RE: non covered benefits (revisited)

[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

[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

[Guest guest]

Sangeetha,My "subscription website" model is not fully fleshed out but my vision at this point is that it would do just what you are suggesting here... but I would not call it triage because triage is likely part of the medical service you are expected to provide per insurance contracts as medical services. In my current vision of how I would possibly do it, the subscription website would clearly provide generalized health information/education that I want my patients to have in a form that is not covered by insurance. That would be the primary premise of the subscription website. (BTW, if others chose to implement such a site, content could be shared.) The website would also be the technology that provides the access to the web/phone visits I do. Of course, triage would have

to occur once a web/phone visit was requested. I currently offer web and phone visits through my practice website (no subscription needed yet) and those offer the patient the option of having me bill their insurance or just paying straight out. I'm risking a bit there since some of my insurance contracts clearly state I should not bill the patient for services the insurance covers.. but I did speak with Blue Cross once about that and they said if the patient requests that I not send a claim to insurance, then I should be okay. So I currently have the patient indicate if they want it billed or not. But billing for it is not really worth my time- the reimbursement is typically low and I get too frustrated sending 3 statements out before I get paid. If I move to the subscription website set up, only those with a subscription will have access to request a web/phone visit. There would be no charge for the

web/phone visit via the subscription website. Those who were not subscribers would not have access to web/phone visits. You could say the subscription fee, in part, covers the technology of hosting the visit but I would not frame it this way publicly because I would want it to be clear that the subscription is about the flow of health education/information that is not directly related to specific visits and thus, does not run afoul of any insurance law or contracts. I am pretty sure that I can "give away" visits all day long without running into trouble... I think it is more risky to discount a fee than to just frankly give the service for free, yes? So, in my mind, I will give away phone and web visits for free - the difference is that the access to them is behind the subscription website "door".Yes, this creates a two tiered system but it is one I can live with. I live with a lot of tiered systems... patients who have insurance and

those who don't; rich patients vs poor patients; good insurance payors and Medicare; and cash pay vs 3rd party payors. Though I do not treat these patients differently as far as what I offer them, I do have to help them navigate the maze of what they can afford and what their insurance pays for. Actually, I do treat them a bit differently, I offer uninsured patients cheap lab billed through my office to save them money. In regard to the subscription website, all patients would have the opportunity to participate if they choose to pay for it.The conversation about altruism and two tiered systems was confusing to me. Per Brady's definition of altruistism, none of us are providing our services without expectation of remuneration or without regard to our own benefit in some way. Sure, I go way above and beyond in many, many instances without payment. We all do. Some do it too frequently and become resentful.

I border on this. The subscription website idea is an easy way that I can hold a boundary that is clear and distinct with my patients in regards to how much "free" service I give them while at the same time I can hopefully provide them with more important health information and motivational content to improve their health in ways that are not possible in typical office visits. Like you, I don't like making patients come in all the time for things that do not require an office visit... I think this concept could be a very satisfying "tweak" to my practice structure . CarlaFrom: Sangeetha Murthy

To: Sent: Tue, January 18, 2011 6:07:40 PMSubject: Re: "non covered" benefits (revisited)

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]

Sangeetha,My "subscription website" model is not fully fleshed out but my vision at this point is that it would do just what you are suggesting here... but I would not call it triage because triage is likely part of the medical service you are expected to provide per insurance contracts as medical services. In my current vision of how I would possibly do it, the subscription website would clearly provide generalized health information/education that I want my patients to have in a form that is not covered by insurance. That would be the primary premise of the subscription website. (BTW, if others chose to implement such a site, content could be shared.) The website would also be the technology that provides the access to the web/phone visits I do. Of course, triage would have

to occur once a web/phone visit was requested. I currently offer web and phone visits through my practice website (no subscription needed yet) and those offer the patient the option of having me bill their insurance or just paying straight out. I'm risking a bit there since some of my insurance contracts clearly state I should not bill the patient for services the insurance covers.. but I did speak with Blue Cross once about that and they said if the patient requests that I not send a claim to insurance, then I should be okay. So I currently have the patient indicate if they want it billed or not. But billing for it is not really worth my time- the reimbursement is typically low and I get too frustrated sending 3 statements out before I get paid. If I move to the subscription website set up, only those with a subscription will have access to request a web/phone visit. There would be no charge for the

web/phone visit via the subscription website. Those who were not subscribers would not have access to web/phone visits. You could say the subscription fee, in part, covers the technology of hosting the visit but I would not frame it this way publicly because I would want it to be clear that the subscription is about the flow of health education/information that is not directly related to specific visits and thus, does not run afoul of any insurance law or contracts. I am pretty sure that I can "give away" visits all day long without running into trouble... I think it is more risky to discount a fee than to just frankly give the service for free, yes? So, in my mind, I will give away phone and web visits for free - the difference is that the access to them is behind the subscription website "door".Yes, this creates a two tiered system but it is one I can live with. I live with a lot of tiered systems... patients who have insurance and

those who don't; rich patients vs poor patients; good insurance payors and Medicare; and cash pay vs 3rd party payors. Though I do not treat these patients differently as far as what I offer them, I do have to help them navigate the maze of what they can afford and what their insurance pays for. Actually, I do treat them a bit differently, I offer uninsured patients cheap lab billed through my office to save them money. In regard to the subscription website, all patients would have the opportunity to participate if they choose to pay for it.The conversation about altruism and two tiered systems was confusing to me. Per Brady's definition of altruistism, none of us are providing our services without expectation of remuneration or without regard to our own benefit in some way. Sure, I go way above and beyond in many, many instances without payment. We all do. Some do it too frequently and become resentful.

I border on this. The subscription website idea is an easy way that I can hold a boundary that is clear and distinct with my patients in regards to how much "free" service I give them while at the same time I can hopefully provide them with more important health information and motivational content to improve their health in ways that are not possible in typical office visits. Like you, I don't like making patients come in all the time for things that do not require an office visit... I think this concept could be a very satisfying "tweak" to my practice structure . CarlaFrom: Sangeetha Murthy

To: Sent: Tue, January 18, 2011 6:07:40 PMSubject: Re: "non covered" benefits (revisited)

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]

Sangeetha,My "subscription website" model is not fully fleshed out but my vision at this point is that it would do just what you are suggesting here... but I would not call it triage because triage is likely part of the medical service you are expected to provide per insurance contracts as medical services. In my current vision of how I would possibly do it, the subscription website would clearly provide generalized health information/education that I want my patients to have in a form that is not covered by insurance. That would be the primary premise of the subscription website. (BTW, if others chose to implement such a site, content could be shared.) The website would also be the technology that provides the access to the web/phone visits I do. Of course, triage would have

to occur once a web/phone visit was requested. I currently offer web and phone visits through my practice website (no subscription needed yet) and those offer the patient the option of having me bill their insurance or just paying straight out. I'm risking a bit there since some of my insurance contracts clearly state I should not bill the patient for services the insurance covers.. but I did speak with Blue Cross once about that and they said if the patient requests that I not send a claim to insurance, then I should be okay. So I currently have the patient indicate if they want it billed or not. But billing for it is not really worth my time- the reimbursement is typically low and I get too frustrated sending 3 statements out before I get paid. If I move to the subscription website set up, only those with a subscription will have access to request a web/phone visit. There would be no charge for the

web/phone visit via the subscription website. Those who were not subscribers would not have access to web/phone visits. You could say the subscription fee, in part, covers the technology of hosting the visit but I would not frame it this way publicly because I would want it to be clear that the subscription is about the flow of health education/information that is not directly related to specific visits and thus, does not run afoul of any insurance law or contracts. I am pretty sure that I can "give away" visits all day long without running into trouble... I think it is more risky to discount a fee than to just frankly give the service for free, yes? So, in my mind, I will give away phone and web visits for free - the difference is that the access to them is behind the subscription website "door".Yes, this creates a two tiered system but it is one I can live with. I live with a lot of tiered systems... patients who have insurance and

those who don't; rich patients vs poor patients; good insurance payors and Medicare; and cash pay vs 3rd party payors. Though I do not treat these patients differently as far as what I offer them, I do have to help them navigate the maze of what they can afford and what their insurance pays for. Actually, I do treat them a bit differently, I offer uninsured patients cheap lab billed through my office to save them money. In regard to the subscription website, all patients would have the opportunity to participate if they choose to pay for it.The conversation about altruism and two tiered systems was confusing to me. Per Brady's definition of altruistism, none of us are providing our services without expectation of remuneration or without regard to our own benefit in some way. Sure, I go way above and beyond in many, many instances without payment. We all do. Some do it too frequently and become resentful.

