Responses to Doctor/Provider relationship part I
Jeremy Sprouse
Description
Collection
Title:
Responses to Doctor/Provider relationship part I
Creator:
Jeremy Sprouse
Date:
2/12/2015
Text:
Thanks for all the responses. Unfortunately this is the only Vascular group
in the area, and a couple of these doctors also run the only wound care in
our area. So there isn't anywhere for the patients to go unless they can
drive about 50 miles to the next group. I'm hoping when the news story comes
out this week about this doctor amputating 3 of the wrong toes on a patient
the hospital will get rid of him. Not likely, but I can always dream. I'm
not too concerned with this group not sending me patients, as I usually get
the patient when they need a replacement leg/brace. My problem is with the
doctor telling the patient they can't change providers, even after they had
a bad experience with the other Clinic. I did furnish lunch and meet with a
couple of the doctors in the vascular group. I was told by the doctor that
owns the group we have had a lot of complaints about his work, so we will
give you a try. I did ask the doctors if they had received any complaints
about our work/service and the answer was no. This was about 3 months ago
and so far not a single order. He also told me to do the same in-service for
the wound care, which I did. Not a single order from them. Again, it
wouldn't be a big deal except for these doctors are taking away the patients
choice to healthcare.
Jeremy
----------
It seems to me the first question to ask patients is, Are you committed to
this vascular surgeon and practice and unwilling to see an alternative such
as a physiatrist? If the answer is yes, then I feel that the best avenue
for recourse, that doesn't sound like you complaining about a lack of
competitive capability-regardless of your actual competence, would be to
have patients contact Medicare directly to explain their loss of choice of
prosthetic providers at the hands of these surgeons. I assume you have
already attempted to meet with them to inquire about their apparent loss of
faith in your service. If they have no specific complaints about your
company then you have more reason to suspect foul play. Sticky situation, I
know, but not uncommon. I would also select an articulate, dissatisfied
patient and urge them to state their case to the surgeons as well if
possible. They do not want to spend valuable clinical time defending their
recommendation and ultimately may refer back to you. Best of luck. I share
your frustration at times with similar situations.
-----------------------------------
Be Professional - refer ALL those patients to another MD. Sounds like
there's a financial interest in there somewhere.
------------------------------------
Would love to hear responses...it seems more and more to be the norm that
prosthetists are locking in relationships with M.D.'s, not based on quality
of care. What I once thought happened only in third world countries is
prevalent in our community and we choose to stay small, obtain word of mouth
clientele, and avoid these interesting relationships.
------------------------------------
Sounds like a tough situation. If it were me. I would get as many patients
as possible to write out a statement and have it notarized. I would forward
a copy of those to AMA with your complaints. Sounds to me like you have
nothing to lose. He is already killing your business and it does sound like
something inappropriate is going on. Good luck.
-------------------------------
I'd try and notify the better business bureau, have your patient lodge a
formal complaint with Medicare and document any and all complaints yourself
until you find the person who you should send them to.
---------------------------
That's terrible and it sounds incredibly wrong, if not illegal, too. I
would do all of the above; report him to CMS & all of his governing bodies
and accreditation agencies. Have any complaining patients do the same
because I imagine a patient complaint, and multiple complaints, will carry
more weight. Good luck and please share the responses and results!
------------------------------
Have the patients call the insurance company and complain...they are more
likely to listen to patients, especially if there are several with the same
complaint
------------------------------
Sorry to hear this. Sadly this is going on all over the place. I would
start digging into both the doctor and the prosthetic practice And try and
find out what their relationship is (which I can hesitate a guess is likely
a monetary one) Then I would write a letter
Of complaint to the AMA and demand that this be investigated. If your
bilateral is willing to help you, he can go a long way by writing to Both
his state representative and his congressman. I am dealing with this as a
new clinic in VA, we had one of the bigger clinics in Seattle, but now we
are like a goldfish in the Ocean. We are being shut out by the company that
rhymes with Anger. So we have not started involving our senators,
representatives And governor - but you will need the help of patients. You
may want to see if you can join with the other two clinics to see if you can
pool your resources
-----------------------------
What a pain in the ass.
I also have a vascular group that won't send patients to us.
