raptor5

Fooled by Randomness
Gold Donor
15+ Year Member
May 28, 2003
1,070
35
Without cell reception
I have heard all the pros and cons to seeing your own patients in the hospital but I just want to hear more thoughts about this. Continuity of care is a great argument but what about the time, coverage, hospital BS involved, peer involvement. It seem as though if you opt out you really isolate yourself as solo doc.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,405
5,223
Status
Attending Physician
raptor5 said:
I have heard all the pros and cons to seeing your own patients in the hospital but I just want to hear more thoughts about this. Continuity of care is a great argument but what about the time, coverage, hospital BS involved, peer involvement. It seem as though if you opt out you really isolate yourself as solo doc.
Re: the isolation issue, I'm actually on the medical staff of the two closest hospitals (with "courtesy" or "community" privileges). I can't admit patients, but I have a hospital ID, am listed on their web page, can attend CME events and departmental meetings, have access to the physicians' parking lot and doctors' lounge, can review patient records, and generally roam the hospital unmolested as long as I have my ID on. It's a lot easier to make "social visits" to hospitalized patients this way. In theory, I could also more easily upgrade my privileges to allow me to admit patients, should I ever need to do so. Insurers seem to like the fact that you've been able to obtain privileges, too...I guess they figure you don't have any skeletons in your closet. ;)

It sounds like you're already familar with the time, reimbursement, and coverage issues, so I won't belabor those.
 

RuralMedicine

Senior Member
Moderator Emeritus
15+ Year Member
Jan 11, 2003
414
47
Status
Attending Physician
raptor5 said:
I have heard all the pros and cons to seeing your own patients in the hospital but I just want to hear more thoughts about this. Continuity of care is a great argument but what about the time, coverage, hospital BS involved, peer involvement. It seem as though if you opt out you really isolate yourself as solo doc.
The hospital I admit at does not have a hospitalist team so if I didn't admit my patients they would go to the physician on unassigned call. I suppose that would be an option (there is a cadre of FPs who do not have privileges in our county) but it didn't seem right at the time. I do think that doing your own hospital work is time efficient overall and you never have to worry about being out of the loop. (Although I do make it a point to call the physicians who don't have privileges before I discharge their patients back to them and I ensure they get a copy of my dictations.)

One drawback of doing inpatient/outpatient is that there will be at least a few times you truly need to go back to (or stay at) the hospital and leave patients waiting in your office. How your patients accept/ react to that I think depends somewhat on the community. Here that is more the norm and most of my patients have reacted with understanding recognizing where they would want me to be if they were on the other side. I also try to give my office staff as much of a heads up as possible (sometimes it's just not possible) and I think that they have done a good job of ?entertaining I suppose my patients when I'm detained intubating in the ICU or admitting a critical patient from the ED. For me it's also convenient (and easier) that my office is literally across the street from the hospital.
 
About the Ads
OP
raptor5

raptor5

Fooled by Randomness
Gold Donor
15+ Year Member
May 28, 2003
1,070
35
Without cell reception
I can imagine it would be a different story if you were some distance from the hospital or had more than 1 hospital. Here in the NE some family docs admit to more than 1 hospital.That seems like lunacy. I personally plan on practicing in the midwest so not much of an issue. What are your thoughts on peds though if there is a peds hospital in the vicinity? is it case by case basis or throw them all to a pediatrician? Obviously this is not an issue for ruralmedicine although I could be wrong. Thanks for the reply KentW and RuralMedicine. Your input is always appreciated.
 

lowbudget

Senior Member
7+ Year Member
15+ Year Member
Aug 4, 2003
1,378
24
Visit site
Status
How does billing work for your hospital services? In residency, because we're in-house in the hospital, it's not uncommon to see patients bid-tid because you want to get them the hell out of there... but private attendings seem to only see their patients qd... do payers only pay for one visit a day?

What if you do have to intubate that unit patient or go to the ER to admit a critical patient and leave your office... how is your time and work compensated? Not quite how it works...
 

ntubebate

Country Doctor
10+ Year Member
Jul 8, 2006
76
0
Status
Attending Physician
I am out in the sticks so YMMV but here the PCP is EXPECTED to see his/her patients in the hospital. Not so much expected to do so in a medical sense, but more from the patients point of view. They seem to be alright seeing another doctor in the same practice but even that is a far leap for some who expect THEIR doctor to be the one seeing them.

