[Practiceimp WAS Re: efficiency and money

October 12, 2006

Along these lines, a couple yrs ago didn't someone post about charging pt a voluntary fee of $50 a year to offset some of the costs of all these unreimbursed care. Whoever that was, could you respond to me off or on list. I am now thinking about doing the same thing.

On another subject, Tim, how much do you charge for Botox, and what geographical area are you in?

--------- RE: [Practiceimp WAS Re: efficiency and>> money>>Date: Tue, 10 Oct 2006 22:20:26 -0400>>>>Lynn, I am finding that I am providing free services to office visits>> at a rate of almost 10 to 1. Is that what you mean by admin time? For>> every visit a patient makes I have to respond to two specialist>>contacts, one radiology report, two lab reports, two formulary and/or>> "care management" issues, three phone calls from the patient, and one>> pharmacy phone call (not a formulary issue).>>>>>>"I am checking my Admin time: patient time ratio and it is HORRIFIC!>> something>&gt

;like 40 hours of admin to 20 patient hours. I have got to FIX THIS!>> I'm>>going to break down my times even more to see where it's leaking out>> to. I>>really want to get to a sustainable work load over the next year, or I>> will>>be BERSERK! I'll keep you guys posted. Thanks again for all the>> support>>and it was lovely to see you all in the flesh.>>>>Lynn">>>>In a "big office" where MAs do a lot of this stuff they don't probably>> realize how much time it eats up, but if you do it all yourself....I>> have randomly reviewed charts in the past to look at this question. In>> the past week and a half I have started leaving all charts open until>> the end of the day... for every patient I actually see during a day>> there are 9 - 10 more open at the end of the day, for who I have had to>> do SOMETHIN

G, but for whom I am paid nothing...What can we do about>> this?>>Annie>>>>>>>>>>>>

October 12, 2006

Along these lines, a couple yrs ago didn't someone post about charging pt a voluntary fee of $50 a year to offset some of the costs of all these unreimbursed care. Whoever that was, could you respond to me off or on list. I am now thinking about doing the same thing.

On another subject, Tim, how much do you charge for Botox, and what geographical area are you in?

--------- RE: [Practiceimp WAS Re: efficiency and>> money>>Date: Tue, 10 Oct 2006 22:20:26 -0400>>>>Lynn, I am finding that I am providing free services to office visits>> at a rate of almost 10 to 1. Is that what you mean by admin time? For>> every visit a patient makes I have to respond to two specialist>>contacts, one radiology report, two lab reports, two formulary and/or>> "care management" issues, three phone calls from the patient, and one>> pharmacy phone call (not a formulary issue).>>>>>>"I am checking my Admin time: patient time ratio and it is HORRIFIC!>> something>&gt

;like 40 hours of admin to 20 patient hours. I have got to FIX THIS!>> I'm>>going to break down my times even more to see where it's leaking out>> to. I>>really want to get to a sustainable work load over the next year, or I>> will>>be BERSERK! I'll keep you guys posted. Thanks again for all the>> support>>and it was lovely to see you all in the flesh.>>>>Lynn">>>>In a "big office" where MAs do a lot of this stuff they don't probably>> realize how much time it eats up, but if you do it all yourself....I>> have randomly reviewed charts in the past to look at this question. In>> the past week and a half I have started leaving all charts open until>> the end of the day... for every patient I actually see during a day>> there are 9 - 10 more open at the end of the day, for who I have had to>> do SOMETHIN

G, but for whom I am paid nothing...What can we do about>> this?>>Annie>>>>>>>>>>>>

October 14, 2006

I think that you are referring to Ira Warshaw, who posts here occasionally. An article about his practice can be found here:http://www.memag.com/memag/article/articleDetail.jsp?id=109006 SetoSouth Pasadena, CAAlong these lines, a couple yrs ago didn't someone post about charging pt a voluntary fee of $50 a year to offset some of the costs of all these unreimbursed care. Whoever that was, could you respond to me off or on list. I am now thinking about doing the same thing.On another subject, Tim, how much do you charge for Botox, and what geographical area are you in?

October 14, 2006

I think that you are referring to Ira Warshaw, who posts here occasionally. An article about his practice can be found here:http://www.memag.com/memag/article/articleDetail.jsp?id=109006 SetoSouth Pasadena, CAAlong these lines, a couple yrs ago didn't someone post about charging pt a voluntary fee of $50 a year to offset some of the costs of all these unreimbursed care. Whoever that was, could you respond to me off or on list. I am now thinking about doing the same thing.On another subject, Tim, how much do you charge for Botox, and what geographical area are you in?

