Sunday, January 06, 2008

So ya say you wanna Resolution, weellll you know...

we all wanna change the world. Happy New Year, everyone! I am fervently attempting to keep up all resolutions, at least until the end of the month, ha! Some are going well:

-drink more wine, check! I'm liking Syrah, right now.
-blog more, check!
-play more/make friends, check! I got a DS for Christmas, and I am addicted to Brain Age and Zelda already. Today I went on a play date with CindyLou and got to chat with her playmate's mother for the afternoon. Woo!
-tell manager where to stick it, check! (Um, well, sort of...more on that later.)

Some are not going so well:

-take less call. Well, OtherDoc is on vacation for the week, so I am taking call for him. I actually have had call all weekend by myself with the kids, as Mr. Whoo was out of town in a wedding. Luckily it has been the "q" word...shhh don't tell anyone!
-lose weight/cook real meals. HA! That is all.
-be an understanding physician. I'm just being bitter, I guess, but I am O-V-E-R the calls for pain meds. I got a call from a pregnant person requesting meds for a migraine, and, as this was a legit request, I phoned the pharmacy. The pharmacy informed me that this particular patient had 2 different narcotic scripts filled in the last week from different physicians, so I opted not to call in the third script. I guess that's what I get for giving someone the benefit of the doubt!

As for telling my office manager where to get off, please allow me to elaborate. (Beware, a long, practice-related rant follows, likely supremely boring for most, but for my fellow OBs/physicians in practice, I'd love some feedback.) I know that I am still yet a novice, in my toddlerhood of practice, if you will. I will be the first to admit that I know very little about the "business" of medicine. I accepted a hospital-employed position for this very reason. Even though I am an employee, and get a paycheck regardless of the revenue I generate (in theory); I still need to generate enough to cover my expenses in order to "earn my keep," so to speak. When I first started out, I (naively, I admit), trusted that my office manager would assist me with any coding/billing of charts and/or surgeries in order to get paid the maximum amount for the work that I was doing. In residency, I had a cursory overview of coding, and I know a little, but I need to take a coding course (in my spare time, of course).

My office manager, however, had no such interest in making certain that I was billing to capacity, since she was too busy making certain that her husband (OtherDoc) was getting all he could. I was (and still am) considered second priority. I found out, almost a year after I had started practice, that my office manager hadn't been billing circs for me. When I asked her why, she said it was because I didn't pull face sheets on the patients. This is fairly standard procedure, and easy enough to do, except *she never told me* this was necessary for reimbursement. She had to know that I was doing them, she just didn't care to point it out until I asked. I know for a fact that OtherDoc does not pull facesheets (I've asked), nor does he do anything special to document his procedures. Our office manager (his wife) just checks his patient lists on the computer and does it for him. She, in theory, could do the exact same thing for me, but she doesn't. Instead of letting me know, however, she let me just "lose" revenue that I was honestly earning. Let me state that I do *know* that it is ultimately my responsibility to make certain I was being reimbursed, but I was naive. I just didn't realize that was good for the gander (in our office) did not apply to the goose!

There are numerous other instances of the gross inequality in our practice, like when she told the front office staff that OtherDoc was first priority when it came to scheduling, or when she flat refuses to let patients transfer from OtherDoc to me (illegal, anyone?) and insists that I (or my nurse) write all insurance letters myself while she writes OtherDoc's for him. I have become aware and wary of her motives, and have accordingly made adjustments. It really sucks to have an office manager that not only couldn't care less about how my practice is going, but openly attempts to sabotage it.

At any rate, I have been in a constant battle with the front office staff (no doubt due to her behind the scenes machinations) over the scheduling of patients. I have been trying to cut my patient schedule back to no more than 35 patients in a full day (down from nearly 50 a day). When I returned to work after the Bean was born, I wrote out a detailed, day-by-day (even hour-by-hour) outline of how I wanted my schedule to flow and gave it to her. I didn't expect it to happen right away, because I knew I had been booked through December before I even left on maternity leave, but I figured that things would start flowing by the end of December/early January. This past week, not once, but twice, I had 8 patients scheduled between 8:45a and 9:45a and 7 patients scheduled between 1p and 2p. This is extremely problematic, as it is damn near impossible to see that many patients in that amount of time, and therefore puts me far behind both morning and afternoon, eating substantially into my "lunch hour" (in which I chart, sign off labs, field office phone calls, eat, and pump) and keeps me up to an hour later in the office in the evening (exactly what I didn't want when I came back). I also asked for a 15 minute block of time in which to pump in the afternoons, which has increasingly been forgotten, forcing me to pump anyway and fall even further behind.

