Listened yesterday I thought they brushed over some big topics like corporations attempts to replace physicians with Midlevels, lack of salary increases, disincentive to stay with same practice and increasing clinical demands.
Hi,
I'm a nurse who's looking into medicare reimbursements, specifically annual wellness visits. I pulled CMS data and noticed a lot of these AWV's aren't completed. If you own a private practice, I'm just curious about the reasoning behind this.
TL;DR how do you find out if a Medicare Advantage can get a 99397? “many but not all plans cover” Goal: MA 99214 AWV 99397 visits. Do you ever split to 99214 AWV one day and 99214 99397 another and does that help compared to both same day?
I have asked my front desk to call case by case and it can be 10-15 minute per patient. There does not seem to be a way is use a portal like for referral management to check this.
Weeds:
System policy is “you bill it patient pays it, no write offs” So: bill everyone with MA: 2wrvu and system earns 200+. But some percent of the people get a bill for 200+ bucks.
They bill 99214-25 G0439 99307-GY with GY being required per them and “patient must pay if non-covered” At least one plan said online to bill 99214 G0439-25 99397-25 which sounded both crazy and specifically different from all the other rules, so designed to get denials.
revenue cycle/billing people say it is hard to track denials, or successful claims by plan. Which seems it should be easy to me. They also say that one MA plan (at random, Aetna) may have some plan agreements that cover for one group (California MA plan) and not another (Ohio MA plan)- and that the MA plans refuse to tell them about this specific coverage.
Howdy! I’m a lowly FM PGY-1 so I apologize if I’m missing something obvious. But, I was reading the updated guidelines on Cervical Cancer screening and the potential for q5yr HPV self-swabs in those >30 y/o, and was curious how many of y’all have adapted this practice yet?
I feel like I’ve had attendings give slightly more pushback when I’ve asked for my WWE patients, but I feel like self swabs might honestly lead to higher compliance rates (e.g., what patient actually wants a Pap done in clinic vs. just self-swabbing). However, I’m also sure that clinician obtained Paps w/ cytology are more reliable periodt. Just wanted to gauge y’all’s thoughts! Thanks :)
PGY6 so have experience but coming back from acute care work. Shout out to u/invenio78 for the offer guide.
Low to medium COL, 20 min from downtown if mid-major city
Base $315,483 guarantee x2 years then productivity
34 patient facing hours, one day of admin
Call for a week Q7 weeks and every provider there says it’s very light (2-3 calls per)
30 days (6weeks) PTO
$25,000 sign on bonus
Expected 16-22 patients per day
$50/rvu with 5,964 rvu threshold
So here is the test I tried to order and I got a message back saying this test is not available in California. I called them and they told me the same thing and that there is no alternative that they know of. There is a "single site" test but my understanding is that this is only for people whose parents already have a known genetic variant. I am not smart enough to know the technical differences but I do know that guidelines recommend panel based testing for suspected FH which this second test is not.
My question is more - what do I do insurance wise? Is there a prior auth for outside lab? Do I have to ask patient to pay out of pocket? I've never dealt with needing lab services that the contracted lab cannot provide so I am not really sure what to do next.
Thanks!!
5 years out of residency, i still can’t figure this out: why do patients with particularly bad cold symptoms almost always get prescribed azithromycin rather than a different antibiotic? I understand the poor antibiotic stewardship aspect of it, that most of these are viral to begin with. But if you are going to assume bacterial, would it not be some type of amoxicillin for sinusitis (or cephalosporin for penicillin allergy)?
The best i can come up with is that azithromycin has anti-inflammatory properties…Can someone make it make sense?
Please note this is not a political concern and more a concern about loss medical/shared decision-making.
The prevalence of biochemical hypogonadism ranges from 10-40% in the general population and increases with age
• Baltimore Longitudinal Study of Aging: prevalence of 12% in men 50-59 and over 50% in men over 80 years of age
*(*exceptionally small minority of our patients demographic)
• Armed Forces (2018-2025): the annual prevalence of male hypogonadism ranged from 0.6 to 0.9%
(Fraction of a percentage of patients that MAY qualify)
• Special Operations Forces: small studies estimate male hypogonadism prevalence higher at approximately 39%-43%
(Population that works themselves out to exhaustion and generally sleep deprived)
This policy*** ***will cost taxpayers 58 million annually just for the initial mandatory screening.
When you were in medical school and residency what was the appeal of clinic that drove you to it? How many extra hours are you working per week?
Do you find local specialists tend refuse referrals when another local physician of the same speciality has seen the patient within the preceding 12-24 months?
In these cases, the previous specialist had already signed off months prior and either the patients aren’t improving, or there are new findings. The previous specialist either declined seeing the patient again, or the patient wishes to see someone else. Our physician is asking for specialty involvement because these are situations genuinely beyond primary care.
