YouDontKnowJack

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is it out of benevolence that doctors ask for follow-up visits with pts, or is it just a sneaky way to charge the pt for one more consultation?

What's the difference between "I would like to see you in 4 days" vs "See me if it doesn't seem to get better.." ?


I'm not against making more money. But I would like to know how the game is played. :smuggrin:
 

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is it out of benevolence that doctors ask for follow-up visits with pts, or is it just a sneaky way to charge the pt for one more consultation?

What's the difference between "I would like to see you in 4 days" vs "See me if it doesn't seem to get better.." ?


I'm not against making more money. But I would like to know how the game is played. :smuggrin:


See me if it doesn't get better = Return for visit PRN.

If someone is telling you to come see them in four days, they usually have a good reason. Your conclusion would be reasonable if physicians didnt have enough patients, which I am sure is not the case for most primary care docs.
 
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Follow-up visits for routine conditions are generally scheduled in order to establish and document that you're meeting the standards of care for efficacy (e.g., is your blood pressure/cholesterol/diabetes/chronic pain/depression/insomnia/whatever well-controlled, or has our newly-initiated treatment helped) and safety (e.g., monitoring for side-effects and/or toxicity - lab work, etc.)

I don't schedule follow-up appointments for conditions that are expected to resolve either on their own or with treatment in a single visit (e.g., URIs, back pain, etc.) I tell patients specific conditions under which they should return, however (e.g., if you're not better after 2 weeks, etc.) If we're more concerned than usual, sometimes we'll place a follow-up phone call to a patient after a day or so to make sure they're doing better, and document their improvement in the chart. That closes the loop in many cases.

There are certain conditions (e.g., cellulitis, pneumonia, burns, intractable migraines, asthma/COPD exacerbations, etc.) where I ask patients to come back for follow-up even if they think they're completely better simply because of the potentially serious nature of their illness, and my desire to ensure and document that it has indeed fully resolved. In some cases (migraines and asthma, for example) we also may need to work on improving a patient's long-term control.

It has nothing to do with money. I'm busy enough without bringing people into the office who don't need to be there.
 
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It has nothing to do with money. I'm busy enough without bringing people into the office who don't need to be there.

If anything, I would say you would loose money. For example, you could be seeing another patient with a new complaint that requires a full work-up or some kind of minor office procedure. Both of these would generate more revenue (higher reimbursment) than a routine follow up visit. Isn't that correct Kent?
 
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If anything, I would say you would loose money. For example, you could be seeing another patient with a new complaint that requires a full work-up or some kind of minor office procedure. Both of these would generate more revenue (higher reimbursment) than a routine follow up visit. Isn't that correct Kent?

Exactly. :thumbup:
 

YouDontKnowJack

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i see. I can understand a busy doctor not really wanting a followup.

however, in my experience, a dermatologist who has open appointment slots available in the same week, wants to follow up on eczema after giving a big cortisone shot and potent steroid creams......
He was pretty confident that the eczema would clear up, and it did. So was the followup really necessary? One thing to think about is that the office visits start at over $100 in cost.
 
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however, in my experience, a dermatologist who has open appointment slots available in the same week

Who? Where? When? I have 10 patients RIGHT NOW that can fill up those spots. That's "I pick up the phone and 2 minutes later have all spots filled" patients.

I mean, unless people are canceling on him, for example, Peds Derm at Duke is 6 months - SIX MONTHS - booked solid. Solid, like logjam/gridlock/impacted concretion stool solid.
 

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I agree with the above posts that point out that most follow ups for minor complaints are brief, problem focused visits (99212) and aren't reimbursed well. And regardless of how cheery your bedside manner, patients don't want to see you if they don't have to. You could end up losing a patient because you keep inconviencing him/her with frequent "follow ups" for non-issues.

So, even from a business aspect, I don't think its good practice. Unless you are overbilling and commiting fraud. Then it might be lucrative, though your career will be short-lived.
 
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And regardless of how cheery your bedside manner, patients don't want to see you if they don't have to. You could end up losing a patient because you keep inconviencing him/her with frequent "follow ups" for non-issues.

Undoubtedly. Shoot, I've even lost a few patients because I wanted them to come in twice/year for their HTN. Hell, even their dentist expects to see them that often! ;)
 

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Actually, the 2nd day of Step 3 (simulator) will test your ability in doing this.
 

