Seeing patients without PCP referrals?

[CherubicDevil]

Hi guys, our new patients number took a hit due to COVID.

Currently, our practice requires a referral from a PCP before we can see them. A lot of PCP offices are still closed in our area. I'm considering allowing patients without referrals to be seen.

My my partner, who is more old-school, is concerned about drug-seekers and DEA narcs if we do away with required referrals.

Do you guys require a referral for new patients? If not, do you notice lots of seekers visiting? How do you keep them at bay?

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[Ducttape]

you can open to self-referrals and mandate that they all undergo a pre-screen before seeing them.

 

[deleted993114]

Hi guys, our new patients number took a hit due to COVID.

Currently, our practice requires a referral from a PCP before we can see them. A lot of PCP offices are still closed in our area. I'm considering allowing patients without referrals to be seen.

My my partner, who is more old-school, is concerned about drug-seekers and DEA narcs if we do away with required referrals.

Do you guys require a referral for new patients? If not, do you notice lots of seekers visiting? How do you keep them at bay?

Most self referrals will be bad.

 

[lobelsteve]

How about referrals from other docs?

oncology, Rheum, Sports, NS, Ortho spine. Etc.

Self referral with PDMP.

 

[CherubicDevil]

How about referrals from other docs?

oncology, Rheum, Sports, NS, Ortho spine. Etc.

Self referral with PDMP.

Yes, we take referrals from other docs as long as we aren't the "first point of contact".

 

[CherubicDevil]

you can open to self-referrals and mandate that they all undergo a pre-screen before seeing them.

What type of pre-screen? Done by front-office staff?

 

[Ronin1]

What type of pre-screen? Done by front-office staff?

My nurses look up the patients on the prescription monitoring system. Usually that’s all that is needed to decide. We take lots of patients without MD referrals. Mostly from other satisfied customers

 

[Agast]

I didn’t know filtering out self referrals was a thing. Most of mine arrive because I treated their family member/neighbor. The drug hopefuls are usually referred by their PCP who is tired of their antics.

 

[CherubicDevil]

My nurses look up the patients on the prescription monitoring system. Usually that’s all that is needed to decide. We take lots of patients without MD referrals. Mostly from other satisfied customers

I'm in CA, and we aren't allowed to look up PDMP more than 24 hours before the patient checks in. I guess we would schedule the patient, and then cancel if the report looks bad?

 

[lobelsteve]

I'm in CA, and we aren't allowed to look up PDMP more than 24 hours before the patient checks in. I guess we would schedule the patient, and then cancel if the report looks bad?

Can set up consult and let them know that pdmp will be checked day before and if it looks like they will not benefit from your care, you will call them and cancel. All legitimate folks will understand.

 

[RM38]

I'm in CA, and we aren't allowed to look up PDMP more than 24 hours before the patient checks in. I guess we would schedule the patient, and then cancel if the report looks bad?

You can also just contact self referred patients and tell them no prescription on the first appointment. You can then get UDS and request what ever records you need if you even want to see them again. If they only care about meds, they probably won't even show up or schedule if they know they can't get an Rx first visit.

 

[Jcm800]

Most of my best referrals are self referrals. They are referrals from friends and family of my current patients. So they are not “ I found you in the phone book” referrals, but are not sent by their pcp. These are the best referrals. The patients are “clean” and you are beholden to no one. I’ve built a career out of referrals from referrals or family and friends. All patients are told “I do not prescribe opiates.” That line alone does most of the screening.

in addition, when and if you do a good job, they do TELL their pcp, and you now are open to a new PCP referral source. And if you are savvy, and the patient was a good patient from a good pcp, you can CALL that pcp and actually attempt to establish a referral relationship

 

[BobBarker]

Self referrals are great. PCP referrals about 50% of the time have no useful information in the referral packet but waste 12 pages of paper.

 

[paindoc007]

Self referrals are horrible. Never would I accept that. Need referral from physicians office with notes, and we check pdmp, and make decision.

I get the “my friend/family member has back trouble, would you be able to see her??” Question all the time. “Sure no problem, have their pcp send a referral” is an easy answer. Never been a problem

 

[Jcm800]

Self referrals are horrible. Never would I accept that. Need referral from physicians office with notes, and we check pdmp, and make decision.

I get the “my friend/family member has back trouble, would you be able to see her??” Question all the time. “Sure no problem, have their pcp send a referral” is an easy answer. Never been a problem

If you don’t prescribe opiates or take over opiates, it’s not a problem. They are told don’t come if you want opiates. It’s probably BETTER than a pcp who says “because of the new laws, the pain doc has to write your opiates.”
In the immortal words of Erick Cartman “I do what I want!!”

