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Cideous

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

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47 minutes ago, PAMEDIC said:

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.
 

 

I know.

 

DFW is utterly saturated and even with my experience in UC it is a tough slog for a decent UC job.  Can't leave either, kid in High School.  Frustrating doesn't begin to describe it.  Ah well...

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Try dealing with this in the ER. The triage nurse CAN'T turn anyone away for fear of an EMTALA violation. So a patient will come in for something like an IUD removal (I don't do that...see a gynecologist), an MRI of the knee "because mine isn't scheduled till next Thursday," or a skin biopsy of a mole that has been on their arm for a year...he or she will be brought back...and will be told, by me, "There's nothing we can do here because this is an emergency department and these things are done on an outpatient basis...please see this doctor...okay...bye" and get the cursory brief physical examination because we all know this is not an emergency, and get discharged after four minutes... Then they walk out and pay their 250.00 copay (or worse, a lot of these people come into the ER without insurance and will undoubtedly be billed HUNDREDS of dollars for this crap). I had a guy check in with requests for a therapeutic drainage of his knee, which didn't even have an obvious effusion. He had knee pain for years and had plans to see his ortho for the arthrocentesis THE FOLLOWING MORNING, but "my wife is here passing a kidney stone and it's going to take a few hours for her CT to be done so I thought I might as well get this done now because I was just sitting there." He tells me he has insurance but a really high copay. I do my cursory knee exam, notice nothing wrong and this guy is walking around without a hitch. I told him there's no need for an emergency arthrocentesis and that he needs to just see his orthopod tomorrow. His response - "that makes sense...are you guys going to charge me for this visit?" Didn't have the heart to tell him that his misguided (and kinda delusional and self-centered, if you ask me... this is a freakin' ER) act was going to cost him hundreds. Yes, for us to do absolutely nothing.

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2 hours ago, ERCat said:

Try dealing with this in the ER. The triage nurse CAN'T turn anyone away for fear of an EMTALA violation. So a patient will come in for something like an IUD removal (I don't do that...see a gynecologist), an MRI of the knee "because mine isn't scheduled till next Thursday," or a skin biopsy of a mole that has been on their arm for a year...he or she will be brought back...and will be told, by me, "There's nothing we can do here because this is an emergency department and these things are done on an outpatient basis...please see this doctor...okay...bye" and get the cursory brief physical examination because we all know this is not an emergency, and get discharged after four minutes... Then they walk out and pay their 250.00 copay (or worse, a lot of these people come into the ER without insurance and will undoubtedly be billed HUNDREDS of dollars for this crap). I had a guy check in with requests for a therapeutic drainage of his knee, which didn't even have an obvious effusion. He had knee pain for years and had plans to see his ortho for the arthrocentesis THE FOLLOWING MORNING, but "my wife is here passing a kidney stone and it's going to take a few hours for her CT to be done so I thought I might as well get this done now because I was just sitting there." He tells me he has insurance but a really high copay. I do my cursory knee exam, notice nothing wrong and this guy is walking around without a hitch. I told him there's no need for an emergency arthrocentesis and that he needs to just see his orthopod tomorrow. His response - "that makes sense...are you guys going to charge me for this visit?" Didn't have the heart to tell him that his misguided (and kinda delusional and self-centered, if you ask me... this is a freakin' ER) act was going to cost him hundreds. Yes, for us to do absolutely nothing.

At least there the patient is out of pocket for an non-emergent visit...here, the tax payers are out close to $1200 for someone to just check in with a cold for less than 24 minutes duration...had a dude the other day that showed up with wounds over 2 weeks old that were quite healed "just to make sure I wasn't missing anything, since I was getting labs drawn anyway...oh and how were my labs?" that were ordered by the FMD for one reason or another...I didn't comment on them.  In fact I was barely polite.

