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Primary Care Practices: Do you charge for telephone calls from patients?

Home Practice Management Primary Care Practices: Do you charge for telephone calls from patients?

  •  Ykcor 
    Participant
    Status: Physician
    Posts: 13
    Joined: 01/02/2019

    Or charge for home health nurses calling  about patient medical issues? For our small town traditional internal medicine practice, it is ridiculous the number of phone calls that we get, not only during the day, but after hours. It is actually getting worse since the hospital and orthopedist are “bundling” the global fee for large joint surgery. Consequently to cut out the inpatient rehab share of the pie, patients are being sent home sicker. They, or the home health personnel, call the primary care doc for multiple problems, which otherwise would have been taken care of in rehab.

    The local psychiatry group charge $50 per phone call. Concierge practice is out of the question as most of our patients are rural and Medicare. There is a CPT code for phone calls, though Medicare or private insurance doesn’t cover it. If you called your attorney for assistance, I assure you there will be a bill coming your way.

    #179525 Reply
     DC Doc 
    Participant
    Status: Physician
    Posts: 13
    Joined: 10/24/2017

    I have been aggressively working to route patient calls not directly tied to recent office visits into virtual visits, as they therefore can be billed. Not all calls can be rerouted this way, but as you mentioned, lawyers bill their time so should we. Others I punt to portal messages. In conclusion, I hate phone calls same as everyone else. I suppose option 3 is to have a nurse triage all your calls and schedule everything they can’t answer themselves.

    #179533 Reply
    Liked by hatton1
    Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 353
    Joined: 09/20/2018

    I do very little care over the phone compared to my peers.  I guess I have a low threshold to bring people in for an evaluation.

    But to answer your question we do not charge for phone calls.  I saw the same issues with coverage you have seen and decided it was not worth it.

    #179534 Reply
    Liked by HikingDO
     HikingDO 
    Participant
    Status: Physician
    Posts: 224
    Joined: 03/09/2017

    We don’t charge for phone calls, but I can count on one hand the number of patients that I talk to over the phone in 1 year. If it can’t be handled by the MA over the phone, they need to come in and talk about it. Our time if valuable, and as physicians we need to get out of the habit of giving away our most valuable assets, which are our time and medical knowledge/opinions. My attorney doesn’t work for free over the phone, and if I call my mechanic I guarantee that he’s not telling me for free over the phone how to change my oil, and I wouldn’t expect him to. However, somehow patients have gotten used to expecting free advice over the phone from physicians, and at some point we need to put our collective feet down and say no.

    #179542 Reply
    TheLocumsLife TheLocumsLife 
    Participant
    Status: Physician
    Posts: 8
    Joined: 04/22/2018

    Ever consider using telemedicine platform in your EMR instead of phone calls?

    It allows a real visit and complete care and is on the record. Patients like it and it allows you to be paid for your time spent reviewing labs, images and providing care remotely

    Can be done in evenings or weekends, can be done from home or office, and is a nice transition away from “phone call care”

    TLL

    #179563 Reply
    Liked by SLC OB
     LizOB 
    Participant
    Status: Physician
    Posts: 287
    Joined: 06/05/2017

    I recently got a message routed to me that a pt wanted me to provide a second opinion on an ultrasound, ordered by someone else. I haven’t seen the pt (nor has anyone else in my practice) in nearly 3 years. That’s a hard no. I don’t give second opinions for free. Make an appointment.

    #179686 Reply
     Ykcor 
    Participant
    Status: Physician
    Posts: 13
    Joined: 01/02/2019
    WCICon18

    As a coincidence, I was talking with a pulmonologist friend at the hospital this am while making rounds, and he said he was going to to do that very same thing with the tele-med deal. He said he was tired of calling in a burst of steroid and a zpac to his COPD patients who were having an exacerbation and not getting paid for the effort.

    #179745 Reply
    Liked by Tim, Firefly, HikingDO
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 2866
    Joined: 01/21/2016

    I recently got a message routed to me that a pt wanted me to provide a second opinion on an ultrasound, ordered by someone else. I haven’t seen the pt (nor has anyone else in my practice) in nearly 3 years. That’s a hard no. I don’t give second opinions for free. Make an appointment.

    Click to expand…

    This is the bane of radiology. Everyone in the world has a CT or MRI from St. Elsewhere, and every patient and referring doc thinks that we live to read their outside exams for free. One oncology patient, someone I diagnosed his cancer with a biopsy and receives treatment at our Hospital, for yearly follow ups, has been getting his CTs at the cheapo outpatient place down the street and has asked for us to “compare” the new scans to the old ones on our system. Not on my watch!

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #179748 Reply
     Kamban 
    Participant
    Status: Physician
    Posts: 1808
    Joined: 08/01/2016
    yearly follow ups, has been getting his CTs at the cheapo outpatient place down the street and has asked for us to “compare” the new scans to the old ones on our system. Not on my watch!

    Click to expand…

    Can’t he take a CD or have his previous scans pushed to the outpatient that does his CT scans and let that radiologist do the comparison.

