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mgriffiths

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mgriffiths last won the day on December 1

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About mgriffiths

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  1. mgriffiths

    RVU Compensation

    Yes they do lose income. It's a long story, but the bottom line is that they also have the ability to calculate my RVUs based on the downgraded billing, and then re-bill the insurance companies with the appropriate billing - this effectively decreases my income while they don't lose anything (assuming they are successful with the insurance companies). Basically it all started with billing making an error in changing my billing and administration is trying to cover the tracks. Of course that doesn't explain why it has continued, but I believe that is because I caught the issue and made it clear to them it was illegal. Furthermore, once I resigned they are trying to keep every dollar they can. There's more to it, but it gets convoluted.
  2. mgriffiths

    Anti-Vaxxers

    Not sure what you mean by an outbreak...I was practicing last year during the flu - and it was bad. I had 12 patients die and over 25 others hospitalized for pneumonia, and I'm in a pretty rural, small-town area. Granted, all 37 of those were older with several comorbidities, but still rough. Sometimes I unfortunately don't take the time to discuss vaccines, as the time is not always available. But, I try to ask the patient (or patient's parents) what their concerns are regarding vaccines. The majority don't want to answer me, but I push a bit. Surprisingly, many don't know why they refuse vaccines. They haven't done "research," they don't even feel strongly about it, they just "just don't know" and therefore choose not to as they feel that not doing it is safer when you don't know. Those are the ones that I will spend time with discussing statistics, herd immunity, and will even respond to the more common "anti-vaxxer" concerns. I would say that I around 2/3 will eventually agree to vaccines. The ones who are vehemently against vaccines I have less patience for. I am much more direct and make it clear the "science" they quote is ridiculous. I am not rude, but I also don't just sit and listen to their ridiculousness. After approximately 30 seconds I end the visit and move on because otherwise they would begin also telling me about their crossfitveganismessentialoilherbalwrapcancercure. Maybe I'm an exception, but I have found that patients respond to respectful authority. This includes vaccines, antibiotics, pain meds, etc. Granted it's not universal, I have experienced many combative patients, but as said above - I don't argue. I don't get angry with the patient, I don't raise my voice, I don't intimidate (I'm a 240lb male previous wrestler/football player), but I'm also not going to allow a patient to verbally abuse me. Far too many providers take this abuse and it's astounding.
  3. This cannot be liked enough!
  4. I try to never do this, but I'm sure I'm guilty. In my area, most specialists won't accept a referral without at least some workup. It get's frustrating sometimes though when ortho ALWAYS wants an MRI before they will accept the patient and it's not warranted (i.e. chronic knee pain and patient wants to try viscosupplementation). But, in general I can understand the frustration. One excuse is that it seems insurance companies push back more on FM in approving imaging/labs etc., whereas things can more easily be green lit by a specialist. I recently had an angina patient that I could not get approved for a stress test. Finally called cardio PA friend, apologized for the referral with no workup. Helaughed and said no problem. He (the PA, not an MD/DO) ordered the stress test sight unseen and it went straight through for approval...grrrr
  5. mgriffiths

    RVU Compensation

    There are CPT codes, E/M codes, and billing modifiers. CPT codes are for procedures, E/M codes are for an actual patient visit (inpatient, outpatient, etc.), and billing modifiers can increase billing value (i.e. hip replacement more difficult than normal because of broken hardware). In general the billing department can correct CPT codes, but there is still a process to follow. E/M codes on the other hand (for outpatient: 99213, 99214, 99215) that is established by the provider who sees the patient and can only be changed by said provider or a CERTIFIED CODING SPECIALIST - most billing departments do not have these, but some I'm sure do - a hospital organization may have some on hand, I don't know. But a normal "billing person" does not have the authority to change E/M codes. See the link pasted below. Billing modifiers: don't know enough to really comment, but would assume it is similar to E/M codes, but again I don't know. https://www.medscape.com/viewarticle/872465 To give an example (I work in outpatient FM): I see a patient for HTN followup who also has knee pain and depression. Assuming I do an appropriate visit this is almost 100% guaranteed to be a 99214 (E/M code), but there may be CPT codes used along the way for a possible knee injection (20610) with a billing modifier of 25 (that's what I've been told to do, but again don't know tons about these). In FM, the vast majority of my RVUs are from "simple" patient visits and therefore the E/M codes, but of course I do office procedures sprinkled in (CPT codes). Bottom line, if you are paid on production, you should have 100% access to your numbers and should know the specifics of any E/M codes that are being changed (whether by a certified coding specialist or otherwise). I am actually changing jobs in large part because my current employer has been actively changing my E/M codes illegally and I am seriously considering reporting them and hiring an employment lawyer, both to recoup the lost bonus income, but also to protect myself as this is blatant fraudulent behavior.
  6. Curious how often others run into this? I work in FM and regularly get bombarded by patients saying Dr. Specialist told them to have me write their prescription. Cardiology asking me to write BP meds? SURE, no problem at all - makes sense!!! But, it's becoming more and more frequent that rheumatologists or other very narrow specialties are asking for me to take over prescribing medications I NEVER prescribe. Example: 87yo male presents with jaundice, new onset bilateral LE edema, and fatigue. History of RA and is treated with methotrexate and hydroxychloroquine (plaquenil) by rheum. Directed patient to call his rheum doctor as both of these meds can irritate liver, rheum told patient to stop methotrexate until problem resolved. Workup reveals patient is severely anemic due to acute GI bleed - gets admitted, 4 units of blood, bleed resolves, discharged and sees me today for hospital followup doing really well. Direct patient to call rheum about restarting methotrexate and rheum tells them to have me restart med. I have never written a prescription for methotrexate and don't really plan on that changing. I don't treat RA, I do initial workup and if rheum problem supported the patient is referred and treated by rheum. This isn't even about extra work, it's about asking me to prescribe "specialist" meds that I am not very familiar with because I NEVER prescribe the med. I mean what is the point for the patient to continue following with the specialist every 6 months if I'm the one prescribing their meds?
  7. mgriffiths

