Re: coping with being all call 24/

[Guest guest]

Teaching patients to not holler wolf takes a lot! I got burned last weekend when a patient who always waits til 5:15 or later on Friday to call for sniffles and headache and UTI's did the same. I decided to ignore it! She ended up at Urgent Care becasue she was bleeding. It did turn out to be UTI but I feel very bad for waiting to answer it til office hours.

So how do others cope with the being on call 24/7?

To: Sent: Saturday, January 21, 2012 11:34 AMSubject: RE: just need to express myself

I got it!

When I am covering my co-covering doctor, I will often get a voicemail “marked as urgentâ€. 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, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low 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.

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]

You know, what, Myria? Don't feel guilty! That's what UC's are for! Maybe

having to go there will make her remember to call during office hours next

time.---Sharlene

> >

> >

> >

> > 

> > 

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

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

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

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

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

> > 

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

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

> > 

> >WK

> > 

> >From: Gordon

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

> >To:practiceimprovement1

> >Subject: just need to express myself

> > 

> > 

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

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

now a call on my urgent line from someone wanting to know what to do about their

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

> > 

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

> >

> >

> >

> >

> >

> >=======

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

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

> >http://www.pctools.com

> >=======

> >

> >

> >

> >

> >

> >=======

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

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

> >http://www.pctools.com

> >=======

> > 

> > 

> >

> >

> >

> >

> >

> >=======

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

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

> >http://www.pctools.com

> >=======

> >

> >

> >

> >

> >

> >=======

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

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

> >http://www.pctools.com

> >=======

>  

>

[Guest guest]

Myria,

It not YOUR fault she ended up at the Urgent care...its her's. If she had called during business hours you would have handled it for her...hopefully with a visit which is what she is trying to avoid by calling so late. If she had been willing to pay to see you she would not have had to pay for the Urgent Care. I hope she learned form this!

Dannielle

To: " " < >Sent: Sat, January 21, 2012 2:47:09 PMSubject: Re: coping with being all call 24/

Teaching patients to not holler wolf takes a lot! I got burned last weekend when a patient who always waits til 5:15 or later on Friday to call for sniffles and headache and UTI's did the same. I decided to ignore it! She ended up at Urgent Care becasue she was bleeding. It did turn out to be UTI but I feel very bad for waiting to answer it til office hours.

So how do others cope with the being on call 24/7?

To: Sent: Saturday, January 21, 2012 11:34 AMSubject: RE: just need to express myself

I got it!

When I am covering my co-covering doctor, I will often get a voicemail “marked as urgentâ€. 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, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low 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.

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]



RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions.

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

[Guest guest]

I hope she did too. I wouldn't have minded handling it after hours if wasn't a routine pattern with her. Thanks, I was taking on fault that wasn't mine.

To: Sent: Saturday, January 21, 2012 8:42 PMSubject: Re: coping with being all call 24/

Myria,

It not YOUR fault she ended up at the Urgent care...its her's. If she had called during business hours you would have handled it for her...hopefully with a visit which is what she is trying to avoid by calling so late. If she had been willing to pay to see you she would not have had to pay for the Urgent Care. I hope she learned form this!

Dannielle

To: " " < >Sent: Sat, January 21, 2012 2:47:09 PMSubject: Re: coping with being all call 24/

Teaching patients to not holler wolf takes a lot! I got burned last weekend when a patient who always waits til 5:15 or later on Friday to call for sniffles and headache and UTI's did the same. I decided to ignore it! She ended up at Urgent Care becasue she was bleeding. It did turn out to be UTI but I feel very bad for waiting to answer it til office hours.

So how do others cope with the being on call 24/7?

To: Sent: Saturday, January 21, 2012 11:34 AMSubject: RE: just need to express myself

I got it!

When I am covering my co-covering doctor, I will often get a voicemail “marked as urgentâ€. 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, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low 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.

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]

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions..

