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There are a lot of forms flitting about the office this month. The clinic where I work requires everyone to fill out updates on their information and insurance. Many remonstrate their information is ‘the same’ but the place is firm they need to do this. As a consequence, between now and approximately the end of March, when I go to fetch somebody from the waiting room, they are hunched over a clipboard, usually in a cross mood. They often assume it is I who is making them do this.

There is a new version of the checkout slip. When I finish with a patient I give them this slip to bring to the check-out gal. It’s amazing how often between leaving my office and going to the check-out window instructions are forgotten.* The slip, which is white, states what we did and the charges for such and when I want them back and whether this person needs an appointment with a counselor or the house manager or the billing lady. There is also the ‘blue’ slip for telephone calls as these too are billable (sometimes). The white and the blue have merged into one (no new color, alas) with add-ons of all sorts of possible charges. The goal: bill for services being done already but haven’t been charged for, as the clinic has been unawares it was possible to do so. **
This new form sure doesn’t lack variety; it has lots of things I thought were just part of being a good doctor, like reviewing records or doing leave of absence papers. Some other examples: providing education on smoking, diet, and weight – who knew one could bill for each of these separately? The form reminds me of the Innkeeper’s song ‘Master of the house’, from Les Misérables:

Residents are more than welcome
Bridal suite is occupied
Reasonable charges
Plus some little extras on the side!
Charge’em for the lice, extra for the mice
Two percent for looking in the mirror twice
Here a little slice, there a little cut
Three percent for sleeping with the window shut
When it comes to fixing prices
There are a lot of tricks he knows
How it all increases, all them bits and pieces
Jesus! It’s amazing how it grows!

The other new form is a rating scale. For years, the academic-types at the psych-conventions have encouraged us lesser shrinks to use rating scales. These are simple checklists the patients do while waiting in the waiting room prior to their appointment. This is the psychiatric equivalent of having your vitals done before seeing your primary care physician. In theory this is a more objective way of measuring progress (or lack of progress) in treatment. There are heaps of these things. As a first step we are using the PHQ-9 which is used to evaluate depression. Rating scales are not only ‘standard of care’ but another billable endeavor. Hot puppies.

It’s been a challenge for Urs Truly trying to remember to circle all services on the checkout slip, and making sure the patients are given a PHQ-9 prior to coming in. Ideally, the latter leads to better patient care, and the former leads to more money. Keep in mind, I am on salary, regardless. In a sort of weird “trickle-down theory” the more bucks raked in should lead to a pay raise for me. ***

I suppose it’ll take some time for the receptionists, the patients, and I to get into the hang of distributing and utilizing rating scales; I am curious to see if all the nickel and dime charging shenanigans ‘add up’ to anything. No harm trying anyway. As a salaried employee I do what the The Boss asks.

*The more pessimistic types at work wonder if patients purposely change the instructions given to them to suit their purposes. “Oh, the doctor wants me back in 4 months” when I asked them to return in one.

**I suspect this is the result of a consultation with The Overlords who are more savvy at billing codes.

***Fat chance of that.

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January 2022

Spo-Reflections 2006-2018