When I brought the scheduling discrepancy to the office manager's attention, she blithely replied, "Well, the girls are doing the best that they can. Doctor's offices run behind all the time, people expect it." To which I bluntly, and probably not very nicely, stated in no uncertain terms that I wanted my schedule the way I had requested (back in September!) and did not want patients overbooked on my schedule at the discretion of the front office staff. I realize that, compared to OtherDoc's schedule, my schedule looks like a cake walk, but I am *not* OtherDoc, I am a wife and a mother and I do patient care differently than he, and I deserve to practice the way I want to practice up until the time that it is shown that I am financially sinking faster than the Titanic.

After my short tirade, she countered, "Oh, and I've been meaning to tell you. We can't bill for your pre-op visits, so you should really quit doing them, and when you code your visits, the time limit means nothing (level 1, 2, 3 visits, etc.) in order to be compensated you have to have pages and pages of documentation." Say *what?* First of all, I think that the pre-op examination (an appointment the day or two before surgery to sign consents, answer questions, and do a physical exam) is crucial in many respects, not to mention the medico-legal aspect, and I don't care if it is included in the surgery fee, I'm still going to do them, thankyouverymuch. And huh? on the coding levels based on time spent in counseling? Is this something recent or is she smoking crack? I know that my attendings in residency used the same forms that I use (complete with review of systems, etc.) and were able to bill high level visits based on that documentation alone. At any rate, I said my piece, but I know it will be at least a week before anything gets done (if it ever does) since she and OtherDoc are now on vacation.

So I guess I am just wondering if I am being a completely naive Jackhole for wanting the things that I want for my practice? What is the average amount of patients seen in *your* office on any given day? 20? 40? 60? What is the proper role of the office manager? What about coding? What is standard practice? Am I expecting too much? So many questions...if anyone has any insight, it is much appreciated. Whew, now I am tired! Thanks for "listening."


A Lupie Momma said...

Wow, I am not a dr but can tell you how my pcp and obgyn do some things and they are both solo practice (well my ob has two midwives that have admitting privileges but he is still the doc on call all the time).

Neither of my docs would allow office staff to treat them that way. YOU bring in the revenue. Without you and other doc, she would NOT have a job. I think you should sit down with other doc. If she does not change her behavior and you can't open an office on your own (I know that opening a practice on your own is difficult and will make you incredibly busy. My PCP works SEVEN days a week as her practice is only a couple of years old. My ob walked in and bought out an existing practice with some kind of deal from the hospital. Small town here.) I think you should sit down with all of the office staff and say this is the way it is going to be. You need to take a stand for yourself. Anyway. If you can't afford to or don't want to put in the time and effort, then I think you need to get your OWN office manager/coder/scheduler. Is there any reason why you can't have someone work JUST for you? Since she is too busy, why not. I am sure that since she has been undercoding all this time (geez, I am just sick thinking about all the circs you have done that were NOT billed for, what else is she undercoding????), all of the increased revenue of having someone code and run things just for you will make that person be able to covered. This woman will never be on your side. It is possible to have a solo practice and still have other doc cover you. My drs do it all the time. Solo practices here are the norm. The obgyns in town are all solo. I remember when I had S that my ob came in to do rounds on me and the nurse stopped into my room and said hey Dr. E, Dr. J is out of town today, can you please round on his patient? He said no problem and did.

This is just a really negative situation. So you have three choices:

1) get tough and talk with other doc and all office staff.

2) hire your own coder/office manager who will look out for your best interests. When that person is hired, make it clear they work for YOU.

