Report from Calif.

My parter and I just finished our first week in our new practice after
a very long wait for the week to finally come. 

We are in a somewhat different situtation than some practices that are
starting from scratch - perhaps it's more of a "downsizing" problem.
We were in a 4 doctor group which I have been in since 1989. Two of
the partners built a new building and left us in our old office.  We
are now renting 1/2 of the office from the hospital that owns it. The
two partners that left have very large patient volumes, which is one
of the things that gradually contributed to the split up. Our goals
and our ideal practice ideas just became too different.

Our staff has suddenly gone from 13 down to 4 besides ourselves. My
wife and sister in law comprise two of the 4. The office, which
formerly seemed very cramped and claustrophobic, now seems much
larger, in fact almost like an empty warehouse. Some patients who've
come in say it seems "dead" when they walk in compared to before. But
most seem to like it. That seemed funny to me, because it was a very
hectic time for me, in spite of the tranquil appearance of the office
from the patient perspective. 

Our first week went fairly well. I kept the equipment in 2 exam rooms
but my partner told the partners that left to just take everything.
They are paying him off for the things they took, and he is getting
some new equipment and supplies.

I had been doing my own billing for private insurance carriers for the
past 7 months with our home-made Tkfp EMR/Billing app. But now I am
also billing Medicare, which was formerly still being done by the old
practice with Medical Manager. The claims are going in, but we have
not gotten a payement check yet on a Medicare patient. We are now
sending in my partners claims along with mine, so the volume of
billing work has gone up for our new system, but we have had the 7
months of trying it on my patients to work out most of the bugs. 

My practice had already been downsized to a Moore size some time ago,
but my partner still has a much larger patient load. He is having some
trouble getting his notes done and spent the weekend catching up. He
is used to using a transcriptionist, but is now entering them into the
computer himself using templates plus free text typing. Our set up
takes the ICD9 code that goes on all our notes, then you generate the
claim yourself, hopefully at the same time the note is saved. This
assumes all the patient's insurance info. is accurately entered. We
depend on the staff to do that, along with collecting any copay due.

But generating the claim takes very little time and integrates well
with doing the progress notes, since you are thinking about diagnoses
etc. at that time, and the physician is the best person to do that
job, I think.  I think my partner will have to decrease his patient
load some more in order to get the notes done and generate his own
claims. He is use to seeing about 20 to even as much as 30 patients a
day in the old practice. I think he could do his own notes and his own
claims and not overload the staff we have if he saw about maybe 15 a
day, although that only would allow about 20 min per patient. 
He was afraid that many of his patients would go with the partners
that left, so he did not want to downsize. But it appears that is not
the case and most of them are wanting to stay with him.

Alex Caldwell
Tulare, California





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