Richmond, VA -- A Hospitalist Group affiliated with Chippenhammer Hospital has implemented a nighttime telemedicine service to get paid for taking cross-cover calls that should have been referred to a physician consultant instead.
"We were getting hundreds of calls a night," said Grace Jones, the new Director of In-house Hospitalist Telemedicine with Tired Hospitalist Group at Chippenhammer Hospital.
Hospitalist medicine growth has transformed the speciality into the path of least resistance. Many doctors and nurses feel hospitalists should be called for all questions because they are already in-house. Some hospitalist groups are even expected to field calls when other doctors don't answer.
"My job has become so ridiculous that I'll even get asked to call a patient's irate physician daughter at 2 a.m. when we aren't even on the case! We had to staff two hospitalists every night plus one more in the 20 bed geriatric observation unit just to field nursing calls while our one night hospitalist admitted 20 patients every night," Grace said while shaking her head in disbelief.
"To fund additional physician staffing, we had to figure out a way to get paid for fielding cross-cover nursing calls to titrate dopamine in a post-MI cardiac ICU patient or provide vent orders in a crashing ARDS patient, even though the order was to "CONSULT MEDICINE FOR DIET CONTROLLED DIABETES ONLY", a written verbal order that was underlined twice and written in all capital letters at the request of the ordering specialist."
Tired Hospitalists worked tirelessly with The Centers for Medicare and Medicaid Services (CMS) to get in-house hospitalist cross-cover calls paid for through telemedicine CPT codes by reducing payments to other physician specialties in a revenue neutral method.
"We analyzed all night cross-cover calls we received in the last six months and discovered 97% of all calls on patients with at least one consultant were inappropriately diverted to our hospitalist physicians. As a result, we have instructed all hospital nurses to call our telemedicine answering service when at least one specialist is involved."
In addition to CMS payments, Tired Hospitalist Group plans to bill every specialty directly using proprietary software to determine how annoying the call really is. Some specialty groups have expressed reluctance in paying a hospitalist to field their calls since they've been getting away with it for free all these years.
"I'm not paying a hospitalist to do my job. If they don't want to take my calls, they shouldn't have become a hospitalist," said Dr. Wiley Scruff, a 78-year-old surgeon who hasn't answered his phone at night in 30 years.
After threatening to stop providing stat pre-operative H&Ps in patients with no medical problems, all surgical specialties agreed to pay Tired Hospitalist Group whatever they wanted.
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"We were getting hundreds of calls a night," said Grace Jones, the new Director of In-house Hospitalist Telemedicine with Tired Hospitalist Group at Chippenhammer Hospital.
Hospitalist medicine growth has transformed the speciality into the path of least resistance. Many doctors and nurses feel hospitalists should be called for all questions because they are already in-house. Some hospitalist groups are even expected to field calls when other doctors don't answer.
"My job has become so ridiculous that I'll even get asked to call a patient's irate physician daughter at 2 a.m. when we aren't even on the case! We had to staff two hospitalists every night plus one more in the 20 bed geriatric observation unit just to field nursing calls while our one night hospitalist admitted 20 patients every night," Grace said while shaking her head in disbelief.
"To fund additional physician staffing, we had to figure out a way to get paid for fielding cross-cover nursing calls to titrate dopamine in a post-MI cardiac ICU patient or provide vent orders in a crashing ARDS patient, even though the order was to "CONSULT MEDICINE FOR DIET CONTROLLED DIABETES ONLY", a written verbal order that was underlined twice and written in all capital letters at the request of the ordering specialist."
Tired Hospitalists worked tirelessly with The Centers for Medicare and Medicaid Services (CMS) to get in-house hospitalist cross-cover calls paid for through telemedicine CPT codes by reducing payments to other physician specialties in a revenue neutral method.
"We analyzed all night cross-cover calls we received in the last six months and discovered 97% of all calls on patients with at least one consultant were inappropriately diverted to our hospitalist physicians. As a result, we have instructed all hospital nurses to call our telemedicine answering service when at least one specialist is involved."
In addition to CMS payments, Tired Hospitalist Group plans to bill every specialty directly using proprietary software to determine how annoying the call really is. Some specialty groups have expressed reluctance in paying a hospitalist to field their calls since they've been getting away with it for free all these years.
"I'm not paying a hospitalist to do my job. If they don't want to take my calls, they shouldn't have become a hospitalist," said Dr. Wiley Scruff, a 78-year-old surgeon who hasn't answered his phone at night in 30 years.
After threatening to stop providing stat pre-operative H&Ps in patients with no medical problems, all surgical specialties agreed to pay Tired Hospitalist Group whatever they wanted.
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