Re: number of patients to be seen/ Ideal insurance mix

[Guest guest]

Jean:

I sent an e-mail about a month ago to the group asking for advice and you requested more details. Let me give you an example of my practice operating expenses in a month. The numbers are rounded up, but they can give you an idea:

Equipment rental ( a CBC machine that gives me nightmares every time I have to pay for the CLIA permits): 300

Insurances (malpractice, liability, health for employees): 4000

Billing company: 8% of collected: 3000-4500

Licenses and permits: 400

Rent: 3200

Salaries: excluding the doctors: 16178

Vaccines 14000

Payroll taxes: 1370

Those were the numbers for the month of January (so happens that I had the calculations of the accountant handy for that month) but for last month for example, expenses were 51907, and collections were 51767.

I don't have an EMR, my computer system is provided by the company that does my billing, and I use it to do schedulling and billing. I would love to get an EMR but I don't have money to do it. Now I'm even running out of space to file charts.

You asked about a business plan, it held up for the first 2 years, and our office grew very nicely, when I worked only with one secretary and a medical assistant, and I opened Monday through Fridays whole day and Sat half day.

When the patients started being too many I hired another physician, another medical assistant and another secretary, and outsourced the billing. Since then I seem to be bitting my tail. Every new patient represent more earnings but more expenses. The space in my office can not accomodate more than 30 patient's a day and that is with patients complaining of a very long wait. On top of that I have a family that complains about my abscense from home.

I know that this is not a psychitric help line, but I'm about to need that kind of help. Any suggestions?

Re: number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician's life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

> Jean:

> Those were the numbers for the month of January (so happens that I had the

> calculations of the accountant handy for that month) but for last month for

> example, expenses were 51907, and collections were 51767.

So you're working for free???

> I don't have an EMR, my computer system is provided by the company that does

Synapse EMR has a free edition but I don't think that's going to

rescue your situation

Maybe the big guns here will have some ideas...

> my billing, and I use it to do schedulling and billing. I would love to get

> an EMR but I don't have money to do it. Now I'm even running out of space

> to file charts.

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

VICTORIA,

50,000/MONTH I WOULD LIKE TO HELP. I WOULD RECOMMEND eMDs. IT WILL PAY FOR ITSELF IN ONE YEAR. IT MAKES EVERYONE'S JOB EASIER. INCREASES VALUE AT EVERY STEP OF THE PATIENT VISIT.

PS LIKELY COULD BE FINANCED OVER 5 YEARS IF YOU REALLY NEED.

WE SEE 12-18 PATIENTS PER DAY WITHOUT STAFF. WHAT WOULD YOUR DAY BE LIKE WITH LESS STAFF AND MORE EFFICIENT SCHEDULING< CHARTING< BILLING <COLLECTIONS?

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

I cannot tell enough so far to help you but a few things jump out1 You list vaccines as an expense You should be being reimbursed for them hence they are no more an expense than say kenalog for jt injection say

If you a re not being paid then you cannot provide immunizations next I wonder if you have too many patientsIn open access scheduling the key component is matching your supply of available appointments to the demand for them IF you continually have more demand than you can meet and you try to meet it by seeing more and more people which causes you to hire more staff( which equal overhead) and stay late then you a re indeed chasing you r tail

the AAP site talks about open access or i can teach you moreThe solution is to take a breath What you are doing is not working so if you keep trying to do more and more of what is not working you become insane, sweetie.

Your rent is way high! Your staffing seems highIf you had a little office and less overhead you can see fewer people and take home more profit-less overheadPeds practices have more trouble closing than others since your patietns grow up and out of the practice but

the AAp site american academy of pediatrics talks about open access that may be a place to startStrangely enough ,it may seem ,you may need less space less staff and fewer patietns not more.Then also there is the issue of how good or bad your reimbursment is Like here in MAine most kids are on mediciad where reimbursement is awful which makes peds really hard- can you tell us about your reimbursement?

Jean

Jean:

I sent an e-mail about a month ago to the group asking for advice and you requested more details. Let me give you an example of my practice operating expenses in a month. The numbers are rounded up, but they can give you an idea:

Equipment rental ( a CBC machine that gives me nightmares every time I have to pay for the CLIA permits): 300

Insurances (malpractice, liability, health for employees): 4000

Billing company: 8% of collected: 3000-4500

Licenses and permits: 400

Rent: 3200

Salaries: excluding the doctors: 16178

Vaccines 14000

Payroll taxes: 1370

Those were the numbers for the month of January (so happens that I had the calculations of the accountant handy for that month) but for last month for example, expenses were 51907, and collections were 51767.

I don't have an EMR, my computer system is provided by the company that does my billing, and I use it to do schedulling and billing. I would love to get an EMR but I don't have money to do it. Now I'm even running out of space to file charts.

You asked about a business plan, it held up for the first 2 years, and our office grew very nicely, when I worked only with one secretary and a medical assistant, and I opened Monday through Fridays whole day and Sat half day.

When the patients started being too many I hired another physician, another medical assistant and another secretary, and outsourced the billing. Since then I seem to be bitting my tail. Every new patient represent more earnings but more expenses. The space in my office can not accomodate more than 30 patient's a day and that is with patients complaining of a very long wait. On top of that I have a family that complains about my abscense from home.

I know that this is not a psychitric help line, but I'm about to need that kind of help. Any suggestions?

Re: number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?

MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?

Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician's life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.

Remember that e-mail may not be entirely secure/ MD ph fax

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

So, billing is about $80/visit on average with 30 patients per day,

and working say 5 days a week with $52k collected for that month.

Does that sound right?

> Then also there is the issue of how good or bad your reimbursment is Like

> here in MAine most kids are on mediciad where reimbursement is awful

> which makes peds really hard- can you tell us about your reimbursement?

