Tough Pill to Swallow

  The case all across America during this time; Corporations tell the doctors what they can and can't do. A handful of business bachelor's and master's degree recipients get to tell our physician's, the one's with the M.D., DO, or PHD how they can or should practice. That did not settle well with a large amount of older doctor's that had been practicing for 20 or more years. Not only was this beginning to happen, but insurance companies were beginning to incur their own pharmacies to keep the scripts cheap for them, Keep the patience on a continuous payment schedule every 3 months. 100 % guaranteed money. These same insurance companies begin to hire their own physicians or MDs to review imaging for patients that the insurance company has rejected. These are called peer to peers.  If imaging is not covered or rejected by insurance, the m.a.'s and docs typically receive a rejection letter or denial letter and why the imaging is denied. Sometimes, it is just the wrong code, but most of the time it isn't. Your doctor must call their doctor and explain to their doctor why you need the imaging they rejected. Most of the time, they will get authorized as long as we do that. Insurance companies know so little about healthcare that they have to hire a physician to make sense of the imaging that is being ordered. Sometimes, the imaging is turned down anyways and the physician tells your doctor what a better option would be. 

  The same happens with prescription drugs.  Prescription after prescription denied by insurance. The pharmacy runs the prescription through to the insurance company, they deny it, send a form back for the doctor to view to complete a prior authorization. There are a couple of ways for the M.A.'s or nurses to complete. You can call or you can complete online though covermymeds.com, Either way, it produces the same results. Online is more convenient as you don't have to wait on hold for an indeterminate time. Each year, more and more prescriptions and imaging orders are being denied. This causes more and more of a workload for the back-office staff. And the doctors. If the approval is not complete within the timeframe the insurance company requires, then they will not allow the prior authorization to be performed. So take 1 prescription per patient at 30 patients a day that is denied. You are going to have 30 prior authorizations to complete. It would take at least 3 hours for 1 M.A. to complete. So, you see, the more authorizations you have to complete, the more probability will be that you will not be able to complete on time. So the insurance gets to save money by declining patients their medication that they need. All while the doctor is too busy healing and saving patients trying to proceed with the next steps in their care.  

  I would say a good practice at this time, given the increase in denials of imaging and prescriptions, office managers should employ 1 or 2 specific people to work on these prior authorizations. I have only worked at one office that hired 1 person to do all prior authorizations. They had a process down and everything was worked from 9-5. This allowed the M.A.'s and doctors to carry on with clinic, return phone calls, all the little things in between. If you are solo, I recommend you do at least 4 a day until the dr has an admin day. Prioritize from oldest to the newest.                                                                                                                                                                                                                                                                                                                                                                                                                                              

 

Life's Little Quirks and Jerks

  The doctor and I got along well. He was a bit ego centered, but I didn't know too many people who weren't. So, I was more passive which helped quite a bit. I was learning so much, felt so confident as an M.A. at last. He hardly did any office procedures. All mostly medication refills, and physicals for the most part. All other reasons would be referred. The load was very heavy. I went in at 7 am and left at 7 pm. Even came in on some Saturdays to catch up. Still, I was game. My children understood I had to sacrifice time to get us to where we need to be as a family. A better house, 

  I was so thankful for the opportunity of the position. I wanted to prove that I could handle the position. I wanted to prove that I belonged. I felt compassion towards the majority of my patients. I wanted to use my position to be the person they could count on. So many complaints of no returned calls, no prescriptions sent in when I started, they were endless. So, my first move with those patients would be correcting the wrongs, being consistent, following through. I knew that would gain their trust. Everything was coming together; I found my flow.... it was go, go, go never truly knowing when I would be able to stop. My 90-day review was good. as was my 6-month review. Our patients knew me, trusted me. By the time Christmas time came, my doctor had taken two vacations. 

  Our nurse practitioner started seeing more patients. They didn't have anyone for her yet, so guess who was elected for coverage

Yes...me. I really had nothing else to do. After that, things around the office seemed to get even more chaotic. The long days were catching up with me. We were again going through staff changes. So everyone was having to cover. The weight of it all was beginning to wear on me. It was what I had signed up for, so I kept going. I worked really hard there. The doctor didn't forget about me, he was very generous at Christmas to me. I was so grateful and so were my kids. They were so excited because we were able to do some things we wouldn't be able to do otherwise. 

