[Stu from NYC]

Originally Posted by Ignatz

Once again, I sure picked the wrong career!!! 😝

Never to late. 75 is the new 40.

[kendi]

Originally Posted by Ham_and_Cheese

This is crazy and I would have told them so - if I'm going to have a virtual visit, it's going to be from my home not their office.

In that case - what's the point of the office at all?
.

They can charge more??

[blueash]

Originally Posted by retiredguy123

If a medical doctor has 10 patients in a nursing home, they can visit the facility every day, 7 days per week, and bill Medicare for 70 home visits every week, even though they may just stop in to ask how they are feeling. For 70 visits, they can collect about $5,600 or more even though they may only spend less than a hour in the facility. If they have 5 nursing homes on their route, they can make $28,000 per week. I have seen this happen.

You are making that up and have no idea what time is required and what Medicare pays. Firstly a simple visit as you described to a nursing home/ long term care facility in 2024 pays the doctor a huge $39.64. This would include reviewing the nursing notes since the previous visit, writing a visit note, reviewing any labs. It would not include a complete physical exam of the patient, if that were required the visit would be billed at a higher code.

I can assure you that no doctor is able to do the work on a single patient including those services in 6 minutes. You've seen how long it takes a doctor to enter a note in an electronic medical record. Figure 10 minutes, then go to the next patient, start over. You do 6 patients an hour and are paid about 240 dollars. I just paid more than that for a plumber for an hour of work. And nobody was going to die if he got something wrong.

If taking care of nursing home patients made doctors rich there wouldn't be a shortage of doctors willing to take on their care. They often have complex illnesses, on multiple medications, cannot clearly define their own needs and symptoms, are cared for by staff that may not be excellent at either documentation or provision of care, etc. It ain't easy and it doesn't pay well compared to almost any other field of medicine.

[kamal]

Originally Posted by Eg_cruz

Yesterday a friend went to Premier Medical at Santa Barbara Blvd. This was her first appointment with the doctor, she traveled from Ocala on a referral. She waiting in the lobby for over an hour. She was brought back into the examination room and put in front of a screen where the doctor pops up.

Yes her appointment at his office was over a computer screen. I have never heard of this it blew my mind.

Are we really at this point that you travel to see a in person doctor wait in his lobby for over an hour to talk to him on a tv screen. The big problem was his accent was very heavy and he spoke very fast so she walked out of there without knowing what was spoken about (part was she was so taken back) She couldn’t tell you what the doctor said it was beyond sad.

I found this way to operate your practice is shameful. Really what the point of traveling to the office to talk to a screen.

Has anyone had this happen to you? Do other doctors do this as well?

I go there also and the TV screen is just for checking in like a receptionist. They always have doctors or nurse practitioner to see you if you go there with an appointment. Or in the same building around the corner you can walk in to their “Urgent Care” with no appointment. And a doctor will see you. They also do lot of in-house routine blood tests there.

[golfing eagles]

Originally Posted by retiredguy123

If a medical doctor has 10 patients in a nursing home, they can visit the facility every day, 7 days per week, and bill Medicare for 70 home visits every week, even though they may just stop in to ask how they are feeling. For 70 visits, they can collect about $5,600 or more even though they may only spend less than a hour in the facility. If they have 5 nursing homes on their route, they can make $28,000 per week. I have seen this happen.

Originally Posted by blueash

You are making that up and have no idea what time is required and what Medicare pays. Firstly a simple visit as you described to a nursing home/ long term care facility in 2024 pays the doctor a huge $39.64. This would include reviewing the nursing notes since the previous visit, writing a visit note, reviewing any labs. It would not include a complete physical exam of the patient, if that were required the visit would be billed at a higher code.

I can assure you that no doctor is able to do the work on a single patient including those services in 6 minutes. You've seen how long it takes a doctor to enter a note in an electronic medical record. Figure 10 minutes, then go to the next patient, start over. You do 6 patients an hour and are paid about 240 dollars. I just paid more than that for a plumber for an hour of work. And nobody was going to die if he got something wrong.

If taking care of nursing home patients made doctors rich there wouldn't be a shortage of doctors willing to take on their care. They often have complex illnesses, on multiple medications, cannot clearly define their own needs and symptoms, are cared for by staff that may not be excellent at either documentation or provision of care, etc. It ain't easy and it doesn't pay well compared to almost any other field of medicine.

Again, absolutely correct. Before I dropped out of taking care of patients at our nursing home, I had about 60. Using RG's math, I would have made $168,000/ week or $8.7 million/year on that alone. In reality, I made about $14,000/ year----before overhead and taxes. It is not a desirable facet of practicing medicine---because you're right, the patients often have complex medical problems, many have severe dementia and mobility issues leading to decubiti and intercurrent infection all in a facility that is not usually staffed by the best nurses and others. Also, the families of these patients, while well meaning, tend to be a PITA. It's not just the ever-increasing time it takes for a visit and documentation, there are the endless phone calls, usually pretty stupid, day and night. Then, at least in NY, the state health department watches these places like a hawk, ready to pounce on any lack of documentation with draconian penalties. One of my partners was fined $15,000 for "failing" to do a breast examination on a 99-year-old woman.

Anyone who thinks that nursing home care is a desirable aspect of practicing medicine, or plans to "get rich" doing it, needs to switch from geriatrics to psychiatry.

