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Gps And Ffs?


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#1 #YOLO

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Posted 14 November 2016 - 01:02 AM

Why are so many new family doctors stressed about not being able to join FHOs?

FFS doesn't seem too bad. Run WIC as a new doc, seeing 40-60 pts a day, and ur doing pretty good. 
almost 1.5-2k a day.

 

FFS seems pretty good, especially for quick 2 minutes cough, colds, and msk.



#2 #YOLO

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Posted 20 November 2016 - 06:21 PM

BUMP



#3 NutritionRunner

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Posted 20 November 2016 - 09:58 PM

If you see 60 patients a day as a family doc, you are doing a lousy job as a family doc.
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#4 Snowmen

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Posted 21 November 2016 - 01:05 AM

You do realise that 60 "standard" 15 minute consultations per day leads to a 15 hour day? Good luck with that. Even seeing 40 patients means working 10 hours per day. And that's before paperwork et al.

 

Also, as was mentioned, I think that if you dispatch a patient after 2 minutes because it must be "just a cough" or "just a simple MSK problem", you're not helping your patients nor are you doing your job.


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#5 #YOLO

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Posted 21 November 2016 - 03:46 AM

Time =/= better care per se. 
Be efficient. 



#6 #YOLO

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Posted 21 November 2016 - 03:59 AM

You do realise that 60 "standard" 15 minute consultations per day leads to a 15 hour day? Good luck with that. Even seeing 40 patients means working 10 hours per day. And that's before paperwork et al.

 

Also, as was mentioned, I think that if you dispatch a patient after 2 minutes because it must be "just a cough" or "just a simple MSK problem", you're not helping your patients nor are you doing your job.

Spent time in clinics seeing almost 40-60 a day. Some patients take long, some don't. Efficient EMRs, nurses, secretaries go a long way. 



#7 BlueSpirit

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Posted 03 January 2017 - 10:20 PM

Spent time in clinics seeing almost 40-60 a day. Some patients take long, some don't. Efficient EMRs, nurses, secretaries go a long way. 

 

The FHO model will give you funding to hire nurses, admin staff, PT, nutritionist, etc. It allows you to work better hours AND provide high quality care to your patients.



#8 NutritionRunner

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Posted 04 January 2017 - 12:39 AM

The FHO model will give you funding to hire nurses, admin staff, PT, nutritionist, etc. It allows you to work better hours AND provide high quality care to your patients.


Why would you hire a nutritionist, when anyone can use the title "nutritionist" even if they have zero training in nutrition? I would think you would want to hire a registered dietitian.
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#9 BlueSpirit

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Posted 04 January 2017 - 12:42 AM

Why would you hire a nutritionist, when anyone can use the title "nutritionist" even if they have zero training in nutrition? I would think you would want to hire a registered dietitian.

 

That's what I meant - good catch.



#10 #YOLO

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Posted 04 January 2017 - 01:54 AM

Why would you hire a nutritionist, when anyone can use the title "nutritionist" even if they have zero training in nutrition? I would think you would want to hire a registered dietitian.

lol



#11 #YOLO

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Posted 04 January 2017 - 01:55 AM

If you see 60 patients a day as a family doc, you are doing a lousy job as a family doc.

lol....k



#12 #YOLO

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Posted 04 January 2017 - 01:56 AM

You do realise that 60 "standard" 15 minute consultations per day leads to a 15 hour day? Good luck with that. Even seeing 40 patients means working 10 hours per day. And that's before paperwork et al.

 

Also, as was mentioned, I think that if you dispatch a patient after 2 minutes because it must be "just a cough" or "just a simple MSK problem", you're not helping your patients nor are you doing your job.

lol....wait till u work in clinics.



#13 ralk

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Posted 04 January 2017 - 02:40 AM

Specialist clinics might be able to pump 60 patients through in a day without compromising quality, but not in family medicine. Primary care means a variety of patients with markedly different needs and presentations, limiting the ability to standardize workflow. There's only so much nurses and admin staff can do to speed things up when patients are coming in with anything under the sun.

 

Some visits will only take 5 minutes, such as a simple prescription renewal. Others can take 30+ minutes, such as the psych visits that often come out of nowhere. Even your basic coughs, colds, and MSK problems should take more than 2 minutes - you're missing pertinent negatives if you're going that fast, not to mention steam-rolling patients. Seeing 60 patients a day, unless you're doing nothing but working and sleeping, is unsafe is primary care.

