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Only doctor left in practice. How do I negotiate with admin?

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  • Dontgetthejab
    replied
    Welcome to employed practice...

    Agree with most of what is said.
    your not obligated to refill meds for patients you haven’t seen, btw that can put yourself at risk.
    make them schedule an appt for refills, forms etc. copays and such shouldn’t be a big deal as they’re likely on Medicare.
    20-25/day is the sweet spot and you should clear $250k easy. Most visits 99214

    Leave a comment:


  • StarTrekDoc
    replied
    Originally posted by Meds1720 View Post
    Thank you everyone for the feedback. This has been very helpful and I appreciate it. It has been difficult being a new attending with not much guidance and not knowing what the norm is.
    And that's what admin (and private practices) prey upon when not led by a good corps of pragmatic leaders (imho).

    Leave a comment:


  • Zaphod
    replied
    Its normal to feel overwhelmed and be slow at the beginning, really feel that by year 3 you hit your stride, its normal.

    Leave a comment:


  • Meds1720
    replied
    Thank you everyone for the feedback. This has been very helpful and I appreciate it. It has been difficult being a new attending with not much guidance and not knowing what the norm is.

    Leave a comment:


  • Random1
    replied
    I went from private practice to an direct RVU based system. So there is no administrative hours in the schedule. If I am not working seeing patients, I am usually out of the office doing something fun. I usually take care of the other issues between patients and at lunch.

    Leave a comment:


  • StarTrekDoc
    replied
    Originally posted by OUSOONERDOC View Post

    Just make sure you are detailed in the time spent. Cant just say "40 mins was spent with patient and/or patient care."
    15 patients 8 hours = 32 min each - and that's assuming no total time coordinating care throughout the day. Time based should probably be reachable in majority of the cases at that clip. Remember the new rules is same day of service. Cannot be spread across multiple days. So if you clinic prep. Prep in the morning; not the night before.

    Leave a comment:


  • OUSOONERDOC
    replied
    Originally posted by Financemd8155 View Post
    If you bill by time using new EM coding >40 minutes spent is a level 5 follow up and that includes charting time!
    Just make sure you are detailed in the time spent. Cant just say "40 mins was spent with patient and/or patient care."

    Leave a comment:


  • Financemd8155
    replied
    If you bill by time using new EM coding >40 minutes spent is a level 5 follow up and that includes charting time!

    Leave a comment:


  • gap55u
    replied
    StarTrekDoc- I see a ton of geriatrics and I code 99215’s very infrequently. Are you suggesting 15/day geriatrics = code for time and get 99215’s? Or that most geriatric follow ups are 99215’s? I will admit that our compliance person is tremendously conservative re 99215, so my feel is that I do a lot of 99214.999’s that don’t tip into 99215 MDM. (Example: address 5 issues and associated medication refills/labs).

    Now, uncontrolled dm2, med change; uncontrolled Htn, med change, both needing labs was posited as a 99215 somewhere that I read. However this didn’t seem to meet guidelines to my understanding.

    Under-coding and giving away care are classic common problems - we aren’t taught to code and we don’t want to inconvenience patients or make them pay. Otoh, I feel very very good that I was able to do a quick 10 minute video visit today to bill a 99215 for all the work around that to get a lady admitted to snf.

    regarding forms, I always tell patients that I want to see them to ensure everything is done accurately and correctly the first time and at the time of the appointment- you get a lot more buyin that way.

    Leave a comment:


  • StarTrekDoc
    replied
    Welcome OP.

    Geriatrics is a different monster. With the 15/day 8 hours; you should be coding Level 5 for the majority of those visits at that pace let alone extended time drops. If you're not - you're not going to make the RVUs that admin is anticipating.

    You need to spell out a very specific issue since your hire: -- clinician coverage/turnover. You're covering for 3 clinicians AND doing the daily work. That is not okay without appropriate compensation/adjustment.

