WEBVTT
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I was looking at the call schedule the other day and something caught my eye.
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It was something I've probably seen, I don't know, a hundred times.
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Never really thought about it.
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It was not the days that I was on call, but the days that I was not.
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Because ironically, even when I'm not on call, the phone keeps ringing and the messages do not stop.
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They continue on as if my phone and the call schedule have never communicated before.
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I'm sure you've experienced this as well.
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You know, a colleague calls or sends a message.
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They've got a patient with something complicated.
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Patient presentation that's ambiguous enough that they just can't seem to sort it out.
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Maybe my thoughts, my specialty, or my years of experience.
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Now, we're talking about a colleague that's I know someone's calling me, not a strange spam call.
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I know that I'm not on call, but I can't ignore that.
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So I stop what I'm doing and I look at the case, I review the date and I think through it.
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I then formulate a decision tree, you know, what to consider next.
00:01:06.319 --> 00:01:13.599
I also may decide whether or not to do an in-person consult if it's worth the patient's wait and drive time.
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Probably 30 minutes of my time.
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Expert judgment that, you know, if a hospital system had purchased that same consultation, they'd pay a couple hundred bucks for it.
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How much do I get?
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Nothing.
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Just another curbside consult when I'm not on call.
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I document nothing, and because I document nothing, I bill nothing.
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It just disappears into the day.
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Welcome back to our podcast.
00:01:40.719 --> 00:01:41.439
I'm your host, Dr.
00:01:41.519 --> 00:01:48.319
Kevin Hallow, Air Force veteran, surgeon, co-founder, and chief medical officer of Clinician Corps.
00:01:48.560 --> 00:01:59.840
Today we're going to talk not about a hidden cost, but an actual true hidden tax that is robbing you of the value of your intellectual wealth.
00:02:00.159 --> 00:02:04.159
Then we're actually going to calculate what that costs your practice every day.
00:02:04.239 --> 00:02:09.360
And finally, we're going to show you a solution that will change how you practice medicine.
00:02:09.599 --> 00:02:11.039
Let's get started.
00:02:21.439 --> 00:02:37.520
Most independent specialists, especially in rural and community settings, spend somewhere between 10 and 20 hours a week answering all kinds of clinical questions and requests on scheduled, unstructured, unbilled, expertise, all free of charge.
00:02:38.319 --> 00:02:41.680
For calculation purposes, that's 15 hours a week.
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40 weeks a year to be conservative.
00:02:44.639 --> 00:02:48.960
That's 600 hours annually of specialized cognitive work.
00:02:49.759 --> 00:02:54.479
Now, what's a reasonable billing rate for a specialist providing a formal consultation?
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We're not talking an office visit, we're just talking documented expert review.
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This would be CPT codes 99446 through 99449.
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And depending on the complexity and review time, using those codes, that amount of money would be anywhere from$95 to$400 per console, depending on what you're billing or who's paying.
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Once again, let's be conservative in our estimates.
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$150 per hour of specialist time.
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600 hours times$150 per hour.
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Now, I'm a surgeon.
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They don't hire surgeons for their brains, right?
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Even I can do that math.
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That's$90,000.
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$90,000?
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That's right.
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You as an independent specialist are likely giving away a minimum of$90,000 annually.
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I'm not kidding.
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This is serious.
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You're truly giving it away.
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It's like a tax.
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Think about this.
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Would your malpractice attorney, accountant, or a consultant do that work for free?
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Um survey says, no.
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Not even.
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So why are you?
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Moreover, what would you do with that extra$7,500 per month?
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Minimum.
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Upgrade the office a bit, trade in that old car with$150,000 miles on it, maybe take a vacation?
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Think about that.
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I was at a conference recently and a family practitioner was discussing ways that she tries to lower her cognitive overload in her practice.
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She says she likes to use a daily huddle.
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That's not really the point.
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It's the underlying theme that's the same.
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She noted how an interruption in the middle of her office, right, or midpatient, can really mess with her brain and throw her off track for like six to eight minutes.
00:04:50.319 --> 00:04:52.240
I mean, we've all experienced it.
00:04:52.560 --> 00:04:57.040
This is yet another issue that makes this problem even worse.
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Not only are you leaving all that money on the table, it actually is costing you even more than you realize.
00:05:04.639 --> 00:05:13.120
Leaving that exam room or rounds mid-documentation, answer a call, review data, think something through, someone else's diagnostic dilemma.
00:05:13.439 --> 00:05:17.279
That causes friction in your practice.
