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No MBB patient ever said that. But it did not lst, how long should it last. My back still hurt (we injected your neck). Why do I need these in a series of 3, can't you just burn the nerves already.
Clinic Ins and Outs- MA’s, Scribes, APP’s
Started by TeslaCoil
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thats true. but the only real nugget i care about is if the mbb made the back feel better. the rest is fluff. i dont care about percentages, numbers, duration. none of that
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hows your neck pain?
bad.
did the last injection last for 3 hours?
maybe. so my sister kicked me out of her house because she said i wasnt paying enough for the food and i forgot to do my dishes so i tried to mvoe back in with my mom and i need a refill of my buspirone and lisonpril which i havent taken in a week thanks and my doctor did change my medication and said the heart attack i had last month was a mild one but i should go back on medication thats some kind of blood thinner because he put a 4th stent in but i thought this appointment was for the epidural for my lower back that lasted for a while like 4 months and can you fill out my SSD paperwork?
And I left my meds at my sister’s house and she won’t give them back, and my other doctor wouldn’t refill them. Can you refill my oxys for me? I just need enough to get me through to next month.
Please send me a copy of the police report.
Stop poaching my patients
I don’t replace meds with a police report. I only use it to determine if I am firing the patient. If it shows they were not careful then, bye bye. The report just is collection of statements, usually lies.
I've never had a patient folllow through with the police report.
And to think you support and champion policies that only enable and encourage life long disability and victim mentality from these patients. You made this bed
And how did you draw this conclusion?
I posted it as a humorous and not inaccurate accounting of common interactions with patients. You appear to have taken offense to it in some fashion or other. Apparently politics?
Your logic is circumspect at best and purpose of your post is the same.
I posted it as a humorous and not inaccurate accounting of common interactions with patients. You appear to have taken offense to it in some fashion or other. Apparently politics?
Your logic is circumspect at best and purpose of your post is the same.
Alright so to begin, I’ll have one APP. For a starting clinic schedule I was thinking 8 New Patients and 10 Follow-ups of my own spread evenly throughout the day plus an additional 6 news that the APP works up which I step in on. 8-4 PM schedule. 3 days of clinic per week. 2 procedure days. What do you guys think? Doable with no scribe? They do have DAX AI which I might use.
To clarify, you mean you’ll see 18 during the day while the mid-level sees 6 — and you’ll check out their patients as well?
Yes. Shared visit on those 6. I get the wRVU cred for that in this hospital role.
if you see 18 and walk in on 6 with them and get credit that's amazing. Super easy day. Cake walk and you get credit for 24 patients at $77/wRVU. Now that's good livin my friend
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7 figures if you work 205 days at that volume. Outstanding.
I would generally say the Midlevel is very unnecessary, but if you’re getting the RVU and the hospital is paying them, and your workload isn’t too high so you can actually make sure they’re not doing insane/illegal stuff, so that seems like a situation where a midlevel may actually be more good for you than bad.
I would generally say the Midlevel is very unnecessary, but if you’re getting the RVU and the hospital is paying them, and your workload isn’t too high so you can actually make sure they’re not doing insane/illegal stuff, so that seems like a situation where a midlevel may actually be more good for you than bad.
Yes! And you can run a “midlevel salvage” in this setup to mitigate no-shows. So when one of your patients no shows, you can step in on an additional visit with a midlevel. Like for a follow-up. So you’re not losing rvu’s.
That’s excellent. I’m not sure I want the hassle/any responsibility for a midlevel anymore (after having many bad experiences in the past)—but if I were to I’d need legit reimbursement and oversight as it sounds like you arranged for yourself. Depending on how your contract reads, there’s a decent chance in a year or so the hospital and midlevel may push back on the setup once they “become experienced” [/s]…and you may need to be ready to tell them that if that’s the case they can stay but need to be 100% responsible for their own actions and you’re not co-sign’ing or formally supervising sh it.
Oh, as long as they are practicing on my license, I’ll make sure to be getting some benefit from it. Or they can find a different doctor to pseudo-supervise.
i dont either
And you dont get compliments from patients having to pay a 40.or 60.dollar copay for a 1 min visit? In my locale no patient would be happy with that. There would mass complaints
Not my problem. Blame insurance. If they want their RF, this is what you have to do.
At this point in my career, I try my best to to do a good job and if a patient doesn’t like it? Shrug. I have a 3 month wait list
i tried that.
the problem is that, system admin see the "double dipping" of rvus as financially unsustainable and will require the APP to generate a certain amount of rvus. the APP is working for free for those visits, and not "to the highest level of their capacity" even though your efficiency is higher.
back in the day, i also had the advantage of having rvus generated by the physician as higher than the APP (85% of physician rvu).
that system flew for about a year.
the problem is that, system admin see the "double dipping" of rvus as financially unsustainable and will require the APP to generate a certain amount of rvus. the APP is working for free for those visits, and not "to the highest level of their capacity" even though your efficiency is higher.
back in the day, i also had the advantage of having rvus generated by the physician as higher than the APP (85% of physician rvu).
that system flew for about a year.