3) Branch out and start your own practice. I think when my ob started out after residency (this is rumor mill here), he was brought in by the hospital (similar to you). Somehow, there were 2 drs that were brought in. Various styles of doing things clashed. Other doc left and went to a different state and started a new practice. My ob eventually bought the practice and was no longer under as a hospital employee. His is private practice now. Oh and I say start out as new practice because I remember you saying that there were only 2 obgyns in town. If you start out with a new practice, you could bring in a NP or a CNM to help you out with calls. I think you'll have patients that will follow you. Since you already have the insurance contracts, they should be able to be transferred to the new practice.

Oh and pregnant patient with migraine??? I have never been given a narcotic for a migraine. Ok, well I take that back. After S was born, my ob prescribed Tylenol 3 inthe hospital which made me puke. The midwife under him who was on the floor changed it to Fiorinal. MUCH BETTER. Dh takes Imitrex. Are those contrained in pregnancy? I'm amazed that she was able to get scripts filled for that without his knowledge. Even for a steroid shot in the knee, I had to get a rx from my ob saying it was ok to get in pregnancy before my ortho will give it to me. It's like pregnant woman has a big yellow warning sign on them saying do not touch.

Hope things get easier for you. It has to be really stressful dealing with all that!

My Own Woman said...

Being just a mere nurse whose daughter is starting up her own medial practice soon, I've been doing LOTS of research on all sorts of topics. If you don't mind, how about a I have to call it advice?

First, there are two books out there worth reading. Both are short and sweet but very informative. One is "The E-myth physician" and the other is the "E-myth Revisited." Both might give you a little insight on having you control your practice and not your practice control you.

In taking to other doctors who have established practices, very few of them do their own billing and coding. They outsource them so they can get a greater return on the procedures they do and the patients they see. That might be an option for you as well since OtherDoc's wife doesn't seem to give a rats behind on what type of care you'd like to give.

Of course, the trend is to go to Electronic Medical Records which would ultimately, (not in the beginning) cut down on time and give you a greater return on investment.

Having said all that, I'm probably going to be my daughter's business/office manager. I'd like to think I'm fair and would do the same for each doctor that works in the office, (right now it will be a solo practice for her), but what if I turn into OtherDoc's counterpart?

Would you have preferred someone who was neutral to both of you? Do you now have a different opinion about hiring family?

Anonymous said...

How is the practice structured? Does OtherDoc own the practice and hire you guys? That's the impression one gets from reading here...and if so, sounds like you are out of luck on a lot of the complaints - they'll do what they damn well want.

Ashley Benz said...

I have not worked in an OB office before, but I have worked in other medical offices. It is rare that an office manager goes to the trouble of (doing their job and) making sure you are reimbursed properly. Often, claims get denied for silly reasons that can be fixed. Also, some of your old billing stuff can be billed now. Try and get some of your money. HTH.

Anonymous said...

I have enjoyed reading your blog and just wanted to comment on your new Nintendo DS. I just got one for Christmas last year and I too love Brain Age. I also really like Big Brain Academy. As far as your practice goes I can offer no insight since I am not a doctor. But I just wanted to say that you must be an amazing person to handle so much. Good for you for pumping even when the time does not allow. Anyway, nice blog.

Dragonfly said...

Your requests do not sound unreasonable. Your office manager doesn't sound like she is smoking crack (that would give her the defence of mental impairment due to addiction), she sounds like an incredibly unprofessional and unpleasant person who has no regard for quality of patient care. I am not up on American workplace laws - but don't you have a legal right to pump?
What a she-jerk. Hope it gets sorted. And am vicariously enjoying someone else telling someone like that where to put it.

frectis said...

What is the proper role of the office manager?

You've got to understand that you got a job in someone's family business. It makes no difference that you're a doctor, it could be the corner drug or hardware store and you're the stock-girl. The Wife is looking out for number one and it ain't you or the patients.

Can't you keep the hospital privileges and set up shop on your own, on your own terms? Or hit the big city where you can get some respect and support from staff, make some money, and see your family?

Anonymous said...