I border on this. The subscription website idea is an easy way that I can hold a boundary that is clear and distinct with my patients in regards to how much "free" service I give them while at the same time I can hopefully provide them with more important health information and motivational content to improve their health in ways that are not possible in typical office visits. Like you, I don't like making patients come in all the time for things that do not require an office visit... I think this concept could be a very satisfying "tweak" to my practice structure . CarlaFrom: Sangeetha Murthy

To: Sent: Tue, January 18, 2011 6:07:40 PMSubject: Re: "non covered" benefits (revisited)

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]

There is a large practice in town that

charges either by the event (webvisit, refills before an appt, etc) or you can “opt-out”

of paying the individual fees and pay the practice $100/year. I

personally don’t want to track that, and don’t think it’s

fair to charge to patients who don’t utilize those services.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sangeetha Murthy

Sent: Wednesday, January 19, 2011

6:49 AM

To:

Subject: Re:

" non covered " benefits (revisited)

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?

On Tue, Jan 18, 2011 at 8:07 PM, Sangeetha Murthy

wrote:

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?

On Mon, Jan 10, 2011 at 9:16 PM, Sangeetha Murthy

wrote:

Very interesting twist..

Sangeetha Murthy

On Jan 10, 2011 5:47 PM, " Carla Gibson "

wrote:

> 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.D

7830

mont Mesa Blvd #287

San

Diego, CA 92111

www.mypcponline.com

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

--

Sangeetha Murthy M.D

7830 mont Mesa

Blvd #287

San Diego,

CA 92111

www.mypcponline.com

[Guest guest]

There is a large practice in town that

charges either by the event (webvisit, refills before an appt, etc) or you can “opt-out”

of paying the individual fees and pay the practice $100/year. I

personally don’t want to track that, and don’t think it’s

fair to charge to patients who don’t utilize those services.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sangeetha Murthy

Sent: Wednesday, January 19, 2011

6:49 AM

To:

Subject: Re:

" non covered " benefits (revisited)

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?

On Tue, Jan 18, 2011 at 8:07 PM, Sangeetha Murthy

wrote:

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?

On Mon, Jan 10, 2011 at 9:16 PM, Sangeetha Murthy

wrote:

Very interesting twist..

Sangeetha Murthy

On Jan 10, 2011 5:47 PM, " Carla Gibson "

wrote:

> 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.D

7830

mont Mesa Blvd #287

San

Diego, CA 92111

www.mypcponline.com

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

--

Sangeetha Murthy M.D

7830 mont Mesa

Blvd #287

San Diego,

CA 92111

www.mypcponline.com

[Guest guest]

There is a large practice in town that

charges either by the event (webvisit, refills before an appt, etc) or you can “opt-out”

of paying the individual fees and pay the practice $100/year. I

personally don’t want to track that, and don’t think it’s

fair to charge to patients who don’t utilize those services.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sangeetha Murthy

Sent: Wednesday, January 19, 2011

6:49 AM

To:

Subject: Re:

" non covered " benefits (revisited)

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?

On Tue, Jan 18, 2011 at 8:07 PM, Sangeetha Murthy

wrote:

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?

On Mon, Jan 10, 2011 at 9:16 PM, Sangeetha Murthy

wrote:

Very interesting twist..

Sangeetha Murthy

On Jan 10, 2011 5:47 PM, " Carla Gibson "

wrote:

> 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.D

7830

mont Mesa Blvd #287

San

Diego, CA 92111

www.mypcponline.com

--

MD

115 Mt Blue

Circle

Farmington

ME 04938

ph fax

impcenter.org

--

Sangeetha Murthy M.D

7830 mont Mesa

Blvd #287

San Diego,

CA 92111

www.mypcponline.com

[Guest guest]

,Thats where Carla's setup sounds intriguing, because you dont have to track anything. The people who pay only get services through the website.  The people who dont and call in/ etc get billed for each little service.

And it is fair. For some people time is money  and they would be willing  to pay for thisand it is unfair to them to deprive them of this kind of access...

 

There is a large practice in town that

charges either by the event (webvisit, refills before an appt, etc) or you can “opt-out”

of paying the individual fees and pay the practice $100/year.  I

personally don’t want to track that, and don’t think it’s

fair to charge to patients who don’t utilize those services.

 

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Sangeetha Murthy

Sent: Wednesday, January 19, 2011

6:49 AM

To:

Subject: Re:

" non covered " benefits (revisited)

 

 

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?

On Tue, Jan 18, 2011 at 8:07 PM, Sangeetha Murthy

wrote:

 

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?

 

 

On Mon, Jan 10, 2011 at 9:16 PM, Sangeetha Murthy

wrote:

Very interesting twist..

Sangeetha Murthy

On Jan 10, 2011 5:47 PM, " Carla Gibson "

wrote:

> 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.D

7830

mont Mesa Blvd #287

San

Diego, CA 92111

www.mypcponline.com

 

--

     MD

     115 Mt Blue

Circle

     Farmington

ME 04938

ph    fax

impcenter.org

--

Sangeetha Murthy M.D

7830 mont Mesa

Blvd #287

San Diego,

CA 92111

www.mypcponline.com

 

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

[Guest guest]

See thats what I struggle with, names, not the service itself...I am not comfortable calling it the TANCS fee... because  I am really selling efficiency , not technologyI am not comfortable calling it health education/information  ... for yet unclear reasons, maybe because I dont see patients signing up unless I say ,wink, wink this is also what you get as a part of the package..

and you are right triage sounds like a medical service..So, What do you call it? 

 

Sangeetha,My " subscription website " model is not fully fleshed out but my vision at this point is that it would do just what you are suggesting here... but I would not call it triage because triage is likely part of the medical service you are expected to provide per insurance contracts as medical services.  In my current vision of how I would possibly do it, the subscription website would clearly provide generalized health information/education that I want my patients to have in a form that is not covered by insurance.  That would be the primary premise of the subscription website.  (BTW, if others chose to implement such a site, content could be shared.) The website would also be the technology that provides the access to the web/phone visits I do.  Of course, triage would have

to occur once a web/phone visit was requested.  I currently offer web and phone visits through my practice website (no subscription needed yet) and those offer the patient the option of having me bill their insurance or just paying straight out.  I'm risking a bit there since some of my insurance contracts clearly state I should not bill the patient for services the insurance covers.. but I did speak with Blue Cross once about that and they said if the patient requests that I not send a claim to insurance, then I should be okay. So I currently have the patient indicate if they want it billed or not.  But billing for it is not really worth my time- the reimbursement is typically low and I get too frustrated sending 3 statements out before I get paid.

If I move to the subscription website set up,  only those with a subscription will have access to request a web/phone visit.  There would be no charge for the

web/phone visit via the subscription website. Those who were not subscribers would not have access to web/phone visits. You could say the subscription fee, in part, covers the technology of hosting the visit but I would not frame it this way publicly because I would want it to be clear that the subscription is about the flow of health education/information that is not directly related to specific visits and thus, does not run afoul of any insurance law or contracts.  I am pretty sure that I can " give away " visits all day long without running into trouble... I think it is more risky to discount a fee than to just frankly give the service for free, yes?  So, in my mind, I will give away phone and web visits for free - the difference is that the access to them is behind the subscription website " door " .

