RE: Slower schedule than you'd like?

[Guest guest]

That’s great . I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week. What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M. Kathy Saradarian, MDQuality Family Practicequalityfp@... From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like? Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or " saves " on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

Thanks Sangeetha

 

That’s great . 

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month.  I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals.    I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

 What has been holding me back (other than right now I am too busy because of a lot of trips and closures)  is that physicals pay way less than a 99214.  So I was seeing new patients and calling it a physical until I reviewed my fees.  (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. 

 If you are seeing no one, it’s certainly better than nothing.  But I don’t know why they pay so little.  But when it gets slow again, I might go that route too.  Then if they actually have issues, I can actually code it as a E & M.

  Kathy Saradarian, MD

Quality Family Practicequalityfp@...

   

From: [mailto: ] On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like?

   Hi all,I just wanted to pass along what we have done to fill our schedule,

just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so we

needed to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have never

done this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we started

sending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we are

in the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although our

schedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area

(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or " saves " on any labsyet, but we are getting patients in for their mammos, colonoscopies,

etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make sure

they are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

My schedule is usually full or at least I expect it to be full up until the day before. I’m wondering what works best to fill in appointments with only a day notice to patients. Airlines have strategies to fill up empty seats at the last minute. Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution? From: [mailto: ] On Behalf Of Sangeetha MurthySent: Saturday, October 08, 2011 10:34 AMTo: Subject: Re: Slower schedule than you'd like? Thanks Sangeetha That’s great . I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week. What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M. Kathy Saradarian, MDQuality Family Practicequalityfp@... From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like? Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or " saves " on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

We fill 75% of our slots ahead of time and leave 25% for same-day urgent care (at least in theory).  If we see no urgent care, then we have time to do call-backs, referrals, etc during the day instead of at the end of the day, which means going home earlier.

Pratt

 

My schedule is usually full or at least I expect it to be full up until the day before.   I’m wondering what works best to fill in appointments with only a day notice to patients.  Airlines have strategies to fill up empty seats at the last minute.  Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution?

  

From: [mailto: ] On Behalf Of Sangeetha Murthy

Sent: Saturday, October 08, 2011 10:34 AMTo: Subject: Re: Slower schedule than you'd like?

   Thanks Sangeetha

  That’s great . 

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month.  I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals.    I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

 What has been holding me back (other than right now I am too busy because of a lot of trips and closures)  is that physicals pay way less than a 99214.  So I was seeing new patients and calling it a physical until I reviewed my fees.  (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. 

 If you are seeing no one, it’s certainly better than nothing.  But I don’t know why they pay so little.  But when it gets slow again, I might go that route too.  Then if they actually have issues, I can actually code it as a E & M.

  

Kathy Saradarian, MDQuality Family Practice

qualityfp@...

   

From: [mailto: ] On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AMTo:

Subject: Slower schedule than you'd like?  

Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October is

historically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with no

copay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. We

are getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12

patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, and

our physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).

For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or " saves " on any labs

yet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nice

surprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

 

[Guest guest]

I believe the best way to handle scheduling is to use " advanced access " . This means that you try to schedule mostly same day appointments. We schedule less than 10% of appoinments ahead of time, and fill 80-120% of them depending on time of year and ecomonic

conditions, each day. We have no appointment requirements, so that on any given day, you can be seen for a cold, a fracture or a physical that same day. I actually wrote one of the publications on this type of scheduling in residency training programs.

Doing " today's work today " has the hidden advantage of avoiding many of the calls that take up time, and after hours calls from patients you could accomodate. Since patients also know that they will be seen the day they call,

they do not call after hours in a panic, nor do they go the ED. Also we do not run into issues of patients who can't be seen before their meds run out.

Also we have zero no shows. As we have tracked it, patients are adults for the most part, and we find that we do not have to use appointments or refills to police appropriate freqency of visits.

There is a rich source of articles on how to make this work, and how to get from a large backlog to get here.

I would urge you to think about this being truly patient centered, assuring patient access when they want it is one big piece of that, without killing yourself to accomodate that late afternoon call after you have exhausted yourself.

From: [ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Saturday, October 08, 2011 10:38 AM

To:

Subject: Re: Slower schedule than you'd like?

We fill 75% of our slots ahead of time and leave 25% for same-day urgent care (at least in theory). If we see no urgent care, then we have time to do call-backs, referrals, etc during the day instead of at the end of the day, which means going home earlier.

Pratt

My schedule is usually full or at least I expect it to be full up until the day before. I’m wondering what works best to fill in appointments with only a day notice to patients. Airlines

have strategies to fill up empty seats at the last minute. Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution?

From:

[mailto: ]

On Behalf Of Sangeetha Murthy

Sent: Saturday, October 08, 2011 10:34 AM

To:

Subject: Re: Slower schedule than you'd like?

Thanks

Sangeetha

That’s great .

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic

disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing

new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then

if they actually have issues, I can actually code it as a E & M.

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

From:

[mailto: ]

On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AM

To:

Subject: Slower schedule than you'd like?

Hi all,

I just wanted to pass along what we have done to fill our schedule,

just when we thought Steve might have to close the practice, as we

cannot survive with 5 patients/day, 4 days/week. October is

historically our slowest month (flu shots are the only thing that gets

patients walking thru the door), followed closely by June, so we

needed to act quickly.

Anyways, now that most health plans are covering preventives with no

copay/deductible, we have started sending out letters to all of our

patients that have not been in for at least 18 months. We have never

done this before, mainly because we have a young practice (6 years

into it now) and we were still trying to get our ducks in a row. We

are getting about a 20% response so far, and our schedule is filling

up nicely (not too busy, not too slow). The past 2 weeks (we started

sending out letters about 3 weeks ago), we have gone from 5

follow-ups/day to yesterday being our busiest Friday ever with 12

patients plus 6 flu shots! I know this is busier than some of you

want to be, but we need to fill our schedule most of the 4 days we are

in the office in order to fulfill our financial responsibilities

(mostly rent and house payment!). We offer 20 minute follow-ups, and

our physicals are 40-60 minutes, depending on the age and complexity

of the patient. On a busy day we can see 14 patients (although our

schedule has a max of 18 slots per day, we use multiple slots for

PE's).

For a small investment of time, envelopes, and stamps, we are seeing a

nice ROI, as 20 preventive exams pays about $2500 in our area

(depending on age). We have yet to see if there is an improvement in

the health of our patients. No huge surprises or " saves " on any labs

yet, but we are getting patients in for their mammos, colonoscopies,

etc. much better than we were previously.

We have only gotten letters out to people on our list that popped up

in our HMO's P4P reports plus everyone else A-J. This has been a nice

surprise for us to increase contact with our patients and make sure

they are staying healthy.

Just wanted to share, hope you all have a great weekend!

Pratt

[Guest guest]

You can bill physical and use modifier 25 and bill level 4 or 3. Most carriers pay both but not the pap. We deserve that as some of my physicals can last up to 2 hrs!

That’s great . I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week. What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M. Kathy Saradarian, MDQuality Family Practicequalityfp@... From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like? Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or "saves" on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

Every now and then I try to do this but in past, it usually has not been paid well.  I might try again.  Can’t hurt. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of ElainemdSent: Saturday, October 08, 2011 1:12 PMTo: Subject: Re: Slower schedule than you'd like? You can bill physical and use modifier 25 and bill level 4 or 3. Most carriers pay both but not the pap. We deserve that as some of my physicals can last up to 2 hrs! That’s great . I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week. What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M. Kathy Saradarian, MDQuality Family Practicequalityfp@... From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like? Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from 5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or " saves " on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

This is practice-specific, or perhaps regional.  We get everyone in same day who needs/wants to get in same day.  Every once in a while there is a call from someone at -literally- 4 pm who wants to be seen same day.  Unless it is an emergency, we won't accommodate.  I think you need to set your limits.  Everyone who calls by 10:30 am gets in that day if they want to getin that day.  Very rarely can we not get patients in same day who want same day, although it does happen on occasion.  Our patients tend to be very specific, " I want 10/13 at 3:00 pm. " . Sometimes we can accommodate, sometimes not.  Steve gets very few after hours calls - 3/month is a heavy month - because we do handle everything as it comes across our desk.