00:05:17.920 --> 00:05:21.040
That switch is a cognitive overload that messes with your brain.
00:05:21.120 --> 00:05:26.720
It results in delays in your patient care and documentation as well as potential errors.
00:05:26.959 --> 00:05:29.839
It's clinical erosion on top of the financial.
00:05:30.160 --> 00:05:36.480
You're exhausted by unknown interruptions that nobody's tracking and therefore nobody's funding and no one's compensating.
00:05:36.720 --> 00:05:38.560
I mean, talk about a catch-22, right?
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You want to help your colleagues even when you're not on call, but doing so means that your patient care and your wallet suffer the consequences when you do.
00:05:46.639 --> 00:05:48.720
Yet, you can't ghost them.
00:05:48.800 --> 00:05:49.680
You know them.
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They're not just your colleagues, but also your friends.
00:05:52.720 --> 00:05:53.839
You need to help them.
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You need them as much as they need you.
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Let's be honest here.
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The real problem isn't that specialists don't want to help colleagues.
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That's not it.
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The problem is infrastructure.
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We don't have a structured way to do this.
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When a community family physician in Nevada or Oregon or Washington or Arizona needs, say, a cardiology input, what happens?
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The formal path is a referral.
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That referral has the patient waiting for maybe a couple months for an appointment, driving for hours to sit in a waiting room in order to be evaluated.
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Ironically, many times, all of that work and effort is to answer a question that probably could have been resolved in, I don't know, 30 minutes through structured dialogue between a primary physician and the specialist.
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The problem is that the infrastructure for that structured dialogue doesn't exist between independent practices.
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I mean, you could pick up the phone, sure.
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You can text on your personal phone.
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You can email through a consumer email channel.
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You can do any of that if you're okay with it not being HIPAA compliant and not having any documentation trail.
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None of these options produce a record.
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None of them map to a billing code, none of them actually count.
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But we all do it informally, off the books, because it's easier and you have no time for anything else.
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That means that it costs the requesting physician time and effort.
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It also costs the specialist the same time and effort.
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Both absorb the labor, the time, and the costs.
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It's a broken infrastructure, dressed up collegially, with a lapel pin displaying the Hippocratic oath.
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Lucky us.
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These independent practices and your independent practice have been operating inside that broken infrastructure for so long that we've stopped noticing how much it actually costs us.
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We just all think it's normal.
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Let's take a moment and talk about a different scenario.
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One where things happen differently, where the infrastructure changes.
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We can start with a secure documented channel where one independent practice can send a structured clinical inquiry to another independent practice.
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This is not a referral.
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This is not a request to please see my patient.
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This is an actual asynchronous consultation on the physician or clinician's time when it's convenient for them.
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It's a simple dialogue.
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Here's the patient history, here's the imaging in some labs, this is my diagnosis, and here's my question.
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What are your thoughts on that?
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That's it.
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That's all you need, right?
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It's just like you do in the hallway or stairwall, it's just virtual.
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The reviewing specialist reviews it, documents the review time, sends back her thoughts and structured guidance along with some recommendations.
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All that information is private, encrypted, and HIPAA compliant.
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All of it is documented and integrated into the practice management system so the financial piece could actually close.
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And now it's official.
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That documented consultation now qualifies as an interprofessional consult under Medicare billing rules CPT-9946 through 99449 for a telephone review or 99451 or two for written consultations.
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The requesting physician documents the expert guidance and can proceed with treatment.
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The patient gets coordinated care without an unnecessary wait and travel time.
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It works because there's now infrastructure that makes it routine, secure, and integrated with billing.
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Everybody wins.
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Let's summarize a bit and get to the bigger point.
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Independent medical practices are the backbone of community healthcare.
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They deliver personalized, continuous care in ways that no hospital can do.
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They build actual relationships with their patients, they know their communities.
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However, independent medicine is under economic pressure, tightening payer contracts, escalating compliance costs, and of course, physician burnout.
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The problem is not with the physician or their staff, it's the infrastructure that is the problem.
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Primary care doctors cannot access specialized knowledge efficiently.
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Because of that, patients wait weeks or months for answers that should come in hours or days.
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Worse yet, we're all giving away hours and hours of work monthly in order to care for those patients.
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The practice of medicine is an individual event.
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The physician-patient relationship is and always should be a personal one.
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However, caring for patients requires a team approach.
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Delivering high-quality health care involves multiple independent practices, independent imaging centers, and independent specialists.
