April 1, 2025 • 43 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, Welcome Internet ready listeners Southeast Texas. Welcome to
the edition of the Doctor Levine Medical Hour. Hopefully you're
having a wonderful Saturday morning. A little bit wet and overcast,
a little bit gloomy outdoors, but none that's a good
stay in the side day. But hopefully you're doing well
(00:22):
this morning. Phone lines are open the doctors in the house,
and we'd love to hear from you. Eight nine six
kV I one one hundred and three to three zero
kov I. I'm here every Saturday trying to help answer
some questions about your health care and help you answer
some medical medical questions because, as you may or may
(00:44):
not know, you have access to a lot of information
out there that's coming at you in so many different directions.
You're not quite sure what is good, what's bad, or
if it's true or not. My show, but hey, I'm
in it. I've been doing it for over twenty years,
(01:06):
and I'm in the hospitals every day. I'm in my
office as often as possible, and I feel like I
know a few things. I've seen a few things over
the years and just want to share that information with
you to make things a little bit better. For you
or easier for you in terms of making decisions or
(01:27):
answering questions, because it is confusing eight nine six KLFT
one hundred and three three zero. Okay, E if I
lived to hear from you, give us a call as
soon as possible. Don't wait till the end of the show.
We don't have much time. Remember, we're trying to give
you as much time as possible. That's not always the
case when you go to your doctor's office. Just time constraints.
(01:50):
Time constraints, time constraints. Right, you wait a whole hour
for your healthcare professional, you only get ten minutes, right,
So I think sometimes if you prepare yourself the night before,
write down all your questions so that when it's your time,
you make the best of it and you get everything in.
So we appreciate you joining the show. As you know,
(02:14):
sometimes we do have guests that come on this show.
Not often. It's tough coming up here in the morning
Saturday weekend. This is when a lot of people unwind
and lounge around the house, maybe do some cleaning, go
to the grocery store, you know, run those errands. But
(02:34):
every now and we do have some guests, and this
morning we do have one of our regular guests that
comes on the show just to spread her knowledge and
insight into more of the what we call admin side
or administrative side of healthcare, as you know, the administrators
(02:55):
who run the hospitals, who run most doctors' offices. You know,
there's this misconception that when you go to your doctor's office, Yeah,
their name is on the billboard, it might be on
your information, but they're really not running the office. Most
doctors are just showing up and seeing patients and doing
(03:16):
what they were trained to do. And there's a whole
administrative team that's responsible for really the day to day
grind of making the office work so that the lights
are on, the chairs are clean, their staff in there,
and they know what to do in order to interact
(03:37):
with your insurance company and then interact with you and
then get you out the door in less than three hours. So,
without further ado, we welcome missus Lavine. Good morning, Charlotte Levine,
Good morning. How you doing.
Speaker 2 (03:54):
There's a little bit more to it than that, but
that's okay.
Speaker 1 (03:58):
Well, we know that's why you here, because there's there's
a there's knowledge busting out of your ears. I can
see it. It's just coming, it's leaking out of your pores.
Just knowledge of administrative duties of a medical office nothing.
Speaker 3 (04:15):
Also as a person in the community that wants to
educate patients, let them know what's going on from the
insurance world connecting to the doctor's office. There's a lot
of information that's transpired daily through email, through phone calls,
through meetings, and of course normally the administrative side of
(04:40):
a doctor's office is behind the scenes. You don't it's
behind a door. You don't know what's behind that door,
what's going on behind that door, what is behind that door.
And normally that's the administrative side because it does require
quiet attention. You know, there's a lot of things being
talked about that you can't really talk about it openly
in the clinic, a lot of arguing. I take up
(05:05):
for our office discussions. I take up for our office.
I take up for doctor Levigne. I take up for
the patients because sometimes it can be unrealistic because they're
not down in the trenches with us, with the patients
with real life scenarios and situations. And so I'm constantly
a patient advocate, honestly, because my degree is nursing, but
(05:29):
I do run our office and I enjoy it. It's
been a challenge through twenty years, but I feel like
I'm a pro at it now. So my job every
day is to really make sure that we're delivering the
highest standard, peer we're making the insurance companies happy enough,
and that the patients understand why we're doing it and
(05:52):
what the reason is behind it. And it changed a
little bit for twenty twenty five, and so I feel
like it is my duty as the practice manager to
come and try to educate the community on what those
changes are so that they better get a grasp of
what their responsibility are as far as the patient to
their primary no matter who they see. Because I want
(06:14):
all patients to succeed. I want all doctors to succeed,
and it takes a team on both sides to make
that happen. So that's what I'm here for today. So
just a few changes that I think are important. I
want to explain why because a lot of patients is like,
why do I have to do that?
Speaker 2 (06:33):
Well, here's why, and.
Speaker 1 (06:36):
So that's let's just stop right there and thank you
for that introduction. A lot of things on your mind,
the knowledge is busting out of your pores. I can
see it. I might have to bring it to the
ear later. So, you know, because you hadn't been here
in a while, so you've sort of got all this
retain knowledge that I guess you had to release today.
(06:56):
You just knew that I had to get it out.
I had to talk of it. And yes, it is
important for everybody.
Speaker 2 (07:02):
To be on the same page. You know, we're in
the first quarter.
Speaker 3 (07:05):
Yes, January, February, March is the first quarter, second quarter,
third quarter. There's four quarters in a year when it
comes to what I do. And so if I educate
the community, educate the patients, they can, you know, start
on the second quarter and hopefully finish as a hero
December thirty first, not only them, but the doctors.
Speaker 1 (07:27):
Do so, Yeah, I guess what I was going to
try and do. You said, why do I have to
do that? And I guess I was going to start there.
In terms of what are the patients asking about the
most that that you know, what is the that that
they have to do. Is it just show up to
the office, is it fill out paperwork? What is the
thing that you're being asked for the most. In terms
(07:50):
of why do I have to do that?
Speaker 3 (07:52):
So compliance is a huge, huge thing this year. It
used to be compliant, non compliant, whatever, but now it's compliance.
So what insurance companies want you to do if you
have chronic medical diseases and you're on multiple medications, is
really to see your doctor every three months. If you
(08:12):
have diabetes, they want a A one C every three months,
and we have to report those things to the insurance company.
We have to report that if you come, if you
pick your meds up on time, if you're taking your
meds correctly, if you have an A one C. I
(08:32):
guess it's not a guess. I'm sorry about that. That's
really wrong to say. But they want the patient.
Speaker 1 (08:39):
Sometimes it is a guess. They don't necessarily they're not
necessarily clear in terms of why they want to see that.
It makes sense to me from a doctor's standpoint. I mean,
I agree with everything. To be honest with you, it's the.
Speaker 3 (08:52):
Way the insurance companies look at it as screenings and
be in compliant with your medications the way you take them,
take them as prescribed, vibed, get your A one C,
come in and see your physician so that we can
catch things through mri ct X ray screening because it's
a lot cheaper to catch it and to treat it
(09:13):
on a minimal standpoint rather than not catching it and
then it's thousands of thousands of dollars to treat you.
Speaker 1 (09:21):
I mean, that's that's what we do, right, We're in
preventative care, right, No, yes, okay, I'm sorry, primary care prevention.
That's what all that stuff is, to be honest with you,
and it does work when yes, patients are complying as
well as doctors, doctors office. It's it's a big system
and we constantly have to talk about it and make
(09:45):
sure that all the moving parts are on the same page,
which it's difficult to do every single day, every single encounter.
But it's always refreshing to know that, yes, the insurance
companies are on board, because why is it. I mean,
they're paying the bill, so they certainly are expecting a
certain outcome or they would like to see a certain outcome,
(10:07):
and they Yeah, it's just like anything. You have to
reach out to the people involved, get a conversation going,
and make sure everybody's on the same page. So, yeah,
the big topic is compliance, but it's been around for
a while right, and it's never going away.
Speaker 3 (10:23):
It's been around for a while. But you know, they
not only hold the physician accountable, they hold the patient accountable.
And they're lightening up just a little bit because there's
patients that can't come in. There's patients that don't have
rise obstacles, obstacles, that's right, and so they're lightening up
on those obstacles, which is great, but it still has
(10:47):
to be reported, and it still has to be There
is so much paperwork behind behind it.
Speaker 1 (10:54):
With more computer right generated, I guess there's still some
paper involved.
Speaker 3 (10:59):
We have to print, we have to print it, you
have to fill it out, we have to upload it.
We have to upload notes, we have to upload vitals.
I mean, there there is a lot. And my staff
they're wonderful.
Speaker 1 (11:09):
They do you think can we completely go paperless? What
do you think we are?
Speaker 3 (11:13):
You're never going to go paperless because it requires a
piece of paper to be filled out by.
Speaker 1 (11:18):
Hand, but completely electronic. Do you think it's you think
we'll ever get there?
Speaker 2 (11:22):
I'm sure.
Speaker 3 (11:23):
I mean, the world is advancing every day, so why
wouldn't it. It may not be in our lifetime, but maybe,
but maybe our granddaughter's lifetime.