 

[paindoc007]

If you don’t prescribe opiates or take over opiates, it’s not a problem. They are told don’t come if you want opiates. It’s probably BETTER than a pcp who says “because of the new laws, the pain doc has to write your opiates.”
In the immortal words of Erick Cartman “I do what I want!!”

I hearyou. But I do some opioids some of the time. I’ve gotten called out before too. “But you do it for my friend!” The curse of working in a small town. So for me I’d rather screen problems before they enter my office.

 

[drusso]

Hi guys, our new patients number took a hit due to COVID.

Currently, our practice requires a referral from a PCP before we can see them. A lot of PCP offices are still closed in our area. I'm considering allowing patients without referrals to be seen.

My my partner, who is more old-school, is concerned about drug-seekers and DEA narcs if we do away with required referrals.

Do you guys require a referral for new patients? If not, do you notice lots of seekers visiting? How do you keep them at bay?

There are two ways to screen: You've got to screen in and screen out...

Hire a patient liaison representative or assign an employee in your office to offer a "white glove" treatment for self-pay/self-referral patient and strategic referral relationships. Service at the pain clinic is just like Disneyland: Some people get to go to the front of the line. Ortho calling with a juicy L1 VCF or a post-ACLR PRP, spine surgeon asking for a stim trial, employer self-funded regen patients, etc those people go to the front of the line.

Hire a drug alcohol counselor or social worker to assess med management referrals: Chart review, clinical interview, urine tox, care coordination with referring provider, etc for "back story," PDMP, etc. Do not schedule those patients with the doctor until all new paperwork has been received and completed, behavioral health eval done, etc. Make sure those patients understand that if they do not show up on time (early) they will be rescheduled and charged a no-show fee.

 

[callmeanesthesia]

There are two ways to screen: You've got to screen in and screen out...

Hire a patient liaison representative or assign an employee in your office to offer a "white glove" treatment for self-pay/self-referral patient and strategic referral relationships. Service at the pain clinic is just like Disneyland: Some people get to go to the front of the line. Ortho calling with a juicy L1 VCF or a post-ACLR PRP, spine surgeon asking for a stim trial, employer self-funded regen patients, etc those people go to the front of the line.

Hire a drug alcohol counselor or social worker to assess med management referrals: Chart review, clinical interview, urine tox, care coordination with referring provider, etc for "back story," PDMP, etc. Do not schedule those patients with the doctor until all new paperwork has been received and completed, behavioral health eval done, etc. Make sure those patients understand that if they do not show up on time (early) they will be rescheduled and charged a no-show fee.

I like the idea. I’m trying to build self-referral volume, and also would love to build more “Procedure-ready” referrals. How do you implement? Do your employees review incoming referrals and direct them to one of these pathways vs a regular appointment, or do you? Our current process is all new patient referral packets come to my message center in the EMR (Aprima) for review. I then review and respond back, and they are scheduled or occasionally rejected.

 

[deleted480308]

Hi guys, our new patients number took a hit due to COVID.

Currently, our practice requires a referral from a PCP before we can see them. A lot of PCP offices are still closed in our area. I'm considering allowing patients without referrals to be seen.

My my partner, who is more old-school, is concerned about drug-seekers and DEA narcs if we do away with required referrals.

Do you guys require a referral for new patients? If not, do you notice lots of seekers visiting? How do you keep them at bay?

Primary care is just closed? I’m having trouble believing they aren’t at least doing telemed

 

[Jcm800]

I hearyou. But I do some opioids some of the time. I’ve gotten called out before too. “But you do it for my friend!” The curse of working in a small town. So for me I’d rather screen problems before they enter my office.

I do it also, I just SAY I don’t do it. It’s the best screening also. So in the rare instances I feel it’s appropriate, it’s my decision. Not an expectation. And I have been burned by that also. The worst was “you give it to my MOM!!!” Oops.

 

[Jcm800]

There are two ways to screen: You've got to screen in and screen out...

Hire a patient liaison representative or assign an employee in your office to offer a "white glove" treatment for self-pay/self-referral patient and strategic referral relationships. Service at the pain clinic is just like Disneyland: Some people get to go to the front of the line. Ortho calling with a juicy L1 VCF or a post-ACLR PRP, spine surgeon asking for a stim trial, employer self-funded regen patients, etc those people go to the front of the line.

