thoughts on specialist ranting

[Guest guest]

Hi all,

I have read the " specialist ranting " and it strikes me is that

the folks on this website are not representative of the average

level of quality of primary care available, and the pains that you

guys feel might be the result of that. We have often lamented that

we wished we were getting referrals from micropractice-style

primaries, but we are not. We get many lousy referrals from

providers who barely know their patients, and many of the referrals

are quite off base.

It is silly that your referred physicians decide for themselves

whether they will see the patient, but I see why. So many of our

referrals have no business in a neurologists office. However, we

believe that we are here in the community to serve the primaries (as

well as the patients), so if they want a consultation, we do it

regardless of how off-base many of them are. We also guarantee same

day appts. to primaries if they believe their pt. needs to be seen.

(Even though all of the same day " emergencies " that we have stayed

late to see were not emergent at all.)

The reason these off-base referrals are a problem is that, even

though specialists are paid more for that initial visit (not for f/u

unless we are formally re-consulted)when you figure the amount of

time it takes to do a thorough initial consultation (record

gathering, reviewing radiology films and thorough psychosocial hx)

and document it in a manner that it is constructive to the primary,

we get paid less per unit time than we do for a f/u office visit.

The only reason I mention this is that inappropriate referrrals are

a money-losing prospect because f/u is not necessary.

About not getting notes back-- your specialists can't be

billing without proof that they are sending you a note.

Requirements for a specialist consultation are that we document the

request (and technically differentiate between a one-time consult

and an evaluate and tx), write a note, and prove that we sent

communication back to the referring physician. Without these, if we

get audited by Medicare, you can only bill an office visit, not a

consult.)

You are also not alone in getting dumped on by specialists-- we

also get dumps from other specialists, i.e. my otolaryngologist sent

me for an MRI and they told me to make an appointment with you to

find out the results. (Never heard of the pt. before.) Kudos to

everyone who kicks it right back to the docs attempting to dump.