An increasingly common way patients are being cared for, and dangerous. Blame the reimbursement system:
Under the team-based health care delivery philosophy, physicians are supposed to communicate with each other but, as talking to other doctors is generally non-reimbursable time, communication suffers for the same reason every other poorly-reimbursed activity suffers. The danger is that patients who are being followed by a disorganized squad of specialists will receive dangerous interventions and studies seemingly willy-nilly and, most importantly, are placed on long lists of medications, the interactions of which cannot possibly be fathomed except that someone has the time to sit down and spend an expensive half hour doing it.
Related posts:
- Reliance on specialists is driving up the cost of care
- Do longer office visits matter?
- How increasing payments for office visits can help specialists
- When specialists provide primary care, and why patients aren’t complaining
- Should primary care distance themselves from specialists?
- Should specialists be re-trained as primary care physicians?
- ED specialists
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{ 5 comments }
Oh boy does this sound familiar. My GP asked me last week: “who is dealing with your menopausal symptoms?” Um, you are? Then he asked ME about my chance of recurrence (for breast cancer).
When I asked my oncologist: “who is supposed to order my yearly MRIs?” He said “we can, if you want.” If I want? Am I supposed to decide what scans I WANT? Who’s in charge here anyway?
UCLA has a new “survivorship” program that I enrolled in, which generated a report of all my treatment, and what tests need to be followed up on. Great idea. Except, my GP claims he never got it, and probably wouldn’t know what to do with it if he had.
I’m sure my primary onc didn’t look at it, as he never seems to know who I am (throughout my treatment he kept asking me things like: “have you started radiation yet” (no, I’m not having it, I had a mastectomy), and has to look through my paperwork in the office to figure how why I’m there.
I understand why the pharmaceutical ads on TV recommend telling your doctor about your medical conditions before asking them to prescribe their drugs.
What’s their job, anyway?
The only time I was referred to a specialist by my GP, it was the specialist who insisted he should continue doing all the follow-ups (amounting to 2-1/2 years of appts and surgeries). Meanwhile, the GP complained to me that she was not being sent test results or given any information at all from the specialist.
Is it a compensation issue or an ego issue, or both? What exactly is a patient supposed to do in these situations? I didn’t exactly want to keep seeing an expensive surgeon for a problem that it seemed the GP could have monitored after the initial biopsy, but I wasn’t given any choice in the matter.
Ego or time. Don’t assume your specialist has any more time than your internist. The same forces are working across all office-based practices, and everyone is looking for ways to shave minutes. Do “proceduralists” earn better? Certainly some seem to, but that doesn’t apply to everyone everywhere.
Partly, it is a compensation issue. When a general internist sends me a patient but no paperwork indicating why or that he is even requesting my consultation, then I really don’t feel I have any obligation to write to him unless I happen to need him to do something for our “mutual” patient. Generating correspondence takes time and costs money, and if I don’t receive a written request, then I cannot treat the encounter as a “consultation” under insurance or Medicare guidelines for that kind of service. Also, if I assume all care for the patient, my work isn’t considered consultative, but rather a “referral”, which does not allow me to bill the higher fee for a consultation, and so my time and costs generating the letter is not paid for. Is that right? I don’t think so. And the so-called referring doctor (those of whom will not refer in writing–there can be penalties for them from some insurers for high rates of referral and consultation) still thinks himself entitled to a letter in reply to nothing.
So if your doctor complains that the specialist hasn’t replied, ask whether the original request was made in writing.
okulus,
so because you can’t bill a consult, and must do a standard E&M office based code instead, you can’t afford to send a letter.
Did you stop and think that the doctor sending you the consult has to bill a standard E&M code, yet you still expect THEM to send you a letter?
Does that make sense?
Why don’t we blame the physicians for agreeing to be reimbursed in that manner?
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