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

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

[Guest guest]

Myria,Sometimes I have found it necessary to just dismiss recurrently abusive patients from the practice.  Quite frankly, if I hate them, and get upset every time I hear their name on a voicemail or see it in a text, then maybe I can’t be objective in her care anymore.  Just a thought. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Sunday, January 22, 2012 12:50 PMTo: Subject: Re: coping with being all call 24/ Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of " wolf " made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay. To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/  RE being available. Hmmmm... I had a pt call Friday evening, hematuria pressure.I knew her well. We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to. AND I made appt for follow up of the hematuria next week. Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you. We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way. Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway. Be available, be open to new solutions. Of course if the pt is not following up in other ways, different issues. Regards from open access heaven (and YES I still have pts going to Urgicares) Matt in Western PASolo since 2004FP since 1988 just need to express myself i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... sorry to intrude on your day as we all get too many emails to start=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======

[Guest guest]

Ooh just put the money in my account In large denominations:)Our job i smuch harder than we are paid for If only I had known  Though I would not have listened I can help with one or two  of these?1.I think you can get rid of refill request Walter by changing your work flow I never get requests for refills really rare   I do them at visits and when there are no more refills to be had that is the reminder to be seen People like this alot as they are all set and on automatic and because of open access they can get right in No more holding on to an appointment card they lose or canceling becasue there is a blizzard then   you have to call in some then reschedule then there is no room etc etc

 YOu could start  tomorrow Walter JUst do it at the visit I do admit I work hard at a visit  Every visit has a million parts with the prescrptions and check themed listand  the oh by the ways but it pays off in the end When they leave they are done

I have very few prior auths wither That could be my population or habits but if Ihave ot do one I try to make the patietn do most of the  work OR come in ans be there for a visit while I do the work

3 When they call you on Friday for Speta   can you say " sure I Can help you go to the website and cut and paste the evist Iwillcheck email in half an hrs and get that taken  care of for you " When I can fill my schedule I do fine here MY problem is too many PCPS here low reimbursement and the people who want to be seen for 5.00 go to a hospital practice where he docs make 2 x as much as me seeing people for free People are always moving to find work OR dying AND some transfer I cannot keep my schedule full !! augh If I am full evne mostly full I  do fine.

Cripes It is always something huh?.

 

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

 

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

 

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

 

 

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

 

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

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

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

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

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

 

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

 

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

 

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

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

 

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

 

Be available, be open to new solutions..

 

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

 

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

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

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

 

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

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

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

 

 

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

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

 

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

=======

--      MD          ph    fax

[Guest guest]

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

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

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

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

CCote

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions..

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

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

[Guest guest]

Patient's like this should just be discharged from this practice, if she doesn't get it after this she never will. I finally discharged someone last year, I had been dreading seeing for each visit. The final straw? When she came in with her daughter for the daughter to be a new patient, "chronic pain, discharged from the University pain clinic", wanting me to not only Rx her daughter's pain meds, but put them in HER (the mother's name) because the daughter had no insurance and couldn't afford. Needless to say I informed her this was against the law on many levels, and that she and her daughter could seek care elsewhere. People will keep pushing you, until you make a firm boundary, and then if they still push, out they go.

CCote

To: Sent: Sunday, January 22, 2012 12:33:36 PMSubject: RE: coping with being all call 24/

Myria,

Sometimes I have found it necessary to just dismiss recurrently abusive patients from the practice. Quite frankly, if I hate them, and get upset every time I hear their name on a voicemail or see it in a text, then maybe I can’t be objective in her care anymore. Just a thought.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of MyriaSent: Sunday, January 22, 2012 12:50 PMTo: Subject: Re: coping with being all call 24/

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

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



RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions.

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

[Guest guest]

Yep, the refill issues keep coming up, but that’s because there are so many permeations of them. 95% of refill requests are easy to deal with. 5% are tricky. What do you do about a medicare patient, as in elderly, who was just in a few days ago, you refilled 10 prescriptions for 90 days with three refills each, and they call back asking for two more that they forgot to ask for? you already spent an hour with them in the previous visit? How about the 85 yo guy that says “Doc, can you do me a favor? refill my prescriptions when I call? I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those? It really gets hard to keep track of?†That’s a pretty common scenario in our practice. How about a formulary change for the patient, non-medicare.

