How to be productive

[Goodlife1119]

---

Members do not see this ad.

Hi all,

I am looking for this group's collective wisdom. I am a new grad building up a practice in a hospital outpatient setting. I am wondering what are some ways to increase my productivity from a clinic/billing/procedural stand point in a way that is *ethical and considered good medical practice*. I understand that building up a patient panel will take time and connections but my question is geared towards what can I do to become the most productive with the few patient's I have. Some ideas I have include spending cme money to taking a billing course so that I can optimize that specific aspect. Another idea I have is having patient's on opioids return to the clinic monthly for close follow up which also means I will have more frequently returning patient's to see and less portal messages to rx refills. (Also please let me know if you think this is a bad idea).

But im open to other thoughts.

-Thanks in advance.

 

[BoardingDoc]

Hi all,

I am looking for this group's collective wisdom. I am a new grad building up a practice in a hospital outpatient setting. I am wondering what are some ways to increase my productivity from a clinic/billing/procedural stand point in a way that is *ethical and considered good medical practice*. I understand that building up a patient panel will take time and connections but my question is geared towards what can I do to become the most productive with the few patient's I have. Some ideas I have include spending cme money to taking a billing course so that I can optimize that specific aspect. Another idea I have is having patient's on opioids return to the clinic monthly for close follow up which also means I will have more frequently returning patient's to see and less portal messages to rx refills. (Also please let me know if you think this is a bad idea).

But im open to other thoughts.

-Thanks in advance.

If you've already opened the door to writing narcs, go ahead and see them monthly. Easy 99214 and justifiable. That said, you're going to get portal messages from this subset of patients a lot anyway.

If you don't have them already, come up with your own personal rules about what you will and won't prescribe. MME cutoff, no to dilaudid, no one can be on concomitant benzos.... whatever. Your monkey, your circus. That said, it is YOUR circus so you better have a plan when someone invariably tells you "my pain is a 9000/10 on oxy10 TID. My last doctor gave me oxy 20s QID plus a fentanyl patch and that's the only thing that worked." God, I hate COT.

Taking a billing course is a waste of time and money. Look up the E+M coding guidelines if you don't already know them. It isn't hard to figure out who is a 99213/4. What will be more useful is looking up the medicare LCD for every procedure you do and knowing what it takes to qualify to get it. Same thing with the coverage guidelines from your major insurers.

If you've never been a practicing attending, start working on your ability to politely tell patients to shut up and stay on topic. Letting them ramble on and on about something that happened in 2007 is rarely going to be a good use of anyone's time. Figuring out how to do this now, when failure has little consequence, is much better than failing at it when you have a full panel and are habitually running behind.

 

[DOctorJay]

you're a wRVU generator as a hospital employed physician.

find the list of codes and they're respective values and you'll quickly see what things to do and what not to do (ultrasound guided joints).

you want to maximize level 4 visits and procedures that yield at least the same as a level 4 office visit follow up for similar time spent (1.92 wRVUs for 99214). understand what it takes to bill a level 4 visit and don't undercode.

you should be doing bread and butter procedures in 15 minute slots or less but make sure you're safe and comfortable with that speed. if not give yourself time to work towards it.

some in this forum do monthly opioid visits, some do every other month, some do 3 months. do what you're comfortable with.

don't waste your time on peer to peers, find out why it was denied and fix it.

when first starting out bring all your MRI reads back in the office to review the findings and determine next step, bring all your MBBs back in for next step, etc until you need more spots to open up for new patients.

you are only paid on your wRVUs (presumably). so maximize your wRVU generation and delegate out as much of the other stuff as you can to your staff.

eventually they may want to add an NP/PA to help you. recognize that may actually decrease your wRVU production (consults/new patients are worth less than 99214s per unit time).

this is simply a list to maximize your wRVU nuggets. first and foremost be a great physician and put your patients' needs first ahead of profits.

 

[clubdeac]

Get a good scribe or AI for notes

 

[BobBarker]

Yes, absolutely crush those office visits and unilateral RFA’s. Nothing pencils out as good, especially starting out.

 

[NVO]

Yes, absolutely crush those office visits and unilateral RFA’s. Nothing pencils out as good, especially starting out.

Unilateral RFAs? Better than doing bilat in regards to practice management?

 

[BobBarker]

The hospital gets the fat facility fee twice.

 

[Ducttape]

sometimes. some savvy insurance companies will not pay for the second side unless a reason is given (for example cervical rfa)


one last point i did not see brought up - once you start on opioids, you will forever be labelled as an opioid prescriber.