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Filling Forms For $$ as a Licensed Resident.

Discussion in 'General Residency Issues' started by Faebinder, May 9, 2008.

  1. Faebinder

    Faebinder Slow Wave Smurf
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    It seems like half the patients come with some sort of a form (Disability, Time Off Work, etc) that a physician needs to fill.

    Each form could take up to 10 minutes and an attending's time is just worth more than that. Some providers even charge for this service, while others have their midlevels do them.

    So how about a resident doing that on the side for $$? Like $7.00 per form.

    Has anyone done anything like that and is it doable?
     
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  3. Doowai

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    I know people who review medical bills from hospitals, when people are stuck paying cash for hospital services, to find discrepencies to help people cut what they have to pay - you know like $125 for a box of Kleenex. Medical bills are one of the main reasons people declare bankruptcy. You pick over it and tell them : $25 per Dilantin is unreasonable, ask them to cut that to 25 cents. etc
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    Give me a call...we charge patients $25 to do it. You do it for $7.00 and I'll collect the $18 "Finder's Fee"! :D
     
  5. Faebinder

    Faebinder Slow Wave Smurf
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    Desperate time calls for desperate measures now a days :( Someone gotta pay the gas, and it aint medicare.
     
  6. Tired

    Tired Fading away
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    In medical school I needed a physical for the military. The local branch health clinic said there was a one month wait. My health plan said they could do it the next day.

    Once I get there, I find out that they require cash up front (despite being an HMO). $120 for a five minute physical exam and 4 pieces of paper filled out. An extra $50 for the HIV test. What a great racket.
     
  7. $25???

    Hell I'll do it for $5!
     
  8. Winged Scapula

    Winged Scapula Cougariffic!
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    I know it seems like a lot but these forms can be very time consuming and I figure my time is worth $250/hr.

    When you factor in my observation that some families try to take advantage of a member's illness (ie, a patient I operated on last week has a very large family and I got no fewer than SIX FMLA forums to fill out - all for a woman that has a husband at home and who doesn't need any special "round the clock care". Seems everyone wants to take time off to care for her.:rolleyes:), it seems fair to me.
     
  9. Chronic Student

    Chronic Student So Fresh, So Clean
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    I'm one of those midlevels that gets to fill out all those forms :(

    I also have my "special" patients (read PITA), do all the d/c summaries, get stuck with most of the H and P's, do the consult notes, write for all the umpteen-million home meds (because "resume home meds" is not acceptable), etc, etc.

    I know, I know, I made my bed and I'll lie in it.

    All you midlevel haters out there just remember that after your 10th FMLA form and your 20th d/c summary.
     
  10. I have filled out SO many of those damn forms. FMLA, Medicare/Medicaid, disability, etc... :(
     
  11. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Yeah, and I'm one of the interns who fills them out since our program doesn't have midlevels. I particularly like getting handed the form by an attending on a patient that came through a month I wasn't on service. Nothing like making me go through their entire chart so I can see why they want this filled out.
    I also appreciate having to look up diagnostic codes, since it isn't like we have a coder or anything that does their surgeries, why can't they code the forms too?

    Karma is me holding on to them next month and not completing them before I leave, I guess.
     
  12. Faebinder

    Faebinder Slow Wave Smurf
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    It seems that many surgery institutions have not logged on to the idea of charging for these forms despite the amount of work time they require.
     
  13. Puffle

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    Just remember that when you sign said form, it's your liability. I'm in psych, and had a patient request a note saying she "needed" a pet dog to help her depression. I told I'd give her a note after she fostered a dog from a local shelter(she had never owned one) and felt that it helped. When she came in for follow-up, she had gone ahead a bought a puppy that she just adored, but her husband didn't. He left her.

    If I had written that note, she might have blamed me for the divorce. Although it's a stretch, in the right lawyer's hands, a jury could have bought it. So as tiresome, tedious, and seemingly thankless task paperwork is, it shouldn't be taken lightly. And just remember, we are getting paid for this, and it's just part of the job.
     
  14. Winged Scapula

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    I agree - its quite a stretch and I would find it hard to believe that a jury would buy that unless you had a really crappy attorney who couldn't argue how ridiculous that would be. But I digress...

    I disagree with this. My job is to offer medical evaluation, advice and treatment. I am very poorly paid for this given the years of training and expertise required. Nonetheless I am accepting and even happy to complete some of these forms. My office staff will complete what parts they can.

    But when it comes to THREE pages of endless questions which may or may not have an answer, or multiple forms for multiple family members, I draw the line. I cannot possibly tell the employer the exact date the patient will be back to work, whether or not they will have treatment complications which require additional time off or if they will need future treatment. They are asking me to get my crystal ball out...if that isn't rife with potential for fraud and lawsuit, I don't know what it is.

    So I will fill them out, but when it takes me that much time (because of course they won't accept my office notes in lieu of the forms), then I feel its fair to charge for it. I don't charge my patients to copy their medical records (where many offices do), for cancelled or missed appointments and send lots of letters and make phone calls to assist them in their care...for free...so in my defense, I feel it evens out.
     
  15. Faebinder

    Faebinder Slow Wave Smurf
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    No we are not. Maybe you are, but as a resident, as a fellow and even the attending... you are not getting paid for the 10 minutes you spend filling a form. If you feel you are getting paid, then clearly you dont value your time. Will your reimburisement change if you do or do not fill those forms? Then you are doing it for free and out of niceness and at a certain point that needs to stop when a bunch take over an hour of your life. How come the guy in McDonald values his 10 minutes but you dont?
     