We found a local rehab doc who was more than happy to increase his patient
load. When we have a new amputee, we send him to the new doctor. I don't
know how big your town is but if you can find a physician who isn't afraid
of those vascular docs, maybe that is a way. Your bilateral should find
another doc to write the Rx and do the documentation. I don't see how the
vascular docs could do anything that would mess up his Medicare. If they
tried, he'd have grounds for a lawsuit. All the best.
----------------------------
I owned a practice for 25 years and had a similar situation. I asked the
doctors in one group why they would not refer to me and they were very
honest about it. The other prosthetist was a school buddy of the main
surgeon in their group and that was it. I never could change it. It was very
frustrating because there is nothing you can do. And it is not illegal.
Referrals are built on relationships first and foremost.
You could go digging around looking for kickbacks but most likely you will
just anger everyone (the opposite of building relationships) and also you
will spend time and energy that you could be devoting to developing your
business in more fertile directions.
My solution: I just focused on giving good service to the other patients I
had and to my loyal referral sources. I developed new relationships,
cemented old relationships and did the best I could in promoting my business
to the community and developing new referral sources. It all worked out
fine.
In other words, for your own sake, Get over it.
----------------------------
Interesting! But, I am not surprised. It sounds highly probable there is
some sort of kick back.
Have you thought about filing a complaint to the medical board against the
MD?
The patient has a choice and should not be held back because of his dr. We
have some doctors who refuse to refer to our company as well and we can only
speculate it is also due to kick backs. Frustrating, I know! We are not
the only ones who experience this Im sure.
I am interested in the responses you receive.
---------------------------
Contact your state Attorney Generals Office, ask for the MEDICAID fraud
section, then explain the situation relevant to Medicare because chances are
that any Medicare claim that processed was also processed by Medicaid; or a
secondary insuror.
Sounds like some god complex MD's I've crossed paths with over the past 45
years.
------------------------------
Always compile a list of the patients. Opie system has this built and it
works great. Since I seldom to never have complaints (lucky i guess), I use
the section to note when patients come in with complaints of other
services.Also use this when I have time to note all the illegal diabetic
inserts that come in.
Also insure the pt complains to medicare. also the pt can get the rx from
the primary and notes. With the list of complaints the physician will not
have a leg to stand on ;). Also the physician can't do what he is doing.
------------------------------
It's good for the other company that the doc likes them so much. We all wish
we had a doc that loyal, but they should never ignore the patient's
preference and refuse care.
The only advice I have for you is to refer that pt to another one of his or
a new doc to get the rx and documentation.
-----------------------------
Wow. Sounds like the vascular clinic needs a swift kick/ reminder of the
Patient Bill of Rights which allows them the right to choose their own care
provider.
I am surprised these patients still go to this group but would gather your
patients together and have them write a letter to the vascular group and
attach the Patient Bill of Rights.
Also, put them on notice with the better business bureau & CMS.
Just my 2 cents.
----------------------------
Are there any other vascular doctors you can refer your patients to?
----------------------------
I have negotiated difficult things and been up against arrogant folks. A
couple things you should know. It is always patients's choice for prosthetic
providers. Obviously patient's Doctors have influence over them. A frequent
simple solution is to use another of the patient's physicians for the
prescription and documentation.
Do the doctors have a financial interest in the other practice? Or are they
under capitation contracts with providers? These are complicating things
that can result in some of the bad behavior you mentioned.
Have your patients change doctors. It sounds like they may be the only game
in town. Next town? I do not remember who or where because it was a long
time ago, but I recall an O and P business that found, encouraged, helped, a
new doctor come to town.
Complaining is not for me, but I have on occasion, pointedly brought to a
physicians office attention that they are under legal obligation to provide
documentation to us.
Are you missing something service wise. This may be painful to consider, but
is there something the other practice does great such as sending the Dr a
personal letter with their clinical notes every time they see a patient? It
may be something that simple.
----------------------
-Should I complain/ is there anyone who would care about this? What exactly
would you complain about? What facts do you have? What can you prove. I
think some referring entities in the Houston area are accepting remuneration
from the provider to compensate for the huge amount of their time that is
taken up by Medicare with respect to eligibility. We don't offer kick
backs of any kind, but I certainly understand the motivation for doing so.
Referring physicians are being put in an impossible position and are not
being adequately compensated by Medicare for these services. (The real
problem lies in the fact that most referring physicians can't reasonably
provide these services in the first place). Who else is going to pay for
their time except the provider?
