RE: non covered benefits (revisited)

[Guest guest]

Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office appointment. I have some insurers who are covering email

and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to make an office visit. This creates a clean system- either in or

out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be considered valuable for many of my patients. And its very much

the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the only purchase other than website hosting you would need to make if you were interested in a similar set

up.CarlaTo: Sent: Mon, January 10, 2011 4:51:02 PMSubject: "non covered" benefits (revisited)

I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a non-patient who has not been heard from since he filed the complaint with BCBS)

New plan is to allow patients to choose:

A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year,

waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)

I still feel strongly that getting paid a small stipend to be personally "on call" 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.

I would appreciate any and all feedback from the group.

Stew Mones

If anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office appointment. I have some insurers who are covering email

and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to make an office visit. This creates a clean system- either in or

out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be considered valuable for many of my patients. And its very much

the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the only purchase other than website hosting you would need to make if you were interested in a similar set

up.CarlaTo: Sent: Mon, January 10, 2011 4:51:02 PMSubject: "non covered" benefits (revisited)

I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a non-patient who has not been heard from since he filed the complaint with BCBS)

New plan is to allow patients to choose:

A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year,

waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)

I still feel strongly that getting paid a small stipend to be personally "on call" 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.

I would appreciate any and all feedback from the group.

Stew Mones

If anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

I’m interested in understanding what joomla can do that traditional web site building tools don’t offer.I assume that http://www.montanahealthsolutions.com/ is the URL for your joomla based web site?Anything worth reading that you can suggest that would explain the advantages of joomla? Neighbors, MDHuntsville, Alabamawww.DocNeighbors.com Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, January 10, 2011 7:48 PMTo: Subject: Re: " non covered " benefits (revisited) Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office appointment. I have some insurers who are covering email and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to make an office visit. This creates a clean system- either in or out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be considered valuable for many of my patients. And its very much the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the only purchase other than website hosting you would need to make if you were interested in a similar set up.Carla To: Sent: Mon, January 10, 2011 4:51:02 PMSubject: " non covered " benefits (revisited) I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a non-patient who has not been heard from since he filed the complaint with BCBS)New plan is to allow patients to choose:A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year, waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)I still feel strongly that getting paid a small stipend to be personally " on call " 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.I would appreciate any and all feedback from the group. Stew MonesIf anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

I’m interested in understanding what joomla can do that traditional web site building tools don’t offer.I assume that http://www.montanahealthsolutions.com/ is the URL for your joomla based web site?Anything worth reading that you can suggest that would explain the advantages of joomla? Neighbors, MDHuntsville, Alabamawww.DocNeighbors.com Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, January 10, 2011 7:48 PMTo: Subject: Re: " non covered " benefits (revisited) Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office appointment. I have some insurers who are covering email and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to make an office visit. This creates a clean system- either in or out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be considered valuable for many of my patients. And its very much the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the only purchase other than website hosting you would need to make if you were interested in a similar set up.Carla To: Sent: Mon, January 10, 2011 4:51:02 PMSubject: " non covered " benefits (revisited) I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a non-patient who has not been heard from since he filed the complaint with BCBS)New plan is to allow patients to choose:A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year, waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)I still feel strongly that getting paid a small stipend to be personally " on call " 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.I would appreciate any and all feedback from the group. Stew MonesIf anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription > website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To: > Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

[Guest guest]

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription > website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To: > Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

[Guest guest]

The subscription website idea is brilliant. The key is getting the business model right. The challenge is to making the value of subscribing clear enough so that the patient can make a well informed choice. Newspapers have been struggling to move their content to this model with varying success. I think that for many IMPs giving a superior level of service 24/7 while still taking insurance is rather tough. It's tricky trying to sort through what afterhours coverage is required by contracts and what then constitutes premium service above that.The patient must then chose between your already great service and even greater service - whatever that is. There might not be enough apparent difference there to make them spend the extra money. It might be more simple to offer them a chance to buy time with you for

a discount if they are a subscriber vs. paying full freight. Can an altruistic IMP give advanced access to subscribers vs. standard access to insurance contracted patients?Ben

[Guest guest]