Pratt

 

I believe the best way to handle scheduling is to use " advanced access " . This means that you try to schedule mostly same day appointments. We schedule less than 10% of appoinments ahead of time, and fill 80-120% of them depending on time of year and ecomonic

conditions, each day. We have no appointment requirements, so that on any given day, you can be seen for a cold, a fracture or a physical that same day. I actually wrote one of the publications on this type of scheduling in residency training programs.

 

Doing " today's work today " has the hidden advantage of avoiding many of the calls that take up time, and after hours calls from patients you could accomodate. Since patients also know that they will be seen the day they call,

they do not call after hours in a panic, nor do they go the ED. Also we do not run into issues of patients who can't be seen before their meds run out.

Also we have zero no shows. As we have tracked it, patients are adults for the most part, and we find that we do not have to use appointments or refills to police appropriate freqency of visits.

 

There is a rich source of articles on how to make this work, and how to get from a large backlog to get here.

I would urge you to think about this being truly patient centered, assuring patient access when they want it is one big piece of that, without killing yourself to accomodate that late afternoon call after you have exhausted yourself. 

 

From: [ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Saturday, October 08, 2011 10:38 AM

To:

Subject: Re: Slower schedule than you'd like?

 

We fill 75% of our slots ahead of time and leave 25% for same-day urgent care (at least in theory).  If we see no urgent care, then we have time to do call-backs, referrals, etc during the day instead of at the end of the day, which means going home earlier.

Pratt

 

My schedule is usually full or at least I expect it to be full up until the day before.   I’m wondering what works best to fill in appointments with only a day notice to patients.  Airlines

have strategies to fill up empty seats at the last minute.  Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution?

 

 

From:

[mailto: ]

On Behalf Of Sangeetha Murthy

Sent: Saturday, October 08, 2011 10:34 AM

To:

Subject: Re: Slower schedule than you'd like?

 

Thanks

Sangeetha

That’s great .

 

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month.  I do 20 minute sick visits, 30 minute chronic

disease f/u and 40 or 60 minutes for physicals.    I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

 

What has been holding me back (other than right now I am too busy because of a lot of trips and closures)  is that physicals pay way less than a 99214.  So I was seeing

new patients and calling it a physical until I reviewed my fees.  (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. 

 

If you are seeing no one, it’s certainly better than nothing.  But I don’t know why they pay so little.  But when it gets slow again, I might go that route too.  Then

if they actually have issues, I can actually code it as a E & M.

 

 

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

 

 

 

From:

[mailto: ]

On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AM

To:

Subject: Slower schedule than you'd like?

 

Hi all,

I just wanted to pass along what we have done to fill our schedule,

just when we thought Steve might have to close the practice, as we

cannot survive with 5 patients/day, 4 days/week. October is

historically our slowest month (flu shots are the only thing that gets

patients walking thru the door), followed closely by June, so we

needed to act quickly.

Anyways, now that most health plans are covering preventives with no

copay/deductible, we have started sending out letters to all of our

patients that have not been in for at least 18 months. We have never

done this before, mainly because we have a young practice (6 years

into it now) and we were still trying to get our ducks in a row. We

are getting about a 20% response so far, and our schedule is filling

up nicely (not too busy, not too slow). The past 2 weeks (we started

sending out letters about 3 weeks ago), we have gone from 5

follow-ups/day to yesterday being our busiest Friday ever with 12

patients plus 6 flu shots! I know this is busier than some of you

want to be, but we need to fill our schedule most of the 4 days we are

in the office in order to fulfill our financial responsibilities

(mostly rent and house payment!). We offer 20 minute follow-ups, and

our physicals are 40-60 minutes, depending on the age and complexity

of the patient. On a busy day we can see 14 patients (although our

schedule has a max of 18 slots per day, we use multiple slots for

PE's).

For a small investment of time, envelopes, and stamps, we are seeing a

nice ROI, as 20 preventive exams pays about $2500 in our area

(depending on age). We have yet to see if there is an improvement in

the health of our patients. No huge surprises or " saves " on any labs

yet, but we are getting patients in for their mammos, colonoscopies,

etc. much better than we were previously.

We have only gotten letters out to people on our list that popped up

in our HMO's P4P reports plus everyone else A-J. This has been a nice

surprise for us to increase contact with our patients and make sure

they are staying healthy.

Just wanted to share, hope you all have a great weekend!

Pratt

 

[Guest guest]

Haha , mine is like yours..not always same day, but definitely next day... but a lot are " 10/13 at 3.00pm " indeedSangeetha

 

This is practice-specific, or perhaps regional.  We get everyone in same day who needs/wants to get in same day.  Every once in a while there is a call from someone at -literally- 4 pm who wants to be seen same day.  Unless it is an emergency, we won't accommodate.  I think you need to set your limits.  Everyone who calls by 10:30 am gets in that day if they want to getin that day.  Very rarely can we not get patients in same day who want same day, although it does happen on occasion.  Our patients tend to be very specific, " I want 10/13 at 3:00 pm. " . Sometimes we can accommodate, sometimes not.  Steve gets very few after hours calls - 3/month is a heavy month - because we do handle everything as it comes across our desk.

Pratt

 

I believe the best way to handle scheduling is to use " advanced access " . This means that you try to schedule mostly same day appointments. We schedule less than 10% of appoinments ahead of time, and fill 80-120% of them depending on time of year and ecomonic

conditions, each day. We have no appointment requirements, so that on any given day, you can be seen for a cold, a fracture or a physical that same day. I actually wrote one of the publications on this type of scheduling in residency training programs.

 

Doing " today's work today " has the hidden advantage of avoiding many of the calls that take up time, and after hours calls from patients you could accomodate. Since patients also know that they will be seen the day they call,

they do not call after hours in a panic, nor do they go the ED. Also we do not run into issues of patients who can't be seen before their meds run out.

Also we have zero no shows. As we have tracked it, patients are adults for the most part, and we find that we do not have to use appointments or refills to police appropriate freqency of visits.

 

There is a rich source of articles on how to make this work, and how to get from a large backlog to get here.

I would urge you to think about this being truly patient centered, assuring patient access when they want it is one big piece of that, without killing yourself to accomodate that late afternoon call after you have exhausted yourself. 

 

From: [ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Saturday, October 08, 2011 10:38 AM

To:

Subject: Re: Slower schedule than you'd like?

 

We fill 75% of our slots ahead of time and leave 25% for same-day urgent care (at least in theory).  If we see no urgent care, then we have time to do call-backs, referrals, etc during the day instead of at the end of the day, which means going home earlier.

Pratt

 

My schedule is usually full or at least I expect it to be full up until the day before.   I’m wondering what works best to fill in appointments with only a day notice to patients.  Airlines

have strategies to fill up empty seats at the last minute.  Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution?

 

 

From:

[mailto: ]

On Behalf Of Sangeetha Murthy

Sent: Saturday, October 08, 2011 10:34 AM

To:

Subject: Re: Slower schedule than you'd like?

 

Thanks

Sangeetha

That’s great .