Personally, I like a prescription refill fee, but it won’t apply to the overwhelmed 80+ yo medicare patients.

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

CCote

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions...

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

 

Yep,  the refill issues keep coming up, but that’s because there are so many permeations of them.   95% of refill requests are easy to deal with.   5% are tricky.    What do you do about a medicare patient,   as in elderly,    who was just in a few days ago,  you refilled 10 prescriptions for 90 days with three refills each,   and they call back asking for two more that they forgot to ask for?then it s my fault that I screwe d up themed lis and I fix it IT will happen once and never again. 

  you already spent an hour with them in the previous visit?   How about the 85 yo guy that says “Doc,  can you do me a favor?   refill my prescriptions when I call?   I’m having a hard time keeping up with my wife’s 15 prescriptions and then mine added on top of those?   It really gets hard to keep track of?â€Â Â Â Â  That’s a pretty common scenario in our practice.   Not any easier for him to do it when you call ,iSilly  You do it at time of visit and explain why it is easier for him to have it DONE  See --patietns do not understand that it  isok to callthings in and nothave to pick them up Thats the missing piece  Just add to your scripts a macro for hold til they call for it Itis then EASIER for Mr r 85 yr old with a  old wife.Patietns aslo need education about the autoatedlines and refills and punching innumbers for new scripts but  does  not take long to teach .PAtietns are our partners not our enemies

 

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

 

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

 I  hope you can feel  better soon,Walter 

 

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

 

 

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

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

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

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

CCote

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

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

 

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

 

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

 

 

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

 

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

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

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

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

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

 

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

 

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

 

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

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

 

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

 

Be available, be open to new solutions...

 

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

 

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

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

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

 

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

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

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=======

--      MD          ph    fax

[Guest guest]

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

From:

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

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

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

I hope you can feel better soon,Walter

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

CCote

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions...

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

[Guest guest]

Hmm if you  can prove you sent it why doesn't the pharmacy have it? that is step 1 to figure outI have seen my eprescribe thing mess up and sned  no refills when I swore I sent three but you can check the  log to see what was sent. If it is your fault fix it  (most things are my fault haha) if the pharmacy's  fault then have a talk with them to problem solve  or sned people elsewhere

 If the pharmacy has it then  you educate the old person Do I have to come over there??

 

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

 

 

 

From:

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

To:

Subject: Re: coping with being all call 24/

 

 

 

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

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

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

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

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

 

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

I  hope you can feel  better soon,Walter 

 

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

 

 

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

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

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

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

CCote

To:

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

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

 

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

 

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

 

 

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

 

To:

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

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

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

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

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

 

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

 

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

 

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

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

 

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

 

Be available, be open to new solutions...

 

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

 

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

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

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

 

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

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

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

 

 

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

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

 

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

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

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

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

--      MD          ph    fax

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

=======

--      MD          ph    fax

[Guest guest]

NA!!! electronic scripts disappear like dryers eat socks. I cannot tell you the number of times I've sent the script and the dog gone compter says it's qued or verified at the pharmacy and I'll still get called being told the pharmacy never got it! Patients see me send the script. I tell them all call first! call first! call first! before they waste gas to go pick it up. Technology is sooooooooooooo far from perfect. To: Sent: Sunday, January 22, 2012 3:34 PM Subject: Re: coping with being all call 24/

Hmm if you can prove you sent it why doesn't the pharmacy have it? that is step 1 to figure outI have seen my eprescribe thing mess up and sned no refills when I swore I sent three but you can check the log to see what was sent. If it is your fault fix it (most things are my fault haha) if the pharmacy's fault then have a talk with them to problem solve or sned people elsewhere

If the pharmacy has it then you educate the old person Do I have to come over there??

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

From:

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

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

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

I hope you can feel better soon,Walter

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

CCote

To:

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

To:

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions...

