Wayne,
We simply code a new patient level whatever, usually a 3 or a 4 with whatever ICD-9, Dx code that is most appropriate be in high PB, Asthma or whatever. I'm telling you there's almost nobody by age 30-35 who doesn't have something... Again for the truely healthy horse, the visit can be a new patient CPE after all is said and done just do a real CPE.
But I'll bet ya dollars to donuts that once they go and get their labs done, something is going to get flagged. People eat like crap, don't get enough exercise, and do all sorts of stupid things to hurt themselves. Heck even "smoking" is a legitimate ICD-9 code for nicotine addiction.
And most people don't just call a PCP out of the blue for no good reason at all. Something made them make that first phone call or look you up in the phonebook or the carriers book or website. They are calling and coming in for some reason, even if it is a 45 year old husband who hasn't been to a doc in 20+ years and his wife finally nagged him enough to come see her doc at our place, your place. Why are you finally coming in today??? What hurts, what happened that scared them enough into finally call and make an appointment, now that is the question.
And here is why this multi-step process also works. Many of the people who call looking for a new patient physical are doing so because in our state many CPE's are covered in full or fall outside their deductables and the like,if their plan doesn't fall under ERISA which allows for such things to not have to be covered. They are trying to get in a single no pay visit where they can hit you up for months of refills on the inhallers, antihystamines, Lipitor you name is. Hey what kind of good medicine is it to write lots of Rx's half in the blind without bloodwork or previous records??? And then many of these Cheapos try to not come back for F/U visits to have a spirometry done, an ECG, review labs. How many folks want free phone calls post labs with no F/U visit?
This way if they want their meds, if they want our doc attention then yes they are going to get our docs attention. Write the Lipitor for one month only so they must get their bloodwork done and come in to have a real "documented" visit to review and make informed choices with the doc to get 3-6 months of refills. This now sets the patients up for a mind set of get their bloodwork done and then come in to have a F/U visit. we get lots of calls now from well taught and cooperative patients asking for their bloodwork orders so then they can schedule an appointment for about a week after the draw. It great!!! After a while they really start to get it. Now we really can help you control your cholesterol by having the data we need to continue as is or tweak your dose or perhaps make some changes, informed changes together with their doc. What a nightmare.
The whole concept is to get them onto a mind set that says they need to partner and cooperate with this process because it is a process to really help someone control their issues and live a healther life. If you want to get in and get out, there's the door there are plenty of rush jobs around town to go to. But if you want the real Village Medical of CNY and Dr Blake, then you must be willing to be a working equal partner in this deal here.
We don't have to be the PCP of everybody in Liverpool and the surrounding area and frankly in many ways we don't want to be. We just need enough to fill our panel and waiting room. And if the idiots in charge would finally start to understand that quality starts when you pay people really well for a job well done and insist that they actually slow down and get the details right then we could all make a reasonable living properly caring for people in the proper way that we are supposed to. Most PCP's and their staff already know and understand what needs to be done. It is simply a matter of getting everyone else on board to cooperate with and support the program.
When I was a union stagehand, they insisted in many instances that we slow down and pay attention to what we were doing, be unloading a truck, climbing a ladder, flying a pipe full of lamps up to trim Height or what ever. Rushing only leads to overlooking something or an accident and lower levels of quality. Nothing in this world comes for free, we can hurry and possible save some money or we can slow down and give you a great high quality job. And just remember many of those mistakes cost lots of money and have other consequencies, human ones. Why can't people simply understand that in our business? At some point efficency comes only from a job properly and well done, not the cheapest but really the best job. In terms of healthcare the savings from a job well done are almost too immense to calculate but we all know they are there.
And it starts with us insisting that folks come in ready to do their part in building a real relationship with a quality doctor who actually gives a CCHIT. Sure there are really healthy folks who only need to be seen once or twice a year and those few folks usually can have a CPE and a single sick visit a year or what have you. But most folks who have one or two chronic issues better get ready to do their share and it starts with coming in regularly for F/U and managment visits. Now if we could only get paid a real living wage for all those office visits.....