  16. Tired

    Tired Fading away
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    Ah, the wonderful disability forms:

    1) Is patient suffering from a condition that will prevent him/her from working for the next 12 months? I don't know, he was in a car accident last week and is still intubated and sedated.

    2) Could the patient return to work if appropriate accomodations were made to his work environment? Yes, if you had a ventilator on site, and his job consisted of pooping in a bed.

    3) What further treatments will the patient require over the next year? I don't know. I'm the covering intern in the ICU. I don't do outpatient management. Maybe you should ask one of the 14 subspecialists who are following him . . . oh wait, they were the ones who gave me this form to fill out.

    4) What is the patient's prognosis for each diagnosis listed above? Um . . . honestly, I don't know, 50-50? Oh wait, this is supposed to sound all serious and medical. "Prognosis is guarded". That sounds better.

    5) Describe the required outpatient treatments and followup that will be necessary for patient to manage his disabling condition, including all types of therapy and medication that will be required. Did you seriously give me two lines to fill this section out? What are you, some kind of sadist?

    6) Below is a list of all body parts and organ systems in the human body. Using a rating scale of 1 through 5, indicate the degree of disability the patient will suffer from in each area in the next 12 months. Appendix 14C of this form also lists assorted clinical descriptors that may or may not apply to each area/organ system; please annotate your answers using the roman numeral correlating with the appropriate descriptor. All answers must be typed in Sanskrit, and failure to follow the above directions will result in this form being rejected, and large men sent to your house to beat you about the head and neck. What?

    7) This form may only be completed by the attending physician. <sigh>
     
  17. Winged Scapula

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    :laugh:

    Exactly. I'd love, just once, to put answers down like yours and make these people see how ridiculous this is.

    For those that have not seen these forms, these questions (save for the last) are pretty much word for word what they want. Even for non-intubated ICU patients, it can be hard to assess what possible treatments the patient might need. Oh, I dunno...maybe some chemo, maybe some radiation, maybe some PT. Do I look like a fortune teller? (don't answer that).
     
  18. MSHell

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    So, then, how do you actually answer these questions seriously?

    (you should just send them back a signed form, nothing filled in and include your crystal ball)
     
  19. Tired

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    It's all about your goal. I think that we can make reasonably accurate guesses about where people will be in a year. Rutured spleen, liver lac, TBI, persistent neuro impairment 2mo post accident = disabled for a year. Broken leg, laceration to arm = not disabled for a year. It's the specifics that cause problems.

    Also, consider your goal. Do you think this guy is going to need prolonged assistance for a disability? Then tailor your answers in that direction. Think he's just b*llsh*ting to try to get on the public dole? Then answer with that in mind.

    The long and the short of it is this: (1) Give you best estimates as a medical provider, because even if you're wrong in the long-term, your guess is still better than everyone else's, (2) Answer honestly, but also in general terms; you don't have to try to be ultra-specific, (3) Tailor your answers to the services you think the patient will need long-term.

    You don't work for these insurance or public assistance agencies. You work for the patient. Do your best to take care of them.
     
  20. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Most of them that are true "trauma" patients are trying to get on the public dole. The normal people (except for the daily 80 year old that falls off his roof) typically leave after their traumas. Sometimes they stay for a week. To get a serious neuro injury? You have to be doing something illegal apparently.
    Oh wait, normal people have decent insurance and end up at some neuro rehab somewhere, not in the rock garden upstairs.
    Why do the crappy trauma patients always have 40 family members in the room? Why don't they move when you come in? Why don't they SHUT THE HELL UP when you are trying to use your stethescope to pretend like you care what the patient's lungs sound like [caveat-important only in patients with chest tubes].

    Best public service announcement on TV should be "Are you older than 40? Do you have trees in your yard? If so, then pay a professional to clean your gutters. Here are some pictures of people who try to do it themselves." As for me, once I crest 50, I'm not even climbing on a chair. Old people simply fall too much, and if you break a hip from standing, think about it from 8 feet.
     
  21. fuzzyerin

    fuzzyerin Senior Member
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    I hate disability forms. I especially hate it from our pregnant patients. The last time I checked, it's not a disability. My favorite was the people who would come in asking them to be filled out at 14 weeks because "my ankles are swollen" when I had a colleague 38+ weeks pregnant, working a 80 hour work week. I would look at these people, point at my colleague running around the office and explain to the patient that, indeed, she could sit at the desk in her office and push papers around, and no, I wasn't going to sign the form.

    And crystal balls? I wish I had one. Not just for the prognosis stuff on the disability forms, but for the inevitable "when do you think I'm going to have my baby?" My answer to that is now "if I could answer that, I'd just do that for a living instead of this. I'd make a lot more money."
     
  22. Tired

    Tired Fading away
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    My favorite part is when you've spent 80-100hrs/wk dragging them back from death, nursed them through three operations and and a half-month ICU stay, explained their situation to the family and patients dozens of times (usually though the PITA translator phone), motivated them to work with physical therapy, and indulged their 40 relatives with cots in the waiting room and 2am pages to "talk", knowing full well that they will never pay one stinking dime towards the million bucks in charity care they are getting despite being a drug dealer who mowed down three kids while simultaneously driving drunk and beating their wife.

    And after all that, you transfer them to the floor, whereupon their "baby mama #4" accuses you of providing substandard care by not giving them a private room.
     
  23. nykka3

    nykka3 Senior Member
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    Really? Sign me up....I'm serious. I will be a resident in just over 1 month.
     
  24. Chronic Student

    Chronic Student So Fresh, So Clean
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    Ahhh, how many times have I had that same situation happen. TNTC.

    BTW, the accomidations to return to work with the ventilator and pooping in the bed. One of my favorite lines EVAR.
     

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