prior auths

[Guest guest]

I ordered a head CT. Prior auth company told me would be 48 hours before they responded. It took over an hour to get the approval after I threatened "you can pay for the CT or you can pay for ER and CT"! They put me right on with one of their doctors who quickly agreed with me! But an hour! When I asked the doctor how this could have been accomplished faster he told me to hire more staff!

To: Sent: Thursday, February 9, 2012 7:00 AMSubject: Re: thinking out loud...

Thanks Sharon for all of the thoughtful advice!I had forgotten about the Venus. Love to know it is framed. Photography and graphic design is my hobby and, as physician burnout has started to smolder, it has progressed to even a PT job, as I now show in local galleries.A few thoughts about below. Thoughtful shaping of the payor mix is important to me. I do do obstetrics, and will likely give this up, but because of this, I take care of a lot of young families. This made me think of a family rate. But I have even considered a "kids under 18 are free" policy, seeing that they usually result in more and easier visits.I am concerned about the HMO problem. Like said, I do not want to add undo burden to my local colleagues (ESP. After getting off the ferris wheel and leaving the remaining 3 with even larger patient panels). A symptom of how bad it is right now, last Friday, I was seeing an HMO patient for abdominal pain, wanted

to get an abdominal CT, space avail right away in radiology, and had the insurance on hold for approval and was told that approval would take two hours, or maybe until Monday. So what did we do? We sent the patient to th ER where it could be done without such approval!And yet, the HMO products are growing here. High deductible, state and commercial HMO's are how we have complied with Romneycare.Regarding seasonal memberships, I think I would offer them, but without the discount. Our seasonal visitors would not blink at the amounts involved. In fact, going into a summer is going to be my best option, I believe. I'm considering the option of doubling as an urgent care center. Walkin clinic. Post info about the membership and member rates, as well as rates that are doubled, per visit, for non-members. In the summer, if the word is out, it will likely be pretty easy to fill with walk-in's.Regarding HelloHealth, I have a conf call

with them this morning. At least their website leads me to believe that they are alive and well. New version just released this month, advertising 10,000 physician users, and Meaningful Use certification. I'll report back on what I learned.Greg> > >> > > What if...> > >> > > Micropractice. Single exam room. No other

employee. Direct pay; no> > insurance.> > >> > > HelloHealth model. Membership (either yearly or monthly, family rate)> > and price this to include the typical access (cell, after-hours, email),> > PLUS, a yearly MDVIP-like wellness visit, AND ER consults AND Inpatient> > care. (We don't have hospitalists and any hospital visit would involve> > impersonal care by one of the other PCPs or the ER PAs.) Then charge a> > reasonable rate for visits, and a lower one for virtual visits.> > >> > > What if the rates were $400 indiv membership, $600 family membership.> > And the virtual visits were $25 and the office visits were $60?> > >> > > If I then signed up 400 people/families and generated $200K in> > membership fees, and saw 30 visits per week for an extra $70K.> > >> > >

Then if I paid $10K in malpractice and $60K in rent and supplies.> > >> > > Final take home of $200K.> > >> > > Help me here. Where am I being naive? What am I missing?> > >> >> > > >>

[Guest guest]

He ( insurance doctor) is sleeping with theEnemy.Adolfo E. Teran, MD

I ordered a head CT. Prior auth company told me would be 48 hours before they responded. It took over an hour to get the approval after I threatened "you can pay for the CT or you can pay for ER and CT"! They put me right on with one of their doctors who quickly agreed with me! But an hour! When I asked the doctor how this could have been accomplished faster he told me to hire more staff!

To: Sent: Thursday, February 9, 2012 7:00 AMSubject: Re: thinking out loud...

Thanks Sharon for all of the thoughtful advice!I had forgotten about the Venus. Love to know it is framed. Photography and graphic design is my hobby and, as physician burnout has started to smolder, it has progressed to even a PT job, as I now show in local galleries.A few thoughts about below. Thoughtful shaping of the payor mix is important to me. I do do obstetrics, and will likely give this up, but because of this, I take care of a lot of young families. This made me think of a family rate. But I have even considered a "kids under 18 are free" policy, seeing that they usually result in more and easier visits.I am concerned about the HMO problem. Like said, I do not want to add undo burden to my local colleagues (ESP. After getting off the ferris wheel and leaving the remaining 3 with even larger patient panels). A symptom of how bad it is right now, last Friday, I was seeing an HMO patient for abdominal pain, wanted

to get an abdominal CT, space avail right away in radiology, and had the insurance on hold for approval and was told that approval would take two hours, or maybe until Monday. So what did we do? We sent the patient to th ER where it could be done without such approval!And yet, the HMO products are growing here. High deductible, state and commercial HMO's are how we have complied with Romneycare.Regarding seasonal memberships, I think I would offer them, but without the discount. Our seasonal visitors would not blink at the amounts involved. In fact, going into a summer is going to be my best option, I believe. I'm considering the option of doubling as an urgent care center. Walkin clinic. Post info about the membership and member rates, as well as rates that are doubled, per visit, for non-members. In the summer, if the word is out, it will likely be pretty easy to fill with walk-in's.Regarding HelloHealth, I have a conf call

with them this morning. At least their website leads me to believe that they are alive and well. New version just released this month, advertising 10,000 physician users, and Meaningful Use certification. I'll report back on what I learned.Greg> > >> > > What if...> > >> > > Micropractice. Single exam room. No other

employee. Direct pay; no> > insurance.> > >> > > HelloHealth model. Membership (either yearly or monthly, family rate)> > and price this to include the typical access (cell, after-hours, email),> > PLUS, a yearly MDVIP-like wellness visit, AND ER consults AND Inpatient> > care. (We don't have hospitalists and any hospital visit would involve> > impersonal care by one of the other PCPs or the ER PAs.) Then charge a> > reasonable rate for visits, and a lower one for virtual visits.> > >> > > What if the rates were $400 indiv membership, $600 family membership.> > And the virtual visits were $25 and the office visits were $60?> > >> > > If I then signed up 400 people/families and generated $200K in> > membership fees, and saw 30 visits per week for an extra $70K.> > >> > >

Then if I paid $10K in malpractice and $60K in rent and supplies.> > >> > > Final take home of $200K.> > >> > > Help me here. Where am I being naive? What am I missing?> > >> >> > > >>

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