Some usual frustrations with private practice

[whopper]

1) Patient has insurance but doesn't know how it works.
E.g. guy has a high deductible, gives us his insurance card, then they don't pay for his visit cause he has a high deductible. So the guy calls my office and starts screaming at my secretary.

Solution: Terminate patient if he continues to be an ass after you've nicely explained to him that it has nothing to do with us on 3 separate occasions.

2) Ordered lab but lab company doesn't give us the results.
I already ranted about this in another thread.

3) Patient continually brings in dysfunctional family members who scream and bicker.
Now this one gets under my skin. I'll terminate a patient that's causing problems but in this type of case the patient isn't doing it, it's his/her family.

I don't have a solution that I like.

4) Patient comes in, and is doing something very obnoxiously messing up the interview. E.g. patient is wearing these

And insists on taking off their boots before I weigh them. They take like 9 minutes getting them on and demands to put them back on before we interview. I tell them forget about weighing them cause it's going to take too long and then they insist they get their weight.

5) Patient comes in and has bed bugs but idiotically doesn't think that by showing up to my office they now won't infect my furniture that I now have to get destroyed.

6) Person comes in smelling very very bad.

7) Patient comes in and you've spend 30 minutes to 1 hour with them and you still don't know WTF is going on. The person is circumstantial but not to the point where you can easily pin it.

8) Walgreens. I get about 5 fake scripts from them a day.

E.g. Patient has a bad reaction with a medication so we stop the medication. Walgreens sends me a script requesting I refill it with a line saying the patient specifically requested it. I call the patient and they deny it. I call Walgreens and they tell me "sorry it's the machine. It just automatically does it."
For each fake script I waste about 15 minutes cause not every patient responds immediately to the first call and the pharmacy often times puts me on hold.

---

Members don't see this ad.

 

[wolfvgang22]

3. Talk to patient about the problem, tell him that he is the patient, not the family. Refer to family therapy. Limit family members in office to one person, if that person causes trouble, ban that family member from the appointment. Terminate patient if they won't work with you in this. Send certified letter about this.

4. Appointment doesn't start until patients boots are off. Mark him as late and tell him to reschedule if he isn't ready. Of course, talk to him so he understands this is now the rule first before doing this. Tell him 3 strikes = termination from now on. Treat him as you would a child when setting rules. Make the rules, explain them clearly, then enforce the rule consistently. Terminate as promised when he does it the 4th time. Send certified letter about this.

5. Meet patient in another room if possible or call patient. Also send certified letter. Explain the problem, establish expectation that she will be bed bug free upon arriving to clinic. Refer to affordable pest control. Explain you will bill her for pest eradication if she brings bugs to your office and you will terminate. Explain other patients have right to expect they won't be infected in your clinic.

6. Similar to #5. Consider meeting patient outdoors in a private area or somewhere else. Send certified letter about this. Offer available support services. Call adult protective services for self neglect. Consider if hospitalization is necessary. I had a patient with Schizophrenia refuse to bathe and pooped on my office chair. He eventually died of alcohol poisoining.

 

[zolof]

1. I would terminate, because other insurance issues likely to come back in future. I have had the same problem with a couple of patients. sent them letter as well as spoke to them in person very nicely more than once for them to complain/discuss with their insurance company. One threatened that he would write a bad review. I haven't seen any bad reviews so far but who knows. I calmly referred them to several other providers to contact who take their insurance. I also said best of luck in finding someone to accomodate you so soon

 

[hamstergang]

8) Walgreens. I get about 5 fake scripts from them a day.

E.g. Patient has a bad reaction with a medication so we stop the medication. Walgreens sends me a script requesting I refill it with a line saying the patient specifically requested it. I call the patient and they deny it. I call Walgreens and they tell me "sorry it's the machine. It just automatically does it."
For each fake script I waste about 15 minutes cause not every patient responds immediately to the first call and the pharmacy often times puts me on hold.

I tell patients that I ignore refill requests coming from the pharmacy. There are only a few who don't seem to ever remember this or understand why even when I explain how it wastes too much time. If someone needs a med refilled, they need to call my office themselves.

Of course this also leads to the annoying scenario where I included refills on the prescription at the last visit so the patient really shouldn't be calling me for the refill, just ask the pharmacy for the fill I already authorized. Though sometimes the pharmacy doesn't register the refills I wrote out and so it takes me calling for them to look at the original script and discover I already planned ahead properly.

