PA only for federal insured patients?

[bedrock]

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I wanted to ask the groups thoughts on this.

I’m the only pain physician in a large ortho group. 10 physicians.

In a more rural part of the Rocky Mountains so historically great contracts, but those are getting pared down significantly in the last few years so profit margins are slipping. However, everyone is very busy.

This is the only orthopedic group in the country of that size, that doesn’t use PAs for clinic. (There are two PAs who are first surgical assists).

Our competition uses PAs regularly in clinic both for follow ups and to screen new patients who haven’t done any conservative care and/or lack MRIs.

We get a lot of patients from those groups who hate seeing a PA. So my partners are reluctant to use PAs in clinic. But we are also making less money than we used to due to reimbursement cuts. But our commercial plans still pay 180% of Medicare so we don’t want to lose any new commercial patients.

What I want to do is to use PAs to screen all federal government patients (Medicare, Medicaid, tricare) because if we lose a few Medicare Medicaid patients because they had to see a PA first, it is no great loss.

My proposal would maintain MDs seeing new commercial patients, because my partners feel they would lose significant market volume of commercial payors otherwise.

My question to you is this. Are there any legal issues with requiring all new federal government patients to see a PA first while we still allow new commercial patients to see an MD first ?

 

[RoloTomassi]

This is what we do, unless they throw a fit about it during scheduling. It's unfortunate, but we can only provide services commensurate with what we're reimbursed.

In addition, because we don't want MC to squeeze out the good payers, there's only one MC slot per day, for new or f/u. You can start with more and whittle it down. When it gets to peak commercial season Oct-Dec, we pause on MC. Saturated area, so there's plenty of other practices that can see them.

 

[Agast]

No it’s fine, just don’t make it obvious

The biggest downside is I suspect you will end up with NPs, and they are not very good

 

[sloh]

This is what we do, unless they throw a fit about it during scheduling. It's unfortunate, but we can only provide services commensurate with what we're reimbursed.

In addition, because we don't want MC to squeeze out the good payers, there's only one MC slot per day, for new or f/u. You can start with more and whittle it down. When it gets to peak commercial season Oct-Dec, we pause on MC. Saturated area, so there's plenty of other practices that can see them.

Why is peak commercial season oct-December? Patient have met their deductible?

 

[RoloTomassi]

Why is peak commercial season oct-December? Patient have met their deductible?

Exactly

 

[Taus]

This is what we do, unless they throw a fit about it during scheduling. It's unfortunate, but we can only provide services commensurate with what we're reimbursed.

In addition, because we don't want MC to squeeze out the good payers, there's only one MC slot per day, for new or f/u. You can start with more and whittle it down. When it gets to peak commercial season Oct-Dec, we pause on MC. Saturated area, so there's plenty of other practices that can see them.

Legal concerns to doing this?

 

[RoloTomassi]

Legal concerns to doing this?

I don't think so. Many practices don't take any Medicaid, marketplace, MC advantage, and more are not taking MC. I'd make the argument that at least we're still seeing. They can always self pay to be seen by my opted-out partners.

 

[Ducttape]

theres no concern about scheduling MC and advantage patients to limited number of slots if it is a financial decision.

the practices that dont take MC have most likely opted out, so there is no concern on their part. i do not believe you can completely shut down MC or Medicaid if you do accept medicare, but you can definitely limit your exposure.

in terms of having advanced practice providers see them first, i dont know if there are any rules pertaining that.

i would urge caution that you are monitoring and are exactly aware of what treatment the APP is offering and that treatment does not go against what you would do (ie opioid prescribing). i know of situations where rogue APPs would prescribe opioids for months without the patient ever seeing an attending.