RE: money/disease management.

[Guest guest]

, Your numbers are right on, but I never said I am able to see a 99214 each hour. I simply do the math collections divided by visits and it come up $91. Now we have many different types of payers. BCBS will pay $180-250 for a complete physical with screeing labs and a pap. Medicare will pay us $79 for a 99214 and $18.72 for a lipid profile, $2-4 for fasting glucose in a Diabetic and hypertensive atient with hyperlipidemia. Thats about $100 with the test cost of $8.80. Now as an internist, I do not have any pediatric patients so my population is skewed slightly, but at last count I had 25% medicare patients most with 3+ chronic medical conditions who account for 40% of our visits but only 34% of revenue. The other patients are less than 65 with between 5-8% medicaid, which pays only .25 cents on the dollar charged. As of today we have seen 1185 patient

visits and collected $105,000 for 88.60 revenue per visit. My business plan calls for $135/hour so we should be able to see a patient every 40 minutes when demand reaches that level. Hope this helps perspective on your population as well. Our next challenge is disease management. We have 450 patient with a combination of hypertension, diabetes, and hyperlipidemia. Seeing each patient just once every three months would generate 1800 followup visits. We are starting to think about using the callender year to phase appropriate interventions so that time is not wasted wondering what needs to be done at a visit. A quick check of last visit if a visit was in the 1st quarter, results should be ready or completed. It is now the second quater so liver functions and fasting glucose or lipid profile is due. Next quarter flu shot. I would realy like other to discuss the

possibility of setting up a system like this. The concept is interval based health care for chronic disease, with certain guidlines checked each quarter. Once every 5 years could be push for saigmoidoscopy. What doi others think. P.S. Once developed one could easily make analysis of costs and revenue. Brock DO wrote: I must be missing something. If you are truly averaging $91 for every pt that walks in the door then: two/hr = $180/hr. If you work 8 hrs/day x 4.5 days/wk x 48 wks/yr that comes out to $311,000/yr before overhead. Even with a traditional 50% overhead you would still be bringing in over $150,000/yr. Now, if you have chosen to work less than these hours I quoted then that is different (personal choice). I could not average $91 per patient without upcoding illegally or not taking any self-pays or Medicaid. Sure, some visits pay more than that but the large majority pay between $50 & $80. -----Original Message-----From: [mailto: ] On Behalf Of GuinnSent: Wednesday, September 13, 2006 9:43 PMTo: Subject: Re: money $91.00 per patient visit is about what I average also - about 2000 visits/year. FPs in this town have never averaged $160,000 year. Hi Larry: Let me assume some numbers for now as follows 2000 patients 300,000 collections 150,000 overhead 150,000 salary Collections per patient then 300,000/2000 or $150/year per patient or a little over $12/ month per patient. My practice has fewer patients but last year we collected $200/patient but still less than 20$ per month per patient. I still feel the way we make primary care affordable is by asking patients/insurers/ and employers to pay $1/day. The only other way to increase revenue and salary is to provide quick care. A friend who provided urgeant carewould see 30-40 patients per day in quick care working 3-4 days per week. He was seeing 4-6 patients per hour. Most 99313's one problem one prescription $50-70 per visit or 200/hour $1600/day. 2000 hours per year 400,000 overhead 200,000 salary. In our low overhead clinic with just medicare, if we could see enough patients with higher level visits for 99214 at two an hour we would collect $158/ hour. For 2000 hours $316,000 in overhead. As it is we are at 35-40 patient per week most are 99214 with in house lab we collect about $92 per patient visit. Overhead is $60,000 to increase to $80,000 next year. At 2000 visits per year we will collect about 180,000. pay $100,000. We feel we will be able to increase daily visits but keep hours the same and hope to evetually provide salary and benefits of $150,000 per year. Note your income is a combination of salary, benefits, CME, professional liscences, health insurance, disability insurance. $20,000 of our overhead covers these expenses. So our real income and benefits is actually $100,000 this year for seeing less than a patient an hour. But is I needed $150,000 in salary alone, I do not see that as possible unser the IMP model or any primary care model for that matter. Larry Lindeman <llindemanmac> wrote: Recently I have had money on my mind. After 2 years in my new practice I an finally close to making $150,000 which is still less than I made at my old job. However I am finding it difficult to figure out how to make anymore than that since I don't think that I can see any more patients in a day. The median income of FP's is over $160.000/yr. How many of you are making more than the median FP income and what are you doing to make that much. If the micropractice model is not capable of producing enough income to provide at least the median income it is probably not going to be a viable model.Larry Lindeman MD Stay in the know. Pulse on the new Yahoo.com. Check it out.

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