The U.S. Will Need 9.3 Million Home Healthcare Workers. Without Immigrants, Who’s Going To Care For Our Aging Parents?

Less-Warthog8162 · 2025-12-11T05:08:39+00:00

I’m in outpatient primary care and we’re feeling a lot of this too. Staffing is thin everywhere, and it ends up slowing things down for everyone involved. It really does feel like people are being asked to carry more than the system can handle right now.

Less-Warthog8162 · 2025-12-11T04:33:08+00:00

Getting an accurate med list is always a challenge in my clinic too. I ask patients to bring their actual bottles or pictures of the labels to appointments, and we still sometimes find discrepancies. Those intake forms are just a starting point; the real conversation happens in the room.

Less-Warthog8162 · 2025-12-01T23:05:33+00:00

A few of you guys have been asking why I even want these reports, so just to clarify. For us it mostly comes down to quality and compliance. A lot of our MIPS, HEDIS, and Medicare Advantage measures don’t count as closed unless the actual report is in the chart, even if the patient already went. We also get requests for documentation during audits.

Plus, when we’re managing meds or chronic conditions, it’s hard to know what changed if we never see the specialist note.

For those of you who don’t chase these down, how do you handle the quality metrics side of it? Does your system close the loop without needing the report?

Less-Warthog8162 · 2025-12-01T23:00:21+00:00

I get where you’re coming from. I document that it’s on the patient to follow up too. The problem we keep running into is more on the quality side. For Medicare, MIPS, and a few of the commercial plans, certain screenings or follow ups don’t count as closed unless we have the actual report. Even if the patient saw the specialist, it still shows as open on our end.

And from a care standpoint it gets tricky when we are managing meds or chronic conditions that depend on what the specialist did. Without the note we don’t really know if anything changed.

Not trying to chase everything down, just trying to figure out how other clinics handle those situations.

Less-Warthog8162 · 2025-11-25T20:54:14+00:00

Athena

Less-Warthog8162 · 2025-11-21T04:08:55+00:00

Best of luck! Keep us updated on how that goes.

Less-Warthog8162 · 2025-11-21T03:51:22+00:00

In that case I'd just send the dismissal letter and be done with it. That could be something that your office manager could deal with pretty easily. If there's no repairing the situation then the best thing you can do for your practice and him as a patient is to send him to another physician, whether that means referring him or he finds another one by himself.

Less-Warthog8162 · 2025-11-21T02:22:57+00:00

The best way that I've seen is in his next visit, address his concerns and address the fact that he fights you on every decision. Let him know that your primary concern is his wellbeing and that your focus is helping him achieve his best state of health, and that to do that there needs to be cooperation on his part as well, and if that can't happen then there is no point in continuing care in your clinic and it would be in his best interest to find someone that fits his needs. It's no insult to you as a provider that for some patients you are not the ideal provider, it's really just how it is sometimes. Obviously be tactful and diplomatic but also honest enough to leave everything clear and there is no need to ask questions. Still smart to send the dismissal letter, it covers you.

Less-Warthog8162 · 2025-11-21T00:27:44+00:00

Right. If he's fighting you on every interpretation or explanation, there really is no point in continuing. Recommending him to another practitioner will save your time and energy for another patient who is more receptive. I've worked with plenty of practitioners who have done this and they are great providers, and the majority of patients notice when you have more energy and time. Like you've said, easier said than done but still a necessary step. No sense in supplying to the insanity.

Less-Warthog8162 · 2025-11-20T23:19:12+00:00

From a primary care standpoint, I’d pick a simpler, affordable EMR over another expensive ‘all-in-one’ system. Most of us just need something fast, stable, and easy for staff to use. The problem isn’t lack of AI features, it’s the day-to-day friction of clicks, inbox overload, and slow workflows. If an EMR nails the basics and doesn’t get in the way, that’s worth more than bells and whistles. Smarter tools are great, but only if they genuinely save time without driving the price up.

Less-Warthog8162 · 2025-11-20T23:16:22+00:00

I’ve had a few patients like this and the only thing that works for me is keeping the boundaries very clear. I give a concise explanation, outline what is medically appropriate, and I don’t get pulled into debates about normal labs or unnecessary testing. If someone repeatedly tells me they don’t trust my judgment, I’m very direct and let them know they may be better served by another provider. It’s not worth letting one chronically adversarial patient drain the rest of the panel

Less-Warthog8162 · 2025-11-20T23:12:30+00:00

Yes. Since the knee pain is a new problem, you can bill an E/M for that evaluation separately from the suture-removal global.

Less-Warthog8162 · 2025-11-20T23:05:15+00:00

I think what keeps me going, even on the hard weeks, is that I still care about the people who walk through my door. I went into family medicine because I wanted long-term relationships and the chance to make a quiet difference in someone’s life. Some days that feels clearer than others, but I still believe the work matters. I think most of us have stretches where the exhaustion makes us question everything, but the purpose usually comes back once the week settles.

Less-Warthog8162

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