It's the end of the month and quarter.
Before I get to numbers, it has been an aggravating tech couple of days. My website had been down for 3-4 days. My webmaster had the hosting switched from one server to his, and it took 3-4 days to switch and "propogate". Of course this happened as soon as I sent out an email newsletter to my patients that included links to my site that they could not get to!!! Great timing!!!!!!!!!!!
Next tech hassle is my EMR. I use soapware. I have been happy with it for 4 years, but over the past 6 months, since their frequent upgrades to become C-CHIT certified, there have been many bugs and glitches, and their tech support has been lacking. I am contemplating making a switch to another vendor if the switch itself does not become another nightmare!
My third tech hassle is that along with my website, my email is also down, now for 4 days. I am being promised it will be back up by tomorrow, but that is the same promise I have heard for the past few days.
Pearl of the day: Technology can be wonderful, but when it does not work it becomes a nightmare.
What will happen next? Hopefully not that April fools worm that might hit tomorrow!
The numbers..................
Pts seen for the 1st quarter of 2009: 590
Average $/patient for the 1st quarter of 2009 $95.53
Pts seen for the 1st quarter of 2008: 570
(if I remove leftover 2007 insurance patients from the total)
Average $/patient for the 1st quarter of 2008: $89.19
(when old(2007) insurance $ removed)
So by switching to a zero copay wellness option, with more money upfront, it seems that I have had a slightly higher patient volume and better $/patient. This may decrease if I do not continue to sign up new wellness patients each month. Of these patients, just over 1/3 are on the monthly autobank draft option that keeps monthly revenue flow coming in. About 25% of the 2009 wellness patients are new to my practice, whereas 95% of 2008 were established patients. About 15% of the new wellness plan patients were self pay in 2008. I have had a few patients switch back to selfpay, almost always the result of either a job loss, or less need for medical care. The new patients and the switch-in patients outnumber the 2008 wellness patient's who went elsewhere for their care in 2009.
The breakdown in patient visits for the first quarter 2009:
Selfpay 39%, Wellness 37%, Medicare 24%
The breakdown in patient visits for the first quarter 2008:
Selfpay 56%, Wellness 22%, Medicare 22%
So the selfpay decreased by 17%, wellness increased by 15%, medicare down 2%
Now part of the wellness relative increase is due to some 2008 patients whose old plans are still in effcet for part of 2009. January 2008 started with zero plan members and it took a few months to increase the wellness patient volume.
My ultimate goal is for Wellness to be about 60%, Selfpay 25%, Medicare 15%. At this breakdown, overhead and collections will be even lower than at present.
Expenses for 2009 are lower than 2008 by about 10% and from 2007 by about 35%.
The revenues have not made up the difference yet, as my take home is still lower.
But the joy of going to the office and just being a doctor, and working for my patient's and not any third party is a pleasure.
My hope is that the revenues increase with slightly more volume. In my set up, if I get 800 active patients, with 600 in wellness plans, averaging about $425 per year per wellness patient, that would bring in $255,000. Selfpay patients would be about 50 visits per month averaging another $48,000 per year. Medicare would be another 25 visits per month averaging another $21,000 per year.
Total hopeful revenues would be about $325,000 per year, with expenses coming in at about $15,000 per month or $210,000. That would be profit of $124,000 per year, with a patient practice of about 800, and seeing about 12-18 patients per day, 4 days a week. If I want to work harder and work 5 or days a week, then increase the profit accordingly.
I welcome any thoughts.
DoctorSH
Tuesday, March 31, 2009
Monday, March 30, 2009
Monday 3-30-09
I saw 11 patients today.
3 Medicare.
3 Wellness- 1 renewed a husband-wife plan- prepaid for the year. I see the husband maybe 3x per year, the wife 6-8. It works out well for all involved.
5 Selfpay- 1 was a full physical in am, 1 was a fit in in the evening with palpitations.
One gentlemen came in with calf pain at 445PM. About 1 week ago he flew back from Hawaii, overall 12-13 hours on a plane. Since I have no need to rush through evaluations to get to the next patient, I called a radiologist friend to see if I could get a stat ultrasound-doppler r/o dvt. A radiologist appt after 5pm??? I made a few calls, scheduled the patient for 7pm and had the radiologist read the studies from home and call me on my cell phone with normal results. I called the patient on his cell phone. He had just left the radiology center and was pleased with the results, and I am sure pleased with the speed of his testing and treatment. Try getting this done with 5 patients in your waiting room complaining of long waits!! Two years ago this patient would have been sent to the ER. Not a fun place to be these days ; )
I also spent some time tidying up the office, helping prepare a room for the massage therapist who starts in 3 days. The room needed some work, but it looks pretty good. Just a few more touches needed.
Tomorrow or wednesday I'll try to post end of month and end of quarter numbers.
DoctorSH
3 Medicare.
3 Wellness- 1 renewed a husband-wife plan- prepaid for the year. I see the husband maybe 3x per year, the wife 6-8. It works out well for all involved.
5 Selfpay- 1 was a full physical in am, 1 was a fit in in the evening with palpitations.
One gentlemen came in with calf pain at 445PM. About 1 week ago he flew back from Hawaii, overall 12-13 hours on a plane. Since I have no need to rush through evaluations to get to the next patient, I called a radiologist friend to see if I could get a stat ultrasound-doppler r/o dvt. A radiologist appt after 5pm??? I made a few calls, scheduled the patient for 7pm and had the radiologist read the studies from home and call me on my cell phone with normal results. I called the patient on his cell phone. He had just left the radiology center and was pleased with the results, and I am sure pleased with the speed of his testing and treatment. Try getting this done with 5 patients in your waiting room complaining of long waits!! Two years ago this patient would have been sent to the ER. Not a fun place to be these days ; )
I also spent some time tidying up the office, helping prepare a room for the massage therapist who starts in 3 days. The room needed some work, but it looks pretty good. Just a few more touches needed.
Tomorrow or wednesday I'll try to post end of month and end of quarter numbers.
DoctorSH
Saturday, March 28, 2009
Another saturday
A nice spring day.
It's saturday am. My wife and daughter are out for the morning. I am home relaxing catching up on emails. I do not have regular scheduled hours on weekends. I only live a few minutes from my office so I can go in to see a patient without messing up my day. But it still is nice to not get any calls.
The prior week was slow in patient's seen, but good for wellness plan signups. We had 39 patient visits, and 9 wellness plan sign-ups or renewals, including a few new to the practice and new to the plan. Revenues still allow take home pay, but still below the average for most family docs. But I would not trade the revenues for the freedom. And if all goes well, the revenues will increase each year. As it is still early in the transition, I find it easier to pay myself quarterly instead of monthly.
My new ad campaign continues in the local paper. Have had a few calls and have seen my website hits rise. It will take time, but it will happen. Why do I say that and why the confidence?
If you hear the compliments I receive from my patient's, not for any special medical skills, but instead for being a different kind of doctor, one who takes the time to listen, and one who does what is necessary, regardless of the outside powers that be, you would also be confident.
