Welcome to On-Call. The first rule of On-Call: you do not talk about On-Call. In fact, we should pre-emptively issue a trigger warning: If currently On-Call, STOP reading. Consumption of vital information that follows MAY result in disruption to an otherwise peaceful weekend.
Now that we’ve gotten that out of the way, let’s talk about on-call and triaging.
I first learned how to triage ocular emergencies in school and in residency, but when I started working for a group private practice where the providers rotated on-call services, I realized a fundamental truth: I actually sucked at triaging and being on-call. But I also realized another truth: that triaging was a skill that I COULD get better at.
And boy, did I need to because, in the months that have followed, my patients, the practice, and my work-life balance have vastly improved.
In this article, I give my five golden rules for handling on-call emergency services.
Rule #1: Bill for your time.
This is the golden rule of on-call. When this rule is intact, everything else falls into place.
Why? When you bill for your on-call time as a telehealth service, it not only opens the door to additional practice revenue (albeit minimal) but also indicates to the patients who call for advice, the ODs that provide the service, and insurance companies that you bill that your time is valuable.
We didn’t initially charge patients for triage calls after hours, but when we did start billing for our time, I personally started giving more attention and consideration to on-call services. Additionally, the “I’ve had this problem since Wednesday, but I didn’t want to take off work” and “Well, I need my glasses to see, so the status of my glasses order is an emergency” calls have depleted.
Using telehealth guidelines to determine fees
At our practice, we use the general telehealth guidelines with average fees for service listed below. For any after-hour service that requires an office visit, a $50 self-pay fee is assigned.
It’s important to consider having an Advance Beneficiary Notice (ABN), which is a document given to the patient acknowledging their financial responsibility for non-covered services should they be denied by insurance. When seeing a patient after hours, we scan their license and medical cards and have them fill out an ABN.
Telehealth billing:
- Procedure code 99441 ($46): 5 to 10 minutes
- Procedure code 99442 ($76): 11 to 20 minutes
- Procedure code 99443 ($110): 21 to 30 minutes
Services after hours:
- Procedure code 99050
It’s standard practice in many industries to track “billable hours.'' It’s important to acknowledge that healthcare is transforming in a similar way to meet the demands of a digital world in which immediate access to healthcare providers is becoming an increasing expectation.
In speaking with my fellow practitioners about this topic, we discussed this as a “concierge service.” I asked, “What is the cost of peace of mind?” One practitioner shared they pay $1,200/year for access to their child’s pediatrician, while another stated $1,000 for a primary care family practice.
Still not convinced? Even Johns Hopkins is putting their foot down and setting a new standard for billable clinician time in 2023.
Rule #2: Prepare yourself to see patients who are scared or in pain.
It seems obvious enough, but I’ve made it a standardized rule because it’s backfired on me.
I now always see patients in pain. I do believe that 90% of the diagnosis IS in the history, but I’ve also experienced that the extra 10% of the information you get when you go into the office will ultimately save you more time in pharmacy calls and trying to convince a patient in any level of pain that you have the right treatment plan.
I’ve mentally committed myself to seeing any patient in pain, and whether or not they want to take me up on the offer is up to them. I’ve also prepared myself to offer visits to any patient who is downright scared. Why? Because a scared patient can easily turn their frustrations out on you.
On a previous call week, the past doc never transferred the call to me. The diagnosis? A posterior vitreous detachment (PVD) that left the patient scared and spiraling. When I called the next day, I didn’t make any excuses—I simply sat there and let my patient vent their frustration.
Some patients who are scared just need to hear that things will be okay. It’s important to recognize that on-call services exist for them, too.
Rule #3: Don’t give out your number.
This may be the number one mistake that new practitioners make. Your personal number isn’t one that can be changed. Alternative options are to use a telehealth app that converts your number or a Google number that you can give to patients as a perfect cost-friendly alternative.
Rule #4: Consider your company.
I feel it would be remiss not to address the gendered changes in our profession. Approximately 75% of all optometrists are women, and 25% are male. The average age is 44 years old.
As a female, I feel much more comfortable seeing patients before dark and in the company of other friends or family members.
Rule #5: Plan for a light weekend.
As a new optometrist, sometimes being on-call can be mentally and socially draining. You never know what will happen when you’re on call, so it’s important to plan a light schedule and maybe even consider it your “self-care” weekend.
Being on-call doesn’t need to hold you back. During my weeks and weekends, I’ve managed to enjoy baseball games and barbecuing with friends with the awareness and self-control that when the phone rings, the patients come first.
Conclusion
For a topic that’s so rarely talked about (no doubt for the superstitious phenomena that it is), it’s not always straightforward. Being on-call and triaging is certainly a skill that requires finesse—not only in clinical but personal skills as well.
With these five tips, you’ll be well on your way to handling any call with the professionalism that sets the practice and optometric profession apart.