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The actual healthcare system is a network with physicians at its center.
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Here is the misalignment that is actually solvable, not with another consumer app or another disconnected point solution, but with unified infrastructure designed explicitly for how independent medicine actually works.
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Architecture that keeps practices independent while connecting them securely.
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A private, physician-centric network that preserves their identity and their autonomy while giving them access to expertise at scale.
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A platform that turns uncompensated cognitive work into fairly compensated, auditable professional exchange.
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It's a network and platform that now exists because we created it and it works.
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All right, that's all we have for today.
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I'm Dr.
00:11:47.840 --> 00:11:51.600
Kevin Hallow, co-founder and chief medical officer of Clinician Corps.
00:11:51.759 --> 00:12:14.000
Visit our website, cliniciancore.com, to see how we are turning the tide on the erosion of independent medical practice and physician burnout by helping these physicians, clinicians, and their staff access the specialists that they need, helping the specialists get paid for the work that they do and getting patients the care that they deserve in a timely and efficient manner.
00:12:14.320 --> 00:12:15.519
We can do better.
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Come join our network and see for yourself.
00:12:18.559 --> 00:12:20.159
Thanks for listening.
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I was looking at the call schedule the other day and something caught my eye.
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It was something I've probably seen, I don't know, a hundred times.
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Never really thought about it.
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It was not the days that I was on call, but the days that I was not.
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Because ironically, even when I'm not on call, the phone keeps ringing and the messages do not stop.
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They continue on as if my phone and the call schedule have never communicated before.
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I'm sure you've experienced this as well.
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You know, a colleague calls or sends a message.
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They've got a patient with something complicated.
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Patient presentation that's ambiguous enough that they just can't seem to sort it out.
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Maybe my thoughts, my specialty, or my years of experience.
00:00:47.200 --> 00:00:54.799
Now, we're talking about a colleague that's I know someone's calling me, not a strange spam call.
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I know that I'm not on call, but I can't ignore that.
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So I stop what I'm doing and I look at the case, I review the date and I think through it.
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I then formulate a decision tree, you know, what to consider next.
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I also may decide whether or not to do an in-person consult if it's worth the patient's wait and drive time.
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Probably 30 minutes of my time.
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Expert judgment that, you know, if a hospital system had purchased that same consultation, they'd pay a couple hundred bucks for it.
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How much do I get?
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Nothing.
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Just another curbside consult when I'm not on call.
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I document nothing, and because I document nothing, I bill nothing.
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It just disappears into the day.
00:01:39.200 --> 00:01:40.640
Welcome back to our podcast.
00:01:40.719 --> 00:01:41.439
I'm your host, Dr.
00:01:41.519 --> 00:01:48.319
Kevin Hallow, Air Force veteran, surgeon, co-founder, and chief medical officer of Clinician Corps.
00:01:48.560 --> 00:01:59.840
Today we're going to talk not about a hidden cost, but an actual true hidden tax that is robbing you of the value of your intellectual wealth.
00:02:00.159 --> 00:02:04.159
Then we're actually going to calculate what that costs your practice every day.
00:02:04.239 --> 00:02:09.360
And finally, we're going to show you a solution that will change how you practice medicine.
00:02:09.599 --> 00:02:11.039
Let's get started.
00:02:21.439 --> 00:02:37.520
Most independent specialists, especially in rural and community settings, spend somewhere between 10 and 20 hours a week answering all kinds of clinical questions and requests on scheduled, unstructured, unbilled, expertise, all free of charge.
00:02:38.319 --> 00:02:41.680
For calculation purposes, that's 15 hours a week.
00:02:41.919 --> 00:02:44.240
40 weeks a year to be conservative.
00:02:44.639 --> 00:02:48.960
That's 600 hours annually of specialized cognitive work.
00:02:49.759 --> 00:02:54.479
Now, what's a reasonable billing rate for a specialist providing a formal consultation?
00:02:54.800 --> 00:02:59.520
We're not talking an office visit, we're just talking documented expert review.
00:03:00.000 --> 00:03:04.719
This would be CPT codes 99446 through 99449.
00:03:05.360 --> 00:03:19.039
And depending on the complexity and review time, using those codes, that amount of money would be anywhere from$95 to$400 per console, depending on what you're billing or who's paying.
00:03:19.840 --> 00:03:23.199
Once again, let's be conservative in our estimates.
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$150 per hour of specialist time.
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600 hours times$150 per hour.