DoctorSH
It's saturday am. My wife and daughter are out for the morning. I am home relaxing catching up on emails. I do not have regular scheduled hours on weekends. I only live a few minutes from my office so I can go in to see a patient without messing up my day. But it still is nice to not get any calls.
The prior week was slow in patient's seen, but good for wellness plan signups. We had 39 patient visits, and 9 wellness plan sign-ups or renewals, including a few new to the practice and new to the plan. Revenues still allow take home pay, but still below the average for most family docs. But I would not trade the revenues for the freedom. And if all goes well, the revenues will increase each year. As it is still early in the transition, I find it easier to pay myself quarterly instead of monthly.
My new ad campaign continues in the local paper. Have had a few calls and have seen my website hits rise. It will take time, but it will happen. Why do I say that and why the confidence?
If you hear the compliments I receive from my patient's, not for any special medical skills, but instead for being a different kind of doctor, one who takes the time to listen, and one who does what is necessary, regardless of the outside powers that be, you would also be confident.
DoctorSH
Wednesday, March 25, 2009
Slow week so far but optimistic
I take Wednesday's off. But as I have alluded to in past posts, I was at the office today anyway, this time for 3 hours upgrading my EMR. I have used Soapware (www.soapware.com) since September 2004. At that time it was very inexpensive and easy to use. The cost has gone up slightly, but it is still inexpensive compared to other EMR's, and the new version is C-CHIT certified. For solo or small practices, it is worth a look.
The weather was sunny on Monday and Tuesday. It seems that nice weather days cause a slowdown in patient volume. I saw 9 patients both days. But of the 18 seen this week, 7 have signed up for the wellness plan, with another new patient tomorrow also expected to join. 2 of the renewals were not even seen. They just sent in a check for payment in full, and the memo section of the check was written "wellness plan". These 7 patients, with one more expected tomorrow represent at least $3,955 of revenues for the year.
Try this on for size.
This should be the future of primary care. But until more physicians utilize this system, and make it the standard, physicians will continue to be stuck in the inferior insurance mill style.
The main question about my system is whether I can grow it to 800 or more patients. It would be easy if the other docs in my area adopted a similar system. If this style became the main force in my community, I would have to turn people away. Revenues would be up, medical care would be non-rushed, costs would be controlled, the doctor-patient relationship would once again mean something, and residents would once again choose primary care as a specialty.
In other words, "Win,Win,Win, Win and Win!"
I just got a text message from one of my wellness patients, He faxed me some labs from another physician. He wants to chat about them. I can have him come to the office for a visit, but he has no copay, and it would take him away from his work. I'll check the efax from my laptop, and call him tonight. It's a nice thing not to worry about payment!!
DoctorSH
The weather was sunny on Monday and Tuesday. It seems that nice weather days cause a slowdown in patient volume. I saw 9 patients both days. But of the 18 seen this week, 7 have signed up for the wellness plan, with another new patient tomorrow also expected to join. 2 of the renewals were not even seen. They just sent in a check for payment in full, and the memo section of the check was written "wellness plan". These 7 patients, with one more expected tomorrow represent at least $3,955 of revenues for the year.
Try this on for size.
- If I am able to grow the practice to 800 patients, with all in the wellness plan, that would be $395,500 in revenues.
- If each average 5 visits per year, that would be 4000 visits per year averaging just under $100 per visit.
- 4000 visits in 50 work weeks = 80 visits/week, or 20 per day in a four day work week.
- That would be 2.5 visits per hour, or about 25 minutes per visit. This is an average, some would be longer, others shorter.
This should be the future of primary care. But until more physicians utilize this system, and make it the standard, physicians will continue to be stuck in the inferior insurance mill style.
The main question about my system is whether I can grow it to 800 or more patients. It would be easy if the other docs in my area adopted a similar system. If this style became the main force in my community, I would have to turn people away. Revenues would be up, medical care would be non-rushed, costs would be controlled, the doctor-patient relationship would once again mean something, and residents would once again choose primary care as a specialty.
In other words, "Win,Win,Win, Win and Win!"
I just got a text message from one of my wellness patients, He faxed me some labs from another physician. He wants to chat about them. I can have him come to the office for a visit, but he has no copay, and it would take him away from his work. I'll check the efax from my laptop, and call him tonight. It's a nice thing not to worry about payment!!
DoctorSH
Saturday, March 21, 2009
Communication and the toys we use
Isn't the weekend supposed to be for rest?
After I finished with the preop physical, I checked the fax and some lab results.
Not when you are trying to build a medical practice!!!
It started last night, after hours when I received two phone calls.
The first from a family I have treated for many years. Their son needs surgey on his finger on Tuesday, and needs a physical and clearance prior. He can not miss any more school, so in to the office I went today. Of course, while I was there, I checked out his older sisters broken toe, and renewed a prescription for his mother.
The second call I received last night was about the 8 year old girl who almost got "peed" on by my dog last week. She is just about over her flu, but broke out in an itchy rash on her face, elbows, and knees.
She was taking several OTC natural remedies. I had her parents take a
digital photo and email it to me. I then checked the picture and spoke to the mother. Mom sent me a text message this morning stating her daughter was fine today and all resolved.
After I finished with the preop physical, I checked the fax and some lab results.
Don't ever do this on a weekend if you want to get home. I received lab results on an octogenarian with CHF whose potassium has risen to 6.1. I am co-
managing her case with a cardiologist. So I called the cardio and left a message on his cellphone voicemail. Then after 15 minutes, I sent him a text message. He returned my call 5 minutes later. He had just landed in Vegas for a conference that his wife needed to attend. We spoke for about 10 minutes and then I called the pateint with further instructions. This is a solo cardiologist who knows each of his patient's very well, and he communicates with me at length. He is always available to talk about any patient, whether it is his or not!
managing her case with a cardiologist. So I called the cardio and left a message on his cellphone voicemail. Then after 15 minutes, I sent him a text message. He returned my call 5 minutes later. He had just landed in Vegas for a conference that his wife needed to attend. We spoke for about 10 minutes and then I called the pateint with further instructions. This is a solo cardiologist who knows each of his patient's very well, and he communicates with me at length. He is always available to talk about any patient, whether it is his or not!The fax machine resulted in an ER report of a 21yo patient who was found to have SVT. He was treated and sent home for cardiology follow-up. I have treated his family for over 10 years and have a good rapport with them. I called his mother on her cell to see if I could speed up the process of a cardiologist appointment. Mom was appreciative for the call!
Pearl of the day: When starting or transitioning a practice, be available, even on your days off, and do not be afraid to use new communication tools like cell phones, email, digital pix, and text messaging. Your patient's appreciate the effort!
Friday, March 20, 2009
Slow but promising
Slow day today. Only saw 8 patients. But brought in over $1100.
How can that be??
1 new patient for a full physical with tests.
1 patient renewed their wellness plan- paid in full.
4 other self pay patients- 1 of which will be returning next week to join the wellness plan, and possibly add her 2 kids.