Yes, this creates a two tiered system but it is one I can live with. I live with a lot of tiered systems... patients who have insurance and

those who don't; rich patients vs poor patients; good insurance payors and Medicare; and cash pay vs 3rd party payors.  Though I do not treat these patients differently as far as what I offer them, I do have to help them navigate the maze of what they can afford and what their insurance pays for.  Actually, I do treat them a bit differently, I offer uninsured patients cheap lab billed through my office to save them money.  In regard to the subscription website, all patients would have the opportunity to participate if they choose to pay for it.

The conversation about altruism and two tiered systems was confusing to me.  Per Brady's definition of altruistism, none of us are providing our services without expectation of remuneration or without regard to our own benefit in some way.  Sure, I go way above and beyond in many, many instances without payment.  We all do.  Some do it too frequently and become resentful.

I border on this.  The subscription website idea is an easy way that I can hold a boundary that is clear and distinct with my patients in regards to how much " free " service I give them while at the same time I can hopefully provide them with more important health information and motivational content to improve their health in ways that are not possible in typical office visits. Like you, I don't like making patients come in all the time for things that do not require an office visit... I think this concept could be a very satisfying " tweak " to my practice structure . 

Carla

From: Sangeetha Murthy

To:

Sent: Tue, January 18, 2011 6:07:40 PMSubject: Re: " non covered " benefits (revisited)

 

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

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

[Guest guest]

Sangeetha,The article by Joe Scherger that mentioned led me to check out his new practice:  http://www.emc.org/body-e365.cfm?id=415

How is Eisenhower Primary Care 365 different?◊

We are offering a model of primary care that puts you in charge of your health in an efficient and meaningful way with your chosen physician 365 days a year. This relationship-centered care with your physician and care team establishes a relationship beyond office visits. By having continual communication with you, your physician will better understand your health care needs. Extended face-to-face time with your physician, personalized focus on your health concerns, and detailed planning for any chronic conditions that may be part of your health profile are just a few ways you will notice a difference with Eisenhower Primary Care 365.

They seem to call it Primary Care 365 and a " relationship beyond visits. " It is a good question.

Sharon

[Guest guest]

Thanks Sharon, I will explore it... 

 

Sangeetha,The article by Joe Scherger that mentioned led me to check out his new practice:  http://www.emc.org/body-e365.cfm?id=415

How is Eisenhower Primary Care 365 different?◊

We are offering a model of primary care that puts you in charge of your health in an efficient and meaningful way with your chosen physician 365 days a year. This relationship-centered care with your physician and care team establishes a relationship beyond office visits. By having continual communication with you, your physician will better understand your health care needs. Extended face-to-face time with your physician, personalized focus on your health concerns, and detailed planning for any chronic conditions that may be part of your health profile are just a few ways you will notice a difference with Eisenhower Primary Care 365.

They seem to call it Primary Care 365 and a " relationship beyond visits. " It is a good question.

Sharon

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

[Guest guest]

I don't like the "wink, wink" aspect either. I've struggled with that and don't have it totally figured out yet. I have not implemented this concept yet so its still a work in progress. Talking about it here is helpful, so thank you.I do have a subscription website which I really enjoy doing, but it is what I describe as a coaching website for "healthy habits" (and weight loss but we don't focus on that aspect). There is no significant one-on-one communication via this website.In regard to the practice subscription website concept, I would love to deliver part of the primary care package this way. The health info/education is "my take" on how my patients can be healthier. So it would be a lot like my healthy habits site in that regard but more directly interactive with the

"virtual communication". How to frame it? Perhaps I would say that this is one method that I offer, in addition to traditional office visits, to provide the best possible care and information to the patients who are interested in optimizing their health. Most of my patients love the fact that I spend so much of their visit providing them information they can use to improve their health, the subscription website would be a way to expand on that. Rather than saying I only offer the web/phone visits through the site, I might explain that the site provides the mechanism to have an ongoing 'virtual conversation' between myself and the subscriber/patient. I could then choose to still offer traditional virtual visits that are more limited in scope to non-subscribers as I have been doing currently (if I found it worthwhile to continue).Here are some examples of what I consider 'ongoing conversations': I have one

patient who loves to update me on every symptom she has on a regular basis by email. I counted a total of what could have possibly been 17 billed visits over a nine month period via emails (each possible visit being several emails back and forth per visit) - none of which I billed because I cannot say where one visit begins or ends. Nor would she have tolerated being billed 17 times. Others want me to tell them what screening labs to do through their extensive workplace screening program ... which means I have to review their chart to see what needs updating, what other labs offered (like 25(OH)D, B12, estradiol, VAP etc) might be appropriate for them. Then, they want me to phone them (or email) about their results for free. I prescribe a lot of hormones and some patients often need more hand-holding than others and want a more continuous conversation. These are just a few examples of what could be done in that

'ongoing conversation' vs simply telling these folks to come in to the office to discuss these things. These services could be delivered as part of a membership practice like 's, but I'm not allowed to do that in this state. Or, it could be part of Jean's dollar a day offer- but again, I cannot do that here. Overall, I see it as a hybrid version of a practice like 's- still taking insurance for office visits but providing the more continuous stream of care and information via the subscription.To drone on a bit more in relation to the content that could be provided.... I like to encourage my patients to use less medication and more lifestyle change when it comes to their health. The subscription website could provide modules of information that are "pushed" to the subscriber via email daily or weekly. I believe many patients will implement changes more easily when they do it in small bites and have

reminders and followup. So, I might have a module on what I recommend for insomnia that includes emails on sleep hygiene, light therapy etc (anyone recommending amber glasses in the evening to block blue light?). Or, there might be a module on hormone use and what they need to know. The website expands my ability to provide the information I really want people to understand. The 'ongoing conversation' with them, when needed, seems like a more satisfying and continuous method of communication...yet would be nearly impossible to bill for, as it is not broken into billable segments or code-able fragments. And I don't think any insurer can say that I would be outside my contract with them. Nor can the state say I would be providing any type of promised reimbursable medical care that I cannot deliver.So that is a long, wandering reply to your simple question. What are your thoughts on the phrase 'ongoing conversation'

? Maybe that is not what you are going for? Its the best I can come up with, so far, to avoid the problem of providing something that could be considered a covered benefit that still fits with the model of care I want to deliver.CarlaTo: Sent: Wed, January 19, 2011 11:24:06 AMSubject: Re: "non covered" benefits (revisited)

See thats what I struggle with, names, not the service itself...I am not comfortable calling it the TANCS fee... because I am really selling efficiency , not technologyI am not comfortable calling it health education/information ... for yet unclear reasons, maybe because I dont see patients signing up unless I say ,wink, wink this is also what you get as a part of the package..

and you are right triage sounds like a medical service..So, What do you call it?

Sangeetha,My "subscription website" model is not fully fleshed out but my vision at this point is that it would do just what you are suggesting here... but I would not call it triage because triage is likely part of the medical service you are expected to provide per insurance contracts as medical services. In my current vision of how I would possibly do it, the subscription website would clearly provide generalized health information/education that I want my patients to have in a form that is not covered by insurance. That would be the primary premise of the subscription website. (BTW, if others chose to implement such a site, content could be shared.) The website would also be the technology that provides the access to the web/phone visits I do. Of course, triage would have

to occur once a web/phone visit was requested. I currently offer web and phone visits through my practice website (no subscription needed yet) and those offer the patient the option of having me bill their insurance or just paying straight out. I'm risking a bit there since some of my insurance contracts clearly state I should not bill the patient for services the insurance covers.. but I did speak with Blue Cross once about that and they said if the patient requests that I not send a claim to insurance, then I should be okay. So I currently have the patient indicate if they want it billed or not. But billing for it is not really worth my time- the reimbursement is typically low and I get too frustrated sending 3 statements out before I get paid.

If I move to the subscription website set up, only those with a subscription will have access to request a web/phone visit. There would be no charge for the

web/phone visit via the subscription website. Those who were not subscribers would not have access to web/phone visits. You could say the subscription fee, in part, covers the technology of hosting the visit but I would not frame it this way publicly because I would want it to be clear that the subscription is about the flow of health education/information that is not directly related to specific visits and thus, does not run afoul of any insurance law or contracts. I am pretty sure that I can "give away" visits all day long without running into trouble... I think it is more risky to discount a fee than to just frankly give the service for free, yes? So, in my mind, I will give away phone and web visits for free - the difference is that the access to them is behind the subscription website "door".