Hire a drug alcohol counselor or social worker to assess med management referrals: Chart review, clinical interview, urine tox, care coordination with referring provider, etc for "back story," PDMP, etc. Do not schedule those patients with the doctor until all new paperwork has been received and completed, behavioral health eval done, etc. Make sure those patients understand that if they do not show up on time (early) they will be rescheduled and charged a no-show fee.

This is literally everything I would hate in my practice...

im a simple man and offer simple services, the same for all... but don’t listen to me. I’m on probation...

 

[gdub25]

We see self referrals, always have, don’t screen them at all and they have never been a problem for us. It’s funny to me that the guys who don’t take self referrals are so adamant about how terrible they are and all the ones that do take self referrals say they are fine. Has anyone actually quit taking self referrals because they were terrible or most of you guys saying not to take them are just making assumptions?

 

[CherubicDevil]

I didn’t know filtering out self referrals was a thing. Most of mine arrive because I treated their family member/neighbor. The drug hopefuls are usually referred by their PCP who is tired of their antics.

True. B

Primary care is just closed? I’m having trouble believing they aren’t at least doing telemed

We have noticed a lot primary care totally closed or only doing telemed. Even when they are doing telemed, they aren't sending over paperwork. Our area is one of the worst hit by Covid in California.

But I have been considering opening up to self-referrals for a while now even before all of this. Just need to figure out how to implement.

 

[paindoc007]

We see self referrals, always have, don’t screen them at all and they have never been a problem for us. It’s funny to me that the guys who don’t take self referrals are so adamant about how terrible they are and all the ones that do take self referrals say they are fine. Has anyone actually quit taking self referrals because they were terrible or most of you guys saying not to take them are just making assumptions?

Location, insurances you take, and those types of things matter a lot.
when you live in a rural + poorer area, and 1/3 of your patients you see are Medicaid,it’s a different story. So that statement above isn't correct. When I started I allowed self referrals, after a few months I stopped due to the drug seeking patients coming in my door unfiltered.

 

[Jcm800]

Location, insurances you take, and those types of things matter a lot.
when you live in a rural + poorer area, and 1/3 of your patients you see are Medicaid,it’s a different story. So that statement above isn't correct. When I started I allowed self referrals, after a few months I stopped due to the drug seeking patients coming in my door unfiltered.

Valid. IF you take MEDICAID and PRESCRIBE opiates, you need to REALLY screen. If you don’t take Medicaid, or have a naturally low level of Medicaid patients, and DO NOT PRESCRIBE OPIATES, screening is largely unnecessary.

 

[10KHertz]

In terms of billing : self referrals, or “specialists network physician “ referrals use 99203-4 since you don’t have a clear referral physician directed order. Medicare requires a pcp on file but Does not necessarily restrict direct referrals. United advantage programs advertise regularly that no referrals are mandatory. When you get audited for consultation codes you really need to show the direct referral order, consultative note, and transfer of consult back to provider (fax, EMR confirmation).

When you reach a certain threshold of patient population, self referrals are inevitable and not necessarily difficult patients...

 

[BobBarker]

Medicaid requires a referral from PCP fo all specialist care in my state.

 

[CherubicDevil]

Valid. IF you take MEDICAID and PRESCRIBE opiates, you need to REALLY screen. If you don’t take Medicaid, or have a naturally low level of Medicaid patients, and DO NOT PRESCRIBE OPIATES, screening is largely unnecessary.

Location, insurances you take, and those types of things matter a lot.
when you live in a rural + poorer area, and 1/3 of your patients you see are Medicaid,it’s a different story. So that statement above isn't correct. When I started I allowed self referrals, after a few months I stopped due to the drug seeking patients coming in my door unfiltered.

We are in a rural + poor area. We don't take Medicaid but do take Medicare. We do prescribe opiates. Makes things tricky.

 

[myrandom2003]

I do it also, I just SAY I don’t do it. It’s the best screening also. So in the rare instances I feel it’s appropriate, it’s my decision. Not an expectation. And I have been burned by that also. The worst was “you give it to my MOM!!!” Oops.

Well now your both discharged for discussing your pain meds... you could be sharing for all I know... who is your mom by the way?? (All in magenta)

 

[Laryngospasm]

Opiates and people who sit at home on disability/unemployed is a recipe for disaster.. imho

 

[Ligament]

Self referred patients are the best as far as I am concerned, IF you do not prescribe chronic opioids. I get patients all the time that hate opioids, don't watn them. The ones that do are not allowed in the door. If you prescribe opioids as a large portion of your business, you don't want any self referrals.

 

[Ducttape]

Opiates and people who sit at home on disability/unemployed is a recipe for disaster.. imho

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