1 patient with a bad back and lingering depression scheduled a 15 minute phone session and paid prior to with a credit card. This is something that I need to consider. Phone sessions for established patients, with a credit card or bank account debit set up. Less stress at the office for the routine and follow-up care. I may need to send out a patient survey on the need for this service. Wellness plan patients already get this service as part of their plan. But if I added a $25 yearly charge per patient, $50 per family for "phone care", with a possible $25 charge per phone session, it could really bring up revenues. The truly sick would be told to come in for evaluation.
DoctorSH
How can that be??
1 new patient for a full physical with tests.
1 patient renewed their wellness plan- paid in full.
4 other self pay patients- 1 of which will be returning next week to join the wellness plan, and possibly add her 2 kids.
1 patient with a bad back and lingering depression scheduled a 15 minute phone session and paid prior to with a credit card. This is something that I need to consider. Phone sessions for established patients, with a credit card or bank account debit set up. Less stress at the office for the routine and follow-up care. I may need to send out a patient survey on the need for this service. Wellness plan patients already get this service as part of their plan. But if I added a $25 yearly charge per patient, $50 per family for "phone care", with a possible $25 charge per phone session, it could really bring up revenues. The truly sick would be told to come in for evaluation.
DoctorSH
Thursday, March 19, 2009
Jeckyl and Hyde patients
Normal day today.
Had about a dozen patients.
But same days seem like old movies. One movie I only saw bits and pieces of was Dr. Jeckyl and Mr. Hyde. I knew one was good and the other evil. I googled their names to find out which was which.
MA: " No she did not. And in all the time I have been working here, no one has complained about your fees. They just pull out their checkbook or credit card and hand over payment."
ME: " It makes me wonder why I have kept fees so low. I should have raised them a long time ago!"
MA: "Let me know when you do, so I can ask for that raise ;) "
===================
HYDE:
This is different from the husband and wife who called up for refills on some meds. The wife also asked me to call in an antibiotic for a "sinus infection". This is the same couple who I saw in January, and left without paying, a combined $200 bill. So I had my MA call them back and tell them they need to send in payment, and if they need to pay it out over time, include a timeline they feel can work. Their answer was that they never received a bill from me. Well, if I was on the phone I might have lost it. When this couple was in my office in January, they came with no intention of paying. I did not find this out until they were about to leave. My assumption was they would put down some payment and pay the rest out over a few months. When they said they could not pay anything, they were given the full bill before they left. They were being disingenous to say the least about payment.
====================
Had about a dozen patients.
But same days seem like old movies. One movie I only saw bits and pieces of was Dr. Jeckyl and Mr. Hyde. I knew one was good and the other evil. I googled their names to find out which was which.
I am getting better at knowing which patient's in my practice are Jeckyl's and which are Hyde's.
An example below:
Jeckyl:
One new patient referred from her boyfriend who is already a patient in my practice. She was not happy with her previous doctor. She felt he did not listen to anyone but himself. At the beginning of the visit she was subdued. By the end of the visit, she asked if we had a form to get her old records transferred to my practice. She paid my full fee. She was not yet interested in a wellness plan. She felt she received good value for her money. So I had a talk with my medical assistant. It went like this:
MA: " No she did not. And in all the time I have been working here, no one has complained about your fees. They just pull out their checkbook or credit card and hand over payment."
ME: " It makes me wonder why I have kept fees so low. I should have raised them a long time ago!"
MA: "Let me know when you do, so I can ask for that raise ;) "
===================
HYDE:
This is different from the husband and wife who called up for refills on some meds. The wife also asked me to call in an antibiotic for a "sinus infection". This is the same couple who I saw in January, and left without paying, a combined $200 bill. So I had my MA call them back and tell them they need to send in payment, and if they need to pay it out over time, include a timeline they feel can work. Their answer was that they never received a bill from me. Well, if I was on the phone I might have lost it. When this couple was in my office in January, they came with no intention of paying. I did not find this out until they were about to leave. My assumption was they would put down some payment and pay the rest out over a few months. When they said they could not pay anything, they were given the full bill before they left. They were being disingenous to say the least about payment.
====================
I learn something new every day.
If I feel a patient will be non-compliant with payment, have an entitlement attitude towards my office, or just be plain untrustworthy, they will not be scheduled again. This is not being mean. This is not allowing myself or my office staff be taken advantage of or enabling of bad behaviour. And yes, lying or twisting the truth about payment for my medical services is BAD behaviour.
DoctorSH
Wednesday, March 18, 2009
Urine, Fit him in, a Baby Shower and T-cubed
Wed March 18th, 2009
My day off.
What did I do today?
Worked out in the am. Had some "me" time.
Then I went to the office to see 2 patients.
The first was a new 8 year-old girl with the flu. Her parents and 2 grandparents are already in my practice, as selfpay patients. Very nice people and very understanding. Why do I say that?
Well.......
URINE:
My wife and I bring my dog to work with us. A cute 20lb poodle named Ellie. Ellie usually stays with my wife or with my medical assistant, usually hoping to get fed. But my wife was shopping at Target, so Ellie just roamed around the office greeting everyone. Well as I was almost finished with the 8 year old, Ellie comes into the room to say hello. Ellie acted like she wanted to get closer to the patient so I allowed her to get up on the exam table. Ellie then proceeded to squat and urinate on the exam table, inches away from the 8 year old. Thank goodness for table paper!! As I saw the squatting, I grabbed Ellie and put her on the floor and had my medical assisstant take her for a quick walk outside. The 8 year old and her mother, instead of being horrified, were laughing it up. It is nice to have patient's who are real people!!
FIT HIM IN:
The other patient is an owner of a small business that is downsizing. He has an HMO insurance via his wife's employer. He called his "primary", but they could not see him until next week. He did not want to wait, so we "fit him in". He had an abcess and early cellulitis on his right thigh. I called a surgeon I have referred to for years and they "fit him in" 2 hours later. I charged him only for a minimal visit, 99212 for those who still code, as I did an evaluation, but no real treatment. I also gave him a break as I treat his wife and mother-in-law.
A BABY SHOWER:
Some nice happenings today. A surprise baby shower for one of my medical assistants. My new part-time medical assistant took charge and planned the surprise shower which we had at the office at lunchtime. today. My other part-timer was there along with a former employee, my wife, and in-laws. One nice thing about a small office is we can do little things like this. It keeps the office happy and running smoothly.
T-CUBED:
After work today, while driving with my wife to go food shopping, I received a call from one of my wellness patients. She was sick for a day, but felt this was not her normal sickness. I was able to get info on the phone to help her, and asked that she text me her pharmacy phone number. I use a treo cellphone that enables me to make calls by tapping the phone number contained in the text message. After calling in an RX to the pharmacy, I replied to her text that the rx was called in and that she should schedule an appointment in 2 days if she is not getting better.