Yes, this creates a two tiered system but it is one I can live with. I live with a lot of tiered systems... patients who have insurance and

those who don't; rich patients vs poor patients; good insurance payors and Medicare; and cash pay vs 3rd party payors. Though I do not treat these patients differently as far as what I offer them, I do have to help them navigate the maze of what they can afford and what their insurance pays for. Actually, I do treat them a bit differently, I offer uninsured patients cheap lab billed through my office to save them money. In regard to the subscription website, all patients would have the opportunity to participate if they choose to pay for it.

The conversation about altruism and two tiered systems was confusing to me. Per Brady's definition of altruistism, none of us are providing our services without expectation of remuneration or without regard to our own benefit in some way. Sure, I go way above and beyond in many, many instances without payment. We all do. Some do it too frequently and become resentful.

I border on this. The subscription website idea is an easy way that I can hold a boundary that is clear and distinct with my patients in regards to how much "free" service I give them while at the same time I can hopefully provide them with more important health information and motivational content to improve their health in ways that are not possible in typical office visits. Like you, I don't like making patients come in all the time for things that do not require an office visit... I think this concept could be a very satisfying "tweak" to my practice structure .

Carla

From: Sangeetha Murthy

To:

Sent: Tue, January 18, 2011 6:07:40 PMSubject: Re: "non covered" benefits (revisited)

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

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

[Guest guest]

I wouldn't want to be him when the OIG comes sniffing. Actually stating that the

fee covers extended visit time seems to offer them ammo that the fee is actually

going toward covered services.

Haresch

>

> Sangeetha,

> The article by Joe Scherger that mentioned led me to check out his new

> practice: http://www.emc.org/body-e365.cfm?id=415

>

> How is *Eisenhower Primary Care 365* different?â—Š

>

> We are offering a model of primary care that puts you in charge of your

> health in an efficient and meaningful way with your chosen physician 365

> days a year. This relationship-centered care with your physician and care

> team establishes a relationship beyond office visits. By having continual

> communication with you, your physician will better understand your health

> care needs. Extended face-to-face time with your physician, personalized

> focus on your health concerns, and detailed planning for any chronic

> conditions that may be part of your health profile are just a few ways you

> will notice a difference with *Eisenhower Primary Care 365*.

>

> They seem to call it Primary Care 365 and a " relationship beyond visits. "

>

> It is a good question.

>

> Sharon

>

> >

>

[Guest guest]

Why don't you simply call it Health Coaching? or Life Coaching or Personal Health Training or Lifestyle Enhancement Counseling or pick something New Age sounding that no one can really figure out. That would probably be most effective in keeping prying eyes from hassling you. "Complementary and Alternative Medicine Newsletter Subscription" would be another idea.If you're exchanging 17 emails back and forth with patients, then you could be writing a book together. Maybe you're a health care writing consultant. Maybe you're aligning her hormone therapy every time the sign of the Zodiac changes. Now, that would be alternative.As far as Google knows, there isn't a cpt code per se for health coaching. Preventive service

counseling as recommended by the USPSTF or Medicare is out of bounds because that's clearly covered as part of an office visit with it's own codes. I would steer clear of anything related to that in your non covered service package.Health coaching to me could mean anything else. I'm no OIG compliance expert, but intuitively it makes sense to me that if there isn't a code for it and the less medical it all sounds, then it's more likely to be a non-covered service. As the government programs cover more preventive things, the non-covered service idea is a moving target. If they expand the covered service menu without you knowing it, you could still get in trouble.BenSubject: Re: "non covered" benefits (revisited)To: Date: Wednesday, January 19, 2011, 7:47 PM

I don't like the "wink, wink" aspect either. I've struggled with that and don't have it totally figured out yet. I have not implemented this concept yet so its still a work in progress. Talking about it here is helpful, so thank you.I do have a subscription website which I really enjoy doing, but it is what I describe as a coaching website for "healthy habits" (and weight loss but we don't focus on that aspect). There is no significant one-on-one communication via this website.In regard to the practice subscription website concept, I would love to deliver part of the primary care package this way. The health info/education is "my take" on how my patients can be healthier. So it would be a lot like my healthy habits site in that regard but more directly interactive with the

"virtual communication". How to frame it? Perhaps I would say that this is one method that I offer, in addition to traditional office visits, to provide the best possible care and information to the patients who are interested in optimizing their health. Most of my patients love the fact that I spend so much of their visit providing them information they can use to improve their health, the subscription website would be a way to expand on that. Rather than saying I only offer the web/phone visits through the site, I might explain that the site provides the mechanism to have an ongoing 'virtual conversation' between myself and the subscriber/patient. I could then choose to still offer traditional virtual visits that are more limited in scope to non-subscribers as I have been doing currently (if I found it worthwhile to continue).Here are some examples of what I consider 'ongoing conversations': I have one

patient who loves to update me on every symptom she has on a regular basis by email. I counted a total of what could have possibly been 17 billed visits over a nine month period via emails (each possible visit being several emails back and forth per visit) - none of which I billed because I cannot say where one visit begins or ends. Nor would she have tolerated being billed 17 times. Others want me to tell them what screening labs to do through their extensive workplace screening program ... which means I have to review their chart to see what needs updating, what other labs offered (like 25(OH)D, B12, estradiol, VAP etc) might be appropriate for them. Then, they want me to phone them (or email) about their results for free. I prescribe a lot of hormones and some patients often need more hand-holding than others and want a more continuous conversation. These are just a few examples of what could be done in that

'ongoing conversation' vs simply telling these folks to come in to the office to discuss these things. These services could be delivered as part of a membership practice like 's, but I'm not allowed to do that in this state. Or, it could be part of Jean's dollar a day offer- but again, I cannot do that here. Overall, I see it as a hybrid version of a practice like 's- still taking insurance for office visits but providing the more continuous stream of care and information via the subscription.To drone on a bit more in relation to the content that could be provided.... I like to encourage my patients to use less medication and more lifestyle change when it comes to their health. The subscription website could provide modules of information that are "pushed" to the subscriber via email daily or weekly. I believe many patients will implement changes more easily when they do it in small bites and have

reminders and followup. So, I might have a module on what I recommend for insomnia that includes emails on sleep hygiene, light therapy etc (anyone recommending amber glasses in the evening to block blue light?). Or, there might be a module on hormone use and what they need to know. The website expands my ability to provide the information I really want people to understand. The 'ongoing conversation' with them, when needed, seems like a more satisfying and continuous method of communication...yet would be nearly impossible to bill for, as it is not broken into billable segments or code-able fragments. And I don't think any insurer can say that I would be outside my contract with them. Nor can the state say I would be providing any type of promised reimbursable medical care that I cannot deliver.So that is a long, wandering reply to your simple question. What are your thoughts on the phrase 'ongoing conversation'

? Maybe that is not what you are going for? Its the best I can come up with, so far, to avoid the problem of providing something that could be considered a covered benefit that still fits with the model of care I want to deliver.CarlaTo: Sent: Wed, January 19, 2011 11:24:06 AMSubject: Re: "non covered" benefits (revisited)

See thats what I struggle with, names, not the service itself...

[Guest guest]

Yes, I agree, advertising that patients get longer visits and making any

connection real or implied between longer visits and add'l fees when third

parties are also being billed for those long visits is a bullseye.

But I advertise to patients that the NCBF allows me to reserve time outside of

visits to give them more time and attention.

See the next post.

Stew

Re: " non covered " benefits (revisited)

I wouldn't want to be him when the OIG comes sniffing. Actually stating that the

fee covers extended visit time seems to offer them ammo that the fee is actually

going toward covered services.

