Telepsychiatry private practice

[TexasPhysician]

Ultimately, for me, it boiled down to Luminello vs Charm. Would love to hear ppl insight abt Luminello Vs Charm.

I think that will come down to individual taste. I know other clinicians that prefer Luminello. I prefer Charm.

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[clausewitz2]

Luminello has been solid and incredibly functional for me. The template creation is quite easy and I love the ability to bombard intakes with questionnaires I adapted from public domain screening instruments.

 

[Sushirolls]

The Sleep Doc I used to have sublease from me used Charm. And being able to see bits of their EMR setup and their complaints/hiccups, I'm glad I went with Luminello. I'd try to help out and troubleshoot their issues when I had time, but was a bit more complex then what we actually need for majority of psych practices. Luminello has it simple, efficient, and now can even expand to do group practice if you want.

But if you know you'll be solo, and want cheap, there are better other ways to piece meal things together for a more simplified setup that other posters have described what they do.

Just today, another one of my higher functioning patients praised the user operations for Luminello - especially opening up the calendar and letting patients self schedule.

 

[romanticscience]

I'm deciding on an EMR now. I'm going to be pretty small. 8-10 hours a week. No staff. 90% tele. Would you recommend simple practice or potentially look at something else? I'm hoping to find an emr that allows prescribing, patient scheduling, portal messaging, submission of billing..

I think you should try a few out. I like simple practice because my psychiatry brand shares more in common with therapists than psychopharmacologists, that like luminello and charm. For instance, simple practice's direct messaging resembles instant messaging instead of email. It's also a bit more optimized for use through an phone app. I could send messages with luminello but I'd have to use the browser. Guys correct me if I'm wrong about charm or luminello mobile apps. SP also is cheaper for me who submits their own insurance claims.

Simple practice also has a professional website builder which is integrated with the patient portal.

 

[TexasPhysician]

Luminello has been solid and incredibly functional for me. The template creation is quite easy and I love the ability to bombard intakes with questionnaires I adapted from public domain screening instruments.

Expect price hikes soon. Luminello was just acquired.

 

[romanticscience]

It was acquired by simple practice

 

[Sushirolls]

Curious to see if they just exist in parallel or if one consumes the other.

 

[texanpsychdoc]

I love SP...I run my online practice solely with SP.

 

[clement]

Which malpractice companies typically cover 100% tele? Doctor’s has preliminarily informed me they have to check with their underwriter. The phone representative sounded a bit unfamiliar with psychiatry practice models, in fairness. My longterm goal is hybrid but want to minimize overhead before accumulating patients.

 

[clausewitz2]

Which malpractice companies typically cover 100% tele? Doctor’s has preliminarily informed me they have to check with their underwriter. The phone representative sounded a bit unfamiliar with psychiatry practice models, in fairness. My longterm goal is hybrid but want to minimize overhead before accumulating patients.

MagMutual seems to have no problem with it.

 

[Atreides]

Which malpractice companies typically cover 100% tele? Doctor’s has preliminarily informed me they have to check with their underwriter. The phone representative sounded a bit unfamiliar with psychiatry practice models, in fairness. My longterm goal is hybrid but want to minimize overhead before accumulating patients.

Interesting, The Doctor's Company told me they don't cover more than 10% telemedicine. I told them that effectively rules out them covering outpatient psychiatry at all because I don't know of any outpatient psychiatrist doing less than 10% telemedicine. They were just liked, "This is our policy." I looked into them twice; when I first started my practice and then again recently, when I needed to switch. They said the same thing both times.

MagMutual and PRMS will cover 100% tele. I liked MagMutual because they give you a free UpToDate subscription but unfortunately, hey don't cover medicolegal work so I had to drop them.

 

[hamstergang]

Interesting, The Doctor's Company told me they don't cover more than 10% telemedicine. I told them that effectively rules out them covering outpatient psychiatry at all because I don't know of any outpatient psychiatrist doing less than 10% telemedicine.

I do tele 5% at most. Many patients are seeing me specifically because I'm in-person and they can only find mostly tele practices out there.

 

[calvnandhobbs68]

Interesting, The Doctor's Company told me they don't cover more than 10% telemedicine. I told them that effectively rules out them covering outpatient psychiatry at all because I don't know of any outpatient psychiatrist doing less than 10% telemedicine. They were just liked, "This is our policy." I looked into them twice; when I first started my practice and then again recently, when I needed to switch. They said the same thing both times.

MagMutual and PRMS will cover 100% tele. I liked MagMutual because they give you a free UpToDate subscription but unfortunately, hey don't cover medicolegal work so I had to drop them.