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

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

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

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

=======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

=======

-- MD ph fax

[Guest guest]

I give hard copies of prescriptions printed out to all my patients along with e-rx’ing. I have gotten to many “they didn’t get it†type of stuff even though it is logged in. Talk to pharmacies? are you kidding? I’m on a hamster wheel. Pharmacy chains have different pharmacists. They all have fairly long hold times for the phone. At some point, it seems to me that the burden should fairly be shifted to the patient.

Auto educate line for patients? You wouldn’t believe how many patients who still have rotary phones. Anything beyond rotary phones for them is hopeless.

-Walter V. Kowtoniuk

From:

Sent: Sunday, January 22, 2012 3:34 PM

To:

Subject: Re: coping with being all call 24/

Hmm if you can prove you sent it why doesn't the pharmacy have it? that is step 1 to figure outI have seen my eprescribe thing mess up and sned no refills when I swore I sent three but you can check the log to see what was sent. If it is your fault fix it (most things are my fault haha) if the pharmacy's fault then have a talk with them to problem solve or sned people elsewhereIf the pharmacy has it then you educate the old person Do I have to come over there??

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

From:

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

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

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

I hope you can feel better soon,Walter

WK

From: magnetdoctor@...

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

To:

Subject: Re: coping with being all call 24/

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

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

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

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

CCote

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions...

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

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

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

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

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

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

[Guest guest]

It is in the back of my mind. Trying to avoid it but will if it continues. Thanks. To: Sent: Sunday, January 22, 2012 1:33 PM Subject: RE: coping with being all call 24/

Myria,Sometimes I have found it necessary to just dismiss recurrently abusive patients from the practice. Quite frankly, if I hate them, and get upset every time I hear their name on a voicemail or see it in a text, then maybe I can’t be objective in her care anymore. Just a thought. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Sunday, January 22, 2012 12:50 PMTo: Subject: Re: coping with being all call 24/ Matt, the point it that some patients are much harder to teach boundaries since I had been in the office 12 hours that Friday and she didn't even try the office but my home after

hours and this is the 6th time she's wanted care over the phone for free without paying her co-pay. Unfortunately her previous calls of "wolf" made me decide to wait to return her call. That's stress for me. I think charging 30 dollars might be a good solution for over the phone care and make her more willing to pay her 25 dollar co-pay. To: Sent: Saturday, January 21, 2012 11:29 PMSubject: Re: coping with being all call 24/  RE being available. Hmmmm... I had a pt call Friday evening, hematuria pressure.I knew her well. We decided to try cranberry juice as all pharmacies closed, no more 24 hours in our area.Asked her to call me back in AM once she confirmed which of several pharmacies she'd go to. AND I made appt for follow up of the hematuria next week. Please try not to penalize pts for being ill or worried after hours...once they know you better AND if you show concern, they will usually not all after hours unless they really need you. We spoke this AM, I called in the prescription (I was contemplating doing it by ePrescribing, but I'm changing systems so held off on that). I did change her follow up appt to another day of her choosing using my scheduler appointmentquest.com Point is, if you try to jam in pts when they don't want to be or just can't, they won't come to you.Now, of course, I wouldn't do this for a pt I didn't know, but as you can see, I'll still see her, just follow up on the hematuria a different way. Others of course would have made an evisit out of it, but I don't do those, I see her every 3-4 months for chronic care issues anyway. Be available, be open to new

solutions. Of course if the pt is not following up in other ways, different issues. Regards from open access heaven (and YES I still have pts going to Urgicares) Matt in Western PASolo since 2004FP since 1988 just need to express myself i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure

being 135/80 and feeling tired... sorry to intrude on your day as we all get too many emails to start=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email

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

[Guest guest]

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

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

I think I will update my policies as well.

Great work Carla! I may borrow portions of it!

To: Sent: Wednesday, January 25, 2012 1:26 AMSubject: Re: coping with being all call 24/

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

Thank you for sharing your process.

Wen

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

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

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

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

Here is what I sent out:

Dear X:

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

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

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

Sincerely,

Carla Gibson

Financial Policies

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

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

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

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

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

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

time is reimbursed appropriately.

