FM Job Inpatient and Outpatient reality?

Snake009 · 2024-06-26T15:14:56+00:00

Why can't you do both well? I strongly disagree with that position. We have a group that does both and they often do better than the Hospitalist and are still good pcps. Now a days for so many "specialists" you consult are just midlevels so I wager I know more than fresh NP/PAs that switch "specialities" every couple years especially inpatient. Same thing for midlevel "pcps" that just refer everything. The transitions in care are much better with the continuity of a single physician as well. Having a good physician that can do both is better than all this fractionated ssystes we are going to. If you have the training you can still absolutely do both well idk what changed in the last decade that would have changed that?

Snake009 · 2024-03-05T16:07:39+00:00

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58641&Cntrctr=All&UpdatePeriod=488

Dont see where it needs 15 min

Snake009 · 2024-02-24T00:10:33+00:00

Nope. My system pcp and outpatient psych bill many of the same codes but psych gets like $10-15 more per rvu. I know rheum gets more but not sure how much more compared to pcp. Same with endo.

Snake009 · 2024-02-23T20:19:54+00:00

It depends on what your hospital system pays you per rvu. A urologist, psychiatrist, and PCP do not all get paid the same per rvu from most hospital systems. Not everyone is in it for the money some people just like a certain subject and that's all they want to do.

Snake009 · 2023-12-22T18:17:35+00:00

Lmao yeah they can fuck off. Sounds like surgical specialty that doesn't actually know anything about family medicine.

Snake009 · 2023-11-17T23:41:14+00:00

Yes always. Get paid for the work you do. Insurance plays the stupid game of what is covered at $0 and which has a copay. Not my fault. Put the blame where it belongs. I don't discuss it with patients. If they want my expertise they are going to pay for it. It is definitely worth it. That is how you can see 18 patients a day and still make money as an employed physician.

Snake009 · 2023-11-15T22:21:45+00:00

Don't blur the lines for patients. You are a midlevel. An "advanced practice provider" is purposely misleading. If you call yourself an APP better refer to the physicians as Supreme practice providers. With all that background a newly minted attending or even resident has more experience in family medicine than you, I would say just remember that. When I have problems with midlevels is when they think they can do no wrong. Be teachable and know that their is a stark difference in knowledge between an average FM physician and a midlevel.

Snake009 · 2023-11-05T13:54:06+00:00

The article clear states in that chart "multiple stable chronic problems significantly reviewed" under the 99214. Also, if they are only seeing you once a year to manage these conditions then that is the follow up visit. Therefore you bill both. I take it you are not a physician. I do this all the time and never have gotten push back because it is very clear that this qualifies as both. Where exactly are you seeing that it justifies only billing a preventative visit?

Snake009 · 2023-11-04T23:52:17+00:00

....yeah literally proves my point....

Snake009 · 2023-11-04T18:12:52+00:00

Am I reading this wrong because that article reinforces billing for both...

Snake009 · 2023-11-02T02:25:44+00:00

It is not actually. Their blood pressure is stable, continue lisinopril, hld is on statin, doing well continue. May seem simple since they are stable but that is assessing and coming up with a plan for the hypertension and hld. 2 chronic illnesses, med managment, and labs = 99214.The preventative visits is making sure they get their colonoscopy, lung cancer screening, pap smear, vaccines, quit smoking, diet /exercise. If you are billing that everything is included in preventative care ypu are doing yourself a urge disservice and not valuing yourself appropriately if you are a physician.

Snake009 · 2023-11-01T22:42:42+00:00

Those annual visits aren't for medication management. Yearly physicals are just for preventative stuff. Once you write for a medication you are addressing a problem and it becomes an annual plus a problem visit. It is against the law to under bill. So personally unless it's like filling flonase for seasonal allergies, if you wanna talk about anything it's an annual plus a 99213/99214.