00:03:31.120 --> 00:03:32.479
Now, I'm a surgeon.
00:03:32.560 --> 00:03:34.719
They don't hire surgeons for their brains, right?
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Even I can do that math.
00:03:36.560 --> 00:03:37.840
That's$90,000.
00:03:38.719 --> 00:03:40.319
$90,000?
00:03:41.439 --> 00:03:42.400
That's right.
00:03:42.719 --> 00:03:47.759
You as an independent specialist are likely giving away a minimum of$90,000 annually.
00:03:48.960 --> 00:03:49.680
I'm not kidding.
00:03:49.919 --> 00:03:50.879
This is serious.
00:03:51.120 --> 00:03:52.560
You're truly giving it away.
00:03:52.639 --> 00:03:53.680
It's like a tax.
00:03:55.039 --> 00:03:56.159
Think about this.
00:03:56.319 --> 00:04:01.840
Would your malpractice attorney, accountant, or a consultant do that work for free?
00:04:02.159 --> 00:04:04.879
Um survey says, no.
00:04:05.199 --> 00:04:06.000
Not even.
00:04:06.800 --> 00:04:08.240
So why are you?
00:04:09.039 --> 00:04:13.120
Moreover, what would you do with that extra$7,500 per month?
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Minimum.
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Upgrade the office a bit, trade in that old car with$150,000 miles on it, maybe take a vacation?
00:04:20.480 --> 00:04:21.680
Think about that.
00:04:24.319 --> 00:04:32.720
I was at a conference recently and a family practitioner was discussing ways that she tries to lower her cognitive overload in her practice.
00:04:32.959 --> 00:04:35.279
She says she likes to use a daily huddle.
00:04:35.680 --> 00:04:37.120
That's not really the point.
00:04:37.759 --> 00:04:40.079
It's the underlying theme that's the same.
00:04:40.319 --> 00:04:50.160
She noted how an interruption in the middle of her office, right, or midpatient, can really mess with her brain and throw her off track for like six to eight minutes.
00:04:50.319 --> 00:04:52.240
I mean, we've all experienced it.
00:04:52.560 --> 00:04:57.040
This is yet another issue that makes this problem even worse.
00:04:57.199 --> 00:05:04.399
Not only are you leaving all that money on the table, it actually is costing you even more than you realize.
00:05:04.639 --> 00:05:13.120
Leaving that exam room or rounds mid-documentation, answer a call, review data, think something through, someone else's diagnostic dilemma.
00:05:13.439 --> 00:05:17.279
That causes friction in your practice.
00:05:17.920 --> 00:05:21.040
That switch is a cognitive overload that messes with your brain.
00:05:21.120 --> 00:05:26.720
It results in delays in your patient care and documentation as well as potential errors.
00:05:26.959 --> 00:05:29.839
It's clinical erosion on top of the financial.
00:05:30.160 --> 00:05:36.480
You're exhausted by unknown interruptions that nobody's tracking and therefore nobody's funding and no one's compensating.
00:05:36.720 --> 00:05:38.560
I mean, talk about a catch-22, right?
00:05:38.639 --> 00:05:46.399
You want to help your colleagues even when you're not on call, but doing so means that your patient care and your wallet suffer the consequences when you do.
00:05:46.639 --> 00:05:48.720
Yet, you can't ghost them.
00:05:48.800 --> 00:05:49.680
You know them.
00:05:50.000 --> 00:05:52.560
They're not just your colleagues, but also your friends.
00:05:52.720 --> 00:05:53.839
You need to help them.
00:05:54.000 --> 00:05:56.639
You need them as much as they need you.
00:05:59.199 --> 00:06:00.879
Let's be honest here.
00:06:01.120 --> 00:06:04.800
The real problem isn't that specialists don't want to help colleagues.
00:06:04.879 --> 00:06:05.920
That's not it.
00:06:06.240 --> 00:06:08.639
The problem is infrastructure.
00:06:08.800 --> 00:06:11.040
We don't have a structured way to do this.
00:06:11.360 --> 00:06:19.680
When a community family physician in Nevada or Oregon or Washington or Arizona needs, say, a cardiology input, what happens?
00:06:19.920 --> 00:06:22.160
The formal path is a referral.
00:06:22.399 --> 00:06:30.319
That referral has the patient waiting for maybe a couple months for an appointment, driving for hours to sit in a waiting room in order to be evaluated.
00:06:31.040 --> 00:06:44.399
Ironically, many times, all of that work and effort is to answer a question that probably could have been resolved in, I don't know, 30 minutes through structured dialogue between a primary physician and the specialist.