As part of my wellness plan, she has no copay. I would not receive any revenues by seeing her in the office. She also lives about 1 hour away. In the olden days, I would have requested she come into the office right away for evaluation. So it would have cost her 2 hours of drivetime on the NJ turnpike, while feeling really ill. Not a pleasant thought! The wellness plan allowed me not to worry about getting paid, but instead to focus on my patient's health.
So what does T-cubed stand for:
T-cubed = Telephone + Treatment + Texting
T-cubed allowed me to treat a patient efficiently and quickly, and we were both happy with the process. No insurance or government regulation to get in the way!!
DoctorSH
My day off.
What did I do today?
Worked out in the am. Had some "me" time.
Then I went to the office to see 2 patients.
The first was a new 8 year-old girl with the flu. Her parents and 2 grandparents are already in my practice, as selfpay patients. Very nice people and very understanding. Why do I say that?
Well.......
URINE:
My wife and I bring my dog to work with us. A cute 20lb poodle named Ellie. Ellie usually stays with my wife or with my medical assistant, usually hoping to get fed. But my wife was shopping at Target, so Ellie just roamed around the office greeting everyone. Well as I was almost finished with the 8 year old, Ellie comes into the room to say hello. Ellie acted like she wanted to get closer to the patient so I allowed her to get up on the exam table. Ellie then proceeded to squat and urinate on the exam table, inches away from the 8 year old. Thank goodness for table paper!! As I saw the squatting, I grabbed Ellie and put her on the floor and had my medical assisstant take her for a quick walk outside. The 8 year old and her mother, instead of being horrified, were laughing it up. It is nice to have patient's who are real people!!
FIT HIM IN:
The other patient is an owner of a small business that is downsizing. He has an HMO insurance via his wife's employer. He called his "primary", but they could not see him until next week. He did not want to wait, so we "fit him in". He had an abcess and early cellulitis on his right thigh. I called a surgeon I have referred to for years and they "fit him in" 2 hours later. I charged him only for a minimal visit, 99212 for those who still code, as I did an evaluation, but no real treatment. I also gave him a break as I treat his wife and mother-in-law.
A BABY SHOWER:
Some nice happenings today. A surprise baby shower for one of my medical assistants. My new part-time medical assistant took charge and planned the surprise shower which we had at the office at lunchtime. today. My other part-timer was there along with a former employee, my wife, and in-laws. One nice thing about a small office is we can do little things like this. It keeps the office happy and running smoothly.
T-CUBED:
After work today, while driving with my wife to go food shopping, I received a call from one of my wellness patients. She was sick for a day, but felt this was not her normal sickness. I was able to get info on the phone to help her, and asked that she text me her pharmacy phone number. I use a treo cellphone that enables me to make calls by tapping the phone number contained in the text message. After calling in an RX to the pharmacy, I replied to her text that the rx was called in and that she should schedule an appointment in 2 days if she is not getting better.
As part of my wellness plan, she has no copay. I would not receive any revenues by seeing her in the office. She also lives about 1 hour away. In the olden days, I would have requested she come into the office right away for evaluation. So it would have cost her 2 hours of drivetime on the NJ turnpike, while feeling really ill. Not a pleasant thought! The wellness plan allowed me not to worry about getting paid, but instead to focus on my patient's health.
So what does T-cubed stand for:
T-cubed = Telephone + Treatment + Texting
T-cubed allowed me to treat a patient efficiently and quickly, and we were both happy with the process. No insurance or government regulation to get in the way!!
DoctorSH
Tuesday, March 17, 2009
This and That
THIS:
Monday and Tuesday- the 16th and 17th of March- St Patty's Day.
24 people the past few days, 3 new patients, 1 renewal of a wellness plan.
A medicare check brought the revenues to January levels.
Hired a massage therapist. Part-time independent contractor to work 2 days a week.
Will be sending out email marketing tomorrow.
Plan is to put together a full introductory wellness package for patient's to try, and maybe at a discounted rate. After the discount, patient's can work out their own deal , but hopefully they will find the services valuable.
THAT:
In between patients, I had 3 pharmaceutical reps sitting in my waiting room. 2 were together, the odd pairing of the rep with the manager. You know how it goes, the rep actually tries to show he knows how to sell the product, while the manager sits and daydreams about how nice it is to not be stuck behind a desk somewhere. Actually, they all should be thankful they still have jobs. With the economy going south, generic price wars, and a new presidential administration calling for changes in the healthcare system, the pharmaceutical industry should be really worried.
But back to the waiting room. The rep who represented medicine X, started to "teach" me about when would be an appropriate time to use medicine X. Usually I just ignore their speeches, but when he started telling me how medicine X now is a tier 2 drug on formulary with so and so insurance plan, instead of tier 3, I abruptly stopped his speech.
I told him the following;
"Nothing personal, but if your industry does not stop bowing to the government and insurance companies, you are digging your own grave. You have enough competition with generics being so cheap, a downward economy, and a new federal administration that will presumably make it even worse, but you continue to dig yourself deeper, by detailing physicians about how we should prescribe medicine X to people with this or that coverage.
What about people with different coverage?
What about people with no coverage?
Why the different pricing for insurers and individuals?
We all know the insurers profit from prescription plans. Their formularies are not based on efficacy, but more on cost and profit. Your industry has taken a huge public opinion drop because the public knows you are not looking out for them. The system needs to be fixed, but it will never happen as long as your industry is seen to be in bed with the insurers. You need to stop making deals with all insurers. This will put an end to formularies and the b.llsh.t preauth nonsense that goes with it. One price for everyone, and a reduced price at that. Get rid of the middlemen, and have a price-point that will be profitable, to keep research and development thriving, and people employed. If insurers want to pay for prescriptions, let them reimburse the patient separately, but keep them out of the doctor-patient-pharmacy loop. It only adds cost and wastes time."
So I finished my little speech, and the three reps looked up and at first were afraid to talk. Finally, the third rep, a woman, decided to try and argue about how much it costs to bring a drug to market, etc, etc. I agreed, but that argument has nothing to do with the insurance-government middleman. She then said how they "voluntarily" signed the pharma code about gifts to doctor's office. The new "code" was signed to hopefully deter the feds from passing laws that would have greater restrictions on gifts. Boo Hoo. My patent's now have to use bank pens instead of drug sponsored pens. What a shame!! As if a free pen makes me write for a drug. Give me a break. But I am sure that politicians never, ever, ever help their lobbyists by passing laws that help them with ......
So back to my speech:
"The more your industry continues down this path, the worse it will get, and you will all be looking for a new job soon. I just heard Pfizer laid off 10 of the 14 reps that were in my area. You don't think you will be next? Your industry leadership needs a new direction. Now have a nice rest of your day, and be sure to go sit in your car and write down everything I just said and pass it on to your higher ups! If they want some advice, have them call me. I'll be glad to talk to them, For $500 per hour! "
Well, that felt good, and now its time for lunch.
Can you believe I actually had to buy my own sandwich today.
No drug rep lunch today ;)
DoctorSH
Monday and Tuesday- the 16th and 17th of March- St Patty's Day.
24 people the past few days, 3 new patients, 1 renewal of a wellness plan.