Speaker 1 (11:29):
When your system goes down, that's that's gridlot.
Speaker 2 (11:34):
Well, you didn't say if the system goes on, we
have to.
Speaker 1 (11:36):
Go paperless, but that is the concern. If your computer
system goes down, that's gridlot. I mean, you can't do
anything with that paper.
Speaker 2 (11:45):
So you have a hand, you have a piece.
Speaker 1 (11:47):
Of I think there'll always be paper around and maybe
maybe five percent of it is paper. It's man, I
would need some security, some known backup system.
Speaker 2 (12:00):
That's you want to pop a Rozzi too.
Speaker 1 (12:03):
Well, no, I'm just saying. I mean when your computerism
goes down, oh my god, it's terrible. I mean, it's
such a huge issue in terms of getting your work
done that it can be a major setback. And I
think the computer system does help with compliance because that
these insurance companies want information basically, but they want data
right so they can plug in their numbers and their
(12:24):
computer models and sort of spit out some things, whether
or not that doctor Levine's doing a good job, whether
not the patient's doing a good job. And one thing
I've seen is the healthcare industry, the insurance companies are
investing heavily in that. One thing I've seen them do
is send out these nurse practitioners, physicians assistants to the house. Right,
(12:46):
have you seen this?
Speaker 2 (12:47):
Absolutely?
Speaker 1 (12:48):
What do you think about that?
Speaker 3 (12:51):
I think that's great as long as the nurse practitioner
that does go to that home communicates with the primary
to say, hey, I went to your patient's house today,
I saw your patient on your behalf and this.
Speaker 2 (13:04):
Is what I did.
Speaker 3 (13:06):
There's a huge disconnect in that, so when the patients
come in to see us, they sometimes don't remember that person.
They just know that a person came into their home
and evaluated them. They don't really remember what they did.
They do remember that it was from their insurance company.
So then we're having to struggle to piece those things
(13:28):
together for the patient.
Speaker 2 (13:29):
So I would love if those.
Speaker 3 (13:33):
Providers that went into the homes to see the patients
on the insurance behalf to close gaps, right, that's what
they're doing, would just communicate that to the office rather
it's a note or call the office or something, because
there's still a disconnect with that.
Speaker 1 (13:52):
Okay, well let me stop you there. That's a big
term that you just threw out their gaps gaps, So
can you just sort of briefly explain what that means
in the insurance lingo.
Speaker 3 (14:05):
Gaps gaps or if you have diabetes and you haven't
had an A one C, that's a gap.
Speaker 1 (14:12):
If you're on insurance company has a list of recommended tests, visits,
et cetera, a hit list if you will, of yeah,
prioritized events, things that they would like to see happening
every year or every six months. Is that correct? If
(14:33):
you're deficient in those activities, they call that a gap?
Would that be okay? Acceptable? Understanding? And so the the
nps of the mid levels that are sent out to
the patient by the insurance company to help fill those gaps.
(14:56):
So reprioritize you should be doing this and this and
this and that. Now my experience is a little different
normal when the patients come back to the office, they
either have a sheet of paper most of them, or
they have a folder which has more sheets of paper
(15:16):
with some of the documentation of what happened during the visit. So, yeah,
so we do have a little bit and I agree,
I'm I'm on board with you. I like it because
it's done at their home. They have zero distractions, there's
no rush, and it's just the patient and the provider
(15:38):
talking about their health. There's the sheet, the documentation. It's
just it's really basic stuff in terms of getting an
A one C, what else? What other hit list? What
else is on the hit list? And for most insurance companies,
getting an A one C in a towently man or
what else? Going to your doctor?
Speaker 3 (16:02):
So vaccine, you want to answer to answer, I mean
you're doing a good job over there. I'm not asleep.
I have my coffee.
Speaker 1 (16:14):
I was just helping you out.
Speaker 2 (16:16):
Thank you for that. I appreciate it.
Speaker 3 (16:20):
A couple of things, probably the most. The largest thing
that is a huge obstacle is met compliance. Medication insurance
companies want you to pick up your medication on time,
take it as directed, and pick up your refills.
Speaker 1 (16:40):
All right, let's let's let's stop there. We've talked about
this before in this show. Just just give me two
obstacles that I just gave you impact a patient's compliance
as it pertains to medications.
Speaker 3 (16:56):
So let's just say they pick up their medications.
Speaker 2 (17:00):
And a big thing is.
Speaker 3 (17:03):
They pick up their medications, they take it home, they
forget to take it, so then they have more than
what they're supposed to have. So that would fall into
a non compliant patient. If they take it twice a
day and they took it once, if they take it
three times a day and they took it once, if
they forgot to take it, if they forgot to take
(17:24):
the dose, if they took their dose right, but they forgot,
if they took it so they took another dose, that
would mean that it's too early to fill the medicine.
So I love pill counters for patients. Have someone come
put your doses in a pill counter, know exactly, make
a list of when you're supposed to take it, what
time you're supposed to take it, and why you're taking work.
Speaker 1 (17:48):
Can I just be normal again?
Speaker 2 (17:51):
What's normal to find? Normally?
Speaker 1 (17:52):
I don't have to take these meds? Doctor? Can I
get off these meds? I take so many? I just
this is too much?
Speaker 2 (18:00):
Are you talking to me? Is if I'm your doctor?
Speaker 4 (18:02):
No?
Speaker 1 (18:02):
This is what I hear every day. Well, then you
just it's cumbersome. It's hard. I mean, they got ten
thousand other responsibilities and it's difficult to keep up with medicines,
especially if you're taking five or six. And what one
complaint I hear all the time is they yes, they
have four or five medicines. Well, two of them they
(18:24):
get every thirty days, and then two of them they
might get every ninety days, and then one of them
is a special medicine have to come into office every
month to get urine and get a special prescription. And
I mean it gets real complicated, real fast, and it's
not automatic, and they're just obstacles to that, you know.
(18:44):
I think talking with patients, I guess what I hear
is that if it could be easier for them to do,
I think they would be more compliant with the medication.
And I think certainly that's a system issue because it's
not just the patient involved. You know, it's us, the
doctor and the doctor's office, and then it's the insurance
(19:06):
company and it's a pharmacy, right, those are the three
big players.
Speaker 3 (19:10):
So I have a suggestion, so patients that are on
multiple meds that don't understand the importance of med compliance
could always have home health come and do medication evaluation
and management to where they put all of their medications
(19:31):
in a pill planner. They write out why they take them,
the importance of them taking them, and what happens if
they miss them. That can happen for the patient. Usually
that's paid for, especially if you have Medicare and a
secondary insurance. They come into the home and they do
medication management for the patient. And that way, that's a
(19:54):
nurse or a medical assistant that's in the home that
will help the patient understand because all the pills are blue,
all the pills are yellow, all the pills are white,
but they will explain to them what this pill is
for and why they take it.
Speaker 1 (20:10):
I honestly, I honestly feel like the computer industry and
modern technologies that pertains electronic world could help out significantly
with that. Just like we have the Internet, information free
to the American public, you just have to type a
few numbers and boom you have. I think certainly software
(20:30):
programs can help patients get that done. And that's the thing.
Getting plugged into the grid the system. I think it
can make that easier. But it's risky, right putting all
your information out there, getting plugged into the grid. You
have to be careful with that. But it's complicated, and
(20:52):
I think that improving the system. What I mean by
is that doctor Levine is in line with the pharmacy choices,
in line with them. The insurance company is paying for it,
and everybody's talking to everybody, and that's what improve the system.
But we're all sort of on different systems. We have
a different EMR, the pharmacy has a different EMR, and
(21:15):
then the healthcare insurance company has different EMR. We're not
even talking to each other. So just that alone generates
a whole lot of potential complications or obstacles for patients
to be compliant. So yes, they have to do their part,
and we have to do our part. I mean a
lot of times we don't even know if the medicine
(21:38):
net we're prescribing is going to be paid for. That's
another big thing, right, Yeah, they go to dark Levine
for their high pertension. I give them the best drug
I think is going to work for them. They take
it to the pharmacy down the street. Oops, they don't
pay for it.
Speaker 3 (21:52):
Well, no, so what happens there? Let's just say that happens.
Then we have to do a authorization to say, okay,
the patient has tried one, two, three medicines.
Speaker 1 (22:02):
How long does that take?
Speaker 2 (22:03):
About seventy two hours?
Speaker 1 (22:06):
But that's three days. Well they're non compliant. Well is
that their fault?
Speaker 3 (22:11):
So what they could do is they could keep taking
their old medicine just to stay covered out.
Speaker 1 (22:17):
That's why they came to the doctor's.
Speaker 2 (22:18):
Well, then we'll see if we have docor.
Speaker 1 (22:20):
Levine's office and you gaining this prescription. It's ninety to
pro authorization. I call your office and I hadn't heard
from anybody. It's been three days.
Speaker 3 (22:31):
Well that you know, they may not have heard of
from anybody in the past, but they will hear from
somebody in the future because we have a really good
person at our office who is on top of authorization,
so it will get done.
