Private space in the office

[feedme]

For those of you who work outpatient, are any of you being refused your own desk space? I work in Dermatology, so my MAs do literally almost all of the charting.  Recently our billing has been sending back many errors, and I'm expected to fix this.  With back-to-back patients and each of my MA on a computer, I am wondering where I can compromise to do my work.  Administration is reluctant to give me any private space as there is none.  I'm not sure if a portable tablet will be useful because there is no desk space either...lol.

 

I've already taken a set of the paperwork home and worked from my home connection, but I'm a little fed up because my connection to our EHR program is, not surprisingly, not working at the moment, and I don't want to spend the extra several hours that this will likely take or continue working from home on my personal computer (and to bring it back and forth to troubleshoot a new connection),

 

Any thoughts here? I know some of you will be of the mindset of no way because you're not getting paid for the extra time charting, yet others will be of the mindset that since it is my chart, it is my responsibility.

 

Thanks.

[Guest Paula]

Do you work in a closet?  How can there be no desk space?  I'm trying to visualize an office with no desk space.  Move the printer to the floor and put a computer on the printer stand or ask the administrator to give you his office. 

[cinntsp]

or ask the administrator to give you his office. 

 

I like this idea!

[Joelseff]

I worked at a practice fresh out of school where I didn't have a desk, phone, heck most days I didn't have a chair! I ran away from there. also I would not trust MAs to do my charting...

[ventana]

simply demand a desk - sort of insane that you do not have one.....

You are a revenue generator and they can atleast provide you a space

 

 

could try the old passive aggressive way of making a ton of errors on the billing sheets  - -- - then say if you had somewhere to work you would be much more accurate....

[feedme]

What I plan on doing is taking my humongous list of charts that need to be fixed back to admin and telling them I am not doing them until I have my own computer or tablet at work.

 

Let me illustrate my work space.  I work in NYC where square footage is more expensive.  I am part of a multi-specialty facility.  My department has 6 patient rooms and a front desk and nothing more.  When I am there 3 days a week, we have 2 providers.  The other provider has 2 MAs, each which have her own patient room, computer, etc. and the provider herself has another patient room which also has its own  computer as well (all our charting is EHR).  I, being the newest, get 2 MAs, 2 patient rooms, and no extra room (so I float between both rooms all day; at the end of the day, the MAs are finishing copying, sending out pre-auths, etc so I'm unable to have anytime to look over anything.).  There is another room exclusively for our laser patients,  1 day a week all 3 derm PA providers are there and we each get 2 rooms (laser is moved out so I can have my second room--previously I was expected to work out of 1 to see 20-30 patients but my load has increased).  The other 2 days I week, I'm in a satellite office and literally have 2 office rooms again to float between.

 

I am sure if I demand something I'll be able to get it, I'm just not sure what that is.  In a few months, the satellite office is moving into a newly renovated area, so it's possible they may allow me a third patient room to work out of.  I have mentioned it to them, and they are reluctant to do so because that room would be a loss of revenue for them.  I am not sure if that would fix the problem either because I would have only 2 days to look over 5 days a work, but it would definitely be better.  In the meantime, there is a small corner of the 1 of the 2 patient rooms in that satellite office where we could place a desk and computer, but I'm not sure how awkward of a site it would be for the patient to see me  ignoring him/her, while I'm charting for other patients and my MA triaging at the same time.

 

We are literally out of other desk space with a computer, sink, and a whole chux laid out with materials for derm procedures laid out.  There's no space in the small rooms for a tray.  It would interrupt flow.  I'm wondering how much better a tablet I can place on my lap 5 days a week would be versus a desktop computer in a corner 2 days a week.  My admin has suggested why can't I look over the MA's shoulder and correct everything from there--well, there's simply no time and the MAs make so many mistakes their self-esteem would crumble to pieces with all the corrections I need to make.

 

Any suggestions I would be so grateful.

[ventana]

take over one of the exam rooms as "yours" 

always go to it to do you charts

kick the MA of the computer so you can work

 

just assume it is yours as you are obviously more important to the practice then an MA

[JohnnyM2]

Your office needs a professional space planner to assess all needs and work flow to figure out how to make the space work. You are asking PAs to do work space planning and, while I have great faith in the combined experience and intellect of this community, you are unlikely to get an optimal solution from people who have never seen the office. Why not suggest that expansion of the practice is creating work flow problems and ask that the services of a space planner be retained?

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[Guest Paula]

What kind of space does the doctor get?  Are you there alone without the doctor?  How are your visits billed?  I would want to know this to make sure your practice is billing correctly too.  For example, if the doctor is not present in the building you can't bill incident-to.  WIth such a high volume of patients I would want to know what the productivity is for your services.  If you are bringing in loads of money they should be able to provide you with an office or a space to work.

 

I like your idea of bringing the charts to management and I like Ventana'a idea. 

 

Who should be training the MAs to do the charts correctly? Sounds like a nightmare to me. 

[feedme]

MD stops by every few months. We have a separate billing and authorization department and see 30-40 mostly Medicaid pts everyday.

 

And yes, it is a nightmare for me, a complete control freak, for the MAs to be doing the charting because it takes me months to get them to be somewhat acceptable. A "head MA" initially trains them for the first two weeks, and then I try to finish up training as we go along, but there's only so much they can do.

[G. Davenport]

This whole scenario is crap. Maybe I'm old but Id just leave it like a bad memory. It smells of disrespect and undermines your value.

[Guest Paula]

It almost sounds like a derm- mill to me and yes I'm old and suspicious of set-ups like this.  I definitely would want to know how billing is done ant make sure you are being billed correctly.   Since I live in wide open spaces with small populations I would probably have a claustrophobic event in an office like this. 

[Boatswain2PA]

 

 

Any suggestions I would be so grateful.

 

 

Move out of New York?  Sounds like a terrible place to live/work.

 

Any suggestions I would be so grateful.

[Febrifuge]

I thought Medicaid especially had strict rules about who can do the charting. Maybe someone who knows their rules better can chip in here, but having medical assistants doing charting seems to me like it might be fraud in some way.

 

Personally, I just consider it bad practice, and ethically sketchy. I don't trust anyone but me to examine the patient; I also don't trust anyone but me to document the visit. However I might feel about the fact that documentation is such a huge part of the practice of medicine now, that is the reality. Writing notes the way I want them is just one part of of me practicing at the level and in the manner I feel is appropriate.

[feedme]

It's very common in Derm for MAs to do majority of the charting. They act as a scribe. I verbalize and they write but the work is not all 100 percent of course. Anything that is missing is a mistake.

 

I'm currently working with admin on a solution to the problem.

 

Sorry if my writing sounds silly. I'm writing most of this on the go.

[cinntsp]

Would it be possible to hire an actual scribe from a scribe service and get them a computer on a rolling cart?  Some of the docs in the ED I rotated through used them and they were quick/accurate.

[Febrifuge]

Thanks, that does help clarify.

 

I guess while I'm in grumpy old man mode, I would question why a scribe can't be doing the scribing live in real-time, and needs a desk for writing everything out later. Some people might even question whether that is really 'scribing' anymore. But hey, if it's normal and standard, it's normal and standard.

[winterallsummer]

I rotated through a FM place which was a great rotation and everyone seemed happy to work there. There was an open office which the PAs used. Then two private offices for the owners who were docs. A third doc used a closet as her office, no joke. Small closet standing and people in and out and no where to sit.