In office doctor apt over a tv screen…..what???
 

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?

Never heard of that before.

But I have heard of Premier. In fact, I used them when we first moved here. Dropped 'em like a bad habit after only a few months of service, for various reasons. But let's just say that because of my experience with them, I can easily see them doing what the OP described.

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?
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I would find a new doctor.

They do it because the insurance company will pay for it. They also schedule appointments with a physician's assistant or a nurse practitioner because insurance will pay the same amount as a personal appointment with a medical doctor. Insurance companies should not pay the same amount for these types of appointments.

Won't be long before surgeons talk you through doing your own surgery.

I had a "virtual" appointment with a doctor just this week. I was fine with it because I was participating from the comfort of my home. I would never go to a doctor's office only to have him/her participate on a screen. That's outrageous.

Eventually AI will put doctors out of work. Next will be lawyers. :shrug:

More $$$$$.

She is not going back

She is reporting the doctor today to the insurance company and Medicare

Most of my discourse with my GP (PCD) these days is by phone.
Saves me a journey, and their time.
I only visit for tests, examination or treatment.
Works for my wife and I.

We had virtual ones during covid. Some value but since doc cannot listen to my heart and lungs and check blood pressure, limited value.

Very quickly asked doc how many masks can we wear so she would feel safe during a real visit. Not about to go back to virtual unless we had no choice.

What the hell! Sorry, this is beyond unacceptable. If it was me I’d write up this experience in every form of media I could think of, and rate the doctor etc etc. And keep on writing it for a long time to make sure as many people as possible would be warned about this practice.

From your lips to God's ears.

Excellent. In 40 years of practice, I never encountered anything so egregious, much less imagine it. You should check the Medicare EOB for the CPT visit code they billed. If it something other than a telemedicine visit, they are "screwed". In particular, look for new patient code 99202-99205, which have certain physical examination criteria, which are impossible to meet if the "physician" isn't in the room. At the very least this should trigger a Medicare audit in which they will look at 25 to 100 patient visits and documentation to see if it meets coding criteria. If blatantly guilty, they can be banned from participating in Medicare for 2 years. I am appalled at this scenario and embarrassed for my profession.

Definitely.

Lots of stuff seems to go on in Florida that is a bit on the shady side. At my last physical the NP recited three words and said she'd aske me what they were in a few minutes. I had never had this happen before but repeated the words and didn't think much about it until for some reason I checked the printout I got from my insurance following the visit. The insurance paid something like $60 extra for that visit for a "dementia screening"!

Not bad pay for one question.

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.

Shady for sure. Can you comment on ACA, HIPAA, and EMR causing a deterioration of the doctor-patient relationship?

My first thought was medicare wellness exam but lots more question go into that. Fraud for sure

Per the rules: An annual wellness visit is ok using telehealth. A Welcome to Medicare is not


14. Can I provide the Welcome to Medicare and Annual Wellness Visit (AWV) via telehealth?

The Medicare AWV codes (HCPCS codes G0438 and G0439) are on the list of approved Medicare telemedicine services. CMS states that self-reported vitals may be used when a beneficiary is at home and has access to the types of equipment they would need to self-report vitals. The visit must also meet all other requirements.

The Welcome to Medicare visit (code G0402, “Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment”) is not on the list of approved Medicare telemedicine services.

That’s all good, I too do most of mine by phone. BUT I don’t travel to the doctor sit in the lobby for over a hour to talk to the doctor on a screen. I sit in my home and I know my apt is a phone call.

Thank you for your feedback, will pass the info to her.
I was very taken back.

Also pass along the info from Blueash re: wellness and welcome to Medicare coding.

I find this kind of odd. I’ve had in person visits and video visits many times and always knew in advance what was going on. I’ve never showed up in person for a visit and been put in front of a video screen I have never had to go to a drs office for a video visit just so the insurance would pay for it. They’ve paid after a home video visit every time. Did the dr get sick at the last minute and they couldn’t reach all patients to cancel in time? Was the patient told in advance that it would be a video visit and they didn’t have a computer or access to one or didnt know how to connect? Was there some other unexpected issue? This sounds more like a miscommunication than an intentional action by the dr.

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

Google Premier Medical Associates in The Villages. They’ve been fined $750K more than once for Medicare fraud, so I’m not sure how they’re still in business. Most personal experience reviews I’ve read about them in a FB group for Villages Medical/Dental recommendations have been really bad, but wow your friend’s experience is appalling.

I would walk out immediately and not pay a dime.

Doctors only PRACTICE medicine. They will be replaced with energy healing machines.
Lawyers are going to be replaced with "Common Law' practitioners- B.A.R.-british accredited registry-"Maritime Law"
Nov 7 (Reuters) - Law graduates will be able to become licensed in Oregon without taking the bar exam, starting in May 2024.
Changes are coming. Be patient

I went to Premier to see my Endocrinologist - same thing they took me to a room and didn't even tell me I was to see him on a screen. Bad, very bad.

Never to late. 75 is the new 40.

They can charge more??

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 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.

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

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.

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.

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...

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

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