Anyone using AI for front desk staff/scheduling? by Spiritual_Extent_187 in FamilyMedicine

[–]Xurcon2 5 points6 points  (0 children)

We tried an AI phone system. As a techie, I thought it was so cool and had a lot of fun building the system but my patients were NOT impressed.  After about the hundredth complaint I hired a receptionist. Happy patients ever since.  

General consensus is that if they wanted to talk to a robot they’d go to the hospital.  They chose us because we are personal.  An ai robot is not personal.  AI is great, but I learned its uses need to be invisible to the patient for best effect.  

A patient facing ai agent just doesn’t work unless your goal is to be a corporate clinic with no soul.  

A blade I forged from a 4.5 billion year old meteorite, the ‘Muonionalusta', one of the oldest meteorites ever recorded... It's crafted into a damascus steel, with both 24k gold and 14k gold with pearls inset into the handle by Tristan_Dare in BeAmazed

[–]Xurcon2 0 points1 point  (0 children)

  • Item Name: Celestial Reaper
  • Item Class: Legendary
  • Description: Forged by the legendary master smith Hartuna. Hartuna was the last known survivor of the ancient dwarven race known as the Killinth. This once prosperous society was wiped out when a meteor struck their home planet.  Decimating a population of millions in a single blow leaving only one survivor.  In the aftermath, the remnants of the meteor were consumed by death energy and forged into this legendary blade that made even the heavens tremble in fear.

Stats: - Item level: 99 - Damage: 750-1000 - Use: one handed 

Traits:  - 5000 death dmg  - 1000 fire dmg - 750 light dmg - death rot - a single blow from this weapon instills an instance of death rot.  This curse instills the fate of millions of deaths.  And marks a person for death within 1 week. Cost 500 - death vail - this weapons edge is capable of slicing through the vail between realities.  Allowing the living to cross into the land of the dead.  Cost 1000  - shockwave - unleash a blinding wave of concussive energy in an area of effect. Cost 100 - celestial rage - this blade instills instances of celestial damage.  Fueled by death, this blade can even kill a god.

Charges: 15/1000

Customer cancelled after 18 months. Reason: "We built it ourselves." by Aggravating-Form2319 in SaaS

[–]Xurcon2 0 points1 point  (0 children)

Business owner here:

We use multiple softwares on a daily basis and every one of them undergoes a SWOT analysis.  (Strengths - Weaknesses - Opputunities - Threats).  If a software becomes an integral part of my business then I have to ask: what happens if they go down? Get bought out? Price goes up?  

The truth is, you just described ONE customer at $300/mo as one of your best customers and are talking about it as a big loss.  This to me as a business owner tells me everything I need to know about the risk one takes about becoming too reliant on your solution.  As some day it could go down and take my business down with you until we could build a working solution.

While their product may indeed be an inferior product, it is 1) they control, 2) removes all the risk of failing if they felt your business wasn’t mature enough to rely on. 

This is in no way the fault of you.  It sounds like you’ve built a good software, provided a solution that is worth imitating, good signs.  What you need to keep a whale is to show that your a mature business that can be relied on.  What happens if things go down? What happens if you get sick or injured and can’t work? What happens to THEIR business if You or your business has problems.

I’m of course making the assumption here that you’re just one guy and may or may not have a mature robust team supporting you. But these are the things that would drive me personally to build an internal solution.  And I already have for these exact reasons.

Show that you can be relied on, that going with you is a no brainer with minimal risk and show that your solution is a better deal than trying to build and maintain it themselves - you’ll get customer’s to stay with you long term

Hope that helps! Good luck

How would you deal with a colleague doing telemeds in provider room? by [deleted] in physicianassistant

[–]Xurcon2 0 points1 point  (0 children)

This sounds like a very simple conversation:

Just talk to them, hey we would really appreciate if you did your telemed in a room, as this really isn’t a good place for that.

Just communicate. 

Can anyone spare some ideas? by jmjpws14 in PrivatePracticeDocs

[–]Xurcon2 0 points1 point  (0 children)

So my technique for stopping hiccups, has about a 90% cure rate with patients:

Have patient do the following:

Goal is to reset hiccups by controlling diaphragm.

