Yelp: When I want to find a good burger…not find a doctor! Friday, May 15 2015 

people-hate-us-on-yelpMy son just finished his first year of college. He is a business major, and I am interested in the viewpoints of his age group of 19 to 20-year-olds. I asked him his perspective on social media and rating sites like “Yelp”, especially in the medical industry. I had to laugh when he responded, “These sites are good for when I want to find a burger, but not trying to find a doctor.” I did have a proud mom moment!

Though I may be a bit bias, I have to say I agree with him. I have never been one to follow the crowd. I would prefer to experience all that life has to offer and make my own mind up based on my experiences. I have found that the vast majority of people who post on these sites are usually malcontents and self-absorbed. As an Administrator of a physician practice, when a patient is trying to “get their way” they typically threaten to go to “Yelp”. It is a threat and a method of intimidation. Before “Yelp”, people would threaten to file a lawsuit or contact their Senator/Congressperson…even the President!

A good portion of patient demands are unreasonable or not in the best interest of patient care. Sometimes, the patient becomes threatening or abusive toward the staff, which results in the patient being fired from the practice. Unfortunately, due to HIPAA, there is no way to defend ourselves against these accusations. Those of us who experience this firsthand know that IF people were to hear the whole story, they would understand our perspective! Would you trust a drug-seeker who is mad because we would not provide opiates since the patient is on marijuana, albeit “legally” with a medical marijuana card? Perhaps the review you are reading is from someone who is upset that they have a high-deductible health plan, and now they owe money to their doctor.

I have discovered that some reviews are in error. I had a review that mentioned a particular physician that was never a member of our practice. The review was regarding a service that we have never provided. It is nearly impossible to redact these erroneous reviews. Why would one want to trust a review that was a mistake?

Then, there is the fact that Yelp will contact the business to “help” them with their business reviews and create more positive responses…for a price. A great article that discusses this can be found at:

Yelp and the Business of Extortion 2.0

Bottomline, leave the reviews to film or restaurant critics…and maybe not even then! Don’t trust strangers with ulterior motives in choosing your physician. Do you want your healthcare in the hands of a trained physician or an unknown person who is trying to lash out because they didn’t get their way?

2012 in review Sunday, Dec 30 2012 

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 12,000 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 20 years to get that many views.

Click here to see the complete report.

Why am I being Charged for my “FREE” physical? Saturday, Sep 1 2012 

Due to the Patient Protection and Affordable Care Act (PPACA), or commonly called “Obamacare”, Health Plans are starting to cover Preventive Medicine services at 100% with no copays, coinsurance or deductible. Unfortunately, insurance companies are not informing patients that dealing with medical issues during these preventive medicine visits will result in an out-of-pocket charge that could result in a co-payment, or a substantial out-of-pocket expense if they have not met their deductible. Insurance companies require all services to be itemized and coded appropriately. One of the primary reasons is to prevent the health plans from paying for services that are not covered. Providers cannot code problem visits as preventive because this would be insurance fraud and could result in the insurance company denying the claim, dropping the physician from their network, and/or, if a government plan, the physician can face imprisonment and fines.

This has resulted in patients becoming angry with their doctor’s offices. Many practices are trying to figure out how to deal with this issue. At my practice, we notify patients before their preventive visit by posting signs on the exam room walls and the medical assistant provides a written notification for the patient to sign that they understand the billing policy. We are also trying to have the physician alert the patient, during the preventive medicine visit, when their concerns become a medical visit and may result in an out-of-pocket expense to the patient. Depending on the severity of the patient’s concern, the physician may be obligated to address the medical issue because, if he didn’t, it could result in a bad outcome for the patient. For example, if the patient states that they have been dizzy and having terrible headaches, this could mean that the patient may have a brain tumor or other significant medical issue. If the physician ignored this complaint, it would harm the patient or could harm others if the patient were driving a vehicle and had an episode. In addition, this would easily become a malpractice lawsuit against the physician.

Some physicians have chosen not to do both a preventive medicine visit and a problem visit on the same day. If the patient is scheduled for a wellness visit and a problem comes up, the physician would either make the decision to change the visit to a problem-oriented visit and reschedule the preventive if the problem is high risk; or have the patient return to deal with the problem issue at a later date if the problem is a low risk. This method keeps the appointments separate and easier for the patient to understand the difference. The downside is that it requires the patient to come back for a second visit, taking additional time off work, to deal with something that could have been handled during one visit.

