Re: MU Payment - was: Slower schedule than you'd like?

[Guest guest]

Hurrah!  Ours has been sent to the " Payment Contractor, " which I'm assuming is Palmetto.  We hope to get it this month.  We completed our attestation in August.

 

 

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 PMTo: 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 AMTo:

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 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, MD

Quality 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

 

-- Pratt