-Should I compile a list of complaints by patients and send it to Medicare?
This seems like a good idea. I think Medicare is fundamentally interested
in seeing that their beneficiaries are receiving excellent care, or at least
the best care that is available.
-Should I just have the patients make a complaint to Medicare? This is a
really good idea because Medicare has more obligations to beneficiaries then
to provider.
-Should I do nothing and just keep trudging along as we have done for 35 One
bright side of RAC audits is that there is less money floating around for
unauthorized payments to referring entities. One provider in the Houston
area is being investigated for providing very expensive prosthetics, buying
the prosthesis back from the beneficiary at around 10% billed to Medicare,
and then obtaining a new Rx for a new prosthesis. This cycle apparently
occurred multiple times with attending monetary compensation to the referral
source. If you haven't been doing any of this, and if there is some way
that you can tighten your belt, then maybe you can weather this storm.
-------------------------
file an online complaint with your attorney general.
-------------------------
Jeremy: So sorry to hear this story...once again. Have the patient complain
to Medicare. That is the best way to get some wheels moving. Especially if
the patient has not been able to wear his current prosthesis and he has made
every effort to give that other provider a chance to make it right. Medicare
would like to see that money back. The patient should document all the
conversations/appointments, including dates and who he spoke with. Medicare
may run with this via phone conversation only, but a written testimony from
the patient would be ideal.
We have tried submitting complaints to OIG Hotline, but without
EMOBs/factual documentation, OIG will not bother.
As AOPA always falls back on...have your patients get involved. This is
just one of those instances where they are right. Get the patient involved
and stuff happens.
Good Luck, keep on Trudg'in...those who make life miserable for others, will
eventually get theirs.
---------------------------
You have the right ideas... Unfortunately, the only thing to do is have
patients make complaints and that can be done to medicare or to the state
medical board or other regulatory bodies. Hopefully you will get some smart
replies on the proper channels available.
My suggestion is moving forward you really could benefit from steering your
patients towards a PM&R doc for their prosthetic needs. The Physiatrist can
be a great relationship for you and is truly more in tune with what's needed
for your patients prosthetic rehab/maintenance. The vascular doc does not
need to be involved from a treatment or RX point of view if he is truly
operating outside of his patients interests
-------------------------
in the area, and a couple of these doctors also run the only wound care in
our area. So there isn't anywhere for the patients to go unless they can
drive about 50 miles to the next group. I'm hoping when the news story comes
out this week about this doctor amputating 3 of the wrong toes on a patient
the hospital will get rid of him. Not likely, but I can always dream. I'm
not too concerned with this group not sending me patients, as I usually get
the patient when they need a replacement leg/brace. My problem is with the
doctor telling the patient they can't change providers, even after they had
a bad experience with the other Clinic. I did furnish lunch and meet with a
couple of the doctors in the vascular group. I was told by the doctor that
owns the group we have had a lot of complaints about his work, so we will
give you a try. I did ask the doctors if they had received any complaints
about our work/service and the answer was no. This was about 3 months ago
and so far not a single order. He also told me to do the same in-service for
the wound care, which I did. Not a single order from them. Again, it
wouldn't be a big deal except for these doctors are taking away the patients
choice to healthcare.
Jeremy
----------
It seems to me the first question to ask patients is, Are you committed to
this vascular surgeon and practice and unwilling to see an alternative such
as a physiatrist? If the answer is yes, then I feel that the best avenue
for recourse, that doesn't sound like you complaining about a lack of
competitive capability-regardless of your actual competence, would be to
have patients contact Medicare directly to explain their loss of choice of
prosthetic providers at the hands of these surgeons. I assume you have
already attempted to meet with them to inquire about their apparent loss of
faith in your service. If they have no specific complaints about your
company then you have more reason to suspect foul play. Sticky situation, I
know, but not uncommon. I would also select an articulate, dissatisfied
patient and urge them to state their case to the surgeons as well if
possible. They do not want to spend valuable clinical time defending their
recommendation and ultimately may refer back to you. Best of luck. I share
your frustration at times with similar situations.
-----------------------------------
Be Professional - refer ALL those patients to another MD. Sounds like
there's a financial interest in there somewhere.
