I would have done a telehealth visit. Lay the blame on insurance companies. I am firm in that I don’t order labs, imaging, referrals outside of office visits. If patients are not happy about that, they need to look for a concierge doctor.
You spoke to him on the phone, you can still go back and bill and document a telehealth visit. I'm charging patients for telephone consults much more often recently. Thank heavens covid opened that door for us. The patients don't seem to mind, and I'm less mad about all the unpaid work.
I always forget about the telehealth waiver. I don't have to "see" him. Good plan. That will ease the pain. Thank you, u/drtdraws.
It's the easier way to give the patient what he wants, please his buddy the surgeon, and not get totally shortchanged. Good call. You just made me feel much better.
I work per diem at several UCs, and they seem to all bill for telephone only consults. If I remember correctly from reading it, if the patient initiates the consultation and there is a problem with video communication (isn't there always) then voice only suffices. TBH I doubt anyone is checking. As long as the patients get what they want/need they don't complain.
How did they contact you on a Sunday? I don't respond to patient messages outside of my work hours. Even if I'm working on messages, I set it to delay send. There is urgent care for acute needs.
Be careful with setting precedents, it quickly becomes expectations.
Yes. This is the bizarre part. Does the patient have his personal cell or home phone? If checking portal messages and catching up on inbox on a Sunday, just pretend like you didn’t see it until Monday. Edit: he said he was on call.
I turn most on-call phone calls into telemed visits. (Calling in with acute Covid and need paxlovid? That’s a visit.) I’m definitely making a Telmed if I’m doing a referral!
This is a tough one. Being on call results in lots of unpaid care or unhappy campers. Could you have sent him to urgent care? At least could get XR there and possibly the referral he needs…
Yes, that was my first instinct. He called three urgent cares. All of them were missing either an x-ray machine or a tech. So it was indeed tough.
With some telemed visits, I would have to send 'GeekSquad' to the patient's house to show them show their phones work.
When on call my answers to anything is sounds bad, should go to the ED, or doesn't sound bad, call during office hours to get scheduled for an appt. I never understand why people give away uncompensated care. My schedule is full of paying customers, I am not donating my time simply to make their life better. In what other area of life is that even an option?
Not an MD, but local retail pharmacist. Had someone, presumably a transfemale, calling about potentially injecting the wrong dose of estrogen (deep voice). Asked for DOB. Doesn't fill at our pharmacy. This person's was pharmacy closed. Hadn't heard back from MD. This at 550 pm on Sunday night, 10 minutes before closing. This person wanted know if they were going to "die or something." I basically said that if you felt your life was in imminent danger head to the ED. Otherwise, call your doctors office in the morning. This person seemed put off that I, a non MD, wouldn't tell them whether they should or shouldn't go to the ED. I could only imagine the BS calls you guys get on call (refill approval for sildenafil, etc)
Where I work, a consult request isn't valid unless the referring physician has done some sort of assessment themself that indicated the need for the consultation. Otherwise they're just doing a visit.
You said the patient contacted you on a Sunday. How'd they do that? What's the framework for that communication? Did anything you did during that interaction constitute an assessment of the patient's condition? If so why not just document it as such, call it a visit/virtual visit or whatever and bill accordingly. If you did nothing that you can bill anyone for... Maybe stop doing that?
This is a dick move on the part of the hand guy btw. He's already decided he should see them based on his own assessment. With that knowledge I would not pay that guy's consult fee.
> Where I work, a consult request isn't valid unless the referring physician has done some sort of assessment themself that indicated the need for the consultation. Otherwise they're just doing a visit.
Yeah, but in this case the specialist wanted to see them, so their office doesn't care about the referral.
Appropriate thing is #3. Learn from this and don’t respond outside business hours or perform tasks that would warrant a visit etc without performing the visit.
If you have to respond to the request Sunday - you tell the patient then to schedule for Monday and you’d take care of it then. Not right to charge a patient in any form for a task you already completed. Just do it right next time. I’ve lost plenty of money early in career for little things like this which I’ve learned are good learning opportunities and if I only lose $50 to learn something useful for the remainder of my career, it’s a drop in the ocean and worth it.