>

> Jean

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

What is your specialty? I find very difficult to practice without staff? Do you have at least a secretary to answer your phone calls, or the system only allows for patients to make appointments on line?

In my case I use the medical assistants to give vaccines and draw laboratories. Do you need to do this kind of procedures in your specialty?

Also my secretaries take care of referrals, school forms (reports of the physical exam requiered by the State before each school year), charging patients, calling to collect late payments, ordering supplies, checking elegibility. I can not see myself doing that in the middle of seeing patients.

Do you do that?

Re: number of patients to be seen/ Ideal insurance mix

VICTORIA,

50,000/MONTH I WOULD LIKE TO HELP. I WOULD RECOMMEND eMDs. IT WILL PAY FOR ITSELF IN ONE YEAR. IT MAKES EVERYONE'S JOB EASIER. INCREASES VALUE AT EVERY STEP OF THE PATIENT VISIT.

PS LIKELY COULD BE FINANCED OVER 5 YEARS IF YOU REALLY NEED.

WE SEE 12-18 PATIENTS PER DAY WITHOUT STAFF. WHAT WOULD YOUR DAY BE LIKE WITH LESS STAFF AND MORE EFFICIENT SCHEDULING< CHARTING< BILLING <COLLECTIONS?

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Thanks for your prompt answer. I will look into the open access info in the AAP web.

Regarding the reimbursement for vaccines, I get reimbursed probably 1 or 2 $ more than what I pay, but I cannot tell my patients that I can not provide vaccines for them. I've tried several times to renegotiate my contracts, and some insurances have increased their fees for the office visits, but then they consider other procedures (like lab tests, hearing and vision test) as included in the visit. Also they refuse to increase my fees for vaccines. Lately there is a movement in the city to unite all pediatricians (or at least a significant number of us) under the same organization in order to negotiate the contracts with the insurances, but I don't think that this will be settled before next year.

Lately also I'm having a big increase in medicaid patients, and as you said their reimbursement is not the best. Starting this month I asked medicaid to close my panel of patients. Also I'm not receiving new patients except for newborns.

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician's life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

What's wrong with this ....

Say you dropped down to 10 patients per day and lost all your staff.

You now have 2/3 of the day to do the stuff they did.

10 x $80 = $800 per day * 5 * 4.33 = $17320 per month

Less 8% for billing company = $15934

Less rental of $3200 = $12734

Equipment rental $300 = $12434

Licenses of $400 = $12034

Less malpractice of ?? $2000 = $10,000

Vaccines are fully reimbursed

So, that $10k per month with payment for utilities and taxes to come off that.

> Equipment rental ( a CBC machine that gives me nightmares every time I have

> to pay for the CLIA permits): 300

>

> Insurances (malpractice, liability, health for employees): 4000

>

> Billing company: 8% of collected: 3000-4500

>

> Licenses and permits: 400

>

> Rent: 3200

>

> Salaries: excluding the doctors: 16178

>

> Vaccines 14000

>

> Payroll taxes: 1370

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

It is right.

Re: number of patients to be seen/ Ideal insurance mix

So, billing is about $80/visit on average with 30 patients per day,and working say 5 days a week with $52k collected for that month.Does that sound right?On Sat, Aug 9, 2008 at 12:53 PM, <jnantonucci@ gmail.com> wrote:> Then also there is the issue of how good or bad your reimbursment is Like> here in MAine most kids are on mediciad where reimbursement is awful> which makes peds really hard- can you tell us about your reimbursement?>> Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.

[Guest guest]

I checked the open access scheduling system. I had some questions regarding how to collect the data to calculate demand. Should I start collecting the data from now on a week each month or should I use data from prior years? Also, remember that my practice is only 4 years old, the first 2 years I was the only provider and the next 2 I had another partner, but now I'm by my self again. I think if I use historic data I can use the data from this year considering that I was working part time and he was working full time. I have the number of patients seen each day and I can speculate the length of their wait based on the time they signed in and the time my secretary checked them out, also I can use the billing code to estimate the length of the visit (assuming that

the billing code was placed correctly). I don't have information about patients that called and were not seen because of lack of supply, so I can not use that variable in the calculations.

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician's life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Your vaccine expense is quite high. Is that accurate? Shop and beat

the prices down any way you can. An EMR will initially slow you

down. I would bet your expenses will be higher initially but at

least you have some hope of getting out of the rat hole if you pick

right w an EMR. Everybody has to buy in w the concept at the office,

if not let them go.

I have heard good things about both eclinical and emds. I use

alteer , the EMR portion is weak compared to others.

Brent

>

>

>

>

>

>

>

>

> I'm a pediatrician in Miami.  I started my office 4 years ago, and

I haven't been able to be productive.  Currently I'm practicing solo,

I see patients from private insurances and from medicaid.  In the

last month I'm seeing about 30 patients a day (working 9 to 7 with

only one hour break for lunch and answering messages).  Before that I

had hired another physician but we never got enough earnings to get a

salary larger than 8000 a month for both of us (we divided that

between the two).  I'm going crazy, and I'm not hiring anyone else

because I don't think that I can afford it.  

>

>

> Can someone give me an orientation in this regards?  Is this the

way a pediatrician' s life should be or there is a way of being

productive seeing less patients?

> What is the average number of patients a pediatrician should see to

be productive?  How do I calculate and get the ideal insurance mix to

have a healthy practice and a healthy life?

>

>

> Fierro

>

>

>

>

> --

> If you are a patient please allow up to 12 hours for a reply by

email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

Your vaccine expense is quite high. Is that accurate? Shop and beat

the prices down any way you can. An EMR will initially slow you

down. I would bet your expenses will be higher initially but at

least you have some hope of getting out of the rat hole if you pick

right w an EMR. Everybody has to buy in w the concept at the office,

if not let them go.

