Comments on: The "team" of specialists http://www.kevinmd.com/blog/2008/01/team-of-specialists.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/01/team-of-specialists.html/comment-page-1#comment-82478 Anonymous Thu, 03 Jan 2008 14:02:00 +0000 http://clients.emmense.com/kevinmd/2008/01/the-team-of-specialists.html#comment-82478 Why don't we blame the physicians for agreeing to be reimbursed in that manner? Why don’t we blame the physicians for agreeing to be reimbursed in that manner?

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/team-of-specialists.html/comment-page-1#comment-82474 Anonymous Thu, 03 Jan 2008 01:26:00 +0000 http://clients.emmense.com/kevinmd/2008/01/the-team-of-specialists.html#comment-82474 okulus,<br/><br/>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. <br/><br/>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? <br/><br/>Does that make sense? 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?

]]> By: Okulus http://www.kevinmd.com/blog/2008/01/team-of-specialists.html/comment-page-1#comment-82462 Okulus Wed, 02 Jan 2008 19:42:00 +0000 http://clients.emmense.com/kevinmd/2008/01/the-team-of-specialists.html#comment-82462 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.<br/><br/>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.<br/><br/>So if your doctor complains that the specialist hasn't replied, ask whether the original request was made in writing. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/team-of-specialists.html/comment-page-1#comment-82461 Anonymous Wed, 02 Jan 2008 18:57:00 +0000 http://clients.emmense.com/kevinmd/2008/01/the-team-of-specialists.html#comment-82461 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. <br/><br/>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. 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.

]]> By: laurasf http://www.kevinmd.com/blog/2008/01/team-of-specialists.html/comment-page-1#comment-82458 laurasf Wed, 02 Jan 2008 18:28:00 +0000 http://clients.emmense.com/kevinmd/2008/01/the-team-of-specialists.html#comment-82458 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).<br/><br/>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?<br/><br/>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. <br/><br/>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.<br/><br/>I understand why the pharmaceutical ads on TV recommend telling your doctor about your medical conditions before asking them to prescribe their drugs. <br/><br/>What's their job, anyway? 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?

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