More doctors charging for e-mail and phone calls
Julianne Weight
Julianne Weight
Weight) wrote:
>http://kcal9.com/health/health_story_052150438.html
Feature Margie Kahn, by the way!
14tonks
lot of insurance refuses to pay for telephone time, and I expect that would
extend to e-mail, which is likely to be a problem with this approach.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Julianne Weight" <jul...@theusual.com> wrote in message
news:3e57bcf6...@News.CIS.DFN.DE...
> http://kcal9.com/health/health_story_052150438.html
Julianne Weight
<mail.2....@recursor.net> wrote:
>Time is time; no reason they shouldn't charge for them. However, I think a
>lot of insurance refuses to pay for telephone time, and I expect that would
>extend to e-mail, which is likely to be a problem with this approach.
That is a problem. Although there are CPT codes for phone conferences
(and other non face-to-face physician time), a lot of insurance
companies don't reimburse them and patients won't pay for them,
either.
I remember when Margie first posted about this conversation with the
doctor. The problem is, there's no way to build in the cost of phone
conferences. It wouldn't be fair to patients who never call and just
come into the office for everything, and it isn't fair to the
physician not to allow them to bill for non face-to-face time.
It makes much more sense you understand how the fees are determined
for each CPT code. There's a lot of work that goes into determining
the average patient encounter and amount of work involved for each
code.
Liz
Julianne Weight wrote:
>
> http://kcal9.com/health/health_story_052150438.html
Margie Kahn
said he had found my posts on "a newsgroup." He asked if he could call me, and
about 15 minutes after I emailed him with my phone #, he called me. We talked
for 10-15 minutes, and I am disappointed that he only quoted a very, very small
portion of what I had to say. He makes me sound like I'm in favor of
unlimited, unbilled telephone time, which I'm not. I do, however, think that
brief phone contact should be built into what I already pay for my medical
care, just as time spent reviewing the chart lab and x-ray results, etc., is.
He also failed to report the fact that this doctor eventually closed her
practice and joined Kaiser, where presumably she doesn't have to deal with such
mundane things as communicating effectively with her patients.
Margie
Bob
mlk...@aol.comgoawayxx says...
I read the AP article in today's paper here in San Antonio and wondered if
that was you.
Bob/Texas
Margie Kahn
Julianne Weight
wrote:
>So does this qualify as my 15 minutes of fame? <g>
I'd say it definitely does!!
JMorngstar
>>So does this qualify as my 15 minutes of fame? <g>
>
>I'd say it definitely does!!
>
I'd say no. I foresee her name in the headlines of some rag some day linked
with something bigger than whether doctors charge for emails. Whether or not
there is an arrest is not quite clear in my crystalball.
janice
RaeMorrill
unlimited, unbilled telephone time, which I'm not. I do, however, think that
brief phone contact should be built into what I already pay for my medical
care, just as time spent reviewing the chart lab and x-ray results, etc., is.
>>
I agree that patients fearing being billed might just not call, to their
detriment. Certainly if they were rushed through an appt (common these days)
and didn't understand what they were told, they shouldn't have to pay to get
the information.
Rae Morrill in Maine
"Ya can't get theyuh from heeah"
_______________________________
Spam mailers WILL be reported to their respective postmasters and AOL TOSSPAM!
Margie Kahn
female general manager of a major league baseball team. Or something.
Julianne Weight
wrote:
>I agree that patients fearing being billed might just not call, to their
>detriment. Certainly if they were rushed through an appt (common these days)
>and didn't understand what they were told, they shouldn't have to pay to get
>the information.
The reverse of that is patients who don't pay attention the first time
around and think the doctor ought to be available to keep repeating it
over and over again. (I did one report where the physician complained
that the patient read a magazine the entire time! Can you imagine how
rude?) And I feel sorry for the really elderly patients who don't have
family to attend appointments with them. It's understandable they
forget.
Julianne Weight
wrote:
But nobody ever said you were limited in the number of times you can
have 15 minutes of fame. <G>
Becky Young
<notto...@forevermail.com> writes:
>I read the AP article in today's paper here in San Antonio and wondered if
>that was you.
>
It was on the Little Rock, Arkansas Channel 4 news tonight AND I MISSED IT!
Becky Young
....Though nothing can bring back the hour of splendour in the grass, of glory
in the flower, We will grieve not; rather find strength in what remains behind
-- William Wordsworth
Gil Carter
I've been billing for phone time for several years. You aren't paid much.
Your profit margin is only about $5 to $7 but sometimes you can treat an
uncomplicated condition assuming you know your patient. The insurance co
saves $20. The patient saves a hassle coming in and also his copay. You
can also email the patient a lab or x-ray slip or his test results which
patients like a whole lot! But if you do it without any reimbursement, it
costs the doctor out of pocket about $10.00 per phone call to provide the
service, assuming only 2-3 minutes to do it. The time required after
hanging up the phone takes another 3-4 minutes to prepare and fax a
prescription, write a note, record the bill or some other associated item.
If your phone service is longer than that, your overhead eats you up.
Overhead in internal medicine, family practice and pediatrics usually runs
$60-100/hour or so. The doctor doesn't get rich on it.
About Kaiser, ... since they're at the top of the premium dollar, if the
doctor provides phone service and it's more efficient and not shortchanging
the patient, then everybody saves. The Kaiser doctor is inherently
reimbursed for his phone service and in fact, Kaiser paved the way for this
20 years ago when they started treating vaginal yeast over the phone.
Private physicians are usually not paid unless they see the patient, altho
some insurance companies do pay. Btw, the *profit* in California from a
single problem visit is $14-$18, and that includes all the ancillary service
for the appointment. It's **tight** economics.
No, I am not a Kaiser physician.
Gil Carter, MD, JD, FP
http://CoreMedicalConcepts.com and the Ten Second Medical Record TM, an
electronic medical record program
"Julianne Weight" <jul...@theusual.com> wrote in message
news:3e5804eb...@News.CIS.DFN.DE...
RaeMorrill
waiting past the appt time. There is simply no excuse for this these days
except trying to see too many patients in too little time. Having worked for a
doc who was always running late - it seemed to be on the days he actually had
to leave the office two or three times to deliver a baby he'd run MORE on time
because of it, rather than sitting in his office reading a newspaper or being
tardy from morning rounds because he was socialing with the staff.
>>But if you do it without any reimbursement, it
costs the doctor out of pocket about $10.00 per phone call to provide the
service, assuming only 2-3 minutes to do it. The time required after
hanging up the phone takes another 3-4 minutes to prepare and fax a
prescription, write a note, record the bill or some other associated item.
If your phone service is longer than that, your overhead eats you up.
Overhead in internal medicine, family practice and pediatrics usuall
Gil Carter
Maybe we live in different worlds. I do not know any physicians who are
able to sit around in their office reading the newspaper. Most doctors I
have known over the last 30 years work 60-80 hrs a week. Usually OB-Gyn is
one of the most taxing jobs, ... up at night constantly, ... chronic sleep
deprivation.
:)
Gil Carter, MD, etc
"RaeMorrill" <raemo...@aol.com.com> wrote in message
news:20030223114533...@mb-md.aol.com...
Gil Carter
Actually, I'd favor putting the patients and their physicians back into a
primary relationship and get the insurance companies and Medicare etc out of
the middle. That way, the patient and physician can agree on the time of
the appointment for example and agree on consequences of not being on time.
This would be basic contract law. I think the amount of time required to
provide the service should be the most important determinant of the charge
although there are other factors. This way, the patient gets what he pays
for, and not what he doesn't. The physician gets paid for what he provides,
and not what he doesn't.
:)
Gil
"RaeMorrill" <raemo...@aol.com.com> wrote in message
news:20030223114533...@mb-md.aol.com...
VHOne
you are saying, but actually stronger. Do you feel that you are being forced to
not give the treatment necessary to a patient or take tests that you feel
necessary According to my conversations with several MDs, the insurance
companies are intimidating the physicians into treatment that they do not agree
with or not ordering tests that they feel is necessary. If the physicians do
not comply, then they are at risk of not being on the approved lists of these
insurance companies, etc., therefore jeopardizing payment for services
rendered, etc. In other words, doctors are not really allowed to be doctors
the way that they were meant to be and have to have permission from
paraprofessionals in order to do what they consider to be necessary testing,
treatment, etc. I think this is sad and I think it is lowering our whole
standard of healthcare.