 

All beside the point though. The reason FM docs tend to prefer FHOs is that in the majority of circumstances, equivalent amounts of work will pay more in an FHO than in FFS. If you can see 40 patients a day, you can carry a pretty large patient roster unless those patients are coming into clinic excessively often. The money from roster is greater than the sum of the billings for each visit. Working hard in either the FHO's capitation model or FFS will increase earnings, but FHO's tend to out-earn FFS for most physicians' practice set-ups.


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#14 #YOLO

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Posted 10 January 2017 - 03:05 AM

id disagree its compromising care. some visits take longer, some don't. ofcourse anything will be terrible if u cut corners. 



#15 cookiemonster99

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Posted 10 January 2017 - 03:33 PM

Have to jump in here as well.

 

it's the same in dentistry, being efficient is hugeee in our line of work 

I could do a filling in 5 mins poorly or i could do it in 15 or maybe even 30 mins well depending on how complex it is. 

 

But if it's a simple procedure sometimes 5 mins is all it takes.

It's quite easy to tell if the work has been done very poorly or if it's been done well in dentistry, either way u don't compromise the care you give to patients

unfortunately, it's not like that at all in dentistry because patients don't know what you are doing in their mouth 99% of the time


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#16 kanakari

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Posted 10 January 2017 - 08:34 PM

You do realise that 60 "standard" 15 minute consultations per day leads to a 15 hour day? Good luck with that. Even seeing 40 patients means working 10 hours per day. And that's before paperwork et al.

 

Also, as was mentioned, I think that if you dispatch a patient after 2 minutes because it must be "just a cough" or "just a simple MSK problem", you're not helping your patients nor are you doing your job.

 

40 in 8 hours is typical. Especially when your EMR and patient flow plan is solid.

 

Have your EMR autopopulate your diabetes tracking chart. Bill an A007 on all patients after you have the nurse take the BP, which counts as a physical exam system. Live in an area where you can bill a modifier for the location. Ensure your screening rates are high, get all the bonus diabetes codes, colon cancer screening etc. Have your nurse do all the vaccinations. Have your receptionist fill out all forms and bill for them. Do additional procedures like liquid nitro of AKs, joint injections etc. 

 

Tons of ways to make money in family medicine if you have business savvy. Too often I see family doctors who have no idea what they are doing with regards to making money, using an incredibly inefficient EMR (aka nightingale), doing physical exams that have no diagnostic/prognostic value, doing procedures you can't bill for, referring out minor procedures, ignoring screening, meticulously filling out government forms, notes etc.


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#17 #YOLO

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Posted 10 January 2017 - 09:48 PM

this person knows what theyre doing.



#18 ralk

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Posted 11 January 2017 - 12:16 PM

40 in 8 hours is typical. Especially when your EMR and patient flow plan is solid.

 

Have your EMR autopopulate your diabetes tracking chart. Bill an A007 on all patients after you have the nurse take the BP, which counts as a physical exam system. Live in an area where you can bill a modifier for the location. Ensure your screening rates are high, get all the bonus diabetes codes, colon cancer screening etc. Have your nurse do all the vaccinations. Have your receptionist fill out all forms and bill for them. Do additional procedures like liquid nitro of AKs, joint injections etc. 

 

Tons of ways to make money in family medicine if you have business savvy. Too often I see family doctors who have no idea what they are doing with regards to making money, using an incredibly inefficient EMR (aka nightingale), doing physical exams that have no diagnostic/prognostic value, doing procedures you can't bill for, referring out minor procedures, ignoring screening, meticulously filling out government forms, notes etc.

 

Every clinic I worked in did all the things you mention, yet were still seeing 25-30 patients a day only. Efficiency can only go so far in shortening patient visits.

 

Now, I'll agree that 40 in 8 hours is feasible under the right conditions, but far from ideal both for patients and even the physician's bottom line. Some visits are higher-paying but require more time. The typical annual physical has higher pay but requires a little bit more time than the standard visit (without defrauding the government). Likewise many of my preceptors would do inpatient care, home visits, or nursing home care into their day, all which pay reasonable well per unit of time, but involve seeing fewer patients in a day. Getting in 40 A007 billings is one thing, but any physician doing that is providing a rather restricted practice that may not be financially optimal.

 

Doing 40 patients in 8 hours means 12 minute visits and while some will be shorter, many will be longer. That leads to long wait times for patients and/or rushed care for those who come after the long visits in order to stay on schedule. Worse, there are some practitioners who stick religiously to their 12 minute appointments and those physicians absolutely miss things - they just don't realize they've missed something because they're out the door too quickly for it to come up. In each case, the physician may be providing technically adequate care, but not exactly patient-centered or comprehensive care. Running a clinic like a business doesn't have to mean improving your own income at the expense of patients, but it often happens that way.

 

And 40 in a day is nowhere near 60 :P


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