Haresch

>

> Sangeetha,

> The article by Joe Scherger that mentioned led me to check out his new

> practice: http://www.emc.org/body-e365.cfm?id=415

>

> How is *Eisenhower Primary Care 365* different?â—Š

>

> We are offering a model of primary care that puts you in charge of your

> health in an efficient and meaningful way with your chosen physician 365

> days a year. This relationship-centered care with your physician and care

> team establishes a relationship beyond office visits. By having continual

> communication with you, your physician will better understand your health

> care needs. Extended face-to-face time with your physician, personalized

> focus on your health concerns, and detailed planning for any chronic

> conditions that may be part of your health profile are just a few ways you

> will notice a difference with *Eisenhower Primary Care 365*.

>

> They seem to call it Primary Care 365 and a " relationship beyond visits. "

>

> It is a good question.

>

> Sharon

>

> >

>

[Guest guest]

Good discussion.

Over the past 2 weeks I have contemplated the issue of altruism and the business

of a medical practice - Brady's comments really made me stop and review if

I'm experiencing " mission-drift " . What we strive for is a balance - a healthy

business and a healthy doctor. The business acumen and self-advocacy so that we

are compensated for the work we do but also the general peace of mind to

practice regular acts of, yes, altruism in this same practice. Fairness and

good care is the goal.

So I have mailed out letters and forms to all my patients, laying out my service

and give them " choices " about how to pay for it. I'll include the link below.

I have a little internal conflict about the possibility of a barrier to care,

but I would like to point out to the group (slightly defensive) that my model is

not two tiered. There are problems with it, but the key element of fairness my

plan is that everyone gets the same level of access, the difference is that I

give people the choice of paying for it monthly (at a savings and discount) or

per episode of use(customary fees apply). The access to me is the same, my

phone numbers are all accessible to everyone. When insurance starts reimbursing

evisits (don't know of any now) there will be issues to work out.

I wonder if there are providers on this listserv who feel that we shouldn't

charge anything to " be on call " . I was trained to devote myself to my patients

welfare, and it has been hard to decide to charge for something that docs have

been donating for decades. But when I look around I see call groups of 10 to 20

doctors - and I know that calling one of those docs at night is McMedicine and

pales in comparison to talking to a familiar person who knows you and cares

about you. And if I don't bill, I might eventually sign on to one of those

mcmedicine call panels.

I then think that charging for this kind of access is the right way to preserve

this old fashioned touch.

As far as encroaching on insurance, insurance is (from wiki) " a form of risk

management primarily used to hedge against the risk of a contingent, uncertain

loss. Insurance is defined as the equitable transfer of the risk of a loss, from

one entity to another, in exchange for payment. "

If it is a service (not monetary compensation) that you clearly CAN provide to

all patients who want it (24x7 access and phone calls/emails - which is for a

finite number of patients such as 500, not 5 zillion) AND there is no element of

the tranaction involving the hedging of risk, then I believe there is no

insurance being sold. How could this be a " promised reimbursable medical care

that cannot be delivered. " If we can not deliver this than we should be

limiting our patient census anyway - fielding medical concerns and questions and

communicating is what we do, we just can't always get paid for it when we are

should.

https://sites.google.com/a/stewmonesmd.com/www-maitreefamilymedicine-com/Home/fo\

rm-download-page

Click and Check out HealthyAccess 2011 policies for my NCBF choices

Stew

Maitree Family Medicine

Solo for 18 months

Re: " non covered " benefits (revisited)

>

>

>

>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.

[Guest guest]

Good discussion.

Over the past 2 weeks I have contemplated the issue of altruism and the business

of a medical practice - Brady's comments really made me stop and review if

I'm experiencing " mission-drift " . What we strive for is a balance - a healthy

business and a healthy doctor. The business acumen and self-advocacy so that we

are compensated for the work we do but also the general peace of mind to

practice regular acts of, yes, altruism in this same practice. Fairness and

good care is the goal.

So I have mailed out letters and forms to all my patients, laying out my service

and give them " choices " about how to pay for it. I'll include the link below.

I have a little internal conflict about the possibility of a barrier to care,

but I would like to point out to the group (slightly defensive) that my model is

not two tiered. There are problems with it, but the key element of fairness my

plan is that everyone gets the same level of access, the difference is that I

give people the choice of paying for it monthly (at a savings and discount) or

per episode of use(customary fees apply). The access to me is the same, my

phone numbers are all accessible to everyone. When insurance starts reimbursing

evisits (don't know of any now) there will be issues to work out.

I wonder if there are providers on this listserv who feel that we shouldn't

charge anything to " be on call " . I was trained to devote myself to my patients

welfare, and it has been hard to decide to charge for something that docs have

been donating for decades. But when I look around I see call groups of 10 to 20

doctors - and I know that calling one of those docs at night is McMedicine and

pales in comparison to talking to a familiar person who knows you and cares

about you. And if I don't bill, I might eventually sign on to one of those

mcmedicine call panels.

I then think that charging for this kind of access is the right way to preserve

this old fashioned touch.

As far as encroaching on insurance, insurance is (from wiki) " a form of risk

management primarily used to hedge against the risk of a contingent, uncertain

loss. Insurance is defined as the equitable transfer of the risk of a loss, from

one entity to another, in exchange for payment. "

If it is a service (not monetary compensation) that you clearly CAN provide to

all patients who want it (24x7 access and phone calls/emails - which is for a

finite number of patients such as 500, not 5 zillion) AND there is no element of

the tranaction involving the hedging of risk, then I believe there is no

insurance being sold. How could this be a " promised reimbursable medical care

that cannot be delivered. " If we can not deliver this than we should be

limiting our patient census anyway - fielding medical concerns and questions and

communicating is what we do, we just can't always get paid for it when we are

should.

https://sites.google.com/a/stewmonesmd.com/www-maitreefamilymedicine-com/Home/fo\

rm-download-page

Click and Check out HealthyAccess 2011 policies for my NCBF choices

Stew

Maitree Family Medicine

Solo for 18 months

Re: " non covered " benefits (revisited)

>

>

>

>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.

[Guest guest]

I downloaded your 2011 Health Access Info sheet and seems

very fair and an inexpensive yearly fee. Incredible how much

we agonize over charging folks very reasonable fees.

Doctors try so hard to be good.

I love the $4/minute idea. How has that worked out?

How did you come up with that #? $360/hr sounds great!

Pamela

Pamela Wible, MD

3575 St. #220

Eugene, OR 97405

www.idealmedicalcare.org

>

>

> >Sangeetha,

> >

> >My " subscription website " model is not fully fleshed out but my vision at

this

> >point is that it would do just what you are suggesting here... but I would

not

> >call it triage because triage is likely part of the medical service you are

> >expected to provide per insurance contracts as medical services. In my

current

> >vision of how I would possibly do it, the subscription website would clearly

> >provide generalized health information/education that I want my patients to

have

> >in a form that is not covered by insurance. That would be the primary

premise

> >of the subscription website. (BTW, if others chose to implement such a site,

> >content could be shared.) The website would also be the technology that

provides

> >the access to the web/phone visits I do. Of course, triage would have to

occur

> >once a web/phone visit was requested.

> >

> >

> >I currently offer web and phone visits through my practice website (no

> >subscription needed yet) and those offer the patient the option of having me

> >bill their insurance or just paying straight out. I'm risking a bit there

since

> >some of my insurance contracts clearly state I should not bill the patient

for

> >services the insurance covers.. but I did speak with Blue Cross once about

that

> >and they said if the patient requests that I not send a claim to insurance,

then

> >I should be okay. So I currently have the patient indicate if they want it

> >billed or not. But billing for it is not really worth my time- the

> >reimbursement is typically low and I get too frustrated sending 3 statements

out

> >before I get paid.

> >

> >

> >If I move to the subscription website set up, only those with a subscription

> >will have access to request a web/phone visit. There would be no charge for

the

> >web/phone visit via the subscription website. Those who were not subscribers

> >would not have access to web/phone visits. You could say the subscription

fee,

> >in part, covers the technology of hosting the visit but I would not frame it

> >this way publicly because I would want it to be clear that the subscription

is

> >about the flow of health education/information that is not directly related

to

> >specific visits and thus, does not run afoul of any insurance law or

contracts.

