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About Dobbyrocks

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  1. You guys know this is hyperbole, right? Medicare reimbursement for cryosurgery of a single AK (17000) is 55.14, each additional lesion is 2.52 (subject to multiple surgical procedure reduction, of course) and 15 or greater AK (17004) reimburses a whopping 102.71. The first tangential (shave) biopsy pays $41.08, each additional biopsy is reimbursed at 23.79, ALL SUBJECT TO MULTIPLE SURGICAL PROCEDURE REDUCTION which cuts reimbursement by 50%, and then of course, as PAs we are reimbursed at 85% of the allowable charge. Complicated, right? And I know it’s not bad money, all in all, for a few minutes work, but a far cry from $1800. The real money in derm is in volume. I see 47-50 patients per day, so believe me I am working my butt off for my hefty paycheck.
  2. Re: forms/prior authorizations, I will usually sign the form and fill in any clinical info I need to contribute, then ask my MAs to fill out the rest. You should realize there may be pushback, especially if you have been doing some of these things yourself. Smile, ask nicely, and expect what you ask to be done.
  3. Has anyone seen this? https://www.policymed.com/2018/07/cms-proposed-evaluation-and-management-e-m-documentation-and-payment-changes-are-sparking-backlash-and-may-hurt-patients.html Under the scenario envisioned for Table 22, rheumatologists would be in for a 3% cut. Allergy/immunology and hematology/oncology practices, along with neurologists, would receive a more minor, less than 3% estimated decrease in overall payment. Nurse practitioners might see a 3% bump, while psychiatrists and physician assistants are among the group that might get a less than 3% increase in overall payment. Nurse practitioners get a bump while we get a cut? What the heck?
  4. So.....2-4 months of training and you would essentially be on your own? Nope nope nope. That’s the kind of crap that gives derm PA’s a bad name on the MD boards, and with good reason. Sure, you’ll be able to biopsy lesions and treat acne but do you think you’ll be able to manage blistering disorders or complicated skin cancer patients on your own without direct and easy access to a board certified dermatologist? And don’t think it doesn’t happen...I know a colleague who saw Sweet’s syndrome her first week in practice. Dermatology is a wonderful field but you can’t learn it in 8 weeks. I’ve been in derm for over 15 years and recently left a job because I was tired of being the only provider at my clinic (my in office SP retired and the company did not replace him). Sure, i could easily take care of 98% of the patients....it’s the 2% that kept me up nights. Find a job where you are appropriately trained and supported. Best of luck come to you.
  5. I have been at the same location since my graduation from PA school in 2002. For years it was just me & my doc, but in 2015, my supervising physician retired and sold the practice to a large company. I stayed on, as did most of our patients, but I am growing weary of corporate medicine. I have not worked with another provider in over two years...my current supervising physician is brilliant and approachable but 55 miles away. I have met him once, talk to him on the phone maybe once a month. The company tells me they are “actively recruiting” for our location...whatever that means! I don’t mind working independently but I am really tired of feeling like I am shouldering all the responsibility with very little support from corporate. So, now I have received this incredible job offer and I think it’s time to bail. I will be in the next Town over so as to avoid issues with my non compete (actually closer to my home!) My question...do I have to worry about patient abandonment legal issues? I would hate to get my supervising physician in trouble...this mess is none of his making...but I can’t imagine my octogenarians traveling 55 miles to see him. I don’t think I can count on the company to hire someone else during the 2 mos that I will have to work my notice. There are other specialists in the area...should I reach out to them? I don’t usually think of this as a PA issue but since there is no longer a doc in the building do you think I need to be concerned? And is this my problem or the problem of the corporate monster I currently work for?
