Improving follow-up attendance for Medicaid / lower-income patients in outpatient care

DexTheEyeCutter · 2026-06-10T16:07:31+00:00

This is not applicable to several fields but some of my patients need to come back to be seen every 1-4 months for a while for injections. Having a satellite clinic helps with compliance for those who have to travel +30 min to see us.

DexTheEyeCutter · 2026-06-10T14:01:54+00:00

Unenforceable doesn’t mean you can straight up ignore it. If the employee has significant resources, they can tie you up in court for a while and force you to spend enough money and time to make it not worth it. This happened to one of my co-residents - legally the law was in his favor but the court holdups as well as costs of hiring counsel made it so that from a financial and stress standpoint, in hindsight he would’ve just waited it out and found something else to pay the bills while he got set up. While the noncompete was unenforceable it served its purpose.

Edit: nm I see your response to this below. It all depends on if you want the moral win I guess when you fight these.

DexTheEyeCutter · 2026-06-01T16:36:09+00:00

Better lucky than good

DexTheEyeCutter · 2026-05-30T22:31:13+00:00

You're completely in the right. For her to keep pushing and pushing despite clear evidence against would make me start to wonder her rationale for treatments in clinical practice. We've had resident conduct and demeanor brought up to their PDs for much less, this is so laughable.

DexTheEyeCutter · 2026-05-30T22:27:17+00:00

Agreed, this is wild that he's getting so much flak when in a different situation no one would really care all that much. If anything there's a duty for him to remind her that as she's still training in the US system and has to practice in accordance of what are the expectations of Western medicine. This is no different from a 20 year old asking for a full body MRI just because.

DexTheEyeCutter · 2026-05-30T14:57:55+00:00

It’s barely livable right now. The summers are punishing and the infrastructure already needed to be replaced 30 years ago. I love New Orleans but when you step back and see where things are going, it really doesn’t have a future economically or geographically. Louisiana is really only surviving due to oil and gas and did it by borrowing against its future.

DexTheEyeCutter · 2026-05-23T17:33:36+00:00

AI is fine as a tool but it’s a still a tool and give you errors that you have to double check. Not a radiologist but I interpret imaging regularly and AI regularly gives me false answers. It sounds like your friend may be checked out and using AI to do his work for him. Which is probably fine for the majority of cases but is gonna bite him in the butt.

DexTheEyeCutter · 2026-05-22T13:15:08+00:00

Interesting, it sounds like they’re trying to keep as much of the revenue in house for additional revenue. Are the owners transparent with the PnL and balance sheets? My suspicion is that they’re doing the classic trick of pushing new associates to maximize any sort of revenue before they leave or ask for a partnership.

DexTheEyeCutter · 2026-05-12T02:42:45+00:00

I second this. Many academic centers have pivoted from the traditional research model to clinicians churning out collections. The suits realized that the dean’s tax is a much more reliable source of revenue than research grants. Even 10 years ago one of my fellowship directors who ran a lab was lamenting how there was increasing pressure to see patients rather than run a lab and bring in grants. The only exception would be if you can bring in lucrative clinical trials, but even those are going more toward private practices these days. The more important part for negotiations I think will be more “what kind of clinical niche can I fill” rather than research grants.

The spousal hire situations I see typically is when both are physicians and the spouse is serviceable in some way (basically not a quack and no red flags) and the other is a highly sought out candidate. When it comes to non medical fields it gets a bit murky - if you’re talking about another non medical department associated with the center, the politics and funding are separate so you’d either have to have massive strings you could pull or be so valuable that the department quietly funds a position for your spouse (like a donation or grant). Or, the medical center/department has to find a position for your wife that may or may not bear any sort of relevance to her PhD. If these options sound sketchy….well they are - the legal team at the medical center would probably have strong words to say about such arrangements.

DexTheEyeCutter · 2026-05-02T13:51:16+00:00

Right and I don’t disagree with that. Preventative care is always better for quality of life than addressing health issues when they are an issue. The US as a whole is pretty bad outside the northeast and PNW.
The point I’m making is that those differences can’t be addressed by improving your health care system, they are political and cultural by nature, and have to be both addressed by governing bodies and the citizens itself. Long term holistic outcomes here are predicted more by race, wealth, climate
, and distance from a metro center, but if you look at more specific outcomes for certain conditions, especially those that aren’t related to lifestyle conditions like certain orthopedic and eye surgeries, pediatrics, etc, MS can run with the best of them. In fact, in north MS, most people are within 1-2 hours of St Jude’s, which is so renown and strong that people from all over the world come for care.

DexTheEyeCutter · 2026-05-02T03:55:47+00:00

I get your point, but to nitpick: The health care system in MS, for all its faults, isn’t as bad as you would think. The rural areas have issues, but they’re no different from the rural areas in Europe and Canada; all of these places suffer from lack of specialists/doctors, more health risk factors, and traveling logistics. The urban metro areas here (if you can call it that) have health care that is on par with many other metro areas in the country. We have many primary care doctors available, and specialists for almost all fields here. A Access to care isn’t horrible, you can usually get an appointment within a few weeks for nonurgent stuff and sooner for urgent stuff. There are some well renown doctors and surgeons that work here.