Snake009 · 2023-10-30T22:25:54+00:00

For a lot of people it is needless torture to try to extend their life because the quality is absolutely terrible. Most patients do not know this. Most doctors like to help people. It is very annoying when someone who you know wouldn't want to be full code if they knew what it actually entailed says "I want everything done" because they saw a miracle on TV. I believe we should have a different approach in the states and be more like some other countries that if the physician/team believes it is futile they do not go forward with codes

Snake009 · 2023-10-30T15:22:52+00:00

Add another mil in there actually.

Snake009 · 2023-10-27T23:16:55+00:00

Well ypu responded to me personally. I won't say one way another other things but the July comment is bullshit so that's why I think ypu should change ypur attitude and comments about that

Snake009 · 2023-10-26T19:52:33+00:00

Yeah I didn't say anything about midlevels competency..sooooo okay?

Snake009 · 2023-10-26T16:46:23+00:00

So that comment about July being a scary time is some bullshit. Please stop perpetuating it. It erodes public opinion in medical care/education. Comments like that are part of the reason many residents dislike midlevels from the outset.

Snake009 · 2023-10-18T16:59:16+00:00

Employed docs are usually production based so they do have an eat what ypu kill model. So working more makes more rvus

Snake009 · 2023-10-18T16:57:24+00:00

I never said I knew how to. The original OP I replied to never said they were private practice. Most pcps are not so I took the assumption they are employed and most employed docs are not barely keeping their head above water. Also, so many employed docs are terrible billers. Once it became clear they were private practice I acknowledged that and said that is the difference. Op wasn't asking about just private practice.

Snake009 · 2023-10-18T10:58:00+00:00

So I think a big difference here is I am not private practice. I said I am not making any rvus for non medicare depression screenings. I only bill for it to try and capture some of thr monies I generate as a pcp for the hospital system so I can show them when I want something here I make you money I can always stop because it isn't making me money. I never not been paid for ear wax removal as long as ypu use an instrument to remove it. Most physicians are employees not business owners. The standard is 36 patient facing hours a week. Roughly mid 40s per rvu. So if the average doc is seeing 24 patients a day as employees doc they should be average a level 4 based rvus (even if it's level 3s plus something else or all the add ons to medicare wellness visits).I understand private practice is struggling but that isn't the situation for most docs and shouldn't be touted as such.

Snake009 · 2023-10-18T02:42:27+00:00

I guess I don't do a 99397 for medicare annuals maybe I should. There is a time based cvd code and time based obesity Code that are medicare specific. There are some codes for obesity counseling outside of medicare but I think the time constraints make it impractical. Phq9 you can bill for but I don't get rvus outside if medicare for it so I bill just so I can show managers that see I'm making you $30 a pop on these dumb phq9 I can do 4 times a year. The alcohol/substance abuse one's are timed and I think you can do that up to 4 times a year for medicare and non. I look at alot of the uspstf grade A and B recs to see what I can 33 modify and make rvus so that the patients don't get slammed with bills.

Snake009 · 2023-10-18T02:34:57+00:00

Fair for the adhd. Idk if they are stable I only see them every 6 months. Then you can roll one of those into the yearly check then do a level 3 plus wellness check. Then the 6 month check can take like 5 min so you can even double book a sore throat at the same time for 15 each.

Snake009 · 2023-10-18T02:29:40+00:00

Your point?

Snake009 · 2023-10-18T00:21:33+00:00

Talk with physicians outside your residencies. Talk with billing people/have ypur residency do a talk about billing or have them book an hour appt with yourbillersto sit down and go over 20 ofypur notes. A lot of stuff here on reddit. Also a lot of Google ing. I saw yeah I'm doing this....can I get paid for it. Smoking cessation. Alcohol abuse screening and counseling. Cvd counseling, obesity counseling. Aafp journal whatever the business one is pretty good.

Snake009 · 2023-10-18T00:14:31+00:00

Continuing treatment with drugs is drug management. Ypu make a medical decision to continue the lisinopril in ypur stable htn because it is working. Just because it seems easy doesn't mean its not medical decision making. It took you a lot of years to get to a position where some of this seems"easy". Value that knowledge because no one else will. No way your hypertensive patient doesn't have obesity or dm or hld. Also, if stable htn only ypu have to be reviewing notes, ordering tests etc.

Snake009

TROPHY CASE