The doctor had come to me early one morning and said he needed to pick up his wife from the airport so all the patients in the afternoon would need to be rescheduled. We were allowed to fix the schedule templates, so since the dr said.....the patients were rescheduled, the office manager was told by the dr about his plans. She requested him to stay, after all this was the 3rd time in two months, he had patients rescheduled with short notice. The doctor walked away from her after telling her this is what he was going to do. The doctor was a bit more theatrical than what I'm describing. He was a "Diva" and would let you know quickly if he didn't like you by ignoring you and looking at you like you have 4 heads when you talk to him. Watching him was entertaining. 

He had been displeased with the way the corporation was running the clinic. He didn't like being told how to practice or when he could take off. He hated writing his notes in the EMR system. EMR was relatively new to most practices at that time, but, to this one, they had been on EMR for a couple of years already. He still had not adapted to the EMR system. He would meet with the other dr's and discuss some private matters regarding the practice with them. 

 Calls weren't getting returned, patients were getting angry, prescriptions left unfilled, clinics were filled up to the max. All of us were drained emotionally, physically, mentally, all of it. We would continuously get emails from corporate or the office manager telling us to meet the pcmh measures, get everything done now, now, now.  At this point, your just like help, help, help! With a middle finger at the computer screen. All of us would express our frustrations to each other. Needless to say we all got to know each other. These ladies and I would help each other out. There were alot of days, we just couldn't. 

 

Corporations only seem to care about numbers, not their employees, not the patients. This office was upside down, and everyone looked to the M.A.'s to fix it. 

 

I was called into the office regarding the doctor's stunt that he pulled with the reschedules. I was being written up because I did what he told me to do. I was never told I couldn't do that. I expressed at that time that I was exhausted, tired, I needed help rooming for two providers. The only thing that made that possible was the fact that the doctor left at 3 and he didn't do procedures. The nurse practitioner was there all day, she did procedures. Flu tests, ear lavages, skin biopsies, ekg's, strep tests, urine tests. At time, 3-5 different tests on top of labs I had to put in and prescriptions I had to refill and print out for the patient. I was stretched to the limit. Meanwhile, nonstop urgent calls that I couldn't get to......at all. Paperwork needed to be filled out for work releases, clearances, nothing changed. 

Finally, they had someone hired that was supposed to help me with the NP. Notice I said supposed to help.......

  Have you ever just met someone or been in a situation that is so absurd or just shocking that you feel like you are a part of an episode on Punk'd? Well, more often than not these days, I do. This particular M.A., I could not find the right words to describe her. 

 

 I was to assist with training her on the computer and the clinical flow.  I sat with her for a few minutes. The doctor came over to me and asked who is that? He had this look on his face like he just smelled rotten eggs. I explained who she was. He wasn't very impressed with her skills. As I started to get happy for the help. She begins behaving strangely. 

 First, I noticed she would not take notes, then I noticed she wasn't helping with the desk work. She would doze off at Random times. I would hear her say the oddest things to the patients. She says it stinks in this room while a patient was standing next her, then sprays what sounded like half a can of lysol in the room.  That strong smell lingered all the way down the hall for the rest of the day, I can only imagine how bad it was in the room. 

  So, I asked her can you do the first 10 calls and some of the home health paperwork. She says, I don't want to do any of that work, I just want to room. I looked at her and said, I know the desk work isn't fun, but it is 80 % part of a medical assistant's job. You can't be a medical assistant and not do desk work. Rooming is a small part of what we do. She carried on as if I never said a word to her.  It was after lunch time; she gets back from lunch. She opens my doctor's cabinet, see his toothpaste, pulls it out and asks him can I use your toothpaste?   Remember, I said when my doctor didn't like someone, he would ignore them, not say anything to them? 

