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!
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