Problems Magnified in Private Practices
These concerns are magnified in private practices. Fewer dollars may be available to cover differences in productivity. Community doctors may have to
consider travel time if the practices are not in the same group or are in different office buildings.
Reimbursement has not been an issue so far. Private and government payers allow both physicians to bill at regular rates. All three experts stressed that making sure the patient knows they are still responsible for two bills and two co-payments can reduce misunderstandings.
Division of Labor & Costs
Housing the clinic is another issue. Some may decide to set up the clinic in areas already used by one of the practices. Many use the dermatologist’s examination rooms because they have the tools needed for biopsies. Others may use rheumatology offices, with the dermatologist bringing what they need with them.
Other things to think about include compatibility of electronic health records systems. Addressing the division of labor, such as which practice does the scheduling, keeps all doctors on the same page. Will each physician provide their own assistants, or will support staff responsibilities fall on the home practice? Will overhead and other “soft” costs be apportioned?
“Another concern of community providers is that some physicians may be hesitant to refer to us because [they believe] we will keep their patients,” says Dr. Siegel. “We are very careful to send [patients] back as soon as possible to lessen these worries.”
Most dual clinics are started organically, by dermatologists with an interest in rheumatologic issues and rheumatologists curious about skin manifestations in their patients. This interaction at the individual level can be the catalyst behind the combination. More rarely, the practice administration starts the process.
In Sum
“Two kinds of physicians actually seeing the patient at the same time and discussing issues in real time brings tremendous benefit to the patient,” says Dr. Siegel. “We can think about their disease process from different perspectives and get a treatment plan taking all these perspectives into account.”
Kurt Ullman has been a freelance writer for more than 30 years and a contributing writer to The Rheumatologist for more than 10 years.
PPACMAN
The Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network Consortium (PPACMAN) was founded to study and facilitate the formation of multidisciplinary clinics.
“PPACMAN was developed with a mission to ‘nucleate psoriatic disease combined clinics and centers to advance a multi-level approach to psoriatic patients, increase disease awareness and accelerate management,’” says Joseph Merola, MD, the organization’s president. “Despite the fact that collaborative care is widely recognized as valuable, little is known about the logistical challenges, detailed benefits and impact on patient outcomes. We also believe these clinics serve as a crucial interface for collaborative research into psoriatic disease.”