 

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month.  I do 20 minute sick visits, 30 minute chronic

disease f/u and 40 or 60 minutes for physicals.    I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

 

What has been holding me back (other than right now I am too busy because of a lot of trips and closures)  is that physicals pay way less than a 99214.  So I was seeing

new patients and calling it a physical until I reviewed my fees.  (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work. 

 

If you are seeing no one, it’s certainly better than nothing.  But I don’t know why they pay so little.  But when it gets slow again, I might go that route too.  Then

if they actually have issues, I can actually code it as a E & M.

 

 

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

 

 

 

From:

[mailto: ]

On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AM

To:

Subject: Slower schedule than you'd like?

 

Hi all,

I just wanted to pass along what we have done to fill our schedule,

just when we thought Steve might have to close the practice, as we

cannot survive with 5 patients/day, 4 days/week. October is

historically our slowest month (flu shots are the only thing that gets

patients walking thru the door), followed closely by June, so we

needed to act quickly.

Anyways, now that most health plans are covering preventives with no

copay/deductible, we have started sending out letters to all of our

patients that have not been in for at least 18 months. We have never

done this before, mainly because we have a young practice (6 years

into it now) and we were still trying to get our ducks in a row. We

are getting about a 20% response so far, and our schedule is filling

up nicely (not too busy, not too slow). The past 2 weeks (we started

sending out letters about 3 weeks ago), we have gone from 5

follow-ups/day to yesterday being our busiest Friday ever with 12

patients plus 6 flu shots! I know this is busier than some of you

want to be, but we need to fill our schedule most of the 4 days we are

in the office in order to fulfill our financial responsibilities

(mostly rent and house payment!). We offer 20 minute follow-ups, and

our physicals are 40-60 minutes, depending on the age and complexity

of the patient. On a busy day we can see 14 patients (although our

schedule has a max of 18 slots per day, we use multiple slots for

PE's).

For a small investment of time, envelopes, and stamps, we are seeing a

nice ROI, as 20 preventive exams pays about $2500 in our area

(depending on age). We have yet to see if there is an improvement in

the health of our patients. No huge surprises or " saves " on any labs

yet, but we are getting patients in for their mammos, colonoscopies,

etc. much better than we were previously.

We have only gotten letters out to people on our list that popped up

in our HMO's P4P reports plus everyone else A-J. This has been a nice

surprise for us to increase contact with our patients and make sure

they are staying healthy.

Just wanted to share, hope you all have a great weekend!

Pratt

 

[Guest guest]

Some of my insurances will pay both physical and E & M without a hitch. Others I have to send the note but then do get paid. Good luck.

To: Sent: Saturday, October 8, 2011 1:20 PMSubject: RE: Slower schedule than you'd like?

Every now and then I try to do this but in past, it usually has not been paid well. I might try again. Can’t hurt.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of ElainemdSent: Saturday, October 08, 2011 1:12 PMTo: Subject: Re: Slower schedule than you'd like?

You can bill physical and use modifier 25 and bill level 4 or 3. Most carriers pay both but not the pap. We deserve that as some of my physicals can last up to 2 hrs!

That’s great .

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

From: [mailto: ] On Behalf Of PrattSent: Saturday, October 08, 2011 10:56 AMTo: Subject: Slower schedule than you'd like?

Hi all,I just wanted to pass along what we have done to fill our schedule,just when we thought Steve might have to close the practice, as wecannot survive with 5 patients/day, 4 days/week. October ishistorically our slowest month (flu shots are the only thing that getspatients walking thru the door), followed closely by June, so weneeded to act quickly.Anyways, now that most health plans are covering preventives with nocopay/deductible, we have started sending out letters to all of ourpatients that have not been in for at least 18 months. We have neverdone this before, mainly because we have a young practice (6 yearsinto it now) and we were still trying to get our ducks in a row. Weare getting about a 20% response so far, and our schedule is fillingup nicely (not too busy, not too slow). The past 2 weeks (we startedsending out letters about 3 weeks ago), we have gone from

5follow-ups/day to yesterday being our busiest Friday ever with 12patients plus 6 flu shots! I know this is busier than some of youwant to be, but we need to fill our schedule most of the 4 days we arein the office in order to fulfill our financial responsibilities(mostly rent and house payment!). We offer 20 minute follow-ups, andour physicals are 40-60 minutes, depending on the age and complexityof the patient. On a busy day we can see 14 patients (although ourschedule has a max of 18 slots per day, we use multiple slots forPE's).For a small investment of time, envelopes, and stamps, we are seeing anice ROI, as 20 preventive exams pays about $2500 in our area(depending on age). We have yet to see if there is an improvement inthe health of our patients. No huge surprises or "saves" on any labsyet, but we are getting patients in for their mammos, colonoscopies,etc. much better than we were

previously.We have only gotten letters out to people on our list that popped upin our HMO's P4P reports plus everyone else A-J. This has been a nicesurprise for us to increase contact with our patients and make surethey are staying healthy.Just wanted to share, hope you all have a great weekend! Pratt

[Guest guest]

We just my $18,000 in MU apayments and expect Kelley's in another month. We attested in April, and I thought we would see it sooner, but not too disappointed

From: [ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Saturday, October 08, 2011 5:18 PM

To:

Subject: Re: Slower schedule than you'd like?

This is practice-specific, or perhaps regional. We get everyone in same day who needs/wants to get in same day. Every once in a while there is a call from someone at -literally- 4 pm who wants to be seen same day. Unless it is an emergency, we won't

accommodate. I think you need to set your limits. Everyone who calls by 10:30 am gets in that day if they want to getin that day. Very rarely can we not get patients in same day who want same day, although it does happen on occasion. Our patients tend

to be very specific, " I want 10/13 at 3:00 pm. " . Sometimes we can accommodate, sometimes not. Steve gets very few after hours calls - 3/month is a heavy month - because we do handle everything as it comes across our desk.

Pratt

I believe the best way to handle scheduling is to use " advanced access " . This means that you try to schedule mostly same day appointments. We schedule less than 10% of appoinments ahead of time, and fill 80-120% of them depending on time of year and ecomonic

conditions, each day. We have no appointment requirements, so that on any given day, you can be seen for a cold, a fracture or a physical that same day. I actually wrote one of the publications on this type of scheduling in residency training programs.

Doing " today's work today " has the hidden advantage of avoiding many of the calls that take up time, and after hours calls from patients you could accomodate. Since patients also know that they will be seen the day they call,

they do not call after hours in a panic, nor do they go the ED. Also we do not run into issues of patients who can't be seen before their meds run out.

Also we have zero no shows. As we have tracked it, patients are adults for the most part, and we find that we do not have to use appointments or refills to police appropriate freqency of visits.

There is a rich source of articles on how to make this work, and how to get from a large backlog to get here.

I would urge you to think about this being truly patient centered, assuring patient access when they want it is one big piece of that, without killing yourself to accomodate that late afternoon call after you have exhausted yourself.

From:

[ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Saturday, October 08, 2011 10:38 AM

To:

Subject: Re: Slower schedule than you'd like?

We fill 75% of our slots ahead of time and leave 25% for same-day urgent care (at least in theory). If we see no urgent care, then we have time to do call-backs, referrals, etc during the day instead of at the end of the day, which means going home earlier.

Pratt

My schedule is usually full or at least I expect it to be full up until the day before. I’m wondering what works best to fill in appointments with only a day notice to patients. Airlines

have strategies to fill up empty seats at the last minute. Anyone have a “stand by” policy/method for filling in last minute open appointments or for that matter any other promising solution?

From:

[mailto: ]

On Behalf Of Sangeetha Murthy

Sent: Saturday, October 08, 2011 10:34 AM

To:

Subject: Re: Slower schedule than you'd like?