On the other hand they don't seem to give our NP's a hard time :confused:

When I went to school and did residency I did it with the understanding that I would get to practice virtually ever facet of medicine. Just can't imagine not seeing my own hospital patients.

ntubebate
 

RuralMedicine

Senior Member
Moderator Emeritus
15+ Year Member
Jan 11, 2003
414
47
Status
Attending Physician
ntubebate said:
I am out in the sticks so YMMV but here the PCP is EXPECTED to see his/her patients in the hospital. Not so much expected to do so in a medical sense, but more from the patients point of view. They seem to be alright seeing another doctor in the same practice but even that is a far leap for some who expect THEIR doctor to be the one seeing them.

ntubebate
I think it's pretty similar here. Or at least in this immediate community (further out in the county there are three separate groups of a total of 4-5 FPs who do not have privileges at our hospital but their patients always end up in our ED and get admitted).
 

RuralMedicine

Senior Member
Moderator Emeritus
15+ Year Member
Jan 11, 2003
414
47
Status
Attending Physician
lowbudget said:
How does billing work for your hospital services? In residency, because we're in-house in the hospital, it's not uncommon to see patients bid-tid because you want to get them the hell out of there... but private attendings seem to only see their patients qd... do payers only pay for one visit a day?
Physicians can only bill for one service in a day (and only one physician can bill for that service in the day---which is why I really love it when kids go to the ED the ED decides to triage them to their UVC where they see a midlevel provider who then calls me with HELP! HELP! and if I see them in my office and don't admit them I can't bill for services provided (because the UVC-ED visit takes priority.)[I see them because once I know and know that the midlevel isn't capable of providing care I feel that I have an ethical obligation to do the right thing. I'm truly not sure where the legal standard lies--I actually think they should be perhaps more appropriately triaged to the ED where they can see a physician--however one of our ED providers instructs triage to send "any kid with a pulse to UVC" (if they are pulseless he calls peds on call) so when he's working that isn't an option and he seems to work way too many day shifts]

Even though you can only bill for services QD I usually round (at least briefly) BID because I feel it's necessary. (It also helps that my office is across the street from the hospital--plus I am often back at noontime or early evening to do a new admission so I'm around and I'll look at new labs, review films, spend a few minutes talking to parents, meet stressed grandparents who flew in from Florida, etc)

If patients deteriorate leading to your return you can bill for critical care time. (Although I usually only do that in the ICU or ICF setting, or patients transfered from the floor to ICU or ICF.) You can also bill for procedures you complete.

lowbudget said:
What if you do have to intubate that unit patient or go to the ER to admit a critical patient and leave your office... how is your time and work compensated? Not quite how it works...
You bill for what you do...
-Admission-probably a level II or level III if they're in the ICU
-You can bill for your procedures (intubation/CVL/ etc)
-Bill for ventilator management if you do it (Daily item and only 1 physician per day so if I intubate my colleagues patients on call at 1AM if I bill for it then they can not until the next day. Of course at least 2 of my colleagues had no idea you could bill for ventilator management until I asked them if they minded if I did)
-If you spend extensive time (physically present with the patient/on their unit) that would not be considered to fit into one of the above you can bill for critical care time. You can also use this when you spend half the night with one of your colleagues patients on call (because you can't bill for physician services as they already did) or when your colleague gets to come in and admit your patient at 3am and then you pick up the pieces a little later the same day (they've billed for the admission so you can't bill for daily services but you can bill for critical care time). I have also billed for critical care time when I've spent extensive time in the ED with the patient stabilizing them sufficiently to make the trip to the ICU. (Arguably something that could have been done by the ED physician in some cases but it's kind of not something to argue about).
 

RuralMedicine

Senior Member
Moderator Emeritus
15+ Year Member
Jan 11, 2003
414
47
Status
Attending Physician
raptor5 said:
I can imagine it would be a different story if you were some distance from the hospital or had more than 1 hospital. Here in the NE some family docs admit to more than 1 hospital.That seems like lunacy. I personally plan on practicing in the midwest so not much of an issue. What are your thoughts on peds though if there is a peds hospital in the vicinity? is it case by case basis or throw them all to a pediatrician? Obviously this is not an issue for ruralmedicine although I could be wrong. Thanks for the reply KentW and RuralMedicine. Your input is always appreciated.
If by not an issue you mean because I am a pediatrician then yes you are correct. That said I still transfer kids to children's hospitals if they need subspecialty services we can not provide. We're about 3 hours away from a good children's hospital.
 
About the Ads