Not an OB, but FP x 25 years, hope you don't mind some input. Holy crap, this is why it's not good to have spouses/significant others working in MD office: you never, never, want anybody in any position of authority who sleeps with the boss. I don't think this is a winnable situation, you may be better off doing whatever time with these birds you're obligated to and getting the heck outta dodge. And get an attorney. These people ARE going to shaft you. Yes she is smoking crack, the time still counts. And stick to your guns about the preops--even if you can't bill for them (and I'm not at all sure she's right about that, but not my specialty) you'd be nuts not to do them for all the reasons you mentioned. Sorry to be negative, but I'm a veteran.

Anonymous said...

Why hasn't anyone commented?

I am a lay person, so I don't know about medicine but I do know that what you've described is unethical work on the part of your office manager. She works not for her husband but the office, her duties need to be outlined and her yearly review based on how she performs those duties. The work she has been doing for her husband needs to be done on her own time outside of the office and not on the office dime, OR she needs to be doing that for all the doctors in the office.

Sorry, you're getting screwed and don't deserve to be stuck in such a manner. She really shouldn't even be working in that office as a hospital based clinic, her behavior is only appropriate for a private practice office, or private business. There is a general lack of equality of services offered to the doctors in your office, and is reprehensible.

Amanda said...

well, I'm not a doctor, but I *am* looking at the possibility after earning my MA, and eventually PhD of private practice and office hours. In my estimation, if you are partner in this office, you have a right to expect your part of the office is run in the manner you deem best. I know physicians in large corporate multi-office sites do not have much say in the runnings of the office, but if that is not your case, it doesn't seem unreasonable to have your day scheduled they way you want. My midwife was only in the office MW until 4:30. Her NP saw patients on TR. As a patient you either adapted to that schedule, or you were SOL, and found another practitioner. But, they didn't triple book appointments, and the care was very personal- something I think the OB field needs more of.

Anonymous said...

I'm not a medical person, but I would definately agree that you should be able to practice the way you want, especially because you have a family. Also, I know that I appreciate not feeling rushed or waiting forever during doctor visits, because they have too many patients to keep up with. Good luck with your office manager...


Anonymous said...

The problem is that it isn't your practice, it's OtherDoc's. And she isn't your office manager, she's his. She has zero motivation to please you, other than your taking call for him every other weekend and when he's gone.

If you decide to stay in your current location, you need to set up your own practice (groan) so you can run it the way you want to.

At my previous practice I saw 20 pts a day (nice long lunch hour) as designed by my former partner, now see 30 trying to pay my rent, etc.

Can't imagine not doing preop visits. When do you get informed consent otherwise? When does the pt find out what to expect? Nurses cannot do all this. It's part of the surgical fee.

Look in the CPT book about 99212, 99213, etc office visits. Each corresponds to a time in minutes and if you document in your note that you spent this amount of time counseling, then you can bill for that code.

All your concerns are legit. You need to get your own practice or (more likely) move on to a large group in a more populated area where you can have a life, and spend time with your precious children while they're little.

Just my 2 cents. Best of luck!

Anonymous said...

I just wanted to say your blog is great!
Sorry I can't give any answers to your medical practice questions. I'm an attorney. However, from my experience anytime you are working with a relative of someone you are almost always going to get the short end of the stick. I would be frustrated though if I were you too especially when you have communicated your expectations very clearly.
Good luck!
Amy in OH

mitchsmom said...

I feel for you. What a sticky situation. The only thing I can think of off the top of my head is, is there any third party that could act as an intermediary? Anyone else you could consult on the actual facts? Could you hire you own manager for your portion? How much are you able to talk with your partner, or is having a heart-to-heart not going to happen since it's his wifey?

The only part I can really comment on is that I know our main set of OB MD's do see up to 50ish pts/day. One is pregnant now and I'm not sure if she plans it differently for when she returns. Her husband is going to take the role of the primary parent, I think, so she can stay sort of full force, the way I understand.

Anonymous said...

Hi Dr. Whoo,
I enjoy your blog and usually click to it from TBATM.