The subscription website idea is brilliant. The key is getting the business model right. The challenge is to making the value of subscribing clear enough so that the patient can make a well informed choice. Newspapers have been struggling to move their content to this model with varying success. I think that for many IMPs giving a superior level of service 24/7 while still taking insurance is rather tough. It's tricky trying to sort through what afterhours coverage is required by contracts and what then constitutes premium service above that.The patient must then chose between your already great service and even greater service - whatever that is. There might not be enough apparent difference there to make them spend the extra money. It might be more simple to offer them a chance to buy time with you for

a discount if they are a subscriber vs. paying full freight. Can an altruistic IMP give advanced access to subscribers vs. standard access to insurance contracted patients?Ben

[Guest guest]

,Joomla is just one open source code (free) that can be used to build a website. What I found in using it was that there were many add-ons, both free and commercial, that added functionality typical of more expensive setups. My montanahealthsolutions.com site is a free template and very simple set up. My other site, a subscription-based coaching site, is more complex. It has a forum, has protected content so that only those with the right subscription can access it, and more. It also has a facebook-like "wall" for the subscribers to use to build "community" that is kind of fun. I could add a "chat" function so people could chat when they were online or it could be done as a way of having a coaching session.... most of these would not be desirable in a

practice-based website. If I were to implement a subscription website for my practice, I would add in the necessary "plug-ins" and "extensions" that would increase the functionality of my practice website. To upgrade my practice site to a subscription site, I would really only need one commercial add-on like 'Community Builder Subs' (http://www.joomlapolis.com/cb-solutions/cbsubs#vtabs18) which costs 95 Euro for a license up to 500 subscribers. That add-on would provide the method to protect the website content (so that only those that are subscribed could access certain content and pages) and the mechanism to run the payments through something like Paypal or another payment gateway.As far as reading sources for Joomla vs other options... oy. Seto may be the better one to ask. Drupal, Wordpress and

Joomla (http://www.joomla.org/) are the major 3 from what I understand and each has certain advantages. I just chose one and ran with it. I'm no expert. I am self-taught and learn what I need to learn to make it work. I previously used Sitebuilder and before that, Frontpage to build my websites. That meant I had to be at the computer that had the files to make changes, then I had to upload them. With Joomla, the database is a SQL database on the server and I connect online and make changes- so any computer will provide access. You have a template with lots of positions for content- so maybe a place to put "news" another to put menus and another to put articles, or banners or ads if you want ads. Like I said before, initially it is confusing but soon it all makes sense and is easy. Particularly if you keep it simple. One example on my montanahealthsolutions

site... I am "off' on Mondays so there is a content position at the top of the site for 'news" and I have two 'articles' I rotate in that position - one for Mondays and another for Tues- Sun... now I realize I should have one for the weekend as I write this. But it essentially tells folks if I'm in or out and that I will respond by email or whatever...I was quoted $8000 by a local company to set up my coaching website the way I wanted it- using Joomla. Instead, I found someone who helped me learn the basics and I've now developed a fairly complicated site (the coaching site) for a total of about $500. Again, to get the practice site running as a subscription site would be much less than that as all you need is the hosting server, domain name and an extension like Community Builder Subs.I'd be happy to show you around my coaching site via skype if you are interested.CarlaTo: Sent: Mon, January 10, 2011 8:52:29 PMSubject: RE: "non covered" benefits (revisited)

I’m interested in understanding what joomla can do that traditional web site building tools don’t offer.I assume that http://www.montanahealthsolutions.com/ is the URL for your joomla based web site?Anything worth reading that you can suggest that would explain the advantages of joomla? Neighbors, MDHuntsville,

Alabamawww.DocNeighbors.com Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, January 10, 2011 7:48 PMTo: Subject: Re: "non covered" benefits

(revisited) Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office

appointment. I have some insurers who are covering email and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to

make an office visit. This creates a clean system- either in or out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be

considered valuable for many of my patients. And its very much the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the

only purchase other than website hosting you would need to make if you were interested in a similar set up.Carla To: Sent: Mon, January 10, 2011 4:51:02 PMSubject: "non covered" benefits (revisited) I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a

non-patient who has not been heard from since he filed the complaint with BCBS)New plan is to allow patients to choose:A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year, waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)I still feel strongly that getting paid a small stipend to be personally "on call" 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with

BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.I would appreciate any and all feedback from the group. Stew MonesIf anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