October 16, 2006

I don't know about that Anemaria, my patients seem to understand perfectly

on the phone, it just takes a bit of time. I think it's a matter of

convenience and copays for them and a matter of free medical practice for

me.

Lynn

>

>Reply-To:

>To:

>Subject: Re: RE: [Practiceimp WAS Re: efficiency and

>money

>Date: Wed, 11 Oct 2006 22:36:48 -0500

>

>Lynn, the problem with phone medicine is that there is a lot of

>misunderstanding. I would rather tell a patient " you have anemia and need a

>colonoscopy " then explain the significance of high MCV. People just don't

>understand things on the phone. If they are more articulate, I would rather

>send an e-mail or a letter.

>

>>Annie-

>> I think that is it in a nutshell. I'm going to try to get some more

>>exact

>> data: how many hours: 1) billing and posting, 2)trying to implement new

>> processes/software, 3) fiddling with the

>>printers/scanners/computers/PDA, 4)

>> dealing with phone calls, 5)posting and calling/emailing test results,

>> 6)doing phone medicine. I guess this is the reason lots of people HAVE

>>an

>> MA/front desk person. It really IS a lot if you are solo-solo and seeing

>>a

>> moderate amount of patients in an 8 hour day (6-10).

>> I know that some people are fairly draconian about the amount of phone

>> medicine they won't do, but I happen to feel it IS an efficient way for

>> people to get care. for example, would you discuss an abnormally high

>> %neutrophils on a complete blood count over the phone? how about a high

>> MCV? how about a cholesterol that was borderline abnormal? a fasting

>>blood

>> glucose of 116? Rather than make people come in, I often will deal with

>> these over the phone, but as we all know it isn't paid. It helps them in

>> the short run, but of course if I go out of business because I can't

>>stand

>> the amount of free admin time I'm putting in, it may not help them in

>>the

>> long run. But I am going to try to quantitate how much time goes where

>>and

>> then put the kibosh the practices that are the worst offenders, and it

>> actually may be phone medicine; I may have to get meaner!

>> Did you have a particular plan to deal with your issues? Should we

>>compare

>> notes in a few weeks?

>>

>> Lynn

>>

>> >

>> >Reply-To:

>> >To: < >

>> >Subject: RE: [Practiceimp WAS Re: efficiency and

>> >money

>> >Date: Tue, 10 Oct 2006 22:20:26 -0400

>> >

>> >Lynn, I am finding that I am providing free services to office visits

>>at

>> >a rate of almost 10 to 1. Is that what you mean by admin time? For

>> >every visit a patient makes I have to respond to two specialist

>> >contacts, one radiology report, two lab reports, two formulary and/or

>> > " care management " issues, three phone calls from the patient, and one

>> >pharmacy phone call (not a formulary issue).

>> >

>> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> >something

>> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> >I'm

>> >going to break down my times even more to see where it's leaking out

>>to.

>> >I

>> >really want to get to a sustainable work load over the next year, or I

>> >will

>> >be BERSERK! I'll keep you guys posted. Thanks again for all the

>> >support

>> >and it was lovely to see you all in the flesh.

>> >

>> >Lynn "

>> >

>> >In a " big office " where MAs do a lot of this stuff they don't probably

>> >realize how much time it eats up, but if you do it all yourself....I

>> >have randomly reviewed charts in the past to look at this question. In

>> >the past week and a half I have started leaving all charts open until

>> >the end of the day... for every patient I actually see during a day

>> >there are 9 - 10 more open at the end of the day, for who I have had to

>> >do SOMETHING, but for whom I am paid nothing...What can we do about

>> >this?

>> >Annie

>> >

>>

October 16, 2006

I don't know about that Anemaria, my patients seem to understand perfectly

on the phone, it just takes a bit of time. I think it's a matter of

convenience and copays for them and a matter of free medical practice for

me.

Lynn

>

>Reply-To:

>To:

>Subject: Re: RE: [Practiceimp WAS Re: efficiency and

>money

>Date: Wed, 11 Oct 2006 22:36:48 -0500

>

>Lynn, the problem with phone medicine is that there is a lot of

>misunderstanding. I would rather tell a patient " you have anemia and need a

>colonoscopy " then explain the significance of high MCV. People just don't

>understand things on the phone. If they are more articulate, I would rather

>send an e-mail or a letter.