Here's a suggestion for those in these UC situations - have a chat with an investigative reporter and tell them what's happening and get them do some fake visits.  Suggest they then have a chat with the state medical board regarding ethics, legalities, etc of these clinics doing this...then have them drop the bomb on the evening news or the local rags for their shady practices.  If all the suits  are worried about are satisfaction scores, this ought to make them sit up for a sec, since it'll be their scores, not yours.

$0.02 Cdn

 

SK

 

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1 hour ago, sk732 said:

Here's a suggestion for those in these UC situations - have a chat with an investigative reporter and tell them what's happening and get them do some fake visits.  Suggest they then have a chat with the state medical board regarding ethics, legalities, etc of these clinics doing this...then have them drop the bomb on the evening news or the local rags for their shady practices.  If all the suits  are worried about are satisfaction scores, this ought to make them sit up for a sec, since it'll be their scores, not yours.

I get your point...but the problem with this is that while the specific provider who "blew the whistle" may never be found out...they still may be out of a job due to the UC closing.  Setting up that kind of a situation often isn't feasible to just go without a paycheck.

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Welp, just happened again.  We were all sent emails that said in no uncertain terms to lie to patients on the phone and "try and talk them into coming in" to capture that charge!

 

I printed the email and have now started keeping them all together just in case the time ever comes where I need them.

 

Days like this I just stare at the computer and ponder how it ever came to this...

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On 6/5/2019 at 4:21 AM, ERCat said:

dealing with this in the ER. The triage nurse CAN'T turn anyone away for fear of an EMTALA violation. So a patient will come in for something like an IUD removal (I don't do that...see a gynecologist), an MRI of the knee "because mine isn't scheduled till next Thursday," or a skin biopsy of a mole that has been on their arm for a year...he or she will be brought back...and will be told, by me, "There's nothing we can do here because this is an emergency department and these things are done on an outpatient basis...please see this doctor...okay...bye" and get the cursory brief physical examination because we all know this is not an emergency, and get discharged after four minutes... Then they walk out and pay their 250.00 copay (or worse, a lot of these people come into the ER without insurance and will undoubtedly be billed HUNDREDS of dollars for this crap).

I'm actually ok with this.  I see it as a way of taxing the stupid.  If you are not smart enough to realize these are not emergencies then you deserve to paybtge stupid tax.

Those who have Medicaid and use the ED for such things drive me more mad, because WE are paying their stupid tax for them.

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7 hours ago, Cideous said:

Welp, just happened again.  We were all sent emails that said in no uncertain terms to lie to patients on the phone and "try and talk them into coming in" to capture that charge!

No wonder you are so jaded.

When are YOU talking to patients on the phone?  I probably only do that 4-5 times a year....

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9 hours ago, Cideous said:

Welp, just happened again.  We were all sent emails that said in no uncertain terms to lie to patients on the phone and "try and talk them into coming in" to capture that charge!

 

I printed the email and have now started keeping them all together just in case the time ever comes where I need them.

 

Days like this I just stare at the computer and ponder how it ever came to this...

Working FM I rarely talk with patients on the phone.  If a lab or image result is complicated enough that my MA can't call, the patient needs an appointment.  Covering UC...I can't even imagine a time I would talk with a patient on the phone.

 

2 hours ago, Boatswain2PA said:

I'm actually ok with this.  I see it as a way of taxing the stupid.  If you are not smart enough to realize these are not emergencies then you deserve to paybtge stupid tax.

Those who have Medicaid and use the ED for such things drive me more mad, because WE are paying their stupid tax for them.

The problem is that even those with commercial insurance don't pay the full bill so all of us with health insurance help to foot the bill...the exception I guess is a HDHP, but these types of patients blow through their deductibles on January 2nd every year so "it's free now right?"...infuriating.  Plus, in my experience...medicaid patients or completely uninsured patients do this exponentially more than commercially insured patients for obvious reasons.