I have heard good things about both eclinical and emds. I use

alteer , the EMR portion is weak compared to others.

Brent

>

>

>

>

>

>

>

>

> I'm a pediatrician in Miami.  I started my office 4 years ago, and

I haven't been able to be productive.  Currently I'm practicing solo,

I see patients from private insurances and from medicaid.  In the

last month I'm seeing about 30 patients a day (working 9 to 7 with

only one hour break for lunch and answering messages).  Before that I

had hired another physician but we never got enough earnings to get a

salary larger than 8000 a month for both of us (we divided that

between the two).  I'm going crazy, and I'm not hiring anyone else

because I don't think that I can afford it.  

>

>

> Can someone give me an orientation in this regards?  Is this the

way a pediatrician' s life should be or there is a way of being

productive seeing less patients?

> What is the average number of patients a pediatrician should see to

be productive?  How do I calculate and get the ideal insurance mix to

have a healthy practice and a healthy life?

>

>

> Fierro

>

>

>

>

> --

> If you are a patient please allow up to 12 hours for a reply by

email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

We can not afford to offer vaccines for the medicaid population and

send them to the health dept. It is the way it is. We also can not

afford to take the time to draw medicare lab for the cost. It is the

way it is until it changes. We send them to the hospital.

You have to pay attention to your payer mix. Open access and

watching your medicaid numbers to keep them at an acceptable level is

the only way to stay afloat. You have to grow w commercial

insurance. Self pay is frequently no pay. Evaluate your fee schedule

and anything that pays at 100 percent on the commercial level

increase. Good luck. You have a good revenue stream. Hospital

pediatrics like newborns and circumcisions pay pretty well so do what

you can do to grow that.

Brent

>

> I'm a pediatrician in Miami.  I started my office 4 years ago, and

I haven't been able to be productive.  Currently I'm practicing solo,

I see patients from private insurances and from medicaid.  In the

last month I'm seeing about 30 patients a day (working 9 to 7 with

only one hour break for lunch and answering messages).  Before that I

had hired another physician but we never got enough earnings to get a

salary larger than 8000 a month for both of us (we divided that

between the two).  I'm going crazy, and I'm not hiring anyone else

because I don't think that I can afford it.  

>

> Can someone give me an orientation in this regards?  Is this the

way a pediatrician's life should be or there is a way of being

productive seeing less patients?

> What is the average number of patients a pediatrician should see to

be productive?  How do I calculate and get the ideal insurance mix to

have a healthy practice and a healthy life?

>

> Fierro

>

>

>

> --

> If you are a patient please allow up to 12 hours for a reply by

email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

>

>

>

> --

> If you are a patient please allow up to 12 hours for a reply by

email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

[Guest guest]

Buy AC, it is certainly the best bang for your buck you are ever going to find in an EMR even if Jon has just admitted to having installed a "kill switch" in the program. So we are leasing AC it would seem for semi-reasonable fees every year and not purchasing it... None the less, for $995 for the first doc you can't go wrong. And think of all the money you will save in paper, ink, folders, stickers it addes up fast. None the less that now four people can all be reading the same chart at the same exact time doing different tasks and no more lost paper charts or paying staff time to pull or fill them either... that is certainly worth some money. You almost can't afford to not use an inexpensive system like AC...

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Try to at least get the to pay the shots at what we call AWS, Average Wholesale usually about 85% there of. Now at least when the cost of something climbs you get paid a proper increase that is at least tied to some form or reality. AWS is usually adjusted quarterly and is a quarter behind all the time in terms of it going up and then your fee getting bumped accordingly. But again at least it is tied to real economic forces and this should not be seen as unreasonable....

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

:

eMDs has won pediatric documentation awards several years running. I believe it can help you. For cost, it is comparable to 3 telephone lines and minimal yellowbook each year. Averaged over the first 5 years. Less for you if you practice solo MD. I am an internist, but am very familiar with eMDs.

Again, it decreases your workload at every point. Workflows would change and only you can create the vision. For $3-4,000 per month I would really considerbringing billing back in house. Even if you didn't change your practice, but employed someone in your office, I think you would come out ahead. That is $36-48,000 per year. $360,000 to $500,000 over 10 years.

That is 3-4 years of my salary. I would look to keep it somehow.

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

:

eMDs has won pediatric documentation awards several years running. I believe it can help you. For cost, it is comparable to 3 telephone lines and minimal yellowbook each year. Averaged over the first 5 years. Less for you if you practice solo MD. I am an internist, but am very familiar with eMDs.

Again, it decreases your workload at every point. Workflows would change and only you can create the vision. For $3-4,000 per month I would really considerbringing billing back in house. Even if you didn't change your practice, but employed someone in your office, I think you would come out ahead. That is $36-48,000 per year. $360,000 to $500,000 over 10 years.

That is 3-4 years of my salary. I would look to keep it somehow.

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

--(warning -- long post)Keep taking notes and keep

categorizing the issues being advised about. You are getting a lot of good

advise I believe. But if you are not careful and don't keep track of it all you are

at risk of trying a piece or two and they by themselves, in the mix of your current

office set up will feel like spitting into the wind.Basically, in my

opinion at least, you are in a typical office in which a doc can only make a living

if it is subsidized by either a hospital system or the government. Only a

small percentage of straight private practices can thrive with such a big overhead

($600,000/yr, right?). Specialists do it by doing procedures that pay well,

and many of those procedures are done at hospitals and surg centers, not in their

offices. But primary care with almost all E & M coding simply doesn't bring

in the bucks from insurance. Our population doesn't understand that but basically it

is what America has decided to do. And most of us primary care docs, with

hearts of gold and masochistic spirits that have led us to work our butts off since

our teens to " succeed " are manipulated by the insurance industry and at

the end of the day go home without as much pay as many people think we do as

doctors. So, that's the system within we work. I wish it wasn't so, but

it is.What are your options?1) Let's start with the most painful

-- you can quit and find another career. Probably not what you want since,

like most of us, you likely love being a doc (I still think it's the best job in the

world).2) You can keep working the traditional model because " that's what

doctors do " and most of us just live with the struggle and " work

harder. " From what I read (between the lines), I worry you'd burn

out in that option, and your family actually wouldn't appreciate it either.3)