------------------------------------
Would love to hear responses...it seems more and more to be the norm that
prosthetists are locking in relationships with M.D.'s, not based on quality
of care. What I once thought happened only in third world countries is
prevalent in our community and we choose to stay small, obtain word of mouth
clientele, and avoid these interesting relationships.
------------------------------------
Sounds like a tough situation. If it were me. I would get as many patients
as possible to write out a statement and have it notarized. I would forward
a copy of those to AMA with your complaints. Sounds to me like you have
nothing to lose. He is already killing your business and it does sound like
something inappropriate is going on. Good luck.
-------------------------------
I'd try and notify the better business bureau, have your patient lodge a
formal complaint with Medicare and document any and all complaints yourself
until you find the person who you should send them to.
---------------------------
That's terrible and it sounds incredibly wrong, if not illegal, too. I
would do all of the above; report him to CMS & all of his governing bodies
and accreditation agencies. Have any complaining patients do the same
because I imagine a patient complaint, and multiple complaints, will carry
more weight. Good luck and please share the responses and results!
------------------------------
Have the patients call the insurance company and complain...they are more
likely to listen to patients, especially if there are several with the same
complaint
------------------------------
Sorry to hear this. Sadly this is going on all over the place. I would
start digging into both the doctor and the prosthetic practice And try and
find out what their relationship is (which I can hesitate a guess is likely
a monetary one) Then I would write a letter
Of complaint to the AMA and demand that this be investigated. If your
bilateral is willing to help you, he can go a long way by writing to Both
his state representative and his congressman. I am dealing with this as a
new clinic in VA, we had one of the bigger clinics in Seattle, but now we
are like a goldfish in the Ocean. We are being shut out by the company that
rhymes with Anger. So we have not started involving our senators,
representatives And governor - but you will need the help of patients. You
may want to see if you can join with the other two clinics to see if you can
pool your resources
-----------------------------
What a pain in the ass.
I also have a vascular group that won't send patients to us.
We found a local rehab doc who was more than happy to increase his patient
load. When we have a new amputee, we send him to the new doctor. I don't
know how big your town is but if you can find a physician who isn't afraid
of those vascular docs, maybe that is a way. Your bilateral should find
another doc to write the Rx and do the documentation. I don't see how the
vascular docs could do anything that would mess up his Medicare. If they
tried, he'd have grounds for a lawsuit. All the best.
----------------------------
I owned a practice for 25 years and had a similar situation. I asked the
doctors in one group why they would not refer to me and they were very
honest about it. The other prosthetist was a school buddy of the main
surgeon in their group and that was it. I never could change it. It was very
frustrating because there is nothing you can do. And it is not illegal.
Referrals are built on relationships first and foremost.
You could go digging around looking for kickbacks but most likely you will
just anger everyone (the opposite of building relationships) and also you
will spend time and energy that you could be devoting to developing your
business in more fertile directions.
My solution: I just focused on giving good service to the other patients I
had and to my loyal referral sources. I developed new relationships,
cemented old relationships and did the best I could in promoting my business
to the community and developing new referral sources. It all worked out
fine.
In other words, for your own sake, Get over it.
----------------------------
Interesting! But, I am not surprised. It sounds highly probable there is
some sort of kick back.
Have you thought about filing a complaint to the medical board against the
MD?
The patient has a choice and should not be held back because of his dr. We
have some doctors who refuse to refer to our company as well and we can only
speculate it is also due to kick backs. Frustrating, I know! We are not
the only ones who experience this Im sure.
I am interested in the responses you receive.
---------------------------
Contact your state Attorney Generals Office, ask for the MEDICAID fraud
section, then explain the situation relevant to Medicare because chances are
that any Medicare claim that processed was also processed by Medicaid; or a
secondary insuror.
Sounds like some god complex MD's I've crossed paths with over the past 45
years.
------------------------------
Always compile a list of the patients. Opie system has this built and it
works great. Since I seldom to never have complaints (lucky i guess), I use
the section to note when patients come in with complaints of other
services.Also use this when I have time to note all the illegal diabetic
inserts that come in.
Also insure the pt complains to medicare. also the pt can get the rx from
the primary and notes. With the list of complaints the physician will not
have a leg to stand on ;). Also the physician can't do what he is doing.
------------------------------
It's good for the other company that the doc likes them so much. We all wish
we had a doc that loyal, but they should never ignore the patient's
preference and refuse care.