    Sometimes the patient has no choice. We have tried to get CT / MRI and PET at the hospital where the original studies were done and the insurance only authorizes it for the cheaper free standing diagnostic centers. Insurance dictates.

    #179755 Reply
    Liked by hatton1, Tim
     wideopenspaces 
    Participant
    Status: Physician
    Posts: 836
    Joined: 01/12/2016

    I’ve tried cutting down on phone calls by scheduling a couple acute slots in my clinic each week. That way I can just ask staff to put them in a slot. But I still get a million MyChart messages a day. We hired an aprn to help with those but honestly it’s a lot of therapy stuff, social issues, etc that are impossible for him to answer. The telemedicine idea is a good one.

    #179759 Reply
    Liked by Firefly
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 402
    Joined: 01/12/2016

    I think in the next 5-10 years we will see most players charging for online messages and calls unrelated to a recent visit within a certain timeframe. Patients will flat out state in a message that office visits have an $x copay so they don’t want to come in, acknowledging their abuse of the system to get free care. Simple things I don’t mind but some people are ridiculous. I’m very lenient with new parents as I don’t expect them to haul their newborn in with every little question but if they seem extra nervous or have a ton of questions at the first visit, I’ll often suggest a sooner follow up to check/in address questions.

    There are new Medicare codes for virtual “check-ins” due to some weird restrictions about a telemed with CMS. I think/hope this will help jumpstart the trend.

    #179762 Reply
     Tim 
    Participant
    Status: Accountant
    Posts: 868
    Joined: 09/18/2018

    @nachos31,
    “Patients will flat out state in a message that office visits have an $x copay so they don’t want to come in, acknowledging their abuse of the system to get free care. “
    No one wants to spend spend extra funds.
    Just as a “good” FA can provide some useful info, some folks think looking things up and trying to DIY with passive investing it’s an abuse of the system.

    If A=B, then X, IF A>B, then Y, If A

    #179808 Reply
    nachos31 nachos31 
    Moderator
    Status: Physician
    Posts: 402
    Joined: 01/12/2016

    @nachos31,
    “Patients will flat out state in a message that office visits have an $x copay so they don’t want to come in, acknowledging their abuse of the system to get free care. “
    No one wants to spend spend extra funds.
    Just as a “good” FA can provide some useful info, some folks think looking things up and trying to DIY with passive investing it’s an abuse of the system.

    If A=B, then X, IF A>B, then Y, If A

    Click to expand…

    I have no doubt that folks don’t want to spend extra funds. Who are the folks who think DIY passive investing is an abuse of the system? Financial advisors?

    #179978 Reply
    Liked by Tim
    CM CM 
    Participant
    Status: Physician
    Posts: 904
    Joined: 01/14/2017

    We don’t charge for phone calls, but I can count on one hand the number of patients that I talk to over the phone in 1 year. If it can’t be handled by the MA over the phone, they need to come in and talk about it. Our time if valuable, and as physicians we need to get out of the habit of giving away our most valuable assets, which are our time and medical knowledge/opinions. My attorney doesn’t work for free over the phone, and if I call my mechanic I guarantee that he’s not telling me for free over the phone how to change my oil, and I wouldn’t expect him to. However, somehow patients have gotten used to expecting free advice over the phone from physicians, and at some point we need to put our collective feet down and say no.

    Click to expand…

    I don’t talk to many patients over the phone, but I respond to an avalanche of phone messages every day. The pt calls the nurse who leaves me a message in the EMR. I read the message, review old notes and labs, formulate a response and send it to the nurse who then calls the pt.

    The calls are for BP too low, BP too high, SOB, CP, edema, uncertainty about meds, “Is symptom “x” a side effect of a med,” dizzy/LH, syncope, “What are test results,” “I’ve got a rash,” etc, etc. My clinic schedule is full. I can’t tell the callers to come in; there are no open slots. If the complaint sounds urgent I recommend ER eval, otherwise I try to manage the query over the phone until the next scheduled f/u appt.

    I had a solo practice in the late 90s with paper charts and no EMR, and as I recall, these calls were very rare. Now I’m inundated.

    I can’t put my foot down as an employee, but I couldn’t do that in private practice either–unless every other cardiologist in town joined the effort.

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #180027 Reply
    Liked by Kamban
     StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1568
    Joined: 01/15/2017

    really depends on the compensation model.

    If you’re pure Fee For service –  then most likely only Face-to-face RVUs unless the contracts call out Telephone or televideo visits for a service fee.

    If full risk, then leverage phone calls/EHR/extenders for asymmetric care and panel management.

    If a hybrid — good luck — trying to be insurance agnostic and finding the balance.  <– this is us.  So minimal personal phone calls, and mostly messages/EHR and let nurse callback;  allows triage and ability to somewhat control response and inflow into clinic as possible.   Still end up doing a lot of unreimbursed work; but minimize it that way.

    I would hate the day insurance/we charge like a taxi meter in 6 sec increments.

    #180036 Reply
    Liked by Kamban

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