Never forget your medication information again! Monday, Jul 2 2012 

Most people have phones with cameras now-a-days. To help remember your medications in an Emergency situation, or even simply when you go to your physicians office, take a close-up picture of the prescription bottle! Try to get the medication name, strength, dosage, and prescribing physician in the picture. In addition, it is helpful to know the pharmacy name, pharmacy telephone number and your prescription number. You can also take pictures of your vitamins, supplements and any over-the counter medications that you take.

Many Smart phones allow you to create files, similar to a computer, where you can create a file called “My Prescriptions” and file each picture of your medication into that file.

I’d rather buy a month’s worth of Starbucks than…pay my doctor bill Wednesday, Jul 6 2011 

One of the biggest frustrations we have in the health care industry is due to patients not understanding their own health insurance benefits. Oftentimes, patients think that just because they carry insurance, that means that everything is covered and they don’t have to pay anything. Patients receive health care service and a month later they discover that their insurance doesn’t cover that particular service; however, instead of accepting the responsibility of paying, many patients fight, demand, and threaten the physician’s office staff to make the balance go away.

This phenomenon has gotten worse in the past twenty years or so. I subscribe to the theory that much of this mentality is due to the inception of HMO’s. In the beginning, HMO’s had either zero patient financial responsibility, or an exceptionally low out-of-pocket cost. People have been conditioned in thinking that health care is an entitlement. After about a decade, due to insurance companies (and employer groups) not being able to withstand the expense of higher utilization of “free” health care, they began to make the consumer more responsible by charging higher co-pays and not covering certain services. Unfortunately, most Americans expect the same Cadillac coverage without any additional expense (beyond their insurance premium and co-pay).

A major challenge in physician practices is to help their patient’s understand their insurance company’s reimbursement policies, all the while maintaining good will. Physicians are finding themselves having to develop various financial informed consent forms to assure that the patient understands that they may be responsible for some of the cost. Medicare has required this, in the form of Advanced Beneficiary Notices (ABN), for years.  Even so, we often hear patients state, “I signed it but didn’t read it.”  Or, “I was afraid if I didn’t sign it that I wouldn’t get the service.” Perhaps the days of accountability are long gone.

One of the biggest threats we hear from patients is that they will leave our practice if we don’t write off their balance. Not much that you can do about that. Health care is a business and we cannot pay the bills with altruism. In addition, it is fraud to bill the insurance company for services and write off the patient’s responsibility. Aside from financial hardship cases, routine adjustments of patient responsibility can get a physician excluded and/or fined by the government when it is a government program such as Medicare or Medicaid. Worst case scenario for commercial insurance is the insurance company dropping the physician from their network.

With lower reimbursements, practices really need to devote more energy in collecting all revenues due. The average overhead for a primary care physician practice is reaching 60%. There are no government subsidies for physicians, other than rural health care, community health care centers and native american health centers. More and more physicians are closing their offices, retiring early, selling their practices to hospitals, transitioning to concierge medicine, or going to cash only practices. This is devastating to primary care because of the physician shortage; however, many specialists are also getting hit hard as well.

FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule Friday, Oct 30 2009 

For Release: 10/30/2009

http://www.ftc.gov/opa/2009/10/redflags.shtm

FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule

At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the “Red Flags” Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC.

The Rule was promulgated under the Fair and Accurate Credit Transactions Act, in which Congress directed the Commission and other agencies to develop regulations requiring “creditors” and “financial institutions” to address the risk of identity theft. The resulting Red Flags Rule requires all such entities that have “covered accounts” to develop and implement written identity theft prevention programs to help identify, detect, and respond to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.

The Commission previously delayed the enforcement of the Rule for entities under its jurisdiction until November 1, 2009. The Commission staff has continued to provide guidance to entities within its jurisdiction, both through materials posted on the dedicated Red Flags Rule Web site (www.ftc.gov/redflagsrule), and in speeches and participation in seminars, conferences and other training events to numerous groups. The Commission also published a compliance guide for business, and created a template that enables low risk entities to create an identity theft program with an easy-to-use online form. FTC staff has published numerous general and industry-specific articles, released a video explaining the Rule, and continues to respond to inquiries from the public. To assist further with compliance, FTC staff has worked with a number of trade associations that have chosen to develop model policies or specialized guidance for their members.