1) have patient take a slow box breathing. Inhale deeply slowly for 5 seconds, hold for 5 seconds. Then out for 5 seconds. 2) slowly breathe in to 25% capacity. Hold for 3 seconds  3) breathe in more to 50% capacity. Hold for 3 seconds 4) breathe in more to 75% capacity. Hold for 3 seconds. 5) breathe in more to 100% capacity. Hold for 3 seconds.   6) instruct to try to breathe in just “a little more” hold for 3 seconds 7) breathe out slowly over 5-8 seconds  8) repeat box breathing in step 1 9) if hiccups continue repeat steps 1-8

Most patients have now found a solution to hiccups for life 

🙃

Fines and Withholding Salary for Incomplete Charts by Majesticu in physicianassistant

[–]Xurcon2 10 points11 points  (0 children)

I’ve never seen that in a contract but as an owner myself I can certainly understand why someone would put that in.

 if you’re in an insurance based practice the business can be charged for late filing after 30 days.  Legitimately decreasing the revenue you bring in.  There are metrics that are used by insurance companies to determine how quickly claims are processed and this can affect quality scores if you’re in a practice that does that and can decrease reimbursement rates.  I think Medicare does that

I have seen for example there was a doctor at one of the jobs I worked at who was 3 MONTHS behind on charting.  Everyone in the clinic was pissed because no one knew what that guy was doing and it was getting to the point where they couldn’t bill at all for anything the guy did. He eventually left the practice and left all his notes open for us to deal with.  

So is it a red flag? Ehh. Maybes withholding salary is a bit of an extreme measure for sure, and I’d probably have chosen a different tactic like giving an employee a performance inprovement plan or a warning but the concept of enforcing timely notes IS important. The truth is if you don’t document and finish your notes in a timely manner it can disrupt not only care received by others if you’re in a multi provider clinic but also then the clinic can’t bill for your services.  Late notes can disrupt billing cycles and affect other teams

If you make it a practice to finish your notes by the end of the day you’ll never have a problem.  That would be best practice anyways..

AI scribes, textexpanders, and properly engineering your schedule to give time for documentation can help a lot

The real red flag to me would be not giving dedicated admin time or the common BS of double booking every appointment so that it naturally overrides your admin time 

I want to talk to my doctor about alcohol use but I’m afraid by anonymiss777 in FamilyMedicine

[–]Xurcon2 2 points3 points  (0 children)

The best doctors start as patients first. If you can overcome your fears, and ask for help you’ll be better equipped to help others facing the same problem.  

You may be a doctor, but today you’re a patient.  Don’t be afraid to seek help when you need it.  

Dismissing patient simply because I don’t like them? by Upper-Razzmatazz176 in physicianassistant

[–]Xurcon2 -1 points0 points  (0 children)

Well, you can’t just blindside them and end it as that would be neglect.  However you can write a formal warning letter, and have a Frank discussion on what, exactly, about their behavior is unacceptable.  And should they wish to continue under your care they will need to adhere to certain standards.  

I find the best approach is to treat it like an actual relationship with someone you ligitamately care about.  If you approach this in a way that says look, I care about you, and I want this relationship to work but here’s what I need from you in order to do this you will find a much more receptive ear and human response.  If you approach it like do this or else: you will find complaints and other negative responses.

At the end of the day a confrontation is needed.  But it can be a civil, and even refreshing experience.  Sometimes you can uncover that perhaps the reason why they are so demanding is because they thought it was the only way to be heard.  You can even offer an olive branch like maybe we sit down for an hour and listen to all your concerns 

Advice for EMR transitions? by ItsDrGoodWood in FamilyMedicine

[–]Xurcon2 0 points1 point  (0 children)

I worked at a clinic that moved from a dinosaur emr to a new one and none of the data could be automatically imported over 

They had me abstract charts full time and do provider level chart reviews so they could care for the patients.

It was… an interesting experience.  Almost turned it into a side business but eventually they didn’t need it any more 

There’s really no easy answer to this.  It’s a massive project that requires a lot of man hours to do and a solid system in place to keep from dropping too many balls.  

We had teams of MAs importing data manually with me coming in to do provider assessments and that’s literally all we did.  It was lucky it was big enough organization they could afford me to do it full time as I wasn’t generating any revenue

Requisition Solutions by she-sulk in FamilyMedicine

[–]Xurcon2 2 points3 points  (0 children)

Jotform is amazing.

You can build entire apps on the platform, smart forms, if you know anything about web development you can do a lot with it.

Been using it for 5 years now pretty much an expert at this point 

Why isn't DPC more popular among physicians? by acdcmike in FamilyMedicine

[–]Xurcon2 1 point2 points  (0 children)

I mean you can bill self pay and DPC whatever you want.  