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I'm in a heavily managed-care area of Southern California. Follow-up visits don't generate any income (beyond that hugely lucrative $5 co-pay) -- so if I'm asking for a patient to come back, there's a reason.

As a primary care doc, it's best to avoid having patients come-in more than necessary. Otherwise they fill-up appointment spaces that new patients or 'higher-disease-priority' patients could use.
 

YouDontKnowJack

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I'm in a heavily managed-care area of Southern California. Follow-up visits don't generate any income


Do they not, really?

I have to correct myself. The follow up visit cost $70... for just 3 minutes of chit chat. That's a pretty high hourly rate!

Why would you not want to schedule a short follow-up if it will only waste <5 minutes of your life? Do insurance companies not reimburse followups 95% of the time?

I have a high deductible insurance plan, and all that just gets tacked onto my bill, so essentially, I'm paying out of pocket.
 

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Do they not, really?

I have to correct myself. The follow up visit cost $70... for just 3 minutes of chit chat. That's a pretty high hourly rate!

Why would you not want to schedule a short follow-up if it will only waste <5 minutes of your life? Do insurance companies not reimburse followups 95% of the time?

I have a high deductible insurance plan, and all that just gets tacked onto my bill, so essentially, I'm paying out of pocket.

Gosh... where were you when we had that thread with the long discussion about overhead and collection percentages.
 
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I will do everything in my power to avoid being a provider in a capitation style program. The only losers there are the doctors.
 

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Sorry, I don't know much about capitation, and whether my insurance program has this limitation.... My plan is a blue cross PPO program. Are these usually capped?
 

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I will do everything in my power to avoid being a provider in a capitation style program. The only losers there are the doctors.

Our residency clinic, which pretty much lives and dies by the medicaid population, does make money. (The medicaid HMO's in PA are all capitated)Of course, we are pretty much the only provider around who takes medicaid, so as soon as someone selects us as their PCP after qualifying for medical assistance, we start getting paid whether we see them or not. And, obviously, residents are cheap labor.

But I think if you are comprehensive and aggressive in managing the chronic conditions and keep them healthy (i.e. out of your office) then having a portion of your patient base capitated may make money for you, perhaps in the doldrums of summer. But I'm not quite in the real world yet, so I could be wrong.
 
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Obvious conflict of interest. There is a perverse incentive to see patients less often in order to maximize profits. Sure, the theory is that "if you keep them healthy, they'll need to see you less often," but considering the precious little influence physicians have over the lifestyle choices made by their patients, I have no interest in assuming that risk.

Fee for service, baby. ;)
 

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Obvious conflict of interest. There is a perverse incentive to see patients less often in order to maximize profits. Sure, the theory is that "if you keep them healthy, they'll need to see you less often," but considering the precious little influence physicians have over the lifestyle choices made by their patients, I have no interest in assuming that risk.

Fee for service, baby. ;)

Well, we (doctors) brought that upon ourselves. If those who came before us didn't abuse the system, the public would still trust us. I think they still do, but everyone gets suspicious when big money is involved. Luckily these days, the animosity is shifted towards the pharmaceutical companies.
 

YouDontKnowJack

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Well, I guess I got jacked then. Next time I'll know better.

My PPO plan probably doesn't have capitation, so the more the doc wants to see me, the more he makes.

fool me twice, shame on me.


This brings me to another thought..... if you knew your pt did NOT have a capped insurance plan, would you take advantage of him? more money for 3 minute followups.... :smuggrin:
That's technically not fraud is it.... I mean, I really really really want to be sure my patients are fully healed, even if it takes 2 more followups. eh?
 
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if you knew your pt did NOT have a capped insurance plan, would you take advantage of him?

Follow-up visits are always based on medical necessity, regardless of the patient's insurance coverage. You should never let money interfere with practicing good medicine.

One annoying thing about capitation is that it forces me to refer more stuff out. I don't do any biopsies or lesion removals on my capitated patients, for example...they all get sent to surgery or derm. It's not worth my time.
 

YouDontKnowJack

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You should never let money interfere with practicing good medicine.


Easier said than done. I should tell that to my derm. His secretary was spending all morning chasing after followups while I sat in the waiting room. :rolleyes:
 
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