FAQs in Geriatric and Long-Term Care Medicine
How do I join a nursing home? Joining a nursing home is easier than joining a hospital. Most facilities have very basic credentialing requirements. You simply need to present yourself to the administrator and be able to produce your medical license, applicable state and federal controlled substance licenses and of course proof of malpractice insurance. You'll also need to be able to convince the administrator of your value to her facility. What is the worst thing about your practice? The most problematic part of Long-Term Care Medicine is the number of phone calls. This can be a deal breaker for the uninitiated and uninformed. If not properly set-up and structured, the phone calls can be overwhelming. I knew one doctor who lasted only 3 months, with only one nursing home. Then again, I know of several other doctors with 5-10 facilities who’ve been in practice for 20 years and are still going strong. There must be systems in place to help control the volume and intensity of calls. Most of this is through training, use of protocols and a large dose of good old common sense. What is one thing you wish someone had told you when you first started in Geriatric Medicine? One thing, for sure, would be to learn how to code properly for your visits. I learned after almost 8 years how to "really" code properly. I was under-coding for years and never knew it. I was reluctant to bill for all I did for fear of catching the attention of Medicare. Now I look forward to Medicare’s input and even used one of their routine spot checks of my coding in my Long-Term Care Practice Manual to help illustrate some coding concepts. How does the billing work? The billing is mainly through third party insurance companies. The primary one, by far, is Medicare, as most of the Geriatric patients in Long-Term Care are over 65 years of age. We do our billing in house with billing software. Another alternative is to use a billing service. The billing service may not be as vigilant in pursing the secondary payments as your own employee, but they can be very economical if you find a good one. How long does it take to “get to speed” from a dead start in Long-Term Care? That all depends on how aggressive you are and how hard you market yourself. Once I started my LTC practice full time, it took me about 6 months to stop working in the Emergency Room. I was in 4 facilities and became Medical Director of one facility. What are the support organizations for Long-Term Care? There are two dominant ones that I belong to and recommend. The first is the American Geriatric Society. It has a wealth of educational materials and CME available. The other is the American Medical Directors Association. It is more geared toward helping Medical Directors but has recently expanded its scope to other disciplines within Geriatric Medicine. Of course, I highly recommend The Long-Term Care Practice Manual as a practical introductory guide to the practice of Long-Term Care Medicine. How do I introduce myself to nursing homes? Who should I talk to? The people to deal with initially are the administrator, the Director of Nursing (DON) and sometimes the Assistant DON. These are the main people to start with; they’re not the people to help you get new patients however. That comes later and is explained more fully in my Long-Term Care Practice Manual. Can I work part-time in Long-Term Care? Absolutely, yes. You’ll still be on call each day, but you don’t have to make patient rounds each day. You can also arrange to share the work and call with another like-minded individual. I started that way. My first partner and I shared the inpatient work and call, and split the week-ends. The work combinations are only limited by your drive and imagination. How do you transition from an out-patient practice to a full time LTC practice? There is no secret formula. Most people I know begin by following one of their own patients to a nursing home, and then begin accepting new patients there. As the business grows, they must make time to see these patients. Most are forced to take a hard look at their practice set-up and choose the least productive hours to devote to LTC. The rest comes naturally, out of necessity. You start to prune your practice to accommodate your “new fruit”. How many patients do you need to make this work? The answer depends on many factors; how hard you want to work, how much income you want, your overhead and what type of patients you are seeing. I devote an entire chapter exploring the many variables involved with this question. You can begin by figuring how many patients you want and can see in an hour. I can see about 4-6 patients per hour. How do I get coverage? Look in your community to the physicians already providing Long-Term Care. Some of these doctors may want some extra coverage and be willing to cover you in return. Otherwise, you can use your present coverage physicians as long as they are willing. |