 

He had not spoken to her since she started working with us.  I was frozen in my chair looking at this goofy chick, not believing what I'm hearing. My eyes quickly diverted over to my doctor to see his reaction. He was signing his papers, he had stopped, had his eyes dead set on her, his eyebrows burrowed, his mouth gaped open partially. But it looked like a what the hell face of his. I looked over at the next desk where my friend/coworker was sitting. She was looking at the doctor, then looked over at me, smirked, trying not to laugh, then she straightened her gaze in front of her trying to disengage in what was taking place as she new this could be bad!

 

My doctor says, NO, looking at her like she was a stupid child. "Why would you want to use my toothpaste, put it back. "He grabbed his laptop, disgusted, he looked at me in shock and took off down the hall. I assumed to talk to the office manager. 

  My doctor always brushed his teeth after lunch, he didn't that day. It was things like that. I was waiting for someone to come out with a camera and say surprise! No one ever did. I'm not sure where they found her, but, it only showed me how desperate we were for help. Even though this help was limited. She roomed for the NP, but, I did all my docs papers, calls, rx's and hers since the new girl didn't like doing it. At this point the office manager was aware of this. 

  My doctor had been making small comments to everyone insinuating he would be leaving the practice. His patients didn't care that he was leaving, they just wanted to know where so they could follow him again. He even hinted to me that he would be leaving. He was very unhappy with the management and the company. It was really unorganized, plus the corporation inserted themselves in a way that doesn't allow the doctor's control over the way they practice. 

 

 Long days continued, it was wearing on me. I wanted to continue to see everything through. Several Saturdays were spent to catch up on everything. And the newest task, billing for home health paperwork the physicians have signed or filled out. Yes, the M.A.'s were tasked with this also. All those home health papers were billable.  Let me tell you, it is an extraordinary amount of paperwork. And we found time to do those on Saturday as well.  After all the hardwork and dedication I put into this place, turns out none of that mattered.

 

  I was brought into the office one afternoon. My office manager and an HR person, wanted to terminate me for not getting a surgical clearance completed for a patient and for rescheduling the doctors patients after he ordered me to do so. This was crushing news to me. I made sure to remind her that we were all needing help as I could not even think of whom she was speaking of regarding the clearance. Either way, I didn't catch it, my fault, yes. I tried so hard and felt like I had many successes. More successes than failures I thought. That would be my biggest down fall for future years to come. Thinking that hard work and dedication gets and keeps your job. No, the fact is, the one's that come in at 8 and leave at 5 and do bare minimum, they get to keep their jobs. They don't get written up. The issue is, people get use to you being this dedicated hard worker so when you don't do something, it is noticed. If you're not in with the manager in some way, you get noticed. I have witnessed manager's go above and beyond to get rid of people they just didn't like. So don't get comfortable, the musical M.A. game carries on. The title will help pay bills, but, work life balance isn't there. And after you are drained of your soul, they get rid of you. Like a disposable latex glove. If you want a secure job, go for the extra time it takes to become an LVN or RN. They get paid alot more, you can do so many different job titles with those credentials, even just instructing cpr classes. There are all kinds of desk jobs you can get, too. Even in clinics, they tell the M.A.'s what to do. There are more LVN's and RN's in the clinical setting now than ever before. So you don't have to work in a hospital setting only. 

 

  Now I'm sure there are plenty of M.A.'s out there that have been a lot more successful and kept a position with the same physician for years. This is my personal experience; these are the changes that I have seen since I started as an M.A. 13 years ago. Healthcare continues to change; our scope of practice is more limited now than ever before. You know yourself and what you are capable of. I wanted to make a difference, wanted to do something that means something.  While I had patients that trusted in me, that felt I made their time at the doctor's office so much more pleasant, they would call and only speak with me. None of that made any difference in the eyes of a manager. The load of nonsense that is placed on you to do daily isn't looked at unless it's an issue across the board or if it's not done. 

      Every doctor should have 2 M.A.'s or 1 RN and 1 M.A. now. The amount of work to be done for one person is near impossible. But they will put it on you as long as possible. They don't want to pay 2 of us. The patient load gets heavier, days get longer, expectations get set higher, No matter what, you will do your best to meet the demands. Because you want to be there for your patients and your doctor. You are the one they look to to help them.