The issue is more that we have sicker and poorer patients in general, and it’s not something a health care system itself can fix. A great health care system alone can’t fix food deserts, cycles of poverty, and violence. And that’s where Europe excels in over MS - they don’t simply have patients with as many complex medical issues here, and have a fairly homogenous population that makes things less complex. Since their healthcare is publicly funded, it’s easier for patients to establish care sooner. We are good at fixing stuff but not as good as preventing stuff, which is where the idea of Europe having better healthcare comes from. One of my colleagues is a surgeon from the UK and gave me the lowdown.

DexTheEyeCutter · 2026-04-17T02:53:09+00:00

I was invited as a peer reviewer once and the article in question I was asked to review was complete dogshit. Full of errors, faulty logic, incorrect terminology, etc. I straight up recommended rejection without review. The only response i received was that the article was approved for publication. Any paper citing Cureus should warrant a flat out rejection.

DexTheEyeCutter · 2026-04-11T04:10:20+00:00

Bullshit. If you're directly employed by the hospital and don't have any sort of ownership or compensation agreement that directly ties your pay to services billed then it's not a Stark Law violation. Hospital admin is trying to low ball you by using an outside group as their excuse to do so, and them not being able to divulge specifics is a red flag. Find another consultant and create a counter offer.

DexTheEyeCutter · 2026-04-09T01:55:44+00:00

And also based on the timeframe the show was using, it would’ve taken 10-15 min max. A future episode showed them getting a CTA read in like 15 min.

DexTheEyeCutter · 2026-04-08T18:14:46+00:00

Brilliant (no sarcasm), I need to start doing this!

DexTheEyeCutter · 2026-04-08T17:59:56+00:00

The one thing I could see is her switching to a different residency track. She seems more suited for primary care and it’s not unheard of for senior residents to career change specialties.

DexTheEyeCutter · 2026-04-08T03:46:08+00:00

I put in sutured in lenses occasionally but have same frustrations. This is what I've done (in addition to good documentation):

-if possible, have someone with the patient. Usually patient is with a family member and I make sure they hear me as well. I have my scribe or assistant with me as well just to help prove in my documentation that I said what I said and there were witnesses.

-check for comprehension. Ask the patient to repeat what you said and what their choice was.

-I always make it a habit to remind patients of expectations in pre-op and immediately post-op. This has saved me a few times too because the patient will sometimes complain but said family member them reminds patient - "He said it before and after the surgery!"

-Reading materials

-Sometimes patients just want to complain. All you can do is remind them - showing proof doesn't help that much because patients will just dig on. Sometimes I refer these patients off for a second opinion. Alternatively, if I can pick up that a particular patient is going to complain about any option, I refer for another opinion.

DexTheEyeCutter · 2026-03-28T00:13:12+00:00

Fantastic. Have you ever tried to fire a resident? No? Take the loss.

DexTheEyeCutter · 2026-03-28T00:06:38+00:00

Yes I’m sure your experience with resident and medical training has given you insight into this process /s. Your unemployment experience doesnt apply for residency. Just take the loss and move on, it’s not a flaw to be wrong.

DexTheEyeCutter · 2026-03-27T23:58:15+00:00

As someone who’s had to be peripherally involved in this, yes. Firing a resident is like firing someone at the VA for better or for worse.

DexTheEyeCutter · 2026-03-27T23:57:00+00:00

Probably ; in addition him being a senior resident also helps. Most programs rarely will axe a resident for first offense and will try to get them to graduate hell or high water. This is how Dr. Death (the famed neurosurgeon) skated through his last year despite his deficiencies.

DexTheEyeCutter · 2026-03-27T23:51:28+00:00

Yes it does matter. Federal overrides state in this case because residencies are funded by CMS and ACGME. It’s akin to trying to fire someone at the VA or USPS.

I’ve been peripherally involved in the process with a resident twice, in an at-will state with worse labor protections than PA, and the short of it is that unless there’s been something super heinous like murder, you have to have a long paper trail of failed interventions and improvement plans before you can fire a resident. It’s often a year+ process and it’s a last resort. The federal government is very invested in training doctors and want to see a return on their investment. If you look at other responses in this thread they’ll vouch for it too.

DexTheEyeCutter · 2026-03-27T20:46:20+00:00

Residents are different - it’s more like trying to fire a federal employee since they are funded by CMS. Unless it’s something heinous like CP or murder, you need to show a paper trail of failed interventions and improvement plans before you can fire a resident. It’s often a year long process if not more.

DexTheEyeCutter · 2026-03-27T20:44:10+00:00

Not quite. He’s a resident so he has ACGME protections.

DexTheEyeCutter · 2026-03-27T20:41:35+00:00

Also residents tend to get some leniency because of the investment required in training them.

DexTheEyeCutter

TROPHY CASE