M.D.O.D.: “It would be less painful to gouge my eyeballs out than to sign endless prescription refills, notes from specialists who have consulted on my patients, disability forms for people who don’t really deserve disability benefits, forms for diabetic shoes, electric scooters, walkers, canes, prior-authorizations for drugs, FMLA forms, and nursing home orders. Of course, most of these forms require rummaging through the patient’s chart for a few minutes to confirm diagnoses, last visit dates, current medications . . . When you get home at 7pm – 8pm, you get to answer your pager all night from patients who think they just might die by morning if they don’t interrupt your dinner and bedtime with your wife and kids. Then, every two weeks you collect a check which is, in general, the lowest pay in the medical field. This is the life of the primary care provider.”
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{ 8 comments }
Ouch, what a soul killing description.
painful but true. the primary care doc spends a good chunk of their time doing unreimbursed paperwork that cms and insurers won’t pay a high school kid to do.
this may not be possible for all specialties, but I have found that it is possible to get paid for the occasional disability/family medical leave forms I am asked to do as a sleep specialist. I have the patient come in for a separate visit in which I spend most of the time filling out the form. I also dictate a note for the visit. Technically, I am not getting reimbursed for filling out the form, but instead for evaluating and managing the patient. For example, I recently saw a sleep apnea patient one week after I had prescribed him CPAP, but on the day he received his machine (the delay in getting the machine was the fault of the DME company). While getting the basic info for the temporary leave form from him, I discussed with him that his sleepiness should soon get better and that I would see him again in 1 week to evaluate his ability to return to his job, which involved some local driving.
I value my time and deserve to be paid for the services I provide my patients. A great deal of medical judgement goes into filling out even supposedly routine forms.
dr rack
sure it is possible to do but if you change occasional to multiple forms for most of the patients pretty soon you don’t have time to see any patients anymore.
if the specialists would handle the ones pertinent to them, that might start to put a dent in the work.
Anon 8:23,
I agree that we specialists need to pick up more of the slack. I don’t try to dump prior authorizations for provigil/hypnotics back on the pcp’s; my staff has gotten pretty good at doing most of the work on those. And of course, filling out the CMN forms for cpap machines is a routine part of sleep medicine and only takes about 45 secs;I wouldn’t schedule the patient an extra visit to do a cpap CMN form or a prior authorization.
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I have stopped taking self-referred MEdicaid patients, not because of the low reimbursement, but because MEdicaid is the worst regarding forms to fill out. I do, however, continue to take Medicaid referrals from other physicians.
I know plenty of local offices that have started directly charging the patient a fee for filling out forms like this. Not ones directly related to receiving care (like the diabetic testing supplies or radiology prior-auths) but forms like DMV tags, sick leave/FMLA forms, camp physical papers, disability papers, etc. Anywhere from $10.00 for the handicap tags to $75.00 for the multi-page disability insurance papers.
That is fair to charge for filling out forms. It takes professional time and it isn’t properly medical care covered by fees paid for professional visits. Doctors shouldn’t have to go through questionable coding exercises to bill time spent in these kinds of activities as if it were counseling time spent to coordinate medical care. These are administrative services, plain and simple.
I find it best to fill out any forms while the patient is present. I can ask what I need to ask that way and it cuts into the reams of uncompensated paperwork. Also it doesn’t leave me working for free an additional 2 hours at the end of the day. It is my position that only the standard HCFA-1500 for the patient to submit to their insurance company for the office visit is incidental to the office fee–other services are either rendered during the apointment time or an additional separate fee incurred.
Many of the forms are frankly an intrusion into the doctor-patient relationship regardless of who pays for my time in filling them out and I am getting more adept at identifying those and minimizing their intrusion.
My job is to diagnose and treat illness. It is not to mediate negotiations about hours, benefits, responsibilities and leave with an employer, benefit payments with a government or insurance company, or moral repsonsibility with criminal justice authorities or spouses. Playing along with others attempt to displace their difficult decisions onto treating physicians undermines my ability to do my job. It distracts both me and my patient from our joint task, gives the patient an incentive to distort, and moves me from an advocate for my patients health to an arbitor of social justice–leaving me torn often between my sense of obligation to my patient and a concern that I am being used to abuse others financially.
It helps to remind myself that my obligation is not to every interest of the patient–only to diagnose and treat their illness. In all but the most obvious cases, I refer disability requests to physicians who have a focus on doing those evaluations. I can not treat someone’s depression encouraging them to not feel helpless and hopeless while filling out a form that basically certifies that they are indeed, hopeless.
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