid will come in if they have gas, as cannot afford 30.00 Mcr also . Self pay find it cheaper to do evisits . Private insurance folks will do evisits also too.

Noone is charged for a breif email Evisits are particular, involve a change in care plan or a prescription . I have a form to fill out you can see jeanantonucci.com it is all there. I take a templated hx etc. .for bp or dm sinusits uti conjunctivitis .Smetimes occurs with a digital photo . HAve done a couple of cellulitis One a little girl who was on west Coast and Dad gave me hx and sent photo.One a facial cellultis recurrent after neck ca and he is 1 hr away with long hrs.

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. I wouldnt either It is no different than calling . I have a friend who laughing says we should pay people to use email. Now ,MaIne has THE highest insurance premiums in the country Which the head of the Medical Association says means we have the highest on the globe. On the globe! I have 33% of the area here on medicaid. Nothing i s easy.With that stuff coming out of folks pockets how dare I ask them pay me to email me?? I would miss my doc if she did the NCBF but I couldnt do it) I piss people off when I ask them to pay for their records becasue they are moving!!

NCBF for same day access, 24 hr phone calls, longer appts, what I am doing now, duh. again overwhelmingly NO. Not even 75/month. Patients deserve to get those things Because WE cannot survive does = patietn should fork it over. THAT'S THE PROBLEM! I am not having an easy time of it here LASt few weeks visits way down I am frightened so I spread the word I take extra precepting work I consider any option I can think of and there are few.

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.

I am sorry you are having trouble The thing in my own opinion is not to identify that patients have to solve the problem that the system has beset US with. WE could all do alot better as docs and across specialites (don't hold your breath) to work as docs to fix the problem. It is still a long ways away. I deeply resent docs in my own field taking home twice what I do but what am I gonna do? I will never be without work and a bag lady .I alwasy have some options though I may not like them (oklahoma? new Zealand? prisons? the VA again)and I could not stand charging a ncbf even if in area that could bear it as it is not consistent with who I am so I plod on.I mean waddya gonna do?

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 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

January 21, 2012

, 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>

>

> Â

>

> Â

>

> Thatâ€™s definitely the problem with blanket e-mail access.Â Â Â You get

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

with a phone/answering message that says if itâ€™s an emergency go to the

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

the patientâ€™s ball court,Â where it ought to be.Â Â

> Â

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

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

> Â

> WK

>

> Â

>

> From: Gordon

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

> To: practiceimprovement1

> Subject: just need to express myself

> Â

>

> 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...

> Â

> 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>

>

> --

>

> Â Â Â MD

> Â Â Â

> ph Â Â fax

>

January 21, 2012

" I could not stand charging a ncbf even if in area that could bear it as it is

not consistent with who I am so I plod on. I mean waddya gonna do? "

you seem to be implying that it is greedy to charge a NCBF to folks who

can afford it when we are giving them service that, while " everybody deserves

it, " is still way above and beyond what they can get elsewhere. That is just not

true. The reason they cannot get those deserved services elsewhere is because

insurance companies do not pay enough to make it financially feasible. Even with

our low-overhead business models, many of us cannot make a sustainable living on

what the insurers are paying us, combined with all the extra work they require

us to do. So, if a doc charges extra for the simple purpose of staying in

business to be able to continue providing those services, that is not greed.

That is just doing what is necessary to continue caring for patients in the way

we feel they deserve. Of course it would be better if we could change the

system, but that certainly isn't going to happen soon enough to save many of us,

no matter how optimistic the folks at the AAFP try to be!

These discussions are depressing, but I'm glad we are having them. I want the

IMP wannabees to know that it is VERY difficult to make an IMP work in a

low-income area. If I had known, I might have been smart enough to set up shop

in the university town 25 miles away, where I think I could have made a NCBF

work. ---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/?cclick=EmailFooterClean_51>

> >>> 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>

> >>> 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>

> >>> 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>

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

> >>> =======

> >>>

> >>

> >

> > --

> >

> > MD

> >

> > ph fax

> >

>

> --

>

> MD

>

> ph fax

>

January 21, 2012

, what kind of 5010 issues are you experiencing since Jan 1?