 

[TexasPhysician]

If I took insurance, I think it would be best to assume no one has reached their deductible and have them pay up front. Getting $ later is no easy task.

 

[zolof]

What about including prior auths? Lately that has been the biggest frustration for my office. Despite clear and repetitive instructions on website, registration forms, and explained to in person multiple times, patients still seem to argue that they have to pay fees. They can't seem to understand this is a problem with their med insurance plan. just a vent.

 

[whopper]

3. Talk to patient about the problem, tell him that he is the patient, not the family. Refer to family therapy. Limit family members in office to one person, if that person causes trouble, ban that family member from the appointment. Terminate patient if they won't work with you in this. Send certified letter about this.

Already tried. Family refuses to engage in therapy.
Now yes I can terminate the patient but I don't like this solution cause it's not the patient's fault. Yes I can refuse to have the family come in (and I have) and then they show up to the office anyways, we don't let them in and they cause a scene in the waiting room. So then it escalates to us considering putting a restraining order on the family and threatening to call the police on them which is highly distruptive to the interview plus the other patients.

At least for perhaps the first 1-2 visits seeing the family was useful so I can see just how much dysfunction there was.

 

[wolfvgang22]

Already tried. Family refuses to engage in therapy.
Now yes I can terminate the patient but I don't like this solution cause it's not the patient's fault. Yes I can refuse to have the family come in (and I have) and then they show up to the office anyways, we don't let them in and they cause a scene in the waiting room. So then it escalates to us considering putting a restraining order on the family and threatening to call the police on them which is highly distruptive to the interview plus the other patients.

That's a tough situation. It's always takes a little mental calculus to decide when to take action such as restraining orders or termination. For me, if it makes me late for other patients or home more than once after we talked about it, or exhausts my carefully developed but limited patience and empathy, it becomes worth it. I'm no use to anyone burned out.

I find that patients talk among themselves, and word gets around when you follow through, and being consistent can prevent a lot of future incidents with other patients. One patient told me he recorded me discussing prescription benzo abuse with him on his phone, and played it for other patients in the waiting room. He expected the other patients to agree I was mean. Their reaction was different than what he was looking for.

 

[whopper]

I decided about 1 year ago I would terminate patients for things like their family if it crosses a line where I can't tolerate it, but for the sake of making sure I'm doing the right thing it'd be only if I've thoroughly reviewed it and tried to fix the solution with several methods failing plus it's really ticking me off to the point where I question I won't be able to do my job effectively.

In the cases so far that ticked me off I was able to come up with a valid reason why the treatment relationship should end that I was able to sleep on without a problem.

e.g. I had a patient who was in a very dysfunctional situation with his family and was highly manipulative. He was able to get away with it cause his grandmother would allow him to not follow any of my recommendations and she owned the house. The patient's mother wanted the recommendations followed but wasn't allowed to force them upon the patient cause the grandmother controlled her housing and said she'd kick out the mother if the mother tried to get the patient to do what I recommended. (He played video games 12 hrs a day, wouldn't find work, etc, I told the mother to refuse to pay for his online game acct).

I told the patient and the family we were at an impasse and since the grandmother was enabling the problem there was no point in seeing me. "Why waste your money? You're not doing anything to help yourself." They stopped seeing me. I also have no problem with a patient not seeing me if they themselves aren't interested in trying my recommendations.

 

[whopper]

What about including prior auths?

I haven't had a problem with that. What I do is have my secretary handle it. She's been doing fine on this end.

 

[st2205]

4. Next time they take the boots off, get individual weight on the boots. At future visits, weigh with boots and then subtract.

 

[Psychotic]

If I took insurance, I think it would be best to assume no one has reached their deductible and have them pay up front. Getting $ later is no easy task.

I am not in private practice and know nothing about insurance reimbursement, but I was under the impression that a physician is only entitled, and indeed is required, to take the applicable co-pay for services rendered. But I am unaware of any scenario under which a physician is entitled to or allowed to require full payment in advance from a patient who presents with insurance. Other PP folks can chime in here...I would like to know.

One exception: if an insured patient has a procedure (expensive $) scheduled at a clinic or hospital, I have been told by family and friends that the amount of the deductible or co-insurance the patient needs to pay up front is determined ahead of the procedure, and clinics and hospitals can require that payment before the procedure.