>Subject: Re: More doctors charging for e-mail and phone calls
>From: "Gil Carter" gca...@rcsis.com
>Date: 2/23/03 12:05 PM Eastern Standard Time
>Message-id: <v5hvr6t...@corp.supernews.com>
Neal Brown
I have to ask the question to you exactly what Medicare and the insurance
companies have to do with scheduling patients and the time they have to wait
in the office before seeing their doctor.
I recently changed my primary practice physician because I would average
waiting in his office for 2-1/2 hours to see him for approximately 10
minutes.
I feel the problem is basically poor office management and an uncaring
attitude, whether it is from the doctor or staff I do not know, but it is
extremely frustrating to the patient.
Neal Brown
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5hvr6t...@corp.supernews.com...
Julianne Weight
wrote:
>Hi all,
>
>Actually, I'd favor putting the patients and their physicians back into a
>primary relationship and get the insurance companies and Medicare etc out of
>the middle. That way, the patient and physician can agree on the time of
>the appointment for example and agree on consequences of not being on time.
>This would be basic contract law. I think the amount of time required to
>provide the service should be the most important determinant of the charge
>although there are other factors. This way, the patient gets what he pays
>for, and not what he doesn't. The physician gets paid for what he provides,
>and not what he doesn't.
>:)
>Gil
Hear, hear! One very large problem with healthcare costs is the
patient doesn't have to participate to any large extent in paying the
bill. IMO, this has given rise to an "entitlement" attitude about
healthcare (I can't even watch "John Q. Public," which I think is
typical Hollywood limousine liberal pablum) and further removed
patients from participating in their own care.
14tonks
different worlds. I've got a dear client who certainly works many hours a
week. However, somehow he never manages to get started seeing the patients
that start arriving at noon until about 4 p.m., and I rarely receive his
dictation before 8 or 9 at night. Having spent several days in his office
setting up computers, troubleshooting, etc., I can tell you that he does
indeed spend a lot of time on business and social calls, social chats,
doodling around on AOL, and skimming the daily paper while those patients
are piling up. His partner is not much better. It probably helps that they
are in a highly paid specialty, not family practice. I would be looking for
another doctor after my first appointment, but he somehow maintains a large
practice with many devoted patients, who just sit there for 6 hours waiting
for him when they come in.
He's a charming person, a warm and generous human being, but he has one of
the worst cases of ADHD I've ever dealt with, and he just cannot manage his
time in any sane manner.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5hv9sc...@corp.supernews.com...
VHOne
being that there was a clause that they could spend a whole 10 minutes with
their patients! I think, but I cannot swear to it, that if they signed a
contract with the HMO that they had to agree to spend that amount of time with
the patient or close to that. I think it was 10 minutes or they were to see so
many patients per hour...that might have been it. Again, cannot swear to it
but it is in my mind as being there as I used to work for one of the HMOs way
back
>Subject: Re: More doctors charging for e-mail and phone calls
>From: "Neal Brown" solut...@access4less.net
>Date: 2/23/03 12:30 PM Eastern Standard Time
>Message-id: <b3b0cj$1i8g2q$1...@ID-47915.news.dfncis.de>
Margie Kahn
>can also email the patient a lab or x-ray slip or his test results which
>patients like a whole lot!
My new primary care physician automatically sent me (without my requesting it)
a copy of my lab results with a dated stamp saying "sent to patient." I was
very pleasantly surprised. My gyn, who has known me for 20 years,
automatically writes on the lab results "send to patient." I certainly don't
think I should have to pay extra for this service.
Margie
14tonks
of problems, but the office scheduling mess existed long before that became
an issue. Some doctors have always been able to run more or less on time
with their appointments, with occasional rare exceptions. Others never seem
to pay the least attention to seeing patients on time, and routinely expect
patients to waste half a day on a routine doctor's appointment.
Like you, when I find I am dealing with an office that routinely expects me
to wait a couple of hours or more to see the doctor, I find another doctor.
It is not easy to run a busy schedule on time, but it can be done if the
doctor and his staff are willing to set up the tools to do it, make it a
priority, and stick to the rules. Having been on the inside, I know how
often the "medical emergency" causing a wait was something like a tennis
tournament at the country club that ran late, the doctor forgetting there
was another patient waiting, skipping out to the bank, and then deciding to
stop and grab some lunch, etc., etc. Some doctors really do place
absolutely no value on their patients' time, and simply run their days
totally to suit their own convenience.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Neal Brown" <solut...@access4less.net> wrote in message
news:b3b0cj$1i8g2q$1...@ID-47915.news.dfncis.de...
Julianne Weight
<solut...@access4less.net> wrote:
>Doctor Carter,
>
>I have to ask the question to you exactly what Medicare and the insurance
>companies have to do with scheduling patients and the time they have to wait
>in the office before seeing their doctor.
>
>I recently changed my primary practice physician because I would average
>waiting in his office for 2-1/2 hours to see him for approximately 10
>minutes.
>
>I feel the problem is basically poor office management and an uncaring
>attitude, whether it is from the doctor or staff I do not know, but it is
>extremely frustrating to the patient.
But if you take the insurance company out of the picture and make the
actual consumer of services the one responsible for paying, there's
more leverage in the situation. Right now, you have two entities who
have no concern for your time -- the doctor and the insurance company.
The doctor knows he doesn't have to keep YOU happy to get paid -- he
only has to meet the requirements of the insurance company. And if
he's so busy his waiting room is jam-packed every day, is he going to
care if you go elsewhere?
Although I agree that bad management is bad management -- some doctors
can't buy a clue when it comes to managing their office and their
time.
My motto: Beware of physicians with large waiting rooms!
Gil Carter
I imagine this varies from provider situation to provider situation. In my
region of Northern California there is an HMO called Hill Physicians'
Medical Group. It is an intermediary for the HMO version of the main
insurance companies here: HealthNet, Calif Blue Shield, Calif Blue Cross,
Cigna, Aetna and Pacificare. They seem to be doing quite reasonably and
largely I am not unreasonably constrained by them. There is a global
economic beating for health care providers here and physicians are Not
moving to this region. That is another story.
The HMO here actually pays $4 more for an office visit than do the PPO's and
it does make service more possible. By and large I am not too constrained
about ordering tests. There are some modest frustrations with obtaining an
MRI or a CT scan. If it's truly urgent, then one can admit the patient to
the ER of hospital and move things along.
The formularies are a limitation based on the insurance company, not the
intermediary HMO. While it increases the knowlege requirement of the
physician vastly, it is still manageable although an irritating stumbling
block in delivering care. That the insurance companies have formularies is
understandable as the cost of most drugs today is often $90/month, dwarfing
the cost of the physicians' services. So while formularies are a barrier to
facile delivery of care, they are useful and usually manageable. If you
only work under one formulary, as for example, with Kaiser, things are
easier for the physician, ... kind of.
Because there is a shortage of physicians here, there's not much badgering
of them by the insurance companies. The insurance companies generally do
not seem to review the care a physician provides but generally they look at
the bottom economic line and if he's costing too much, I think they just say
"Bye" without giving a reason. They do Not look at whether the physician
has a difficult or particularly ill patient population, or conversely a
healthy patient population. I think they find the cost of reviewing a
physician by looking at each individual case of patient care as being way
too costly for them to do. Of course, they could look at 20 and
extrapolate.
The insurance companies do send us letters constantly suggesting we change a
person's meds for a variety of reasons ... often for reasons based on a
scientific study... and we're asked to review and consider whether or not we
should change the treatment for 20 to 40 patients, for example. There is no
reimbursement for reviewing the 100-150 or so pages of mail from insurance
companies received daily.
Gosh, I am running on and on about costs of delivering service. I'd better
take some prozac. Answer: I do Not feel I am being constrained unreasonably
in *my current* environment.
:)
Gil
"VHOne" <vh...@aol.com> wrote in message
news:20030223122526...@mb-bd.aol.com...