  6. What is the American Board of Physician Specialties? Is this a legitimate medical board? Are these physicians trained through a proper residency? Dori Hite MPAS, PA-C
  7. Ok, after 13 years my boss is retiring and selling his practice. He has not disclosed to me who he is selling too (although I have a pretty good idea...my medical assistants could be CSI agents). He tells me I will meet with the new group sometime in March. Here's the rub...my current contract has a non compete AND an assignment clause which means my non compete goes right along to whoever buys us out. This may be no problem if I like the guys but a SERIOUS problem if I don't. I went to my boss and asked him to sign a release (drawn up by my attorney) stating essentially the non compete would be null and void in the event of a sale. He has refused. I know my collections are well more than half of the total practice income and he has stated I am a "valuable asset" to the business, so I'm thinking he's worried the sale won't go through if he can't guarantee my ongoing employment. I think my ability to negotiate a decent compensation package with the new group is severely compromised with a non compete in place AND I'm pissed off at being sold like cattle. Should I give my notice and take something outside the non compete geographical area (18 miles) just to be done with this? I'm thinking if I quit and then he sells the practice or even closes my non compete should be null and void once his business is closed. Or should I just stick it out and see how the new group works out? Does this tick you off or am I just overreacting? Dori Hite, MPAS, PA-C
  8. I was out of town once on vacation and on a Sunday morning woke up with a raging UTI. I walked in to the Walgreens pharmacy across the street from my hotel, found the pharmacist and told her the problem. She let me write myself a 4 day supply of Cipro...enough to get me home. The pharmacist was really nice about it. I just gave her my prescribing #, she looked me up in their system, and I used one of their in house RX pads. She filled it right away while I waited. Oh, and I charted it all when I got back to the office :)
  9. Anyone ever work for a practice that was sold? All signs indicate that my SP is considering selling, including the unannounced addition of an assignment clause in my employment contract (which I have not yet signed). Neither the boss or his wife (yes...wife) have mentioned anything to me or any of the other staff members but it's pretty apparent that change is afoot. Anyone else worked for a practice that sold or been in any similar situation? I'm looking for guidance as I navigate these very murky waters.... Thanks!
  10. I have been at the same practice for 10 years so I seem to get less and less of this (thank goodness). I usually will say something like "I'm sorry if there was a misunderstanding, but you were on my schedule today. I'd be happy to get started with you now or you can wait to see the doctor." That's it. If they say they'll wait, then I make sure they do (wait, that is. In our office we probably wouldn't reschedule them but you can bet they'll be cooling their heals in that exam room for quite some time before I get a chance to let my SP know that they only want to see him). I used to try to convice, cajole, smile, impress, catch more flies with honey, that sort of thing. Now, for the most part, I just get the hell out of the room. The thing to remember, it's not about you...it's about them. Usually these patients are either (1) outrageously self important or (2) uneducated. Their request to see the doctor has nothing to do with your skill, training, competance or personality. So don't take it personally. Avoid the bullet that's about to hit you and get the hell out of the room! Let it go, and go see the next patient.
  11. Over the years, I have become less sympathetic (meaning, less likely to offer reduced prices) to patients without insurance and MORE likely to reduce my fees to patients with insurance that carry a high deductable. So often THESE patients are paying huge costs out of pocket just to have insurance, then turn around and have to pay again when they receive medical services. On the other hand, patients with out insurance at all have no initial out of pocket costs. I realize not every one can get insurance (maybe turned down due to pre-existing condition) but I see just as many driving a nice car, carrying an expensive cell phone, wearing designer clothes, etc... We have to be honest and admit that many of these patients simply choose not to spend their money on insurance, while others sacrifice to carry a high deductible policy. THAT is the patient I want to help. I guess I can relate since my own insurance costs me about $750 a month (family plan) and has a $10K deductible. That's a lot of money!
  12. Mike, I work in Derm and Allergan has been a thorn in the side of several derm PA's over the years. Evidently, there is a free practice management program for big Botox providers provided by Allergan. This practice manager people have then told SP's their derm PA's are overpaid, over-utilized, all kinds of meddlesome and undocumented comments that evidently have caused some real hardship between the PA's and their docs. My understanding is the salary numbers Allergan suggested were WELL below industry standard (but try telling that to your boss who now thinks you're seriously overpaid). I personally have not had any of these issues...guess we're not a big enough botox seller. All the same, we've switched to Dysport for 99% of our paralytics. I think it works better, faster and (best of all) it's cheaper! Good luck to you! \
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