,Joomla is just one open source code (free) that can be used to build a website. What I found in using it was that there were many add-ons, both free and commercial, that added functionality typical of more expensive setups. My montanahealthsolutions.com site is a free template and very simple set up. My other site, a subscription-based coaching site, is more complex. It has a forum, has protected content so that only those with the right subscription can access it, and more. It also has a facebook-like "wall" for the subscribers to use to build "community" that is kind of fun. I could add a "chat" function so people could chat when they were online or it could be done as a way of having a coaching session.... most of these would not be desirable in a

practice-based website. If I were to implement a subscription website for my practice, I would add in the necessary "plug-ins" and "extensions" that would increase the functionality of my practice website. To upgrade my practice site to a subscription site, I would really only need one commercial add-on like 'Community Builder Subs' (http://www.joomlapolis.com/cb-solutions/cbsubs#vtabs18) which costs 95 Euro for a license up to 500 subscribers. That add-on would provide the method to protect the website content (so that only those that are subscribed could access certain content and pages) and the mechanism to run the payments through something like Paypal or another payment gateway.As far as reading sources for Joomla vs other options... oy. Seto may be the better one to ask. Drupal, Wordpress and

Joomla (http://www.joomla.org/) are the major 3 from what I understand and each has certain advantages. I just chose one and ran with it. I'm no expert. I am self-taught and learn what I need to learn to make it work. I previously used Sitebuilder and before that, Frontpage to build my websites. That meant I had to be at the computer that had the files to make changes, then I had to upload them. With Joomla, the database is a SQL database on the server and I connect online and make changes- so any computer will provide access. You have a template with lots of positions for content- so maybe a place to put "news" another to put menus and another to put articles, or banners or ads if you want ads. Like I said before, initially it is confusing but soon it all makes sense and is easy. Particularly if you keep it simple. One example on my montanahealthsolutions

site... I am "off' on Mondays so there is a content position at the top of the site for 'news" and I have two 'articles' I rotate in that position - one for Mondays and another for Tues- Sun... now I realize I should have one for the weekend as I write this. But it essentially tells folks if I'm in or out and that I will respond by email or whatever...I was quoted $8000 by a local company to set up my coaching website the way I wanted it- using Joomla. Instead, I found someone who helped me learn the basics and I've now developed a fairly complicated site (the coaching site) for a total of about $500. Again, to get the practice site running as a subscription site would be much less than that as all you need is the hosting server, domain name and an extension like Community Builder Subs.I'd be happy to show you around my coaching site via skype if you are interested.CarlaTo: Sent: Mon, January 10, 2011 8:52:29 PMSubject: RE: "non covered" benefits (revisited)

I’m interested in understanding what joomla can do that traditional web site building tools don’t offer.I assume that http://www.montanahealthsolutions.com/ is the URL for your joomla based web site?Anything worth reading that you can suggest that would explain the advantages of joomla? Neighbors, MDHuntsville,

Alabamawww.DocNeighbors.com Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, January 10, 2011 7:48 PMTo: Subject: Re: "non covered" benefits

(revisited) Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office

appointment. I have some insurers who are covering email and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to

make an office visit. This creates a clean system- either in or out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be

considered valuable for many of my patients. And its very much the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the

only purchase other than website hosting you would need to make if you were interested in a similar set up.Carla To: Sent: Mon, January 10, 2011 4:51:02 PMSubject: "non covered" benefits (revisited) I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a

non-patient who has not been heard from since he filed the complaint with BCBS)New plan is to allow patients to choose:A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year, waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)I still feel strongly that getting paid a small stipend to be personally "on call" 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with

BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.I would appreciate any and all feedback from the group. Stew MonesIf anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

Not if he/she is truly altruistic (unselfish concern for or devoted to the welfare of others). The dichotomy of service levels would result in too much internal conflict. The real question is whether a altruistic IMP can remain altruistic in the American medical system. Does the system itself destroy altruism? From: [mailto: ] On Behalf Of Ben BrewerSent: Tuesday, January 11, 2011 12:37 AMTo: Subject: Re: " non covered " benefits (revisited) The subscription website idea is brilliant. The key is getting the business model right. The challenge is to making the value of subscribing clear enough so that the patient can make a well informed choice. Newspapers have been struggling to move their content to this model with varying success. I think that for many IMPs giving a superior level of service 24/7 while still taking insurance is rather tough. It's tricky trying to sort through what afterhours coverage is required by contracts and what then constitutes premium service above that.The patient must then chose between your already great service and even greater service - whatever that is. There might not be enough apparent difference there to make them spend the extra money. It might be more simple to offer them a chance to buy time with you for a discount if they are a subscriber vs. paying full freight. Can an altruistic IMP give advanced access to subscribers vs. standard access to insurance contracted patients? Ben