I'm not an MD, but I am a clinical manager in one of the divisions of the department of surgery at a teaching hospital. I am so angry for you as to how you are being treated by your office manager. We had some similar issues with our former division chief (he didn't have a family member working for him, but he manipulated the staff in such a way that the other physicians were not compensated appropriately and did not get the billing assistance they needed).

I'm not sure if my suggestions will help, but here goes. I don't think you can work around your office manager's personality disorder, but perhaps you can work with someone in the hospital, since you are a hospital employee. I'm making the assumption that you aren't a direct report to OtherDoc, but to someone else within the hospital. If that's the case, is there someone within hospital administration that you can talk to about this situation and get some advice? I know you can't air out all of the dirty laundry, but you could focus on your billing issues first. Perhaps you could spin it that OtherDoc's practice is just so busy that the office staff is overwhelmed already and can't spend sufficient time on your billing and administrative needs. These little code words may go a long way and if you are a hospital employee, I would hope that they can do something to support your success. The higher-ups at my institution had enough people coming for "advice" about my former division chief that they did more investigation and were able to hire neutral support staff (and eventually get us a new chief).

So, if hospital administration is supportive, perhaps you could ask for your own part-time administrative assistant? Even just 10 hours/week could go a long way to do the busy work that you should not be doing, including pulling face sheets and writing insurance letters. Even better would be if that person did not sit in your clinic, but perhaps somewhere else within the hospital that the two of you could work privately. I'm speaking from experience on that issue, that's for sure.

In terms of our outpt f/u, my BF is an internal medicine MD and he definitely gets reimbursed differently for the different level visits. So it sounds like your office manager is indeed partaking of the crackpipe!

I hope this helped you a little bit in some way...

I don't have a blogger identity yet, so unfortunately I remain anonymous in the identity section.

Margaret Polaneczky, MD (aka TBTAM) said...

Wow - Lots to say here.
#1 Rule of starting in a practice -
Keep copies of all your superbills and track your daily billings. It's easy - just an excel spreadsheet and have the office staff total up what you've billed and collected every day. Track collections. Meet with the billing staff on a regular basis to see what they are collecting. If they are not, you have a problem.

You dont need pages of documentation to bill on time - just a brief summary of the topics discussed.

Send you manager to a coding course.

Or get a new manager.

Anonymous said...

I wish I had time to comment on all of your concerns, Dr. Whoo, but I would offer the following.

We schedule as follows:
10 min for return OBs, first post partums
20 min for all GYN, final post-partums and all post-ops, including C/S
30 min for all new OBs or new GYN, for colpos, LLEEPs, etc.
40 minutes for HerOptions and Essures
We NEVER overbook.
Of my 14 OB/GYNs, only on EVER misses lunch or goes home late.
Many get finished before their scheduled time.
We do same day appointments for ANYBODY who asks, as long as they call by 1500 or so. If after, we get them in the next business day.
We don't divide income by production, at all, so we never compete with each other.
We make FAR more money than any other practice (that doesn't do abortions) in our state.
We don't come to the office on call days, and no physician in our practice covers more than one hospital the same day.
We stay in L&D when primips are 5-6 cms, multips are 4-5 (most of our colleagues saunter in when the patient is pushing.
We work very hard when we're on call, NEVER do anything for the practice when we're not.

Lynette said...

First, you need to hire a certified professional coder who understands all angles of the job - documentation requirements, coding, and billing. Get someone with CCS-P credentials for highest quality.

Second, it does sound like you're office manager is playing games with you. It's not clear whether she works for you or for the hospital. If the latter, find out who she works for open up a line of communication with that individual.

Third, if the hospital/practice you work for does not have organized and formal service level standards, my guess is there are other things wrong as well. Poorly run organizations such as this are a patient care disaster waiting to happen. Perhaps you should seek other alternatives when your contract is coming due.

Good luck!

Anonymous said...

I feel you! I am a certified coder and believe me, OtherDoc's wife is WRONG!

Anonymous said...

found your blog today for the first time and, maybe it wasn't your intent, but i found it invigorating!