Julianne Weight
<mail.2....@recursor.net> wrote:
>I have to agree with you, Neal. The insurance companies have created a lot
>of problems, but the office scheduling mess existed long before that became
>an issue. Some doctors have always been able to run more or less on time
>with their appointments, with occasional rare exceptions. Others never seem
>to pay the least attention to seeing patients on time, and routinely expect
>patients to waste half a day on a routine doctor's appointment.
>
>Like you, when I find I am dealing with an office that routinely expects me
>to wait a couple of hours or more to see the doctor, I find another doctor.
>It is not easy to run a busy schedule on time, but it can be done if the
>doctor and his staff are willing to set up the tools to do it, make it a
>priority, and stick to the rules. Having been on the inside, I know how
>often the "medical emergency" causing a wait was something like a tennis
>tournament at the country club that ran late, the doctor forgetting there
>was another patient waiting, skipping out to the bank, and then deciding to
>stop and grab some lunch, etc., etc. Some doctors really do place
>absolutely no value on their patients' time, and simply run their days
>totally to suit their own convenience.
I used to see an orthopaedic surgeon for my back who would tell
patients who called in the night before with some "emergency" -- "Be
in my office at 9 a.m." OK -- but then he'd see them before the
patients who had scheduled appointments weeks in advance. The wait was
hours, not minutes.
I made such a stink the first time I saw him that the second time they
put me in an exam room right away and tried to get me to put on a
gown. I told them I'd put on a gown when I saw the whites of his eyes.
I waited half an hour (15 minutes more than my usual, just because I
was curious -- I'm sure I could've gone another hour) and left. Nobody
seemed to notice, nobody said anything. The next time I saw him was
when my son was in the ER with a broken arm. He asked why I hadn't
called him -- and I told him. NOBODY is worth waiting hours for, end
of story! (He hasn't changed and he never will.)
Conversely, one of the most caring pediatric ENTs I've ever known had
a routine 2-hour wait in his office. My son, who had chronic ear
infections, loved him and so did I. I learned to call ahead and ask
how far behind they were running -- then call again when that time had
elapsed. I was able to cut my waiting time down to 15 minutes by doing
that. <G>
Barbara Carlson
patient lists with my tapes, as I am sure many of you do, and there are
always a fair percentage of "no shows." If the doctor doesn't overbook he
will be sitting in his office reading a newspaper--which I have never seen a
doctor do with patients in the waiting room unless he was on his lunch hour!
And more than one of my doctors has dictated while eating that lunch--in the
office!
Yes, it annoys me to wait an unreasonable amount of time past my
appointment. I feel 15 or 20 minutes is acceptable, because it is
impossible for a doctor to know exactly how much time he needs to spend with
a patient but......I waited 6 1/2 hours once to see a specialist! That is
unconscionable! If an emergency comes up that requires that kind of delay,
patients should be informed, and given an alternative to twiddling their
thumbs or reading year-old magazines for that amount of time!
Barb C.
Gil Carter
You're right. Even one hour is too long unless there was a true emergency.
In which case they should have rescheduled.
Most likely, your doctor is having major trouble keeping his head above
water. Some doctors are slower than others, some faster. Some spend more
time trying to find a better answer, others say here's the prescription and
you're out the door. Most doctors are somewhere in the middle.
There's nothing like having a really hard time to kill a caring attitude.
Some things that drag doctors down: administrative paper work that they're
not paid for. Last year I had a patient with severe lung disease needing
oxygen. Medicare required documentation of oximetry with numerous specific
dates and numbers filled in. It was disallowed that those numbers be
provided by the oxygen supply company. Ultimately, a company from a distant
town went to his house, measured his oxygen and provided the numbers and
faxed them to me. The first fax was illegible. Then the form was not
filled out correctly due to a misunderstanding. Then the form wasn't filled
out because I was getting upset. Ultimately, my time required to accomplish
completion was about one hour over two months. I did have him come in once
in order to get some payment for completion of the form, but of course, it
cost me $45 more than I received in order to complete the form. On a
brighter note, I programmed an oximetry statement function to my computer
program so now it should only take two seconds. Also, my partners and I
bought an oximeter two weeks ago. It cost about $600 and the payment for
checking a persons oximetry is, I think, $3 to $4. It is not uncommon for
physicians to spend 3 hours or more per day performing some service for
patients even though the patient is not in the office.
So more than likely, your doctor's failure is probably stemming from how
difficult delivering medical care has become. I am sorry for him and you
both. If your doctor cannot keep his doors open he will likely join a medic
al group of some sort where he might be protected for a while at least.
Five years ago, I was hired by Family Practice Associates, a multi-thousands
of family practioners national medical group. It went belly up bankrupt 4
years ago. My earlier partners and I and a group of local internists were
picked up by a local large medical group, but they departed my small town 3
years ago. I figured I could do that badly all by myself and hence returned
to private practice, then joined two other local physicians a year later.
We're doing ok.
"Neal Brown" <solut...@access4less.net> wrote in message
news:b3b0cj$1i8g2q$1...@ID-47915.news.dfncis.de...
Gil Carter
I agree. If results are Normal, there is no charge for notifying patient of
those results at least in my office. The standard way about 30 years ago
was to have patients return to go over results. Email is great for getting
results to patients if they are open to it and it doesn't cost for the
stamp, envelope and mailing, .... and patients love it.
On the other hand, wouldn't it be great to be treated for an uncomplicated
bladder or sinus infection over the phone from your regular doctor, without
him having to pay for it? Or to get the answer or advice regarding some
burning question without having to wait in the office and/or lose half of
your day?
Yep, it is good.
:)
Gil
"Margie Kahn" <mlk...@aol.comgoawayxx> wrote in message
news:20030223124405...@mb-fj.aol.com...
VHOne
was not aware of a provider shortage. That leaves me to ask another
question....do you feel that because there is a shortage that medical schools
and residency programs are lowering their criteria for entry?
Vickie
>Subject: Re: More doctors charging for e-mail and phone calls
>From: "Gil Carter" gca...@rcsis.com
>Date: 2/23/03 1:10 PM Eastern Standard Time
>Message-id: <v5i3lcl...@corp.supernews.com>
14tonks
of the person you are scheduling for, and the average time required for
various types of visits, and schedule accordingly. One patient every 10
minutes for every doctor in the office is a guarantee of disaster.
Once upon a time I could schedule 250 cats in 6 to 12 different categories
through 6 rings in an unending stream over 8 hours, and get everyone to
dinner on time, without anyone wanting to see the same cat in two different
places at the same time. One of the judges could finish all 250 cats in 4
hours without breaking a sweat. (He probably could have finished in 2 hours
if a show committee had ever let him try it.) One struggled to get through
the list in 9 hours, with a good clerk riding herd, an extra steward, and
someone from the show committee to keep constant check on progress, and
crack the whip every couple of hours. The trick was to know which was which,
and juggle the schedule to allow for the difference in pace, and then juggle
it again to allow for the difference in time required for the different
classes. A household pet kitten final is going to be done in 10 minutes. A
longhair final is likely to take at least 30 minutes.
With that for training, I found it duck soup to schedule several dozen
patients through three catheterization and two EPS labs every day for a
dozen different doctors, without any long patient delays in the holding
area, empty rooms, or conflicts. Other people couldn't run the board for a
day without major holdups to save their souls, because they'd divvy up the
patients into even allotments, without looking at who the doctor was, or
what the procedure was. (You did not schedule doctor X to start off the day
in any room, unless you didn't want that room to get rolling before 10 a.m.;
you did not schedule anyone at all to follow a complex angioplasty by Dr. Y,
because he was likely to still be there 4 hours later, and eventually have
the nurse call you to order in midnight pizza. And so forth, and so on.
Fairly simple if you just paid attention.)
Unfortunately, scheduling doesn't seem to be a required course for either
doctors or office managers.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5i52le...@corp.supernews.com...
Liz
to hear Dr. Gil's impression!
Anne Collins
practice in coding and compliance. Not only do I work for a family
practice, but I also work for three specialty practices - ENT, Ortho and
Podiatry. One of my main jobs is to work the "coding denials." One thing
that surprises me is that you are getting paid for an oximeter reading -
everyone here in North Carolina bundles it into the office visit and will
not pay for it. Especially Medicare.