A medicare check brought the revenues to January levels.
Hired a massage therapist. Part-time independent contractor to work 2 days a week.
Will be sending out email marketing tomorrow.
Plan is to put together a full introductory wellness package for patient's to try, and maybe at a discounted rate. After the discount, patient's can work out their own deal , but hopefully they will find the services valuable.
THAT:
In between patients, I had 3 pharmaceutical reps sitting in my waiting room. 2 were together, the odd pairing of the rep with the manager. You know how it goes, the rep actually tries to show he knows how to sell the product, while the manager sits and daydreams about how nice it is to not be stuck behind a desk somewhere. Actually, they all should be thankful they still have jobs. With the economy going south, generic price wars, and a new presidential administration calling for changes in the healthcare system, the pharmaceutical industry should be really worried.
But back to the waiting room. The rep who represented medicine X, started to "teach" me about when would be an appropriate time to use medicine X. Usually I just ignore their speeches, but when he started telling me how medicine X now is a tier 2 drug on formulary with so and so insurance plan, instead of tier 3, I abruptly stopped his speech.
I told him the following;
"Nothing personal, but if your industry does not stop bowing to the government and insurance companies, you are digging your own grave. You have enough competition with generics being so cheap, a downward economy, and a new federal administration that will presumably make it even worse, but you continue to dig yourself deeper, by detailing physicians about how we should prescribe medicine X to people with this or that coverage.
What about people with different coverage?
What about people with no coverage?
Why the different pricing for insurers and individuals?
We all know the insurers profit from prescription plans. Their formularies are not based on efficacy, but more on cost and profit. Your industry has taken a huge public opinion drop because the public knows you are not looking out for them. The system needs to be fixed, but it will never happen as long as your industry is seen to be in bed with the insurers. You need to stop making deals with all insurers. This will put an end to formularies and the b.llsh.t preauth nonsense that goes with it. One price for everyone, and a reduced price at that. Get rid of the middlemen, and have a price-point that will be profitable, to keep research and development thriving, and people employed. If insurers want to pay for prescriptions, let them reimburse the patient separately, but keep them out of the doctor-patient-pharmacy loop. It only adds cost and wastes time."
So I finished my little speech, and the three reps looked up and at first were afraid to talk. Finally, the third rep, a woman, decided to try and argue about how much it costs to bring a drug to market, etc, etc. I agreed, but that argument has nothing to do with the insurance-government middleman. She then said how they "voluntarily" signed the pharma code about gifts to doctor's office. The new "code" was signed to hopefully deter the feds from passing laws that would have greater restrictions on gifts. Boo Hoo. My patent's now have to use bank pens instead of drug sponsored pens. What a shame!! As if a free pen makes me write for a drug. Give me a break. But I am sure that politicians never, ever, ever help their lobbyists by passing laws that help them with ......
So back to my speech:
"The more your industry continues down this path, the worse it will get, and you will all be looking for a new job soon. I just heard Pfizer laid off 10 of the 14 reps that were in my area. You don't think you will be next? Your industry leadership needs a new direction. Now have a nice rest of your day, and be sure to go sit in your car and write down everything I just said and pass it on to your higher ups! If they want some advice, have them call me. I'll be glad to talk to them, For $500 per hour! "
Well, that felt good, and now its time for lunch.
Can you believe I actually had to buy my own sandwich today.
No drug rep lunch today ;)
DoctorSH
Saturday, March 14, 2009
Availability
Saturday, the day after Friday the 13th.
Office is closed. But I still went in and evaluated 3 patients.
1 new, 1 established self pay, 1 established wellness.
All three were thankful I came in on my day off. In fact the wellness patient called at 10am , and I was already going to the office at 11am, His words at the end of the visit,
"I am happy and impressed! I called on a day off, was met and treated at the office in an hour, and as part of the wellness plan I don't have to pay for the visit! "
Even though I do not have routine hours on Wednesdays or weekends, I am still available when needed. It is not that big a deal to go to the office for an hour or so when a patient is in need. It builds loyalty and grows a practice.
DoctorSH
Office is closed. But I still went in and evaluated 3 patients.
1 new, 1 established self pay, 1 established wellness.
All three were thankful I came in on my day off. In fact the wellness patient called at 10am , and I was already going to the office at 11am, His words at the end of the visit,
"I am happy and impressed! I called on a day off, was met and treated at the office in an hour, and as part of the wellness plan I don't have to pay for the visit! "
Even though I do not have routine hours on Wednesdays or weekends, I am still available when needed. It is not that big a deal to go to the office for an hour or so when a patient is in need. It builds loyalty and grows a practice.
DoctorSH
Friday, March 13, 2009
The end of the week and Jan-Feb analysis
Friday ended.
It was definitely not thursday. Had 6 patients thru the office.
One gentlemen came in for his wellness physical. With my open scheduling, he called yesterday, and we performed the exam today. Spent about one hour with him, performed an ekg, spirometry, reviewed labs, full exam, and chit-chatted about other things. It's called having time to get to know your patient's, building trust and loyalty, and being a true family physician.
Ended up with 46 patients for the week. It would be nice to have them spread evenly throughout the week, but now that would not be realistic, would it?
I have some numbers for the first 2 months of 2009 for analysis:
400 total patient encounters
154 selfpay ---- avg $77 per encounter
152 in wellness plan---- avg $126 per encounter
94 Medicare---- avg $85 per encounter
An encounter is any patient that is in the office to see myself or the medical assistant, even if just for venipuncture, a B12 shot, or quick nurse vitals. If they were seen and paid something, it counts as an encounter.
So the selfpay and medicare $/encounter underestimate the avg amount that physician visits would generate.
The wellness plan average may decrease if I fail to continue to enroll new patients in the program, but will stay the same or increase if my marketing and other word of mouth generates a buzz.
If you still take insurance, let me know what your average $/encounter is with your payers for comparison. Also we should calculate the extra overhead involved in collections, and the third party bureaucratic machine. My way is not for everyone, but it is a nice way to do business and provide medical care.
Oh, and by the way, my patients all call me doctor, not provider!!
I found the definition of provider in the new AMA dictionary.
provider: an evil word that came from the third party intruders when they took over healthcare. The dumbing down of physicians who provide care while chaining themselves to bad contracts.
DoctorSH
It was definitely not thursday. Had 6 patients thru the office.
One gentlemen came in for his wellness physical. With my open scheduling, he called yesterday, and we performed the exam today. Spent about one hour with him, performed an ekg, spirometry, reviewed labs, full exam, and chit-chatted about other things. It's called having time to get to know your patient's, building trust and loyalty, and being a true family physician.
Ended up with 46 patients for the week. It would be nice to have them spread evenly throughout the week, but now that would not be realistic, would it?
I have some numbers for the first 2 months of 2009 for analysis:
400 total patient encounters
154 selfpay ---- avg $77 per encounter
152 in wellness plan---- avg $126 per encounter
94 Medicare---- avg $85 per encounter
An encounter is any patient that is in the office to see myself or the medical assistant, even if just for venipuncture, a B12 shot, or quick nurse vitals. If they were seen and paid something, it counts as an encounter.
