paperwork is killing me!

[ORBITAL BEBOP]

Advertisement - Members don't see this ad

In my psych program, after 6pm, all evals, precerts, transfers, state transfers are all done by the residents, which kills a lot of time.

How is it done at other programs?

 

[Anasazi23]

A pre-cert patient shouldn't be coming in as a transfer after hours.

Any managed care patient that does require pre-cert can be transferred in the morning. The bill will be their problem. They could have checked to see if their hospital was in network before they got there.

No state transfer has to be done on-call. That's the day resident and social worker's responsibility.

Tell your people there to pony up and quit dumping...

 

[ORBITAL BEBOP]

Our problem is the ER. They ER HATES taking care of psych patients. I guess they feel they are taking up too much ancillary care. The ER runs the show, so the patients have to be worked up at night.

If a pt has Aetna, and needs to be transferred. I have to call Aetna, precert, then find the proper hospital for the pt.

I tried to pend a State transfer for a few hours until the morning sworkers could do it, and I got yelled at by them for dumping the case on them. Even social workers get more respect then me.

🙁

 

[Anasazi23]

Sometimes you have to play hard ball. Pre-certs and searching for hospitals is not the job of a physician. Talk to your program director and not leave the option. While every residency has some unavoidable scut, what you're describing is somewhat unreasonable.

Social workers don't like doing social work? Too bad. The other choice is, like I said, to admit them, and they get a bill and are transferred in the morning.

I'm not exactly sure how your ER works, but it sounds like you don't have a dedicated CPEP or psych ER. Sounds like you have a regular medical ER that triages psych patients, right?

If so, you're the consult service to the ER. The patient is their responsibility. You can find a hospital for them as a courtesy, but pre-cert and all the other stuff is the ER social worker's responsibility. You don't see them making cardiologists calling hospitals and getting pre-certs for their patients, right? You provide a consult, and the patient is theirs until they are admitted to your service. If they're being transferred, it's not your patient per se, whether they "like psych patients" or not.

Make changes - it's tough but can be done.

 

[ORBITAL BEBOP]

You are right, the ER does not have a dedicated psych ER. They also dont have their own social worker! This is a community hospital and I guess they cannot afford an all night social worker when they have residents who work for peanuts.

 

[Anasazi23]

Under EMTALA, you must admit a patient if they require hospitalization - whether they are in network or not.

If this is the case, admit the patient, and have them transferred in the morning. You admitted them for the acute duration of thier emergency, which may or may not be resolved. If the acute clinical condition still exists, they are transferred the following day and they receive a bill.

 

[50960]

In no way is any of this your job. You are there to practice medicine, not manage the facility. Social workers should do this for you, but even if they do not it is not yours to do; you Tx not manage. It is really sad that this is getting dumped on you when we have such dire shortage of psychiatry in this country.......

 

[ORBITAL BEBOP]

Does anyone else have to do precerts and transfers on their own?

 

[MBK2003]

Does anyone else have to do precerts and transfers on their own?

In my moonlighting job I do all that for all the admittable patients in the ER, but I'm getting paid $60/hr for my time, so I'll suck it up and call the managed medicaid company in the middle of the night and call around to other hospitals to find a bed when we have none. Although honestly when I hear, "5 open beds, 2 suicidal patients in the ER with straight medicaid" I am beaming like I won the lottery.

MBK2003

 

[ORBITAL BEBOP]

I cant be the only one who has to do these in their program. Am I?

 

[ORBITAL BEBOP]

I hope applicants are checking on this issue in their interviews!

 

[ORBITAL BEBOP]

How has this question been answered on interviews?

 

[whopper]

Oh boy, I gave a lot of advice on residencies and forgot to mention that!!!

Several programs make you do the scutwork on stuff like this and its not really psychiatry!

Also no where have I seen a place that makes attendings do this stuff, so its not like knowing how to do pre-certs will make you a better attending.

My own program (Robert Wood Johnson-Cooper/Atlantic City Medical Center)doesn't have the residents doing any of this stuff. However my program is part of a larger program that operates in Camden and the Camden residents have to do pre-certs and they hate it.

They always complain to me about how they wasted a few hours a day just calling up insurance companies, and they also do social work (in Atlantic City we got social workers doing that part for us).

Man, sounds like a waste. Thank God I don't have to waste my time on that in Atlantic City. In our crisis center the nurses handle that stuff. In the inpatient unit the social workers handle it. Thnkfully, the residents can just focus on treatment on patients!

 

[TheWowEffect]

I wonder if you have ever talked to your PD about it. My suggestion would be to get together as residents and bring it up at your meeting. If that is not possible, I rec writing a collective letter to PD and chairman about it. Might help....