From: magnetdoctor@comcast

From: magnetdoctor@comcast.net
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Tue, 29 Mar 2005 21:36:05 +0000
Subject: Re: [Practiceimprovement1] Going Solo
Reply-To: Practiceimprovement1@yahoogroups.com

Wanted to share my experience. Also was motivated to Gordon Moore model by his articles, and negative experiences with being an employee for many yrs, in two different hospital financed systems. Both systems overtime demanded more and more pt visits, less staff, more hrs, to keep income stable. I felt over-whelmed an liable to make a serious mistake in medical judgement some day by being rushed.

After looking around my local community and subletting a room from an alternative clinic model (accupuncturist/naturopath), decided it was not completely feasilbe for me. Only rental space available in this growing suburb was 1050 sq feet of older building prev used by a chiropractor. Signed lease for $16/sq ft and triple net, monthly cost was 1850 just for the rent. Did minor renovations costing only about $10,000. Since I am female, this is more rural than not area, did not feel save back in exam room, with lots of empty waiting room up front. Also did not need the 3 exam rooms, so rented one out to a Speech therapist for kids for 2 d a wk, helps the overhead.

Hired a CMA from the local mega speciality, hospital owned group with 16 y exp and same desires to leave system. For over 1 yr she did it all, just the two of us. She answered phones, took co-pays, drew labs, photocopied etc. Had to pay higer salary than I expected but have felt extremely luck to have her. Initially started with Amazing Charts and their billing service at that time 6%. Had no end of problems with the biller. Loved being able to download the file immediately to the biller electronically, but the actual biller at other end, routinely would loose thousands of dollars of claims, and billed incorrectly. Fired her, went on board with Medrium. To Jon's credit his AC company by then had gotten completely new billing company and system, I hear much better, but once burned, twice shy. I now have a friend doing the billing, she had done 10 yr ago, took a brush up course. Love Medrium, joined before the startup costs. Bill $20-25,000 a month in charges, and capture 50% of what is due within 3 wk. Have 95% within 60 days, and very few denials. Despite their fee increase will stay with them, as haven't invested in another PMS and ones I looked at over a yr ago, not very user friendly. I made decision from start to no longer see Medicaid or Medicare and opted out. Only see PPO and traditional insurers, small number of local biggest plans. This means I will close to new pt more slowly, but keep more of what I earn. Had initially some philosophical problems with this, but at last job, we were only place taking new Medicaid and Medicare, and in less than a yr, that was 40% of my panel. Did not feel that was financially sustainable.

I now see anywhere from 8-19 people a day, completely open access, avg 12/d. Have a full time CMA, another parttime to call in for busy days, and the less than 1/2 time biller. My overhead is higher than I expected, and just gave myself a raise up to about $60,000 a yr. Since not at full capacity, hope to get to 90,000 someday, maybe I will or maybe not. I work 4 d, Monday -Thurs, and occ see pt on Fridays if necessary.

First 9 mo, I lived off a home equity loan on my home, now paying that off will be a priority for yrs. Last yr billed about 200,000, volume lower than currently, made more than a resident, but not alot more. Have been open now almost exactly 2 yr, happier than I have ever been in medicine before, more debt ridden also. Believe over time will reach a higher income, as the overhead for now is stable. Agree completely with Joseph that a few staff make you more efficient, but you have to decide how many and what to farm out. Realistically if you see 2 pt an hr, and charge 100 or more each, you can afford an MA. If you mostly see colds you could go higher with same number.

I did not invest in super duper EMR, but have been very happy with AC, wish labs went directly in, but currently just run a paper chart with that, consultant letters, etc, have not went over to scanning. I personally don't want to do that, and don't know how. Will likely get computer savy teen to do so for minimum wage.

I continue to mostly be a lurker on this listserve, but was unable to answer for several months, think that problem now resolved with my service provider. In the end, I believe each of our situations ends up being unique to what we what to do, can do, and that a model halfway between Moore and traditional still far better than the " see 28/d or more to make the salary we are already paying you". I know I no longer advertise, get all my pt from word of mouth, only loose people when they move or insurance goes to an HMO. I believe I give much better care, but am not yet being tracked on the pay for performance as I am too small with a pt panel of just over 1000 total, spread across many insurances.

Hope you find the right mix of staff, overhead, hrs to make it work.

Cynthia Cote, MD

Maple Valley Wa

Four Corners Family Medicine

425-413-8292