Embracing technology

I visited my ob-gyn friend Keevan in his office today to offer a consultation on medical billing software. Keevan's hardware was archaic: a 286 machine with a monochrome monitor. Using his computer was like tying bleeders instead of using cautery. His software company was out of business. No upgrades were available. He clearly needed a makeover, yet he approached using my system with some trepidation. “Will it bill rural health?” he wanted to know. “Keevan,” I said, “it will bill God if you know the address.”

It's always amazed me how you have to drag doctors kicking and screaming into the electronic information age. You'd think that after getting through medical school, running a medical office would be a snap. It isn't. I think the fear of it drives some of us to give up on private practice.

Customer service

Isabel, my office manager, is a godsend. Friday, just before noon, a Hispanic man named Juan came in with a nasty cellulitis of his lower extremity. He spoke no English, so Isabel had to translate for me. It turned out that he had injured his leg working in the woods as a choker setter. The leg was mottled, swollen and hot — and I was about to leave town for the weekend to take my son back to college. So I called David, an orthopedic colleague, and asked if he would take care of my patient.

When I returned Monday I found out that Juan hadn't had a clue as to where to go or what to do, so Isabel personally took him to Dave's office. When she heard Dave greet Juan with, “Hola; baja los pantalones” (“Hello; drop your pants”), she thought Dave was fluent, meaning she would be out of there in time for lunch. Unfortunately, that was the extent of Dave's Spanish, so Isabel stuck around and translated for him, too. When Dave decided to put Juan in the hospital, Isabel still stuck with him. She took him in, got him registered and explained to Juan's family what was happening. When she finally left for lunch, it was 3 p.m.

Juan was discharged from the hospital in improved condition after two days of intravenous antibiotics. We just received a call from his employer, who is very pleased with our service and wants us to do all his workers' compensation visits and pre-employment physicals. I told Isabel her college books this semester are on me.

Small victories

Isabel regards it as a personal affront when she gets a rejected claim back from the electronic clearinghouse. We've made a game out of fixing and resending them. Sometimes she figures out what's wrong and sometimes I do, but sometimes we're stumped. That happened today. We had a surgical assist claim denied for lack of a facility ID number. It's not that we didn't know the hospital's ID; we just didn't know where to enter it in our program. So Isabel called the surgeon's secretary to ask if they had been paid for the surgery and asked her to fax over a HCFA claim form. She found where the ID appeared on their form and fiddled around with entering the number in various fields until she found the one that worked by a process of elimination. She was proud of herself, and I was proud of her too. We don't take small victories for granted around here!

Penny wise, pound foolish

A patient, Bob, called me last week to ask if I would write a letter to his insurance company after it refused to pay for his HeartScan. The company had said the test was “investigational” and wouldn't authorize it, so I wrote a quick note listing his cardiac risk factors and explaining why the test was ideal given that he was asymptomatic. Today, the company capitulated and said it would allow the test just this once. Of course had I ordered an exercise stress test, which costs twice as much, the insurer would have paid for it with no questions asked. And had the company not hassled Bob about his HeartScan, it would have had a grateful customer, relieved to find out he did not have coronary artery disease. Instead, I'm afraid my patient is now yet another believer in the avariciousness of third-party payers.

Getting along with insurers

Insurance companies are indeed the bane of many of our existences, but I wonder whether part of the problem is that we just don't know how to deal with them to get what we want. I don't need to get many preauthorizations, but I'm always interested in knowing why I haven't been paid in a timely fashion. My insurance file has the 800 numbers of most of my insurers and, after a month goes by without payment, we call them up and ask what's wrong and how do we fix it. We're always nice; maybe that's the key (my wife says that if I know how to ask, I can get almost anything). Claims reps are almost universally helpful, and over time my practice has gotten past the “how's the weather up there” stage with the reps and has developed a network of extensions that we punch in for each company. It's not a perfect relationship by any means, but we've found that getting to know our claims reps and expressing gratitude for their service is much more effective than an adversarial approach to resolving conflicts.