MedPro didn't seem to care about how much tele I did, just wanted a form saying if I did tele or not and some questions about the practice...but I have an actual in person office too so idk if it matters that I have somewhere to see people in person.

 

[lol.psych]

There’s also the American professional agency — the insurer that APA endorses/affiliates with — they have a “cyber suite” add-on option

 

[clement]

Doctor’s was also unexpectedly hard to get a hold of to discuss quotes with a human. That was kind of a turnoff. In addition to the fact that they still haven’t replied for days… after telling me they’ll check with their underwriter re tele. The phone rep did say, “Oh…but you’re psychiatry so let me find out.” My long term goal is of course hybrid.

I was counseled to go with companies that are very familiar with psychiatry practice models and assumed Doctor’s was. FWW I found out CAP covers 100% tele but not in all states.

 

[When is graduation again?]

To return to an earlier topic in this thread, I'm curious about how people are handling labs. I have a Labcorp account and I ask patients for medical records, but with these methods I rarely have the labs at the first appointment. Do you all typically prescribe at the 1st appointment, with the expectation that you'll have labs by the 2nd visit? What do you do if the patient never gets the labs? I'm assuming this is the only approach, but it feels strange to do since I've been trained to have labs pretty much at the time of the 1st encounter in residency.

 

[ObsequiousAplomb]

To return to an earlier topic in this thread, I'm curious about how people are handling labs. I have a Labcorp account and I ask patients for medical records, but with these methods I rarely have the labs at the first appointment. Do you all typically prescribe at the 1st appointment, with the expectation that you'll have labs by the 2nd visit? What do you do if the patient never gets the labs? I'm assuming this is the only approach, but it feels strange to do since I've been trained to have labs pretty much at the time of the 1st encounter in residency.

I guess I wasn't trained that way. For most issues, I prescribe before the labs. I also don't do things at the first visit that would make me uncomfortable without labs (e.g. start lithium). Just due to lack of opportunities to try I've never gotten around to prescribing Tegretol. I wouldn't give clozapine without labs. If I have strong suspicion of a secondary cause for the symptoms I tell the patient and we have a discussion and they make an informed choice. Just about everything else (I'm sure I'm forgetting some stuff), based on the way I was taught, the labs can wait.

Are you waiting to start Zoloft until you have a normal chemistry panel?

 

[When is graduation again?]

I guess I wasn't trained that way. For most issues, I prescribe before the labs. I also don't do things at the first visit that would make me uncomfortable without labs (e.g. start lithium). Just due to lack of opportunities to try I've never gotten around to prescribing Tegretol. I wouldn't give clozapine without labs. If I have strong suspicion of a secondary cause for the symptoms I tell the patient and we have a discussion and they make an informed choice. Just about everything else (I'm sure I'm forgetting some stuff), based on the way I was taught, the labs can wait.

Are you waiting to start Zoloft until you have a normal chemistry panel?

That makes sense. It's not so much I was trained to have labs, so much as they were always there or I could get them pretty quickly after prescribing. I'm still early private practice days, so haven't prescribed anything yet, but I'm starting to get some potentially complex cases in the weeks to come, so I'm preparing my workflows/processes now.

 

[ObsequiousAplomb]

That makes sense. It's not so much I was trained to have labs, so much as they were always there or I could get them pretty quickly after prescribing. I'm still early private practice days, so haven't prescribed anything yet, but I'm starting to get some potentially complex cases in the weeks to come, so I'm preparing my workflows/processes now.

That's a smart thing to do. We're in the same boat, this is my first year of private practice. The medically complicated patients (I have a few who are dying) can be really tough when there's no system. It's very tough to get most things like that. Thankfully, I'm in Maryland and in Maryland the labs are usually reported into the central registry, so I can see them sometimes. Do you have anything like that in your region?

 

[When is graduation again?]

That's a smart thing to do. We're in the same boat, this is my first year of private practice. The medically complicated patients (I have a few who are dying) can be really tough when there's no system. It's very tough to get most things like that. Thankfully, I'm in Maryland and in Maryland the labs are usually reported into the central registry, so I can see them sometimes. Do you have anything like that in your region?

I wish. That sounds amazing. Maybe it'll happen someday.

 

[clement]

Medicare came up on here and is ever present on such threads. For those accepting Medicare in their main gig… Would a side hybrid cash practice serving medically ill patients (advanced and serious illnesses, caretakers, survivors) be a Medicare living hell…and ultimately a poor business model? I.e. accepting no Medicare pts and notifying them of such at the onset. Obviously folks can qualify for Medicare under 65 if on SSDI.