As far as "overbooking" goes - what a nightmare. Our family practice
doctors do not like to turn anyone away who wants an appointment. They
don't think about the money, they truly care about the patient. You can't
imagine the phone calls from patients demanding an appointment the same
day - not to mention the walk-ins who demand immediate attention. We are in
a fairly rural area and we don't have may "Doc in a Box" type facilities.
If we didn't see them, then they would end up in an emergency room
somewhere - and imagine how they would tie up the system there! So, it's
not always possible to spend more than 10-15 minutes with a patient. It
doesn't mean he doesn't care. Sometimes, 10-15 minutes is all he needs to
assess and diagnose your problem.
The one thing that bothers me is that everyone thinks all the doctors are
getting rich and all they care about is money. So wrong. Did you know that
Medicare pays about 49 cents on the dollar and that we have to write off the
balance (other than the 20% of the allowed amount)? The same with the HMOs,
though they pay somewhat more, but not near what the true charge for the
office visit is. With managed care contracts, we give considerable
discounts. Do you have any idea what it costs to run an office? We pay our
transcription service over $150,000 a year. That is just our family
practice. We have about 20 other physician practices. Here in our part
of the country the cost of malpractice insurance has skyrocketed due to
huge, unbelievable settlements. So much so that some doctors in W. Virginia
and other states have staged a "slowdown" in work in protest. Has anyone
here had to find an OB lately? They have been one of the hardest-hit
specialties.
Our doctors are very caring people. It's frustrating to them when I have to
tell them that no, Medicare never pays for physicial exams. The patient
will have to pay for it out of pocket if he wants one done. Medicare does
not pay for preventive exams at all. So, guess what - the patient won't
have it because he will have to pay for it. Can I blame them? No - most of
our patients are elderly and on a fixed income. And Cigna won't pay for an
office visit and a procedure done the same day. No matter that the
physician did a comprehensive exam to determine that the patient had a
broken bone and needed fracture care. I guess that when the patient comes
in and says his leg hurts we should automatically know it's broken without
even looking and just slap a cast on it.
So, no wonder the docs overbook. The cost of running an office is
astronomical. They're just as frustrated as you, believe me. And it
frustrates me when I have to appeal a $76 office visit when we only get
reimbursed a little more than half of it.
Okay. I'll get off my soapbox now. :-)
Anne
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5i52le...@corp.supernews.com...
Gil Carter
At least regarding residency programs the answer in my experience seems to
be yes. By this, I mean that residency programs receiving only say 10
applicants for 10 positions will likely accept all that applied, ... but
they can still say "No." It's just painful when their hours are longer, or
their promises for a certain call schedule are no longer true, or they have
to close their program. At least in 1996, when I last was actively in
contact with a residency program, the residents seemed fine. They were
actually above average as measured by the board exam results... but that's
just one location.
The shortage here in Sacramento really has to do with low pay rates for
physicians. If everywhere were like here, you wouldn't want your son or
daughter to go to medical shool. It's tough.
:)
Gil
"VHOne" <vh...@aol.com> wrote in message
news:20030223140638...@mb-bd.aol.com...
Liz
>
> One of the reasons doctors overbook, too, is because of "no shows". I get
> patient lists with my tapes, as I am sure many of you do, and there are
> always a fair percentage of "no shows." If the doctor doesn't overbook he
> will be sitting in his office reading a newspaper--which I have never seen a
> doctor do with patients in the waiting room unless he was on his lunch hour!
> And more than one of my doctors has dictated while eating that lunch--in the
> office!
My DIL had a very annoying experience last summer in this regard. She
had been experiencing what were eventually diagnosed as migraine
headaches following the birth of her son. Her GP referred her to a
local neurology group - 5 docs. At the time of her first appointment
with the first available doc in the practice, she had to wait close to
two hours before he was free (despite the fact that as a nursing mother
of a 3-month-old her presence was needed elsewhere!). What was really
annoying, though, was that one of the other docs in the practice came
out to the front desk and just hung around there for 45 minutes chatting
as two of his patients were no-shows. My DIL just couldn't understand
why he couldn't see her instead of the doc she was waiting for,
particularly since she hadn't seen anyone in the practice yet!
RaeMorrill
this case I believe. However, doctors offices are known make patients wait.
>>Maybe we live in different worlds. I do not know any physicians who are
able to sit around in their office reading the newspaper. Most doctors I
have known over the last 30 years work 60-80 hrs a week. Usually OB-Gyn is
one of the most taxing jobs, ... up at night constantly, ... chronic sleep
deprivation..
Gil Carter
Great response! I loved it!
:)
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3b666$1k54du$1...@ID-173555.news.dfncis.de...
RaeMorrill
you are saying, but actually stronger. Do you feel that you are being forced to
not give the treatment necessary to a patient or take tests that you feel
necessary According to my conversati>>
A great FP I used to work for finally went to work at a local hospital quick
care. I typed enough letters to insurance companies to feel the frustration
felt trying to provide care to patients and having to fight tooth and nail,
wasting hours of time fighting with the insurance companies.
Gil Carter
Thanks for your response.
There is such a huge difference in reimbursement rates. I hear that in
Nashville, a 99213 (regular one problem office visit) is reimbursed on
average $72. That's not the amount charged but the amount paid on average.
That's a HUGE difference. Here in the Sacramento area, it's about $38 for
California Blue Cross and Blue Shield and $42 with the HMO. Further, the
PPO patient has a charge every step of the way, to the lab or anywhere, that
the hmo patient does not have.
For that $150,000 transcription cost per year, how many doctors does that
represent?
:)
Gil
"Anne Collins" <aecol...@earthlink.net> wrote in message
news:Q796a.1032$a63...@tornadotest1.news.pas.earthlink.net...
Iris Brown
past the time of my appointment, if the staff does not notify me there is a
problem, then I tell them I am leaving and we can reschedule when they
actually have time to see me. They always seem so surprised. Much of this
problem is that patients do wait, we make no noise about it. It does not
work to put me in the room either to shut me up...waiting is a terrible
waste of time, especially to someone on production. Not to mention the fact
that the blood pressure goes up exponentially with each passing moment :-)
"Liz" <liz...@Erols.com> wrote in message news:3E591D...@Erols.com...
JBuxton569
appointment. I feel 15 or 20 minutes is acceptable, because it is
impossible for a doctor to know exactly how much time he needs to spend with
a patient>>
I'm a Kaiser subscriber and have been for over 20 years. It has been very rare
that I've had to wait to see my doctors and sometimes even get called into the
office before my scheduled time since I try to sign in early.
Until this year I've had the same family practice doctor and had nothing but
praise for her. Many of you have been talking about a doctor spending 10 or so
minutes with each patient. Back in 1996 when my sister died, Dr. B. actually
let me figuratively cry on her shoulder. I wasn't sick, just so sad and
depressed. She did offer me a referral to a therapist, but just having her
listen helped me. Since she went on a leave of absence I've been assigned
another doctor, but I miss Dr. B.
I've transferred to a center closer to where I live with better parking. That
has been my only complaint about the Santa Rosa, CA center, horrible parking.
I spend more time circling the parking lot looking for an empty space than I do
in the waiting room. Hopefully this problem won't be as bad in the new Rohnert
Park, CA center that just opened last week.
Judity
Julianne Weight
everything was in one place. Otherwise, the waiting was horrible.
You waited to get an appointment (weeks, months even). You waited to
see the doctor. If the doctor sent you to the lab, you waited at the
lab. God help you if you had to go for labs, x-ray and a prescription
-- you would be there all day.
And we won't even get into the doctors (yes, more than one) who
blithely told me there was absolutely nothing wrong with my son's
elbow and no fracture on x-rays and sent us home. That one year of
Kaiser coverage cost a 9-year-old boy 50% range of motion in his arm
for the rest of his life for a fracture that is clearly visible on the
Kaiser x-rays and could have been fixed at that time with a good
prognosis.
On 23 Feb 2003 19:49:41 GMT, jbuxt...@aol.comignore (JBuxton569)
wrote:
Gil Carter
Yep, it's an interesting article. Once I used to spend enormous amounts of
time with each patient. It was when I was a naive but good hearted barefoot
hippy doctor 30 years ago, delivering free care. I haven't been that way in
a long time. I added on law school during the 1980's. Some of my friends
said "Law school has been good to Gil. It has beaten some of the excessive
niceness out of him." But then I went back to Family Practice.