>

>>Annie-

>> I think that is it in a nutshell. I'm going to try to get some more

>>exact

>> data: how many hours: 1) billing and posting, 2)trying to implement new

>> processes/software, 3) fiddling with the

>>printers/scanners/computers/PDA, 4)

>> dealing with phone calls, 5)posting and calling/emailing test results,

>> 6)doing phone medicine. I guess this is the reason lots of people HAVE

>>an

>> MA/front desk person. It really IS a lot if you are solo-solo and seeing

>>a

>> moderate amount of patients in an 8 hour day (6-10).

>> I know that some people are fairly draconian about the amount of phone

>> medicine they won't do, but I happen to feel it IS an efficient way for

>> people to get care. for example, would you discuss an abnormally high

>> %neutrophils on a complete blood count over the phone? how about a high

>> MCV? how about a cholesterol that was borderline abnormal? a fasting

>>blood

>> glucose of 116? Rather than make people come in, I often will deal with

>> these over the phone, but as we all know it isn't paid. It helps them in

>> the short run, but of course if I go out of business because I can't

>>stand

>> the amount of free admin time I'm putting in, it may not help them in

>>the

>> long run. But I am going to try to quantitate how much time goes where

>>and

>> then put the kibosh the practices that are the worst offenders, and it

>> actually may be phone medicine; I may have to get meaner!

>> Did you have a particular plan to deal with your issues? Should we

>>compare

>> notes in a few weeks?

>>

>> Lynn

>>

>> >

>> >Reply-To:

>> >To: < >

>> >Subject: RE: [Practiceimp WAS Re: efficiency and

>> >money

>> >Date: Tue, 10 Oct 2006 22:20:26 -0400

>> >

>> >Lynn, I am finding that I am providing free services to office visits

>>at

>> >a rate of almost 10 to 1. Is that what you mean by admin time? For

>> >every visit a patient makes I have to respond to two specialist

>> >contacts, one radiology report, two lab reports, two formulary and/or

>> > " care management " issues, three phone calls from the patient, and one

>> >pharmacy phone call (not a formulary issue).

>> >

>> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> >something

>> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> >I'm

>> >going to break down my times even more to see where it's leaking out

>>to.

>> >I

>> >really want to get to a sustainable work load over the next year, or I

>> >will

>> >be BERSERK! I'll keep you guys posted. Thanks again for all the

>> >support

>> >and it was lovely to see you all in the flesh.

>> >

>> >Lynn "

>> >

>> >In a " big office " where MAs do a lot of this stuff they don't probably

>> >realize how much time it eats up, but if you do it all yourself....I

>> >have randomly reviewed charts in the past to look at this question. In

>> >the past week and a half I have started leaving all charts open until

>> >the end of the day... for every patient I actually see during a day

>> >there are 9 - 10 more open at the end of the day, for who I have had to

>> >do SOMETHING, but for whom I am paid nothing...What can we do about

>> >this?

>> >Annie

>> >

>>

October 16, 2006

It is hard to figure out where the time goes in an IMP practice. I

tried a form that was supposed to help one figure out where the

distractions came from, but I got distracted too many times and never

finished the form. I can get distracted from my task just in the small

space of time of walking from the reception area to my main computer to

fax prescriptions and then they don't get done.

We finally hired an office manager, who does most of our billing and

miscellaneous items, such as answering the phone and scheduling- some

of the time. He really isn't a medical person in that he couldn't

triage on the phone at all, but I would rather do that anyway or just

have them come in.

I was so behind prior to that and getting to just dread answering the

phone as it was always interrupting me. We have a voice mail system

now that works well for us, but I find that some of the elderly

patients just can't figure it out.

I like the idea of the instant medical history, but the subjective is

the part I can now finish during the visit. I suppose the screening

tools would be helpful and I would be less likely to forget to ask

something. And then there are those days when my brain is moving like

molasses, where anything would help.

I also wonder about the phone medicine and unfortunately I wasn't too

strict about this in the beginning and now patients expect to get me on

the phone to tell their tale in hopes that they won't need to come in.

I usually find that if I see someone that I was tempted to take care of

on the phone, there is always some other issue that wouldn't have been

addressed over the phone, but comes up in the office visit.

Some simple things that probably everyone else is doing that have

really helped me is that I schedule followups when patients leave,

otherwise they never remember to call back and I don't remember to call

them in. I try to send lab order forms with them for the their

subsequent visit. They don't lose the forms as frequently as the lab

does, if I fax it directly to the lab, plus that is one less thing for

me to do and thus less to forget to do. I am sure that there are other

flow issues that I could do that I haven't thought of that would save

me time. I am also trying to just renew medications at appointments,

but I have to train myself as well as the patient.

Kathy Broman

>

> I don't know about that Anemaria, my patients seem to understand

> perfectly

> on the phone, it just takes a bit of time. I think it's a matter of

> convenience and copays for them and a matter of free medical practice

> for

> me.

>

> Lynn

>

> >

> >Reply-To:

> >To:

> >Subject: Re: RE: [Practiceimp WAS Re:

> efficiency and

> >money

> >Date: Wed, 11 Oct 2006 22:36:48 -0500

> >

> >Lynn, the problem with phone medicine is that there is a lot of

> >misunderstanding. I would rather tell a patient " you have anemia and

> need a

> >colonoscopy " then explain the significance of high MCV. People just

> don't

> >understand things on the phone. If they are more articulate, I would

> rather

> >send an e-mail or a letter.

> >

> >>Annie-

> >> I think that is it in a nutshell. I'm going to try to get some more

> >>exact

> >> data: how many hours: 1) billing and posting, 2)trying to implement

> new

> >> processes/software, 3) fiddling with the

> >>printers/scanners/computers/PDA, 4)

> >> dealing with phone calls, 5)posting and calling/emailing test

> results,

> >> 6)doing phone medicine. I guess this is the reason lots of people

> HAVE

> >>an

> >> MA/front desk person. It really IS a lot if you are solo-solo and

> seeing

> >>a

> >> moderate amount of patients in an 8 hour day (6-10).

> >> I know that some people are fairly draconian about the amount of

> phone

> >> medicine they won't do, but I happen to feel it IS an efficient way

> for

> >> people to get care. for example, would you discuss an abnormally

> high

> >> %neutrophils on a complete blood count over the phone? how about a

> high

> >> MCV? how about a cholesterol that was borderline abnormal? a fasting

> >>blood

> >> glucose of 116? Rather than make people come in, I often will deal

> with

> >> these over the phone, but as we all know it isn't paid. It helps

> them in

> >> the short run, but of course if I go out of business because I can't

> >>stand

> >> the amount of free admin time I'm putting in, it may not help them

> in

> >>the

> >> long run. But I am going to try to quantitate how much time goes

> where

> >>and

> >> then put the kibosh the practices that are the worst offenders, and

> it

> >> actually may be phone medicine; I may have to get meaner!

> >> Did you have a particular plan to deal with your issues? Should we

> >>compare

> >> notes in a few weeks?

> >>

> >> Lynn

> >>

> >> >

> >> >Reply-To:

> >> >To: < >

> >> >Subject: RE: [Practiceimp WAS Re:

> efficiency and

> >> >money

> >> >Date: Tue, 10 Oct 2006 22:20:26 -0400

> >> >

> >> >Lynn, I am finding that I am providing free services to office

> visits

> >>at

> >> >a rate of almost 10 to 1. Is that what you mean by admin time? For

> >> >every visit a patient makes I have to respond to two specialist

> >> >contacts, one radiology report, two lab reports, two formulary

> and/or

> >> > " care management " issues, three phone calls from the patient, and

> one

> >> >pharmacy phone call (not a formulary issue).

> >> >

> >> > " I am checking my Admin time: patient time ratio and it is

> HORRIFIC!

> >> >something

> >> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

> >> >I'm

> >> >going to break down my times even more to see where it's leaking

> out

> >>to.

> >> >I

> >> >really want to get to a sustainable work load over the next year,

> or I

> >> >will

> >> >be BERSERK! I'll keep you guys posted. Thanks again for all the

> >> >support

> >> >and it was lovely to see you all in the flesh.

> >> >

> >> >Lynn "

> >> >

> >> >In a " big office " where MAs do a lot of this stuff they don't

> probably

> >> >realize how much time it eats up, but if you do it all

> yourself....I

> >> >have randomly reviewed charts in the past to look at this

> question. In

> >> >the past week and a half I have started leaving all charts open

> until

> >> >the end of the day... for every patient I actually see during a day

> >> >there are 9 - 10 more open at the end of the day, for who I have

> had to

> >> >do SOMETHING, but for whom I am paid nothing...What can we do about

> >> >this?

> >> >Annie

> >> >

> >>

>

October 16, 2006