I am the financial manager for a very busy personal injury clinic. On good days we see 60-80 a day. On slow days closer to 30-40. Our goal is to have the doctors concentrate on patient care. My role as the office manager for three different doctors is to ensure that all coding and billing is done correctly so that my doctors receive maximum reimbursements in all areas. Most of my doctors don't know the difference between billing an office visit or a therapeutic code. Honestly, as his wife she cares what goes into her husbands pocket because ultimately that pocket is being shared. And she should never tell you NOT to do soemthing because it isn't covered. There are ways to get certain codes covered depending on the circumstances, DX and treatment. She has no right to tell you how to treat. Thats just hogwash. Thats why my opinion that you should never hire your spouse to serve as your office manager will never change. This is a perfect example. Stand your ground...and if i were you i'd consider hiring my own manager to oversee all coding related issues. Even if its part time. Too bad im in Florida because i would certainly love to set her ass straight!

Good luck!

adventures in disaster said...

I know this may seem a little aggressive but you need to hire your own office staff.
You need someone to look after your schedule and your billing.
This woman is truth be told screwing you and I can bet what you are losing her husband is gaining.
Might be a good idea to see who actually got paid for your circs.
I bet ten bucks she billed your circs to her husband hence not telling you anything.
I wouldn't trust a word she says.
Maybe she is billing your preop clinics under her husband..of course she is trying to steer you away.

Time to get your own help and it's time for an office audit.

This fool may think she is doing something harmless, just making more money for her husband but what she hasn't considered is her husband will be the first name in the law suit if anything goes wrong because she has billed the insurance fraudulently.

I would meet with the other doctor explain in detail your concerns and tell him you are hiring your own administrator.
Your new help will ease any issues between this nutjob and you.
My own family doctor had to do this and as a patient it's been wonderful. Much better care and communication.

CNH said...

I have no idea. Just wanted to say thank you for making yourself and your patients your priority. :-) I hated going to an OB's office and waiting a minimum of an hour, often up to 2, only to be rushed through a 5 minute appointment and paying hefty out of pocket for my insurance which was crap and only gets worse each year.

A Lupie Momma said...

Oh forgot to say this, the not billing preop appts is crap. In the last 18 months I had major knee surgery and two laps one with lysis of adhesions. All three surgeries had preop appts that were billed for and paid for by my insurance company. Then the actual surgery was billed and paid for. The only thing not paid for was the post op appts. Post op appts are bundled in with the surgery costs. The physician is responsible for aftercare from the surgeries. I think my insurance said my obgyn was responsible for 90 days after my laps for any complications. My knee surgery, postop appts were covered for 9 months. So she is a liar and you need to call her on it.

A Lupie Momma said...

Hey forgot to add. Check into what kind of incentives the hospital can provide for you. You could possibly open a hospital based clinic where they provide you with space, equipment and patients. OR there could be some kind of financial arrangements and assistance that they can provide in order to provide more providers. I know that our obs are getting up in age. Two are in their 60s and my doc is 46 (being a dr was a second career for him).

dr. whoo? said...

pe mommy~ Thanks so much for all of your great comments! The practice that I'm currently in *is* a hospital based practice. Myself, OtherDoc, OfficeManagerFromHell (OMFH), my nurse, his nurse, and the entire front office staff are all employed directly by the hospital. They own the space, equipment, and run advertising.

When I first moved here, I was led to believe that I would be in more of a group-based practice, as there is a third hospital-employed physician in a different office, sharing call q 3 and q 3 weekends. Instead, I practically am in my own solo practice with call coverage (and I didn't even get that until I had been here a whole year. Yea, I was on call, working, every single day unless I was on vacation!)

I really kind of don't want to be a solo practitioner, IYKWIM. I'd rather have a bit larger group (like 4 or so) to be able to have less weekday and weekend call. The hospital here had some great incentives to get me here (paid malpractice, paying off student loans, a very competitive salary, etc.) but I am going to have to have a bit more call coverage (and maybe my own billing manager) if they want me to stay. We shall see.

my own woman~ Thanks for the book recommendations, I will definitely check them out! The hilarious thing about this situation is that the office actually has someone with the title of biller/coder, but she doesn't do the billing, OMFH does (because she's a big fat control freak with major issues!) Instead she does surgery scheduling, patient care follow ups, and will chase down overdue accounts, etc.