[Guest guest]

Not if he/she is truly altruistic (unselfish concern for or devoted to the welfare of others). The dichotomy of service levels would result in too much internal conflict. The real question is whether a altruistic IMP can remain altruistic in the American medical system. Does the system itself destroy altruism? From: [mailto: ] On Behalf Of Ben BrewerSent: Tuesday, January 11, 2011 12:37 AMTo: Subject: Re: " non covered " benefits (revisited) The subscription website idea is brilliant. The key is getting the business model right. The challenge is to making the value of subscribing clear enough so that the patient can make a well informed choice. Newspapers have been struggling to move their content to this model with varying success. I think that for many IMPs giving a superior level of service 24/7 while still taking insurance is rather tough. It's tricky trying to sort through what afterhours coverage is required by contracts and what then constitutes premium service above that.The patient must then chose between your already great service and even greater service - whatever that is. There might not be enough apparent difference there to make them spend the extra money. It might be more simple to offer them a chance to buy time with you for a discount if they are a subscriber vs. paying full freight. Can an altruistic IMP give advanced access to subscribers vs. standard access to insurance contracted patients? Ben

[Guest guest]

You hit the nail on the head. I am avoiding tiered system. It would cause me untold internal grief. Instead I cope by offering 10% of my practice is medicaid and otherwise keep to the better payers. But I do think the system as a whole does destroy altruism or I wouldn't be forced to use such limits.

The system also destroys patient responsibility in that my malpractice trainer just couldn't see that it was "safe" to give patients a card that said, "Call to schedule your next appointment" and on the line it says "first week in Feb 2011".

Somehow I think it's connected. Without responsibility then patients become "entitled" and fail to see how much extra they get in practices like ours.

I think IMP's in general have a whole lot more altruism than others who ae getting worn out on the hamster wheel.

To: Sent: Tue, January 11, 2011 6:43:42 AMSubject: RE: "non covered" benefits (revisited)

Not if he/she is truly altruistic (unselfish concern for or devoted to the welfare of others). The dichotomy of service levels would result in too much internal conflict. The real question is whether a altruistic IMP can remain altruistic in the American medical system. Does the system itself destroy altruism?

From: [mailto: ] On Behalf Of Ben BrewerSent: Tuesday, January 11, 2011 12:37 AMTo: Subject: Re: "non covered" benefits (revisited)

The subscription website idea is brilliant.

The key is getting the business model right. The challenge is to making the value of subscribing clear enough so that the patient can make a well informed choice. Newspapers have been struggling to move their content to this model with varying success. I think that for many IMPs giving a superior level of service 24/7 while still taking insurance is rather tough. It's tricky trying to sort through what afterhours coverage is required by contracts and what then constitutes premium service above that.

The patient must then chose between your already great service and even greater service - whatever that is. There might not be enough apparent difference there to make them spend the extra money. It might be more simple to offer them a chance to buy time with you for a discount if they are a subscriber vs. paying full freight. Can an altruistic IMP give advanced access to subscribers vs. standard access to insurance contracted patients?

Ben

[Guest guest]