> >I am pretty sure that I can " give away " visits all day long without running

into

> >trouble... I think it is more risky to discount a fee than to just frankly

give

> >the service for free, yes? So, in my mind, I will give away phone and web

> >visits for free - the difference is that the access to them is behind the

> >subscription website " door " .

> >

> >Yes, this creates a two tiered system but it is one I can live with. I live

with

> >a lot of tiered systems... patients who have insurance and those who don't;

> >rich patients vs poor patients; good insurance payors and Medicare; and cash

pay

> >vs 3rd party payors. Though I do not treat these patients differently as far

as

> >what I offer them, I do have to help them navigate the maze of what they can

> >afford and what their insurance pays for. Actually, I do treat them a bit

> >differently, I offer uninsured patients cheap lab billed through my office to

> >save them money. In regard to the subscription website, all patients would

have

> >the opportunity to participate if they choose to pay for it.

> >

> >The conversation about altruism and two tiered systems was confusing to me.

Per

> >Brady's definition of altruistism, none of us are providing our services

without

> >expectation of remuneration or without regard to our own benefit in some way.

> >Sure, I go way above and beyond in many, many instances without payment. We

all

> >do. Some do it too frequently and become resentful. I border on this. The

> >subscription website idea is an easy way that I can hold a boundary that is

> >clear and distinct with my patients in regards to how much " free " service I

give

> >them while at the same time I can hopefully provide them with more important

> >health information and motivational content to improve their health in ways

that

> >are not possible in typical office visits. Like you, I don't like making

> >patients come in all the time for things that do not require an office

visit...

> >I think this concept could be a very satisfying " tweak " to my practice

structure

> >.

> >

> >

> >

> >

> >Carla

> >

> >

> ________________________________

>

> >To:

> >Sent: Tue, January 18, 2011 6:07:40 PM

> >Subject: Re: " non covered " benefits (revisited)

> >

> >

> >

> >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.

>

[Guest guest]

Stew,

Good luck in your new “choices.”

One word of caution….most insurance contracts will require 24 hour access

to either you, or a call service, or something. I’m not certain if

it’s required in your contract if you can charge extra for that? Those

of us who choose to take our own call 24/7/365 have done so for different

reasons. For us, we chose it because it was actually LESS work and EASIER

than when Steve was in a call group of 20. We will continue to not charge

our patients for that service, and our patients don’t abuse it.

This past weekend, Steve had a “busy” call weekend----2 calls

regarding the same patient on the same day. But they weren’t middle

of the night, late night, or early morning. And our patients love it that

they get their own doctor on the phone. Maybe we should be charging for

that? But for now, we don’t. We do, however, charge for

everything else…..after-hours visits, phone calls, web visits, forms

completion, records, etc.

Again, good luck!

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of Stew Mones MD

Sent: Wednesday, January 19, 2011

10:40 PM

To:

Subject: RE:

" non covered " benefits (revisited)

Good

discussion.

Over the past 2 weeks I have contemplated the issue of altruism and the

business of a medical practice - Brady's comments really made me stop and

review if I'm experiencing " mission-drift " . What we strive for is a

balance - a healthy business and a healthy doctor. The business acumen and

self-advocacy so that we are compensated for the work we do but also the

general peace of mind to practice regular acts of, yes, altruism in this same

practice. Fairness and good care is the goal.

So I have mailed out letters and forms to all my patients, laying out my

service and give them " choices " about how to pay for it. I'll include

the link below. I have a little internal conflict about the possibility of a

barrier to care, but I would like to point out to the group (slightly

defensive) that my model is not two tiered. There are problems with it, but the

key element of fairness my plan is that everyone gets the same level of access,

the difference is that I give people the choice of paying for it monthly (at a

savings and discount) or per episode of use(customary fees apply). The access

to me is the same, my phone numbers are all accessible to everyone. When

insurance starts reimbursing evisits (don't know of any now) there will be

issues to work out.

I wonder if there are providers on this listserv who feel that we shouldn't

charge anything to " be on call " . I was trained to devote myself to my

patients welfare, and it has been hard to decide to charge for something that

docs have been donating for decades. But when I look around I see call groups

of 10 to 20 doctors - and I know that calling one of those docs at night is

McMedicine and pales in comparison to talking to a familiar person who knows

you and cares about you. And if I don't bill, I might eventually sign on to one

of those mcmedicine call panels.

I then think that charging for this kind of access is the right way to preserve

this old fashioned touch.

As far as encroaching on insurance, insurance is (from wiki) " a form of

risk management primarily used to hedge against the risk of a contingent,

uncertain loss. Insurance is defined as the equitable transfer of the risk of a

loss, from one entity to another, in exchange for payment. "

If it is a service (not monetary compensation) that you clearly CAN provide to

all patients who want it (24x7 access and phone calls/emails - which is for a

finite number of patients such as 500, not 5 zillion) AND there is no element

of the tranaction involving the hedging of risk, then I believe there is no

insurance being sold. How could this be a " promised reimbursable medical

care that cannot be delivered. " If we can not deliver this than we should

be limiting our patient census anyway - fielding medical concerns and questions

and communicating is what we do, we just can't always get paid for it when we

are should.

https://sites.google.com/a/stewmonesmd.com/www-maitreefamilymedicine-com/Home/form-download-page

Click and Check out HealthyAccess 2011 policies for my NCBF choices

Stew

Maitree Family Medicine

Solo for 18 months

Re: " non covered " benefits

(revisited)

>

>

>

>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.

[Guest guest]

How about Relationship Management Services?On that note..Does anybody use any CRM software? I was hoping after Salesforce invested in Practice Fusion , that PF would get some CRM features or at least an interface with salesforce..

I cant wait. I ,now, want it now.I have seen it work fantasticallly in 2 different situations-My husband faxed the childcare savings stuff to the HR office and promptly got an email that it was recieved ( can u imagine the potential? no more did u get this , have u sent this etc etc)

-A property management query  got me 4 prompt replies and 4 followup questions>..

 

Why don't you simply call it Health Coaching? or Life Coaching or Personal Health Training or Lifestyle Enhancement Counseling or pick something New Age sounding that no one can really figure out.  That would probably be most effective in keeping prying eyes from hassling you. 

  " Complementary and Alternative Medicine Newsletter Subscription " would be another idea.If you're exchanging 17 emails back and forth with patients, then you could be writing a book together.  Maybe you're a health care writing consultant.  

Maybe you're aligning her hormone therapy every time the sign of the Zodiac changes.  Now, that would be alternative.As far as Google knows, there isn't a cpt code per se for health coaching.  

Preventive service

counseling as recommended by the USPSTF or Medicare is out of bounds because that's clearly covered as part of an office visit with it's own codes.  I would steer clear of anything related to that in your non covered service package.

Health coaching to me could mean anything else.  I'm no OIG compliance expert, but intuitively it makes sense to me that if there isn't a code for it and the less medical it all sounds, then it's more likely to be a non-covered service.  As the government programs cover more preventive things, the non-covered service idea is a moving target.  If they expand the covered service menu without you knowing it, you could still get in trouble.

Ben

Subject: Re: " non covered " benefits (revisited)To:

Date: Wednesday, January 19, 2011, 7:47 PM

 

I don't like the " wink, wink " aspect either. I've struggled with that and don't have it totally figured out yet.  I have not implemented this concept yet so its still a work in progress.  Talking about it here is helpful, so thank you.

I do have a subscription website which I really enjoy doing, but it is what I describe as a coaching website for " healthy habits " (and weight loss but we don't focus on that aspect).  There is no significant one-on-one communication via this website.

In regard to the practice subscription website concept, I would love to deliver part of the primary care package this way. The health info/education is " my take " on how my patients can be healthier. So it would be a lot like my healthy habits site in that regard but more directly interactive with the

" virtual communication " .  How to frame it?  Perhaps I would say that this is one method that I offer, in addition to traditional office visits,  to provide the best possible care and information to the patients who are interested in optimizing their health.  Most of my patients love the fact that I spend so much of their visit providing them information they can use to improve their health, the subscription website would be a way to expand on that.  Rather than saying I only offer the web/phone visits through the site, I might explain that the site provides the mechanism to have an ongoing 'virtual conversation' between myself and the subscriber/patient.  I could then choose to still offer traditional virtual visits that are more limited in scope to non-subscribers as I have been doing currently (if I found it worthwhile to continue).

