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We will now "capture that charge..."........


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Some people are still at a loss at what Urgent Care does, but more importantly, what we don't do.  We have people come up to the window and ask questions all the time and up until now there has always been an uneasy truce between the admins and the clinical staff on what we told them.   For example, "I'm having pain and numbness in my arm that I've had for years and need an MRI.  Can you order that?  As a rule we do not order outpatient imaging (unless they are worker's comp) and in the past we would let them know up front...until now.  Now, "everyone who walks in the door gets checked in and charged an office visit (before ANY of their questions are answered) whether we perform the service or not....".  We have been told that our recommendation on where to go for the "MRI" is a use of our time and therefore chargeable.  The exact phrase told to all of us was, from now on we will be, "capturing that charge".

Anyone calling and asking questions is to be told, "yes! we can help you".  Just come in and we will take care of it, no matter what the CC is.

I've been doing this a long time, but the the money grabbing and false promises simply leaves me to deal with the pissed off patients, and it has us all extremely frustrated.  

I know...if I don't like it, just quit.  Ah well,

/vent off

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IMO UC should never give advice over the phone.  Call your PCP for advice.  Better yet, go see them.  UC is only for acute medical problems, not chronic.  (unless we're talking acute on chronic, such as COPD exacerbation.)  I work occasional UC.  I tell those patients that I can give the ibu, etc for tonight, go see your PCP for chronic care and non-urgent diagnostic eval.

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1 minute ago, mgriffiths said:

and yet somehow you (...we...) are supposed to have exceptional Press Gainey scores...

Yup.  That is our #1 priority.  Our Medical director told us as such two weeks ago.  Anyone dropping below a certain % is now referred for formal counseling and a review performance increase plan.

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I also work in urgent care, and my employer has started cracking down on us about this too. It makes me feel like we are taking advantage of patients and feels deceptive, even if it's not technically "wrong".

I really hate working in urgent care and I regret ever taking this job. I want to get out of urgent care so badly. I'm scared that the longer I work in urgent care, the less marketable I will be as a PA in other specialties. I just don't know how exactly to break out. I see more and more of these clinics opening every day, which makes me very nervous about the sustainability of my job. My employer treats its employees fairly well overall (for now) ... but I've heard horror stories about working for some of these newer, private urgent care chains. Initially I thought working in urgent care was a great way to keep up my general skills and see a lot, but I've quickly grown to hate it. 

I used to be so hopeful about my career prospects as a PA, but now it feels like I've fallen into a depression slump. I've even considered switching careers altogether. Urgent care just feels like a dead end pathway - it doesn't seem to prepare you for much. 

 

 

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5 minutes ago, GMM2019 said:

...my career prospects as a PA, but now it feels like I've fallen into a depression slump. I've even considered switching careers altogether. Urgent care just feels like a dead end pathway - it doesn't seem to prepare you for much. 

 

 

If you are young and have any way to switch fields, I would.  I have seen nothing but the degradation of this field from money grabbing procedures and policies that have no place in urgent care to expected volumes enough to crush even the strongest AP's.  I've had to damn near crawl to my car after some shifts especially during a bad flu season.

 

Given the choice 20 years ago, I would not choose to do UC again.  I would focus on a specialty I loved and become an expert at it.  It's too late for me, but it's why I always preach to the new PA's.....DO A RESIDENCY IN SOMETHING YOU LOVE.  Don't just flounder out there or you like me might end up on your knees before the corporate overlords of Urgent Care.  It's not pretty.

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15 minutes ago, Cideous said:

If you are young and have any way to switch fields, I would.  I have seen nothing but the degradation of this field from money grabbing procedures and policies that have no place in urgent care to expected volumes enough to crush even the strongest AP's.  I've had to damn near crawl to my car after some shifts especially during a bad flu season.

 

Given the choice 20 years ago, I would not choose to do UC again.  I would focus on a specialty I loved and become an expert at it.  It's too late for me, but it's why I always preach to the new PA's.....DO A RESIDENCY IN SOMETHING YOU LOVE.  Don't just flounder out there or you like me might end up on your knees before the corporate overlords of Urgent Care.  It's not pretty.

