Topic: Are you a "thorny challenge" or part of the "doorknob syndrome"?
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Well, excuse me!
The "Afterthought" Patient Questions That Snarl Up Your Schedule
Elizabeth Woodcock
Patients who bring up last-minute questions are a thorny challenge, even for the physician who is meticulous about staying on time.
These "oh, by the way, doctor" questions seem to be on the rise. Maybe more patients want to squeeze extra value out of visits to either maximize their time off work or to get more in return for paying higher insurance copayments, deductibles, and other out-of-pocket costs.
Regardless of the reasons, these afterthoughts cause delays for you and other patients. Because they often occur after you've closed the chart -- electronically or manually -- handling patients' last-minute questions might not get documented and could cost you money.
Don't let the "doorknob syndrome" get the better of you. Try these tips to rein in the problems that it can create.
Conquering Doorknob Syndrome: Some Helpful Tips
Prevention Is the Best Medicine
Gather the reason for the visit during the scheduling call.
At the beginning of the visit, have your clinical support staff query the patient: "Ms. Jones, I understand that you're here to talk to Dr. Smith about [x, y, z]; is there anything else that you want to discuss with her?"
Use a similar query after the patient relates the complaint to you in the exam room: "Mr. Jones, I'm going to summarize what you've told me.
I'll be addressing those concerns today. Is there anything else that you'd like to discuss with me today?"
Developing an agenda for the visit encourages patients to state more concerns up front.
Reschedule With Respect
Some patients raise issues that can be delayed. Instead of briskly saying that you have 3 patients waiting and no time to talk, politely defer that last-minute request.
Try saying, "Ms. Jones, the issue that you are raising is so important that I'd like to allow enough time to thoroughly discuss it with you." Give her a follow-up appointment.
Get Paid for the Work
An often overlooked coding rule may apply to the "oh, by the way" situation.
If counseling or coordination of care with a patient and/or the family dominates the encounter, you can code the visit on the basis of time.
Document, code, and bill for the appropriate level of the evaluation and management code on the basis of the typical times found in the Current Procedural Terminology (CPT�) Manual.
For example, the 2010 CPT� Manual says that a CPT 99203 office visit (new patient) typically requires 30 minutes of a physician's time, whereas a 99213 office visit (established patient) requires 15 minutes on average.
The CPT� Manual doesn't offer detailed guidance about how to document the time, but the Centers for Medicare & Medicaid Services (CMS) offers this advice in the July 2009 Evaluation and Management Services Guide:
"... [I]f the level of service is reported based on counseling and/or coordination of care, the total length of time of the encounter should be documented and the record should describe the counseling and/or activities to coordinate care."
Coding experts recommend getting at this documentation in 1 of 2 ways:
Time of day: For example, enter "Total visit, 3:18 to 3:47 PM; counseling, 3:31 to 3:47 PM," into the record; and
Length of time: For example, enter "16 minutes spent counseling; 29 minutes total visit," into the record.
Like any visit, those in which counseling and/or coordination of care dominate must be medically necessary.
Although last-minute patient requests can be frustrating -- and will never go away completely -- a well-executed, multistep strategy can help prevent, manage, and obtain the reimbursement that you deserve for them.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
quote: "Maybe more patients want to squeeze extra value out of visits to either maximize their time off work or to get more in return for paying higher insurance copayments, deductibles, and other out-of-pocket costs."
Yes, I'm only asking questions so that I can squeeze more out of you OR because I want to take more time off work. NOT because I actually want or need answers. Really bizarre attitude.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
I've been playing this game for nearly 25 years. My husband, a seasoned scientist, attends every appointment with me. He and I prepare a list (short page) of symptoms and questions to address. On a separate sheet of paper we list my meds and dosages.
We give one copy to the doc and keep one for ourselves. We also get copies of all lab results to share with my other doctors and copies of any new prescriptions.
My husband sits with a notebook and writes down the info he gains from the doctor. I answer questions.
The doctor seems to like this approach and winds up giving us more time than we expect.
Our doctor does not accept insurance so he is quite expensive. But I see a pain doctor in between LLMD visits and she does take insurance. So by utilizing both docs, being organized and sharing info we get the most for our money.
Does this make sense?
-------------------- DOCTOR: "I don't think you are sick." PATIENT: "We are all entitled to our opinions. I don't think you are a doctor." Posts: 697 | From Northern California | Registered: Jul 2009
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posted
This article has disgusting overtones, it is true. It is the nature of any profession that inevitably there's gonna be time , um, uh, ...'not paid for'... But the fees involved indubitably make it totally unethical for a physician NOT to supply such 'extra' time! What a bunch of baloney. Fortunately most docs I've seen, especially real lyme docs,, would happily address such 'extra' questions. (I'll bet this sad tome was written by ... ...'insurance'.... (yeah, right)- BROKE-ers!) DaveS
Posts: 4567 | From ithaca, NY, usa | Registered: Nov 2000
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quote:Originally posted by Tincup: Well, excuse me!
Talk about trying to get blood out of a turnip. Geeze!
And how much should we charge them for making us wait when we have an appointed time to be there and have to sit for a long while?
That's right... our time isn't valuable. We are only dumb patients.
Wouldn't it be great to charge them?
When I am feeling better and can work I am going to try it at $60/hr just for the reaction after of course calling first and making sure the doctor is on schedule etc.Then I'd use it AFTER they try to dismiss me for another question with they made me wait a long time.
-------------------- Bitten about 20 years ago and untreated until Aug 09 Posts: 43 | From Midwest | Registered: Dec 2009
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ping
Frequent Contributor (1K+ posts)
Member # 6974
posted
When I first read the title of this thread, I missed the "t" in thorny and thought it read something else... To my disappointment, now!
I was about say, "I can be any challenge you want, darlin'..."
Happy New Year!
-------------------- ping "We are more than containers for Lyme" Posts: 1302 | From Back in TX again | Registered: Mar 2005
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Yes, I'm only asking questions so that I can squeeze more out of you OR because I want to take more time off work. NOT because I actually want or need answers. Really bizarre attitude.
Stupid attitude.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
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