You can change and start moving toward a better balance.If #3 is the

option you want to explore, read, print, re-read, break down and re-write in your

own words all the points folks make here. IMP concepts are an option.IMP does not mean solo-solo doc (that is my choice actually, but it's just

mine). Many of us have small office with some staff and other providers in the

mix.First, you need to know if you are in a dead zone. $80/ appt

doesn't sound too bad except that I assume that also includes the charges for

vaccinations (pay back for all that expense you reported), so, if I'm right,

$80/appt sucks.I'm worried your area doesn't pay well enough for any primary

care to survive, or your billing company is really, really bad and you ain't getting

what you earned for the 8%.So, I'd say evaluate your billing and

re-imbursement. You may do better by bringing that in-house.Second, you have to control overhead, big time. The paper charts are likely

not serving your purposes, and actually may be costing you a lot -- buying the

charts/paper, time for folks to manage the paper/file, space to store. There

are reasonably priced EMRs (I use AC, others do too, but other posts mention some

other inexpensive ones which work well too). But that is a challenge if you

have a big staff as you need to get everyone on board for the effort to transition

to EMR.Third, I worry about the size of your staff. Are they all

doing well at their assigned tasks? Do you have a system for evaluation?

Are they communicating well? One of gurus on the list ( Brady... actually

deserves a better title than guru ... hmm, maybe Grand Pubah Guru Brady) often

discusses how the more staff you have, the more lines of communication you have, and

the more potential mis-communication you can have. Something to think about as

you may not be getting the " bang for the buck " considering how much you

are investing in your personnel.Fourth, you may need to put a freeze on

your practice size for a while until you get your situation evaluated and consider

your options, and ultimately decide how you will navigate ahead. With that,

you might be able to measure your supply and demand, get a better sense of your

staff and who is producing and who is not, etc.Fifth, you may need to

drop your worst payers. Others have spoken on that often in the past.Sixth, understand that little things add up to big benefits in the end. For

example, if you can find a way to save 15 mins of work per day, you save 1 hr 15 min

per week and about 60 hours per year (kind of like getting a one week

vacation! How cool is that?! ;-). So keep thinking about the systems

your office uses and where there are inefficiencies.Seventh, take care

of yourself. You are the most important asset in the office. More important than any

staff, or EMR or building, or anything. Be sure to get your rest, eat right,

stay physically active and get your time to sit/meditate/pray. Talk to your

family so they know what you feel about your career and profession. Let them know

you want to make it work better financially and there may need to be a few bumps in

the road ahead before there's smooth sailing. Eighth, be ready to face

your own demons. What I mean is that as we challenge ourselves to change and

improve, our own weaknesses and inadequacies can come to the forefront. If we

don't stay aware of them and try to address them, they will keep blocking our way.

None of us are perfect.Understand that you can make some improvements

each month, but the real process may take 1- 3 years before you find the right

balance. But that's all the more reason to get started now.In the

end, you may have an IMP that looks similar to what you have now, but the office may

be running smoother and leaner and offering superb care. Or it may be much smaller

in every way but due to lean operations you can still do better financially.I'll tell you one thing about myself however. I think I spend as much,

or perhaps more time, for work now than I use to. But, each of the hours I

work is now more in my control and not as stressful -- I actually enjoy the time

" working " as a doctor. So in the end I'm simply not as worn out and I can

enjoy the time in the office and out of it better. I'm also more flexible with

time and can switch schedules as I want more easily. I enjoy being a doc

again. Now, in my third year, I think I will finally equal what I use to take

home in my salaried job. I've done it with a solo-solo office and a hybrid

model (fam med and some skin aesthetics), but I do not suggest everyone try that as

the two parts of the office need to be run very differently and should only be tried

very carefully (my opinion).OK, that's a ton of info. I hope it's

helpful in some way. There are a thousand other ideas and points you can consider

too. Other folks will have great, great suggestions too. I'll keep

reading them because I need to be reminded of them too even after 2 1/2 yrs of being

open. This is an on-going process.All the best.TimOn Fri, August 8, 2008 11:00 pm EDT, Fierro

wrote:

I checked the open access scheduling system. I had some questions regarding how

to collect the data to calculate demand. Should I start collecting the data from

now on a week each month or should I use data from prior years? Also, remember that

my practice is only 4 years old, the first 2 years I was the only provider and the

next 2 I had another partner, but now I'm by my self again. I think if I use

historic data I can use the data from this year considering that I was working part

time and he was working full time. I have the number of patients seen each day and

I can speculate the length of their wait based on the time they signed in and the

time my secretary checked them out, also I can use the billing code to estimate the

length of the visit (assuming that the billing code was placed correctly). I

don't have information about patients that called and were not seen because of lack

of supply, so I can not use that variable in the calculations.

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs

etc?did you make a business plan when you started-- doe s it hold

up?MAny times kids are on medicaid and in that case the pay to care

for them is so low that it is virtually not feasible to earn a good living

without being subsidizedCAn you tell us more about your EMR, does solo

mean any staff? and other details?Some area are just dead zones but

some folks on the list may be able to offer suggestions in

MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro

vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't

been able to be productive. Currently I'm practicing solo, I see patients from

private insurances and from medicaid. In the last month I'm seeing about 30

patients a day (working 9 to 7 with only one hour break for lunch and answering

messages). Before that I had hired another physician but we never got enough

earnings to get a salary larger than 8000 a month for both of us (we divided that

between the two). I'm going crazy, and I'm not hiring anyone else because I don't

think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a

pediatrician's life should be or there is a way of being productive seeing less

patients?