On October 30, 2009, the U.S. District Court for the District of Columbia ruled that the FTC may not apply the Red Flags Rule to attorneys. Today’s announcement that the Commission will delay enforcement of the Rule until June 1, 2010, does not affect the separate timeline of that proceeding and any possible appeals. Nor does it affect other federal agencies’ ongoing enforcement for financial institutions and creditors subject to their oversight.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,700 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of consumer topics.

MEDIA CONTACT:
Office of Public Affairs
202-326-2180

(Red Flags October 09)

Patient Notice for Preventive Medicine Visits and Office Visits Thursday, Jun 11 2009 

This is a notice that we have in every exam room explaining to patients how physicals and medical visits are coded and the expectant results by the insurance company.

ATTENTION PATIENTS:

If you are here for a scheduled preventive medicine visit (i.e. well-visit, Prev Med, or yearly physical exam) this visit will be submitted as a preventive exam to your insurance. Depending on your health plan’s policy, your insurance may or may not cover this visit. Not all insurance companies cover well visits; or, you may have a maximum annual cap for well benefits that is less than our charges.

If during the course of your preventive exam, the physician addresses and documents a problem-related issue (i.e. hypertension, depression, diabetes, pain, acne, etc.), you may also receive an office visit charge as well. In addition, your insurance may require you to pay two co-pays for today’s visit because of the well-visit and a problem-visit charge on the same day.

Some health plans have forced us to schedule the physical on a different day than the well-woman (annual female exam with pap), due to the fact that they will not pay for both on the same day. Please be assured that we understand that this is not convenient for our patients. We are sorry for the inconvenience.

Lastly, the physician assigns codes according to the services he/she provides. The doctor cannot alter the coding submitted to your insurance in order for your insurance carrier to make payment.

If you have any questions, please contact our billing department.

Rating physicians on websites Sunday, May 24 2009 

I’ve been troubled by the fact that patients can go to websites that allow them to rate their physicians and add comments. The main problem is that physicians can not defend themselves on these sites without breaching patient confidentiality. How is it fair for someone to provide a one-sided statement that usually is derogatory toward the physician or practice and we can not refute the claims by giving our side of the story. Who can make an informed decision based on one person’s claim of being treated poorly or unfairly?

There is always another side to the story! What is not being told is that the disgruntled patient may have wanted something that violated policy, the physician’s license, or the medical practice act. Perhaps the patient was abusive toward staff and was discharged? Maybe the patient just didn’t want to pay their bill and became upset that the practice sent him to collection? I can definitely say we have had our share of demanding patients who “want what they want when they want it”, otherwise known as the Burger King mentality. They do not want to go along with our rules and policies. They dont care that it was against the medical practice act to provide a prescription for something that the physician never treated them for.

I believe that anybody who looks at these rating websites really take it with a grain of salt. More often than not, satisfied people rarely go out of their way to find one of these sites and give their feedback. The patients who are fired up to get revenge are the ones that frequent these sites on a regular basis. Just think about how many patients a physician has and if you go to one of these rating websites and see 2 or 3 negative comments, is that really bad? Can you trust everything someone else tells you? What is their motive? Did that person have any part of the conflict? Have you ever met someone that was adamant that they were right about something and would not have an open mind to accept anything beyond what they believed?

Wall Street Journal article Saturday, May 23 2009 

I recently read this article in the Wall Street Journal. The intended audience are patients; however, I think that the comments are very informative to see the physician side of the equation. Yes…of course…I had to add my say and have commented on a variety of other people’s comments!

Why Patients May Be Billed for Free Exams
Coding-System Confusion Can Cause Insurers to Deny Coverage of Preventive Care

http://online.wsj.com/article/SB124287021368941879.html

Wall Street Journal
HEALTHY CONSUMER
MAY 21, 2009
By ANNA WILDE MATHEWS

Thinking…. Thursday, May 7 2009 

I haven’t updated my blog lately…I am trying to think of what to post next and I have been trying to catch up with work and home stuff. I hope to add something this weekend. Please bear with me!

Thanks for your interest! Keep those comments coming in!!!!

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