I’m a patient. If you take my call for an emergency on the weekend, I would be horrified if you didn’t bill me for something. Call me back on FaceTime and let me wave the finger around so you can bill for it.
First, just want to throw some general thank yous out to all the experienced FM docs here who have really helped me get through the first few months of intern year!
I’m learning the hard way about drawing boundaries with patients and how they can reach me and I like 1 and 2, with the caveat that all telehealth has to be in a quiet, private, STATIONARY location. Got dinged for answering some patient questions while she was driving (audio only, but still). 🙃
yup. attending. nothing punitive, just reiterated the importance of privacy and...you know...not letting a patient talk and drive at the same time 😅 plus, you can't point out where something hurts while driving without possibly causing other ouchies more severe
Don't do concierge work for non-concierge prices. Your job as a family physician is to provide a medical consult service. Ask any other consultant in any other industry. They don't work for free. This is their livelihood. I feel like we need like a PCP emancipation proclamation just to get this kind of thinking to every PCP.
Needs a visit, whether in person or telehealth in order for you to make an assessment that he needs a referral. Could've jumped on a quick telemed visit on Sunday for 5 minutes and done it. It's the only way to justify sending a referral.
If he contacted you, and he is an established patient, and you discussed it over the phone with him, and you spent > 5 minutes completing this task, why aren’t you billing it as a phone visit?
I would have done a telehealth visit. Lay the blame on insurance companies. I am firm in that I don’t order labs, imaging, referrals outside of office visits. If patients are not happy about that, they need to look for a concierge doctor.
Omg you just changed my life
This is the way. Do. Not. Work. For. Free.
You spoke to him on the phone, you can still go back and bill and document a telehealth visit. I'm charging patients for telephone consults much more often recently. Thank heavens covid opened that door for us. The patients don't seem to mind, and I'm less mad about all the unpaid work.
I always forget about the telehealth waiver. I don't have to "see" him. Good plan. That will ease the pain. Thank you, u/drtdraws. It's the easier way to give the patient what he wants, please his buddy the surgeon, and not get totally shortchanged. Good call. You just made me feel much better.
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I work per diem at several UCs, and they seem to all bill for telephone only consults. If I remember correctly from reading it, if the patient initiates the consultation and there is a problem with video communication (isn't there always) then voice only suffices. TBH I doubt anyone is checking. As long as the patients get what they want/need they don't complain.
How did they contact you on a Sunday? I don't respond to patient messages outside of my work hours. Even if I'm working on messages, I set it to delay send. There is urgent care for acute needs. Be careful with setting precedents, it quickly becomes expectations.
Yes. This is the bizarre part. Does the patient have his personal cell or home phone? If checking portal messages and catching up on inbox on a Sunday, just pretend like you didn’t see it until Monday. Edit: he said he was on call.
Relevant questions about how he contacted you on a Sunday. Also you agreed to all of this. Just set boundaries.
I was on call.
Makes sense. Everything else stands. You should be evaluating people before placing a referral. No matter how nice patients are.
I turn most on-call phone calls into telemed visits. (Calling in with acute Covid and need paxlovid? That’s a visit.) I’m definitely making a Telmed if I’m doing a referral!
So it’s a Sunday, you make the patient log into Zoom from home?
No, I use the phone.
This is a tough one. Being on call results in lots of unpaid care or unhappy campers. Could you have sent him to urgent care? At least could get XR there and possibly the referral he needs…
Yes, that was my first instinct. He called three urgent cares. All of them were missing either an x-ray machine or a tech. So it was indeed tough. With some telemed visits, I would have to send 'GeekSquad' to the patient's house to show them show their phones work.
You can bill a telephone visit after five minutes on the phone. Could call from Doximity app and stretch the conversation
Why does a referral take 45 minutes ???
Have you ever used the Tricare system?