I think that boutique practices are probably ok so long as the doctor
doesn't see Medicare patients. Otherwise, I think they're looking at jail
time. Medicare has an elaborate and comprehensive plan for reimbursement
for medical care of the seniors. I would expect the Feds to see charging
$2000 per year per senior as a blatant attempt at an end run around all the
statutes governing Medicare reimbursement. The physicians could seek an
advisory opinion from the US Attorney General or Inspector General's office.
So long as the physician is not on a PPO insurance plan as a preferred
provider, he could potentially do ok. Otherwise, it would be a contract
violation of the physicians contract under the PPO.
Gil
"Liz" <liz...@Erols.com> wrote in message news:3E591A...@Erols.com...
Anne Collins
average about $38-54 for commercial, less for Medicare. Luckily for us, we
have lab and x-ray in our facility, so we don't have to send them anywhere
else and they don't have to pay another co-pay. The reimbursement rate is
based on region, too. More doctors, less reimbursement. Rural areas get a
break. Our reimbursement rate is pretty good compared to the northeast -
and now I see the west, too. So I should stop complaining. :-)
We have 6 providers in our family practice - 5 MDs and 1 NP. We are one of
the smaller practices, too. We have one family practice that has 12
providers - so you can imagine what they pay for transcription - all of
which is outsourced. Here, they charge by the word. Coming from Florida,
that was certainly a shock to me, since I had always been paid by the line
when I was a transcriptionist. Here, as everywhere else, there is a
shortage of MTs. In fact, our hospital transcriptionists do very well
indeed. They tell me I was crazy to leave - but money ain't everything! I
do all right as a coder and it's easier on my hands and my back. :-) And I
love what I do.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5i8n2i...@corp.supernews.com...
14tonks
As far as no-shows, add-ons and walk-ins are concerned, yes, they can make
it hard to run things smoothly, and on an occasional day Murphy will work
overtime, they will get away from you, and things will get behind. However,
you can usually figure the average percentage of no-shows. (If you want 250
cats in that show hall, accept 270 to 290 entries, depending on the show
date and location. You should end up with 240 to 260 furry bodies that
actually show, and you can juggle things to cover that small a difference.)
Experience will also tell you about how many last minute calls you are going
to get on average from owners of campaigned cats who wait until the last
minute to enter, so they can make the show likely to get them the most
points, without paying entry fees to several shows in advance. You
therefore cut off the household pet and alter entries before you max out on
total entry numbers, to leave the necessary margin to accept those
last-minute championship entries. As to walk-ins, they have to go on an
as-space-allows waiting list. When the regular entries are accounted for,
they can buy whatever cages are left, get written into the catalog with an A
number, and wait until the end of the line to be called to the rings.
It isn't that different in a medical office. Make sure someone makes those
reminder phone calls to reduce your no-shows. Don't overbook more than your
average number of no-shows for the season, and spread the overbookings out
over the day - don't just double up all the early morning appointments. For
heaven's sake, don't see a walk-in when there are five scheduled patients in
the waiting room who arrived at their appointed time, unless it is going to
take longer to get out all the blood they are going to put on the carpet
while they are waiting than it is going to take to deal with them. And if
you know you get same-day calls, or if you know you can anticipate an
emergency or two, hold some space in the appointment book for them.
(Once upon a time, when there was a major problem booking OR time, one of
our fellows invented a fictitious patient, complete with fictitious chart.
Fortunately, none of the cardiac surgeons were W.C. Field fans, and they
never caught on that Edgar Souse (accent grave) was a purely fictitious
patient, not just a kid with a notoriously unreliable welfare mom, who
consistently failed to appear in admitting, no matter how serious the
appointment. Edgar would fail to arrive, his mother would fail to respond
to phone calls, he would be cancelled at the last minute, yet again, and
what do you know, as luck would have it, there actually was then an O.R.
opening free that day for the referral straight from the cath lab the fellow
had known he was going to need to schedule, but hadn't been able to book.
Sometimes scheduling requires outsmarting the system.)
No system works perfectly all the time, and occasionally a patient is going
to be stuck with a long wait. However, if you are waiting two hours or more
every time you see a certain doctor, he and his staff have made it clear
that they don't know how to schedule, and can't be bothered learning. I
figure that's a good reason for the patient to get another doctor, or for
the doctor to get another office manager.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5i842s...@corp.supernews.com...
14tonks
patients let them do it. I could _never_ get it through my sister-in-law's
and my mother's heads that they should just walk out if she was kept waiting
around for an hour, and come back another day when the doctors could see her
promptly. She ended up sitting around once for something like 6 hours to
get a simple radiology procedure done, with my stupid SIL sitting right
there with her. She had a tumor pressing on her spinal cord, was in a lot
of pain from sitting upright that long, and was wiped out for the rest of
the week.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Iris Brown" <ilbro...@earthlink.net> wrote in message
news:b3b7vv$1khnhi$1...@ID-157009.news.dfncis.de...
JBuxton569
see the doctor. If the doctor sent you to the lab, you waited at the
lab. God help you if you had to go for labs, x-ray and a prescription
-- you would be there all day.>>
I'm sorry your experiences with Kaiser were so bad. However, maybe I just
lucked out having a better run center.
I've very rarely been sick in the last 20 years, but when I needed to see a
doctor, I usually got in within the same week if not the same day. My
ophthalmologist has seen me twice a year to monitor my ocular pressure and even
schedules me on a regular basis for that horrible peripheral vision test. This
has been going on for many, many years.
Dr. B. always got me in to see any specialist I needed to see very quickly.
The only problem I had was seeing someone to put a cast on my ankle when I
started having problems walking about 15 years ago. My boss called, and I was
"red flagged" for casting the next day.
I think the amount of time you might have to wait depends also on the time of
day of your appointments. So far, keeping fingers crossed, I've been lucky and
only have to wait a few minutes for lab or mammograms, etc. I use the mail
option for my rare prescriptions, and they arrive within a couple days. No
standing in line there.
Judity
RaeMorrill
results to patients if they are open to it and it doesn't cost for the
stamp, envelope and mailing, .... and patients love it.>>
Are you encrypting these files? If not, are patients aware this is not secure
unless it is encrypted?
RaeMorrill
often the "medical emergency" causing a wait was something like a tennis
tournament at the country club that ran late, the doctor forgetting there
was another patient waiting, skipping out to the bank,>>
Exactly. I'm sure some doctors find this difficult to believe, but I sure don't
doubt it for one minute.
RaeMorrill
that the blood pressure goes up exponentially with each passing moment :-)
LOL. Maybe that is what causes white coat hypertension!
RaeMorrill
and my mother's heads that they should just walk out if she was kept waiting
YOu can bet some of the offices would have the balls to try to bill for a
missed appt too!
Gil Carter
Yes of course... It's by informed consent. I don't leave it up to my staff.
I discuss it myself. Email is Not private. To start with, the ISP's can
see it. Hackers can easily get in I am told. The same warning text is in
the email as well, and if they don't want email access, they know all they
have to say is "stop." But I cannot tell you how many of my patients tell
me how much they appreciate it.
Also, it's not like sending their entire medical record through email. For
somethings email is great, for somethings it's not.
:)
Gil
"RaeMorrill" <raemo...@aol.com.com> wrote in message
news:20030223164839...@mb-bd.aol.com...
JMorngstar
>Are you encrypting these files? If not, are patients aware this is not secure
>unless it is encrypted?
>
This is being handled in a different way for HIPAA. When a patient calls the
office and leaves a number for a call back and the call back happens to be a
cell phone. The patient is in sorts giving their permission for an unsecure
communication of their HPI.
Since (in CA anyways) patients sign an authorization for treatment, this
usually includes authorization to share information with the insurance company,
referring physician or any entity that will be involved in the care of the
patient, I have recommended to my offices that they also include phrases
concerning this information about cell phones and emails. If the patient is
aware and consents to have calls to their cell phones and also information
emails, then it is entirely permissible by the office.