Speaker 2 (22:42):
Are you trying to go on break over there?
Speaker 1 (22:44):
We need to take a break. Phone lines are open
eight nine six kalvy. I won one hundred three three zero.
Speaker 4 (22:49):
Kay.
Speaker 1 (22:49):
Hey, I'll be back in two minutes. All right, Welcome
back to Doctavi Medical. Our phone line to open eight
nine six kV I want one hundred three three zero
kov I. I'm here this morning with Missus Levine. She's
(23:10):
the administrator general at our office, Golden Triangle Troma Medicine
Geriatrics here in Beaumont, Texas, cross street from Baptist Hospital.
Been there for that location for about five years, just
right before the pandemic hit. But we've been in a
business for over fifteen years here in my hometown of
(23:31):
bau My, Texas. Proud to be here, and I'm proud
that she's here. Very talented female, just an incredible mind,
and she's able to navigate through all of the issues
that come up running a modern medical office day. And
she wanted to share some of the information because she
hadn't been here a long time. She was just congested
(23:52):
with information. Well now I just had to get it out.
And you can tell just from my conversation. I mean,
we could here all day just talking about all the
issues that come up every single day, not just in
our office, in any office. Go to the hospital. It's
fourfold in terms of the complexity of just taking care
(24:15):
of one patient, let alone three hundred patients, six hundred
patients in modern hospitals. I mean, it is amazing how
the system for the most part works on a daily basis.
But we have these hiccups, and that's what we're talking
about as it pertains to compliance. We have Michael from Pasadena,
what's going on.
Speaker 4 (24:35):
Well, good morning. A quick question for missus Leline. I
wondered if how the compliance effects if Medicare has the
same type of compliance requirements.
Speaker 1 (24:51):
Compliance for the patient or the doctor or what.
Speaker 3 (24:54):
No, no, no, He's just asking if Medicare has this same compliance.
So honestly, what I am talking about is all Medicare patients,
rather you're on traditional Medicare or you're on an HMO,
So this are the this is the gold standard expectations
for all Medicare patients.
Speaker 4 (25:17):
Okay, I wasn't sure I understand. Well, thanks, thank you both,
and a very good subject. And I appreciate everything you do.
Speaker 1 (25:32):
All right, Michael, appreciate that phone call. And I think
that some HMOs and some Medicare policies are more aggressive than.
Speaker 3 (25:43):
Others, are way more aggressive than just traditional Medicare.
Speaker 1 (25:48):
Okay, right, and aggressive would be yes. They're sending out
nurse practitioners. They're asking us to fill out paperwork and
mounds and yeah, and provide certain types of targeted documentation
in the chart when we see the patient. We were
discussing doing the break about one or two of the
(26:10):
insurances that we work with requiring the doctor's office to
have documentation that we know they're in the hospital and
that we know when they get discharged, so when they
get admitted. They want us to document in the chart
we know they're admitted, and.
Speaker 3 (26:25):
We have seventy two hours that we have seventy it's timed, yes,
so a lot of times if a patient goes to
an emergency room that doctor Levine is not affiliated with,
we never get that information, so we don't know. So
that's a measure that we fail. That's not our fault,
but they make it our fault because you are the
(26:47):
primary you're the gatekeeper.
Speaker 1 (26:49):
Okay, let me stop you there, So fault do we
get penalized?
Speaker 2 (26:54):
We can't.
Speaker 1 (26:55):
How do we get penalized or how did they correct that?
Or what's there were to the doctor for me? Documenting that?
Speaker 3 (27:04):
For me, I just try I call the patient and
just say, you know, please let us know.
Speaker 2 (27:10):
Wherever you are that you are in the hospital.
Speaker 3 (27:14):
Because patients have the freedom to go wherever they want,
we can't control that.
Speaker 2 (27:18):
That's their choice.
Speaker 3 (27:20):
But just let us know, communicate that with us, because
all we'd have to do is get onto a portal
and report it. We have seventy two hours, and we
don't get penalized if we felt that measure. But if
you felt a lot of measures at let's just say
you have thirty patients a year that do that, it's
going to bring your star score down. And star scores
(27:42):
are on the Medicare website, which your five star by
the way, and you're also five star on quality.
Speaker 2 (27:47):
Yes, I take that very serious.
Speaker 1 (27:49):
That is my job, right and even know it.
Speaker 3 (27:51):
Yes, you don't need to know it. You just need
to be a good doctor. Go see your patients.
Speaker 1 (27:55):
I know I'm trying.
Speaker 2 (27:57):
I do the rest.
Speaker 1 (27:58):
Even that's hard sometimes, but you try hard every day, of.
Speaker 2 (28:02):
Course, yeah, you give it your best. What else can
you do?
Speaker 1 (28:05):
You keep trying, wake up every day and keep doing
your best to be as good as you can. But
these star ratings, so if doctor Levine does not do that,
the star rating goes down. Now is reimbursement connected to that,
because that's publicly known that.
Speaker 3 (28:21):
You get the same reimbursement no matter what. Okay, wouldn't
that be nice?
Speaker 1 (28:25):
So what's the okay, So what's the incentive for a
doctor's office just to get the star rating?
Speaker 2 (28:31):
You want the star rating?
Speaker 3 (28:32):
Because I would hope that everybody would look at that
and investigate that before you choose a new primary right,
because you want someone that's going to give you gold
standard of care most likely what I've heard, and this
is just a speculation that in the future, if you're
(28:55):
a one star, two star, whatever, they can pull that
patient a graphic load from that pain from that physician
and give it to someone who is, yeah, going to
do a five star.
Speaker 1 (29:07):
And that makes sense, right, I mean, that makes sense.
Speaker 2 (29:10):
Well, let me just tell you, I get it.
Speaker 3 (29:12):
Well, if you have a two star, that means that
you're really not doing what the insurance company wants you
to do. You may be doing what you want to
do for your patient, but you may not be doing
what the insurance company wants you to do.
Speaker 1 (29:26):
Play the game, right, right.
Speaker 2 (29:30):
I guess, Yeah, that's what you want to call it.
Speaker 1 (29:32):
That's correct. I mean I think that's frustrating for physicians
and healthcare providers is when you're in medical education, none
of this stuff really comes up that often. Star ratings
and paperwork and all these things that you're talking about.
Speaker 3 (29:49):
Are you talking about when you're in medical school. When
you're in residency, Oh, you're trying to learn about cells
and yeah, you know.
Speaker 1 (29:55):
Tissue, that's right, right, disease. You get out in the
world and all of a sudden you have representatives for
the insurance companies showing up at your office saying we
want you to do this, this, and this, What is this?
I've never heard of this? And how does that affect
patient care? I mean, why am I doing that? I
wasn't taught that.
Speaker 3 (30:15):
So and you get you get pretty fired up in
those meetings, and I have to kind of come in
and sit down and be.
Speaker 1 (30:20):
Like, well, because I think providers, it's a foreign topic
to providers. It's it's added responsibility, added stress on top
of what you're already trying to accomplish. It is the
paperwork of healthcare, which is not our computer work of healthcare,
which is not going anywhere, by the way, and.
Speaker 2 (30:38):
You're pretty good at computers.
Speaker 3 (30:39):
I have to say, you are the fastest typer I've
ever seen.
Speaker 1 (30:43):
Well, I tried to, but all I'm saying is from
my stamp on as provider, I know that if I
want to be viable as a practitioner, if I want
to be successful as a practitioner, I need to learn
how to work with these insurance companies because they are
hanging the bill. I need to figure out what it
is they need for their patient, and then combine that
(31:06):
with what the medical world is telling me to do
for the patient.
Speaker 2 (31:10):
It's their member, member, your patient, it's their member.
Speaker 1 (31:13):
Sorry, And that's really her struggle. A lot of times
is patient might walk in with ten complaints and as
the physician, you want to address that that day. You
know you have limited time. But then you have the
sheet of paper sitting in front of you where the
insurance comes ask you to do this, and you just
run out of time. You don't have time to do
(31:35):
it every single day. And just like with being informed
that a patient or a member has been admitted to
the hospital, they've been discharged hospital.
Speaker 2 (31:43):
Or even if they go to the emergency right.
Speaker 1 (31:45):
Yeah, that requires the involvement of some other players that
are not necessarily involved with their office. That has to happen.
So again, so.
Speaker 3 (31:55):
That's when you that's when you communicate with the hospitals
and you say, if any of us our patients show
up and they're not admitted, they come to the er,
they get to go home from the er. Yeah, send
us over a fax just stating that.
Speaker 1 (32:12):
And at the end of the day, I kind of
get it, you know, because several years ago before you know,
we send our patients to consultants cardiology, lung doctor, kidney doctor. Right,
And at one time they didn't really send us any
of their information. They would go out to these doctors,
all this stuff would happen, and they would come back
a year later. They went around the world, Well how
(32:34):
are you doing. Yeah, I've been here and here and
here and here and here, and we absolutely have zero
information in the chart. But then I think the insurance
companies started requiring consultants. Hey, you need to send this
information to the premier so they can be educated and
they can be involved with their healthcare delivery. Sort of
the same concept. You're going to the hospital, you're going
(32:57):
to the r Hey, then your primary needs to know
about that, maybe give a primary diagnosis, maybe meds that
will change. All that stuff is critical information. So I
get it. We're trying to link everything.