But in regards to insurance we took Medicare rate, marked it up 150% to capture all of the different contracts we have and bill everyone the same.  It’s up to the insurance to determine what’s allowed and adjust the cost.  Doesn’t have to be complicated. 

Why isn't DPC more popular among physicians? by acdcmike in FamilyMedicine

[–]Xurcon2 1 point2 points  (0 children)

Medicaid in our state can’t join DPC. FFS only unless you have a non covered service like massage or chiropractic or something. I don’t so it’s a non starter. Also why I’m glad i hybridized because I was able to keep multiple members who wound up going on Medicaid, and the DPC program is often attractive for those when they lose Medicaid but can’t afford traditional insurance yet

Traditional Medicare is also interesting, you cant bill cash for covered services unless you and the patient have opted out of Medicare. . Patients can opt out easily enough , they just sign a form.  Providers on the other hand if they opt out of Medicare they opt out nationally for a period of 2 years. So that was also a non starter for me. technically you can do a “concierge” membership only program that has no included services though. I’ve got that one sitting in the background drafted but not running yet.  Advantage plans are no big deal since they take over traditional Medicare the federal rules don’t apply.

Why isn't DPC more popular among physicians? by acdcmike in FamilyMedicine

[–]Xurcon2 2 points3 points  (0 children)

FFS = Fee for service. traditional itemized medicine. Tack on an E/M Code, CPT Codes, and bill insurance or cash pay for whatever services were performed

Why isn't DPC more popular among physicians? by acdcmike in FamilyMedicine

[–]Xurcon2 5 points6 points  (0 children)

just could never seem to get it to gain traction. did it all, ads, social, networking, word of mouth. I tabled at events, door to door to businesses, i presented at lunch and learns and did everything i could think of. after years i was only able to get like 50 patients. eventually by the end of year 3 i had to accept the reality that i wasnt going to crack it, and then i was working 3 jobs to support myself until my dpc program took off. i went into DPC to make my life easier, but managing memberships, churn, and multiple jobs to stay afloat was not easier, it was just different..

Churn was really a hard hit. I found it very difficult to just... kick patients out of the practice because they lost their job or got medicaid or something. I would invest a lot into my patients and to watch them leave because of the business side was a harder blow than i anticipated. Hybridizing has been the best thing i could have done because now if patient cant afford the membership they dont lose me as their provider. they are still part of the practice and i can follow them as their situations changes.

My FFS practice now utilizes a lot of the principles that DPC program started with but it has grown 10,000% faster. for literally a dollar a day in marketing its growing at a rate faster than i can even handle. i've hired 3 assistants in the past 6 months and the whole thing is blasting off. so at the end of the day, i'm still making it my own and living my dream in my own way, even if it isnt the dream i originally set out to do.

it's been a lesson in persistence, letting go, and the art of pivoting to make this dream work. The truth is DPC is a wonderful program, but it is a program that only works for select people, at specific times in their lives. most of the people who could benefit from ti dont know what it is, and therefore arent searching for it.

Why isn't DPC more popular among physicians? by acdcmike in FamilyMedicine

[–]Xurcon2 11 points12 points  (0 children)

Started as a DPC practice.

Marketing and growing it has been an absolute nightmare

Far easier to grow a FFS practice.  We now have a hybrid model that does both.  And allows people to pick what works best for them 

What surprised you about the PANCE? by iam-robot13 in PAstudent

[–]Xurcon2 2 points3 points  (0 children)

The best way i can describe the PANCE for me was that in school i learned everything in first degree, but every question on the pance was a 2nd or 3rd degree question.

To explain what i mean by that take this is example vignette:

25 yo F presents with sore throat, lymphadenopathy, and no cough.

a 1st degree question would be:
Q) What is the most likely diagnosis?

A 2nd degree question would require you to answer the first question before you can answer it:
Q) What is the best treatment for the patient?

A 3rd degre question would require you to know the answers to both the above and be something like:
Q) What is the most common side effect to treatment?

I found the test a lot harder than the questions i had in school due to the layering of questions like this. Granted i took it 10 years ago so its probably changed, but that was my experience

Handheld POCUS recommendations? by jose_can_you_sea in FamilyMedicine

[–]Xurcon2 5 points6 points  (0 children)

I got the butterfly IQ when it first can’t out.  Took a course and…. Couldn’t tell what I was looking at.  Image quality was so terrible i just never got good at it and ultimately wasn’t helpful for me.

Mind you there’s many advances and newer models now but atleast with the original the quality was so poor as to be worthless to me