What is the average number of patients a pediatrician should see to be

productive? How do I calculate and get the ideal insurance mix to have a healthy

practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12

hours for a reply by email/please note the new email address.Remember

that e-mail may not be entirely secure/ MD115 Mt Blue

Circle ph fax

-- If you are a patient please allow up to 12

hours for a reply by email/please note the new email address.Remember

that e-mail may not be entirely secure/ MD115 Mt Blue

Circle ph fax

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

At some point in my first year in the office I was seeing that amount of patients (10-12/day), I didn't have medicaid at the moment, and my staff consisted in one medical assistant and one do it all front desk. Still the income matched the expenses with a left over of $2000 that was my salary, and that was doing the billing in-house.

I still think that I would need at least someone to do the referals, check elegibility and filter calls, but certainly with only 10/day a medical assistant is not needed. You don't use even a secretary?

Re: number of patients to be seen/ Ideal insurance mix

What's wrong with this ....Say you dropped down to 10 patients per day and lost all your staff.You now have 2/3 of the day to do the stuff they did.10 x $80 = $800 per day * 5 * 4.33 = $17320 per monthLess 8% for billing company = $15934Less rental of $3200 = $12734Equipment rental $300 = $12434Licenses of $400 = $12034Less malpractice of ?? $2000 = $10,000Vaccines are fully reimbursedSo, that $10k per month with payment for utilities and taxes to come off that.On Sat, Aug 9, 2008 at 12:01 PM, Fierro <vhfierroyahoo (DOT) com> wrote:> Equipment rental ( a CBC machine that gives me nightmares every time I have> to pay for the CLIA permits): 300>> Insurances (malpractice, liability, health for employees): 4000>> Billing company: 8% of

collected: 3000-4500>> Licenses and permits: 400>> Rent: 3200>> Salaries: excluding the doctors: 16178>> Vaccines 14000>> Payroll taxes: 1370>-- Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.

[Guest guest]

How about having the MA multi-task? Some phones combined with answering machine doing some of the work, check insurances and do referals and then some amount of patient work if needed or time allows. MA's may "like" to do the clinical more than the clerical but the clerical was as much in their training as the clinical and this is to be part of their job. I know our friend Michele who interned at our office thru the last part of her schooling became our full time MA afterwards and we got a very close look at her studies.

In the end the MA is your employee and you must assign him/her the tasks that you and your office need to get done, not what will always make them happy. A really good employee like our Shel will do as directed and needed because they want to help and keep the practice moving along. Actually many times when Shel's starting patients, it slows down as waits for Shel to finish her interview, notes and so on. But we like to let her play nurse might we say most days because this is probably the more rewarding side of her job and most of the time we can afford to let her do it. uses the time to finish the last note, go take a bathroom or tea break, return a call or phone in a quick Rx, read her email or messages, or even just get a "hug" from me her Hubby practice manager, you get the picture. So the extra time spent in a 10-15 patient day is not really a waste, it is just dividing the tasks up into smaller bites which if

done well actually can keep the doc from looking at a long list of crap to do at the end of the day because she did half of them during these pauses in the action. And even the mental time thing isn't always a really bad thing either. does a whole lot of pysch and at times it is very draining for her and so the extra little down time I hope helps even if just a little. An extra 5 minutes in between visits isn't always the worst thing in the world.... Keep the doctor healthy too. But most of Shel's day is all that awful carrier based CCHIT that has to get done combined with regular doc paperwork and phone calls like referals to specialists, Rx's sent out, so on and so forth... and she has gotten real good at and we really apperciate that.

He's my job description for the folks who have interviewed for MA in the past. If you know MASH then you understand the reference. Radar O'Reilly the office assistant. The first Col. on the show was Col. Blake and that is last name so it kind makes for good, bad joke. Someone who gets all the garbage done every day, and keeps the paperwork and phone calls one step ahead of the doc so she can get a quick answer to a question, getting something off the doc's plate, hands her a bunch of orders and Rx's to sign so the doc can attend to something else. Col Blake needs to talk to Gen. Hammond is the old joke and so Blake turns to Radar and say, "Radar get Gen. Hammond on the phone for me would ya?" And the beauty of it is, is that Radar already knew what he wanted or needed and so he is already standing there with the phone in his hand, to give to Col. Blake and Radar immediately replies, "Gen. Hammond on the phone for you sir..."

as he hands him the phone. Keep the doctor moving and get the obsticals out of her way. And then when they get to run an ECG or assist with a nice procedure that is their reward for all that other pain in the neck work they do every day.

Remember that they are there because they work for you, and so assign them the tasks that you actually need for them to do for you so you can get your day done easier, quicker, better. You're a doc, you can get your own temp or BP now can't ya? And frequently you docs seem to get better and more accurate BP readings anyway, so why not just do it yourself then? How many times does the patient report to the nurse or MA starting the visit something completely different than what they eventually tell the doc and what the patient and the doc actually work on too? All too many times, so again cut that out if need be and let that MA keep working the insurance garbage for you instead. If you need her to actually hold down a baby for a shot or pass you 4X4's during a procedure then that is another story.

Sorry for the long post but I thought is was important.... A husband PM's perspective on these things....

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

What's wrong with this ....Say you dropped down to 10 patients per day and lost all your staff.You now have 2/3 of the day to do the stuff they did.10 x $80 = $800 per day * 5 * 4.33 = $17320 per monthLess 8% for billing company = $15934Less rental of $3200 = $12734Equipment rental $300 = $12434Licenses of $400 = $12034Less malpractice of ?? $2000 = $10,000Vaccines are fully reimbursedSo, that $10k per month with payment for utilities and taxes to come off that.On Sat, Aug 9, 2008 at 12:01 PM, Fierro <vhfierroyahoo (DOT) com> wrote:> Equipment rental ( a CBC machine that gives me nightmares every time I have> to pay for the CLIA permits): 300>> Insurances (malpractice, liability, health for employees): 4000>> Billing company: 8% of

collected: 3000-4500>> Licenses and permits: 400>> Rent: 3200>> Salaries: excluding the doctors: 16178>> Vaccines 14000>> Payroll taxes: 1370>-- Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.

