Admin interested in stopping chart reviews to decrease patient wait time to consult

[DOctorJay]

---

Members do not see this ad.

please select a choice within the poll and comment regarding any specifics on your process

 

[drusso]

It's a vital source of control and just good medicine. Can't emphasize how important it is to vet/screen patients before they get in front of you.

 

[NJPAIN]

It's a vital source of control and just good medicine. Can't emphasize how important it is to vet/screen patients before they get in front of you.

Couldn’t agree more. If you don’t screen out the garbage you will increase the number of unpleasant patients encounters, increase your opioid prescribing and decrease your patient satisfaction scores. Your admin can’t manage your practice like an ortho practice; it’s apples and oranges.

 

[lobelsteve]

Next step: admin tells you when to Rx.

 

[callmeanesthesia]

I’m in a 10-doc private group, mostly ortho/sports med. All external referrals come to me for approval prior to scheduling, and all Medicaid and WC internal referrals. Medicare and private internal referrals are directly scheduled.

 

[SSdoc33]

i have a list of things i want to before the patients are booked, but no formal screening process. i dont personally screen all the charts. i see just about everything, every insurance, and don't Rx opioids, so its not a huge problem. i get a 99203/4 as long as they show up

 

[Ducttape]

only screen if the nurses point out an issue. seeing all patients is a service I offer the system, in exchange for the system being aware that I reserve the right not to establish a working relationship with the patient.

i rely on nurses at picking up potential problem patients prior to their arrival.

 

[drusso]

only screen if the nurses point out an issue. seeing all patients is a service I offer the system, in exchange for the system being aware that I reserve the right not to establish a working relationship with the patient.

i rely on nurses at picking up potential problem patients prior to their arrival.

This is also about control. No one wants to end up the "dumping ground" for health system detritus.

 

[DOctorJay]

I need a few more responses in the poll here. Please vote if you haven't already done so and thanks for all the comments thus far!

 

[Gauss]

This is also about control. No one wants to end up the "dumping ground" for health system detritus.

I'm surprised to hear of a health system that allows any screening to occur prior to scheduling for a pain & PM&R clinic. that's a zebra
it will not last, admin views screening as impeding access and not in alignment with the "Triple Aim"

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

 

[DOctorJay]

what about quadruple aim

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated...

www.annfammed.org

Abstract
The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

 

[Gauss]

what about quadruple aim

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated...

www.annfammed.org

Abstract
The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

HA
that's from a medical society biased towards physicians best interests
triple aim was created by a hospital lobby biased towards increasing income for the Csuite
always remember, the hospital will never love you back

 

[DOctorJay]

The hospital will not love you back

The Hospital Will Not Love You Back - The Physician Philosopher

Have you ever felt resentful towards your job? Sick of the constant requirements, administrative tasks, and lack of autonomy? You might be feeling bitter, and Vagabond MD has written a guest post to help you figure it out.

thephysicianphilosopher.com

sad but true

 

[Orin]

I'm surprised to hear of a health system that allows any screening to occur prior to scheduling for a pain & PM&R clinic. that's a zebra
it will not last, admin views screening as impeding access and not in alignment with the "Triple Aim"

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

Screening is a great way to meet the triple aim.

I advocate for patients seeing PT or psychology first, as they would have better quality/satisfaction with longer visits and faster access to a team member, and have better outcomes for less cost if they weren't all getting medications, procedures, and surgeries.

If the admin wants to take away the chart review screen, tell them to hire an APP or Pain PT/Psych person to be your first person to evaluate the patient.

 

[drusso]

Vigilant screening and MD-approval/sign-off reduces complications and improves patient care. Kaiser has been doing it for years.

 

[drusso]

The hospital will not love you back

The Hospital Will Not Love You Back - The Physician Philosopher

Have you ever felt resentful towards your job? Sick of the constant requirements, administrative tasks, and lack of autonomy? You might be feeling bitter, and Vagabond MD has written a guest post to help you figure it out.

thephysicianphilosopher.com

sad but true

This needs to be internalized early in medical training by students, residents, and fellows. Institutions can't care about you. Only people can. Choose who you do business with care and only do business with people you trust.