 

[calvnandhobbs68]

Medicare came up on here and is ever present on such threads. For those accepting Medicare in their main gig… Would a side hybrid cash practice serving medically ill patients (advanced and serious illnesses, caretakers, survivors) be a Medicare living hell…and ultimately a poor business model? I.e. accepting no Medicare pts and notifying them of such at the onset. Obviously folks can qualify for Medicare under 65 if on SSDI.

Are you saying that you're trying not to get patients who are covered under medicare in this practice or asking if you can accept medicare in one setting and not another?

Medicare is all in or all out. You can't cash charge Medicare patients in any capacity if you accept Medicare anywhere. If you're seeing a lot of medically or psychiatrically complex patients, you do increase your chances you might inadvertently pick up some Medicare patient.

Also yes this would probably be a very time consuming and poor dollars per hour spent business model, unless you're slowly building up a practice of rich sick people I guess. Even the high end concierge PCPs don't really want a bunch of sick people though, they want a bunch of "worried well" rich people who will pay them thousands of bucks a month to order fancy tests/full body MRIs or get the COVID shot early.

 

[clement]

Are you saying that you're trying not to get patients who are covered under medicare in this practice or asking if you can accept medicare in one setting and not another?

Medicare is all in or all out. You can't cash charge Medicare patients in any capacity if you accept Medicare anywhere. If you're seeing a lot of medically or psychiatrically complex patients, you do increase your chances you might inadvertently pick up some Medicare patient.

Also yes this would probably be a very time consuming and poor dollars per hour spent business model, unless you're slowly building up a practice of rich sick people I guess. Even the high end concierge PCPs don't really want a bunch of sick people though, they want a bunch of "worried well" rich people who will pay them thousands of bucks a month to order fancy tests/full body MRIs or get the COVID shot early.

Forget the body scans.
Yes, I’m saying that my intent is NO Medicare patients (at least for the first year or two). This stinks because the early phase of PP is marketing and well I’d be excluding a lot (I suspect). The aim is concierge psychotherapy, mindfulness focused (my niche being palliative care/ psycho onc).
So I should:
-provide notice that I don’t accept Medicare patients and will fire them if they get on Medicare
-check front and back of their cards
-ask if they’re looking to get ssdi

Or like some gero practices, go with a biller and take Medicare? I guess that’s inevitable in the long run.

Invariably I’ll run into people that have it but are desperate for care or don’t know they have Medicare.

All of this said, how do people run into hot water if accidentally taking a pt on Medicare in such a practice model? Is it the pt trying to get reimbursed? In other words, how does Medicare find out if I inadvertently treat such a pt? I imagine it’s more likely to happen for those whose practice is more heavily psychopharm based.

 

[TexasPhysician]

Forget the body scans.
Yes, I’m saying that my intent is NO Medicare patients (at least for the first year or two). This stinks because the early phase of PP is marketing and well I’d be excluding a lot (I suspect). The aim is concierge psychotherapy, mindfulness focused (my niche being palliative care/ psycho onc).
So I should:
-provide notice that I don’t accept Medicare patients and will fire them if they get on Medicare
-check front and back of their cards
-ask if they’re looking to get ssdi

Or like some gero practices, go with a biller and take Medicare? I guess that’s inevitable in the long run.

Invariably I’ll run into people that have it but are desperate for care or don’t know they have Medicare.

All of this said, how do people run into hot water if accidentally taking a pt on Medicare in such a practice model? Is it the pt trying to get reimbursed? In other words, how does Medicare find out if I inadvertently treat such a pt? I imagine it’s more likely to happen for those whose practice is more heavily psychopharm based.

I don’t like the plan as a cash side gig. You are marketing toward the population that will likely get Medicare at random times thus causing massive headaches for you.

This is better designed as a Medicare practice. A fragile medical population is also not a great population to have limited hours and support staff. This is a group that may struggle more with remembering appointments and dealing with technology issues.

This population is better geared toward an opted-out psychiatrist that can spend time and ignore Medicare issues or a higher volume practice that accepts Medicare with ample support staff to manage issues.

 

[clement]

I don’t like the plan as a cash side gig. You are marketing toward the population that will likely get Medicare at random times thus causing massive headaches for you.

This is better designed as a Medicare practice. A fragile medical population is also not a great population to have limited hours and support staff. This is a group that may struggle more with remembering appointments and dealing with technology issues.

This population is better geared toward an opted-out psychiatrist that can spend time and ignore Medicare issues or a higher volume practice that accepts Medicare with ample support staff to manage issues.

All very valid points. Still wonder what the stakes are with a therapy-only practice.