 

[ridethecliche]

4. Next time they take the boots off, get individual weight on the boots. At future visits, weigh with boots and then subtract.

This is so simple it's genius!

 

[birchswing]

2. I have a doctor for whom I have to print out LabCorp results from their portal, even though the results say delivered to doctor (days before I am able to view them). They say they never get results from LabCorp. Makes me wonder what they do with other patients who don't print out lab results.

7. They're probably trying to say something about their sex life.

I once tried describing difficulties with masturbation during a therapy session. I later found out that all the academic-sounding euphemisms I used avoiding the word masturbation led my therapist to think I was engaging in auto-erotic asphyxiation (not the case).

 

[wolfvgang22]

2. I have a doctor for whom I have to print out LabCorp results from their portal, even though the results say delivered to doctor (days before I am able to view them). They say they never get results from LabCorp. Makes me wonder what they do with other patients who don't print out lab results.

7. They're probably trying to say something about their sex life.

I once tried describing difficulties with masturbation during a therapy session. I later found out that all the academic-sounding euphemisms I used avoiding the word masturbation led my therapist to think I was engaging in auto-erotic asphyxiation (not the case).

Heh, sometimes. Most of my patients just say "Hey doc, why can't I get a boner? Can I get some Viagra? How about testosterone?"

Most patients are confused about what is going on and start out with the vague idea we are going to be doing some sort of psychoanalysis immediately. They think if they give you their entire 6 hour monologue life story in their own words you will understand them better and come to the best solution, or maybe their problems will become more sensical to them. That is what happens on TV!
Patients are anxious and want to be heard. They may not consider that we have spent years learning how to interview patients and diagnose psychiatric disorders, and sometimes get frustrated and offended when you try to lead the interview in a structured manner. Many times the inability of the patient to give up control of the interview does help illuminate a lot of pathology, but it eats up time we don't have in most of our clinics. Patients feel stuck and assume if they can't see a way forward, the solutions must be very complex. It's usually not. (Simple solutions are not necessarily easy to carry out, mind you.)

 

[whopper]

4. Next time they take the boots off, get individual weight on the boots. At future visits, weigh with boots and then subtract.

Oh a completely reasonable solution that would work on a reasonable patient! The patient ain't reasonable!

I tell the patient I already know what the boots will likely weigh (I've weighed thousands of people with and without clothes so I got a good idea) and the freak out and INSIST they take off their boots.

I even tell them them the same thing you recommended! "If you don't trust me I can weigh your boots so we don't have to do this again" and they get all ticked off and offended saying they want to see the number with their boots off.

If you've noticed people with eating disorders often time will literally freak out if they see their weight even with the knowledge that their clothes is adding to it.

At an eating disorder clinic I once worked at the number from the scale showed up in a different room cause some patients literally became suicidal or violent when they saw their number.

 

[wolfvgang22]

Hopefully this patient doesn't have bad foot odor. I had one patient take off her shoes, and the receptionist around the corner said "Does anybody else smell Doritos? I'm hungry."

 

[TexasPhysician]

(I've weighed thousands of people with and without clothes so I got a good idea)

You’ve weighed thousands of patients nude and still have your license? Impressive.

 

[Armadillos]

Glad to hear I’m not the only one who was driven insane those faxed refill requests. I’m surprised they are even legal how they are worded. I think it’s CVS that says “patient expects to pick up prescription on X day” regardless of if they actually talked with patient or not

 

[PikminOC]

Glad to hear I’m not the only one who was driven insane those faxed refill requests. I’m surprised they are even legal how they are worded. I think it’s CVS that says “patient expects to pick up prescription on X day” regardless of if they actually talked with patient or not

We need a class action suit

 

[st2205]

Oh a completely reasonable solution that would work on a reasonable patient! The patient ain't reasonable!

I tell the patient I already know what the boots will likely weigh (I've weighed thousands of people with and without clothes so I got a good idea) and the freak out and INSIST they take off their boots.

I even tell them them the same thing you recommended! "If you don't trust me I can weigh your boots so we don't have to do this again" and they get all ticked off and offended saying they want to see the number with their boots off.

If you've noticed people with eating disorders often time will literally freak out if they see their weight even with the knowledge that their clothes is adding to it.

At an eating disorder clinic I once worked at the number from the scale showed up in a different room cause some patients literally became suicidal or violent when they saw their number.