If you choose not to utilize the structured access to these visits available through the website, I reserve the right to bill for a visit when I have done the work typically contained in a visit. These type of visits, whether billed as a visit or not, incur malpractice liability risk and require the same type of time-consuming documentation as an office visit. In reality, it takes more skill to safely conduct a virtual visit than an office-based visit. If you utilize the formal access to a Virtual Visit and I determine that the extent of the visit does not meet my criteria for a visit, there will be no charge and, if needed, I will refund any payment you have made.

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

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

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

Preventive care vs Problem oriented care:

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

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

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

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

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

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

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

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

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

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

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

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

 RE being available.

Hmmmm...

I had a pt call Friday evening, hematuria pressure.

I knew her well.

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

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

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

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

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

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

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

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

Be available, be open to new solutions..

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

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

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

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

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

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

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

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

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

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

[Guest guest]

We bill a 99211 for TB readings and INR checks.  Would post the ICD-9, but am in Michigan for a synchro skating event with my daughter and can't access the office until after hours when our support staff goes home...

Pratt

 

Can you list a few nurse visits? I charge insurance nurse visit for returning vaccination and admin, like Hep A, Hep B. Nurse visit is denied. No copay either. Only vaccine and admin reimbursed.

Thanks,

Wen

 

Then I won't waive nurse visit co-pays.  Thanks for letting me know.  If the doc goes to jail it won't helpt the patients!

To: " " < >

Sent: Wednesday, January 25, 2012 8:42 PM Subject: Re: coping with being all call 24/

 

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

Pratt

 

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

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

I think I will update my policies as well.

Great work Carla! I may borrow portions of it!

To:

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

Subject: Re: coping with being all call 24/

 

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

Thank you for sharing your process.

Wen

 

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

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

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

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

Here is what I sent out:

Dear  X:

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

 

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

 

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

 

 

Sincerely,

 Carla Gibson

Financial Policies 

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

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

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

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

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

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

time is reimbursed appropriately.

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

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

 

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

 

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

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

Preventive care vs Problem oriented care:

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

 

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

 

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

 

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

 

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

 

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

To:

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

 

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

 

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

 

-WK

From: Myria

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

To:

Subject: Re: coping with being all call 24/

 

 

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

 

To:

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

 

 

 RE being available.

 

Hmmmm...

 

I had a pt call Friday evening, hematuria pressure.

I knew her well.

 

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

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

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

 

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

 

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

 

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

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

 

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

 

Be available, be open to new solutions..

 

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

 

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

 

Matt in Western PA

Solo since 2004

FP since 1988

just need to express myself

 

 

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

 

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

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

=======

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

=======

 

 

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

=======

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

=======

 

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

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

=======

[Guest guest]

Wen, did you put the -25 modifier on the nurse visit code? If, so, I read that

the insurers only pay for a nurse visit with an immunization if some separately

identifiable work was done. Otherwise, they think the vaccine fee and the

administration fee are adequate to cover it. So, if the person had a URI and the

nurse had to check w/ the doctor to see if the vaccine could be given, you could

bill the nurse visit fee with a -25 modifier and the URI dx, and it would

probably get paid. If there is no dx other than the need for immunization, it

won't get paid.---Sharlene

> >

> >

> >

> >

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

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

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

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

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

> >

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

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

> >

> > WK

> >

> > *From:* Gordon

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

> > *To:* practiceimprovement1 < >

> > *Subject:* just need to express myself

> >

> >

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

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

> > voice mail and now a call on my urgent line from someone wanting to know

> > what to do about their blood pressure being 135/80 and feeling tired...

> >

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

> >

> >

> >

> >

> >

> > =======

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

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

> > http://www.pctools.com

> > =======

> >

> >

> >

> >

> >

> > =======

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

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

> > http://www.pctools.com

> > =======

> >

> >

> >

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> > =======

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

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

> > http://www.pctools.com

> > =======

> >

> >

> >

> >

> >

> > =======

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

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

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

> > =======

> >

> >

> >

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> > =======

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

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

> > http://www.pctools.com

> > =======

> >

> >

> >

> >

> >

> > =======

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

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

> > http://www.pctools.com

> > =======

> >

> >

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[Guest guest]

I see. Thanks, Sharlene.