Janice
RaeMorrill
aware and consents to have calls to their cell phones and also information
emails, then it is entirely permissible by the office.>>
That's fine, of course, but the key would be is it something that must be
explained to the patient. Most people would not stop to think about that part
of a cell phone call (i.e. that people can and are listening in)
14tonks
attentively yet, I believe the new security rule indicates that information
must be secured at the covered entity's end of the communication, even if it
is not secure at the patient end. In other words, it would be acceptable
for the patient to e-mail their PHI unencrypted to a doctor , but not for a
doctor to mail it unencrypted to a patient. Now, I agree that is completely
daft, but no one said the HIPAA regulations were sane, just that doctors
were going to have to comply with them.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"RaeMorrill" <raemo...@aol.com.com> wrote in message
news:20030223173649...@mb-fh.aol.com...
Julianne Weight
wrote:
>This is being handled in a different way for HIPAA. When a patient calls the
>office and leaves a number for a call back and the call back happens to be a
>cell phone. The patient is in sorts giving their permission for an unsecure
>communication of their HPI.
>
>Since (in CA anyways) patients sign an authorization for treatment, this
>usually includes authorization to share information with the insurance company,
>referring physician or any entity that will be involved in the care of the
>patient, I have recommended to my offices that they also include phrases
>concerning this information about cell phones and emails. If the patient is
>aware and consents to have calls to their cell phones and also information
>emails, then it is entirely permissible by the office.
>
>Janice
E-mail is different, especially if medical advice is going to be given
or if the non face-to-face encounter is going to be billed. There has
to be a means to authentice that the physician is actually the one who
sent the e-mail and verification that it was sent and received by the
person for whom it was meant.
JMorngstar
>attentively yet, I believe the new security rule indicates that information
>must be secured at the covered entity's end of the communication, even if it
>is not secure at the patient end.
Are you saying that even if the patient asks the doctor to email them that it
needs to be encrypted. If this is what you are saying, I believe that you are
wrong. Now if I doctor sends this unsolicitated unencrypted, then there would
be a problem.
The patient is taking on the responsibility for asking for information to be
sent via email and via cell phone.
Janice
JMorngstar
>E-mail is different, especially if medical advice is going to be given
>or if the non face-to-face encounter is going to be billed. There has
>to be a means to authentice that the physician is actually the one who
>sent the e-mail and verification that it was sent and received by the
The statement that I made was not as part of a billing or giving medical
treatment via email. Patients are asking that their followup reminders be sent
to them via email. The answer I gave was not particularly regarding medical
care although it could be (i.e., yes double the dose of Protonix), but I was
not speaking to medical care that could be billed, nor would I speak to that as
I don't know a thing about it.
Janice
Julianne Weight
wrote:
That's why I said this was different -- it has nothing to do with
HIPAA.
You might also check the California privacy law -- they're more
restrictive than HIPAA.
Melinda Meahan - take out TRASH to reply
>I imagine this varies from provider situation to provider situation. In my region of Northern California there is an HMO called Hill Physicians'
>Medical Group.
>
Hey, there are several of us in that area, too.
--
I know God will not give me anything I can't handle.
I just wish that He didn't trust me so much. - Mother Teresa
Margie Kahn
reply <mme...@TRASHsonic.net> wrote:
>Gil Carter wrote:
>
>>I imagine this varies from provider situation to provider situation. In my region of Northern California there is an HMO called Hill Physicians'
>>Medical Group.
>>
>
>Hey, there are several of us in that area, too.
Yeah, Melinda, there are, but I doubt he needs any transcription!
Gil Carter
I have not billed for email service although I understand that either Blue
Cross or Blue Shield of California, has begun to pay for such service by the
Univ of Calif Davis Medical Center.
With respect to auththentication, a note can easily be written to hard copy
and signed just like a non-electronic medical record. That is of course the
traditional method of authentication, ... a written signature by the signor
affirming that he provided the service. Like other things in law, a
signature is not incontrovertible proof.
It is easier to provide phone service for those insured by companies who
cover such service. It would only be appropriate when the phone service
constitutes a signficant change in treatment plan or is sufficiently
substantial in nature to so warrant, which is stated in the CPT code
guidelines. The words I stated above are not the exact wording of the CPT
codes 99271, 2 and 3 as I do not have a copy in front of me.
It's too bad that more patients and physicians are not aware of the
telephone service, as it would be well worth the usual $25 charge to obtain
treatment for a sinus infection or bladder infection or otherwise avoid an
office visit. Arguably, physicians would lose by doing telephone service
because they would be paid only $25 instead of $40 if the patient comes in
for an appointment. It could not be done for Medicare patients unless
they've signed a waiver recognizing that it's not covered by Medicare.
Obviously, one should not send someone a surprise bill when they had no
reason to expect that they were incurring one. It goes against the most
basic aspects of contract law.
:)
Gil
"JMorngstar" <jmorn...@aol.comnojunk> wrote in message
news:20030223182242...@mb-cm.aol.com...
Gil Carter
EMR is Not for everyone! Plastics, ophthalmologists, orthopedists and
surgeons of all sorts have No need for it, or at least nearly none, which is
good because they can afford it <g>
If the doctors using your services set up their own templates, or use a
standardized one, there is cream to be had between the amount of work you
have to do and the amount they pay. For example, if they dictate or jot
down "5 d sinusitis" and circle it or someother special mark, you can just
strike the key strokes "5 d" then the 4 keys or so that trigger the typical
sinusitis note. He would only have to add to his writing or dictation any
variation from the standard. Ideally you would be able to fax in the
prescription for him after he says "amo242" for "amoxil 250 mg tid #42."
The "doctor cannot type barrier" is alive and well.
It may be that transcriptionists in the doctors' offices with EMR skills are
the next thing. :) I sure know I've been thinking about it.
:) :)
Gil
"Margie Kahn" <mlk...@mindspring.com> wrote in message
news:n4oi5v0j1p2a50d0o...@4ax.com...
14tonks
read through the whole thing. But I do remember hitting a passage when I
was skimming it briefly that I interpreted to mean that if it is originating
from the covered entity, it must be sent encrypted, although if it is
originating from the patient, it can be sent in the open. I remember
thinking that was demented. It may be it will be interpreted as you say,
i.e., if the patient requests it to be sent unencrypted, then it is
permissible for the covered entity to do so. When I get back to studying
the thing, if I find some relevant passages, I will post them.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"JMorngstar" <jmorn...@aol.comnojunk> wrote in message
news:20030223182015...@mb-cm.aol.com...
JMorngstar
>thinking that was demented.
I don't understand this. If a patient does not want it to be protected PHI
because they want to get called on their cell phone and no way to protect it,
why isn't this their right.
If the email originated from the office and was solely for the benefit of the
doctor and his employees then I can see where it is necessary.
Prior to the final regs, and with my scenario, it had the patient calling the
office on a cell phone and the office personel if they suspected it was a cell,
had to educate the patient right then at that point that this was not a secure
way to conduct business and document it in the chart that the patient had given
their permission to discuss this over a cell phone. Now if the office was not
aware that it was a cell phone, then they were screwed. That is demented.
I think that the final regs are trying to help establish some of the
appropriateness of some of these communications and making the patient
partially responsible. Many people may not care, and evidently they don't
because many offices are left cell numbers every single day.
Janice
14tonks
the theory of type a few letters and get a sentence or a paragraph. It's
just that we wouldn't want to have to learn a whole separate list of
abbreviations for each of our clients - we need a universal system that
works for everything we type.
What you are doing works fine for you, but multiply you by ten people in
your group, each with his own long list of abbreviations, each according to
his own system, and the transcriptionist is going to run screaming.
When I type from handwriting, I have no problem if the doctor uses standard
medical abbreviations in a context that make the specific meaning clear.
(There are a _lot_ of possible meaning for a number of those acronyms.) I
give them hell if they start trying to use their own secret shorthand - they
are not paying me for time wasted reading minds, or verifying guesses.
I do think trancription linked to EMRs, with or without VR, is something
there will be increasing interest in. I would be very interested in seeing
some good systems for that, with an open link that makes it easy to use any
transcriptionist, not the EMR's proprietary service. Maybe you should work
along those lines.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5ip5hi...@corp.supernews.com...
RaeMorrill
must not one fully comprehend the risk? I personally think sending unencrypted
email patient files is low risk as far as say MY OWN personal information being
breeched, but is that the point?
>> If this is what you are saying, I believe that you are
wrong. Now if I doctor sends this unsolicitated unencrypted, then there would
be a problem.