I’m wondering if joomla provides a level of security that would pass HIPAA requirements.   Before switching from my simplistic Sitebuilder solution, security has to be an important feature.   Sometime early this year my EMR vendor is planning to have a patient portal add-on so for now I’m waiting to see what that offers. As with all technology the big question is whether it will survive the inevitable contest with competitors.   Like you, I began with Frontpage and evolved to sitebuilder before looking for the next great thing. My greatest concern if it works well is what happens when problems come up.  Who do you turn to? With the small business solution package through Yahoo that I use (web site built with Sitebuilder) I get fantastic support anytime I call with the right person for the question ask almost every time on the first call.  Granted SiteBuilder has its limitations but it does allow almost any add-ons that I can figure out how to use (so I’m told). Now, back to joomla.  How do you host it?  Does it take a special ISP? Thanks Neighbors, MDHuntsville, Alabama From: [mailto: ] On Behalf Of Carla GibsonSent: Tuesday, January 11, 2011 12:02 AMTo: Subject: Re: " non covered " benefits (revisited) ,Joomla is just one open source code (free) that can be used to build a website. What I found in using it was that there were many add-ons, both free and commercial, that added functionality typical of more expensive setups. My montanahealthsolutions.com site is a free template and very simple set up. My other site, a subscription-based coaching site, is more complex. It has a forum, has protected content so that only those with the right subscription can access it, and more. It also has a facebook-like " wall " for the subscribers to use to build " community " that is kind of fun. I could add a " chat " function so people could chat when they were online or it could be done as a way of having a coaching session.... most of these would not be desirable in a practice-based website. If I were to implement a subscription website for my practice, I would add in the necessary " plug-ins " and " extensions " that would increase the functionality of my practice website. To upgrade my practice site to a subscription site, I would really only need one commercial add-on like 'Community Builder Subs' (http://www.joomlapolis.com/cb-solutions/cbsubs#vtabs18) which costs 95 Euro for a license up to 500 subscribers. That add-on would provide the method to protect the website content (so that only those that are subscribed could access certain content and pages) and the mechanism to run the payments through something like Paypal or another payment gateway.As far as reading sources for Joomla vs other options... oy. Seto may be the better one to ask. Drupal, Wordpress and Joomla (http://www.joomla.org/) are the major 3 from what I understand and each has certain advantages. I just chose one and ran with it. I'm no expert. I am self-taught and learn what I need to learn to make it work. I previously used Sitebuilder and before that, Frontpage to build my websites. That meant I had to be at the computer that had the files to make changes, then I had to upload them. With Joomla, the database is a SQL database on the server and I connect online and make changes- so any computer will provide access. You have a template with lots of positions for content- so maybe a place to put " news " another to put menus and another to put articles, or banners or ads if you want ads. Like I said before, initially it is confusing but soon it all makes sense and is easy. Particularly if you keep it simple. One example on my montanahealthsolutions site... I am " off' on Mondays so there is a content position at the top of the site for 'news " and I have two 'articles' I rotate in that position - one for Mondays and another for Tues- Sun... now I realize I should have one for the weekend as I write this. But it essentially tells folks if I'm in or out and that I will respond by email or whatever...I was quoted $8000 by a local company to set up my coaching website the way I wanted it- using Joomla. Instead, I found someone who helped me learn the basics and I've now developed a fairly complicated site (the coaching site) for a total of about $500. Again, to get the practice site running as a subscription site would be much less than that as all you need is the hosting server, domain name and an extension like Community Builder Subs.I'd be happy to show you around my coaching site via skype if you are interested.Carla To: Sent: Mon, January 10, 2011 8:52:29 PMSubject: RE: " non covered " benefits (revisited) I’m interested in understanding what joomla can do that traditional web site building tools don’t offer.I assume that http://www.montanahealthsolutions.com/ is the URL for your joomla based web site?Anything worth reading that you can suggest that would explain the advantages of joomla? Neighbors, MDHuntsville, Alabamawww.DocNeighbors.com Solo using FlexMedical EMR/Billing From: [mailto: ] On Behalf Of Carla GibsonSent: Monday, January 10, 2011 7:48 PMTo: Subject: Re: " non covered " benefits (revisited) Stew,I've been thinking about this issue for about 10 years. I'm in Montana and my contacts with the insurance commissioner here has not been favorable when trying to negotiate some sort of access plan- even if paid in arrears by patients or employers. After reading your previous emails and thinking a bit more about how my patients access me, I do think a two tiered system is the way to go. I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - so what part is non-covered? I've provided email and phone visits beyond what I should have, as I'm a bit of a patsy. That has changed and I now either direct them through my official Virtual Visit system or ask them to make an office appointment. I have some insurers who are covering email and phone visits... which makes things complicated.My solution, which I am considering implementing, is to have a subscription website for my patients. I have already created a Joomla-based subscription website for a health coaching program I am offering, and when I saw how that worked, I realized I could do the same for my practice. The content available to 'subscribers' would be helpful information re: current health news, my advice on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription site would provide the secure contact forms for phone visits and email visits (at no additional charge above the subscription fee). Patients without a subscription would still be able to access limited parts of the site such as appointments and contact info... but they would not be able to access email or phone visits and thus, would need to make an office visit. This creates a clean system- either in or out and I don't have to keep track (the only way to request an email or phone visit will be if they are a subscriber). Payments for the subscription site are handled by a module in the site and automatically notify them of expiration.I believe that this set up eliminates my risk in regards to a NCBF... where some insurance company would say I have to be available by phone within reason to all patients, or where some insurance plans are covering email and phone visits and thus, those servcies could not be included in a NCBF for those beneficiaries. In my mind, the subscription access to the enhanced website content is clearly a non-medical service and is non-covered. They will also receive newsletters with extra content. And the benefit of having access to set up email and phone visits versus having to come in for an office visit seems like it would be considered valuable for many of my patients. And its very much the way I want to interact with patients- sending out info of value to them and interacting with them as appropriate outside the office.The only hitch I can foresee in my plan might be that an insurer could say that I have to offer all patients the same services. Not sure if that is in any of my contracts or not. I don't think it would be an issue since technically all patients are offered the subscription service... and I don't think they can argue about the email and phone visits if I don't charge for them specifically.The cost of such a website is minimal. Joomla is free and generally easy to set up on a server. It then takes a bit to figure out how to load content, but once you understand it, its easy and very adaptable on the fly. The subscription management module would be the only purchase other than website hosting you would need to make if you were interested in a similar set up.Carla To: Sent: Mon, January 10, 2011 4:51:02 PMSubject: " non covered " benefits (revisited) I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because Regence BC/BS took issue with patients not having a choice. (This came about due to a complaint from a non-patient who has not been heard from since he filed the complaint with BCBS)New plan is to allow patients to choose:A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for $100/year, waive HealthyAccess (the unlimited communication part). Still get 24 x 7 access but have to pay $4/minute after hours and $10 per email. (if not related to an office visit, prescription refill, or scheduling an office visit)I still feel strongly that getting paid a small stipend to be personally " on call " 24 x 7 for my patients and be willing to talk and email on the small stuff without forcing office visits is a worthwhile service. I don't feel good about plan B because I didn't want two tiers, but I feel forced to offer it and I'm hoping that not too many patients choose it. Would rather open the flood gates to communication then shut it down, but I feel like I've got to provide an alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over it. Nor do I want to ditch the NCBF which I think any other professional giving this level of service would require from clients/patients.I would appreciate any and all feedback from the group. Stew MonesIf anyone believes that the OIG would take issue with this set up, let me know or send me a link to check out. Thanks