Wen

 

Wen, did you put the -25 modifier on the nurse visit code? If, so, I read that the insurers only pay for a nurse visit with an immunization if some separately identifiable work was done. Otherwise, they think the vaccine fee and the administration fee are adequate to cover it. So, if the person had a URI and the nurse had to check w/ the doctor to see if the vaccine could be given, you could bill the nurse visit fee with a -25 modifier and the URI dx, and it would probably get paid. If there is no dx other than the need for immunization, it won't get paid.---Sharlene

> >> >> >> >> > That’s definitely the problem with blanket e-mail access. You get > > stupid e-mails and then you feel obligated to respond. On the other> > hand, with a phone/answering message that says if it’s an emergency go to > > the ER, otherwise wait til Monday, you relax better because you put it> > in the patient’s ball court, where it ought to be. > >> > I have given e-mail access to a handful of patients and I universally> > regret doing so. Having done so, I have a problem to solve.> >> > WK> >

> > *From:* Gordon > > *Sent:* Friday, January 20, 2012 4:50 PM> > *To:* practiceimprovement1 < >

> > *Subject:* just need to express myself

> >> >> > i may be annoyed because friday is my early day and i've been at the> > office since 715 but in the past 20 minutes i've had an email, a general

> > voice mail and now a call on my urgent line from someone wanting to know> > what to do about their blood pressure being 135/80 and feeling tired...> >> > sorry to intrude on your day as we all get too many emails to start

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

> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.

> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >

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

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

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

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

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

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

>

[Guest guest]

I do nurse visit for blood pressure check, post UTI check of urine. Funny thing about the shots - I just had insurance refuse to pay for giving allergy shots because I hadn't billed for the medicine (patient brings own from allergist). I've never had an insurance deny the office visit with the immunization administration code to my knowledge so that might be insurer specific.

To: Sent: Thursday, January 26, 2012 2:56 PMSubject: Re: Re: coping with being all call 24/

I see. Thanks, Sharlene.

Wen

Wen, did you put the -25 modifier on the nurse visit code? If, so, I read that the insurers only pay for a nurse visit with an immunization if some separately identifiable work was done. Otherwise, they think the vaccine fee and the administration fee are adequate to cover it. So, if the person had a URI and the nurse had to check w/ the doctor to see if the vaccine could be given, you could bill the nurse visit fee with a -25 modifier and the URI dx, and it would probably get paid. If there is no dx other than the need for immunization, it won't get paid.---Sharlene > >> >> >> >> > That’s definitely the problem with blanket e-mail access. You get > > stupid e-mails and then you feel obligated to respond. On the other> > hand, with a phone/answering message that says if it’s an emergency go to > > the ER, otherwise wait til Monday, you relax better because you put it> > in the patient’s ball court, where it ought to be. > >> > I have given e-mail access to a handful of patients and I universally> > regret doing so. Having done so, I have a problem to solve.> >> > WK> >> > *From:* Gordon > > *Sent:* Friday, January 20, 2012 4:50 PM> > *To:* practiceimprovement1 < >> > *Subject:* just need to express myself

> >> >> > i may be annoyed because friday is my early day and i've been at the> > office since 715 but in the past 20 minutes i've had an email, a general> > voice mail and now a call on my urgent line from someone wanting to know> > what to do about their blood pressure being 135/80 and feeling tired...> >> > sorry to intrude on your day as we all get too many emails to start> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No

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

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

[Guest guest]

Insurance will pay for an OV.  They won’t pay for a NV or a 99211 if all that is done is vaccine administration. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Friday, January 27, 2012 1:11 AMTo: Subject: Re: Re: coping with being all call 24/ I do nurse visit for blood pressure check, post UTI check of urine. Funny thing about the shots - I just had insurance refuse to pay for giving allergy shots because I hadn't billed for the medicine (patient brings own from allergist). I've never had an insurance deny the office visit with the immunization administration code to my knowledge so that might be insurer specific. To: Sent: Thursday, January 26, 2012 2:56 PMSubject: Re: Re: coping with being all call 24/ I see. Thanks, Sharlene. Wen Wen, did you put the -25 modifier on the nurse visit code? If, so, I read that the insurers only pay for a nurse visit with an immunization if some separately identifiable work was done. Otherwise, they think the vaccine fee and the administration fee are adequate to cover it. So, if the person had a URI and the nurse had to check w/ the doctor to see if the vaccine could be given, you could bill the nurse visit fee with a -25 modifier and the URI dx, and it would probably get paid. If there is no dx other than the need for immunization, it won't get paid.---Sharlene > >> >> >> >> > That’s definitely the problem with blanket e-mail access. You get > > stupid e-mails and then you feel obligated to respond. On the other> > hand, with a phone/answering message that says if it’s an emergency go to > > the ER, otherwise wait til Monday, you relax better because you put it> > in the patient’s ball court, where it ought to be. > >> > I have given e-mail access to a handful of patients and I universally> > regret doing so. Having done so, I have a problem to solve.> >> > WK> >> > *From:* Gordon > > *Sent:* Friday, January 20, 2012 4:50 PM> > *To:* practiceimprovement1 < >> > *Subject:* just need to express myself > >> >> > i may be annoyed because friday is my early day and i've been at the> > office since 715 but in the past 20 minutes i've had an email, a general> > voice mail and now a call on my urgent line from someone wanting to know> > what to do about their blood pressure being 135/80 and feeling tired...> >> > sorry to intrude on your day as we all get too many emails to start> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com> > =======> >> >> >> >> >> >> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> >> >> > > >>

[Guest guest]

They also won't often pay for the 99211 with a vaccine admin (tried it once because we bill 99211 for inr testing). Now if they want vaccines when there for INR, steve pokes his head in to talk about the INR so it is a 99212. Crazy, stupid insurance!

Insurance will pay for an OV. They won’t pay for a NV or a 99211 if all that is done is vaccine administration. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Friday, January 27, 2012 1:11 AMTo: Subject: Re: Re: coping with being all call 24/ I do nurse visit for blood pressure check, post UTI check of urine. Funny thing about the shots - I just had insurance refuse to pay for giving allergy shots because I hadn't billed for the medicine (patient brings own from allergist). I've never had an insurance deny the office visit with the immunization administration code to my knowledge so that might be insurer specific. To: Sent: Thursday, January 26, 2012 2:56 PMSubject: Re: Re: coping with being all call 24/ I see. Thanks, Sharlene. Wen Wen, did you put the -25 modifier on the nurse visit code? If, so, I read that the insurers only pay for a nurse visit with an immunization if some separately identifiable work was done. Otherwise, they think the vaccine fee and the administration fee are adequate to cover it. So, if the person had a URI and the nurse had to check w/ the doctor to see if the vaccine could be given, you could bill the nurse visit fee with a -25 modifier and the URI dx, and it would probably get paid. If there is no dx other than the need for immunization, it won't get paid.---Sharlene > >> >> >> >> > That’s definitely the problem with blanket e-mail access. You get > > stupid e-mails and then you feel obligated to respond. On the other> > hand, with a phone/answering message that says if it’s an emergency go to > > the ER, otherwise wait til Monday, you relax better because you put it> > in the patient’s ball court, where it ought to be. > >> > I have given e-mail access to a handful of patients and I universally> > regret doing so. Having done so, I have a problem to solve.> >> > WK> >> > *From:* Gordon > > *Sent:* Friday, January 20, 2012 4:50 PM> > *To:* practiceimprovement1 < >> > *Subject:* just need to express myself > >> >> > i may be annoyed because friday is my early day and i've been at the> > office since 715 but in the past 20 minutes i've had an email, a general> > voice mail and now a call on my urgent line from someone wanting to know> > what to do about their blood pressure being 135/80 and feeling tired...> >> > sorry to intrude on your day as we all get too many emails to start> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools..com> > =======> >> >> >> >> >> >> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> > =======> > Email scanned by PC Tools - No viruses or spyware found.> > (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)> > http://www.pctools.com> > =======> >> >> >> >> >> >> >> > > >>