But to dispute one aspect of that post, I suppose a plumber could cause a massive leak to the ceiling of a watertight home and create a life and death scenario

[nn0wheremann]

Originally Posted by Eg_cruz

Yesterday a friend went to Premier Medical at Santa Barbara Blvd. This was her first appointment with the doctor, she traveled from Ocala on a referral. She waiting in the lobby for over an hour. She was brought back into the examination room and put in front of a screen where the doctor pops up.

Yes her appointment at his office was over a computer screen. I have never heard of this it blew my mind.

Are we really at this point that you travel to see a in person doctor wait in his lobby for over an hour to talk to him on a tv screen. The big problem was his accent was very heavy and he spoke very fast so she walked out of there without knowing what was spoken about (part was she was so taken back) She couldn’t tell you what the doctor said it was beyond sad.

I found this way to operate your practice is shameful. Really what the point of traveling to the office to talk to a screen.

Has anyone had this happen to you? Do other doctors do this as well?

Premier has some outstanding doctors, but the support staff seems to be hired from special ed and reform schools, and their billing practices are outrageous.

[retiredguy123]

Originally Posted by blueash

You are making that up and have no idea what time is required and what Medicare pays. Firstly a simple visit as you described to a nursing home/ long term care facility in 2024 pays the doctor a huge $39.64. This would include reviewing the nursing notes since the previous visit, writing a visit note, reviewing any labs. It would not include a complete physical exam of the patient, if that were required the visit would be billed at a higher code.

I can assure you that no doctor is able to do the work on a single patient including those services in 6 minutes. You've seen how long it takes a doctor to enter a note in an electronic medical record. Figure 10 minutes, then go to the next patient, start over. You do 6 patients an hour and are paid about 240 dollars. I just paid more than that for a plumber for an hour of work. And nobody was going to die if he got something wrong.

If taking care of nursing home patients made doctors rich there wouldn't be a shortage of doctors willing to take on their care. They often have complex illnesses, on multiple medications, cannot clearly define their own needs and symptoms, are cared for by staff that may not be excellent at either documentation or provision of care, etc. It ain't easy and it doesn't pay well compared to almost any other field of medicine.

I am not making it up. My mother was seen by a private practice doctor, who she never hired, in the hospital. The doctor followed her to every rehab nursing home she was sent to (5 facilities and the hospital). The doctor billed Medicare for every day for 4 months, 7 days per week. Medicare paid the doctor $80 per visit. For some visits, the doctor had to shake my mother to wake her up, and spent less than a minute in the room. It was months later that I received all of the Medicare receipts. I assume that the doctor got my mother's Medicare number from her chart or from my mother and just started billing it. We assumed that the doctor worked for the hospital because my mother never hired her. The doctor never treated my mother for anything or prescribed any medication. All she ever did was to ask how she was feeling.

[Djean1981]

My insurance offers teledoc service (in home on your own computer). If I use it, I save my copay. However, I would not use it for something serious...

[golfing eagles]

Originally Posted by retiredguy123

I am not making it up. My mother was seen by a private practice doctor, who she never hired, in the hospital. The doctor followed her to every rehab nursing home she was sent to (5 facilities and the hospital). The doctor billed Medicare for every day for 4 months, 7 days per week. Medicare paid the doctor $80 per visit. For some visits, the doctor had to shake my mother to wake her up, and spent less than a minute in the room. It was months later that I received all of the Medicare receipts. I assume that the doctor got my mother's Medicare number from her chart or from my mother and just started billing it. We assumed that the doctor worked for the hospital because my mother never hired her. The doctor never treated my mother for anything or prescribed any medication. All she ever did was to ask how she was feeling.

There is a difference between rehab and nursing home. Both the physician and the facility are paid differently.

[dpmers]

Do some research on Dr Khanna and will learn what you are dealing with.
We had an attorney drive all the way from south Florida only to find out he has no malpractice insurance

[retiredguy123]

Originally Posted by golfing eagles

There is a difference between rehab and nursing home. Both the physician and the facility are paid differently.

When my mother was released from the hospital, which happaned at least 6 times before she died, they would always send her to a nursing home for rehab, where she would stay for a few weeks and then go back to the hospital. The rehab stays were always paid by Medicare. The doctor who followed her around, showed up every day and she had multiple patients in each nursing home. The Medicare statement said that the doctor was paid $80 for every visit. This doctor did not work for the hospital or for any nursing home. She had a private practice. One problem with Medicare is that my mother never hired this doctor to do anything, and Medicare never verified that the doctor had ever been hired. Another problem is that when you are in the hospital, you never know who works for the hospital and who doesn't and who is going to bill you when you leave. Because my mother had Medicare Part B and a supplement, she never received a bill. The Medicare statement didn't arrive until after she had died. I checked the statement and determined that the doctor had billed for a visit every day for 4 consecutive months. I am not making this up.

[Red Rose]

Plus, this was her very first visit to this doctor, so I don’t think a telehealth visit would apply here.

[Pugchief]

Originally Posted by waterflower

Law graduates will be able to become licensed in Oregon without taking the bar exam, starting in May 2024.

You know this will turn out well bc it's Oregon....

[Michael G.]

Originally Posted by MrFlorida

I would find a new doctor.

Yeah, and wait another 8 months to see another.

[Stu from NYC]

Originally Posted by Djean1981

My insurance offers teledoc service (in home on your own computer). If I use it, I save my copay. However, I would not use it for something serious...

At our age things can start happening that we are not aware of and a telehealth visit will not catch.

At each appt want doctor to listen to my heart and lungs and discuss things that I might not be aware of. If we would have to pay a copay to do this, so be it.