Home Forums Discussions Feedback and Recommendations Printing Prescriptions

That is unbelievable. I wouldn't be able to collect five cents. Can't charge Medicaid anything over and above and even my private pay wouldn't pay that.

I plan to fax no matter what. Of course, the pharmacies won't take them. I also will use TSP800 which, IMHO, is the way to go.

Medicine is a mess, because we doctors want it to be. Business people, lawyers, etc. would never stand for this. Once again, just imagine every single docotr in Maine simply telling their patients they can't write scripts anymore because the government and HIPAA won't let them. What would it take? About three days?

I agree, Bert. I think come the first of the year all doctors all over the country should simply refuse to refill scripts unless they can fax them or charge the patient to come pick them up. I too plan to buck this with all my efforts.

Leslie

Well two of us can create a helluva boycott!

I also think it would benefit both the EDs and the PCPs and medicine as a whole if ED doctors could only give one dose of a sample or one dose on a script. To get the other nine doses, the patient would be forced to go to their PCP. I think that would stop the ear infections, etc. from going to the ED pretty quickly. Higher copays may work for the private pay patients but not for the others.

As a combination FP and ER doctor I tend to give the pt. only 12 pills - such as 12 ibuprofen, 12 vicoden, etc, but I do tend to give the whole course of antibiotics since I don't want to see all the earaches over again in my office. This cuts down the drug seekers looking for pain meds.

The problem with primary care is that we expect pt. to have personal responsibility - this weekend I saw multiple pt. who have had symptoms,complaints for 2 weeks to 3 months and just came to the ER because it is convenient and in our town has little or no waiting. Unfortunately due to liability we get backed into ordering workups on these things even if we think they can wait because they are already here...... sorry almost climbed back on that soapbox....

Take care. P.S. I tell my pt. that my policy is to fax all my scrips and I only write about 6 scrips per week on a pad because they are schedule II with medicaid.... I am planning on buying a TPS printer though, just because I am tired of typing the scrip in AC for bookkeeping and then handwriting it out.

Steven,

Thanks for your post and the view that only an FP and ED doctor could give. I have to say with all due respect that I couldn't disagree more. Granted, it would be a little uncomfortable and to the patient it would appear as though you are "double-dipping" so to speak to send them back to you. But, for the average PCP seeing the patient back who inappropriately went to the ED ear pain, especially when one dose at 10PM will make little or no difference in the outcome or pain.

One of the main way people learn is through consequences. They can get a letter from Medicaid over and over, but if they realize that they will have to be seen twice, they will think again before going to the ED inappropriately.

And, if a patient goes to the ED for something chronic from three weeks to three months, I find working that up due to medicolegal reasons is simply not good medicine. Most chronic conditions require a long history and physical with an algorithm approach that saves money and avoids needless tests. The responsibility for the patient going to their primary care doctor is on them, and I don't think there is any medicolegal pressure on the ED. In fact, our ED sometimes does the appropriate thing by calling me and making sure the patient follows up the next day. There are very few things that cannot wait 18 more hours before being seen by the PCP.

You make valid points, but in a system where pt's are told to followup and either don't because they fail to do it or some offices in many towns will tell an established pt. that they can't see pt. for 2 weeks for acute problems like sinusitis - this creates a problem. I would love to send pt. to PCP's office, but even in small towns I run into the above - even when we try to leave open slots for acute issues these are rapidly filled.

We spend a lot of time trying to screen people back to the office and many of them just learn to say the things that they think will get the right attention - chest pain, SOB, etc.

The other main issue for me is pediatrics - I really don't want any child to delay treatment once I see them - unfortunately children can't choose their parents and many of them don't have a real good chance anyway......

Good points. I guess pediatric patients just have it made in the Bangor area. 100% of pediatric offices will see a patient same day. I used to have my MA call each family that had a kid go in after three days of fever or vomiting to ask why they didn't come here (after asking how they were of course). It's the adult patients who have to wait. I wish the ED would simply ask the patient if they had called their PCP, then call me and send them over. The problem is there is no copay for a Medicaid patient either at the ED or at the PCP's office.

I solicited and got this email response from the eRx folks. They are considering adding in CCR exchange support:

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Will your EMR accept an industry standard CCR for import? My developers are looking into possible interface solutions.

Thank you,

Ruth Hummel
eRx NOW Support
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I'll look into this further. Anyone heard anything else about this?

Al