Speaker 3 (33:09):
Well, I have to say, we do get a lot
of consolet notes from.
Speaker 1 (33:15):
They're very helpful.
Speaker 2 (33:16):
We do get a lot.
Speaker 1 (33:18):
I love them because the patients come to the office
or how you've been doing. And that's one thing that
I've added to my cadence. You know, if you're a
patient of mine, you know every time you see me,
I'm going to ask you about the same basic four
or five questions.
Speaker 2 (33:33):
What did you eat today?
Speaker 1 (33:34):
Yes, that's one of my sweating if you're a patient mind,
you know I do that. What are you drinking? All right,
it's just a cadence, right, it's just some you know,
you go get your oil changed and your car. You
want your basic things done, and I sort of get
that and I try to do that, right. And so
(33:55):
one question that I've added to my cadence is well
have you been to the er? And who else are
you seeing as a doctor? Right, because a lot can
happen and then they will say, well, I went here,
but I don't know what happened. I go to their console,
don't boom, I got it. Yeah, and it's just information.
Phone lines are open eight nine six kcalvy. I won
(34:16):
one hundred three three zero kova. I'll be back in
two minutes. All right, welcome back to Doca, vinmnic our.
Phone lines to open eight not one six kalv I
one in one hundred three three zero ko v I
talking about the kaleidoscope of health care delivery in the
administrative side. All you guys remember kaleidoscope that used to
(34:38):
be a little art show here, But I wonder if
they still have that Kaleidoscope anyway. I used to go
to it every year here in Beaumont, Texas. It was fun.
I remember had good times with that. But talking with
Missus Levine about just issues that come up on the
admin side, these are things that are happening to all
(34:59):
healthcare offices hospitals, just trying to get better and trying
to get that system as operational as possible in terms
of delivery of healthcare, patience, safety, all these things. We're
talking primarily about compliance and in terms of what the
insurance company is trying to get everybody on board with,
(35:21):
and they're heavily invested in that because why, it really
keeps your disease at bay and it really does cut
down being in the hospital. Hospital care is very expensive
and it can be harmful being in the hospital. A
lot of people don't think of it that way. But
your body is under stress. You have needles going through you,
(35:45):
you got tubes going through you, you're getting blood, you're
getting very strong medications.
Speaker 2 (35:52):
Other people, MM, I don't think of my mind.
Speaker 1 (35:56):
There you go. You're talking so much, you broke the mic.
I mean so much energy is going through the mic.
You broke it, let me see. Yeah, there you're there,
go ahead.
Speaker 3 (36:09):
So I wanted to also tell the general public, if
you're not a patient patient of ours, we have a
Facebook page that we have started putting a ton of
educational information on this year to educate the community, because
it doesn't matter if you're our patient or not. So
if you do have Facebook, I want you to look
up doctor Mussanthi B Levine and just read what we
(36:34):
do post, because we do post a lot of things
that I think would help the general public learn, learn terms,
learn differences and diseases, learn compliance, learn what the insurance
companies want from us, and I post those and so
a lot of people have commented. When I'm out in
(36:55):
the grocery store at a restaurant, they will walk up
to me and say, you know, we really appreciate that
we read what was posted today on doctor Levine's Facebook,
and we've really enjoyed it. So of course that makes
me feel good because I want to educate the community
so that they can be the best that they can
be health wise, you know, just because I'm I'm on
(37:18):
the other side of it.
Speaker 1 (37:19):
So yeah, again, just like me, I'm just trying to
deliver medical knowledge, just to try and help patients understand
the complexity of their health. And then you're on the
admin's side, just trying to help patient understand the paperwork
admin side of healthcare, which is very complex as well.
We have our battles every day that we have to
(37:40):
fight as it pertains to that, and yes, we're just
trying to share that information and give you some insight
into that. There have been a few patients that have
come to the office talking about the website, so it
sounds like you guys are doing a phenomenal job delivering
that information and just bringing it down to a level
where an average person can understanding, because that's one problem
(38:02):
with sometimes health care delivery is that the terms are
too complex and the processes are too complex, and so
a lot of patients just sort of churn it off
and they never engage, and unfortunately it's have their demise
because normally that means just like you say, don't take
their meds and.
Speaker 3 (38:19):
And there's a there's a there's a helpful hint, and
there's some recommendations on the website is med compliance and
how you can do your part as a patient. So
instead of me sitting here talking about it because we
only have an hour. They can go to our website
and actually read about it, and there's some really cool
hints that we've given you our suggestions to try to
(38:41):
help you.
Speaker 2 (38:41):
Keep up with it.
Speaker 1 (38:42):
Because I'll I'll say this from my own experience, it's
kind of hard to be compliant. I'm just going to
say that it's kind of hard.
Speaker 3 (38:52):
Once every three months, go to your doctor's office. Okay,
pick your meds up on time and take them as
direct and prove, complain report.
Speaker 2 (38:59):
To your doctor's If you went to.
Speaker 1 (39:01):
The emergency and you have to sit at your doctor's
off for three hours. Hey, that's a lot of time.
You know. I don't. I gotta work, you know, I
got kids to pick up. I'm just saying we're going
on last break and we'll finish up and wrap up
those ideas. Phone lines open A nine to six scalva
I one one hundred and three three zero O kyov.
I'll be back in two minutes. All right, welcome back
(39:22):
to Doctor Menic. Our phone lines are open and closed.
At the end of the show, Missus Levigne, any closing thoughts.
Speaker 3 (39:30):
So one thing I did want to say before we
closed is if you do have chronic kidney disease, insurances
believe it or not want you seen once a month
at your primary.
Speaker 1 (39:42):
Which I'll be I'll be honest about that. I think
that it should still be left up to the physician
of the patient how frequent they need to come in.
These are just suggestions and recommendations by the insurance company.
They are our partner in terms of healthcare delivery, and
they're just making their recommendation. I feel like it's a
(40:05):
waste of time. If I have a person with KD
chronic kin disease, and their blood pressure is normal, their
labs are normal, they have no complaints, all their risk
factors are being successfully managed. They're on what we call
goal directed therapy.
Speaker 2 (40:22):
What's their stage?
Speaker 1 (40:24):
Back once a month.
Speaker 2 (40:26):
What's the stage of kidney disease?
Speaker 1 (40:28):
It doesn't matter what the stage is. You can have
stable KD chronic kin disease four five three two one,
it doesn't matter. All I'm saying is I know they're
trying to be helpful.
Speaker 2 (40:40):
They just don't want their patient to end up on dialysis.
Speaker 1 (40:42):
Yeah, I got that they're trying to be helpful, But
I don't think it's a mandatory, mandatory, it's sugg always
up to the clinician and the patient. It's a partnership
the patient, the clinician, and the insurance company all trying
to improve patient care. And I think yes, CKD certainly
(41:05):
factors in a lot of different diseases, because if your
kidneys are hurt, it means your system is probably also
hurting as well, and you're someone that needs to be
monitored more closely. I think a month is too frequent.
If I have a person they're doing well, No, I'm
not doing a month. I mean I don't want to
waste my time in their time. I saw them last month.
(41:26):
We didn't change anything. They have no new complaints. And again,
this is cumbersome to go to doctor's office. Is one
thing that this a it can do to improve compliance.
How can we make the doctor's office visit more efficient,
less time can How can we do that? I mean
that would certainly improve compliance. How can we make the
system of getting the medication to the patient on a
(41:49):
regular basis? What all this hassle that they go through
in terms of interacting with the pharmacy. Then they got
to call us back and interact with us and then
they got to call the insurance company about the pharmacy,
about doctor.
Speaker 2 (42:08):
Happens.
Speaker 1 (42:09):
It's can generate so much chaos. And I hear this
that you hear it every day, right, which is why.
Speaker 3 (42:14):
You hear Another big thing is male orders do lose
the male order, so then that makes the patient non compliant.
Speaker 2 (42:22):
That's not their fault.
Speaker 1 (42:24):
So we don't want to make it seem like it's
the patient's fault. No, absolutely, Yeah, we're just saying that
that's a big area of concern for the insurance company
and it's something that all doctors are trying to improve.
We want you to understand that as well. We all
need to do our parts and generate a better system.
(42:45):
And I think that will help out everything. But certainly
I believe in it. I think it's going to help anything.
Speaker 3 (42:50):
We are patient advocates, not insurance advocates.
Speaker 1 (42:54):
Is that on our website. I can add it anyway,
have a good weekend.
Speaker 2 (43:00):
Her for weekends, eat your vegetables, drink your water.
Speaker 1 (43:04):
Thank you.
Speaker 2 (43:04):
Yeah, I listen to you every Saturday morning.
Speaker 1 (43:06):
Bye mm hmm.