[Guest guest]

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

oh god I will have to  have more caffeine before I can  help you:)

 

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax

impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

oh god I will have to  have more caffeine before I can  help you:)

 

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax

impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

oh god I will have to  have more caffeine before I can  help you:)

 

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax

impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

[Guest guest]

Me tooI dont know what I said

 

oh god I will have to  have more caffeine before I can  help you:)

 

Yes absolutely, emails webvisits, form fees  fill teh same need.. etc, but that model leads to the feeling of nickeladn diming etc etc..If we are looking to get away from that model... AND some webvisits are insurance covered and some are not...AND we dont want to set up a 2 tier system.....   AND we dont want to run afoul of the Insurance regs...

then names matter, like the TANCS fee charged in chico.. its really for better access  and coordination, where, technically you are charging for the TECHNOLOGY, because they hobble you in myriad ways if you try to charge for the rest

 

 evisits serve the same purpose yes? what  services do you mean then that are not  web vists  Example ?or simply 15.00 fees( whaetver price   for doing forms  They drop off forms and the cash or you send a simple bill

I have templates  pre made up I send about the  questions needed.What kinds of services are you meaning that  you have run  up against?

 

Ok I have been feeling very stupid making patients come in for stuff that I could do without requiring a reimburseable visit. However I also do not want  to give my services away.

Would a subscription only electronic triage service make sense?Patients check in and answer questions, Physicians reviews the info and determines if they need to come in or it can be done without a visit. and triages to office visit, or does whatever is necessary.

                       Patients can be provided services  that would not be web visits/ telephone consults. You could argue this is all semantics, but some names get you in trouble, some names get you paid!

It provides- value to the patient saves time and money  for the patient who wants it..- efficiencies for the physician, and a vehicle for reimbursement for all the services performed. 

