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Jim Gagne MD: Patient & Practice Information

I'm a physician certified in internal medicine, pain medicine, and addiction medicine.

The new office is up and running!

Last month (February 2014) I closed my internal medicine practice at Verdugo Internal Medicine. We've notified patients via letters and an email. My new office is up and running! Please call the office if you'd like to schedule an appointment. I'm now limiting my practice to in pain medicine and addiction medicine. I share office space with Dr. Hilary Fausett, who I regard as a superb interventional pain management specialist (i.e., she specializes in injections and other procedures to relieve pain). Our practices will remain entirely separate, except we'll share space and some office staff. Paid parking is available on the ground floor (unfortunately, there's no way to validate).

On April 1, I will see patients in ANOTHER office, sharing space with Dr. Chris Charbonnet in Glendale, right behind Glendale Adventist Medical Center. His address is 1530 Chevy Chase Drive, Suite 204, Glendale CA 91206. The office phone numbers will remain the same (see below). Thankfully, validated parking is available on the building's lot.

My internal medicine patients will need a new primary care physician. If you'd like, office manager Kris Graf at Verdugo Internal Medicine will arrange for your care. Contact Kris directly for more information: (818) 790-6225. Note that I can still see some internal medicine problems if you'd like, but my limited availability means you should have a regular primary physician in case an urgent problem arises. I will do very little hospital work.

My plans should now have settled down. Please use the secure email system to give me feedback about anything I discuss here.

Contact Me

39 Congress Street, Suite 303
Pasadena CA 91105
(818) 790-4300 (voice)
(818) 790-4301 (fax)

To schedule an appointment

The office phone is open for you to make an appointment from 9:15 AM to noon, 1:15 PM to 5:00 PM weekdays, except the office is closed on Wednesday afternoons: (818) 790-4300.

Change in Billing

While I was at Verdugo Internal Medicine, it was hard to earn enough revenue to cover my overhead and still have something left over at the end of the day. Practicing medicine for free is no fun, and it cannot continue. Part of the reason for this poor outcome is how I practice. Many of my visits with patients are quite lengthy, which I believe is necessary for the complex problems many of my patients have. But this type of visit is poorly reimbursed. Medicine rewards frequent quick visits and procedures: doing things to patients, not talking with them.

In the new practice there is no simple, affordable way for me to bill insurance directly, and many of you don't use insurance or have found it doesn't pay well anyway. So the new arrangement will be cash plus insurance. What this means is everyone will pay at the time of service, and we'll provide you with a "superbill" to send to your insurance so you get the maximum insurance reimbursement. Fees will be roughly the same as before, some slightly higher and others slightly lower. Credit cards will work fine.

Medicare patients: This will work the same way, with two exceptions. First, Medicare determines the fees you will pay, which are significantly lower than my standard charges. Second, we will automatically send statements to Medicare about your encounter, so Medicare and your secondary insurance will reimburse you for most of the cost of the visit.

Workers compensation patients: For now we'll continue to bill workers compensation for your care, same as always. Frankly, it's always required frequent calls to the insurance company to get them to pay the fees they've agreed on, and that will be difficult to do with the new arrangement. We'll see how it goes.

The Prior Authorization Hassle

For many years insurance companies required prior authorization ("prior auth") for certain expensive, brand-name drugs, especially if a cheaper generic equivalent was available. This didn't come up too often and was usually quick and painless. I did a couple of prior authorizations a month--no big deal.

In the past few months this has all changed. Almost all brand-name drugs now require prior authorization, even if there's no generic. Many generics need them too. Because it costs insurance companies money to do this, some companies have offloaded much of the time and expense to the prescriber and made it as difficult as possible to reach them. Here's how it works:

First, the pharmacist faxes me a asking for prior auth, including the patient information, insurance 800 number, and the patient's special drug ID number. These numbers are different from the ones on your insurance card. Often the information is incorrect, and I have to call the pharmacist to get that updated. Without this information I can do nothing.

Next, I call the 800 number. About half the time the pharmacist has given me the wrong phone number, and I can't get through to anyone. I have to call the pharmacy to get the correct number. Or I call the insurance company, wait on hold, and am redirected to another number. Or it's after 2 PM and they're closed.

When I do get through, I wait up to an hour on hold. Occasionally they won't take my call at all and insist I fill out a form on a web page, which takes 20 minutes. (That way they don't have to pay a clerk to enter this information.)

If an insurance clerk will speak with me, we spend a few minutes going over the same information as before. Usually the clerk can authorize the medication, but occasionally it must be reviewed by a pharmacist. They'll fax me the determination in 1-2 days. As a rule, having it reviewed means they won't cover the medication.

The bottom line is that it often takes 20-40 minutes to get a prior auth for each patient, which is much worse than before. This is as much time as I spend on a patient visit. It was tolerable when I was doing one or two prior auths a week, but recently it's one or two a day. So now you'll be charged $42 for each prior auth unless I can get it done in a few minutes. (Unfortunately, insurance won't cover this charge.)

Why Did You Close Your Internal Medicine Practice?

Purely business. Normally, when a doctor joins a medical group as a new associate, he/she builds up his practice over a few years until he's bringing in enough revenue to buy into the practice and become a partner. But with me, that never happened: just as my practice was building, the 2008 Great Recession hit. Most people under age 65 stopped going to the doctor. Many of those who did see me couldn't afford routine office fees and needed a discount. Most of my internal medicine patients have Medicare insurance, which fixes what it pays physicians to about half my usual charges.

In short, if you're trying to run an airline but your flights go out half full, with almost all discounted fares, you'll never make any money. I've been practicing internal medicine for free since 2002; my only take-home revenue came from my pain medicine and addiction medicine patients. And practicing internal medicine for free took a lot of time.

Though I love primary care and internal medicine and do a good job providing this kind of care, there are many good primary care internists. I believe my care of patients with addiction problems and chronic pain is unique.

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The information provided on drgagne.com (or jamesgagne.com, which is the same location) is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Its purpose is to present medical information to Dr. Gagne's patients and to the public at large. Also, Dr. Gagne hopes those who are looking for a physician will find drgagne.com useful to learn more about him and to help decide if they are a good fit. Its intended audience is existing and potential patients and the general public. This site is funded solely by its author and owner, Dr. Jim Gagne. It accepts no advertising or other outside funding aside from fees for purchases referred to the Amazon website. Except where other material is quoted, Dr. Gagne is the author of all the information on the site.

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Last updated Mon, Mar 24, 2014

©2011, James Gagné, MD. All rights reserved. Except where otherwise indicated, Dr. Gagne is the sole author of all content.