All right, Welcome Internet ready listeners Southeast Texas. Welcome to
the edition of the Doctor Levine Medical Hour. Hopefully you're
having a wonderful Saturday morning. A little bit wet and overcast,
a little bit gloomy outdoors, but none that's a good
stay in the side day. But hopefully you're doing well
(00:22):
this morning. Phone lines are open the doctors in the house,
and we'd love to hear from you. Eight nine six
kV I one one hundred and three to three zero
kov I. I'm here every Saturday trying to help answer
some questions about your health care and help you answer
some medical medical questions because, as you may or may
(00:44):
not know, you have access to a lot of information
out there that's coming at you in so many different directions.
You're not quite sure what is good, what's bad, or
if it's true or not. My show, but hey, I'm
in it. I've been doing it for over twenty years,
(01:06):
and I'm in the hospitals every day. I'm in my
office as often as possible, and I feel like I
know a few things. I've seen a few things over
the years and just want to share that information with
you to make things a little bit better. For you
or easier for you in terms of making decisions or
(01:27):
answering questions, because it is confusing eight nine six KLFT
one hundred and three three zero. Okay, E if I
lived to hear from you, give us a call as
soon as possible. Don't wait till the end of the show.
We don't have much time. Remember, we're trying to give
you as much time as possible. That's not always the
case when you go to your doctor's office. Just time constraints.
(01:50):
Time constraints, time constraints. Right, you wait a whole hour
for your healthcare professional, you only get ten minutes, right,
So I think sometimes if you prepare yourself the night before,
write down all your questions so that when it's your time,
you make the best of it and you get everything in.
So we appreciate you joining the show. As you know,
(02:14):
sometimes we do have guests that come on this show.
Not often. It's tough coming up here in the morning
Saturday weekend. This is when a lot of people unwind
and lounge around the house, maybe do some cleaning, go
to the grocery store, you know, run those errands. But
(02:34):
every now and we do have some guests, and this
morning we do have one of our regular guests that
comes on the show just to spread her knowledge and
insight into more of the what we call admin side
or administrative side of healthcare, as you know, the administrators
(02:55):
who run the hospitals, who run most doctors' offices. You know,
there's this misconception that when you go to your doctor's office, Yeah,
their name is on the billboard, it might be on
your information, but they're really not running the office. Most
doctors are just showing up and seeing patients and doing
(03:16):
what they were trained to do. And there's a whole
administrative team that's responsible for really the day to day
grind of making the office work so that the lights
are on, the chairs are clean, their staff in there,
and they know what to do in order to interact
(03:37):
with your insurance company and then interact with you and
then get you out the door in less than three hours. So,
without further ado, we welcome missus Lavine. Good morning, Charlotte Levine,
Good morning. How you doing.
Speaker 2 (03:54):
There's a little bit more to it than that, but
that's okay.
Speaker 1 (03:58):
Well, we know that's why you here, because there's there's
a there's knowledge busting out of your ears. I can
see it. It's just coming, it's leaking out of your pores.
Just knowledge of administrative duties of a medical office nothing.
Speaker 3 (04:15):
Also as a person in the community that wants to
educate patients, let them know what's going on from the
insurance world connecting to the doctor's office. There's a lot
of information that's transpired daily through email, through phone calls,
through meetings, and of course normally the administrative side of
(04:40):
a doctor's office is behind the scenes. You don't it's
behind a door. You don't know what's behind that door,
what's going on behind that door, what is behind that door.
And normally that's the administrative side because it does require
quiet attention. You know, there's a lot of things being
talked about that you can't really talk about it openly
in the clinic, a lot of arguing. I take up
(05:05):
for our office discussions. I take up for our office.
I take up for doctor Levigne. I take up for
the patients because sometimes it can be unrealistic because they're
not down in the trenches with us, with the patients
with real life scenarios and situations. And so I'm constantly
a patient advocate, honestly, because my degree is nursing, but
(05:29):
I do run our office and I enjoy it. It's
been a challenge through twenty years, but I feel like
I'm a pro at it now. So my job every
day is to really make sure that we're delivering the
highest standard, peer we're making the insurance companies happy enough,
and that the patients understand why we're doing it and
(05:52):
what the reason is behind it. And it changed a
little bit for twenty twenty five, and so I feel
like it is my duty as the practice manager to
come and try to educate the community on what those
changes are so that they better get a grasp of
what their responsibility are as far as the patient to
their primary no matter who they see. Because I want
(06:14):
all patients to succeed. I want all doctors to succeed,
and it takes a team on both sides to make
that happen. So that's what I'm here for today. So
just a few changes that I think are important. I
want to explain why because a lot of patients is like,
why do I have to do that?
Speaker 2 (06:33):
Well, here's why, and.
Speaker 1 (06:36):
So that's let's just stop right there and thank you
for that introduction. A lot of things on your mind,
the knowledge is busting out of your pores. I can
see it. I might have to bring it to the
ear later. So, you know, because you hadn't been here
in a while, so you've sort of got all this
retain knowledge that I guess you had to release today.
(06:56):
You just knew that I had to get it out.
I had to talk of it. And yes, it is
important for everybody.
Speaker 2 (07:02):
To be on the same page. You know, we're in
the first quarter.
Speaker 3 (07:05):
Yes, January, February, March is the first quarter, second quarter,
third quarter. There's four quarters in a year when it
comes to what I do. And so if I educate
the community, educate the patients, they can, you know, start
on the second quarter and hopefully finish as a hero
December thirty first, not only them, but the doctors.
Speaker 1 (07:27):
Do so, Yeah, I guess what I was going to
try and do. You said, why do I have to
do that? And I guess I was going to start there.
In terms of what are the patients asking about the
most that that you know, what is the that that
they have to do. Is it just show up to
the office, is it fill out paperwork? What is the
thing that you're being asked for the most. In terms
(07:50):
of why do I have to do that?
Speaker 3 (07:52):
So compliance is a huge, huge thing this year. It
used to be compliant, non compliant, whatever, but now it's compliance.
So what insurance companies want you to do if you
have chronic medical diseases and you're on multiple medications, is
really to see your doctor every three months. If you
(08:12):
have diabetes, they want a A one C every three months,
and we have to report those things to the insurance company.
We have to report that if you come, if you
pick your meds up on time, if you're taking your
meds correctly, if you have an A one C. I
(08:32):
guess it's not a guess. I'm sorry about that. That's
really wrong to say. But they want the patient.
Speaker 1 (08:39):
Sometimes it is a guess. They don't necessarily they're not
necessarily clear in terms of why they want to see that.
It makes sense to me from a doctor's standpoint. I mean,
I agree with everything. To be honest with you, it's the.
Speaker 3 (08:52):
Way the insurance companies look at it as screenings and
be in compliant with your medications the way you take them,
take them as prescribed, vibed, get your A one C,
come in and see your physician so that we can
catch things through mri ct X ray screening because it's
a lot cheaper to catch it and to treat it
(09:13):
on a minimal standpoint rather than not catching it and
then it's thousands of thousands of dollars to treat you.
Speaker 1 (09:21):
I mean, that's that's what we do, right, We're in
preventative care, right, No, yes, okay, I'm sorry, primary care prevention.
That's what all that stuff is, to be honest with you,
and it does work when yes, patients are complying as
well as doctors, doctors office. It's it's a big system
and we constantly have to talk about it and make
(09:45):
sure that all the moving parts are on the same page,
which it's difficult to do every single day, every single encounter.
But it's always refreshing to know that, yes, the insurance
companies are on board, because why is it. I mean,
they're paying the bill, so they certainly are expecting a
certain outcome or they would like to see a certain outcome,
(10:07):
and they Yeah, it's just like anything. You have to
reach out to the people involved, get a conversation going,
and make sure everybody's on the same page. So, yeah,
the big topic is compliance, but it's been around for
a while right, and it's never going away.
Speaker 3 (10:23):
It's been around for a while. But you know, they
not only hold the physician accountable, they hold the patient accountable.
And they're lightening up just a little bit because there's
patients that can't come in. There's patients that don't have
rise obstacles, obstacles, that's right, and so they're lightening up
on those obstacles, which is great, but it still has
(10:47):
to be reported, and it still has to be There
is so much paperwork behind behind it.
Speaker 1 (10:54):
With more computer right generated, I guess there's still some
paper involved.
Speaker 3 (10:59):
We have to print, we have to print it, you
have to fill it out, we have to upload it.
We have to upload notes, we have to upload vitals.
I mean, there there is a lot. And my staff
they're wonderful.
Speaker 1 (11:09):
They do you think can we completely go paperless? What
do you think we are?
Speaker 3 (11:13):
You're never going to go paperless because it requires a
piece of paper to be filled out by.
Speaker 1 (11:18):
Hand, but completely electronic. Do you think it's you think
we'll ever get there?
Speaker 2 (11:22):
I'm sure.
Speaker 3 (11:23):
I mean, the world is advancing every day, so why
wouldn't it. It may not be in our lifetime, but maybe,
but maybe our granddaughter's lifetime.