 

I've been out of school for less than 2 years... so I'm hoping maybe I can still break into something else. Hopefully... 

Urgent care isn't terrible when it's done well, and there is obviously a need for that kind of service. But I think too many private investors and business people are taking advantage of the urgent care bubble and they are completely destroying it. These private urgent care chains with unethical standards come into the market and put competitive pressure on urgent care facilities that are trying to practice high quality, evidence based medicine. 

Either way, I just find the work very uninteresting and soul crushing. I don't think I could tolerate doing it for years. I'm just sad 😞

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This sounds like those "free" dinner seminar postcards we get in the mail.

Come listen to our spiel, we give you dinner and for a "small fee" you too can learn to flip houses and make millions, just like HGTV...

If someone comes to the front desk - just direct them appropriately.

Don't bait and hook.

AND, if it is L&I then you see them and you don't fill out any forms -you not gonna get paid...... dummies in suits.

Capturing charges. What a horrible phrase to imply one is capturing a patient, holding hostage and withholding common sense answers for money.

I hope Press and Ganey are ashamed of what they created.

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^^^. Say anything other then "let's get you checked in then we will answer all of your questions..." and you are written up.  On the 3rd write up, you're gone.

I've literally had patients yelling at me in the room because they were lead to believe I could do something completely out of the realm of UC, only to find out AFTER they pay their co-pay that we can't do it.  It feels like fraud to me.  Shower time.

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I'm telling you folks.  If you can find an employer based clinic where you and the clientele are one, it makes a difference.  Especially if you're in one where you don't do any procedures and you don't serve as the PCP.  It isn't much for professional development long term but it sure pays the bills, gets you in/out on time, there is no call, holidays, or weekends; and if the clientele complain too much you just take it up with your office/clinic manager who can then get in touch with those higher up than the employee and let them have a chat.

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Trying to find a silver lining in all this, we live in a very transactional economy.  Local craftsman and retailers who took pride in their service have been undercut and driven out of business by national chains.  The traditional retailers, such as Sears, managed to alienate customers with their responses to this crisis, when those old school loyal customers were the only thing keeping them afloat.

So... medicine.  Maybe if the urgent care model starts treating clients (not patients, clients) even more undeniably like expendable sources of one-off revenue, people start wanting to be actually treated by medical professionals who know their name and medical history, who WON'T inappropriately bill them just because they can get away with it.  Maybe this is one more nail in the coffin of corporate-overlord medicine.  We can hope.

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We had a similar process until last year and the admins started that "we don't turn anyone away" nonsense. So when people get angry because they waited to be seen, get put in a room, and after all that time get told we don't provide that service I tell them I'm not happy about it either, describe the old policy, and give them admins phone number.

I was told to stop doing that and I politely declined advising if they wanted to make bad policy they needed some ownership and me and my staff aren't going to get yelled at every day while they hide in their offices protected form the consequences of their policy.

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1 hour ago, sas5814 said:

We had a similar process until last year and the admins started that "we don't turn anyone away" nonsense. So when people get angry because they waited to be seen, get put in a room, and after all that time get told we don't provide that service I tell them I'm not happy about it either, describe the old policy, and give them admins phone number.

I was told to stop doing that and I politely declined advising if they wanted to make bad policy they needed some ownership and me and my staff aren't going to get yelled at every day while they hide in their offices protected form the consequences of their policy.

how did it turn out???

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34 minutes ago, sas5814 said:

I still do it but the policy remains unchanged. I swear they manage this place by bumper sticker sayings like "we don't turn anyone away."

 

That is exactly the phrase my admins use.  A front office girl asked me a question the other day, relaying a bizarre "could we do this" request from a patient, the clinic manager heard her and utterly blasted the 20 year old for asking me.  She told her not to ask me any questions and we never turn anyone away for anything until they are checked in and their co-pay/deductible collected.  100% true story and the origin of of this post.  The whole day was tense after that.  Asinine.