Thanks

Sangeetha

That’s great .

I’ve been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic

disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing

new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

If you are seeing no one, it’s certainly better than nothing. But I don’t know why they pay so little. But when it gets slow again, I might go that route too. Then

if they actually have issues, I can actually code it as a E & M.

Kathy Saradarian, MD

Quality Family Practice

qualityfp@...

From:

[mailto: ]

On Behalf Of Pratt

Sent: Saturday, October 08, 2011 10:56 AM

To:

Subject: Slower schedule than you'd like?

Hi all,

I just wanted to pass along what we have done to fill our schedule,

just when we thought Steve might have to close the practice, as we

cannot survive with 5 patients/day, 4 days/week. October is

historically our slowest month (flu shots are the only thing that gets

patients walking thru the door), followed closely by June, so we

needed to act quickly.

Anyways, now that most health plans are covering preventives with no

copay/deductible, we have started sending out letters to all of our

patients that have not been in for at least 18 months. We have never

done this before, mainly because we have a young practice (6 years

into it now) and we were still trying to get our ducks in a row. We

are getting about a 20% response so far, and our schedule is filling

up nicely (not too busy, not too slow). The past 2 weeks (we started

sending out letters about 3 weeks ago), we have gone from 5

follow-ups/day to yesterday being our busiest Friday ever with 12

patients plus 6 flu shots! I know this is busier than some of you

want to be, but we need to fill our schedule most of the 4 days we are

in the office in order to fulfill our financial responsibilities

(mostly rent and house payment!). We offer 20 minute follow-ups, and

our physicals are 40-60 minutes, depending on the age and complexity

of the patient. On a busy day we can see 14 patients (although our

schedule has a max of 18 slots per day, we use multiple slots for

PE's).

For a small investment of time, envelopes, and stamps, we are seeing a

nice ROI, as 20 preventive exams pays about $2500 in our area

(depending on age). We have yet to see if there is an improvement in

the health of our patients. No huge surprises or " saves " on any labs

yet, but we are getting patients in for their mammos, colonoscopies,

etc. much better than we were previously.

We have only gotten letters out to people on our list that popped up

in our HMO's P4P reports plus everyone else A-J. This has been a nice

surprise for us to increase contact with our patients and make sure

they are staying healthy.

Just wanted to share, hope you all have a great weekend!

Pratt

[Guest guest]

Consider getting a Twitter account and tweet that there is an opening and " come

on down " . With the penetrance of Twitter now, at least a couple patients should

have access to it.

>

>

>

> That's great .

>

>

>

> I've been thinking that physicals would be a good way to fill the schedule

> too though that is not my problem this month. I do 20 minute sick visits,

> 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I

> schedule patients an average of 6.5 to 7 hours a day 4 days a week.

>

>

>

> What has been holding me back (other than right now I am too busy because of

> a lot of trips and closures) is that physicals pay way less than a 99214.

> So I was seeing new patients and calling it a physical until I reviewed my

> fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more

> than a physical does and I spend a lot of time and do a lot of work.

>

>

>

> If you are seeing no one, it's certainly better than nothing. But I don't

> know why they pay so little. But when it gets slow again, I might go that

> route too. Then if they actually have issues, I can actually code it as a E

> & M.

>

>

>

>

>

> Kathy Saradarian, MD

>

> Quality Family Practice

>

> qualityfp@...

>

>

>

>

>

>

>

> From:

> [mailto: ] On Behalf Of Pratt

> Sent: Saturday, October 08, 2011 10:56 AM

> To:

> Subject: Slower schedule than you'd like?

>

>

>

>

>

> Hi all,

> I just wanted to pass along what we have done to fill our schedule,

> just when we thought Steve might have to close the practice, as we

> cannot survive with 5 patients/day, 4 days/week. October is

> historically our slowest month (flu shots are the only thing that gets

> patients walking thru the door), followed closely by June, so we

> needed to act quickly.

>

> Anyways, now that most health plans are covering preventives with no

> copay/deductible, we have started sending out letters to all of our

> patients that have not been in for at least 18 months. We have never

> done this before, mainly because we have a young practice (6 years

> into it now) and we were still trying to get our ducks in a row. We

> are getting about a 20% response so far, and our schedule is filling

> up nicely (not too busy, not too slow). The past 2 weeks (we started

> sending out letters about 3 weeks ago), we have gone from 5

> follow-ups/day to yesterday being our busiest Friday ever with 12

> patients plus 6 flu shots! I know this is busier than some of you

> want to be, but we need to fill our schedule most of the 4 days we are

> in the office in order to fulfill our financial responsibilities

> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> our physicals are 40-60 minutes, depending on the age and complexity

> of the patient. On a busy day we can see 14 patients (although our

> schedule has a max of 18 slots per day, we use multiple slots for

> PE's).

>

> For a small investment of time, envelopes, and stamps, we are seeing a

> nice ROI, as 20 preventive exams pays about $2500 in our area

> (depending on age). We have yet to see if there is an improvement in

> the health of our patients. No huge surprises or " saves " on any labs

> yet, but we are getting patients in for their mammos, colonoscopies,

> etc. much better than we were previously.

>

> We have only gotten letters out to people on our list that popped up

> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> surprise for us to increase contact with our patients and make sure

> they are staying healthy.

>

> Just wanted to share, hope you all have a great weekend!

>

>

> Pratt

>

[Guest guest]

Jim,

The concern I've always had with Advance Access is that if a patients doesn't

have an appt, they won't come back. For example, for my teeth cleaning, they

have me come back in 6 months. I make an appt before I leave and put it in my

calender. If something comes up that conflicts, I can call the dentist to

reschedule. If I forget, the dentist sends me a postcard and email saying that

my appt is in a week. I say " oops " and either carve out time or reschedule.

If I didn't make an appt upon leaving for 6 months out and they just said " call

us in 6 months when you are ready to come in " , I wouldn't remember to call for

the appt until 12-18 months later!!

How do you prevent this??

Craig

> That's great .

>

> I've been thinking that physicals would be a good way to fill the schedule too

though that is not my problem this month. I do 20 minute sick visits, 30 minute

chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients

an average of 6.5 to 7 hours a day 4 days a week.

>

> What has been holding me back (other than right now I am too busy because of a

lot of trips and closures) is that physicals pay way less than a 99214. So I

was seeing new patients and calling it a physical until I reviewed my fees.

(also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a

physical does and I spend a lot of time and do a lot of work.

>

> If you are seeing no one, it's certainly better than nothing. But I don't

know why they pay so little. But when it gets slow again, I might go that route

too. Then if they actually have issues, I can actually code it as a E & M.

>

>

> Kathy Saradarian, MD

> Quality Family Practice

> qualityfp@...

>

>

>

> From: <mailto: >

<mailto: \

>

[mailto:<mailto: >@yahoog\

roups.com<mailto: >] On Behalf Of Pratt

> Sent: Saturday, October 08, 2011 10:56 AM

> To: <mailto: >

<mailto: \

>

> Subject: Slower schedule than you'd like?

>

>

> Hi all,

> I just wanted to pass along what we have done to fill our schedule,

> just when we thought Steve might have to close the practice, as we

> cannot survive with 5 patients/day, 4 days/week. October is

> historically our slowest month (flu shots are the only thing that gets

> patients walking thru the door), followed closely by June, so we

> needed to act quickly.