Speaker 1 (11:29):
When your system goes down, that's that's gridlot.
Speaker 2 (11:34):
Well, you didn't say if the system goes on, we
have to.
Speaker 1 (11:36):
Go paperless, but that is the concern. If your computer
system goes down, that's gridlot. I mean, you can't do
anything with that paper.
Speaker 2 (11:45):
So you have a hand, you have a piece.
Speaker 1 (11:47):
Of I think there'll always be paper around and maybe
maybe five percent of it is paper. It's man, I
would need some security, some known backup system.
Speaker 2 (12:00):
That's you want to pop a Rozzi too.
Speaker 1 (12:03):
Well, no, I'm just saying. I mean when your computerism
goes down, oh my god, it's terrible. I mean, it's
such a huge issue in terms of getting your work
done that it can be a major setback. And I
think the computer system does help with compliance because that
these insurance companies want information basically, but they want data
right so they can plug in their numbers and their
(12:24):
computer models and sort of spit out some things, whether
or not that doctor Levine's doing a good job, whether
not the patient's doing a good job. And one thing
I've seen is the healthcare industry, the insurance companies are
investing heavily in that. One thing I've seen them do
is send out these nurse practitioners, physicians assistants to the house. Right,
(12:46):
have you seen this?
Speaker 2 (12:47):
Absolutely?
Speaker 1 (12:48):
What do you think about that?
Speaker 3 (12:51):
I think that's great as long as the nurse practitioner
that does go to that home communicates with the primary
to say, hey, I went to your patient's house today,
I saw your patient on your behalf and this.
Speaker 2 (13:04):
Is what I did.
Speaker 3 (13:06):
There's a huge disconnect in that, so when the patients
come in to see us, they sometimes don't remember that person.
They just know that a person came into their home
and evaluated them. They don't really remember what they did.
They do remember that it was from their insurance company.
So then we're having to struggle to piece those things
(13:28):
together for the patient.
Speaker 2 (13:29):
So I would love if those.
Speaker 3 (13:33):
Providers that went into the homes to see the patients
on the insurance behalf to close gaps, right, that's what
they're doing, would just communicate that to the office rather
it's a note or call the office or something, because
there's still a disconnect with that.
Speaker 1 (13:52):
Okay, well let me stop you there. That's a big
term that you just threw out their gaps gaps, So
can you just sort of briefly explain what that means
in the insurance lingo.
Speaker 3 (14:05):
Gaps gaps or if you have diabetes and you haven't
had an A one C, that's a gap.
Speaker 1 (14:12):
If you're on insurance company has a list of recommended tests, visits,
et cetera, a hit list if you will, of yeah,
prioritized events, things that they would like to see happening
every year or every six months. Is that correct? If
(14:33):
you're deficient in those activities, they call that a gap?
Would that be okay? Acceptable? Understanding? And so the the
nps of the mid levels that are sent out to
the patient by the insurance company to help fill those gaps.
(14:56):
So reprioritize you should be doing this and this and
this and that. Now my experience is a little different
normal when the patients come back to the office, they
either have a sheet of paper most of them, or
they have a folder which has more sheets of paper
(15:16):
with some of the documentation of what happened during the visit. So, yeah,
so we do have a little bit and I agree,
I'm I'm on board with you. I like it because
it's done at their home. They have zero distractions, there's
no rush, and it's just the patient and the provider
(15:38):
talking about their health. There's the sheet, the documentation. It's
just it's really basic stuff in terms of getting an
A one C, what else? What other hit list? What
else is on the hit list? And for most insurance companies,
getting an A one C in a towently man or
what else? Going to your doctor?
Speaker 3 (16:02):
So vaccine, you want to answer to answer, I mean
you're doing a good job over there. I'm not asleep.
I have my coffee.
Speaker 1 (16:14):
I was just helping you out.
Speaker 2 (16:16):
Thank you for that. I appreciate it.
Speaker 3 (16:20):
A couple of things, probably the most. The largest thing
that is a huge obstacle is met compliance. Medication insurance
companies want you to pick up your medication on time,
take it as directed, and pick up your refills.
Speaker 1 (16:40):
All right, let's let's let's stop there. We've talked about
this before in this show. Just just give me two
obstacles that I just gave you impact a patient's compliance
as it pertains to medications.
Speaker 3 (16:56):
So let's just say they pick up their medications.
Speaker 2 (17:00):
And a big thing is.
Speaker 3 (17:03):
They pick up their medications, they take it home, they
forget to take it, so then they have more than
what they're supposed to have. So that would fall into
a non compliant patient. If they take it twice a
day and they took it once, if they take it
three times a day and they took it once, if
they forgot to take it, if they forgot to take
(17:24):
the dose, if they took their dose right, but they forgot,
if they took it so they took another dose, that
would mean that it's too early to fill the medicine.
So I love pill counters for patients. Have someone come
put your doses in a pill counter, know exactly, make
a list of when you're supposed to take it, what
time you're supposed to take it, and why you're taking work.
Speaker 1 (17:48):
Can I just be normal again?
Speaker 2 (17:51):
What's normal to find? Normally?
Speaker 1 (17:52):
I don't have to take these meds? Doctor? Can I
get off these meds? I take so many? I just
this is too much?
Speaker 2 (18:00):
Are you talking to me? Is if I'm your doctor?
Speaker 4 (18:02):
No?
Speaker 1 (18:02):
This is what I hear every day. Well, then you
just it's cumbersome. It's hard. I mean, they got ten
thousand other responsibilities and it's difficult to keep up with medicines,
especially if you're taking five or six. And what one
complaint I hear all the time is they yes, they
have four or five medicines. Well, two of them they
(18:24):
get every thirty days, and then two of them they
might get every ninety days, and then one of them
is a special medicine have to come into office every
month to get urine and get a special prescription. And
I mean it gets real complicated, real fast, and it's
not automatic, and they're just obstacles to that, you know.
(18:44):
I think talking with patients, I guess what I hear
is that if it could be easier for them to do,
I think they would be more compliant with the medication.
And I think certainly that's a system issue because it's
not just the patient involved. You know, it's us, the
doctor and the doctor's office, and then it's the insurance
(19:06):
company and it's a pharmacy, right, those are the three
big players.
Speaker 3 (19:10):
So I have a suggestion, so patients that are on
multiple meds that don't understand the importance of med compliance
could always have home health come and do medication evaluation
and management to where they put all of their medications
(19:31):
in a pill planner. They write out why they take them,
the importance of them taking them, and what happens if
they miss them. That can happen for the patient. Usually
that's paid for, especially if you have Medicare and a
secondary insurance. They come into the home and they do
medication management for the patient. And that way, that's a
(19:54):
nurse or a medical assistant that's in the home that
will help the patient understand because all the pills are blue,
all the pills are yellow, all the pills are white,
but they will explain to them what this pill is
for and why they take it.
Speaker 1 (20:10):
I honestly, I honestly feel like the computer industry and
modern technologies that pertains electronic world could help out significantly
with that. Just like we have the Internet, information free
to the American public, you just have to type a
few numbers and boom you have. I think certainly software
(20:30):
programs can help patients get that done. And that's the thing.
Getting plugged into the grid the system. I think it
can make that easier. But it's risky, right putting all
your information out there, getting plugged into the grid. You
have to be careful with that. But it's complicated, and
(20:52):
I think that improving the system. What I mean by
is that doctor Levine is in line with the pharmacy choices,
in line with them. The insurance company is paying for it,
and everybody's talking to everybody, and that's what improve the system.
But we're all sort of on different systems. We have
a different EMR, the pharmacy has a different EMR, and
(21:15):
then the healthcare insurance company has different EMR. We're not
even talking to each other. So just that alone generates
a whole lot of potential complications or obstacles for patients
to be compliant. So yes, they have to do their part,
and we have to do our part. I mean a
lot of times we don't even know if the medicine
(21:38):
net we're prescribing is going to be paid for. That's
another big thing, right, Yeah, they go to dark Levine
for their high pertension. I give them the best drug
I think is going to work for them. They take
it to the pharmacy down the street. Oops, they don't
pay for it.
Speaker 3 (21:52):
Well, no, so what happens there? Let's just say that happens.
Then we have to do a authorization to say, okay,
the patient has tried one, two, three medicines.
Speaker 1 (22:02):
How long does that take?
Speaker 2 (22:03):
About seventy two hours?
Speaker 1 (22:06):
But that's three days. Well they're non compliant. Well is
that their fault?
Speaker 3 (22:11):
So what they could do is they could keep taking
their old medicine just to stay covered out.
Speaker 1 (22:17):
That's why they came to the doctor's.
Speaker 2 (22:18):
Well, then we'll see if we have docor.
Speaker 1 (22:20):
Levine's office and you gaining this prescription. It's ninety to
pro authorization. I call your office and I hadn't heard
from anybody. It's been three days.
Speaker 3 (22:31):
Well that you know, they may not have heard of
from anybody in the past, but they will hear from
somebody in the future because we have a really good
person at our office who is on top of authorization,
so it will get done.
