Revolution in prior authorizations

I had a small one doc family practice clinic for ten years. Spent more time with patients. The trade off was that if they need a prior authorization, they had to come in for a visit. I would call the insurance company from the room face to face counselling and coordination of care and all that crap. This did a number of things:

1. I could bill for the time.

2. The patient saw how the insurance company treats us and our offices. The rep on the line would try to call me by my first name since doctors rarely call. I would say, “No, please call me Dr. Ottaway.”

3. The patients sometimes had called their insurances already and been told “Have your doctor call.” When I would call, the company rep would sometimes say, “We don’t cover that.” The patient would be outraged and say, “But I called YESTERDAY.” The rep would say, “I only talk to doctors. The part of the company that talks to patients is a different part.” The insurance companies can’t triangulate their way out of that.

4. I would end the call by saying, “This has been a face to face with the patient call, you have been on speaker phone and I am documenting the call and the time in the patient’s chart.” At first the calls took 25-30 minutes. Some companies apparently flagged me, and would say “Yes.” if I called, and get me off the phone as fast as possible. They really do not like it being documented in the chart.

5. Insurance companies sometimes drop patients on purpose because the person has gotten more expensive. I had a snow bird from Alaska whose insurance had dropped him. He said he’d paid on time. I said, come in if you want and I will call them. I spent 45 minutes on the phone where they made multiple excuses, lied (we can’t send you a copy of his insurance because we don’t have a fax after they’d said he was not allowed to leave Alaska and I said, “For how long? What do you mean? You don’t insure him if he’s out of the state? Send me a copy of his insurance contract!”) I finally realize that they have dropped him on purpose because he’s been diagnosed with diabetes. I say “Ok, look, I am staying on the phone until he’s reinstated and I don’t care how long it takes. And if you hang up on me I will contact the insurance commissioner in Alaska and Washington states.”

6. Patients are truly outraged at how a physician is treated when she calls an insurance company herself. I have to give my name, my NPI number, my address, my phone number, my fax number, the patient name, the patient address, the patient phone number the patient insurance number and sometimes have to do it every time someone transfers me. When they see me spend 25-30 minutes on the phone to get a prior auth, especially if it is refused, they are up in arms.

I think it would be truly revolutionary if every doc in the country called an insurance company with a patient in the room and documented the conversation in the chart. Wouldn’t that be fun?

Gonna be a revolution, yeah…..

Getting rid of stuff

This is not my forte. I was raised by pack rats and I have genes from both sides. My OCD tendencies are confined to patient charts and keeping shoes in their original shoe boxes. Otherwise my house is piler pack rat. Piler, not filer. Filing is boring. My office managers have to be Queen Filers to keep me in line. Both of them were, too.

Cleaning out the clinic was difficult. I found stuff I didn’t know I had, of course. What to do with the metal speculums? Keep for posterity or in case we run out of oil? I don’t actually know where the speculums went, they went off with a friend who is helping.

In retrospect, I think my mother would have made paper mache ducks with speculums as beaks and wish I’d kept one. Ah, well.

Weird shelves, microwave and printer.

Someone bought the weird shelves. The microwave’s owner picked it up. We had three printers running at any one time except when one would die and we’d only have two. This printer went home with me. New and old computers went home with me because one has to wreck the hard drive because HIPAA. My house currently looks like a computer/printer/scanner/file cabinet graveyard. It’s annoying.

Home office guest bedroom.

Besides this messy room, there are also 8-10 more boxes of stuff moved down to the basement. I have to keep patient charts for ten years or until they are 21 for minors. I have paid a company Big Bucks to take that over. I have to keep business records for 7-10 years depending on if it’s state or feds.

Well, I’ll sort it before I’m dead, or else my kids will.

Quimper Family Medicine contact information

Quimper Family Medicine is closed.

For Medical Records, here is contact information:

Spectrum Information Systems

PO Box 739

Enumclaw, WA 98022

phone 206-686-3821

fax 206 686 3840

The contact information for billing is by mail only:

Quimper Family Medicine

PO Box 1053

Port Townsend, WA 98368

I had the fax number set up to fax to the cloud, but Century Link botched it massively. I spent an hour on the phone with them a week ago Thursday and couldn’t fix it. Good it wasn’t in person, because I wanted to break things. They screwed up the change of address, didn’t send me a bill, didn’t sent me the email to activate the damn thing, then passed me off to someone else who hung up on me. My thoughts about Century Link currently are quite dark and not publishable on a family friendly blog.

Empty clinic right before closing.

I miss my peeps. You people, friends and patients.

empty waiting room and front door of a clinic
Empty clinic waiting room and front door.

Mordechai on fleek

For the Ragtag Daily Prompt: fleek.