>

> Anyways, now that most health plans are covering preventives with no

> copay/deductible, we have started sending out letters to all of our

> patients that have not been in for at least 18 months. We have never

> done this before, mainly because we have a young practice (6 years

> into it now) and we were still trying to get our ducks in a row. We

> are getting about a 20% response so far, and our schedule is filling

> up nicely (not too busy, not too slow). The past 2 weeks (we started

> sending out letters about 3 weeks ago), we have gone from 5

> follow-ups/day to yesterday being our busiest Friday ever with 12

> patients plus 6 flu shots! I know this is busier than some of you

> want to be, but we need to fill our schedule most of the 4 days we are

> in the office in order to fulfill our financial responsibilities

> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> our physicals are 40-60 minutes, depending on the age and complexity

> of the patient. On a busy day we can see 14 patients (although our

> schedule has a max of 18 slots per day, we use multiple slots for

> PE's).

>

> For a small investment of time, envelopes, and stamps, we are seeing a

> nice ROI, as 20 preventive exams pays about $2500 in our area

> (depending on age). We have yet to see if there is an improvement in

> the health of our patients. No huge surprises or " saves " on any labs

> yet, but we are getting patients in for their mammos, colonoscopies,

> etc. much better than we were previously.

>

> We have only gotten letters out to people on our list that popped up

> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> surprise for us to increase contact with our patients and make sure

> they are staying healthy.

>

> Just wanted to share, hope you all have a great weekend!

>

>

> Pratt

>

[Guest guest]

CraigI schedule the way Jim does unless the patient wants an appointment 6 months in advance, in which case I give it to themI use the reminder system to send an email when people are dueI'm going to transition to Boomerang to have it done automatically after IMPcamp when I get a red second to do it.Second safeguard is medications, if they run out unless I've screwed up (or as it happens often the eprescribing pharmacy has screwed up) it means they were/are due for an appointment .LynnTo: From: rossmd@...Date: Wed, 12 Oct 2011 05:46:02 +0000Subject: Re: Slower schedule than you'd like?

Jim,

The concern I've always had with Advance Access is that if a patients doesn't have an appt, they won't come back. For example, for my teeth cleaning, they have me come back in 6 months. I make an appt before I leave and put it in my calender. If something comes up that conflicts, I can call the dentist to reschedule. If I forget, the dentist sends me a postcard and email saying that my appt is in a week. I say "oops" and either carve out time or reschedule.

If I didn't make an appt upon leaving for 6 months out and they just said "call us in 6 months when you are ready to come in", I wouldn't remember to call for the appt until 12-18 months later!!

How do you prevent this??

Craig

> That's great .

>

> I've been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

>

> What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

>

> If you are seeing no one, it's certainly better than nothing. But I don't know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.

>

>

> Kathy Saradarian, MD

> Quality Family Practice

> qualityfp@...

>

>

>

> From: <mailto: > <mailto: > [mailto:<mailto: > <mailto: >] On Behalf Of Pratt

> Sent: Saturday, October 08, 2011 10:56 AM

> To: <mailto: > <mailto: >

> Subject: Slower schedule than you'd like?

>

>

> Hi all,

> I just wanted to pass along what we have done to fill our schedule,

> just when we thought Steve might have to close the practice, as we

> cannot survive with 5 patients/day, 4 days/week. October is

> historically our slowest month (flu shots are the only thing that gets

> patients walking thru the door), followed closely by June, so we

> needed to act quickly.

>

> Anyways, now that most health plans are covering preventives with no

> copay/deductible, we have started sending out letters to all of our

> patients that have not been in for at least 18 months. We have never

> done this before, mainly because we have a young practice (6 years

> into it now) and we were still trying to get our ducks in a row. We

> are getting about a 20% response so far, and our schedule is filling

> up nicely (not too busy, not too slow). The past 2 weeks (we started

> sending out letters about 3 weeks ago), we have gone from 5

> follow-ups/day to yesterday being our busiest Friday ever with 12

> patients plus 6 flu shots! I know this is busier than some of you

> want to be, but we need to fill our schedule most of the 4 days we are

> in the office in order to fulfill our financial responsibilities

> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> our physicals are 40-60 minutes, depending on the age and complexity

> of the patient. On a busy day we can see 14 patients (although our

> schedule has a max of 18 slots per day, we use multiple slots for

> PE's).

>

> For a small investment of time, envelopes, and stamps, we are seeing a

> nice ROI, as 20 preventive exams pays about $2500 in our area

> (depending on age). We have yet to see if there is an improvement in

> the health of our patients. No huge surprises or "saves" on any labs

> yet, but we are getting patients in for their mammos, colonoscopies,

> etc. much better than we were previously.

>

> We have only gotten letters out to people on our list that popped up

> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> surprise for us to increase contact with our patients and make sure

> they are staying healthy.

>

> Just wanted to share, hope you all have a great weekend!

>

>

> Pratt

>

[Guest guest]

Craig,

Our system (Jim is on the same system) has a " recall date " option.  So if the patient doesn't want to schedule their appointment 3-6 months from now, we put in a recall.  We run the recall report each month (usually about 10-12 patients on it), check to see if they've been in or are on the schedule, and then we remind them - usually by phone or Patient Portal - that it's time for their follow-up.  I rarely know my schedule a month in advance, so I'm glad that my dentist sends me a reminder postcard and then I schedule my appt.  He is easy to get in to. 

 

Jim,The concern I've always had with Advance Access is that if a patients doesn't have an appt, they won't come back. For example, for my teeth cleaning, they have me come back in 6 months. I make an appt before I leave and put it in my calender. If something comes up that conflicts, I can call the dentist to reschedule. If I forget, the dentist sends me a postcard and email saying that my appt is in a week. I say " oops " and either carve out time or reschedule.

If I didn't make an appt upon leaving for 6 months out and they just said " call us in 6 months when you are ready to come in " , I wouldn't remember to call for the appt until 12-18 months later!!

How do you prevent this??Craig

> That's great .> > I've been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.

> > What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.

> > If you are seeing no one, it's certainly better than nothing. But I don't know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.

> > > Kathy Saradarian, MD> Quality Family Practice> qualityfp@...

> > > > From: <mailto: > <mailto: > [mailto:<mailto: > <mailto: >] On Behalf Of Pratt > Sent: Saturday, October 08, 2011 10:56 AM> To: <mailto: > <mailto: >

> Subject: Slower schedule than you'd like?> > > Hi all,> I just wanted to pass along what we have done to fill our schedule,> just when we thought Steve might have to close the practice, as we

> cannot survive with 5 patients/day, 4 days/week. October is> historically our slowest month (flu shots are the only thing that gets> patients walking thru the door), followed closely by June, so we> needed to act quickly.

> > Anyways, now that most health plans are covering preventives with no> copay/deductible, we have started sending out letters to all of our> patients that have not been in for at least 18 months. We have never

> done this before, mainly because we have a young practice (6 years> into it now) and we were still trying to get our ducks in a row. We> are getting about a 20% response so far, and our schedule is filling

> up nicely (not too busy, not too slow). The past 2 weeks (we started> sending out letters about 3 weeks ago), we have gone from 5> follow-ups/day to yesterday being our busiest Friday ever with 12> patients plus 6 flu shots! I know this is busier than some of you

> want to be, but we need to fill our schedule most of the 4 days we are> in the office in order to fulfill our financial responsibilities> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> our physicals are 40-60 minutes, depending on the age and complexity> of the patient. On a busy day we can see 14 patients (although our> schedule has a max of 18 slots per day, we use multiple slots for

> PE's).> > For a small investment of time, envelopes, and stamps, we are seeing a> nice ROI, as 20 preventive exams pays about $2500 in our area> (depending on age). We have yet to see if there is an improvement in

> the health of our patients. No huge surprises or " saves " on any labs> yet, but we are getting patients in for their mammos, colonoscopies,> etc. much better than we were previously.>

> We have only gotten letters out to people on our list that popped up> in our HMO's P4P reports plus everyone else A-J. This has been a nice> surprise for us to increase contact with our patients and make sure

> they are staying healthy.> > Just wanted to share, hope you all have a great weekend!> > > Pratt>

-- Pratt

[Guest guest]

Craig,

I also use

advance access. I have a couple of methods to help my pts and myself know

when they are due for a follow up. I use a tickler system and my remote

assistant manages that – for labs, referrals, f/u, etc. She sends

out a reminder in the form of a postcard, email, or phone call depending on the

preferred communication format of the individual pt, and uses a different

format if they have not responded after 2 attempts. I also set up their

medication refills to match (ideally) when they are due for something like

labs, BP log, f/u appt, etc. Most of my pts don’t want to schedule

something farther out than a month. But if they do, then no problem –

I schedule it.