So have the MA get weight after the visit.

 

[PikminOC]

So have the MA get weight after the visit.

What ma in pp?

 

[st2205]

What ma in pp?

Then you’re already losing money, I’d have to presume.

 

[PikminOC]

Losing money paying for an ma, they want 20 an hour and benefits..

 

[whopper]

2. I have a doctor for whom I have to print out LabCorp results from their portal, even though the results say delivered to doctor (days before I am able to view them). They say they never get results from LabCorp. Makes me wonder what they do with other patients who don't print out lab results.

I don't know the psychiatrist but I've had plenty of times where a lab tells the pt they faxed the results to me and I never got them. While I have access to the Labcorp portal I've had times where the patient alleged they got the labs done and the results aren't in the portal.

Also if we demand the labs be sent to us by the lab they can claim they were following HIPAA cause we weren't the patient even if I was the ordering doctor. Yes I know you're not supposed to do that but it happens.

It's gotten to a point where I have a policy cause of the ineptitude of getting labs. If a patient gets mad at me cause the lab won't send me the results I'll terminate the patient once I told the patient that nothing of this is my fault 3x.

I had a patient who had labs done with Labcorp and I literally got the results over 1 year later. This is after my secretary and I called Labcorp over 10x and the patient did too. His results showed on the portal that he did get them when he said they did which was a year before I got them.

 

[Shufflin]

Note taken, stay away from Labcorp.

Anyone have any negative experience with Quest?

 

[whopper]

Well as bad as Labcorp has been with me I also believe it's the local employees. You might, for example, have one down the road where the employees are awesome.

But I will say this-I've tried to link Labcorp several times to my Practice Fusion acct. So far more than 10 attempts with no success! PF shows you the success rate of other clinicians and it's at about 35%! Whenever I contact them I get someone on the phone who just redirects the calls and doesn't take any responsibility to fix the problem.

Quest: I've had only 1 occasion where they did the lab and it didn't show up on PF. I know for a fact the patient got the labs done cause when we called Quest they faxed us the labs 10 minutes later--but it still doesn't show in my PF account.

Adding to the prior post here's the story I tell the patients. "You go to a Mcdonalds and you order a burger and they mess up your order. Do you cross the street and yell at the pizza joint cause Mcdonalds messed up? No you take it up with Mcdonalds. You, sir, are that person and I'm the pizza joint. Don't yell at me."

Due to the rather pointed nature of that story I intentionally only do it if the person is out of line 3x and taking their anger out on me, and I already explained to them that this is not my fault but I'm working on trying to fix it.

If the patient really gets out of line I tell them, "I'm doing more than what the pizza joint would've done for you. The fault is not that person's fault but at least I'm trying to fix this problem that's not my fault."

And then the coup-de-grace: "Sir please get another doctor. I will not take your verbal abuse over something that's not my fault."

Bear in mind this is if the patient is taking it out on me. If the person's angry I understand and I don't hold that against them. I had a patient calling me incompetent every few minutes because of this type of lab BS that happens often with Labcorp and I even warned them this happens with them but they went there anyway.

 

[hamstergang]

Also if we demand the labs be sent to us by the lab they can claim they were following HIPAA cause we weren't the patient even if I was the ordering doctor.

Are you saying that it's a HIPAA violation for a lab to send the ordering doctor the lab results directly?

 

[PikminOC]

Thats what the other side says hamster

 

[whopper]

Same thing above. They can also claim they can't be for sure who we claim to be when we call them despite that the fax number we tell them to send to labs to is the same as the office that ordered the damned lab in the first place which is really them finding inappropriate excuses for their laziness.

 

[Walter Raleigh]

This is so simple it's genius!

I might look up the weight of the boots. If not, call them a pound apiece and call it a day.

 

[Crayola227]

yeah people invoke HIPAA all the time in ways that impedes care and doesn't apply, just what it wasn't intended for

 

[dl2dp2]

Haha Whooper your thread makes me laugh.

I think the key to all your problems is #PayerMix. I say start charging membership fees and weed out troublemakers.

 

[whopper]

You’ve weighed thousands of patients nude and still have your license? Impressive.

During my Internal Medicine rotation I did. Also during my eating disorder rotation the patients were weighed only wearing a gown cause of exactly what I mentioned above. Many of them would demand to be weighed nude-except the gown and would start screaming if we did not allow it.