 

[hyperalgesia]

please select a choice within the poll and comment regarding any specifics on your process

This is the war I've been preparing for my entire career.

 

[Gauss]

Vigilant screening and MD-approval/sign-off reduces complications and improves patient care. Kaiser has been doing it for years.

Kaiser does not 'screen' in the way you do, they can't turn away referrals. access is a huge metric for them. the only screening they do is for something like epilepsy getting routed to the specialized neurologist or EP going to the correct cardiologist

 

[Gauss]

Screening is a great way to meet the triple aim.

ok...
go on

I advocate for patients seeing PT or psychology first, as they would have better quality/satisfaction with longer visits and faster access to a team member, and have better outcomes for less cost if they weren't all getting medications, procedures, and surgeries.

in every hospital system I know of, PT and psych have longer wait times than you. access
patients want to see the specialist, not a therapist. patient experience
therapists can't do anything without physician orders. scope of practice
cost differential between physician visits vs therapist visits is trivial to the hospital system. more care = increased revenue. enrich the Csuite

Screening referrals creates roadblocks and sends patients with complaints back to PCPs which impacts their practices reducing access. PCPs vent to leadership. Leadership removes specialist ability to screen. Specialists revolt. Leadership creates centralized scheduling offsite to prevent any clinic or physician interference of access. Specialists revolt. Leadership recommends more metrics for physicians... The Hospital will not love you back.

 

[DOctorJay]

Screening referrals creates roadblocks and sends patients with complaints back to PCPs which impacts their practices reducing access. PCPs vent to leadership. Leadership removes specialist ability to screen. Specialists revolt. Leadership creates centralized scheduling offsite to prevent any clinic or physician interference of access. Specialists revolt. Leadership recommends more metrics for physicians... The Hospital will not love you back.

is this a formula somewhere, like listed in Becker's Hospital Review or created by the Studer Group?

 

[NOSfan]

We review all referrals from outside of our system. This ensures the patient is seen by the appropriate clinician, is cost-effective, optimizes care, improves access, improves patient and staff satisfaction.
Note, we have a <24 hour turnover rate.

 

[Gauss]

is this a formula somewhere, like listed in Becker's Hospital Review or created by the Studer Group?

working in the clinical admin side, I've seen this process occur across several large hospital systems and Universities, not always exactly in this order. each time it was far too similar to be coincidental.
one standout was when leadership wanted to promote 'transparency' and mandated each department email out the monthly RVUs and take home pay (including outside income) of each physician to every physician in the dept. every physician basically saw each other's paycheck. this had the intended effect of creating jealousy and physicians turning on each other

 

[DOctorJay]

we see each other's wRVUs and metrics and can easily extrapolate what that means for paychecks

 

[Gauss]

we see each other's wRVUs and metrics and can easily extrapolate what that means for paychecks

but was it directly emailed to you in take home $$$ ?
RVu conversion is still a guess excluding outside income, admin income, stipends, research grants, etc.

 

[drusso]

Kaiser does not 'screen' in the way you do, they can't turn away referrals. access is a huge metric for them. the only screening they do is for something like epilepsy getting routed to the specialized neurologist or EP going to the correct cardiologist

I didn't say turn-away referrals. I said triage/screening patients so that they get "the right care," "at the right time," with the "right clinician." It's not rocket science. A 39 year old obese female with history of bipolar and fibromyalgia on Vicosomaxannax does not need to meet the double-board certified, fellowship trained pain specialist on the first visit. That patient needs to be processed by behavioral health, presented in multi-disciplinary review, and told what's "on the menu" and "not on the menu" before taking her order. Otherwise, these patients are just "shopping at Bergdorf's." Lot's of stuff they want, but nothing within their reach. Screening promotes efficiency, the right kind of access, and improves satisfaction by "setting the agenda" early in the phase of treatment. That also free's up medically trained clinicians to focus on the patients with urgent medical needs and do productive work.

 

[Ligament]

I do not personally review charts PRIOR to scheduling for a consult. However, I dont need to.