I think it is great that you are planning to work with your daughter as her office manager. I think the situation is very different because, for OMFH, the billing directly affects what goes into her pocket, and she views me as "the competition" for that money. (Which is utterly ridiculous, there is a very large patient base here.) She is also a crazy person who paid like $2000 to have OtherDoc's exam rooms painted with a "faux finish" and $6000 for freaking curtains for the office! Kee-razy.

As for your questions, I think I definitely would have preferred a neutral party as office manager, but when looking at the whole offer, it was a risk I was willing to take. I still don't think that having family is necessarily a bad thing, I guess it just depends on the actual person/personality.

sara~ Ha! That is what it sounds like, isn't it? I explained in detail above, but OtherDoc did practice here for like 10 years as a solo practitioner, OMFH was his billing/office manager, and a few of the office girls worked with them in their previous office, he was going to leave the area, and the hospital hired him so that he would stay. He makes a ton of money because he is so busy, and therefore, the hospital really wants to keep him happy. Me, I am a good draw for patients (young, female, US Grad, etc.) but my production is probably a quarter of his...not as much incentive to keep me happy!

ashley benz~ I am planning to sit down and review the billing for the last 3 months with the hospital physician coordinator, so we'll see for which exactly I am getting credit. Hopefully it's not to late to bill some things!

fujimommy~ Hi! Thank you so much! I'm glad you like the blog. I have the Big Brain Academy game, too, fun! It is important to be to be able to get Bean breastmilk for at least his first year, so I am going to do what I can to ensure that, even if I suffer a bit.

dragonfly~ Ding, ding, ding! You hit it square on! She-jerk, love it! You're totally correct, of course. She is amazingly unpleasant *and* unprofessional. Lucky me!

Oh, and they aren't telling me that I can't pump, they just are not blocking off time on my schedule for it, so when I choose to pump (and I do) it puts me behind on seeing patients. Makes me crazy.

frectis~ Yes, I know. Family business, indeed. I am sure it is possible to be out on my own and still get hospital support, but I truly don't want that lifestyle (on call every day). We may be looking at greener pastures if certain requests are not met, but we really, really like where we are (weather, community, schools, people, etc.) and really, really dislike "the big city." Sigh.

anonFP~ Thanks so much for your insight. I feel like OMFH is definitely trying to screw me over, and to tell the truth, she is the "boss" in the relationship, as well. When they are fighting, she loads up his schedule to *punish* him. OtherDoc isn't such a bad guy, I'm sure he has no idea what is going on...too busy!

Ack...fussy baby! More later :)

dr. whoo? said...

Ok, now, where was I? Oh, yes..

ethel~ Hi! I agree that her behavior is reprehensible (and better suited to private practice), but when I speak with the physician director (her boss, sort of) I get the distinct impression that keeping her in the office keeps OtherDoc happy, and that is more important than my perceived slights. Bleah.

amanda~ I know! I don't understand why, just because I want to do things differently, I am being treated as though I am being demanding and unreasonable. My office hours are 9-5 M, T, Th, 9-2 on F, and Weds is my surgery day. It's not like I'm aiming for a three day weekend every week, and that is how my scheduling limitations are being treated! I know the patients appreciate it, and the wait difference is apparent in our waiting room (my wait, less than 30 min, OtherDoc's up to 3 hours).

mandy~ Hi and thank you! I think it is important to patient care to have sufficient time to interview and examine. I know most all of my OB patients by name and gestational age...this blows the nurses on L&D away. It shouldn't.