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of rossmd

Sent: Tuesday, October 11, 2011 11:46 PM

To:

Subject: Re: Slower schedule than you'd like?

Jim,

The concern I've always had with Advance Access is that if a patients doesn't

have an appt, they won't come back. For example, for my teeth cleaning, they

have me come back in 6 months. I make an appt before I leave and put it in my

calender. If something comes up that conflicts, I can call the dentist to

reschedule. If I forget, the dentist sends me a postcard and email saying that

my appt is in a week. I say " oops " and either carve out time or

reschedule.

If I didn't make an appt upon leaving for 6 months out and they just said

" call us in 6 months when you are ready to come in " , I wouldn't

remember to call for the appt until 12-18 months later!!

How do you prevent this??

Craig

> That's great .

>

> I've been thinking that physicals would be a good way to fill the schedule

too though that is not my problem this month. I do 20 minute sick visits, 30

minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule

patients an average of 6.5 to 7 hours a day 4 days a week.

>

> What has been holding me back (other than right now I am too busy because

of a lot of trips and closures) is that physicals pay way less than a 99214. So

I was seeing new patients and calling it a physical until I reviewed my fees.

(also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a

physical does and I spend a lot of time and do a lot of work.

>

> If you are seeing no one, it's certainly better than nothing. But I don't

know why they pay so little. But when it gets slow again, I might go that route

too. Then if they actually have issues, I can actually code it as a E & M.

>

>

> Kathy Saradarian, MD

> Quality Family Practice

> qualityfp@...

>

>

>

> From: <mailto: >

<mailto: >

[mailto:<mailto: > <mailto: >]

On Behalf Of Pratt

> Sent: Saturday, October 08, 2011 10:56 AM

> To: <mailto: >

<mailto: >

> Subject: Slower schedule than you'd like?

>

>

> Hi all,

> I just wanted to pass along what we have done to fill our schedule,

> just when we thought Steve might have to close the practice, as we

> cannot survive with 5 patients/day, 4 days/week. October is

> historically our slowest month (flu shots are the only thing that gets

> patients walking thru the door), followed closely by June, so we

> needed to act quickly.

>

> Anyways, now that most health plans are covering preventives with no

> copay/deductible, we have started sending out letters to all of our

> patients that have not been in for at least 18 months. We have never

> done this before, mainly because we have a young practice (6 years

> into it now) and we were still trying to get our ducks in a row. We

> are getting about a 20% response so far, and our schedule is filling

> up nicely (not too busy, not too slow). The past 2 weeks (we started

> sending out letters about 3 weeks ago), we have gone from 5

> follow-ups/day to yesterday being our busiest Friday ever with 12

> patients plus 6 flu shots! I know this is busier than some of you

> want to be, but we need to fill our schedule most of the 4 days we are

> in the office in order to fulfill our financial responsibilities

> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> our physicals are 40-60 minutes, depending on the age and complexity

> of the patient. On a busy day we can see 14 patients (although our

> schedule has a max of 18 slots per day, we use multiple slots for

> PE's).

>

> For a small investment of time, envelopes, and stamps, we are seeing a

> nice ROI, as 20 preventive exams pays about $2500 in our area

> (depending on age). We have yet to see if there is an improvement in

> the health of our patients. No huge surprises or " saves " on any

labs

> yet, but we are getting patients in for their mammos, colonoscopies,

> etc. much better than we were previously.

>

> We have only gotten letters out to people on our list that popped up

> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> surprise for us to increase contact with our patients and make sure

> they are staying healthy.

>

> Just wanted to share, hope you all have a great weekend!

>

>

> Pratt

>

[Guest guest]

, What is a “remote assistant” Neighbors, MDHuntsville, Alabama From: [mailto: ] On Behalf Of EadsSent: Wednesday, October 12, 2011 9:17 AMTo: Subject: RE: Re: Slower schedule than you'd like? Craig, I also use advance access. I have a couple of methods to help my pts and myself know when they are due for a follow up. I use a tickler system and my remote assistant manages that – for labs, referrals, f/u, etc. She sends out a reminder in the form of a postcard, email, or phone call depending on the preferred communication format of the individual pt, and uses a different format if they have not responded after 2 attempts. I also set up their medication refills to match (ideally) when they are due for something like labs, BP log, f/u appt, etc. Most of my pts don’t want to schedule something farther out than a month. But if they do, then no problem – I schedule it. Eads, MDPinnacle Family MedicineColorado Springs, COwww.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of rossmdSent: Tuesday, October 11, 2011 11:46 PMTo: Subject: Re: Slower schedule than you'd like? Jim,The concern I've always had with Advance Access is that if a patients doesn't have an appt, they won't come back. For example, for my teeth cleaning, they have me come back in 6 months. I make an appt before I leave and put it in my calender. If something comes up that conflicts, I can call the dentist to reschedule. If I forget, the dentist sends me a postcard and email saying that my appt is in a week. I say " oops " and either carve out time or reschedule.If I didn't make an appt upon leaving for 6 months out and they just said " call us in 6 months when you are ready to come in " , I wouldn't remember to call for the appt until 12-18 months later!!How do you prevent this??Craig> That's great .> > I've been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.> > What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214. So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.> > If you are seeing no one, it's certainly better than nothing. But I don't know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.> > > Kathy Saradarian, MD> Quality Family Practice> qualityfp@...> > > > From: <mailto: > <mailto: > [mailto:<mailto: > <mailto: >] On Behalf Of Pratt> Sent: Saturday, October 08, 2011 10:56 AM> To: <mailto: > <mailto: >> Subject: Slower schedule than you'd like?> > > Hi all,> I just wanted to pass along what we have done to fill our schedule,> just when we thought Steve might have to close the practice, as we> cannot survive with 5 patients/day, 4 days/week. October is> historically our slowest month (flu shots are the only thing that gets> patients walking thru the door), followed closely by June, so we> needed to act quickly.> > Anyways, now that most health plans are covering preventives with no> copay/deductible, we have started sending out letters to all of our> patients that have not been in for at least 18 months. We have never> done this before, mainly because we have a young practice (6 years> into it now) and we were still trying to get our ducks in a row. We> are getting about a 20% response so far, and our schedule is filling> up nicely (not too busy, not too slow). The past 2 weeks (we started> sending out letters about 3 weeks ago), we have gone from 5> follow-ups/day to yesterday being our busiest Friday ever with 12> patients plus 6 flu shots! I know this is busier than some of you> want to be, but we need to fill our schedule most of the 4 days we are> in the office in order to fulfill our financial responsibilities> (mostly rent and house payment!). We offer 20 minute follow-ups, and> our physicals are 40-60 minutes, depending on the age and complexity> of the patient. On a busy day we can see 14 patients (although our> schedule has a max of 18 slots per day, we use multiple slots for> PE's).> > For a small investment of time, envelopes, and stamps, we are seeing a> nice ROI, as 20 preventive exams pays about $2500 in our area> (depending on age). We have yet to see if there is an improvement in> the health of our patients. No huge surprises or " saves " on any labs> yet, but we are getting patients in for their mammos, colonoscopies,> etc. much better than we were previously.> > We have only gotten letters out to people on our list that popped up> in our HMO's P4P reports plus everyone else A-J. This has been a nice> surprise for us to increase contact with our patients and make sure> they are staying healthy.> > Just wanted to share, hope you all have a great weekend!> > > Pratt>