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Another blessing of my snot/cough job.  We don't call patients unless we want to call them.  If they call it is handled by the MA and if there is a question then the MA asks us.  Cideous, a little birdie says that Nov/Dec will show a job posting in a snot/cough clinic when someone retires after the first of the year.

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90% of the time the front office answers the phone and this email was sent to them (and the providers).  I do answer the phone from time to time if the front is busy or goes to the BR etc.  The email I referenced was however aimed at everyone. If a patient calls and asks "do you guys do X, Y, or Z"...Everyone is to say "We evaluate and treat all conditions, come in and we will take care of you...".   Just vague enough to get them in the door, charged and then when they get to the back...leave it to the provider to tell them actually no, we do not do that....AFTER the charge has been captured.

 

 It pisses me off just typing about it.

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25 minutes ago, Cideous said:

90% of the time the front office answers the phone and this email was sent to them (and the providers).  I do answer the phone from time to time if the front is busy or goes to the BR etc.  The email I referenced was however aimed at everyone. If a patient calls and asks "do you guys do X, Y, or Z"...Everyone is to say "We evaluate and treat all conditions, come in and we will take care of you...".   Just vague enough to get them in the door, charged and then when they get to the back...leave it to the provider to tell them actually no, we do not do that....AFTER the charge has been captured.

 

 It pisses me off just typing about it.

I would make up business cards with the office and personal cell number of the adminiscritter who sent that email.  Anytime I got a patient upset because the front desk inferred you do whatever test/procedure/etc, I would explain it's not my fault, and it's not the receptionist's fault...it is THIS guy's fault.  Please give him a call!

 

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5 hours ago, Boatswain2PA said:

I would make up business cards with the office and personal cell number of the adminiscritter who sent that email.  Anytime I got a patient upset because the front desk inferred you do whatever test/procedure/etc, I would explain it's not my fault, and it's not the receptionist's fault...it is THIS guy's fault.  Please give him a call!

 

To be absolutely clear up front I completely agree with this. 

 

That being said: do this at a point where you are comfortable being fired, because that is the almost assured end to doing what is appropriate here.  

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1 hour ago, anewconvert said:

To be absolutely clear up front I completely agree with this. 

 

That being said: do this at a point where you are comfortable being fired, because that is the almost assured end to doing what is appropriate here.  

 

^^^ Boy are you correct.  I would be punching my own ticket out the door.  Having said that, I can not steal from patients and that is what they are doing.  I simply refuse.  I did not practice this long only to sell my professional soul now.

Edited by Cideous
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5 hours ago, anewconvert said:

That being said: do this at a point where you are comfortable being fired, because that is the almost assured end to doing what is appropriate here

A benefit of being financially secure....I dont have to work!

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I did it for a while and when asked told my admin/department head he didn't get to make bad policy, force us to carry it out, and then hide in his office. I almost got fired but he got promoted (after inspiring 60% of the APP staff quit in less than a year) so he didn't get the chance. 

Now I just tell patients "I'm sorry. I don't like it either. Please make a loud complaint to the people who write policies."

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If I had a patient come in to UC and ask for an order for an MRI for his neck for longstanding radiculopathy, I would order the MRI.  But I would send the order over to one of the Smart MRI companies that charges a much lesser cost to the MRI than what the standard corporate medicine facility charges.  

At least you might get a good PG score for helping them save money on the MRI.  Don't forget to send the results to the neurologist or neurosurgeon and their PCP!!)

 

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1 hour ago, Paula said:

If I had a patient come in to UC and ask for an order for an MRI for his neck for longstanding radiculopathy, I would order the MRI.  But I would send the order over to one of the Smart MRI companies that charges a much lesser cost to the MRI than what the standard corporate medicine facility charges.  

At least you might get a good PG score for helping them save money on the MRI.  Don't forget to send the results to the neurologist or neurosurgeon and their PCP!!)

 

No.

 

Not what Urgent Care does.