Here are some examples of what I consider 'ongoing conversations': I have one

patient who loves to update me on every symptom she has on a regular basis by email. I counted a total of what could have possibly been 17 billed visits over a nine month period via emails (each possible visit being several emails back and forth per visit) - none of which I billed because I cannot say where one visit begins or ends.  Nor would she have tolerated being billed 17 times.  Others  want me to tell them what screening labs to do through their extensive workplace screening program ... which  means I have to review their chart to see what needs updating, what other labs offered (like 25(OH)D, B12, estradiol, VAP etc) might be appropriate for them.  Then, they want me to phone them (or email) about their results for free.  I prescribe a lot of hormones and some patients often need more hand-holding than others and want a more continuous conversation.   These are just a few examples of what could be done in that

'ongoing conversation' vs simply telling these folks to come in to the office to discuss these things. These services could be delivered as part of a membership practice like 's, but I'm not allowed to do that in this state. Or, it could be part of Jean's dollar a day offer- but again, I cannot do that here.  Overall, I see it as a hybrid version of a practice like 's- still taking insurance for office visits but providing the more continuous stream of care and information via the subscription.

To drone on a bit more in relation to the content that could be provided.... I like to encourage my patients to use less medication and more lifestyle change when it comes to their health.  The subscription website could provide modules of information that are " pushed " to the subscriber via email daily or weekly.  I believe many patients will implement changes more easily when they do it in small bites and have

reminders and followup.  So, I might have a module on what I recommend for insomnia that includes emails on sleep hygiene, light therapy etc (anyone recommending amber glasses in the evening to block blue light?).  Or, there might be a module on hormone use and what they need to know.  The website expands my ability to provide the information I really want people to understand.  The 'ongoing conversation' with them, when needed, seems like a more satisfying and continuous method of communication...yet would be nearly impossible to bill for, as it is not broken into billable segments or code-able fragments.  And I don't think any insurer can say that I would be outside my contract with them. Nor can the state say I would be providing any type of promised reimbursable medical care that I cannot deliver.

So that is a long, wandering reply to your simple question. What are your thoughts on the phrase 'ongoing conversation'

?  Maybe that is not what you are going for? Its the best I can come up with, so far, to avoid the problem of providing something that could be considered a covered benefit that still fits with the model of care I want to deliver.

Carla

To:

Sent: Wed, January 19, 2011 11:24:06 AMSubject: Re: " non covered " benefits (revisited)

 

See thats what I struggle with, names, not the service itself...

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

[Guest guest]

How about Relationship Management Services?On that note..Does anybody use any CRM software? I was hoping after Salesforce invested in Practice Fusion , that PF would get some CRM features or at least an interface with salesforce..

I cant wait. I ,now, want it now.I have seen it work fantasticallly in 2 different situations-My husband faxed the childcare savings stuff to the HR office and promptly got an email that it was recieved ( can u imagine the potential? no more did u get this , have u sent this etc etc)

-A property management query  got me 4 prompt replies and 4 followup questions>..

 

Why don't you simply call it Health Coaching? or Life Coaching or Personal Health Training or Lifestyle Enhancement Counseling or pick something New Age sounding that no one can really figure out.  That would probably be most effective in keeping prying eyes from hassling you. 

  " Complementary and Alternative Medicine Newsletter Subscription " would be another idea.If you're exchanging 17 emails back and forth with patients, then you could be writing a book together.  Maybe you're a health care writing consultant.  

Maybe you're aligning her hormone therapy every time the sign of the Zodiac changes.  Now, that would be alternative.As far as Google knows, there isn't a cpt code per se for health coaching.  

Preventive service

counseling as recommended by the USPSTF or Medicare is out of bounds because that's clearly covered as part of an office visit with it's own codes.  I would steer clear of anything related to that in your non covered service package.

Health coaching to me could mean anything else.  I'm no OIG compliance expert, but intuitively it makes sense to me that if there isn't a code for it and the less medical it all sounds, then it's more likely to be a non-covered service.  As the government programs cover more preventive things, the non-covered service idea is a moving target.  If they expand the covered service menu without you knowing it, you could still get in trouble.

Ben

Subject: Re: " non covered " benefits (revisited)To:

Date: Wednesday, January 19, 2011, 7:47 PM

 

I don't like the " wink, wink " aspect either. I've struggled with that and don't have it totally figured out yet.  I have not implemented this concept yet so its still a work in progress.  Talking about it here is helpful, so thank you.

I do have a subscription website which I really enjoy doing, but it is what I describe as a coaching website for " healthy habits " (and weight loss but we don't focus on that aspect).  There is no significant one-on-one communication via this website.

In regard to the practice subscription website concept, I would love to deliver part of the primary care package this way. The health info/education is " my take " on how my patients can be healthier. So it would be a lot like my healthy habits site in that regard but more directly interactive with the

" virtual communication " .  How to frame it?  Perhaps I would say that this is one method that I offer, in addition to traditional office visits,  to provide the best possible care and information to the patients who are interested in optimizing their health.  Most of my patients love the fact that I spend so much of their visit providing them information they can use to improve their health, the subscription website would be a way to expand on that.  Rather than saying I only offer the web/phone visits through the site, I might explain that the site provides the mechanism to have an ongoing 'virtual conversation' between myself and the subscriber/patient.  I could then choose to still offer traditional virtual visits that are more limited in scope to non-subscribers as I have been doing currently (if I found it worthwhile to continue).

Here are some examples of what I consider 'ongoing conversations': I have one

patient who loves to update me on every symptom she has on a regular basis by email. I counted a total of what could have possibly been 17 billed visits over a nine month period via emails (each possible visit being several emails back and forth per visit) - none of which I billed because I cannot say where one visit begins or ends.  Nor would she have tolerated being billed 17 times.  Others  want me to tell them what screening labs to do through their extensive workplace screening program ... which  means I have to review their chart to see what needs updating, what other labs offered (like 25(OH)D, B12, estradiol, VAP etc) might be appropriate for them.  Then, they want me to phone them (or email) about their results for free.  I prescribe a lot of hormones and some patients often need more hand-holding than others and want a more continuous conversation.   These are just a few examples of what could be done in that

'ongoing conversation' vs simply telling these folks to come in to the office to discuss these things. These services could be delivered as part of a membership practice like 's, but I'm not allowed to do that in this state. Or, it could be part of Jean's dollar a day offer- but again, I cannot do that here.  Overall, I see it as a hybrid version of a practice like 's- still taking insurance for office visits but providing the more continuous stream of care and information via the subscription.

To drone on a bit more in relation to the content that could be provided.... I like to encourage my patients to use less medication and more lifestyle change when it comes to their health.  The subscription website could provide modules of information that are " pushed " to the subscriber via email daily or weekly.  I believe many patients will implement changes more easily when they do it in small bites and have

reminders and followup.  So, I might have a module on what I recommend for insomnia that includes emails on sleep hygiene, light therapy etc (anyone recommending amber glasses in the evening to block blue light?).  Or, there might be a module on hormone use and what they need to know.  The website expands my ability to provide the information I really want people to understand.  The 'ongoing conversation' with them, when needed, seems like a more satisfying and continuous method of communication...yet would be nearly impossible to bill for, as it is not broken into billable segments or code-able fragments.  And I don't think any insurer can say that I would be outside my contract with them. Nor can the state say I would be providing any type of promised reimbursable medical care that I cannot deliver.

So that is a long, wandering reply to your simple question. What are your thoughts on the phrase 'ongoing conversation'

?  Maybe that is not what you are going for? Its the best I can come up with, so far, to avoid the problem of providing something that could be considered a covered benefit that still fits with the model of care I want to deliver.

