Patient Management
With all of the responsibilities a rheumatologist has in private practice, there may be a perception that patient visits are kept short to meet the demands. Actually, the opposite is true, Dr. Magnano says. “While my clinic days are busy, the best part about owning my own practice is the autonomy I have to take as long or as little time as I need to see each patient,” she explains.
“We have worked hard to design our practice and schedule to give both patients and providers time to have meaningful office visits,” Dr. Chatwell says. Return office visits are usually 15–20 minutes with physicians and 30 minutes with advanced practice practitioners. If needed, an extended visit may be offered, he adds.
The rheumatologists interviewed for this article had mixed reviews on whether telemedicine has continued to work well for them beyond the COVID-19 pandemic. Dr. Chatwell says his practice isn’t using telemedicine currently because of the inability to physically examine the patient, the complexity of multisystem diseases and the need for lab monitoring for certain medications. Dr. Magnano uses one of her four clinic days each week for a virtual clinic, done from her home office. These appointments enable her to deliver test results, establish a diagnosis after an in-person consultation and provide routine follow-up care for stable patients.
Dr. Daugherty’s office uses telemedicine because some patients have to travel long distances to get to the office. “We emphasize the need for in-office visits as well, so we can ensure optimal safe and effective care,” he adds.
Another major patient care issue is deciding who will handle prior authorizations. At the Arthritis Center of Nebraska, staff nurses, most of whom are registered nurses, handle this task. The practice tried using third-party vendors in the past, but the vendors had so many questions, it wasn’t a time-saving option, Dr. Chatwell explains. “Insurance companies and pharmacy benefit managers continue to hamper or delay our ability to care for patients,” he says.
Prior authorization is also done in-house at Pacific Rheumatology, managed by three well-trained medical assistants, Dr. Magnano says.
At times, community practice rheumatologists must refer their patients to academic centers. Geography can play a big role in this option, with Dr. Daugherty mentioning his close location to medical resources in Boston as a positive. However, a shortage of rheumatologists around the U.S., including in Boston, sometimes hinders referrals.