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4 hours ago, Paula said:

If I had a patient come in to UC and ask for an order for an MRI for his neck for longstanding radiculopathy, I would order the MRI.  But I would send the order over to one of the Smart MRI companies that charges a much lesser cost to the MRI than what the standard corporate medicine facility charges.  

At least you might get a good PG score for helping them save money on the MRI.  Don't forget to send the results to the neurologist or neurosurgeon and their PCP!!)

 

As stated, not what UC does, but also good luck getting that covered by insurance since UC won't be completing the required PA, which wouldn't be approved anyway due to need baseline workup and followup - which again UC doesn't do (and shouldn't do).

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22 hours ago, Paula said:

If I had a patient come in to UC and ask for an order for an MRI for his neck for longstanding radiculopathy, I would order the MRI.  But I would send the order over to one of the Smart MRI companies that charges a much lesser cost to the MRI than what the standard corporate medicine facility charges.  

At least you might get a good PG score for helping them save money on the MRI.  Don't forget to send the results to the neurologist or neurosurgeon and their PCP!!)

 

You are making it harder on other providers to say no to people like this. Then they give us a bad "score" or complain about it. Not fair to all of use that work full time/PRN at urgent cares. Please stop doing stuff like this, urgent care is for "urgent care" as you know long standing radicular pain does not count. 

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23 minutes ago, camoman1234 said:

You are making it harder on other providers to say no to people like this. Then they give us a bad "score" or complain about it. Not fair to all of use that work full time/PRN at urgent cares. Please stop doing stuff like this, urgent care is for "urgent care" as you know long standing radicular pain does not count. 

Indeed. We have a very aggressive antibiotic and steroid reduction program in our institution and admin supports it. I have 2 or 3 in my group (from about 30) who won't have the "hard talk" and take the heat and gives out steroids and antibiotics willy nilly. It makes life harder for everyone.

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I don't work in UC.  I do work in a private practice cash/contract clinic.  We are busting out the seams since patients come to us for help when it takes 3-4 months to get in to see their providers.  We do order MRI for selected patients and have access to medical records from the 2 large health systems in the area.  So if I order, it would  be with careful selection and I do the required PT/ NSAIDS/ xrays,etc.

I  send orders to Smart MRI however as patients appreciate the lower cost, especially those without insurance.

We've not had a problem with patient paying for their services either.  

 

It's all good.  I'M NOT RUINING YOUR UC

 

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If an urgent care provider is going to order outside imaging studies at 9 PM at urgent care, they'd better be prepared to call the patient back with results at 10 AM the next morning when the PA is off duty at home.  Personally, not something I would like to do.

It's absurd to order a study and then offload the reporting to a different provider who likely has no idea that the study was ordered or why it was ordered.

It's also a huge liability if the provider you "hand off" the results too doesn't receive it correctly or doesn't follow-up correctly.

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1 hour ago, Gordon, PA-C said:

If an urgent care provider is going to order outside imaging studies at 9 PM at urgent care, they'd better be prepared to call the patient back with results at 10 AM the next morning when the PA is off duty at home.  Personally, not something I would like to do.

It's absurd to order a study and then offload the reporting to a different provider who likely has no idea that the study was ordered or why it was ordered.

It's also a huge liability if the provider you "hand off" the results too doesn't receive it correctly or doesn't follow-up correctly.

I won't get wrapped up in longitudinal care for chronic conditions as a UC provider. Referrals to PCP, specialist or sub-specialist exist for these conditions.

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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. 
 
 


I understand you completely! I moved from UC to pediatrics pretty easily. They liked I had so much acute care knowledge bc peds we see so much sick visits. I think you could also go to family medicine or ortho easily. Good luck I know how hard UC is


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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.


That’s such a terrible position to be in! I feel like if they’re going to make you do this there should be a manager there to take over when patients start to get really upset. As a PA you are there to take care of the medical issues not the upset patients. But so often urgent care is all about customer service and getting people to come back.


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