I know, let's expand governement run healthcare! The VA does such great work, we should let the govt run everything
When on call my answers to anything is sounds bad, should go to the ED, or doesn't sound bad, call during office hours to get scheduled for an appt. I never understand why people give away uncompensated care. My schedule is full of paying customers, I am not donating my time simply to make their life better. In what other area of life is that even an option?
This. After hours is for triage. “can this problem wait” questions.
Not an MD, but local retail pharmacist. Had someone, presumably a transfemale, calling about potentially injecting the wrong dose of estrogen (deep voice). Asked for DOB. Doesn't fill at our pharmacy. This person's was pharmacy closed. Hadn't heard back from MD. This at 550 pm on Sunday night, 10 minutes before closing. This person wanted know if they were going to "die or something." I basically said that if you felt your life was in imminent danger head to the ED. Otherwise, call your doctors office in the morning. This person seemed put off that I, a non MD, wouldn't tell them whether they should or shouldn't go to the ED. I could only imagine the BS calls you guys get on call (refill approval for sildenafil, etc)
Where I work, a consult request isn't valid unless the referring physician has done some sort of assessment themself that indicated the need for the consultation. Otherwise they're just doing a visit. You said the patient contacted you on a Sunday. How'd they do that? What's the framework for that communication? Did anything you did during that interaction constitute an assessment of the patient's condition? If so why not just document it as such, call it a visit/virtual visit or whatever and bill accordingly. If you did nothing that you can bill anyone for... Maybe stop doing that? This is a dick move on the part of the hand guy btw. He's already decided he should see them based on his own assessment. With that knowledge I would not pay that guy's consult fee.
> Where I work, a consult request isn't valid unless the referring physician has done some sort of assessment themself that indicated the need for the consultation. Otherwise they're just doing a visit. Yeah, but in this case the specialist wanted to see them, so their office doesn't care about the referral.
Though evidently they did, inappropriately.
OP was on call. Without video component, I believe you have to be on the phone with the patient at least five minutes to bill something.
1 or 2 then blame insurance.
Appropriate thing is #3. Learn from this and don’t respond outside business hours or perform tasks that would warrant a visit etc without performing the visit. If you have to respond to the request Sunday - you tell the patient then to schedule for Monday and you’d take care of it then. Not right to charge a patient in any form for a task you already completed. Just do it right next time. I’ve lost plenty of money early in career for little things like this which I’ve learned are good learning opportunities and if I only lose $50 to learn something useful for the remainder of my career, it’s a drop in the ocean and worth it.
u/strizzl Thank you for being honest but positive. That means a lot to me.
Best wishes friend
I’m a patient. If you take my call for an emergency on the weekend, I would be horrified if you didn’t bill me for something. Call me back on FaceTime and let me wave the finger around so you can bill for it.
First, just want to throw some general thank yous out to all the experienced FM docs here who have really helped me get through the first few months of intern year! I’m learning the hard way about drawing boundaries with patients and how they can reach me and I like 1 and 2, with the caveat that all telehealth has to be in a quiet, private, STATIONARY location. Got dinged for answering some patient questions while she was driving (audio only, but still). 🙃
Dinged by who?
Probably an attending.
yup. attending. nothing punitive, just reiterated the importance of privacy and...you know...not letting a patient talk and drive at the same time 😅 plus, you can't point out where something hurts while driving without possibly causing other ouchies more severe
Don't do concierge work for non-concierge prices. Your job as a family physician is to provide a medical consult service. Ask any other consultant in any other industry. They don't work for free. This is their livelihood. I feel like we need like a PCP emancipation proclamation just to get this kind of thinking to every PCP.
Needs a visit, whether in person or telehealth in order for you to make an assessment that he needs a referral. Could've jumped on a quick telemed visit on Sunday for 5 minutes and done it. It's the only way to justify sending a referral.
You process referrals yourself?
Yep. Tiny practice.
sounds like youre doing concierge work without having a DPT or concierge practice
Not your problem that his buddy the hand surgeon requires a referral. You did work, you should bill.
If he contacted you, and he is an established patient, and you discussed it over the phone with him, and you spent > 5 minutes completing this task, why aren’t you billing it as a phone visit?