Wayne,
Step one, NEVER do a CPE on the first visit! We always insist on an "Establishing Visit". Almost all adults have at least one small issue to use as a Dx code for the first visit. It really is doing everyone a big favor and practicing better medicine.
First it makes them commit to at least two visits firming up their committment to the process and the doctor. But the real issue here is that the doc knows not who this new person is. Does she really need to see their old records according to their Hx, and that could take weeks after they sign your release. But as I explain it, we want to let the doc and you explore your issues, and who you are as a patient and a person, and according to what she learns the doc is almost certainly going to send you out the door with orders for labs and or images and other tests. And then when all that data comes back she will incorporate all this good data into a great CPE.
Now you have much less no-shows for these big slots, the doc is armed with much better data to get to know her patient and therefore care for them better too, and you break this process down into a two or three visit process that allows the doc and the patient to work thru what they will learn and attend to them in a more edible bites. How many patients have you had walk out the door with "too much new info" only to call and need to ask about how to take their new meds or test their own sugars??? Busting this out into a getting to know you kind of experience is better for the patient, better for the doc and her office, and in the long run usually helps get the patient accustomed to their new doc and their relationship with her. It's just much better medicine.
For those one or two people a year who are absolutely healthy as a horse and have NO issues (almost never once they are 30+) then your doc can code a new patient CPE. We are building a long term relationship and both sides are going to have to do some work for it. If the new patient doesn't care to do this, this is a great weeding out process for us. They want a get in and get out, they can go find another office. We do real medicine at our office and that still takes some time and effort, a relationship is developed and long terms treatment and other plans are made. This all takes time and we are not going to do "Marine" sytle or rushed.
In the end your patients will like the extra care, work and concern and your doc will feel better about caring for her patients as they actually get to know one another over two or three first visits. And for those who don't like we are fine with that, they can go to the big impersonal factory down the road.... Just wait til they see the care they get over there...