[Guest guest]

Limiting the meds to visits only absolutely does work. Takes time to train the patients but it works. It's harder to train the VNA but I'm getting them too. And if they have to come in 3 weeks because they "forgot" then they learn pretty quick to check all the bottles. I also check the "history" if one med is due then more is probly due and my EMR easily lets me see the last date each med was ordered. I pre-book 25-35% of my day and the rest gets filled in the day before and that day. I, too, hand a card that says, Call middle of November. I also use backup tickler that goes to my nurse/receptionist at the end of November. I do have several that will wait til two weeks out of meds and I document every time, "Rediscussed the risk of

untreated blood pressure and recurrent elevations because patient does not come in as directed." The malpractice insurance risk evaluator liked that my notes read "F/U in ...., sooner if needed, pt to call for appointment" as it puts some responsibility on the patient. For those with dementia, developmental disabilities, or using Medicaid taxior home visits get prebooked. I also will negotiate visits before I do the meds so it will match.

To: Sent: Wednesday, October 12, 2011 12:06 PMSubject: Re: Re: Slower schedule than you'd like?

Actually ti works great 6 + yrs of doing that THAT is their reminder They know that when they need meds they can get in All meds are done at the same tim,e just update them, and you've re set them They are taught to call when they cannot get more refills when on th e last few days of pills needs a repeat TSh? 6 weeks of the new dose- bottle runs low --they are remeinded oh that is when they needed to go to the lab PAtietns know they can get in - crucial as Kath says do not pre book ? 4-% of the day til it gets here They know they will not get meds without being seen and respect it becasue they set teh re visit interval with mePharmacists praise this enormously I point out that duh this is saftety I do not call in my profession. I see folks and prescribe;; The re -visit interval is negotiated before we end

a visit. that's it done I am sorry to disagree with Kathy becasue I think she is doing good work and for yrs and in a tough environment but this is the keystone of my access and it is fabulous patietn do get a card call to see m e in november but the refills get them back in hand s downfor those who need a tickler yes I have that most show up. I also have a remote assistant a virtual MA logs in free form home into the emr messages me through teh emr calls reminds send s results etc.

Getting patients to make appts when they need refills doesn't work either. Patients meds all get refilled at different times. They call after they have finished their last pill and can't possibly come in. Too many patient barriers.

Kathy Saradarian, MD

To: Sent: Wednesday, October 12, 2011 9:17:21 AM

Subject: RE: Re: Slower schedule than you'd like?

Craig,

I also use advance access. I have a couple of methods to help my pts and myself know when they are due for a follow up. I use a tickler system and my remote assistant manages that – for labs, referrals, f/u, etc. She sends out a reminder in the form of a postcard, email, or phone call depending on the preferred communication format of the individual pt, and uses a different format if they have not responded after 2 attempts. I also set up their medication refills to match (ideally) when they are due for something like labs, BP log, f/u appt, etc. Most of my pts don’t want to schedule something farther out than a month. But if they do, then no problem – I schedule it.

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of rossmdSent: Tuesday, October 11, 2011 11:46 PMTo: Subject: Re: Slower schedule than you'd like?

Jim,The concern I've always had with Advance Access is that if a patients doesn't have an appt, they won't come back. For example, for my teeth cleaning, they have me come back in 6 months. I make an appt before I leave and put it in my calender. If something comes up that conflicts, I can call the dentist to reschedule. If I forget, the dentist sends me a postcard and email saying that my appt is in a week. I say "oops" and either carve out time or reschedule.If I didn't make an appt upon leaving for 6 months out and they just said "call us in 6 months when you are ready to come in", I wouldn't remember to call for the appt until 12-18 months later!!How do you prevent this??Craig> That's great .> > I've been thinking that physicals would be a good way to fill the schedule too though that is not my problem this month. I do 20 minute sick visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule patients an average of 6.5 to 7 hours a day 4 days a week.> > What has been holding me back (other than right now I am too busy because of a lot of trips and closures) is that physicals pay way less than a 99214.

So I was seeing new patients and calling it a physical until I reviewed my fees. (also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a physical does and I spend a lot of time and do a lot of work.> > If you are seeing no one, it's certainly better than nothing. But I don't know why they pay so little. But when it gets slow again, I might go that route too. Then if they actually have issues, I can actually code it as a E & M.> > > Kathy Saradarian, MD> Quality Family Practice> qualityfp@...> > > > From: <mailto: > <mailto: > [mailto:<mailto: > <mailto: >] On Behalf Of Pratt> Sent: Saturday, October 08, 2011 10:56 AM> To: <mailto: > <mailto: >> Subject: Slower schedule than you'd like?> > > Hi all,> I just wanted to pass along what we have done to fill our schedule,> just when we

thought Steve might have to close the practice, as we> cannot survive with 5 patients/day, 4 days/week. October is> historically our slowest month (flu shots are the only thing that gets> patients walking thru the door), followed closely by June, so we> needed to act quickly.> > Anyways, now that most health plans are covering preventives with no> copay/deductible, we have started sending out letters to all of our> patients that have not been in for at least 18 months. We have never> done this before, mainly because we have a young practice (6 years> into it now) and we were still trying to get our ducks in a row. We> are getting about a 20% response so far, and our schedule is filling> up nicely (not too busy, not too slow). The past 2 weeks (we started> sending out letters about 3 weeks ago), we have gone from 5> follow-ups/day to yesterday being our

busiest Friday ever with 12> patients plus 6 flu shots! I know this is busier than some of you> want to be, but we need to fill our schedule most of the 4 days we are> in the office in order to fulfill our financial responsibilities> (mostly rent and house payment!). We offer 20 minute follow-ups, and> our physicals are 40-60 minutes, depending on the age and complexity> of the patient. On a busy day we can see 14 patients (although our> schedule has a max of 18 slots per day, we use multiple slots for> PE's).> > For a small investment of time, envelopes, and stamps, we are seeing a> nice ROI, as 20 preventive exams pays about $2500 in our area> (depending on age). We have yet to see if there is an improvement in> the health of our patients. No huge surprises or "saves" on any labs> yet, but we are getting patients in for their mammos,

colonoscopies,> etc. much better than we were previously.> > We have only gotten letters out to people on our list that popped up> in our HMO's P4P reports plus everyone else A-J. This has been a nice> surprise for us to increase contact with our patients and make sure> they are staying healthy.> > Just wanted to share, hope you all have a great weekend!> > > Pratt>

-- MD ph fax

[Guest guest]

I guess I misunderstood Jim. I thought he was talking pure Open Access with 0%

pre-booked and no appts are open until one day prior. From the response, it

looks like few if any are doing this.

One other trick is to avoid scheduling patients to follow up on a Monday since

Mondays have the highest acute visit demand. If I see someone on Monday who

needs f/u in, say, 2-3 months, I ask them which day, Tues thru Fri, is best for

them to make as their routine follow up day. Let's say they pick Fri. So they

are booked on Fri and when they come in 2-3 months later and need f/u in 4

months, it is again booked on Fri.

This way patients start associating a certain day of the week as their " medical

day " . So if they know they have a f/u appt this week, they don't have to guess

which day of the week it will be .... they just have to remember the time of day

which we also tried to keep constant with each patient.

