Defining Expectations

Lesson 2 of 5

Just like any new staff member, it is critical to ensure that the right specialist is chosen for your organization. It’s important to know what your expectations of the specialist are, and what specialists expectations of you are. The following questions may help you clarify these roles before signing a contract

Staff Interview

#1: What is the expected time frame that specialists will require for new and follow-up patients?

Time frames vary for each specialty and specialist. Most specialists require 40 minutes with new patients and 20 minutes for follow-up. This is crucial to know if your billing model is to pay by the hour. You will want to structure your patient scheduling strategy to ensure you can accommodate the maximum number of patients in the time allotted.

#2: Does the specialist expect a presenter in the room with the patient, and if so, at what level, and for how much time?

Some specialists will have a preference and may not be willing to let you determine who presents the patient. Some specialties, like Behavioral Health, don’t require a provider in the room during the consult. Agree in advance how much time the specialist will require staff to be in the room. This is important to know for staffing, scheduling, billing and budgeting purposes. For example, if your organization is billing on behalf of the specialist, you can only submit one bill per patient, per day (with the exception of a medical visit and behavioral health visit on the same day). You will not be able to submit one bill for the PCP’s time and another for the specialist’s time. In this case, the specialty service provider that doesn’t require a PCP to be present during the consult would be economically preferable.

#3: What is the onboarding process for new clinics?

Specialty service provider groups may provide some, if not all, of the following: training on patient presentation techniques, referral process, equipment usage, as well as video meet and greet sessions with the specialists and referring providers. Some, or all of these, may be of no cost to you, while others may come with a small charge.

#4: Will you be able to utilize the same specialist that has already seen the patient, or does it depend on availability?

Maintaining your relationship with the same specialist helps you feel confident of what to expect and also assures continuity of care as it pertains to diagnosis and medication prescribing. Making sure the patient has formed a relationship and is comfortable with the same specialist is crucial for trust and compliance with treatment recommendations.

#5: What is the policy on patient no-shows or cancellations?

Each specialist may have a different no-show policy. It’s important to know upfront if you are able to cancel or reschedule patients, and any resulting financial implications. If you are paying the specialist by the completed encounter, their tolerance for no-show patients will be lower than if you are paying them by the hour.  It’s also important for you to set expectations for the specialist cancelling due to other commitments (how far in advance, notification via phone/text/email, etc).

#6: Is the referring site allowed or expected to overbook patients?

Knowing there are often no-shows with patient appointments, most specialists will allow and/or expect you to overbook patients. It’s important to establish what you mutually agree will work and will not disrupt the practice and the telehealth clinic. You should also discuss how payment is structured. Some specialists that charge by the hour, may charge you for the full hour regardless if you have patients no-show, and some may allow you to have the primary care provider step in and get a second opinion on other patient cases.

#7: Does the specialist provide direct patient care or offer consultation only?

Direct patient care implies the specialty provider will make a diagnosis and treatment plan and will prescribe medication independent from the primary care provider. With the consultation only model, the specialist will send treatment recommendations to the primary care provider, who will be responsible for prescribing medication. This is important to know and discuss with your primary care providers prior to signing a contract.  Will they feel comfortable prescribing for a patient after only reviewing the specialists notes and recommendations? If not, the direct patient care model would probably work best for your organization.

#8: How are medication refills handled?

It’s important to discuss who will be responsible and how will prior authorizations be handled. For example, if the provider operates in your EHR and is using e-script, you will want someone to handle theses refill requests and prior authorizations just as you would for any of your providers in-person.

#9: Will the specialty group provide a bio of the specialist?

It’s very reassuring to you and your patients to see the level of education, training, and the affiliations/board certification of the specialist before the first meeting.