1. Patients are told we do not prescribe opioids and will not be refilling their opioids.
2. Any mean, denegrating, or rude patients to any of my staff are not scheduled
3. Patients must leave a credit card on file which will be charged if they no show or late cancel
4. Patients must fill out a 25 page new patient intake prior to being seen. No intake, no consult.
5. I opted out of Medicare
6. I do not take Medicaid
7. I do not take workers comp/L&I
8. I do not take community health plans

Due to #1 primarily, we turn away a high percentage of new patient calls and physician referals.

I cant imagine a pain clinic where you have to take all comers no matter what. Total nightmare and insulting.

I get maybe one inappropriate patient per month this way.

Addendum: I should add 99% of my patients are very pleasant, motivated, and cooperative as a result. I enjoy working with my patients as a result. No drug seekers, no disabiliy seekers. They just want to get better.

 

[DOctorJay]

but was it directly emailed to you in take home $$$ ?
RVu conversion is still a guess excluding outside income, admin income, stipends, research grants, etc.

We don’t have any of that. We know exactly what each other make based on what’s sent out monthly but some simple calculations are required.

 

[DOctorJay]

2 referrals this week.

One for a patient on oxymorphone 30 TID who is from Florida and spending 6 months here and was told to establish with a pain management specialist. No thanks.

Another referred who is being treated for sepsis and abscesses currently from injecting heroin. No thanks.

 

[drusso]

2 referrals this week.

One for a patient on oxymorphone 30 TID who is from Florida and spending 6 months here and was told to establish with a pain management specialist. No thanks.

Another referred who is being treated for sepsis and abscesses currently from injecting heroin. No thanks.

Get out.

P.S. Credit card on file for no-show's and cancellation promotes accountability and should be a best practice for all health care organizations.

 

[Ligament]

Get out.

P.S. Credit card on file for no-show's and cancellation promotes accountability and should be a best practice for all health care organizations.

My no show rate is very low.

 

[Gauss]

I didn't say turn-away referrals. I said triage/screening patients so that they get "the right care," "at the right time," with the "right clinician." It's not rocket science. A 39 year old obese female with history of bipolar and fibromyalgia on Vicosomaxannax does not need to meet the double-board certified, fellowship trained pain specialist on the first visit. That patient needs to be processed by behavioral health, presented in multi-disciplinary review, and told what's "on the menu" and "not on the menu" before taking her order. Otherwise, these patients are just "shopping at Bergdorf's." Lot's of stuff they want, but nothing within their reach. Screening promotes efficiency, the right kind of access, and improves satisfaction by "setting the agenda" early in the phase of treatment. That also free's up medically trained clinicians to focus on the patients with urgent medical needs and do productive work.

completely agree, i've been preaching the same "right physician, right care" gospel for years. but that's not how it works in hospital systems which Jay is stuck in. leadership's response: "well they (pain specialist) can still see the patient as a 1 time consult and then direct them to the appropriate care". makes sense right - a specialist doing triage? but that's how it works in that world. it's probably best to get out asap while he still has a good rep there and you have their support. over time they'll grind you down and you end up being 'disengaged' or worse a 'disruptive' physician. those that stay and try to make it work follow this:

1. Maintaining an emotional distance, an arm’s length relationship, with your employer, your department, your Hospital (system), and or your University (if applicable) may help stave off bitterness.

 

[Ligament]

THats right. "disruptive" physician. Not a good corporate citizen. Guilty of wrongthink and likely wrongspeak. Welcome to 1984.

 

[Doctodd]

Hospital board guy says “ if there’s no margin there’s no mission. “

 

[myrandom2003]

I tried to implement a screening process but the request went into the void and patient still get on my schedule.

 

[hyperalgesia]

I tried to implement a screening process but the request went into the void and patient still get on my schedule.

You have to speak in Admin language: "I want to implement an improved access, satisfaction, and efficiency program".
You could execute a pilot with surveys, etc.

 

[callmeanesthesia]

You have to speak in Admin language: "I want to implement an improved access, satisfaction, and efficiency program".
You could execute a pilot with surveys, etc.

Agreed! Need to make the point that opioid patients who don’t get opioids are notoriously the most unhappy (admins are going to be familiar because it’s the prototypical example of the problem with patient satisfaction surveys in the ER). Screening of referrals by the receiving Dr prevents sending patients away unhappy after a visit. No visit = no satisfaction survey.