http://032a410.netsolhost.com/WordPress/?p=830 Blog Fri, 24 Feb 2012 17:23:22 +0000 hourly 1 http://wordpress.org/?v=3.2.1 http://032a410.netsolhost.com/WordPress/?p=830&cpage=1#comment-70 surgerycenterok Wed, 14 Dec 2011 12:22:58 +0000 http://032a410.netsolhost.com/WordPress/?p=830#comment-70 Great point. Imagine the reaction of your patients if you called them and said I need to see you 2 weeks before your surgery so we can have a fresh history and physical exam so I can bill you for that. Also, I would like to make even more money by ordering unnecessary lab and Xray and you will be expected to pay for that, as well. Your patient would probably fire you or say, "You know, I'll just see you on the day of surgery!" The presence of this third party billing, at now this unholy alliance between hospitals and their "collaborator" physician employees will run the cost of care up even more and drive the quality down. I have talked with third party administrator executives and insurance company executives that are already aware of this. There is no question that care rendered from the physician who is a hospital employee costs more and your example points this out. Thanks for your always insightful contirubtions to this blog. G. Keith Smith, M.D. Great point. Imagine the reaction of your patients if you called them and said I need to see you 2 weeks before your surgery so we can have a fresh history and physical exam so I can bill you for that. Also, I would like to make even more money by ordering unnecessary lab and Xray and you will be expected to pay for that, as well. Your patient would probably fire you or say, “You know, I’ll just see you on the day of surgery!” The presence of this third party billing, at now this unholy alliance between hospitals and their “collaborator” physician employees will run the cost of care up even more and drive the quality down. I have talked with third party administrator executives and insurance company executives that are already aware of this. There is no question that care rendered from the physician who is a hospital employee costs more and your example points this out. Thanks for your always insightful contirubtions to this blog.
G. Keith Smith, M.D.

]]> http://032a410.netsolhost.com/WordPress/?p=830&cpage=1#comment-69 Jason sigmon Wed, 14 Dec 2011 04:09:35 +0000 http://032a410.netsolhost.com/WordPress/?p=830#comment-69 At a recent meeting, I overheard another surgeon in my specialty who was part of a hospital multi specialty group, speaking with other surgeons about preoperative history and physicals. I was interested because my daughter is treated by a surgeon who is employed by children's hospital in OKC and has surgery pending in January. My wife told me she has to go back no more than two weeks before surgery for a preop history and physical. Similarly, the doctor at the meeting said that all his patients must return for a history/physical as well. This is their group's requirement. I began to wonder if maybe I was not providing appropriate standard of care, since I do all my H and P's the day of the patient's visit and again the day of surgery. Since I have a physician assistant, I thought I would just have her do these a few weeks before my patients' surgeries. I notified my billing coordinator of the proposed change. She notified me that that was ok, but that we could not bill for the H and P, as this was considered a global part of our surgery fee. So, as in your above example, both my daughter's surgeon ( hospital employed) and the surgeon I overheard at the meeting ( mulitispecialty clinic employed) are required to send their surgery patients to primary care doctors in their respective organizations for a service which they can then bill for, since it's is provided by a physician who is not restricted by the global service restriction. Therefore, these patients are billed for an additional service that could otherwise be performed at the time of their surgical consult or the day of surgery for free. Certainly, during the H and P visit, the patient will likely receive other "standard of care" preop labs or X-rays that otherwise are unnecessary. Add that up for all the employed surgeons providing surgical care around the country for some serious "cost savings"! At a recent meeting, I overheard another surgeon in my specialty who was part of a hospital multi specialty group, speaking with other surgeons about preoperative history and physicals. I was interested because my daughter is treated by a surgeon who is employed by children’s hospital in OKC and has surgery pending in January. My wife told me she has to go back no more than two weeks before surgery for a preop history and physical.
Similarly, the doctor at the meeting said that all his patients must return for a history/physical as well. This is their group’s requirement. I began to wonder if maybe I was not providing appropriate standard of care, since I do all my H and P’s the day of the patient’s visit and again the day of surgery.
Since I have a physician assistant, I thought I would just have her do these a few weeks before my patients’ surgeries. I notified my billing coordinator of the proposed change. She notified me that that was ok, but that we could not bill for the H and P, as this was considered a global part of our surgery fee.
So, as in your above example, both my daughter’s surgeon ( hospital employed) and the surgeon I overheard at the meeting ( mulitispecialty clinic employed) are required to send their surgery patients to primary care doctors in their respective organizations for a service which they can then bill for, since it’s is provided by a physician who is not restricted by the global service restriction.
Therefore, these patients are billed for an additional service that could otherwise be performed at the time of their surgical consult or the day of surgery for free. Certainly, during the H and P visit, the patient will likely receive other “standard of care” preop labs or X-rays that otherwise are unnecessary.
Add that up for all the employed surgeons providing surgical care around the country for some serious “cost savings”!

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