Can you suggest anything we can do here? The specialists all work out of the same buildings and work closely together.
Background: We are seeing this happen repeatedly. I’m a RN working for a PMD in a small to moderate sized city (pop 200k). We have very few specialists here.
Genuinely sometimes it feels like they are avoiding our practice..(?) is there a social underpinning for this?
Update: thank you so much for your replies lol I really didn’t expect some of those responses! Very interesting
I am about 2 months in to FM residency and the part I am struggling with the most so far is managing my inbox. I try to minimize taking work home from the hospital/clinic, but right now I am on an inpatient surgery block and the hours I can relay results and talk with patients over the phone are very limited.
It’s extra difficult because the way our clinic is run, it’s often other residents seeing each others patients but we get the results if we are their official PCP. This means that I sometimes get results back before a note is posted so I have no clinical context, and we are supposed to discuss abnormal results with patients same day. I’ve been having a lot of anxiety about making these kinds of decisions and figuring out next steps through the inbox. It’s also difficult because we frequently cover our co-residents inboxes, so then I am covering two inboxes.
What can I do to manage my inbox better and stop feeling so nervous about it?
I'm in my 2nd job post-residency and wanted to get a sense of how much control other people have over their own scheduling.
First, how much are you able to modify your schedule template? At my first job, I met with my clinic manager to review my hours and how many new patients per half-day, how many acute visits slots to keep blocked until the 3-7 days prior to the actual day, etc. And we met to modify my template when my hours changed after coming back from maternity leave and when I needed time to pump. Now, there's a default template for everyone in the same specialty with modifications only if you work a "flexible schedule" (e.g. shorter lunch to leave earlier).
Second, are you able to schedule your own patients' follow ups if needed? Or do only certain staff members or administrators have access to add patients to your schedule and/or block slots?
Your medical journal comes in the mail and you think, "damn this looks like a banger."
VHCOL region.
Offer 1:Base 320k fixed for 2 years and then move to productivity model where you can apparently clear 400k easily. 36 patient contact hours that can be over 4 or 5 days my choice. 18-20 patients per day. Call once every 6 weeks. 4 weeks pto . 100k sign on, 15k relocation
Offer 2: everything same as offer 1 except that it moves to 50:50 model in year 3 and has shareholder track
I am 4 years out of residency, working at my second large hospital system as 1.0 FTE. At our office we have 32 clinical hours and 8 admin hours per week, which I feel is better than many places these days, but still am working 55ish hours per week when you include pajama time.
I use all the Epic efficiency tips, AI scribe and feel I’m generally a pretty efficient person. Am starting to feel going “part time” is the only way to achieve a 40 hour work week.
Curious to hear others experiences with going part time?
I swear I spent more of this week fighting prior authorization requests than actually seeing patients. I wrote a refill my patient has been stable on for two years, and the insurer kicked it back demanding I make her 'try and fail' something cheaper first. Then I'm sitting on hold for 40 minutes for a peer-to-peer with someone who isn't even in primary care, defending a decision that was obvious to anyone who's met the patient. It's gotten to where prior authorization is the actual job and medicine is the side gig I squeeze in between the paperwork. Is everyone else just drowning in this too, or has anyone found a way to keep it from eating the whole day?
Patient on 400mg ibuprofen 4-5 times a day for his RA. He's been using it for everyday for past 3 months prescribed by his rheumatologist.
His recent labs show Cr went from 1(baseline) to 2.
What's your next step other than stopping the NSAID?
Does anyone do house calls? Or is it a relic of a bygone era? Between the insurance and the schedule, is it even possible?
Maybe I’m just a dumb-dumb posting from my iPad as the Epic’s production build refuses to launch in Citrix, but holy cow how is Canto like this? I will readily admit that, as soon as I got Citrix running on the iPad, I switched to real Epic exclusively, so maybe I just need to commit to using this thing more frequently. Why can’t I have my dot phrases? I have spent SO much time trying to optimize my workflow because the workload is unmanageable. It feels straight-up insulting to just NOT have any of that available. Also I feel like I cannot access a bunch of information that I routinely look at in Epic. For example, a patient of mine now has a different PCP at a different practice listed and I’m getting annoyed messages from the pharmacy regarding to whom the prescription belongs; how do I tell if I switched the PCP because the patient told me, or if one of the nurses did it because the patient said so at the ER, or if registry management has decided my day needs just a little more chaos? In the desktop environment, I click PCP, then I look at the history. In Canto, I click PCP and it invites me to undock my iPad from its keyboard so I can “jot” on the screen. Why?!?!
I guess it’s time to go call up the help desk.
I was watching the Indy Car race and there was a commercial to “ask you doctor about getting screened for heart valve disease.” Who’s pushing this? I assume some cards groups to pump echo numbers up but I’ve never seen this before.