    Job saturation? Michigan

    I just accepted a job that starts late January 2019: FM, 36 hours per week, $110,000 with RVU bonus structure, good benefits (but nothing special). Granted I have 2 years of experience (6 months ortho and 1.5 years FM), but had ZERO problems finding a job. I was not looking in Detroit, Lansing, Grand Rapids, etc. but when I looked there were several job openings in the larger cities and the one I accepted is NOT rural.
  8. mgriffiths

    Candy Man Situation

    WOW!!! Some excellent information here that I had never actually thought of, but am so sorry for OP. That is quite sad/disturbing, but I agree you really need to consider some form of change either within the practice or looking for new employment.
  9. mgriffiths

    BA degree at WGU

    yep, I brought it to their attention 1 week before graduation when grades were released and basically got, "Oops, you're right but nothing we can do now!" They've calculated it correctly since...I guess that's worth something. Definitely not worth doing anything now. The good news is that it hasn't held me back in any way, just stupid, annoying, and would have been nice to graduate with honors - but at this point would just be words on a really expensive piece of paper.
  10. mgriffiths

    BA degree at WGU

    That's as bad as my bachelor's degree: was on track to graduate with honors with a double major Biology and Secondary education. Completed my student teaching and my average GPA dropped significantly taking me out of graduating with honors. Student teaching was a full semester's worth of "classes" (22 credits) and was pass/fail and therefore didn't count as grades toward my GPA, but the 22 credits were still used when actually calculating my GPA...infuriating!
  11. mgriffiths

    RN or PA?

    Not every program has cut offs, but that is few and far between. As for getting a job your last year of school, some schools do not count being a scribe - so double check on that before you go that path. While all of the points brought up are good, one is the difference in the job. Nurses are phenomenal and an integral part of the healthcare team, but their decision making is limited. In general they are given orders by the provider (MD/DO, PA, NP) and they carry out those orders. As a provider you are the one making decisions. If you care about making every decision about everything then go to MD/DO school. If you don't mind working collaboratively and having a physician overrule you at times then PA school (of course I'm biased, but in my opinion NP school is deficient...doesn't mean you can't find a good NP and I've known several good ones). If you don't mind being given orders then consider nursing school. I considered RN, but after spending time working in a hospital and shadowing a variety of healthcare workers I knew I would not be satisfied being an RN. It's not that I can't take orders and follow directions, but I wanted to know the reasoning behind the decision and also be involved in that decision making. As for schedule, as has been said: as a nurse - expect to work nights somewhat regularly while starting out. As you gain experience you can often transition to day shift, but usually the rotation still requires working a regular rotation of weekends and holidays - hospitals don't close. The exception is if you move up the ranks to some form of nursing management/administration, but then you often lose the 3x12 shifts and move to a normal M-F 8-5 schedule. Also: GRE is not everything. The greatest hump for PA school is getting in. It's something like only 5-10% of applicants get into a PA school, but 95%+ graduate and pass licensing exam. That doesn't mean you can relax in PA school, it's rough, but getting in is the "hard part." Last comment: I would HIGHLY recommend figuring out what you want before you spend $100k+ on PA school (yes many school's tuition is less than $100k, but factor in loans for rent/food/gas/etc.). Nursing school is FAR cheaper and often is shorter - and you can usually work while in school.
  12. This statement alone means you should have some anxiety as you walk into work no matter how many days, weeks, months, or years of experience you have. The patients are in the ICU for a reason. Doesn't mean you don't know what you are doing, it's the acuity of the patient. I would actually be more worried if you didn't have some anxiety.
  13. mgriffiths

    BA degree at WGU

    I know that when I was looking into different PA schools there were some that did not accept Pass/Fail grading for certain courses. I don't remember which schools, and maybe that has changed now. My other question is how they calculate a GPA if only Pass/Fail? That alone could create an issue. Lastly, I am no expert on accreditation, but regional accreditation may be a problem. Most graduate schools and beyond require a degree from a nationally accredited school.
  14. I want to clarify that this is not kicking the can, I don't just ignore them, but I am not going to fight with them. I only discharge patients for violating their controlled substance contract. It is their choice to continue with me or go elsewhere, but it's very simple - chronic narcotics are not the right answer and should never be treated as a "right." But this is 100% true
  15. I have been on the receiving end several times and what I found is that word spreads quickly through the community. Granted, I'm in a small, rural community so may be different if you are in a larger town. But, I have found it's really only a headache for the first 1-2 months and then everything settles down, or maybe I just get used to it. I also view it as: this is not a discussion, it's unsafe and bad medicine, I will NOT prescribe this dangerous combination of meds...end.of.story. I know some on here don't like that approach, but I am done fighting with patients. It is the same as antibiotics, the patient came to see me for my professional opinion, whether they view it that way or not. If they don't like my approach to medicine then drive two doors down.
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