Speaker 2 (22:42):
Are you trying to go on break over there?
Speaker 1 (22:44):
We need to take a break. Phone lines are open
eight nine six kalvy. I won one hundred three three zero.
Speaker 4 (22:49):
Kay.
Speaker 1 (22:49):
Hey, I'll be back in two minutes. All right, Welcome
back to Doctavi Medical. Our phone line to open eight
nine six kV I want one hundred three three zero
kov I. I'm here this morning with Missus Levine. She's
(23:10):
the administrator general at our office, Golden Triangle Troma Medicine
Geriatrics here in Beaumont, Texas, cross street from Baptist Hospital.
Been there for that location for about five years, just
right before the pandemic hit. But we've been in a
business for over fifteen years here in my hometown of
(23:31):
bau My, Texas. Proud to be here, and I'm proud
that she's here. Very talented female, just an incredible mind,
and she's able to navigate through all of the issues
that come up running a modern medical office day. And
she wanted to share some of the information because she
hadn't been here a long time. She was just congested
(23:52):
with information. Well now I just had to get it out.
And you can tell just from my conversation. I mean,
we could here all day just talking about all the
issues that come up every single day, not just in
our office, in any office. Go to the hospital. It's
fourfold in terms of the complexity of just taking care
(24:15):
of one patient, let alone three hundred patients, six hundred
patients in modern hospitals. I mean, it is amazing how
the system for the most part works on a daily basis.
But we have these hiccups, and that's what we're talking
about as it pertains to compliance. We have Michael from Pasadena,
what's going on.
Speaker 4 (24:35):
Well, good morning. A quick question for missus Leline. I
wondered if how the compliance effects if Medicare has the
same type of compliance requirements.
Speaker 1 (24:51):
Compliance for the patient or the doctor or what.
Speaker 3 (24:54):
No, no, no, He's just asking if Medicare has this same compliance.
So honestly, what I am talking about is all Medicare patients,
rather you're on traditional Medicare or you're on an HMO,
So this are the this is the gold standard expectations
for all Medicare patients.
Speaker 4 (25:17):
Okay, I wasn't sure I understand. Well, thanks, thank you both,
and a very good subject. And I appreciate everything you do.
Speaker 1 (25:32):
All right, Michael, appreciate that phone call. And I think
that some HMOs and some Medicare policies are more aggressive than.
Speaker 3 (25:43):
Others, are way more aggressive than just traditional Medicare.
Speaker 1 (25:48):
Okay, right, and aggressive would be yes. They're sending out
nurse practitioners. They're asking us to fill out paperwork and
mounds and yeah, and provide certain types of targeted documentation
in the chart when we see the patient. We were
discussing doing the break about one or two of the
(26:10):
insurances that we work with requiring the doctor's office to
have documentation that we know they're in the hospital and
that we know when they get discharged, so when they
get admitted. They want us to document in the chart
we know they're admitted, and.
Speaker 3 (26:25):
We have seventy two hours that we have seventy it's timed, yes,
so a lot of times if a patient goes to
an emergency room that doctor Levine is not affiliated with,
we never get that information, so we don't know. So
that's a measure that we fail. That's not our fault,
but they make it our fault because you are the
(26:47):
primary you're the gatekeeper.
Speaker 1 (26:49):
Okay, let me stop you there, So fault do we
get penalized?
Speaker 2 (26:54):
We can't.
Speaker 1 (26:55):
How do we get penalized or how did they correct that?
Or what's there were to the doctor for me? Documenting that?
Speaker 3 (27:04):
For me, I just try I call the patient and
just say, you know, please let us know.
Speaker 2 (27:10):
Wherever you are that you are in the hospital.
Speaker 3 (27:14):
Because patients have the freedom to go wherever they want,
we can't control that.
Speaker 2 (27:18):
That's their choice.
Speaker 3 (27:20):
But just let us know, communicate that with us, because
all we'd have to do is get onto a portal
and report it. We have seventy two hours, and we
don't get penalized if we felt that measure. But if
you felt a lot of measures at let's just say
you have thirty patients a year that do that, it's
going to bring your star score down. And star scores
(27:42):
are on the Medicare website, which your five star by
the way, and you're also five star on quality.
Speaker 2 (27:47):
Yes, I take that very serious.
Speaker 1 (27:49):
That is my job, right and even know it.
Speaker 3 (27:51):
Yes, you don't need to know it. You just need
to be a good doctor. Go see your patients.
Speaker 1 (27:55):
I know I'm trying.
Speaker 2 (27:57):
I do the rest.
Speaker 1 (27:58):
Even that's hard sometimes, but you try hard every day, of.
Speaker 2 (28:02):
Course, yeah, you give it your best. What else can
you do?
Speaker 1 (28:05):
You keep trying, wake up every day and keep doing
your best to be as good as you can. But
these star ratings, so if doctor Levine does not do that,
the star rating goes down. Now is reimbursement connected to that,
because that's publicly known that.
Speaker 3 (28:21):
You get the same reimbursement no matter what. Okay, wouldn't
that be nice?
Speaker 1 (28:25):
So what's the okay, So what's the incentive for a
doctor's office just to get the star rating?
Speaker 2 (28:31):
You want the star rating?
Speaker 3 (28:32):
Because I would hope that everybody would look at that
and investigate that before you choose a new primary right,
because you want someone that's going to give you gold
standard of care most likely what I've heard, and this
is just a speculation that in the future, if you're
(28:55):
a one star, two star, whatever, they can pull that
patient a graphic load from that pain from that physician
and give it to someone who is, yeah, going to
do a five star.
Speaker 1 (29:07):
And that makes sense, right, I mean, that makes sense.
Speaker 2 (29:10):
Well, let me just tell you, I get it.
Speaker 3 (29:12):
Well, if you have a two star, that means that
you're really not doing what the insurance company wants you
to do. You may be doing what you want to
do for your patient, but you may not be doing
what the insurance company wants you to do.
Speaker 1 (29:26):
Play the game, right, right.
Speaker 2 (29:30):
I guess, Yeah, that's what you want to call it.
Speaker 1 (29:32):
That's correct. I mean I think that's frustrating for physicians
and healthcare providers is when you're in medical education, none
of this stuff really comes up that often. Star ratings
and paperwork and all these things that you're talking about.
Speaker 3 (29:49):
Are you talking about when you're in medical school. When
you're in residency, Oh, you're trying to learn about cells
and yeah, you know.
Speaker 1 (29:55):
Tissue, that's right, right, disease. You get out in the
world and all of a sudden you have representatives for
the insurance companies showing up at your office saying we
want you to do this, this, and this, What is this?
I've never heard of this? And how does that affect
patient care? I mean, why am I doing that? I
wasn't taught that.
Speaker 3 (30:15):
So and you get you get pretty fired up in
those meetings, and I have to kind of come in
and sit down and be.
Speaker 1 (30:20):
Like, well, because I think providers, it's a foreign topic
to providers. It's it's added responsibility, added stress on top
of what you're already trying to accomplish. It is the
paperwork of healthcare, which is not our computer work of healthcare,
which is not going anywhere, by the way, and.
Speaker 2 (30:38):
You're pretty good at computers.
Speaker 3 (30:39):
I have to say, you are the fastest typer I've
ever seen.
Speaker 1 (30:43):
Well, I tried to, but all I'm saying is from
my stamp on as provider, I know that if I
want to be viable as a practitioner, if I want
to be successful as a practitioner, I need to learn
how to work with these insurance companies because they are
hanging the bill. I need to figure out what it
is they need for their patient, and then combine that
(31:06):
with what the medical world is telling me to do
for the patient.
Speaker 2 (31:10):
It's their member, member, your patient, it's their member.
Speaker 1 (31:13):
Sorry, And that's really her struggle. A lot of times
is patient might walk in with ten complaints and as
the physician, you want to address that that day. You
know you have limited time. But then you have the
sheet of paper sitting in front of you where the
insurance comes ask you to do this, and you just
run out of time. You don't have time to do
(31:35):
it every single day. And just like with being informed
that a patient or a member has been admitted to
the hospital, they've been discharged hospital.
Speaker 2 (31:43):
Or even if they go to the emergency right.
Speaker 1 (31:45):
Yeah, that requires the involvement of some other players that
are not necessarily involved with their office. That has to happen.
So again, so.
Speaker 3 (31:55):
That's when you that's when you communicate with the hospitals
and you say, if any of us our patients show
up and they're not admitted, they come to the er,
they get to go home from the er. Yeah, send
us over a fax just stating that.
Speaker 1 (32:12):
And at the end of the day, I kind of
get it, you know, because several years ago before you know,
we send our patients to consultants cardiology, lung doctor, kidney doctor. Right,
And at one time they didn't really send us any
of their information. They would go out to these doctors,
all this stuff would happen, and they would come back
a year later. They went around the world, Well how
(32:34):
are you doing. Yeah, I've been here and here and
here and here and here, and we absolutely have zero
information in the chart. But then I think the insurance
companies started requiring consultants. Hey, you need to send this
information to the premier so they can be educated and
they can be involved with their healthcare delivery. Sort of
the same concept. You're going to the hospital, you're going
(32:57):
to the r Hey, then your primary needs to know
about that, maybe give a primary diagnosis, maybe meds that
will change. All that stuff is critical information. So I
get it. We're trying to link everything.