Thoughts?

Very interesting twist..

Sangeetha Murthy

> Stew,> > I've been thinking about this issue for about 10 years. I'm in Montana and my

> contacts with the insurance commissioner here has not been favorable when trying > to negotiate some sort of access plan- even if paid in arrears by patients or > employers. After reading your previous emails and thinking a bit more about how

> my patients access me, I do think a two tiered system is the way to go. > > > I've struggled with the NCBF idea because yes, I am 24-7 for all my patients - > so what part is non-covered? I've provided email and phone visits beyond what I

> should have, as I'm a bit of a patsy. That has changed and I now either direct > them through my official Virtual Visit system or ask them to make an office > appointment. I have some insurers who are covering email and phone visits...

> which makes things complicated.> > My solution, which I am considering implementing, is to have a subscription > website for my patients. I have already created a Joomla-based subscription

> website for a health coaching program I am offering, and when I saw how that

> worked, I realized I could do the same for my practice. The content available > to 'subscribers' would be helpful information re: current health news, my advice > on cholesterol, vitamins, nutrition, sunscreen, yada yada. The subscription

> site would provide the secure contact forms for phone visits and email visits > (at no additional charge above the subscription fee). Patients without a > subscription would still be able to access limited parts of the site such as

> appointments and contact info... but they would not be able to access email or > phone visits and thus, would need to make an office visit. This creates a clean > system- either in or out and I don't have to keep track (the only way to request

> an email or phone visit will be if they are a subscriber). Payments for the > subscription site are handled by a module in the site and automatically notify > them of expiration.> > I believe that this set up eliminates my risk in regards to a NCBF... where some

> insurance company would say I have to be available by phone within reason to all > patients, or where some insurance plans are covering email and phone visits and > thus, those servcies could not be included in a NCBF for those beneficiaries.

> In my mind, the subscription access to the enhanced website content is clearly a > non-medical service and is non-covered. They will also receive newsletters with > extra content. And the benefit of having access to set up email and phone

> visits versus having to come in for an office visit seems like it would be > considered valuable for many of my patients. And its very much the way I want > to interact with patients- sending out info of value to them and interacting

> with them as appropriate outside the office.> > > The only hitch I can foresee in my plan might be that an insurer could say that > I have to offer all patients the same services. Not sure if that is in any of my

> contracts or not. I don't think it would be an issue since technically all > patients are offered the subscription service... and I don't think they can > argue about the email and phone visits if I don't charge for them specifically.

> > The cost of such a website is minimal. Joomla is free and generally easy to set > up on a server. It then takes a bit to figure out how to load content, but once > you understand it, its easy and very adaptable on the fly. The subscription

> management module would be the only purchase other than website hosting you > would need to make if you were interested in a similar set up.> > Carla> > > > > ________________________________

> > To:

> Sent: Mon, January 10, 2011 4:51:02 PM

> Subject: " non covered " benefits (revisited)> > > I modified my HealthyAccess (non-covered benefit fee-NCBF)in 2011 because > Regence BC/BS took issue with patients not having a choice. (This came about

> due to a complaint from a non-patient who has not been heard from since he filed > the complaint with BCBS)> > New plan is to allow patients to choose:> A) Healthyaccess 24x7 unlimited communication by phone or email with doc(me) for

> $100/year, > > waive HealthyAccess (the unlimited communication part). Still get 24 x 7 > access but have to pay $4/minute after hours and $10 per email. (if not related > to an office visit, prescription refill, or scheduling an office visit)

> > I still feel strongly that getting paid a small stipend to be personally " on > call " 24 x 7 for my patients and be willing to talk and email on the small stuff > without forcing office visits is a worthwhile service. I don't feel good about

> plan B because I didn't want two tiers, but I feel forced to offer it and I'm > hoping that not too many patients choose it. Would rather open the flood gates > to communication then shut it down, but I feel like I've got to provide an

> alternative in order to work with BC/BS and it wasn't worth leaving BC/BS over > it. Nor do I want to ditch the NCBF which I think any other professional giving > this level of service would require from clients/patients.

> > I would appreciate any and all feedback from the group. > > Stew Mones> > If anyone believes that the OIG would take issue with this set up, let me know > or send me a link to check out. Thanks

> > >

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax

impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

--      MD          ph    fax impcenter.org

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com