You mentioned this "pediatrician" does not do acute care! That's like saying she does not do vaccinations. Does she not take night call? Is this just a practice of (her) convenience? It is easy to do 9-5 medicine. But to me, the reason we get paid the "big bucks" is providing the 100% 24-7 care that is required to be a real doc. Do patients really attach to this part-time doctor? I guess she selects for "well" patients. g barden > > At 10:47 PM 10/9/99 -0500, Eve, Seth and Amina Switzer wrote: > >In our small town, I work in the only peds group in town (3 of us total). > >The only other pediatrician here is part-time, solo and, in her explanation > >to me, doesn't do "acute care". She says that she simply cannot "keep up" > >with current treatments/standards of care. For virtually all inpatients and > >newborns on her service she will consult one of us - we write all orders > >and, basically, take over. To my understanding she charges her patients for > >her services *AND* we charge her patients for our consultations. That just > >doesn't seem right but I'm not exactly willing to consult on her patients > >for free! This has been the arrangement since before I joined the group. > >So my questions are: (1) Do insurance companies reimburse for this sort of > >arrangement? (2) Are there any medico-legal issues? (3) Short of asking > >her to give up her hospital privileges, is there an alternative arrangement > >that would make more sense? > > > >I'm just looking for some input before I take this problem up with my > >partners... > > > >Eve H. Switzer, MD > >rural peds > > The definition of a "consultation", as I understand it, is when one > provider asks another for their expert opinion. You are a specialist (in > general pediatrics) and a physician has requested your expert opinion. One > requirement of a consultation is that you provide a written report (which > states that the other physician has requested your services) back to that > physician. As far as I know, there is no prohibition regarding both > providers being in the same general specialty. You should use consultation > codes, not regular E&M or hospital visit codes to bill. On the surface, > this doesn't seem too much different than when one of my patients gets > admitted to the NICU or PICU. I follow the patient, write notes, speak to > the family and consultant each day, and try to stay as involved in the > child's care as possible. The neonatologist or intensivist is the > "consultant", but in reality manages the case for all practical > purposes. The big difference is I need a neonatologist or intensivist to > make sure the patient gets superior subspecialty care, while you are > providing services that - theoretically - this other pediatrician "should" > be able to provide. Though payment should be made for both your and this > other pediatrician's services, it does seem like unnecessary duplication of > care - and if the family has co-pays or deductibles, it certainly isn't > fair that they should pay double. OTOH, if enough families had complained > over the years to this pediatrician, she likely would have stopped doing > what you describe. > > Michael Sachs, M.D. > General Pediatrician >