[Guest guest]

You have to look at all the expenses, both dollar amounts and time amounts.Huge problem can be the variance from one area to another.For example, one

family do'cs malpractice can be $5000-$6000/yr and another's $25000.One doc's

office can be $450/month (ie-mine at $12/sq ft/yr... and others) while another fam

doc can be paying $20/sq ft/yr.Salaries for staff can vary.Workload for

insurances can vary... some are more heinous for prior auths, verifications, etc.... etc, etc, etc.So, yeah, I get by with no staff. But, from what I

can tell, my insurers pay reasonably well (not like Portland, OR though!), my

malpractice is cheap, my rent is cheap and I don't lease any medical equipment. Keep

overhead as low as possible -- that may mean someone needs an assistant for some

matters if the " time expenses " (I just made up that term) is too great

(for calling insurances, etc) and that means they'll need to see a couple more

patients in a day. But we all have to work hard at not getting into the

vicious circle of providing more services leading to needing more appts, needing

more expenses, needing more appts .... the only thing that can not, and will not

change is that there are 60 minutes in an hour and 24 hours in a day. All

other variables in the equation can, and sometimes must, change.TimOn Sat, August 9, 2008 9:22 am EDT,

Fierro wrote:

At some point in my first year in the office I was seeing that amount of patients

(10-12/day), I didn't have medicaid at the moment, and my staff consisted in one

medical assistant and one do it all front desk. Still the income matched the

expenses with a left over of $2000 that was my salary, and that was doing the

billing in-house.

I still think that I would need at least someone to do the referals, check

elegibility and filter calls, but certainly with only 10/day a medical assistant is

not needed. You don't use even a secretary?

Re: number of patients to be seen/ Ideal insurance

mix

What's wrong with this ....Say you dropped down to 10 patients per

day and lost all your staff.You now have 2/3 of the day to do the stuff they

did.10 x $80 = $800 per day * 5 * 4.33 = $17320 per monthLess 8%

for billing company = $15934Less rental of $3200 = $12734Equipment

rental $300 = $12434Licenses of $400 = $12034Less malpractice of ??

$2000 = $10,000Vaccines are fully reimbursedSo, that $10k

per month with payment for utilities and taxes to come off that.On Sat,

Aug 9, 2008 at 12:01 PM, Fierro vhfierroyahoo (DOT) com> wrote:>

Equipment rental ( a CBC machine that gives me nightmares every time I have> to pay for the CLIA permits): 300>> Insurances

(malpractice, liability, health for employees): 4000>> Billing

company: 8% of collected: 3000-4500>> Licenses and permits:

400>> Rent: 3200>> Salaries: excluding the

doctors: 16178>> Vaccines 14000>> Payroll taxes:

1370>-- Graham Chiuhttp://www.synapsed irect.comSynapse

- the use from anywhere EMR.

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Hi ,

Welcome.

I'm a new IMP. Started July 15th.

I am doing solo-solo without staff.

I hear you about the secretary. How else to manage 50 calls and still see patients? Since I don't have a full panel like you do I'm not entirely sure. Some of it is training patients. Some of those 50 calls were people who weren't used to the answering machine as the previous doc had a secretary and so some of them were repeats. Some of those calls were sales pitches, etc. etc. But for what it's worth I'm using a digital phone that I set to "Do Not Disturb" while with patients. Fifteen minutes of every hour is to return calls. One thing the answering machine does -- makes some people come to the point. My fax is on the same line and if a fax tone is heard the fax machine will pick it up instead of that answering machine. And it's saving it digitally so I can import it to my computer. Others in the IMP Community are using internet faxing or services like One Box and Up Dox. I am using Amazing Charts and find

it much easier to use than eCW and certainly love the price. I will be doing in house billing. The folks on this list serve have been giving feedback to help me with that. I agree with Tim that I work just as hard and maybe longer hours ( to be expected as a newbie) but it is not as stressful as working at seeing more and more patients to pay for overhead. (Some of the reason it's not as stressful is my daughter can be with me when we are printing up business cards or new patient packets, etc. So spending time with her makes less stress for me as a mom and makes me a better doctor, mom, person.) But also remember solo-solo is not the only way to go --- lots of folks here are IMP and have support staff. Others here are morphing into IMP by cutting out lowest paying or big hassle factor insurances and/or cutting staff to 3/4 and gradually phasing out. It takes time. I've been following the list serv and

hooking up with mentors for a year. I also took a business course and currently have a friend teaching me billing/coding and another teaching me phlebotomy. I'll be doing my first order of immunizations next week (there goes the rest of the start up money). It's a very steep learning curve for doing all the stuff I had support staff doing for me all these years. It takes big energy and committment to do this but clearly it's doable with lots of individuals making it work "their way" from cash only to specialty care (endo, neuro, optho and I think we have an ortho IMP too), to adding asthetics from city to rural with some working part time and others full time. Were you comfortable that first year when you were seeing 10-12 patients a day during your first year? Were you stable financially? Were you happy? What would have been your salary if you weren't paying the front desk person? Was Medicaid the tipping point

that started making the need for more and more visits? Is it time to say good by to Medicaid? As to Open Access I've lost track of the original formula but I plan on capping my panel at 800 because the figures seem to indicate that will be about 8 calls per day for same day access and my schedule allows for 12 visit per day at full capacity. I hope the sharing of my new practice gives you encouragement to find what will work for you to get off the hamster wheel that only leads to burnout and frustration. Pick one change at a time -- eliminate an insurance, start using EMR, cross train staff and don't replace if one leaves, etc. etc. I have never been happier. Myria (family practice, upstate new york, Amazing Charts)> Equipment rental ( a CBC machine that gives me nightmares every time I have> to pay for the CLIA permits): 300>> Insurances (malpractice, liability, health for employees): 4000>> Billing company: 8% of collected:

3000-4500>> Licenses and permits: 400>> Rent: 3200>> Salaries: excluding the doctors: 16178>> Vaccines 14000>> Payroll taxes: 1370>-- Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.

