RE: out of network referrals and preauthorizations// malpractice//hospital systems?

[Guest guest]

Welcome, Judy.

I’ll take a stab at answering

some of your questions. FYI, I am not contracted with any insurances and

have a direct pay practice in CO.

1a) I will likely take some insurances to start, but it keeps bugging me

because I don't know how it works if a patient sees me out of network and they

need a CTscan or a referral to a specialist. Do they then go back to their

in-network provider that they've never met? If

I can’t do them myself (usually I can even though I’m not an

in-network provider), then I work with a provider who is. The pt also

sees them, if required by the in-network doc, but I send all the info and what

test I’m wanting and why, and ask them to order it. Some are just

happy that I do all the work for them and will do the order after I send them

the info, w/o seeing the pt.

1b) For unemployed patients, have you the doctors tried to talk to neighborhood

consultants and radiology establishments for their cash prices? Should I? The

idea of PIFATO is very encouraging, but what happens when the patients need

more than what I can provide? Yes, I’ve

found cheaper cash prices for my pts for imaging, colonscopies, labs,

etc. You have to call the facilities/docs, and some of them have no clue

what you are talking about, but I think more of them are understanding

now.

2) Looking into malpractice. With the two carriers in NY that offer occurrence

malpractice, the rate is $24-$26/yr. I have always been taught that occurrence

is the best, but have any of you had experience with the program offered as a

partner of AMWA (American Women's Medical Assoc)-- The Star Doctor's Insurance

Program (a special program just for Women offered by the Wood Insurance Group)?

http://www.stardoctorinsurance.com/ins_program_info.cfm

Lenghthy application for a claims-made policy... Does being an owner change

whether claims made is appropriate? No idea.

3)I am also talking to area hospital systems. Many practices have been bought

up by them in the last few years, and I have not established an LLC yet-- until

I find out from the hospitals what my options are. What made each of you decide

against joining the hospital? I imagine the answer is autonomy and soverignty

over your work, which I am starting to crave.

Bingo.

4) Do any of you incorporate home visits in your practices? I left hospice due

to the administrative quagmires, but I loved the work of home visits. I will

probably cut out hospital visits. Do most of you do that/leave the hospital

work)? Yes – a couple of docs do an

entire practice of house calls, and several do office, phone, online, and home

visits. I don’t like hospital work, and when my pts are admitted,

they are managed by a hospitalist with close communication if needed.

5)I am writing a lot... four topics in one post... in the future shall I separate

them out? Either way fine w/ me.

Judy

Good luck!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com