Anon~ Wow, just 20 patients a day? That sounds like heaven! I really do appreciate your insightful comments. You are so right on so many levels! The crazy thing is that the 99213 codes are printed right on our billing sheets! (But they don't exist, see??) When my contract comes up in 1.5 years, I'm sure I will have to make decisions. I'm hoping that the hospital will be bringing more obs in (a new hospital is opening around 2010) and one of them will want more call sharing/group based practice. Thanks for the good luck, I think I am going to need it.

amy in oh~ Thank you for the compliments on the blog! It could be so much more if I had some real time to devote to it. Any legal advice? FP anon says I should hire a lawyer! : ) Thanks for reading!

a.~ Thanks for the sympathy! I did try to contact our "third party" intermediary, but as I mentioned upthread, since OtherDoc is pulling in so much money ( and he, himself, is making close to $500K a year) he is priority on the "making happy" list! As I said, Other Doc is a good guy, and likely has no idea about the runnings of the office (at 60-80 patients a day, who has the time?) Sitting down with him and talking to him would do no good at all...his wife is pulling all the strings.

Sirky~ Wow, thank you so much for all of your words of wisdom! I am planning on meeting with the physician coordinator to discuss many of the "buzz words" that you mentioned in your post. Thanks for reading and thank you for your help!

TBTAM~ I really value your opinion as somebody that has "made it." I have plans to sit down and go over billing/collections in the coming weeks as a first step; I just don't know what is supposed to be normal or average, since OtherDoc sees such a higher proportion of patients than the average bear. Skews expectations a bit, I think! If only I could get a new manager! I believe that this would solve 90% of my problems! Thank you for reading and commenting!

cjg~ Okay, so can I come work with you?? Your set up sounds are probably in a "big city," huh? Sounds ideal. So jealous.

Ok, now it is bath time...more later?

Maggie Rosethorn said...

Dr Whoo...meant to comment on this earlier but got called away. As mentioned above, look for a CPC and have him/her review your billing for a while. A good biller should be able to bill all the codes that are eligible.

Another suggestion...see if any of your insurance companies do "provider audits". If they do, and use CPC's to do them, they will do it for free. In my previous job, we audited providers and recommended appropriate billing levels (sometimes higher than what the group was billing, sometimes lower). The CPCs are usually happy to help with correct coding.

Too bad you are so far from me...I'd be happy to help you out.

Anonymous said...

Sorry no real legal advice for you :) I mainly practice in domestic relations. Is it possible to look and see if any of your circs were billed as procedures that OtherDoc did? I would sit down and read your contract very closely. For example, in your contract it may or may not say you will be provided with an office manageer whose duties shall be.... If this is in there it would seem to give you some leverage with the powers that be.
I sympathize with you trying to get more time with your family. I have two kids and another on the way and it is a constant battle. I myself am solo for this reason, but I understand why it would be harder for you to be solo.
Also, just wanted to say you sound like you really care about your patients. My OB is so awesome. She and I have been pregnant two times together and for my second child she came back two weeks after having her daughter just to do my second C-section (big babies with huge heads). I will never forget that. She totally went above and beyond the call of duty and it sounds like you do too.
Keep up the good work!
Amy in OH

A Lupie Momma said...

Since you are hospital based, did you ask if they would provid you with your own manager? I think you are selling yourself a bit short. I would not wait 3 hours for an obgyn at every visit. I would wait 30 minutes. I would wait if it was an emergency because I would want the same done for me if it was me in an emergency, kwim? If he is seeing 60-80 patients a day, how on earth can he keep them straight? Patients value when you don't have to go in and explain your life history to them everytime simply because they are on the robot exam. My docs (both small town and solo) know who I am, don't have to go rifiling through my history. That's a really nice thing to have. Patients also value when they have time to discuss whatever ails them in an appt instead of here is a pain rx and sent on their way. Which is something other doc does. Both practices here are extremely busy. They seem to get out at a decent time from work except when there is a sick boom or baby boom going on. If a patient finds a doc they like, TRUST me, they will follow them to the ends of the earth! I know with our pcp, I asked her if she would be checking baby out at the hospital when born and she said yes, absolutely. That made me feel so much better cause she is who I trust as our family doc. I also feel confident knowing my ob comes in when he is on vacation just to deliver his patients. I think you have a lot to offer, your patients will speak of you highly (we talk about who is good and why and who is bad and to avoid), if your patients love you, they will talk to the hospital. I know that at my ob's office when they asked who my pcp was I said Dr. L. They said, don't you just love her? We refer all our patients to her now for pcp. She does the same for him. Anyway, enough. I think you get my point. :)