We did this when I was in VT and it seemed it cut down the no-shows, freed up

Mondays for acute access, and made it easier to balance patient flow during the

week. If one day got busier than others, you start looking for patients willing

to change their " follow appt day " to a different day of the week.

Craig

> >> That's great .

> >>

> >> I've been thinking that physicals would be a good way to fill the schedule

too though that is not my problem this month. I do 20 minute sick visits, 30

minute chronic disease f/u and 40 or 60 minutes for physicals. I schedule

patients an average of 6.5 to 7 hours a day 4 days a week.

> >>

> >> What has been holding me back (other than right now I am too busy because

of a lot of trips and closures) is that physicals pay way less than a 99214. So

I was seeing new patients and calling it a physical until I reviewed my fees.

(also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a

physical does and I spend a lot of time and do a lot of work.

> >>

> >> If you are seeing no one, it's certainly better than nothing. But I don't

know why they pay so little. But when it gets slow again, I might go that route

too. Then if they actually have issues, I can actually code it as a E & M.

> >>

> >>

> >> Kathy Saradarian, MD

> >> Quality Family Practice

> >> <mailto:qualityfp@>qualityfp@<mailto:qualityfp@>

> >>

> >>

> >>

> >> From: <mailto: >

<mailto: \

>

[mailto:<mailto: >@yahoog\

roups.com<mailto: >] On Behalf Of Pratt

> >> Sent: Saturday, October 08, 2011 10:56 AM

> >> To: <mailto: >

<mailto: \

>

> >> Subject: Slower schedule than you'd like?

> >>

> >>

> >> Hi all,

> >> I just wanted to pass along what we have done to fill our schedule,

> >> just when we thought Steve might have to close the practice, as we

> >> cannot survive with 5 patients/day, 4 days/week. October is

> >> historically our slowest month (flu shots are the only thing that gets

> >> patients walking thru the door), followed closely by June, so we

> >> needed to act quickly.

> >>

> >> Anyways, now that most health plans are covering preventives with no

> >> copay/deductible, we have started sending out letters to all of our

> >> patients that have not been in for at least 18 months. We have never

> >> done this before, mainly because we have a young practice (6 years

> >> into it now) and we were still trying to get our ducks in a row. We

> >> are getting about a 20% response so far, and our schedule is filling

> >> up nicely (not too busy, not too slow). The past 2 weeks (we started

> >> sending out letters about 3 weeks ago), we have gone from 5

> >> follow-ups/day to yesterday being our busiest Friday ever with 12

> >> patients plus 6 flu shots! I know this is busier than some of you

> >> want to be, but we need to fill our schedule most of the 4 days we are

> >> in the office in order to fulfill our financial responsibilities

> >> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> >> our physicals are 40-60 minutes, depending on the age and complexity

> >> of the patient. On a busy day we can see 14 patients (although our

> >> schedule has a max of 18 slots per day, we use multiple slots for

> >> PE's).

> >>

> >> For a small investment of time, envelopes, and stamps, we are seeing a

> >> nice ROI, as 20 preventive exams pays about $2500 in our area

> >> (depending on age). We have yet to see if there is an improvement in

> >> the health of our patients. No huge surprises or " saves " on any labs

> >> yet, but we are getting patients in for their mammos, colonoscopies,

> >> etc. much better than we were previously.

> >>

> >> We have only gotten letters out to people on our list that popped up

> >> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> >> surprise for us to increase contact with our patients and make sure

> >> they are staying healthy.

> >>

> >> Just wanted to share, hope you all have a great weekend!

> >>

> >>

> >> Pratt

> >>

>

>

> --

>

>

>

>      MD

>     

>     

> ph    fax

>

>

[Guest guest]

since i have a huge patient panel, i think one of the biggest advantages of open

access is no phonecalls during the weekends..

that in itself is proof enough it works.

grace

> > >> That's great .

> > >>

> > >> I've been thinking that physicals would be a good way to fill the

schedule too though that is not my problem this month. I do 20 minute sick

visits, 30 minute chronic disease f/u and 40 or 60 minutes for physicals. I

schedule patients an average of 6.5 to 7 hours a day 4 days a week.

> > >>

> > >> What has been holding me back (other than right now I am too busy because

of a lot of trips and closures) is that physicals pay way less than a 99214. So

I was seeing new patients and calling it a physical until I reviewed my fees.

(also no co-pay for the patient) and a 99203 or 99204 pays a lot more than a

physical does and I spend a lot of time and do a lot of work.

> > >>

> > >> If you are seeing no one, it's certainly better than nothing. But I don't

know why they pay so little. But when it gets slow again, I might go that route

too. Then if they actually have issues, I can actually code it as a E & M.

> > >>

> > >>

> > >> Kathy Saradarian, MD

> > >> Quality Family Practice

> > >> <mailto:qualityfp@>qualityfp@<mailto:qualityfp@>

> > >>

> > >>

> > >>

> > >> From: <mailto: >

<mailto: \

>

[mailto:<mailto: >@yahoog\

roups.com<mailto: >] On Behalf Of Pratt

> > >> Sent: Saturday, October 08, 2011 10:56 AM

> > >> To: <mailto: >

<mailto: \

>

> > >> Subject: Slower schedule than you'd like?

> > >>

> > >>

> > >> Hi all,

> > >> I just wanted to pass along what we have done to fill our schedule,

> > >> just when we thought Steve might have to close the practice, as we

> > >> cannot survive with 5 patients/day, 4 days/week. October is

> > >> historically our slowest month (flu shots are the only thing that gets

> > >> patients walking thru the door), followed closely by June, so we

> > >> needed to act quickly.

> > >>

> > >> Anyways, now that most health plans are covering preventives with no

> > >> copay/deductible, we have started sending out letters to all of our

> > >> patients that have not been in for at least 18 months. We have never

> > >> done this before, mainly because we have a young practice (6 years

> > >> into it now) and we were still trying to get our ducks in a row. We

> > >> are getting about a 20% response so far, and our schedule is filling

> > >> up nicely (not too busy, not too slow). The past 2 weeks (we started

> > >> sending out letters about 3 weeks ago), we have gone from 5

> > >> follow-ups/day to yesterday being our busiest Friday ever with 12

> > >> patients plus 6 flu shots! I know this is busier than some of you

> > >> want to be, but we need to fill our schedule most of the 4 days we are

> > >> in the office in order to fulfill our financial responsibilities

> > >> (mostly rent and house payment!). We offer 20 minute follow-ups, and

> > >> our physicals are 40-60 minutes, depending on the age and complexity

> > >> of the patient. On a busy day we can see 14 patients (although our

> > >> schedule has a max of 18 slots per day, we use multiple slots for

> > >> PE's).

> > >>

> > >> For a small investment of time, envelopes, and stamps, we are seeing a

> > >> nice ROI, as 20 preventive exams pays about $2500 in our area

> > >> (depending on age). We have yet to see if there is an improvement in

> > >> the health of our patients. No huge surprises or " saves " on any labs

> > >> yet, but we are getting patients in for their mammos, colonoscopies,

> > >> etc. much better than we were previously.

> > >>

> > >> We have only gotten letters out to people on our list that popped up

> > >> in our HMO's P4P reports plus everyone else A-J. This has been a nice

> > >> surprise for us to increase contact with our patients and make sure

> > >> they are staying healthy.

> > >>

> > >> Just wanted to share, hope you all have a great weekend!

> > >>

> > >>

> > >> Pratt

> > >>

> >

> >

> > --

> >

> >

> >

> >      MD

> >     

> >     

> > ph    fax

> >

> >

>