The patient is taking on the responsibility for asking for information to be
sent via email and via cell phone.>
RaeMorrill
originating from the patient, it can be sent in the open. I remember
thinking that was demented. It may be it will be interpreted as you say,
i.e., if the patient requests it to be sent unencrypted, then it is
permissible for the covered entity to do so. When I get back to studying
the thing, if I find some relevant passages, I will post them.
-->
I don't think it is "demented." In that if I send my doctor my personal
records, including any delicate information about positive lab results (say
HIV) or other delicate information. He can't be responsible for my ignorance if
I initiate contact, any more than it is my business if a doctor sends me voice
files unencrypted. I can't help what someone sends me.
RaeMorrill
because they would be paid only $25 instead of $40 if the patient comes in
for an appointment. It could not be done for Medicare patients unless
they've signed a waiver recognizing that it's not covered by Medicare.<<
Seems Medicare ("The Gummint") should look to save money this way. Never mind
it is often hard for elders to get into office.
>>Obviously, one should not send someone a surprise bill when they had no
reason to expect that they were incurring one. It goes against the most
basic aspects of contract law.>>
OBVIOUSLY!
RaeMorrill
variation from the standard. Ideally you would be able to fax in the
prescription for him after he says "amo242" for "amoxil 250 mg tid #42."
The "doctor cannot type barrier" is alive and well.>
Ah, no thanks. I'm not interested in that end responsibility.
RaeMorrill
When I type from handwriting, I have no problem if the doctor uses standard
medical abbreviations in a context that make the specific meaning clear.
(There are a _lot_ of possible meaning for a number of those acronyms.) I
give them hell if they start trying to use their own secret shorthand - they
are not paying me for time wasted reading minds, or verifying guesses.>
Bingo. There are often more than one meaning for the same exact abbreviation,
maybe in the same specialty and if not given in full elsewhere it is guessing
on my part.
One thing is I CANNOT TYPE FROM COPY and don't want to.
ste...@my-deja.com
wrote:
> It is an intermediary for the HMO version of the main
>insurance companies here: HealthNet, Calif Blue Shield, Calif Blue Cross,
>Cigna, Aetna and Pacificare.
You mean they are an "independent physicians association"? They
contract for capitation from the insurer, and each member physician
gets capitated, gets a fee monthly per patient?
That is the sometimes crazy HMO model that has been used for the last
10 or more years here. The doc has 10,000 patients assigned at $1
each per month (an example), and then has to take care of any of those
that happen to show up. Is that what you mean?
Gdubson
>
>
>Rae Morrill in Maine
Same here, gives me vertigo or something near to it.
Gisele
Gil Carter
In *my* case, no. But in other models, sometimes yes. All the primary care
physicians, internists, FP, peds, and obg are not capitated, nor are any but
a few of the specialties. We only get paid when we actually provide a
service and send them a bill for it. I share with you the confusion in
meanings of some of these entities. In this case, Hill Physicians Medical
Group reaches some capitated global agreement with each of the primary
insurance companies that I mentioned.
Patients are only connected through Hill Physicians when they select a Hill
group HMO plan through their insurance company AND find themselves a
physician in the Hill group. For example, a patient has HealthNet
insurance and wants the HMO version, they must then select a physician
contracted with the Hill group otherwise they are assigned one by the
insurance company if one is available.
Independent practice associations, according to Online Medical Dictionary,
is a partnership, corporation, association, or other legal entity that
enters into an arrangement for the provision of services with persons who
are licensed to practice medicine, osteopathy, and dentistry, and with other
care personnel. Under an ipa arrangement, licensed professional persons
provide services through the entity in accordance with a mutually accepted
compensation arrangement, while retaining their private practices. Services
under the ipa are marketed through a prepaid health plan. 1998.
Perhaps an independent *physicians* association is different. I do not
know.
:)
Gil
"Ste...@my-deja.com" <ste...@my-deja.com> wrote in message
news:nm0j5v8fdd6mdhn66...@4ax.com...
Bob
The satisfaction for Kaiser patients seems to vary wildly depending upon the
location.
When I lived in Dallas and worked for a large corporation, there were major
complaints about premium increases one year. My cost for my plan was going up
something like 47%. We had the choice of 4 different providers/plans.
Corporate H.R. replied that there was one "quality" provider whose costs
weren't going up and were the cheapest of the 4 plans. A week later, the
Dallas Morning News did an expose on HMOs in the area. All of them were
experiencing major enrollment increases except for one which was dropping.
This same HMO also had almost double the wrongful death lawsuits filed
against it as all the others combined.
We had an employee transfer in from California and immediately signed for
this provider despite many people recommending against them, because they
were absolutely wonderful in California. Shortly thereafter, this employee
had to visit the provider. Upon returning from visit, the employee wanted to
change plans IMMEDIATELY, but had to wait until the annual enrollment date.
The provider in both of the above situations? Kaiser.
I'm sure this is true of almost all providers to a certain extent, but I've
never seen such a difference as with Kaiser.
Bob/Texas
Bob
> This article appeared in The Philadelphia Inquirer this a.m. I'd love
> to hear Dr. Gil's impression!
>
> http://www.philly.com/mld/inquirer/5240244.htm
>
This is happening all over the country. It's great for those who can afford
it.
Bob/Texas
Gil Carter
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3bt4p$1kekg1$1...@ID-173555.news.dfncis.de...
> Well, you see we all use expanders already, so we are quite familiar with
> the theory of type a few letters and get a sentence or a paragraph. It's
> just that we wouldn't want to have to learn a whole separate list of
> abbreviations for each of our clients - we need a universal system that
> works for everything we type.
__________________________
**********I agree 100%
_________________________
>
> What you are doing works fine for you, but multiply you by ten people in
> your group, each with his own long list of abbreviations, each according
to
> his own system, and the transcriptionist is going to run screaming.
_______________________
********I concur wholeheartedly
_______________________
>
> When I type from handwriting, I have no problem if the doctor uses
standard
> medical abbreviations in a context that make the specific meaning clear.
> (There are a _lot_ of possible meaning for a number of those acronyms.) I
> give them hell if they start trying to use their own secret shorthand -
they
> are not paying me for time wasted reading minds, or verifying guesses.
__________________
***********Yep, no doubt!
__________________
>
> I do think trancription linked to EMRs, with or without VR, is something
> there will be increasing interest in. I would be very interested in
seeing
> some good systems for that, with an open link that makes it easy to use
any
> transcriptionist, not the EMR's proprietary service. Maybe you should
work
> along those lines.
_________________
************YYYEEESSS!
Each doctor can have his own module. Activate Doctor William's module when
doing his reports, and sinusitis for Dr Smith becomes sinusitis for Dr
Williams. If your using MS Word, you pop Smith's module out and pop
William's module into the MS Word Starup folder, and you're good to go. :)
:)
Gil Carter
I'd be interested in what you find.
:)
Gil
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3bqta$1k7kmb$1...@ID-173555.news.dfncis.de...
RaeMorrill
employer (Florida Power and Light - at least in the Maine facility he works
for) are now self-insured. No more HMO. No more referrals to see a specialist.
I just can't deal with this myself. I KNOW when I want to see a specialist.
Heck this plan even covers massage therapy (X dollars w/o referral)- which will
be helpful to those aching muscles caused by falls from a horse!
Gil Carter
I've also had this discussion with an attorney for the State of California's
HMO oversight department. He has been discussing it with some of the
insurance company heads, and ... so far ... it sounds pretty much like our
discussion here.
:)
Gil
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3bqta$1k7kmb$1...@ID-173555.news.dfncis.de...
Gil Carter
for the last 100 years. They got us paying for them, don't they? <G>
"RaeMorrill" <raemo...@aol.com.com> wrote in message
news:20030223210326...@mb-ct.aol.com...
14tonks
I'm not popping any modules in or out of anywhere if I'm working with a
computerized system. All I should need to do is identify the doctor the
report is for, and the computer should take care of all of that. You, as
the programmer, get to figure out how to take care of those little tasks. I
am not going to shut down Word and drag things in and out of the startup
folder every time I change the doctor I am transcribing for. I can open a
document based on a given template if necessary, but that is as far as I am
prepared to go. And really, a fully computerized EMR link should automate
the whole thing for me.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5j3g78...@corp.supernews.com...
