Hello Everyone,

I've search but don't yet have a clear idea. I'm listing (right now) to the CMS presentation on e-prescribing and it's not clear that AC does this. Can someone enlighten me?

Thanks!

Barbara

Hi Barbara! Where have you been?

Sorry, all I can say is hi. I don't know much about e-Prescribing and I hope I don't have to. But, then I don't have Medicare either.

G'Morning Bert,

Thanks for the hello! I've been so busy it's unreal. Had to close the practice to new people for awhile. And after yesterday...have to wonder if I should close all together (just a unplesant day with patients trying to bully me).

I would imagine life with Medicare is nice...heck life without insurance companies just might be perfect

Barbara

Agreed on the insurance. I am thinking of closing as well. At least to Mainecare.

Always good to not do things on the spur of the moment. My hospital is making it hard on me to admit. I am really thinking of giving up my privileges. It would be sooooo nice to never have to worry when the pager goes off at 2AM that it may be the ED.

I did get a call from the ED on Friday night at 11PM with an admit. I felt like filling out the paperwork right there for giving up privileges. I just hate giving up the chance to admit certain patients and certain fun to manage diagnoses.

Bert,

Go to courtesy staff, as did I. Then if there was a special patient that I really wanted to follow in the hospital, I could. Over the years, however, the number of special patients has dropped to zero.....I really love not going to the hospital. It made a tremendous change in my attitude and was the saving force behind my being able to tolerate medicine any more at all. I do still miss at times being able to manage patients, especially to have the power not to order things again that were done as an outpatient last week!! That crap really burns me up.

Leslie

Around here you have to have active staff privileges somewhere else and there is still a minimum number of annual admissions. It's been nice having no "privileges" (more requirements and obligtions than a privilege) but some insurance companies still think it means I am an inferior doctor and won't allow me on their plan. THEIR LOSS!!!

>>> Go to courtesy staff...

I tried that in one of my outlying hospitals since they wanted to force me to go to all of their meetings or else I'd be kicked off staff. During my year as a "courtesy" physician I saw over 150 patient visits (you're allowed like 12). Heck, I figured that what are they going to do? Kick me out for admitting there? Well, what they did was to make me an active physician again, but without enforcing the meeting thing.

Now they are ramping up their "hospitalist" army, so I see that in the future I may have to give up my priviledges again eventually, but then again, I may not send them the bone marrow transplant cases that bring in $200000.00 per case. We'll see...

I hate going to the hospital too...

Al

The final straw that pushed me over the edge was the hospital's insistence that I attend their committee meetings for free (what other "consultant" or CEO would do that?) I also became worn out having to take their ER call, getting perhaps 8-10 No Pay admissions in one night, along with my own admits. They refused to allow me to continue to admit over 25/year (I was averaging 350) without serving on their committees. I told them to GTH and started sending my patients across the river to other hospitals. Needless to say, I am not on very good terms with my local hospital but I really do not care. In fact, I rejoice every time I can take business away from them. We are building a new physician-owned hospital in my area and I am hopeful things will return to "the good old days".

Leslie

GTH? "Good Times Hospital"? Probably not but not a bad thought.

Wow, everyone is validating all my issues:

No more meetings.
Knowing my day is 8AM to 5PM (and then 5PM until ??? for paperwork -- but still)
No more worries about ED calls. I would still get them, but I would just say I have don't have privileges. Please give "the privilege" to someone else.
I, too, would hate starting someone on Flovent and Singulair or Risperdal only to have them come back on Advair, but that would be the price I would pay.
It's inevitable that one day the hospitalists will be the only one allowed. It happened with the PICU and NICU. God forbid if I even visit a patient there -- they are convinced that I will tell the patient that the dopamine drip is not necessary or too high. Granted they probably can't stop me from admitting if I have privileges, but they can change the rules so that I have to see the patient within 15 minutes or something crazy like that.

On another note which is kind of funny -- my previous partner who is now retired -- went to courtesy privileges. I told him to use it just for pediatric admissions on the pediatric floor, but he went nuts still admitting his newborns. Used up his limit within two weeks. He just never listened to me.

And, you KNOW how I never have any opinions. LOL.

I love you guys. It's all about the solo doc trying to survive in a solo world. Isn't there a song about that? Paul? Anyone?

You know, Bert, as a primary care physician (Internist) in a metropolitan area, I found it harder and harder to actually define my role in the hospital. The lawyers essentially forced us to use the specialists even though we felt capable of managing most hospital patients. So, over the years my rounding consisted of asking patients things like "Have you pooped yet?" or "Have you considered a stop-smoking class"? But my liability never diminished, nor did my paperwork or midnight calls for Tylenol or Colace. I got stuck with the H&P and DC summaries, signing the Home Health orders and writing the scripts, taking ER call and sitting on the stupid do-nothing committees. The only time I was ever ( so far)sued was because a specialist failed to manage a complication he caused and the review board said I should have jumped in and taken over...yea right. So nope, it was no longer worth it to me. I am so glad I am out.