Carla

To:

Sent: Wed, January 19, 2011 11:24:06 AMSubject: Re: " non covered " benefits (revisited)

 

See thats what I struggle with, names, not the service itself...

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

[Guest guest]

Agree with .

From: [ ] On Behalf Of Pratt [karen.oaktree@...]

Sent: Thursday, January 20, 2011 8:09 AM

To:

Subject: RE: " non covered " benefits (revisited)

Stew,

Good luck in your new “choices.” One word of caution….most insurance contracts will require 24 hour access to either you, or a call

service, or something. I’m not certain if it’s required in your contract if you can charge extra for that? Those of us who choose to take our own call 24/7/365 have done so for different reasons. For us, we chose it because it was actually LESS work and

EASIER than when Steve was in a call group of 20. We will continue to not charge our patients for that service, and our patients don’t abuse it. This past weekend, Steve had a “busy” call weekend----2 calls regarding the same patient on the same day. But

they weren’t middle of the night, late night, or early morning. And our patients love it that they get their own doctor on the phone. Maybe we should be charging for that? But for now, we don’t. We do, however, charge for everything else…..after-hours

visits, phone calls, web visits, forms completion, records, etc.

Again, good luck!

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From:

[mailto: ] On Behalf Of

Stew Mones MD

Sent: Wednesday, January 19, 2011 10:40 PM

To:

Subject: RE: " non covered " benefits (revisited)

Good discussion.

Over the past 2 weeks I have contemplated the issue of altruism and the business of a medical practice - Brady's comments really made me stop and review if I'm experiencing " mission-drift " . What we strive for is a balance - a healthy business and a healthy

doctor. The business acumen and self-advocacy so that we are compensated for the work we do but also the general peace of mind to practice regular acts of, yes, altruism in this same practice. Fairness and good care is the goal.

So I have mailed out letters and forms to all my patients, laying out my service and give them " choices " about how to pay for it. I'll include the link below. I have a little internal conflict about the possibility of a barrier to care, but I would like to

point out to the group (slightly defensive) that my model is not two tiered. There are problems with it, but the key element of fairness my plan is that everyone gets the same level of access, the difference is that I give people the choice of paying for it

monthly (at a savings and discount) or per episode of use(customary fees apply). The access to me is the same, my phone numbers are all accessible to everyone. When insurance starts reimbursing evisits (don't know of any now) there will be issues to work out.

I wonder if there are providers on this listserv who feel that we shouldn't charge anything to " be on call " . I was trained to devote myself to my patients welfare, and it has been hard to decide to charge for something that docs have been donating for decades.

But when I look around I see call groups of 10 to 20 doctors - and I know that calling one of those docs at night is McMedicine and pales in comparison to talking to a familiar person who knows you and cares about you. And if I don't bill, I might eventually

sign on to one of those mcmedicine call panels.

I then think that charging for this kind of access is the right way to preserve this old fashioned touch.

As far as encroaching on insurance, insurance is (from wiki) " a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another,

in exchange for payment. "

If it is a service (not monetary compensation) that you clearly CAN provide to all patients who want it (24x7 access and phone calls/emails - which is for a finite number of patients such as 500, not 5 zillion) AND there is no element of the tranaction involving

the hedging of risk, then I believe there is no insurance being sold. How could this be a " promised reimbursable medical care that cannot be delivered. " If we can not deliver this than we should be limiting our patient census anyway - fielding medical concerns

and questions and communicating is what we do, we just can't always get paid for it when we are should.

https://sites.google.com/a/stewmonesmd.com/www-maitreefamilymedicine-com/Home/form-download-page

Click and Check out HealthyAccess 2011 policies for my NCBF choices

Stew

Maitree Family Medicine

Solo for 18 months

Re: " non covered " benefits (revisited)

>

>

>

>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.

[Guest guest]

Agree with .

From: [ ] On Behalf Of Pratt [karen.oaktree@...]

Sent: Thursday, January 20, 2011 8:09 AM

To:

Subject: RE: " non covered " benefits (revisited)

Stew,

Good luck in your new “choices.” One word of caution….most insurance contracts will require 24 hour access to either you, or a call

service, or something. I’m not certain if it’s required in your contract if you can charge extra for that? Those of us who choose to take our own call 24/7/365 have done so for different reasons. For us, we chose it because it was actually LESS work and

EASIER than when Steve was in a call group of 20. We will continue to not charge our patients for that service, and our patients don’t abuse it. This past weekend, Steve had a “busy” call weekend----2 calls regarding the same patient on the same day. But

they weren’t middle of the night, late night, or early morning. And our patients love it that they get their own doctor on the phone. Maybe we should be charging for that? But for now, we don’t. We do, however, charge for everything else…..after-hours

visits, phone calls, web visits, forms completion, records, etc.

Again, good luck!

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From:

[mailto: ] On Behalf Of

Stew Mones MD

Sent: Wednesday, January 19, 2011 10:40 PM

To:

Subject: RE: " non covered " benefits (revisited)

Good discussion.

Over the past 2 weeks I have contemplated the issue of altruism and the business of a medical practice - Brady's comments really made me stop and review if I'm experiencing " mission-drift " . What we strive for is a balance - a healthy business and a healthy

doctor. The business acumen and self-advocacy so that we are compensated for the work we do but also the general peace of mind to practice regular acts of, yes, altruism in this same practice. Fairness and good care is the goal.

So I have mailed out letters and forms to all my patients, laying out my service and give them " choices " about how to pay for it. I'll include the link below. I have a little internal conflict about the possibility of a barrier to care, but I would like to

point out to the group (slightly defensive) that my model is not two tiered. There are problems with it, but the key element of fairness my plan is that everyone gets the same level of access, the difference is that I give people the choice of paying for it

monthly (at a savings and discount) or per episode of use(customary fees apply). The access to me is the same, my phone numbers are all accessible to everyone. When insurance starts reimbursing evisits (don't know of any now) there will be issues to work out.

I wonder if there are providers on this listserv who feel that we shouldn't charge anything to " be on call " . I was trained to devote myself to my patients welfare, and it has been hard to decide to charge for something that docs have been donating for decades.

But when I look around I see call groups of 10 to 20 doctors - and I know that calling one of those docs at night is McMedicine and pales in comparison to talking to a familiar person who knows you and cares about you. And if I don't bill, I might eventually

sign on to one of those mcmedicine call panels.

I then think that charging for this kind of access is the right way to preserve this old fashioned touch.

As far as encroaching on insurance, insurance is (from wiki) " a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another,

in exchange for payment. "

If it is a service (not monetary compensation) that you clearly CAN provide to all patients who want it (24x7 access and phone calls/emails - which is for a finite number of patients such as 500, not 5 zillion) AND there is no element of the tranaction involving

the hedging of risk, then I believe there is no insurance being sold. How could this be a " promised reimbursable medical care that cannot be delivered. " If we can not deliver this than we should be limiting our patient census anyway - fielding medical concerns

and questions and communicating is what we do, we just can't always get paid for it when we are should.

https://sites.google.com/a/stewmonesmd.com/www-maitreefamilymedicine-com/Home/form-download-page

Click and Check out HealthyAccess 2011 policies for my NCBF choices

Stew

Maitree Family Medicine

Solo for 18 months

Re: " non covered " benefits (revisited)

>

>

>

>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.

[Guest guest]

I agree about taking our call and being available and that it is easier to cover

yourself than be in large call group, etc. However, how come specialists are not

held to the same standards? Our local cardiologist puts on his machine to

contact your primary doctor after hours if you need anything. A local

psychiatrist cancelled my patient's appointment and when she called to get a

refill of her medicine, the message said to go to ER if you need medications.

When she went to the office for the follow up appointment, there was a note on

the door saying there was a family emergency and if you need medications, go to

the ER. They did not even try to call her to cancel the appointment. Last summer

I got a call and when I answered it, it was a local HMO I participate with

testing to see how long it took for me to call back.

Just my two cents!

Margaret

Re: " non covered " benefits (revisited)

>

>

>

>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.