Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 (Funny how this thread got hijacked by other topics, but now back to the original...) As I had mentioned I was planning, this evening, I held my public meeting to garner feedback from patients about options to improve my financial viability. I think I had about 85 people show up, and the response was very positive. Most people who spoke up felt that everyone should pay me $175/year, the amount I had raised as a voluntary fee that I would expect 30% of patients to pay. However, those present and vocal were my biggest supporters, mostly comfortable retirees. I'll be waiting to see what feedback I get over the coming days from those who couldn't afford that or feel differently. I'll keep you posted on further developments. Other suggestions that arose -- anyone with ideas on these? 1. Accept volunteer assistance. Some patients, including nurses, have offered time. Has anyone tried this? It seems unwieldy to me, that I would spend more time training than they could offer back. But maybe one person could learn enough about, say, insurance to be useful doing follow-up calls? Etc.? 2. Do a required fee, then ask patients to offer scholarships for those who can't pay. They wanted that to be tax-deductible, which it wouldn't be if paid to me. So one guy figured that the IMP network could collect these funds and dole them back out to practices in the names of needy patients! Haresch www.onefamilydoctor.com > > > > As I've mentioned to some of you before, I plan to have an open > > patient meeting to discuss sustainability of my practice. The > > invitation I just sent out (attached to my announcement of moving my > > office to a larger, cheaper space!) is below. My plan is to present > > brief information on: 1) evidence of IMP quality 2) how that reflects > > in my own data 3) how medical billing/payment works 4) my current > > practice and personal finances. Then I'm going to present options I > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > visits by 15/week 2) voluntary non-covered services fee 3) required > > non-covered services fee 4) two-tier care, with paying patients > > getting appropriate services without a visit (which they're getting > > for free now). I want to know what changes my patients can deal with > > best. 24 hours after the invite, I have 37 RSVPs. > > > > Anyone who has done something similar with any guidance to offer me? > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > that I can plagiarize? > > > > Thanks. > > Haresch > > > > ---------------------------- > > > > You're invited: Practice feedback meeting > > > > I am asking for your input on the future of the practice at a public > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > I hope that the advantages of advanced access to your physician at One > > Family Doctor are useful to you. But maintaining this level of access > > is difficult. I must make changes to the practice in order to keep it > > afloat, and these changes will affect you. At the meeting, I will show > > how this type of practice improves health and share the financial > > details of its operation. I will present you with options for changes > > I am considering and ask for your opinions. The practice must work for > > you. > > > > Please respond to me if you plan to attend. The current plan is to > > meet at the new office, but we may need to find a larger space. > > > > If you would like to have input into these decisions but cannot attend > > the meeting, please let me know. I will send you my presentation > > materials. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2010 Report Share Posted May 6, 2010 I'm in NC. I'm only contracted with private payers that pay better than Medicare -- at least after 6/1 when I drop Aetna. > > > > > > As I've mentioned to some of you before, I plan to have an open > > > patient meeting to discuss sustainability of my practice. The > > > invitation I just sent out (attached to my announcement of moving my > > > office to a larger, cheaper space!) is below. My plan is to present > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > in my own data 3) how medical billing/payment works 4) my current > > > practice and personal finances. Then I'm going to present options I > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > non-covered services fee 4) two-tier care, with paying patients > > > getting appropriate services without a visit (which they're getting > > > for free now). I want to know what changes my patients can deal with > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > that I can plagiarize? > > > > > > Thanks. > > > Haresch > > > > > > ---------------------------- > > > > > > You're invited: Practice feedback meeting > > > > > > I am asking for your input on the future of the practice at a public > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > I hope that the advantages of advanced access to your physician at One > > > Family Doctor are useful to you. But maintaining this level of access > > > is difficult. I must make changes to the practice in order to keep it > > > afloat, and these changes will affect you. At the meeting, I will show > > > how this type of practice improves health and share the financial > > > details of its operation. I will present you with options for changes > > > I am considering and ask for your opinions. The practice must work for > > > you. > > > > > > Please respond to me if you plan to attend. The current plan is to > > > meet at the new office, but we may need to find a larger space. > > > > > > If you would like to have input into these decisions but cannot attend > > > the meeting, please let me know. I will send you my presentation > > > materials. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 Working without staff, overhead is pretty good, under $30k per year. I have about 800 active patients and plenty more potential patients, but my time is full. During visits, I typically take care of a lot more than is required for a 99214, but that is usually what I code. I offered to my patients to start cranking up the visit numbers and let them know what that would mean for my availability, and, so far, no one has voted for that option. They're saying they would rather pay to keep things the way they are. Haresch > > > > > > > > As I've mentioned to some of you before, I plan to have an open > > > > patient meeting to discuss sustainability of my practice. The > > > > invitation I just sent out (attached to my announcement of moving my > > > > office to a larger, cheaper space!) is below. My plan is to present > > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > > in my own data 3) how medical billing/payment works 4) my current > > > > practice and personal finances. Then I'm going to present options I > > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > > non-covered services fee 4) two-tier care, with paying patients > > > > getting appropriate services without a visit (which they're getting > > > > for free now). I want to know what changes my patients can deal with > > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > > that I can plagiarize? > > > > > > > > Thanks. > > > > Haresch > > > > > > > > ---------------------------- > > > > > > > > You're invited: Practice feedback meeting > > > > > > > > I am asking for your input on the future of the practice at a public > > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > > > I hope that the advantages of advanced access to your physician at One > > > > Family Doctor are useful to you. But maintaining this level of access > > > > is difficult. I must make changes to the practice in order to keep it > > > > afloat, and these changes will affect you. At the meeting, I will show > > > > how this type of practice improves health and share the financial > > > > details of its operation. I will present you with options for changes > > > > I am considering and ask for your opinions. The practice must work for > > > > you. > > > > > > > > Please respond to me if you plan to attend. The current plan is to > > > > meet at the new office, but we may need to find a larger space. > > > > > > > > If you would like to have input into these decisions but cannot attend > > > > the meeting, please let me know. I will send you my presentation > > > > materials. > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 I participate with payers, so charging more doesn't make any difference. As I said, I offered as an option to my patients to see more pts, cut down on visit times, cut down on my availability to them, and hire staff to support the increase. It seems that they don't want that, and I don't, either, if I can avoid it. I feel good about the care I can give to this size panel and hesitate to start down the slippery slope. > > > > > > > > > > As I've mentioned to some of you before, I plan to have an open > > > > > patient meeting to discuss sustainability of my practice. The > > > > > invitation I just sent out (attached to my announcement of moving my > > > > > office to a larger, cheaper space!) is below. My plan is to present > > > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > > > in my own data 3) how medical billing/payment works 4) my current > > > > > practice and personal finances. Then I'm going to present options I > > > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > > > non-covered services fee 4) two-tier care, with paying patients > > > > > getting appropriate services without a visit (which they're getting > > > > > for free now). I want to know what changes my patients can deal with > > > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > > > that I can plagiarize? > > > > > > > > > > Thanks. > > > > > Haresch > > > > > > > > > > ---------------------------- > > > > > > > > > > You're invited: Practice feedback meeting > > > > > > > > > > I am asking for your input on the future of the practice at a public > > > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > > > > > I hope that the advantages of advanced access to your physician at One > > > > > Family Doctor are useful to you. But maintaining this level of access > > > > > is difficult. I must make changes to the practice in order to keep it > > > > > afloat, and these changes will affect you. At the meeting, I will show > > > > > how this type of practice improves health and share the financial > > > > > details of its operation. I will present you with options for changes > > > > > I am considering and ask for your opinions. The practice must work for > > > > > you. > > > > > > > > > > Please respond to me if you plan to attend. The current plan is to > > > > > meet at the new office, but we may need to find a larger space. > > > > > > > > > > If you would like to have input into these decisions but cannot attend > > > > > the meeting, please let me know. I will send you my presentation > > > > > materials. > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 Agreed. But, while I feel I frequently do far more than required for a 99214, I also feel that I rarely meet the requirements for 99215, due to the MDM issues that we have discussed before. I may need to revisit the extended-time codes that I don't use much, but I do worry that they are flags for audits. > > > > > > > > > > As I've mentioned to some of you before, I plan to have an open > > > > > patient meeting to discuss sustainability of my practice. The > > > > > invitation I just sent out (attached to my announcement of moving my > > > > > office to a larger, cheaper space!) is below. My plan is to present > > > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > > > in my own data 3) how medical billing/payment works 4) my current > > > > > practice and personal finances. Then I'm going to present options I > > > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > > > non-covered services fee 4) two-tier care, with paying patients > > > > > getting appropriate services without a visit (which they're getting > > > > > for free now). I want to know what changes my patients can deal with > > > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > > > that I can plagiarize? > > > > > > > > > > Thanks. > > > > > Haresch > > > > > > > > > > ---------------------------- > > > > > > > > > > You're invited: Practice feedback meeting > > > > > > > > > > I am asking for your input on the future of the practice at a public > > > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > > > > > I hope that the advantages of advanced access to your physician at One > > > > > Family Doctor are useful to you. But maintaining this level of access > > > > > is difficult. I must make changes to the practice in order to keep it > > > > > afloat, and these changes will affect you. At the meeting, I will show > > > > > how this type of practice improves health and share the financial > > > > > details of its operation. I will present you with options for changes > > > > > I am considering and ask for your opinions. The practice must work for > > > > > you. > > > > > > > > > > Please respond to me if you plan to attend. The current plan is to > > > > > meet at the new office, but we may need to