Leslie

Funny you mentioned about the H & Ps and the discharge summaries. The residents used to do these for me, but they no longer work with me. (Long story)

One of the heads of our Outreach Program, developed this one page discharge summary (still have to do the actual dictated version), which essentially is a good idea. It's designed so that if one is taking care of an unassigned patient for a PCP from 50 miles away, he or she gets a very quick, yet detailed version of what happened to his or her patient so when they show up the next day all of the info would be there.

Well, I have been admitting my own patients now for over a year without the help of the residents. I have been dictating all H & Ps. But, I have not used the discharge form.

So, today I discharged a patient, and I received a call from the hospital saying they couldn't send the patient home until I filled it out. Another knee-jerk, doesn't make sense decision. So, they faxed me the form, I filled it out, and they very nicely and timely faxed it back. Thank God. Because he is coming in on Wednesday, and I would have hated to not been aware of what I did. Hospital politics.

Guys, I've been reading your posts for a few weeks now. I finished training and became a hospitalist for a couple years. The things I enjoyed about inpatient care during my training quickly eroded. Hospitalists are essentially H&P & D/C machines for the specialists. We get called at all times to clear patients for procedures, admit all the no-pay/self pay patients that no one wants, and basically do the paperwork (prescriptions, home health, etc.)

So I figured starting my own practice would make me feel better. I just opened about a month ago. I must say, it's not the case. At least in the hospital, you don't have to worry about seeing a difficult patient after discharge. Just dealing with all the calls, refills, whiny patients in a few weeks has me wondering why I didn't choose a different specialty. And hospital call isn't any better.

What has happened to us in Primary Care? We're all miserable and unsatisfied. Very few residents want to join our specialties. And there is very little hope for any improvement in the horizon.

Sorry for the pessimism...I just had to vent a little.

IntMedDoc,

Welcome to AC. A lot of do share your sentiments. And, yes the refills, etc. are frustrating. As I read your note, I can't help but see some upside to your situation that many of us don't have.

First, you do have the option of setting up a concierge practice with cash only (if that would be financially feasible).

Second, I think you could do what Leslie has done and start right off the bat with a website and setting rules that your patients quickly become familiar with. You could even pre-screen your patients to weed out those who may "fit the profile" for the above that you mention that are problematic.

Third, don't do hospital or hospital call.

Fourth, per above don't do any refills or other inappropriate things during office hours.

Fifth, (and this depends on the other doctor's standard of care for call) you can set up your call system anyway you wish. I think (I have seen other doctors do this) you could have an answering machine that simply says you are closed, leave a message or go to the ER.

Sixth, the fewer the residents that go into primary care, the more of a shortage. Supply and demand dictates that our lot has to get better.

We do very little, if nothing, to improve out bottom line. Why we don't stand up to Medicaid and Medicare and other 3rd party payers is beyond me. All of us should cancel our AAP, AAFP, AMA and local medical society groups until they start lobbying for better conditions, mainly better reimbursement.

How many General Motors workers would be willing to pay union dues if all they got were weekly email newsletters and a free online subscription to "Oil Changes in Chevrolets."

Again, welcome to the Amazing Charts community. Can you give us your first name. It is easier and more personal than IntMedDoc.

And, misery loves company.

DITTO! Also, check out the yahoo group Practice Improvement 1. It is a group of docs doing the "Ideal Medical Practice". Although I am not one of them, I am envious. Too old now to make that drastic a change. Most importantly, you are the boss. Just because an insurance company or hospital or lawyer says you need to do something does not make it so. For example, if a mail order pharmacy in Arizona says it is against Arizona law for them to accept stamped signatures, tell them (as I do) that you do not practice in Arizona. Make them take the added steps and cost to get an "original signature" rather than you doing it. Set your rules, limits, policies now because it is harder to change down the road. Do not be afraid to be a rebel, as long as what your are rebelling against benefits your patients and you in the long run.

Good Luck,

Leslie

I am testing the eprescribing that can be done for a price.

I have been using the "free" allscripts service which is clumsy and very user unfriendly-didn't surprise me at all when they merged with misys-the worlds worst in satisfaction emr.

The eprescribing in ac is ok. It has quite a bit of redundancy, but once your list is built, I am hoping it will be ok.

I really like not having to do double entry for scripts.

About admitting-I really enjoy hospital and have lots of scripts. I am in the process of changing my office hours to 12-6 so I can do my rounding before I come to the office.

Leslie,

How old is too old? I just committed "professional menopause" by re-entering private practice after the age of 50. Won't say how much "after" and except for a slower than anticipated start it has been worth it.

Bruce.

Bruce,

Well, let's just say I remember Woodstock and let it go at that . If I were just starting a practice, regardless of my age, I would seriously consider an IMP. But, after over 20 years in private practice, I think the stress of dumping all my insurances would be cardiogenic suicide. Solo practice has its own herd of tribulations but I would never, ever (I think) go back into a group or an academic practice.

Leslie

I, too remember Woodstock and like they say, if you remember it you weren't there!

aafp has a program called Metric that helps you with "best practices"

There are also Practice Enhancement Forums that you can attend. I took my office manager and nurse to one. It was fantastic. Just preparing for the conference helped us make some make some much needed changes in our practice.

It has taken a lot of effort, but it is really paying off in our happiness and in the long run, much less work each day.