In October, Mordechai the plastic skeleton hangs out in the Quimper Family Medicine waiting room. She changes outfits. We had a 10 year old visitor who rearranged everything and now Mordechai is on fleek. She is holding out emergency preparedness pamphlets.

DSCN4262.JPG

 

Mordechai goes out

Mordechai, the Quimper Family Medicine genuine plastic skeleton, came out to dinner with us on Saturday and seemed to have a great time. She is wearing a sequinned top, though you can still see her ribs through it. Lots of people stopped by to get introduced….

Kathy Carr took this photograph, many thanks!

primary care medicine: schedule

I see patients from 8:30 or 8:00 am until 2:00 pm.

We have people say, “You are off after 2:00.”

Well, no. Most days I work for 2-3 hours beyond the patient contact time. Sometimes I come in early and sometimes it is from 2pm to 5pm and sometimes it is the weekend or into the evening.

So what am I doing?

  1. returning phone calls
  2. doing refills. To do a refill I check when the patient was last seen and whether they are due for laboratory.
  3. reading specialist notes and updating medicine lists, diagnoses and contacting patients to get tests or follow up that the specialist has recommended
  4. reviewing lab results and sending a letter or signing to be scanned and to be available at the follow up visit or calling the patient
  5. reading emergency room notes and hospital discharge summaries and setting those patients up for follow up, updating medicine lists and adding to diagnosis lists.
  6. dealing with multiple stupid letters from insurance companies questioning the medication that I have prescribed. Mostly I mail these to patients.
  7. running my small business: long term planning, short term planning, advertising, commercial insurance
  8. 50 hours of continuing medical education yearly
  9.  Updating my medical license, medical specialty board eligibility, business license, CAQH, DEA number, Clia lab waiver, medicare’s shifting rules, medicaid’s shifting rules, tricare’s rules, and 1300 insurance company’s shifting rules and medicine rejections and prior authorizations even for a medicine a person has been on for 20 years.
  10. Worrying about small business costs as reimbursement costs drop: health insurance. Retirement. L&I. Employees. Malpractice insurance, small business insurance, the lease, staff costs.
  11.  Discussing and updating medical supplies and equipment, office supplies and equipment
  12. Updating clinic policies and paperwork per the change in laws. Have you read the Obamacare Law? Over 3000 pages. HIPAA. The DEA. Recommendations from the CDC, federal laws, state laws, internet security, patient financial and social security security.
  13. Trying to track what we collect. That is, say I bill $200.00. Since I accept insurance, the insurer will tell me what is the “allowed” amount per me contracting as a “preferred” provider. The “allowed” amount is really the contracted amount. Then the insurance company either pays it or says that the patient has a deductible. This could be $150 per year or $5000.00 per year. With medicare I then have to bill a secondary if the person has it and then anything left is billed to the patient. Oh, don’t forget copays, if they don’t pay that we have to bill it. So to get paid the complete contracted amount, aka “allowed” we may have to submit bills to two or even three insurances and the patient. We might be done two months after the patient is seen.
  14. Trying to convince recalcitrant computers and printers and equipment that indeed, it doesn’t have a virus, oh, or maybe it does, and fixing them.

My goals are to give excellent care AND to work 40 hours a week. Half of my patients are over 65 and many are complicated, with multiple chronic illnesses.  When I saw patients 4 days a week for 8 hours, with an hour hospital clinic meeting every day, I also spent at least an additional 8 hours and more trying to keep up with most of those things above. The average family practice physician makes more money than I do. But they also report working 60-70 hours a week on average. I do not think this is good for patients or doctors or doctors’ families or their spouses or children. The primary care burn out report rose from 40% to 50% of the doctors surveyed.

We need change, we need it now, and we need to be realistic about how much work is healthy.

When I was still delivering babies, women would ask if I could guarantee doing the delivery. I would explain: “We do call for up to 72 hours. If you go into labor at the end of that, you would rather have a physician who is awake and rested and has good judgement. Besides, I’m a bit grumpy after 72 hours. ” And they agreed that they really don’t want an exhausted burned out physician.

I took the photograph of Mordechai, our skeleton, today. She is genuine plastic. I wish she would do some of the paperwork, but at least she lightens things by making us laugh. She gets various wigs and outfits and sometimes comes out to show a patient a hip joint.

I am NOT attracted to paperwork. I think I am repelled. For the Daily Prompt: magnetic.

 

Art at Quimper Family Medicine

I change the art at clinic, these for the summer. We had four reproductions up before, of alchemy paintings from the 1400-1600s. I thought they were creepy but also interesting and beautiful.

The painting on the left is by my mother, Helen Burling Ottaway, of my sister, Christine Robbins Ottaway. On the right is an oil by an artist that I don’t know. It looks like my father. I inherited art, but I keep finding beautiful pieces. At least I can display a little and rotate them with the seasons…