00:06:44.879 --> 00:06:51.519
The problem is that the infrastructure for that structured dialogue doesn't exist between independent practices.
00:06:51.920 --> 00:06:54.399
I mean, you could pick up the phone, sure.
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You can text on your personal phone.
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You can email through a consumer email channel.
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You can do any of that if you're okay with it not being HIPAA compliant and not having any documentation trail.
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None of these options produce a record.
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None of them map to a billing code, none of them actually count.
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But we all do it informally, off the books, because it's easier and you have no time for anything else.
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That means that it costs the requesting physician time and effort.
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It also costs the specialist the same time and effort.
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Both absorb the labor, the time, and the costs.
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It's a broken infrastructure, dressed up collegially, with a lapel pin displaying the Hippocratic oath.
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Lucky us.
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These independent practices and your independent practice have been operating inside that broken infrastructure for so long that we've stopped noticing how much it actually costs us.
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We just all think it's normal.
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Let's take a moment and talk about a different scenario.
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One where things happen differently, where the infrastructure changes.
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We can start with a secure documented channel where one independent practice can send a structured clinical inquiry to another independent practice.
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This is not a referral.
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This is not a request to please see my patient.
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This is an actual asynchronous consultation on the physician or clinician's time when it's convenient for them.
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It's a simple dialogue.
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Here's the patient history, here's the imaging in some labs, this is my diagnosis, and here's my question.
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What are your thoughts on that?
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That's it.
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That's all you need, right?
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It's just like you do in the hallway or stairwall, it's just virtual.
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The reviewing specialist reviews it, documents the review time, sends back her thoughts and structured guidance along with some recommendations.
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All that information is private, encrypted, and HIPAA compliant.
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All of it is documented and integrated into the practice management system so the financial piece could actually close.
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And now it's official.
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That documented consultation now qualifies as an interprofessional consult under Medicare billing rules CPT-9946 through 99449 for a telephone review or 99451 or two for written consultations.
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The requesting physician documents the expert guidance and can proceed with treatment.
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The patient gets coordinated care without an unnecessary wait and travel time.
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It works because there's now infrastructure that makes it routine, secure, and integrated with billing.
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Everybody wins.
00:09:44.399 --> 00:09:47.600
Let's summarize a bit and get to the bigger point.
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Independent medical practices are the backbone of community healthcare.
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They deliver personalized, continuous care in ways that no hospital can do.
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They build actual relationships with their patients, they know their communities.
00:10:01.039 --> 00:10:11.440
However, independent medicine is under economic pressure, tightening payer contracts, escalating compliance costs, and of course, physician burnout.
00:10:11.759 --> 00:10:16.480
The problem is not with the physician or their staff, it's the infrastructure that is the problem.
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Primary care doctors cannot access specialized knowledge efficiently.
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Because of that, patients wait weeks or months for answers that should come in hours or days.
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Worse yet, we're all giving away hours and hours of work monthly in order to care for those patients.
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The practice of medicine is an individual event.
00:10:36.960 --> 00:10:40.559
The physician-patient relationship is and always should be a personal one.
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However, caring for patients requires a team approach.
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Delivering high-quality health care involves multiple independent practices, independent imaging centers, and independent specialists.
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The actual healthcare system is a network with physicians at its center.
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Here is the misalignment that is actually solvable, not with another consumer app or another disconnected point solution, but with unified infrastructure designed explicitly for how independent medicine actually works.
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Architecture that keeps practices independent while connecting them securely.
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A private, physician-centric network that preserves their identity and their autonomy while giving them access to expertise at scale.
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A platform that turns uncompensated cognitive work into fairly compensated, auditable professional exchange.
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It's a network and platform that now exists because we created it and it works.
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All right, that's all we have for today.
00:11:47.200 --> 00:11:47.759
I'm Dr.
00:11:47.840 --> 00:11:51.600
Kevin Hallow, co-founder and chief medical officer of Clinician Corps.
00:11:51.759 --> 00:12:14.000
Visit our website, cliniciancore.com, to see how we are turning the tide on the erosion of independent medical practice and physician burnout by helping these physicians, clinicians, and their staff access the specialists that they need, helping the specialists get paid for the work that they do and getting patients the care that they deserve in a timely and efficient manner.
00:12:14.320 --> 00:12:15.519
We can do better.
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Come join our network and see for yourself.
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Thanks for listening.