Who is the doctor here? You decide who you see, not admin. I want that easy 99214. APPs get the Latina with a million non focal complaints and the guy who only decides to show up every third visit and the LOL who has more pain a few days after her ESI
i should point out that i was responding to Teslacoil's posts:
unless you are paying the APP directly, admin gets decide how their time will be spent.
unless you are paying the APP directly, admin gets decide how their time will be spent.
Nope. Ive already asked and they have given me the reigns.
oh yes. the classic "go ahead, run it the way you want."
they allowed that for 2 years in my case. maybe you will get lucky.
they allowed that for 2 years in my case. maybe you will get lucky.
Im not the only doc here. Im following suit. I don't think the hospital system wants to piss off its doctors. They’re pretty desperate for docs. I know the game you speak of well though. Hospital admin is scum. Absolute scum. This hospital is entirely run and managed by physicians.
Yeah until they say no we don’t want that anymore
That’s what they want you to think
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Dont be jealous. 🙂
Definitely not, been there and left that same situation
Care to share why you left, and where you went?
Thats fair but one of the pain docs here has been there 20 yrs and says nothing has changed which is why he stayed. Hey if they f me im out.
This attitude perfectly describes everything wrong with the US healthcare system. Just imagine how you would feel if you DID have skin in the game?
Money they were paying was great but not worth the poor care I was only able to offer.
Started a private practice and making just as much and will make more soon.
100 %. I don’t deny it
im sorry but the implication that i get from this statement is that making money is the key to better care...
how specifically are you offering better care as a PP doc?
By controlling the means of production.
he said "specifically". you could not get more "general" with your answer
I’m able to get patients in faster and provide timely care without unnecessary delays.
I can shape the work culture around patient experience, accountability, and professionalism — without the burden of disengaged staff affecting the quality of care.
I can hire the right people, including staff who actually answer the phone when patients call, instead of letting operational issues linger for years.
I can keep costs lower for patients by avoiding unnecessary facility fees for office visits or simple procedures. Patient with commercial insurance pay a lot with the facility fee games.
If a patient has a problem, I can address it directly rather than redirecting them into a hospital system maze.
I have the flexibility to adjust my schedule to meet patient needs rather than institutional constraints.
Money never drove me into medicine, and it certainly didn’t drive me into pain management. Patient care did.
In other words, "I'm accountable."
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good for you.
but it sounds like you were not working with a responsive healthcare system.
with the exception of the facility fee, none of those cannot be done with a responsive and responsible admin.
i have been in a system that had such a responsive admin that engaged and interacted weekly with physicians.
oh and i cant tell. is that steak or actually a turkey leg, (which wouldnt be red meat per se)
but it sounds like you were not working with a responsive healthcare system.
with the exception of the facility fee, none of those cannot be done with a responsive and responsible admin.
i have been in a system that had such a responsive admin that engaged and interacted weekly with physicians.
oh and i cant tell. is that steak or actually a turkey leg, (which wouldnt be red meat per se)
I’ll say that most are that way but I can imagine there are exceptions to it.
Typically, midlevels in pain have their own production target. I could conceive the scenario where they roll the midlevels expense into the practice overhead and let the doc take some of the excess. This is what they do a lot with ortho where the midlevel is covered up with post ops in the 90 day global. In the scenario of a new practice there is no reason for a midlevel. My first day at the hospital, I had 13 on my schedule. I would not recommend a midlevel until you are personally seeing over 40 patients a day. At the private practice, I had a midlevel for the first year. I brought her on as I was still working at the hospital. That was a mistake.
The midlevels here are production incentivized and therefore have a mostly independent schedule, however, I think doctors forget one very important detail these days. And its one hospitals absolutely love to try to bury. PA’s still need a supervisory agreement with a doctors name and liability on it. Therefore, the doctor had better be getting something out of the deal. In my case, when I step in on the 6 news or any other follow-ups as necessary, I get the wRVU credit. Of the 4 hospitals where I interviewed recently, two did not allow this and two encouraged it. The two that didnt allow it seemed sorely disappointed that I had discovered their nefarious intentions, which by the way, were not stated anywhere in the contract or any other policy they voluntarily gave me. I had to literally dig it out of them. Those were also the two hospitals who offered the most absolutely pathetic offers and most predatory contract. Run by typical non-clinical suits.
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We pay our advanced practice providers on production just like their supervising physicians.