[Guest guest]

You definitely need to control your medicaid/medicare patients. I'm not sure how it is in your area. Here in NYC, many docs do not accept medicaid, medicare, workman's comp. or no-fault. I finally convinced Alice to drop medicaid/medicare, and I am in the process of implementing that. On your vaccines, we get a little more than you quoted ($10-$15) -- thats still not even close to FMV. You are using your administration fee code? If you are a ped (sounds like it) I don't know if you can get away with not giving vaccines at all. But they cause HUGE cash flow problems and unless they can be successfully used strategically, stop giving them if you can. I don't know the details of your market or the pediatrician issues so I cant really say.

You really need to run the hard numbers on "the marginal cost to see a patient" at different staffing levels. And your marginal income. This will let you fine-tune your decisions as to how many patients you will see per day, and if you want/need a second provider--either a doctor or "extender."

I just stumbled onto code 99051 as an add-on for scheduled evening/weekend visits. If you arent using it, try it out. I can't give any info on my success yet since we just sent in the first claims this week.

Are there any services that you can offer that are not covered by insurance? Think about this one, as it can make a nice difference.

Re: [Practiceimprovemen t1] number of patients to be seen/ Ideal insurance mix

Hi As someone else suggested much depends on your overhead- do you want to tell us your rent/malpractice/ utilites/ computer costs etc?did you make a business plan when you started-- doe s it hold up?MAny times kids are on medicaid and in that case the pay to care for them is so low that it is virtually not feasible to earn a good living without being subsidizedCAn you tell us more about your EMR, does solo mean any staff? and other details?Some area are just dead zones but some folks on the list may be able to offer suggestions in MAine

On Mon, Jul 21, 2008 at 9:11 PM, Fierro <vhfierroyahoo (DOT) com> wrote:

I'm a pediatrician in Miami. I started my office 4 years ago, and I haven't been able to be productive. Currently I'm practicing solo, I see patients from private insurances and from medicaid. In the last month I'm seeing about 30 patients a day (working 9 to 7 with only one hour break for lunch and answering messages). Before that I had hired another physician but we never got enough earnings to get a salary larger than 8000 a month for both of us (we divided that between the two). I'm going crazy, and I'm not hiring anyone else because I don't think that I can afford it.

Can someone give me an orientation in this regards? Is this the way a pediatrician' s life should be or there is a way of being productive seeing less patients?

What is the average number of patients a pediatrician should see to be productive? How do I calculate and get the ideal insurance mix to have a healthy practice and a healthy life?

Fierro

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

myria makes a good pint about why are all thos e people calling/If oneslows down and does the work that needs to be done when they are in- refills etc answer all questions hear their whole agenda one getst less calls later

It goes back to matching supply and demandPeds practices have their own special features i htink

Hi ,

Welcome.

I'm a new IMP. Started July 15th.

I am doing solo-solo without staff.

I hear you about the secretary. How else to manage 50 calls and still see patients? Since I don't have a full panel like you do I'm not entirely sure. Some of it is training patients. Some of those 50 calls were people who weren't used to the answering machine as the previous doc had a secretary and so some of them were repeats. Some of those calls were sales pitches, etc. etc. But for what it's worth I'm using a digital phone that I set to " Do Not Disturb " while with patients. Fifteen minutes of every hour is to return calls. One thing the answering machine does -- makes some people come to the point. My fax is on the same line and if a fax tone is heard the fax machine will pick it up instead of that answering machine. And it's saving it digitally so I can import it to my computer. Others in the IMP Community are using internet faxing or services like One Box and Up Dox. I am using Amazing Charts and find

it much easier to use than eCW and certainly love the price. I will be doing in house billing. The folks on this list serve have been giving feedback to help me with that. I agree with Tim that I work just as hard and maybe longer hours ( to be expected as a newbie) but it is not as stressful as working at seeing more and more patients to pay for overhead. (Some of the reason it's not as stressful is my daughter can be with me when we are printing up business cards or new patient packets, etc. So spending time with her makes less stress for me as a mom and makes me a better doctor, mom, person.) But also remember solo-solo is not the only way to go --- lots of folks here are IMP and have support staff. Others here are morphing into IMP by cutting out lowest paying or big hassle factor insurances and/or cutting staff to 3/4 and gradually phasing out. It takes time. I've been following the list serv and

hooking up with mentors for a year. I also took a business course and currently have a friend teaching me billing/coding and another teaching me phlebotomy. I'll be doing my first order of immunizations next week (there goes the rest of the start up money). It's a very steep learning curve for doing all the stuff I had support staff doing for me all these years. It takes big energy and committment to do this but clearly it's doable with lots of individuals making it work " their way " from cash only to specialty care (endo, neuro, optho and I think we have an ortho IMP too), to adding asthetics from city to rural with some working part time and others full time. Were you comfortable that first year when you were seeing 10-12 patients a day during your first year? Were you stable financially? Were you happy? What would have been your salary if you weren't paying the front desk person? Was Medicaid the tipping point

that started making the need for more and more visits? Is it time to say good by to Medicaid? As to Open Access I've lost track of the original formula but I plan on capping my panel at 800 because the figures seem to indicate that will be about 8 calls per day for same day access and my schedule allows for 12 visit per day at full capacity. I hope the sharing of my new practice gives you encouragement to find what will work for you to get off the hamster wheel that only leads to burnout and frustration. Pick one change at a time -- eliminate an insurance, start using EMR, cross train staff and don't replace if one leaves, etc. etc. I have never been happier. Myria (family practice, upstate new york, Amazing Charts)

> Equipment rental ( a CBC machine that gives me nightmares every time I have

> to pay for the CLIA permits): 300>> Insurances (malpractice, liability, health for employees): 4000>> Billing company: 8% of collected:

3000-4500>> Licenses and permits: 400>> Rent: 3200>> Salaries: excluding the doctors: 16178>> Vaccines 14000>> Payroll taxes: 1370>--

Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Thanks, thanks, thanks!