find a larger space. > > > > > > > > > > If you would like to have input into these decisions but cannot attend > > > > > the meeting, please let me know. I will send you my presentation > > > > > materials. > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 I believe that my coding is supported by my documentation, not undercoded. The requirement is not that 50% was face-to-face. The requirement is that 50% was care coordination and counseling. I often spend 50% of time listening, taking a history, so I don't use time-based billing in those cases. > > > > > > > > > > > > As I've mentioned to some of you before, I plan to have an open > > > > > > patient meeting to discuss sustainability of my practice. The > > > > > > invitation I just sent out (attached to my announcement of moving my > > > > > > office to a larger, cheaper space!) is below. My plan is to present > > > > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > > > > in my own data 3) how medical billing/payment works 4) my current > > > > > > practice and personal finances. Then I'm going to present options I > > > > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > > > > non-covered services fee 4) two-tier care, with paying patients > > > > > > getting appropriate services without a visit (which they're getting > > > > > > for free now). I want to know what changes my patients can deal with > > > > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > > > > that I can plagiarize? > > > > > > > > > > > > Thanks. > > > > > > Haresch > > > > > > > > > > > > ---------------------------- > > > > > > > > > > > > You're invited: Practice feedback meeting > > > > > > > > > > > > I am asking for your input on the future of the practice at a public > > > > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > > > > > > > I hope that the advantages of advanced access to your physician at One > > > > > > Family Doctor are useful to you. But maintaining this level of access > > > > > > is difficult. I must make changes to the practice in order to keep it > > > > > > afloat, and these changes will affect you. At the meeting, I will show > > > > > > how this type of practice improves health and share the financial > > > > > > details of its operation. I will present you with options for changes > > > > > > I am considering and ask for your opinions. The practice must work for > > > > > > you. > > > > > > > > > > > > Please respond to me if you plan to attend. The current plan is to > > > > > > meet at the new office, but we may need to find a larger space. > > > > > > > > > > > > If you would like to have input into these decisions but cannot attend > > > > > > the meeting, please let me know. I will send you my presentation > > > > > > materials. > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2010 Report Share Posted May 7, 2010 So maybe I won't bother with the prolonged visit codes.... I've never actually been dinged for any of this, so I don't really know if this is an audit risk. But I still worry about it, and do this on a limited basis, because just feeling that we needed to spend over an hour with a patient does not solely justify the use of time-based coding. It still has to be medically necessary, and it's going to be someone with way less training than me looking at these notes to determine whether it's medically necessary.... That's part of the reason that I basically gave my patients the choice of my changing my practice to run at the 99214 level (more frequent, shorter visits with less telephone care) or pay for the current level of service. Haresch > > > > > > > > > > > > > > As I've mentioned to some of you before, I plan to have an open > > > > > > > patient meeting to discuss sustainability of my practice. The > > > > > > > invitation I just sent out (attached to my announcement of moving my > > > > > > > office to a larger, cheaper space!) is below. My plan is to present > > > > > > > brief information on: 1) evidence of IMP quality 2) how that reflects > > > > > > > in my own data 3) how medical billing/payment works 4) my current > > > > > > > practice and personal finances. Then I'm going to present options I > > > > > > > see to keep the practice afloat: 1) increase staff by 1/2 FTE and > > > > > > > visits by 15/week 2) voluntary non-covered services fee 3) required > > > > > > > non-covered services fee 4) two-tier care, with paying patients > > > > > > > getting appropriate services without a visit (which they're getting > > > > > > > for free now). I want to know what changes my patients can deal with > > > > > > > best. 24 hours after the invite, I have 37 RSVPs. > > > > > > > > > > > > > > Anyone who has done something similar with any guidance to offer me? > > > > > > > > > > > > > > And anyone (Gordon?) with an updated presentation on IMP quality data > > > > > > > that I can plagiarize? > > > > > > > > > > > > > > Thanks. > > > > > > > Haresch > > > > > > > > > > > > > > ---------------------------- > > > > > > > > > > > > > > You're invited: Practice feedback meeting > > > > > > > > > > > > > > I am asking for your input on the future of the practice at a public > > > > > > > meeting on Wednesday, May 5, 2010, at 5:30 p.m. > > > > > > > > > > > > > > I hope that the advantages of advanced access to your physician at One > > > > > > > Family Doctor are useful to you. But maintaining this level of access > > > > > > > is difficult. I must make changes to the practice in order to keep it > > > > > > > afloat, and these changes will affect you. At the meeting, I will show > > > > > > > how this type of practice improves health and share the financial > > > > > > > details of its operation. I will present you with options for changes > > > > > > > I am considering and ask for your opinions. The practice must work for > > > > > > > you. > > > > > > > > > > > > > > Please respond to me if you plan to attend. The current plan is to > > > > > > > meet at the new office, but we may need to find a larger space. > > > > > > > > > > > > > > If you would like to have input into these decisions but cannot attend > > > > > > > the meeting, please let me know. I will send you my presentation > > > > > > > materials. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2010 Report Share Posted May 9, 2010 Wow! Good one . . . > > > > > > > #2 is a fascinating idea. I don't know the legalities of this, but I'm > > sure we could find out. It might be a cool pseudo-Robin hood model. > > Definitely worth looking into. > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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