14tonks
unencrypted e-mail, so the answer to this is a lot more urgent for you than
it is for me <smile>.
Here's the link to the whole miserable 289 pages:
http://www.cms.hhs.gov/regulations/hipaa/cms0003-5/0049f-econ-ofr-2-12-03.pd
f
Read through it, talk to your lawyer about it, and let us know what the
verdict is.
--
&%) Sheila
To reply to me, you must add the prefix real. to my address.
"Gil Carter" <gca...@rcsis.com> wrote in message
news:v5j3i96...@corp.supernews.com...
Bob
raemo...@aol.com.com says...
There can be one downside to 'self-insured'. In most states, the laws
governing health insurance do NOT apply to self-insured companies. For
example, most states require health insurance companies to cover diabetic
testing equipment and supplies. However, self-insured companies are not
required to do so.
Bob/Texas
RaeMorrill
Each doctor can have his own module. Activate Doctor William's module when
doing his reports, and sinusitis for Dr Smith becomes sinusitis for Dr
Williams. If your using MS Word, you pop Smith's module out and pop
William's module into the MS Word Starup folder, and you're good to go. :)>
That's great! Except one thing. We're lucky if the doctor's offices are
computer literate enough to FIND the file we emailed, never mind put in
variables that allow for this.
I can program my expander (should I choose) to override correctness using IF
statements. Most people are not that computer literate. So if one doc wants PRN
and another p.r.n. and another prn I am screwed
RaeMorrill
There can be one downside to 'self-insured'. In most states, the laws
governing health insurance do NOT apply to self-insured companies. For
example, most states require health insurance companies to cover diabetic
testing equipment and supplies. However, self-insured companies are not
required to do so.>
Bob,
Probably likely - luckily at this point I'm healthy. However, I have already
found this particular plan beats the "others cold (old Pepsi ad). Had some
dental work done. First it paid 100% (not just UCR) of my my cleaning, exam`
and bitewings - 159 bucks). Then, though the office required 30% plus 50 buck
deductible), the plan paid 80% with no deductible on dental (there is a limit).
RaeMorrill
Message-id: <v5j3u2f...@corp.supernews.com>
I think the seniors are the most ogranized and powerful group in the U.S.
for the last 100 years. They got us paying for them, don't they? <G>>
LOL! Funny guy, Gil!
Course since I am a "few" years older than spouse, I"m going to pay rather than
claim SENIOR at some point
ste...@my-deja.com
wrote:
>In this case, Hill Physicians Medical
>Group reaches some capitated global agreement with each of the primary
>insurance companies that I mentioned.
>
>Patients are only connected through Hill Physicians when they select a Hill
>group HMO plan through their insurance company AND find themselves a
>physician in the Hill group. For example, a patient has HealthNet
>insurance and wants the HMO version, they must then select a physician
>contracted with the Hill group otherwise they are assigned one by the
>insurance company if one is available.
And Hill gets paid each month for each assigned patient, there is no
"fee for service". That is a flawed model IMHO because the doctors
group only makes money if the patient does NOT come in to the office.
If they have to see to many patients they lose money, and god help
them if someone actually gets sick! Who wants a doctor who doesn't
want to see you?
Now with the Kaiser HMO system (which I am a member of) everyone works
there. If you need to see a specialist, it's not much problem,
"Doctor Smith already works here, go down the hall and see him".
Referral issues are minimized by no money changing hands. There is no
money between the doctor and the patient.
I will never forget sitting in my dad's cardiologist's office and
having the doc complaining to my dad about his $2 a patient/month
capitation. As if my dad is responsible for his contract with the
IPA! I told him "if you are not happy with your contract, get a new
one, or dump the IPA". Anyway, he prolly has 3000 patients assigned
at $2 a month, and sees only a fraction of those. Lucky for him.
I think fee for service works, with a number of serious problems.
There needs to be some sort of managed care, or there is no one to
stop silly spending on worthless procedures. Sad but true. We saw the
example in Tenet-Redding recently. Dishonest doctors doing balloon
angioplastys on healthy patients. That is a terrible example, but it
actually happened.
ste...@my-deja.com
wrote:
>Prior to the final regs, and with my scenario, it had the patient calling the
>office on a cell phone and the office personel if they suspected it was a cell,
>had to educate the patient right then at that point that this was not a secure
>way to conduct business and document it in the chart that the patient had given
>their permission to discuss this over a cell phone. Now if the office was not
>aware that it was a cell phone, then they were screwed. That is demented.
phones are not easy to listen in on.
What is NOT secure is those cordless phones that everyone has at home.
Those can easily be listened in on. There was a court case about it,
as I recall the judgment was that there was no expectation of privacy
on a cordless phone. Not true on a cell phone, it is actually illegal
to listen in or disclose what you heard in a cellphone conversation.
That HIPPA stuff is all loony. I don't disagree about the importance
of safeguarding medical records, but the idea is to use normal care
and not blab what you might know.
Gil Carter
Thanks to all you. You've been very informative and helpful. :)
Yer right. It should be quite an easy item to accomplish. I've set my
program to allow different pharmacy fax telephones for different regions,
and different doctor directories for the same. It shouldn't be difficult to
have a drop down menu of doctors modules. I had not originally written the
program with MT's in mind for multiple doctors, but it's very do-able.
It would in effect activate MS Word's toolbar items: Tools/Templates and
Add-ins/Attach with the name of attaching module being listed as the
doctor's name in a plainly visible file. I might add this in to the program
"just for the fun of it." (I am a sick puppy.) That would make it easier
for a transcriptionist linked to certain physicians.
I appreciate your input.
:)
Gil
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3c39q$1kv9vc$1...@ID-173555.news.dfncis.de...
RaeMorrill
example in Tenet-Redding recently. Dishonest doctors doing balloon
angioplastys on healthy patients. That is a terrible example, but it
actually happened.
>>
And the horrified reaction you get from other docs or anyone in the system with
a conscience will be THIS NEVER HAPPENS
I am of old school. In those days any advertising would have been malpractice
(or close to it)
Gil Carter
I thought Kaiser had to flee Texas a few years back. Did they not leave or
did they come back for more Texas barbeque? <g> I am from San Antonio,
Austin, Galveston but have been out on the west coast for a long time.
:)
Gil
"Bob" <notto...@forevermail.com> wrote in message
news:MPG.18c348329...@news-server.satx.rr.com...
Bob
raemo...@aol.com.com says...
Self-insured plans can be very good. I've been covered by them. When I
mentioned the fact that they didn't have to cover what the law required of
insurance companies, the HR director replied that they made it a point to
cover whatever the state required of insurance companies. So in that case, I
was in good hands (not so-old Allstate ad). I just wanted you to be aware of
the situation.
Bob/Texas
Bob
> Hi Bob,
>
> I thought Kaiser had to flee Texas a few years back. Did they not leave or
> did they come back for more Texas barbeque? <g> I am from San Antonio,
> Austin, Galveston but have been out on the west coast for a long time.
> :)
> Gil
>
This was back in the '93-94 time frame. I moved to Florida in late 1996 and
now I'm back in San Antonio, so I'm afraid I don't know what happened with
them.
Bob/Texas
Gil Carter
this point. http://www.cms.hhs.gov/providerupdate/regs/cms0049f.pdf
Gil
"14tonks" <mail.2....@recursor.net> wrote in message
news:b3c3nq$1kqod4$1...@ID-173555.news.dfncis.de...
Melinda Meahan - take out TRASH to reply
>>Hey, there are several of us in that area, too.
>>
>
>
>Yeah, Melinda, there are, but I doubt he needs any transcription!
>
>
I don't need any more work. I already have more work available to me
than I have the capability of doing. I just still find it a kick to
corespond online with people who are spitting distance from me.
--
I know God will not give me anything I can't handle.
I just wish that He didn't trust me so much. - Mother Teresa
Melinda Meahan - take out TRASH to reply
>With respect to auththentication, a note can easily be written to hard copy and signed just like a non-electronic medical record. That is of course the traditional method of authentication, ... a written signature by the signor affirming that he provided the service. Like other things in law, a signature is not incontrovertible proof.
>
This one psych doc I hate writes lots of notes for phone calls, and he
bills people for them, too.