Speaker 3 (33:09):
Well, I have to say, we do get a lot
of consolet notes from.
Speaker 1 (33:15):
They're very helpful.
Speaker 2 (33:16):
We do get a lot.
Speaker 1 (33:18):
I love them because the patients come to the office
or how you've been doing. And that's one thing that
I've added to my cadence. You know, if you're a
patient of mine, you know every time you see me,
I'm going to ask you about the same basic four
or five questions.
Speaker 2 (33:33):
What did you eat today?
Speaker 1 (33:34):
Yes, that's one of my sweating if you're a patient mind,
you know I do that. What are you drinking? All right,
it's just a cadence, right, it's just some you know,
you go get your oil changed and your car. You
want your basic things done, and I sort of get
that and I try to do that, right. And so
(33:55):
one question that I've added to my cadence is well
have you been to the er? And who else are
you seeing as a doctor? Right, because a lot can
happen and then they will say, well, I went here,
but I don't know what happened. I go to their console,
don't boom, I got it. Yeah, and it's just information.
Phone lines are open eight nine six kcalvy. I won
(34:16):
one hundred three three zero kova. I'll be back in
two minutes. All right, welcome back to Doca, vinmnic our.
Phone lines to open eight not one six kalv I
one in one hundred three three zero ko v I
talking about the kaleidoscope of health care delivery in the
administrative side. All you guys remember kaleidoscope that used to
(34:38):
be a little art show here, But I wonder if
they still have that Kaleidoscope anyway. I used to go
to it every year here in Beaumont, Texas. It was fun.
I remember had good times with that. But talking with
Missus Levine about just issues that come up on the
admin side, these are things that are happening to all
(34:59):
healthcare offices hospitals, just trying to get better and trying
to get that system as operational as possible in terms
of delivery of healthcare, patience, safety, all these things. We're
talking primarily about compliance and in terms of what the
insurance company is trying to get everybody on board with,
(35:21):
and they're heavily invested in that because why, it really
keeps your disease at bay and it really does cut
down being in the hospital. Hospital care is very expensive
and it can be harmful being in the hospital. A
lot of people don't think of it that way. But
your body is under stress. You have needles going through you,
(35:45):
you got tubes going through you, you're getting blood, you're
getting very strong medications.
Speaker 2 (35:52):
Other people, MM, I don't think of my mind.
Speaker 1 (35:56):
There you go. You're talking so much, you broke the mic.
I mean so much energy is going through the mic.
You broke it, let me see. Yeah, there you're there,
go ahead.
Speaker 3 (36:09):
So I wanted to also tell the general public, if
you're not a patient patient of ours, we have a
Facebook page that we have started putting a ton of
educational information on this year to educate the community, because
it doesn't matter if you're our patient or not. So
if you do have Facebook, I want you to look
up doctor Mussanthi B Levine and just read what we
(36:34):
do post, because we do post a lot of things
that I think would help the general public learn, learn terms,
learn differences and diseases, learn compliance, learn what the insurance
companies want from us, and I post those and so
a lot of people have commented. When I'm out in
(36:55):
the grocery store at a restaurant, they will walk up
to me and say, you know, we really appreciate that
we read what was posted today on doctor Levine's Facebook,
and we've really enjoyed it. So of course that makes
me feel good because I want to educate the community
so that they can be the best that they can
be health wise, you know, just because I'm I'm on
(37:18):
the other side of it.
Speaker 1 (37:19):
So yeah, again, just like me, I'm just trying to
deliver medical knowledge, just to try and help patients understand
the complexity of their health. And then you're on the
admin's side, just trying to help patient understand the paperwork
admin side of healthcare, which is very complex as well.
We have our battles every day that we have to
(37:40):
fight as it pertains to that, and yes, we're just
trying to share that information and give you some insight
into that. There have been a few patients that have
come to the office talking about the website, so it
sounds like you guys are doing a phenomenal job delivering
that information and just bringing it down to a level
where an average person can understanding, because that's one problem
(38:02):
with sometimes health care delivery is that the terms are
too complex and the processes are too complex, and so
a lot of patients just sort of churn it off
and they never engage, and unfortunately it's have their demise
because normally that means just like you say, don't take
their meds and.
Speaker 3 (38:19):
And there's a there's a there's a helpful hint, and
there's some recommendations on the website is med compliance and
how you can do your part as a patient. So
instead of me sitting here talking about it because we
only have an hour. They can go to our website
and actually read about it, and there's some really cool
hints that we've given you our suggestions to try to
(38:41):
help you.
Speaker 2 (38:41):
Keep up with it.
Speaker 1 (38:42):
Because I'll I'll say this from my own experience, it's
kind of hard to be compliant. I'm just going to
say that it's kind of hard.
Speaker 3 (38:52):
Once every three months, go to your doctor's office. Okay,
pick your meds up on time and take them as
direct and prove, complain report.
Speaker 2 (38:59):
To your doctor's If you went to.
Speaker 1 (39:01):
The emergency and you have to sit at your doctor's
off for three hours. Hey, that's a lot of time.
You know. I don't. I gotta work, you know, I
got kids to pick up. I'm just saying we're going
on last break and we'll finish up and wrap up
those ideas. Phone lines open A nine to six scalva
I one one hundred and three three zero O kyov.
I'll be back in two minutes. All right, welcome back
(39:22):
to Doctor Menic. Our phone lines are open and closed.
At the end of the show, Missus Levigne, any closing thoughts.
Speaker 3 (39:30):
So one thing I did want to say before we
closed is if you do have chronic kidney disease, insurances
believe it or not want you seen once a month
at your primary.
Speaker 1 (39:42):
Which I'll be I'll be honest about that. I think
that it should still be left up to the physician
of the patient how frequent they need to come in.
These are just suggestions and recommendations by the insurance company.
They are our partner in terms of healthcare delivery, and
they're just making their recommendation. I feel like it's a
(40:05):
waste of time. If I have a person with KD
chronic kin disease, and their blood pressure is normal, their
labs are normal, they have no complaints, all their risk
factors are being successfully managed. They're on what we call
goal directed therapy.
Speaker 2 (40:22):
What's their stage?
Speaker 1 (40:24):
Back once a month.
Speaker 2 (40:26):
What's the stage of kidney disease?
Speaker 1 (40:28):
It doesn't matter what the stage is. You can have
stable KD chronic kin disease four five three two one,
it doesn't matter. All I'm saying is I know they're
trying to be helpful.
Speaker 2 (40:40):
They just don't want their patient to end up on dialysis.
Speaker 1 (40:42):
Yeah, I got that they're trying to be helpful, But
I don't think it's a mandatory, mandatory, it's sugg always
up to the clinician and the patient. It's a partnership
the patient, the clinician, and the insurance company all trying
to improve patient care. And I think yes, CKD certainly
(41:05):
factors in a lot of different diseases, because if your
kidneys are hurt, it means your system is probably also
hurting as well, and you're someone that needs to be
monitored more closely. I think a month is too frequent.
If I have a person they're doing well, No, I'm
not doing a month. I mean I don't want to
waste my time in their time. I saw them last month.
(41:26):
We didn't change anything. They have no new complaints. And again,
this is cumbersome to go to doctor's office. Is one
thing that this a it can do to improve compliance.
How can we make the doctor's office visit more efficient,
less time can How can we do that? I mean
that would certainly improve compliance. How can we make the
system of getting the medication to the patient on a
(41:49):
regular basis? What all this hassle that they go through
in terms of interacting with the pharmacy. Then they got
to call us back and interact with us and then
they got to call the insurance company about the pharmacy,
about doctor.
Speaker 2 (42:08):
Happens.
Speaker 1 (42:09):
It's can generate so much chaos. And I hear this
that you hear it every day, right, which is why.
Speaker 3 (42:14):
You hear Another big thing is male orders do lose
the male order, so then that makes the patient non compliant.
Speaker 2 (42:22):
That's not their fault.
Speaker 1 (42:24):
So we don't want to make it seem like it's
the patient's fault. No, absolutely, Yeah, we're just saying that
that's a big area of concern for the insurance company
and it's something that all doctors are trying to improve.
We want you to understand that as well. We all
need to do our parts and generate a better system.
(42:45):
And I think that will help out everything. But certainly
I believe in it. I think it's going to help anything.
Speaker 3 (42:50):
We are patient advocates, not insurance advocates.
Speaker 1 (42:54):
Is that on our website. I can add it anyway,
have a good weekend.
Speaker 2 (43:00):
Her for weekends, eat your vegetables, drink your water.
Speaker 1 (43:04):
Thank you.
Speaker 2 (43:04):
Yeah, I listen to you every Saturday morning.
Speaker 1 (43:06):
Bye mm hmm.
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