    Action you can take:
    1. Spell this out in specific terms. Forms, refills, non-F2F work not directly related to your patients you are assigned -- will not be done. Admin will need to either get Locums or pay you for that coverage.

    2. Code adequately for the 15patients a day. This is probably the primary reason admin thinks 15 is light. They are most likely watch the RVUs. If not - ask them specifically what metrics they are using assess proper amount of patient load.
    Last edited by StarTrekDoc; 07-06-2021, 11:33 AM.

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  • gmed120
    replied
    This is a fun one. I am with you. New primary care attending (IM). Been in practice for 2 years.

    First issue (your former retired colleague), remember that you do not have a patient-physician relationship with these patient if you have never seen them or provided a refill. Once you provide a refill, you do have a patient-physician relationship. It is not your responsibility to provide refills without seeing your former colleague's patients. It is your health system's job to figure out how to maintain them within their system. I personally do no provide refills unless I have seen the patient with the exception of covering for one of my colleagues. I will provide enough medication until they follow up with their PCP if I am covering while they are on vacation.

    Next issue is coverage of your current colleague. Did you agree to cover for them while he/she is out? If not, let admin figure out that stuff. If I was taking an extended leave of absence, I would monitor my messages and inbox once a week for my patients for refills, etc. No way would I burden my colleagues like that.

    Patient load: will get easier as your learn your patients. It does suck when everyone is new and complicated. Bill appropriately. Sounds like most are 99214 visits. You will be in the 20 to 25 range in a short amount of time. Also do not handle every problem at every visit.

    Contract: No one here has seen your contract. If you have allotted time specifically designated in your contract, you have a few choices: 1. Block off your allotted time per your contract 2. Meet with an attorney and determine if your hospital system has breached your contract 3. Continue doing what you are currently doing.

    Remember that your health and wellbeing are important. Also remember that you bring in money for the healthcare system. You have both tangible and intangible value. If your current employer does not seem to grasp that, there are other jobs out there.

    Leave a comment:


  • Tim
    replied
    "This is my first post and I am hoping to get some advice.
    I recently started my first job post residency in an outpatient primary care clinic associated with a large hospital system. I have been in the position for less than a year."

    I understand the frustrations. But you also need to be realistic. Transition to attending takes time. Your volumes will increase as you make adjustments and hopefully you on your own or with coaching make adjustments and get comfortable and meet the expectations.
    What was missing was the expectations for patient volumes under your current contract as a new attending. Very difficult to negotiate an increase out of "thin air". The problem is the additional work on top of the "expected" work. The admin has not clarified the "expected" patient volumes without the additional work. That is not unexpected during the first year of a two year contract. I would suggest that solidifying the "expectations" before you ask for compensation for the additional work.
    The baseline is the question mark. From their point of view, the additional work might be viewed as only making up for lower than expected volumes.

    Purely a numbers game in knowing your worth.

    Leave a comment:


  • BruinBones
    replied
    At 15 pts/day, it should not be too hard to squeeze them into 7 hours 4 days/week.
    Voila! There’s your 4 hours of admin time.

    Leave a comment:


  • Financemd8155
    replied
    Similar thing happened to me but the other provider went on leave for 6 months. It was actually beneficial to me given I was seeing the other providers patients which increased my wRVUs and some of those patients remained with me. Agree don't refill or fill out forms without appt unless it's a necessary medication, anything you don't feel comfortable just have them follow up.

    Don't get off guarantee otherwise if your wRVUs presently is less than projected you'll take a cut in pay.

    Make sure you are billing appropriately based on new EM coding given you are seeing complex patients, 15 complex patients can get you to easily above 20 wRVUs a day

    Leave a comment:


  • Sampter
    replied
    All forms of patients that you had never met need an office visit to meet them and fill out that form. I rarely fill out forms even from my own patients without an office visit. Refills the same. This will reduce your uncompensated work and increase your office visit numbers.

    Leave a comment:

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