So the selfpay and medicare $/encounter underestimate the avg amount that physician visits would generate.
The wellness plan average may decrease if I fail to continue to enroll new patients in the program, but will stay the same or increase if my marketing and other word of mouth generates a buzz.
If you still take insurance, let me know what your average $/encounter is with your payers for comparison. Also we should calculate the extra overhead involved in collections, and the third party bureaucratic machine. My way is not for everyone, but it is a nice way to do business and provide medical care.
Oh, and by the way, my patients all call me doctor, not provider!!
I found the definition of provider in the new AMA dictionary.
provider: an evil word that came from the third party intruders when they took over healthcare. The dumbing down of physicians who provide care while chaining themselves to bad contracts.
DoctorSH
Thursday, March 12, 2009
It has been an eclectic week so far
After the slowest day of the year on tuesday, I had 19 patients through my office today. Most of my time was spent with patient's, very little on other matters. It felt good!!!
Of the 19, 6 were Medicare, 6 were wellness plan, and 7 were selfpay.
3 New wellness plan enrollees today.
1 was a renewal from last year, 1 was already a patient, but enrolled this year as she wants to work more on prevention, and 1 was new to the practice. Interestingly, this last patient recently moved from California, and wanted to work with a doc who has the time to listen, and also who will not nickle and dime her with office visits. When she saw the wellness plan, with the monthly auto-pay option, she signed right after our visit was over.
I may have said this before, but I think the zero copay option to the wellness plan along with the monthly autopay option is attracting more patients, especially the uninsured, and those with high deductible policies. In fact, one wellness patient came in tonight, just for 2 rxs, and informed me as soon as he gets his hsa funded, within the month, he will be enrolling his family in the plan, instead of just himself. This is what I hoped to be able to do, enroll more families!!
This last patient also switched, at my suggestion, into an HSA with a $5000 deductible for his family. His previous family premiums were $1500/month with $10 copays. He now pays only $700/month. Thats $9,600 in premiums savings a year. His $5000 deductible is self funded but is tax deductible, which saves him another 28-31%. So his savings by being in an HSA , even if he uses all his deductible is about $6000 a year. And his wellness plan will come directly out of his HSA and count towards his deductible.
If we can somehow get more HSA plans in to the mainstream, my style of practice will thrive!!
DoctorSH
Of the 19, 6 were Medicare, 6 were wellness plan, and 7 were selfpay.
3 New wellness plan enrollees today.
1 was a renewal from last year, 1 was already a patient, but enrolled this year as she wants to work more on prevention, and 1 was new to the practice. Interestingly, this last patient recently moved from California, and wanted to work with a doc who has the time to listen, and also who will not nickle and dime her with office visits. When she saw the wellness plan, with the monthly auto-pay option, she signed right after our visit was over.
I may have said this before, but I think the zero copay option to the wellness plan along with the monthly autopay option is attracting more patients, especially the uninsured, and those with high deductible policies. In fact, one wellness patient came in tonight, just for 2 rxs, and informed me as soon as he gets his hsa funded, within the month, he will be enrolling his family in the plan, instead of just himself. This is what I hoped to be able to do, enroll more families!!
This last patient also switched, at my suggestion, into an HSA with a $5000 deductible for his family. His previous family premiums were $1500/month with $10 copays. He now pays only $700/month. Thats $9,600 in premiums savings a year. His $5000 deductible is self funded but is tax deductible, which saves him another 28-31%. So his savings by being in an HSA , even if he uses all his deductible is about $6000 a year. And his wellness plan will come directly out of his HSA and count towards his deductible.
If we can somehow get more HSA plans in to the mainstream, my style of practice will thrive!!
DoctorSH
Wednesday, March 11, 2009
I should have been a Veterinarian !!
My day off. I took my dog to the vet for her annual checkup. 30 minutes and $175 later, I was driving home. They did not ask to see my insurance. They did not ask for a copay. They did not ask for an insurance referral. All they asked was for payment in full at the end of the visit. Cash, check or credit card please, Ka-ching!!!
The $175 breaks down as:
$50 for the exam
$61 for 3 vaccines
$48 for blood and stool test
$16 for a flea-tic collar
So if we look at it more closely, the bill is actually reasonable. And it was one stop shopping. Pretty convenient!!
Now let's compare to a managed care practice for humans.
You show up at the office and are asked for your insurance card prior to anything else. Once the insurance is verified, you wait to be called back to the exam room. If you need blood tests, the office must first check to see what lab your insurance participates with and whether the tests will be covered. Then you may be given a labslip to get the tests performed at a capitated laboratory.
Then you must wait 3-5 days for most test results.
Vaccines can be given. But with the insurer changing the rules frequently, the doctor does not know if he will get paid. If not, good luck getting paid afterwards by the patient. As for medications and treatments, you need to give a prescription for patient's to get filled at a local pharmacy, or a mail order pharmacy, which can take a few weeks to obtain.
After all this, the patient pays a copay, averaging $20-25. Then the doctor's office must submit a claim to the insurance company and hope to get paid within the next month or two, and not for the full amount, but a discounted rate.
It may just be me, but it sounds much easier and more efficient at the vet's office!!
And you wonder why I transitioned out of third party contracts!!
DoctorSH
The $175 breaks down as:
$50 for the exam
$61 for 3 vaccines
$48 for blood and stool test
$16 for a flea-tic collar
So if we look at it more closely, the bill is actually reasonable. And it was one stop shopping. Pretty convenient!!
Now let's compare to a managed care practice for humans.
You show up at the office and are asked for your insurance card prior to anything else. Once the insurance is verified, you wait to be called back to the exam room. If you need blood tests, the office must first check to see what lab your insurance participates with and whether the tests will be covered. Then you may be given a labslip to get the tests performed at a capitated laboratory.
Then you must wait 3-5 days for most test results.
Vaccines can be given. But with the insurer changing the rules frequently, the doctor does not know if he will get paid. If not, good luck getting paid afterwards by the patient. As for medications and treatments, you need to give a prescription for patient's to get filled at a local pharmacy, or a mail order pharmacy, which can take a few weeks to obtain.
After all this, the patient pays a copay, averaging $20-25. Then the doctor's office must submit a claim to the insurance company and hope to get paid within the next month or two, and not for the full amount, but a discounted rate.
It may just be me, but it sounds much easier and more efficient at the vet's office!!
And you wonder why I transitioned out of third party contracts!!
DoctorSH
Tuesday, March 10, 2009
Slow day
Tuesdays are usually slow. Today wins the award for slowest of the year.
Only had 5 people through the office, however one established patient paid for the wellness plan without being seen. Also had a new self-pay patient as well. While I saw 1/3 of the volume of the previous day, the revenues were still 2/3 . Still making a profit even with only 5 patient's today. Try that with insurers.
I am off tomorrow. But thursday already looks busier with 11 patient's scheduled, with 2 potential wellness plan enrollments.
On slow days, you need to make good use of your time. My spare time was spent partially with the patient's I evaluated today, an extra 5-10 minutes goes a long way for goodwill, and the rest was spent negotiating for a mortgage refinancing for my home. With interest rates so low, the few hours I spent could have a huge return on the time investment.
DoctorSH
Only had 5 people through the office, however one established patient paid for the wellness plan without being seen. Also had a new self-pay patient as well. While I saw 1/3 of the volume of the previous day, the revenues were still 2/3 . Still making a profit even with only 5 patient's today. Try that with insurers.
I am off tomorrow. But thursday already looks busier with 11 patient's scheduled, with 2 potential wellness plan enrollments.
On slow days, you need to make good use of your time. My spare time was spent partially with the patient's I evaluated today, an extra 5-10 minutes goes a long way for goodwill, and the rest was spent negotiating for a mortgage refinancing for my home. With interest rates so low, the few hours I spent could have a huge return on the time investment.
DoctorSH
Monday, March 9, 2009
Annoying day
Ever have one of those annoying days?
Mondays are tough enough, but you walk into your office, find out your medical assistant is late. She walks in 2 minutes before the first patient.
Then my first patient complains about his bill, $90 for an office visit that lasted 30 minutes + a labdraw. The next patient was a no show. The 11am new patient also no showed.
I like to start off Mondays on a good note, and when patients No Show, it kind of ticks me off. It shows lack of respect, and a lack of true value. I track all no shows in my emr, and I have stopped scheduling repeat no show-ers.
Overall we had 16 patients thru the office today.
1 wellness plan renewal from last year.
1 new wellness plan for a child. This child is on medicaid, but the mother, who joined last week, has trouble getting in to her pediatricians office quickly. My assumption is the quick availability in my office is valuable.
The revenues for the day were actually good as we had a good number of selfpay patients.
So what started out annoying actually turned out ok.
Pearls for the day:
Don't let the ignorant (no show-ers) annoy you.
Show your value by being available, If a patient is sick and wants an appointment, get them in same day. They might not be sick tomorrow!
DoctorSH
Mondays are tough enough, but you walk into your office, find out your medical assistant is late. She walks in 2 minutes before the first patient.
Then my first patient complains about his bill, $90 for an office visit that lasted 30 minutes + a labdraw. The next patient was a no show. The 11am new patient also no showed.
I like to start off Mondays on a good note, and when patients No Show, it kind of ticks me off. It shows lack of respect, and a lack of true value. I track all no shows in my emr, and I have stopped scheduling repeat no show-ers.
Overall we had 16 patients thru the office today.
1 wellness plan renewal from last year.
1 new wellness plan for a child. This child is on medicaid, but the mother, who joined last week, has trouble getting in to her pediatricians office quickly. My assumption is the quick availability in my office is valuable.
The revenues for the day were actually good as we had a good number of selfpay patients.
So what started out annoying actually turned out ok.
Pearls for the day:
Don't let the ignorant (no show-ers) annoy you.
Show your value by being available, If a patient is sick and wants an appointment, get them in same day. They might not be sick tomorrow!
DoctorSH
Sunday, March 8, 2009
Decisions do affect your future
It is a tough time to do anything in a medical practice these days.
I chose to be in control of my future and to do it my way, independent of intruders.
The way I see it, if any form of healthcare insurance reform occurs, there will be a huge shortage of primary care as all the newly covered start showing up in medical offices. This will either drive more patient's fed up with the "mill practices" to my office, or if physician's are forced into the system, there will be more than enough patient's to keep everyone busy.
But that is the problem. I do not want to be busy for the sake of being busy. I want to do the best job possible for those that ask for my help. A smaller practice size with more time allotted for each patient is the method that works best for me!
It is time that physician's start advocating for this type of care, as more time with patient's improves the care they receive.
DoctorSH
I chose to be in control of my future and to do it my way, independent of intruders.
The way I see it, if any form of healthcare insurance reform occurs, there will be a huge shortage of primary care as all the newly covered start showing up in medical offices. This will either drive more patient's fed up with the "mill practices" to my office, or if physician's are forced into the system, there will be more than enough patient's to keep everyone busy.
But that is the problem. I do not want to be busy for the sake of being busy. I want to do the best job possible for those that ask for my help. A smaller practice size with more time allotted for each patient is the method that works best for me!
It is time that physician's start advocating for this type of care, as more time with patient's improves the care they receive.
DoctorSH
Saturday, March 7, 2009
Talk is cheap
How many docs hate giving away free advice?Shouldn't there be a system that rewards us for this sidewalk chatter or elevator conference?
The issue is our present payment system. We make our living evaluating patients in our offices or hospital and then send a bill, not to our patient, but usually to a third party go between. We can wait for months to be paid for our services, and during the wait our frustrations mount. There must be a better way as it seems we are working for free!
So what do we do??About 2 years ago I came to a crossroads in my practice. I was getting busier, and not being able to spend as much time with each patient as I liked. Even though I was busier, my revenues were stagnant, and my expenses were rising. Not a great situation for the future. I belonged to a multi-specialty IPA that was quickly disintegrating, as specialists withdrew to form single specialty organizations. Many family docs in the IPA got together to see if we too, could convert to a single specialty of our own. The thinking was that if we got enough members, we would have the clout to battle the insurers for better contracts.
At the same time I was approached by a practice management company that offered to convert my office to a concierge retainer style practice. I went through the process of sending out surveys and was very close to joining this company. However the lack of being 100% in control of my own destiny made me decline the offer.
I decided to remain independent, because as I like to say, "I don't play well with others." But remaining independent was a guarantee for continued decreasing revenues , or I would have to see a greater volume of patient's. To me, that would be selling out my values for income. Many of the primary docs in the IPA joined another IPA that already had clout with the insurers. At this time, they are doing well financially, however with the possible changes in our healthcare system, I do not know if that model will be sustainable.
So I chose to terminate from third party contracts other than traditional medicare. I focused in the first year on retaining as many patient's as possible within a reduced self-pay fee and also the introduction of wellness and retainer plan options. I survived the first year. Percentage numbers have been previously reported on this blog. Now it is year two, and my focus is on retaining my first year patient's while starting to market to new. I have merged the wellness plan with the retainer option, so now I offer medicare, selfpay and retainer- with a monthly payment option. The retainer with monthly payment option has been popular so far, as there is no copay per visit. This has attracted many patient's with HSA's, FSA's and also the uninsured.
So what does this have to do with free advice. As more of my patient's transition into my retainer option, there is no such thing as free advice. As 2 minutes on the phone may negate a 20-30 minute office visit, and as I am being paid to be available, not per office visit, sidewalk chats are welcome.
It is nice to be able to help my patient's without worrying about getting paid, and without any third party in my mind. I am free to be a physician again!!
DoctorSH
Friday, March 6, 2009
A slow friday
Boring day today.
Only had 7 patients today. The weather thawed for the first time in over a week. The sun was out and the temp. hit 50. An apple a day does not keep the doctor away. But a warm sunny day after a week of miserable weather will keep the doctor away.
1 new wellness patient. This patient has a $3000 deductible and rarely goes to the doctor. But he felt $45/month was a good deal for my services.
I have 11 patients scheduled for monday.
Hopefuly next week will be busier.
DoctorSH
Only had 7 patients today. The weather thawed for the first time in over a week. The sun was out and the temp. hit 50. An apple a day does not keep the doctor away. But a warm sunny day after a week of miserable weather will keep the doctor away.
1 new wellness patient. This patient has a $3000 deductible and rarely goes to the doctor. But he felt $45/month was a good deal for my services.
I have 11 patients scheduled for monday.
Hopefuly next week will be busier.
DoctorSH
Thursday, March 5, 2009
OBama's Healthcare Summitt
I worked today in my private office. I receive no outside funding. I work for myself and my patient's. I do not ask for any handouts or any special political favors.
Today was President OBama's healthcare summit.
My main question: How many physicians who own and operate their own private practice were included in the "summit" ?
Here I am trying to do what is right for the healthcare needs of my patient's. My practice is set up to be accessible and affordable. I keep overhead low and time with patient's high. I do this by avoiding any third party intrusion into the exam room. My fear is that Mr. OBama will try to jam down more third party intruders into the exam room, and as a result will dismantle the doctor-patient relationship even further. This will not be good for our country. My goal is to be able to provide family healthcare needs to any who want it at an affordable price. This may get difficult if the bureaucrats take over.
Todays stats:
15 patients- 12 in the am shift, 3 in the afternoon.
1 new patient who joined my wellness plan. this is the daughter of a current wellness patient, who is presently uninsured. She has medical issues she wants to address, some of which may be hereditary. As I treat her parents, and have an affordable monthly payment option, she had no hesitation in joining my office.
There is value in trust. More docs need to remember this!!
1 wellness patient renewed for the year.
Only 1 medicare patient today, and 7 selfpay.
If my 4 workdays were all like this, my revenues would be higher than when I participated with insurers.
My ad campaign starts next week. I will be running 4 consecutive ads, costing under $70 each, with bullet points that share my views on healthcare and how my practice differs from others.
I'll comment later in my return on investment (roi).
DoctorSH
Today was President OBama's healthcare summit.
My main question: How many physicians who own and operate their own private practice were included in the "summit" ?
Here I am trying to do what is right for the healthcare needs of my patient's. My practice is set up to be accessible and affordable. I keep overhead low and time with patient's high. I do this by avoiding any third party intrusion into the exam room. My fear is that Mr. OBama will try to jam down more third party intruders into the exam room, and as a result will dismantle the doctor-patient relationship even further. This will not be good for our country. My goal is to be able to provide family healthcare needs to any who want it at an affordable price. This may get difficult if the bureaucrats take over.
Todays stats:
15 patients- 12 in the am shift, 3 in the afternoon.
1 new patient who joined my wellness plan. this is the daughter of a current wellness patient, who is presently uninsured. She has medical issues she wants to address, some of which may be hereditary. As I treat her parents, and have an affordable monthly payment option, she had no hesitation in joining my office.
There is value in trust. More docs need to remember this!!
1 wellness patient renewed for the year.
Only 1 medicare patient today, and 7 selfpay.
If my 4 workdays were all like this, my revenues would be higher than when I participated with insurers.
My ad campaign starts next week. I will be running 4 consecutive ads, costing under $70 each, with bullet points that share my views on healthcare and how my practice differs from others.
I'll comment later in my return on investment (roi).
DoctorSH
Tuesday, March 3, 2009
The Day After The Snow
It is the day after a missed day at work due to snow.
The usual happened. 2 no shows in the morning. And then it hits. The phone starts ringing and we start filling up. All the afternoon slots were filled by lunchtime. Still could be no shows, but I can't worry about that.
Ended up with 13 patients today. 3 wellness renewals including the two I will mention soon. 1 patient returned after 2 years away, and when he found out I did not participate with his insurance, he didn't mind, he said it was worht it as I took almost 45 minutes with him for a short physical and talk session. I could not have done that 2 years ago. I would not have had the time.
A good feeling this morning. An 82 yo man, a patient in my practice for many years, renewed his and his wifes wellness plan for the year. They have a Medicare-HMO plan that would enable them to recieve care elsewhere, and at a much reduced cost. Instead , he paid today in full for the wellness plan on his credit card. His wife was only in my office twice last year, but he still wanted her on the plan, primarily to fix the costs for the year. This couple does not have a lotof money, and lives off of a fixed income. But they obviously value my services. They have trust that I am working solely for them.
On another note, I am looking to further the wellness part of the practice. I am in the process of hiring a massage therapist. I think this will add to the value that patient's receive from my office. The fee schedule has not been cemented yet, but patient's in my wellness plans will get a discount.
The goal of my practice is to be as third party free as possible, and be able to give truly valuable services to those who come to my office for care. The key to keeping patient's in this system is one word, trust!
DoctorSH
Monday, March 2, 2009
Monday, aka snowday
I woke up this morning and looked outside, and saw a blanket of white. I was informed last night that schools were closed for today. So should I go in to work or stay home?
The conditions were not terrible, but far from ideal. Winds and snow, and temps in the teens, with a wind chill in the single digits. So here is how I made my decision to close for the day.
DoctorSH
The conditions were not terrible, but far from ideal. Winds and snow, and temps in the teens, with a wind chill in the single digits. So here is how I made my decision to close for the day.
- Only had 4 people scheduled for the am, 2 of which were for labwork only. None were urgent. I cancelled them out last night.
- I had no one scheduled for the afternoon-evening appointment slots. Now, on a normal day I average about a dozen call-in appointments on mondays. But with the weather, I did not expect too many, and there is always tuesday.
- My medical assistants are paid hourly. It would cost me more to pay them to work, then I would get in pay form the few patient's who braved the weather.
- By 1pm, I had 3 phone calls from patient's. 2 for UTI's , and 1 a question on blood pressure. So I am not exactly losing much in revenue for the day. And if previous years show a pattern, I will make up most of the revenues in added patients the next few days.
DoctorSH
Sunday, March 1, 2009
Its snowing!!
It's sunday evening, and it just started snowing. I used to enjoy the snow, when I was a salaried physician. A free day to sit on my sofa and watch the snow fall, play with my daughter in the snow, and laugh while watching my dog's hair turn white in the snow.
But now I have a solo practice. If I do not work, I do not get paid! That is not fair. But as I tell my daughter all the time, "Life is not fair!"
The forecast is for anywhere from 6-14 inches of snow. But it is a NorEaster, and they tend to be trouble. Doubly troubly is that mondays are my busiest day of the week.
Now as 40% of my revenues are prepaid wellness plan patient's, I have no revenue loss from this group. But the 20% Medicare and 40% selfpay patient's are another story. This is another reason why trying to get a larger percentage of wellness patient's would be beneficial.
DoctorSH
P.S. Let's hope the weather forecast is wrong.
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