Your advices are very interesting, but they sound a little scary for the change to happen.

Currently the phone calls that my office receives are for schedulling, referrals, people asking if we carry a particular insurance or the characteristics of the practice, or medical questions, the latter are written down and I take care of them. I guess in a solo/solo practice I would have to take care of all those.

Also the secretaries address the registration of the patients (checking if their insurances are active and if their data are correct, and even with that sometimes the data is inaccurate).

I don't know of any pediatrician in Miami that has a practice without staff, and it would be very difficult for me to lay off the personnel that has been with me for four years.

I'm thinking in adopting Amazing charts ( I see that many of the people in the group use this system and it seems to be cheap), and try to restart billing in house with the charts that I pass to electronic, keeping the current system in paper and with the billing company until one of my secretaries feels comfortable doing all the billing. Then I would have to really be very, very business strong and fire the rest of the staff.

The vaccines issue is difficult, because I know that insurances reimburse differently other practices but I don't have the strength to move their arms towards increasing their fees for me. The AAP and the Florida Chapter for the AAP is all the time sending e-mails and complaining about the decrease in the reimbursement for vaccines (that is without including the administration fees) but they havent' been able to help. I will seat again this week and reevaluate each vaccine and the payment that I receive for them to see if it's worth it to give them. I will problably open another question to the group regarding that.

Re: number of patients to be seen/ Ideal insurance mix

myria makes a good pint about why are all thos e people calling/If oneslows down and does the work that needs to be done when they are in- refills etc answer all questions hear their whole agenda one getst less calls laterIt goes back to matching supply and demandPeds practices have their own special features i htink

On Sat, Aug 9, 2008 at 10:46 AM, Myria <myriaemenyyahoo (DOT) com> wrote:

Hi ,

Welcome.

I'm a new IMP. Started July 15th.

I am doing solo-solo without staff.

I hear you about the secretary. How else to manage 50 calls and still see patients? Since I don't have a full panel like you do I'm not entirely sure. Some of it is training patients. Some of those 50 calls were people who weren't used to the answering machine as the previous doc had a secretary and so some of them were repeats. Some of those calls were sales pitches, etc. etc. But for what it's worth I'm using a digital phone that I set to "Do Not Disturb" while with patients. Fifteen minutes of every hour is to return calls. One thing the answering machine does -- makes some people come to the point. My fax is on the same line and if a fax tone is heard the fax machine will pick it up instead of that answering machine. And it's saving it digitally so I can import it to my computer. Others in the IMP Community are using internet faxing or services like One Box and Up Dox. I am using Amazing Charts and find

it much easier to use than eCW and certainly love the price. I will be doing in house billing. The folks on this list serve have been giving feedback to help me with that. I agree with Tim that I work just as hard and maybe longer hours ( to be expected as a newbie) but it is not as stressful as working at seeing more and more patients to pay for overhead. (Some of the reason it's not as stressful is my daughter can be with me when we are printing up business cards or new patient packets, etc. So spending time with her makes less stress for me as a mom and makes me a better doctor, mom, person.) But also remember solo-solo is not the only way to go --- lots of folks here are IMP and have support staff. Others here are morphing into IMP by cutting out lowest paying or big hassle factor insurances and/or cutting staff to 3/4 and gradually phasing out. It takes time. I've been following the list serv and

hooking up with mentors for a year. I also took a business course and currently have a friend teaching me billing/coding and another teaching me phlebotomy. I'll be doing my first order of immunizations next week (there goes the rest of the start up money). It's a very steep learning curve for doing all the stuff I had support staff doing for me all these years. It takes big energy and committment to do this but clearly it's doable with lots of individuals making it work "their way" from cash only to specialty care (endo, neuro, optho and I think we have an ortho IMP too), to adding asthetics from city to rural with some working part time and others full time. Were you comfortable that first year when you were seeing 10-12 patients a day during your first year? Were you stable financially? Were you happy? What would have been your salary if you weren't paying the front desk person? Was Medicaid the tipping point

that started making the need for more and more visits? Is it time to say good by to Medicaid? As to Open Access I've lost track of the original formula but I plan on capping my panel at 800 because the figures seem to indicate that will be about 8 calls per day for same day access and my schedule allows for 12 visit per day at full capacity. I hope the sharing of my new practice gives you encouragement to find what will work for you to get off the hamster wheel that only leads to burnout and frustration. Pick one change at a time -- eliminate an insurance, start using EMR, cross train staff and don't replace if one leaves, etc. etc. I have never been happier. Myria (family practice, upstate new york, Amazing Charts)> Equipment rental ( a CBC machine that gives me nightmares every time I have> to pay for the CLIA permits): 300>> Insurances (malpractice, liability, health for employees): 4000>> Billing company: 8%

of collected: 3000-4500>> Licenses and permits: 400>> Rent: 3200>> Salaries: excluding the doctors: 16178>> Vaccines 14000>> Payroll taxes: 1370>-- Graham Chiuhttp://www.synapsed irect.comSynapse - the use from anywhere EMR.-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax