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.

• 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.

If anyone reading this blog does not like these numbers, please tell me why?

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

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

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

February 17, 2009

2-17-09

Average day at the office. Saw 11 patients. On the business side, one uninsured patient signed up for my Zero copay wellness plan, with a monthly payment of $45. She felt it was cheap for what she was getting and allowed her to budget her money accordingly. If she paid full price for the same service , it would cost her more than double, and she would probably refrain from the service. The Wellness Plan includes a full one hour physical exam, EKG, spirometry, review of labs, and review of full personal and family medical history, while creating a game plan for health, wellness and prevention. All done without any third party intervention and at a cost most can afford, if they choose.

Part of what I like about my new system is that the time constraints have been removed. Case in point where this is helpful: I have an unfortunate patient just diagnosed a few days ago with Liver Cancer with probable mets to the lung. When he called yesterday to schedule to review his recent hospital stay, my medical assistant was able to schedule him for 40 minutes. His son, also a patient in the practice, came along for the visit. I had plenty of time in my schedule to review the hospital chart with the patient and help to coordinate his future care. This would have been very difficult a few years ago, when anything over 15 minutes per patient would have caused a hardship.

One of the joys I have in Family Practice is the building of trust and relationships with patients and their families. When a patient refers their family member, it is one of the nicest compliments I can get. Unfortunately, in the case I mentioned earlier, this can also be one of the sorrows of family practice. Seeing how bad medical news affects other patients, especially family members, can be very trying.

DoctorSH