WK

From: magnetdoctor@...

Sent: Saturday, January 21, 2012 2:34 PM

To:

Subject: Re: just need to express myself

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 itBear 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

=======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=======

January 21, 2012

Naw, I am not implying any such thing I do hold that all patietns deserve the types of care being marketed to cover these fees Time with your doc?? check. Access? check..The usual experience of care is not very good in many places but is however fine in others There are places where insurance pays fine I believe..

I do not support charging patietns extra to give what usual care should be is my point. I understand it is what some docs are needing to do . I am say it is not sustainable as a nationwide model Docs talk about these things becasue they are tired and downtrodden

I get that There will always be third party payors and there should be, ones that are accountable and structured far better than -here I can say greedy now- the greedy blood suckers that control us now.

It is the system that is broken We struggle to find individual solutions to survive but need global solutions We are divided and are conquered. I unsderstand what patietns cannot get . I cannot get good care! I have had many health care experiences that are plain lousy I am trying to figure out how we can do better. ..

Asking patients t o further foot the bill to get what they deserve will get us a tiered system of care for just the basics -which widens disparities .. That 's what i think.I am sure someone will now verbally slaughter me:)

Jean

" I could not stand charging a ncbf even if in area that could bear it as it is not consistent with who I am so I plod on. I mean waddya gonna do? "

you seem to be implying that it is greedy to charge a NCBF to folks who can afford it when we are giving them service that, while " everybody deserves it, " is still way above and beyond what they can get elsewhere. That is just not true. The reason they cannot get those deserved services elsewhere is because insurance companies do not pay enough to make it financially feasible. Even with our low-overhead business models, many of us cannot make a sustainable living on what the insurers are paying us, combined with all the extra work they require us to do. So, if a doc charges extra for the simple purpose of staying in business to be able to continue providing those services, that is not greed. That is just doing what is necessary to continue caring for patients in the way we feel they deserve. Of course it would be better if we could change the system, but that certainly isn't going to happen soon enough to save many of us, no matter how optimistic the folks at the AAFP try to be!

These discussions are depressing, but I'm glad we are having them. I want the IMP wannabees to know that it is VERY difficult to make an IMP work in a low-income area. If I had known, I might have been smart enough to set up shop in the university town 25 miles away, where I think I could have made a NCBF work. ---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/?cclick=EmailFooterClean_51>

> >>> 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>

> >>> 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>

> >>> 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>

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

> >>> =======

> >>>

> >>

> >

> > --

> >

> > MD

> >

> > ph fax

> >

>

> --

>

> MD

>

> ph fax

>

-- MD ph fax

January 21, 2012

No, you certainly don't deserve to be slaughtered. You are one of the

Good Guys! I admire you for pursuing your quest for system change, when I can't

even keep up with my day-to-day work. I'm just searching for something that

will help us survive NOW, instead of all this bureaucrat-speak coming out of CMS

and even the AAFP about valuing quality of care over quantity and starting pilot

programs that will take years and documenting our value with reams of paperwork

only after we let ourselves all get bought up by hospitals...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/?cclick=EmailFooterClean_51>

> > > >>> 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>

> > > >>> 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>

> > > >>> 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>

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

> > > >>> =======

> > > >>>

> > > >>

> > > >

> > > > --

> > > >

> > > > MD

> > > >

> > > > ph fax

> > > >

> > >

> > > --

> > >

> > > MD

> > >

> > > ph fax

> > >

> >

>

> --

>

> MD

>

> ph fax

>

January 21, 2012

RE making pts follow procedures, is access resonable to give?

I still use an answering service, cost now about $90 -- they text messages into my phone for after hours (and also Wed and Fri afternoons when at a satellite and my main admin office is closed up from the morning)

I also use RelayHealth as a secure "HIPAA" portal -- about $22/month. Those who are hesitant about emails may consider that.

I do call pts back on my cell phone, and sometimes they then call me directly on it, but I discourage that.

I encourage them to call when ill, and I "fit them in" or treat them as need be...implied is that weekends I'd have less availability.

My experience after 8 years of this is that if you give "open access" you get less calls...but in bad weather, like this weekend in Western PA, I got a few on Friday evening and this AM.

I try to be as available as possible, and give same day access/next day access to limit inappropriate calls. But you'll still get 'em.

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=======

January 21, 2012

RE why is cash flow lower?

Deductibles higher? Think fed kept monies back for a few weeks as they weren't sure about the reduction in Medicare.

Matt in Western PA

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=======

January 22, 2012

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>> > Ã‚ > > Ã‚ > > > ThatÃ¢â‚¬â„¢s definitely the problem with blanket e-mail access.Ã‚ Ã‚ Ã‚ You get stupid e-mails and then you feel obligated to respond.Ã‚ Ã‚ Ã‚ On the other hand, with a phone/answering message that says if itÃ¢â‚¬â„¢s an emergency go to the ER,Ã‚ Ã‚ otherwise wait til Monday,Ã‚ Ã‚ you relax better because you put it in the patientÃ¢â‚¬â„¢s ball court,Ã‚ where it ought to be.Ã‚ Ã‚ > Ã‚ > I have given e-mail access to a handful of patients and I universally regret doing so.Ã‚ Ã‚ Ã‚ Having done so,Ã‚ I have a problem to solve.Ã‚ Ã‚ > Ã‚ > WK > > > Ã‚ > > From: Gordon > Sent: Friday, January 20, 2012 4:50 PM > To: practiceimprovement1 > Subject: just need to express myself > Ã‚ > Ã‚ > > > 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... > Ã‚ > 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 > ======= > Ã‚ > > > Ã‚ > > > > > ======= > 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>> > > > -- > > > > Ã‚ Ã‚ Ã‚ MD > Ã‚ Ã‚ Ã‚ > Ã‚ Ã‚ Ã‚ > ph Ã‚ Ã‚ fax > >

January 22, 2012

Ok, here is my two cents!

Patients want only a few things from their doc.

1) trust - especially that they are putting their interests ahead of any third

party.

2) access - they want to know that they can be seen for what they feel is urgent

care at a convenient time. They would rather be seen in our office than have to

go to an ER or specialist office.

3) knowledge - this I will assume we have

My practice is made up of three components.

1) self pay at time of service

2) yearly retainer contracts, about 1/3 the cost of concierge practices

3) traditional Medicare

When I switched to this style in 2008, I initially had my non-medicare patients

who wanted the retainer portion pay a yearly fee of about $300 and a $25 copay

per visit. My patients who trusted me stayed with me. Others remained self pay

or left.

In 2009 I raised my yearly fee, but ended the copay portion and this part of the

practice grew substantially. The feedback I get is they trust that I am solely

working for them, AND, they have access to me whether in office same day

appointments, by phone in office, cell phone, email or text messaging. This year

I added Skype visits.

The patients who remain self pay all pay a $25 yearly fee at their first visit

of each year to cover mandated state and federal requirements such as Hippa and

emr's, etc... Only had two patients push back, and when I explained why, they

paid and remain in my practice.

My traditional Medicare patients do not get charged the $25 fee.

What I have learned in the 4+ years since transitioning to this style is that

patients want, trust, knowledge and access. If they get these three things, they

will remain with you and refer their friends and family. They do not want to be

nickel and dimed.

Yes this works in my area, and may not work in yours. But you never know unless

you try!

Steve

stown, NJ

> > > >>>

> > > >>> 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/?cclick=EmailFooterClean_51>

> > > >>> 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>

> > > >>> 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>

> > > >>> 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>

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

> > > >>> =======

> > > >>>

> > > >>

> > > >

> > > > --

> > > >

> > > > MD

> > > >

> > > > ph fax

> > > >

> > >

> > > --

> > >

> > > MD

> > >

> > > ph fax

> > >

> >

>

> --

>

> MD

>

> ph fax

>

January 22, 2012

Steve,Your two cents makes a whole lot of sense (and hopefully cents!). Rhonda To: Sent: Sat, January 21, 2012 6:32:01 PMSubject: Re: just need to express myself

Ok, here is my two cents!

Patients want only a few things from their doc.

1) trust - especially that they are putting their interests ahead of any third party.

2) access - they want to know that they can be seen for what they feel is urgent care at a convenient time. They would rather be seen in our office than have to go to an ER or specialist office.

3) knowledge - this I will assume we have

My practice is made up of three components.

1) self pay at time of service

2) yearly retainer contracts, about 1/3 the cost of concierge practices

3) traditional Medicare

When I switched to this style in 2008, I initially had my non-medicare patients who wanted the retainer portion pay a yearly fee of about $300 and a $25 copay per visit. My patients who trusted me stayed with me. Others remained self pay or left.

In 2009 I raised my yearly fee, but ended the copay portion and this part of the practice grew substantially. The feedback I get is they trust that I am solely working for them, AND, they have access to me whether in office same day appointments, by phone in office, cell phone, email or text messaging. This year I added Skype visits.

The patients who remain self pay all pay a $25 yearly fee at their first visit of each year to cover mandated state and federal requirements such as Hippa and emr's, etc... Only had two patients push back, and when I explained why, they paid and remain in my practice.

My traditional Medicare patients do not get charged the $25 fee.

What I have learned in the 4+ years since transitioning to this style is that patients want, trust, knowledge and access. If they get these three things, they will remain with you and refer their friends and family. They do not want to be nickel and dimed.

Yes this works in my area, and may not work in yours. But you never know unless you try!

Steve

stown, NJ

> > > >>>

> > > >>> 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/?cclick=EmailFooterClean_51>

> > > >>> 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>

> > > >>> 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>

> > > >>> 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>

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

> > > >>> =======

> > > >>>

> > > >>

> > > >

> > > > --

> > > >

> > > > MD

> > > >

> > > > ph fax

> > > >

> > >

> > > --

> > >

> > > MD

> > >

> > > ph fax

> > >

> >

>

> --

>

> MD

>

> ph fax

>

January 22, 2012

I think the first problem a lot of us have is that we get stuck working for people who either don't value our services enough to pay for them or who lack the ability to pay for them. It's reasonable to bend over backwards to take crappy insurance reimbursements if you feel morally compelled to do so. But I don't think it's reasonable to take things so far that you go bankrupt in order to have the privilege of saving your fellow humans from themselves. If anybody else is in this position, I would seriously suggest you think long and hard about what your time and your life are worth, and structure your business accordingly. If nothing else, you won't be skewing the local market so much that you also prevent all the other local doctors from making a living. :^) / 2. Only when the public perceives primary care to be something worth paying for will the profession regain the respect it so desperately needs. And I think the only way to get to that point... Is to run things so that people have to pay for it. Really. The liberating thing is that then we're free to earn their dollars in creative and patient-value-centric ways.Ken Stone

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

January 22, 2012

Matt

No, the $25 fee is just assumed to be part of the yearly retainer fee.

For retainer patients, there is no copay.

Steve

> > > > >>>

> > > > >>> 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/?cclick=EmailFooterClean_51>

> > > > >>> 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>

> > > > >>> 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>

> > > > >>> 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>

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

> > > > >>> =======

> > > > >>>

> > > > >>

> > > > >

> > > > > --

> > > > >

> > > > > MD

> > > > >

> > > > > ph fax

> > > > >

> > > >

> > > > --

> > > >

> > > > MD

> > > >

> > > > ph fax

> > > >

> > >

> >

> > --

> >

> > MD

> >

> > ph fax

> >

>

January 24, 2012

I use Medrium, which is a billing and scheduling software company, ASP. They assured us multiple times they were ready, and compliant. However was informed by my staff person that handles billing that she had about 2000 in claims since early Jan that were denied, and had to be resubmitted, based on error codes from their end, not ours. Can't tell you more about it than that, except on the sign in page it has a red highlight saying, yes they are experiencing more denials than expected if it is this one code set, they list, you have to do X to get it to go through, and it must be resubmitted.

To: Sent: Saturday, January 21, 2012 3:30:45 PMSubject: Re: just need to express myself