Physicians Practice - April 2008 - (Page 16)

LETTERS Thank you for your article. I wanted to write you to show that there are some of us out here who love being a physician — even in the dreaded primary care ﬁeld! —Sam Lin, MD La Quinta, Calif. I appreciated your inspirational column in the February issue, but I think those highly educated, distressed faces know the truth. larger than groups of physicians who are driving this (government, business, and other healthcare entities). We are feeling this squeeze and no matter how hard we struggle to stop these forces, they are relentless. I know this personally, having negotiated contracts with payers and having helped manage our sevenphysician surgical practice. It is not “if” but “when,” and that is why there are highly educated people exhibiting clear signs of distress. It is Fifty percent expense rate you say? Eminently doable if you cut the expenses needed for managed care and Medicare compliance. Want to help the poor? Do a halfday or day of pro bono. You may not even need malpractice for the pro bono work under various Good Samaritan exclusions. Primary-care physicians just don’t believe this model is possible, but this will work for many of them. It works for dentists. If only doctors, especially PMDs, would realize that the whole system collapses without them, they would understand their power. —John Williams, MD, MBA Radnor, Pa. “If only doctors, especially PMDs, would realize that the whole system collapses without them, they would understand their power.” DOC DEPENDENT Dr. Thomas Russell, executive director of the American College of Surgeons, visited our hospital in Charleston, S.C. two weeks ago. With twenty surgeons sitting around a conference table, he stated, in no uncertain terms, that we will all gradually be forced to “integrate” (become employed) into a large healthcare provider or system in the near future. He stated that there are forces much the end of an era of medicine where the doctor and patient are central, and this change will happen on our watch and may be our legacy. Boutique doctors may be spared, but blue-collar worker bees, like general surgeons, will not. —George D. Grice III, MD Charleston, S.C. Thanks for your great column. But even though you are correct, remember what was said long ago about advice: Wise men don’t need it and fools won’t take it. The message for all primary-care physicians is to get out of Medicare, Medicaid, and managed care, and deliver enough value that your patients are willing to pay you reasonable fees in cash. Imagine: $100 for a half-hour visit and $200 for an hour; eight hours a day, ﬁve days a week, 48 weeks a year; 90 percent collected (at the point of service via cash or credit card), with 50 percent gross expenses. That comes to $172,800 a year. Raise rates annually at medical inflation rate or slightly above. Done. COMBINATION CODING I am writing because I strongly disagree with the answer given to the “Admitting from the Ofﬁce” question in the “Ask the Experts” section of the January 2008 issue. I do agree that all evaluation and management services provided by that physician in conjunction with the admission are considered part of the initial hospital care when performed on the same date as the admission. However, I disagree with the way that the answer implies that you can do the entire visit from the ofﬁce. This is not true. If you see the patient in both the ofﬁce and the hospital setting, then you may combine the encounters and charge them as a hospital admit 99221-99223. We must remember that not only do you list the procedure on the claim, but you also list the place of service. If you bill for an Initial Hospital Admission, e.g. 99221, or an admission to observation, e.g. 99219, and list the place of service as 11 (Physician Ofﬁce), it will deny for the place of service, and if you list the place of service as 21 (Hospital) or 22 (Outpatient Hospital) and only saw the patient in the ofﬁce that would be listing a fraudulent place of service for the service performed. —Phyllis Davis, CPC Poplar Bluff, Mo. WWW.PHYSICIANSPRACTICE.COM Mad as heck about something we wrote? Couldn’t agree more? Just want to add your 2 cents? Write us: editor@physicianspractice.com 16 | PHYSICIANS PRACTICE | APRIL 2008 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - April 2008

Physicians Practice - April 2008 Contents The Bigger Picture: Medicare Decision Time Letters Physicians Practice Pearls: Outsource Your Pain Noteworthy Cover Story: Trial Lawyers Tell All Management: When It’s Time to Change Ask the Experts Technology: Do You Know Where Your Data Is? The Tech Doctor: Are Your Discarded PCs Really Clean? Billing & Collections: Playing Hardball The Administrator's Desk: Recruiting for Patient Satisfaction Start It Up: Finance - Mastering the Numbers Game Coding The Great Practice Makeover: Taking Care of Business Associates Classifieds Advertiser Index

Physicians Practice - April 2008

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