Re: Office Testing (RE: Thanks for the input, Keep it coming)

November 8, 2006

In IMP practice, minimize lab/hassle/overhead, keep life simple, avoid

stress (especially at the beginning). You can easily add complexity later

(if you're a glutton for punishment by then). Starting out is tough enough

without adding to complexity and confusion.

In addition to simple tests like dipsticks & Hemoccult, I also use Nitrazine

pH paper tape for all vaginal exams -- it costs pennies per exam (a half

inch of tape), takes seconds, and only changes color (pH over 4.5) if there

is BV or trichomonas (both treated by Flagyl), so I call it BV if odor, or

trich if bubbles, but the treatment is right for both. Both are contagious,

while monilia is not but does not elevate pH or need partner treatment, so I

treat monilia only if itchy with pasty white discharge. I am a recovering

microscope addict who can't get one in the office where I work now, but I

find my treatment is just as good this way, and I even pick up some cases

where the patient didn't mention discharge in the chief complaint. I always

document pH in every vaginal exam (pH 4.5, 5.0, etc) to support normal or

vaginitis. Clinical judgment should also tell you if an elevated pH is

occasionally from atrophic vaginitis or a copious cervical discharge

instead.

I don't bother billing for a urine dipstick, Hemoccult or vaginal pH,

because it's not worth the hassle for seconds of my time (like billing for

tongue blades or table paper). I'm selling primarily my encounter time and

clinical judgment.

I use a courier lab (Quest, which interfaces with my Praxis EMR) for most

tests, and I centrifuge blood & keep in fridge until pickup. X-rays are

sent out to hospital or free-standing facility, and they bill

insurance/patient. They do the hassle, I just practice here.

Wes Bradford

Thanks for the input, Keep it coming.

I just want to thank everyone for the input. I think I may move forward with

a contract lawyer and see how it goes from there.

Things I need an opinion from thos more experienced so I may sleep better at

night...

1. given that my practice will be very close to the new hospital I will be

able to send virtually all pts to their rad/lab for tests and could limit my

initial overhead. On the other hand I want to provide as much for my pts as

I can. I know I can grow a limited lab in my office but not sure what I

should start with. Coming from residency, I have no clue what lab services

are financially feasible and what are not. There are lots of new

" minimalist " lab equipment from very small machines, to just fancy clia

waived dip tests for all kinds of things. Can you guys help me come up with

a start up plan for this stuff?

2. Not quite the micro practice, but here is my theoretical startup plan.

Start-up with eMDs and an office " manager " type person (a good friend of

mine who I can trust, is an accountant and can be very flexible with $/time

and willing to learn) to help with phones, billing, pt check in, etc. And a

medical assistant. With clear cut job descriptions that everybody does

everything as it needs done.

Does that sound good or like too much?

3. As someone mentioned before, I will have to take all insurance

plans/payors that the hospital takes " within reason. " But the town has a

good payor mix. Near Dallas, ~50% of the working pop commutes to work in the

city. The other half works in the many large corporations that are located

in/just outside the city. City is growing quickly and has a good portion of

young working people. This is the good thing about the whole area around the

DFW metroplex..it is growing rapidly and there are alot of workers making it

do so.

Now the whole billing/collecting process is where I know I will likely be

burned and learn the hard way...but I will do my best to plan for that. The

medical office consultant is actually to help me to negotiate insurance

contracts...I can use them as needed. This may sound like a waste to you,

but since I really don't have working experience with this I would rather

invest in getting the help to try to do this right, esp since it will be

paid for as part of my " loan " to be paid of with time in the town. (4 yrs

after guarantee yr). I feel like I should take advantage of this help.

...have much more to ask, but just got a page...gotta go round on some

cardiology patients! Have a good Sunday. God bless you all! ...and keep the

opinions/thoughts coming.

November 8, 2006