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Just my opinion but if asked a medical question while working and rendering an opinion opens the door for litigation.  Therefore the potential patient needs to know before going to the back to ask a question what we will or will not do.  Therefore we should capture the charge if they get to the back..  Maybe a lesser fee for just verbal advice but document something.  I had a patient once who came in to review his CMP, CBC, etc.  He had been told on the phone that all labs were 100% normal but he insisted on being seen.  We did,, repeated the same message and proceeded to charge him for a low level visit.  He was not happy.???

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That's a different situation as you are able to provide that service. If the patient showed up to your office wanting their...heck I don't know...their deep brain stimulator adjusted I guess would you bring them back, inform them you couldn't do it and charge them for a visit? If I read this thread right the whole discussion is revolving around whether to bring the patient to the back when you may not be able to provide the service they want/need.

I just got nailed by my PCPs office for this so I'm mildly fired up about it. 

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51 minutes ago, MediMike said:

That's a different situation as you are able to provide that service. If the patient showed up to your office wanting their...heck I don't know...their deep brain stimulator adjusted I guess would you bring them back, inform them you couldn't do it and charge them for a visit? If I read this thread right the whole discussion is revolving around whether to bring the patient to the back when you may not be able to provide the service they want/need.

I just got nailed by my PCPs office for this so I'm mildly fired up about it. 

^^^ That is exactly what the front office girls are suppose to do.  They are to say, "I can't answer any questions but let's get you checked in (and charged) and get you to the back where they can talk to you about it."

-They get checked in and charged.

-Brought to the back.

-I walk in and say...umm no.  We do not provider that service.

-I get yelled at, called a crook and a horrible PG score.......

 

End of visit.  Nice eh?

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1 hour ago, Cideous said:

^^^ That is exactly what the front office girls are suppose to do.  They are to say, "I can't answer any questions but let's get you checked in (and charged) and get you to the back where they can talk to you about it."

-They get checked in and charged.

-Brought to the back.

-I walk in and say...umm no.  We do not provider that service.

-I get yelled at, called a crook and a horrible PG score.......

 

End of visit.  Nice eh?

Ridiculous. Horrible customer service by any measurement. Likely unethical. Would be interesting to get the viewpoint of state or major medical associations, have them weigh in on this, issue a statement. 

If a colorectal surgeon won't see you for a dental abscess why should you be seeing patients you aren't equipped to help?

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2 hours ago, Cideous said:

^^^ That is exactly what the front office girls are suppose to do.  They are to say, "I can't answer any questions but let's get you checked in (and charged) and get you to the back where they can talk to you about it."

-They get checked in and charged.

-Brought to the back.

-I walk in and say...umm no.  We do not provider that service.

-I get yelled at, called a crook and a horrible PG score.......

 

End of visit.  Nice eh?

Honestly, if I was a patient and this happened to me, I would definitely be complaining to governing bodies about inappropriate, unethical, and potential fraudulent business practices...and if I wasn't a provider I would probably go after the provider as well, but I do know better so would just go after the business.

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Let me tell you the counter argument and, while I don't agree with it I do see why someone would think this.

 

1. Telling people at the window "we don't do that" is turning them away. This is complete BS. If I went to the Ford dealer and told them I wanted to buy a helicopter and they said "we don't do that" it isn't turning me away.

2. Turn someone away at the window and they have some bad medical thing happen afterwards you have liability. This, at least, has a nominal bit of merit though it seems unlikely. My medical director prepared a general list of what we do and don't do to be presented to patients when they sign in so they had some forewarning before waiting and getting roomed. Admin shot it down out of hand. See #1

Medicine is slowly being destroyed by bean counters and PR people.

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When I worked UC, if we had a case like this to where they were roomed but we were completely unable to help them, we never charged them for the visit. 

I would quit and find other employment if I was told to "capture the charge" even if no service or care was rendered.
 

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