The only advice I have for you is to refer that pt to another one of his or
a new doc to get the rx and documentation.
-----------------------------
Wow. Sounds like the vascular clinic needs a swift kick/ reminder of the
Patient Bill of Rights which allows them the right to choose their own care
provider.
I am surprised these patients still go to this group but would gather your
patients together and have them write a letter to the vascular group and
attach the Patient Bill of Rights.
Also, put them on notice with the better business bureau & CMS.
Just my 2 cents.
----------------------------
Are there any other vascular doctors you can refer your patients to?
----------------------------
I have negotiated difficult things and been up against arrogant folks. A
couple things you should know. It is always patients's choice for prosthetic
providers. Obviously patient's Doctors have influence over them. A frequent
simple solution is to use another of the patient's physicians for the
prescription and documentation.
Do the doctors have a financial interest in the other practice? Or are they
under capitation contracts with providers? These are complicating things
that can result in some of the bad behavior you mentioned.
Have your patients change doctors. It sounds like they may be the only game
in town. Next town? I do not remember who or where because it was a long
time ago, but I recall an O and P business that found, encouraged, helped, a
new doctor come to town.
Complaining is not for me, but I have on occasion, pointedly brought to a
physicians office attention that they are under legal obligation to provide
documentation to us.
Are you missing something service wise. This may be painful to consider, but
is there something the other practice does great such as sending the Dr a
personal letter with their clinical notes every time they see a patient? It
may be something that simple.
----------------------
-Should I complain/ is there anyone who would care about this? What exactly
would you complain about? What facts do you have? What can you prove. I
think some referring entities in the Houston area are accepting remuneration
from the provider to compensate for the huge amount of their time that is
taken up by Medicare with respect to eligibility. We don't offer kick
backs of any kind, but I certainly understand the motivation for doing so.
Referring physicians are being put in an impossible position and are not
being adequately compensated by Medicare for these services. (The real
problem lies in the fact that most referring physicians can't reasonably
provide these services in the first place). Who else is going to pay for
their time except the provider?
-Should I compile a list of complaints by patients and send it to Medicare?
This seems like a good idea. I think Medicare is fundamentally interested
in seeing that their beneficiaries are receiving excellent care, or at least
the best care that is available.
-Should I just have the patients make a complaint to Medicare? This is a
really good idea because Medicare has more obligations to beneficiaries then
to provider.
-Should I do nothing and just keep trudging along as we have done for 35 One
bright side of RAC audits is that there is less money floating around for
unauthorized payments to referring entities. One provider in the Houston
area is being investigated for providing very expensive prosthetics, buying
the prosthesis back from the beneficiary at around 10% billed to Medicare,
and then obtaining a new Rx for a new prosthesis. This cycle apparently
occurred multiple times with attending monetary compensation to the referral
source. If you haven't been doing any of this, and if there is some way
that you can tighten your belt, then maybe you can weather this storm.
-------------------------
file an online complaint with your attorney general.
-------------------------
Jeremy: So sorry to hear this story...once again. Have the patient complain
to Medicare. That is the best way to get some wheels moving. Especially if
the patient has not been able to wear his current prosthesis and he has made
every effort to give that other provider a chance to make it right. Medicare
would like to see that money back. The patient should document all the
conversations/appointments, including dates and who he spoke with. Medicare
may run with this via phone conversation only, but a written testimony from
the patient would be ideal.
We have tried submitting complaints to OIG Hotline, but without
EMOBs/factual documentation, OIG will not bother.
As AOPA always falls back on...have your patients get involved. This is
just one of those instances where they are right. Get the patient involved
and stuff happens.
Good Luck, keep on Trudg'in...those who make life miserable for others, will
eventually get theirs.
---------------------------
You have the right ideas... Unfortunately, the only thing to do is have
patients make complaints and that can be done to medicare or to the state
medical board or other regulatory bodies. Hopefully you will get some smart
replies on the proper channels available.
My suggestion is moving forward you really could benefit from steering your
patients towards a PM&R doc for their prosthetic needs. The Physiatrist can
be a great relationship for you and is truly more in tune with what's needed
for your patients prosthetic rehab/maintenance. The vascular doc does not
need to be involved from a treatment or RX point of view if he is truly
operating outside of his patients interests
-------------------------
Citation
Jeremy Sprouse, “Responses to Doctor/Provider relationship part I,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237117.
