why does it cost so much?

Your 10 minute office visit needs 8 people and 45 minutes of work

by Mary Pat Whaley | in Physician | 101 responses

• Tweet

I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation. If you haven't worked your check-in and check-out desks recently, I highly recommend it.

An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, "But he was only in the room for ten minutes!" I was briefly at a loss for words. I recovered, we agreed on a payment plan, I made a note on her encounter form for the billing office and she left.

I've been thinking about our conversation, and thinking about what that $100 is supposed to cover…

1. First, we scheduled the appointment, which was a work-in, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
2. When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID for red flags. An encounter form was generated at the nurse's station to notify her of the patient's arrival.
3. The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief chief complaint, review the medications she is taking and check to see if she needed any chronic medication refills while she was there.
4. The physician came in to see her, asked about any changes since she'd last been seen, reviewed her history of present illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.
5. He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.
6. He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.
7. He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled. The chart was filed, and the encounter form was sent to the billing office.
8. At the billing office the charges and any payment was posted and the claim was filed. If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.
9. If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.
10. Since the patient did not pay at the check-out desk, the patient-responsible balance is billed to the patient. If the patient pays on the first statement, it has taken 45 to 60 days to receive complete payment. Since the patient has BCBS, there is a negotiated rate, so the payment will not even total $100.

I know that patients often say "But he only spent 10 minutes with me." Checking back with the provider, I find it was typically longer. Patients tend to underestimate the time as it goes very fast.

The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller. It took 8 people, and at least 45 minutes of work to make that appointment happen. Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable. It's what we all want. And it ain't cheap.

Mary Pat Whaley is board certified in healthcare management and a fellow in the American College of Medical Practice Executives. She blogs at Manage My Practice.

--
Hollecrest & Associates Inc  -"Turnaround Consultants"  .

Sunridge Lodge   "Back to Eden"  Quality 24/7 care
261 Oakhill Drive, Brantford  backtoeden.ontario@gmail.com
"Building elder peer communities that are cozy,caring and comfortable" -
 
Brant Positive Action Group  "a positive community affirmative action group"

promoting goodwill and timely cost effective creative solutions to enhance the competitive well being of Brant, Brantford and Six Nations 

Why and how therapy works (Sunridge)

Who benefits most from psychological therapy?

by Christina Girgis, MD | in Patient | 4 responses

• Tweet

There is a saying in psychiatry, "even bad therapy is good therapy."

I always thought this was a terrible thing to say, but really, there's some truth to it. The basic tenet of therapy is that a person is able to vent their feelings with an objective third party. Depending on how good the therapist is, he or she will be able to help that person process their feelings in a productive manner. Bad therapists talk about themselves too much, give too much advice, and don't acknowledge their own biases.

Good therapists are the opposite of this. And of course, there are many types of therapy, including supportive, cognitive behavioral, and psychodynamic. Without getting too technical, supportive is the most basic type, and is exactly what it sounds like. Cognitive behavioral helps a person change how they think, which in turn helps moderate feelings and behaviors better. Psychodynamic is the most intensive type of therapy, and focuses on relationships. This is the type of therapy where you end up talking about your childhood and your mother a lot.

The best candidates for therapy are people with stable lives (i.e. supportive and intact family and livelihood), a sense of introspection and curiosity about themselves, and the time and money to attend regularly. In essence, this is what is termed the "worried well." An example is a PhD candidate who has writer's block for their thesis. Or a couple struggling with communication issues. Of course, sadly, people with much greater difficulties and problems probably could use therapy even more, but access, finances, and life stress get in the way. Therapists also veer away from therapy with people who have more problems, because even the best therapy doesn't help when someone needs to figure out how to put food on the table and get the rent paid.

If you feel therapy might be of benefit to you, and you have the resources to go to therapy, then go. Even if you don't have a specific psychiatric diagnosis, learning about yourself in a structured manner only makes you a better and stronger person. Of course, it's certainly not for everyone — therapy is one of those things that only works for you if you approach it with an open mind.

Christina Girgis is a psychiatrist who blogs at getaheadwithdrg.

Submit a guest post and be heard on social media's leading physician voice.

--
Hollecrest & Associates Inc  -"Turnaround Consultants"  .

Sunridge Lodge   "Back to Eden"  Quality 24/7 care
261 Oakhill Drive, Brantford  backtoeden.ontario@gmail.com
"Building elder peer communities that are cozy,caring and comfortable" -
 
Brant Positive Action Group  "a positive community affirmative action group"

promoting goodwill and timely cost effective creative solutions to enhance the competitive well being of Brant, Brantford and Six Nations 

Smile

Classic Quotes by H. L. Mencken (1880-1956) US writer

      A bore is simply a nonentity who resents his humble lot in life, andseeks satisfaction for his wounded ego by forcing himself on hisbetters.

------------------------

A church is a place in which gentlemen who have never been to heavenbrag about it to persons who will never get there.

--
Hollecrest & Associates Inc  -"Turnaround Consultants"  .

Sunridge Lodge   "Back to Eden"  Quality 24/7 care
261 Oakhill Drive, Brantford  backtoeden.ontario@gmail.com
"Building elder peer communities that are cozy,caring and comfortable" -
 
Brant Positive Action Group  "a positive community affirmative action group"

promoting goodwill and timely cost effective creative solutions to enhance the competitive well being of Brant, Brantford and Six Nations