Low income Population IMP

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, we're struggling to continue meeting our low income population.We just gave raises and increased hours to our two staff as we're committed to them having a living wage. So we suddenly have our part time biller, bookkeeper at 30 hrs at 18$/hr. and our receptionist/ patient care coordinator at $18 hr/ 37.5 hr week. Gives us a base expense of 300K - with me taking home 80k a year and my partner 60K a year (he is well subsidized by his wife). We currently see just shy of 200 patients/ month so now need to make $150/ visit. We think we can get to 250 visits/ month but still need to then make $100/ visit.We want to give same quality long visit care with email and phone access to all- but see so much Medicaid and non insured no money $50/ visit folks also know unless we set up different systems- and we are trying to simplify systems- not sure what to do. Looking for ideas of how to make ends meet. Thinking about asking for donations to support our low income population but don't want more paperwork of going non profit.Very nice email - well said. Seems ok by insurances to charge annual fee for non covered services even when folks have insurance? And your annual fee doesn't come across too onerous... Weakland, MDng Ballard Neighborhood Doctors5416 Ave NWSeattle, WA 98107Phone: Fax:

Actually my experience is more in line with ’s. When we opened and operated our first site I started giving out my cell phone number and e-mail with some trepidation I must confess (e-mail not such a problem because most of my patients are too poor to have internet connection at home). My approach was if it gets too crazy I will simply change my number and that is that. To my surprise most my patients were very respectful of the use of the phone and the calls I got, except for my super anxious pt that though he was having an MI every other day, were very appropriate. By the way I did stop my anxious pt form going to the ER more often than not. As we open our second site (long story to be told off line to save you some time) in one week I plan to give my phone number and e-mail address to all my patients with explicit instructions of when to text and when to call (I even have a hand out explaining it in English and Spanish). Given the population I serve (very low income low literacy individuals) I will not be able to add the fee for this service but… se la vie Anyway these are my two cents on the subject… and I am sorry to hear your Friday was less than stellar J Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone "Don't ever let injustice go by unchallenged." From: [mailto: ] On Behalf Of SetoSent: Saturday, January 21, 2012 12:42 AMTo: Subject: Re: just need to express myself Walter,I have a different take on e-mail access. When I set up my practice, I tried to set it up to be the kind of practice I would want if I were a patient. I try to make it as easy as possible for patients to get a hold of me, which means I give out my cellphone and e-mail address to everyone. And yes, I get stupid questions by phone calls and e-mail that are no more stupid than questions asked in person at an office visit. The questions may seem stupid to us because we already know the answer, but it's not stupid to the person asking the question. ly I'm happy to educate patients about relatively simple and benign health issues, more so than having to counsel them about the breast cancer or DM they were just diagnosed with. I don't mind spending 5-10 minutes calling the patient back to reassure them that their BP is normal and unlikely to be the cause of their fatigue ("and by the way, since there are many causes of fatigue, let's schedule an appointment"), especially if it saves them a trip to the ER where they wait 2 hours to be seen and end up with a $500+ bill. And you know there are patients who will do this because they don't know any better. If I can, I want to be my patient's trusted advisor and partner in healthcare, rather than forcing them to fend for themselves. But I have to admit that my practice charges a small annual fee ($150) that covers things like e-mail and phone consultation that insurance doesn't pay for, so I don't have to feel like I'm getting nothing for my services. Anyways, , I sympathize with you. I have those days, too, where I don't want to work anymore, but because of the way I've set up my practice, it's easy for patients to contact me with stupid, as well as smart, e-mails. But why do they always seem to come on a late Friday afternoon, right? I don't mean to say that everyone should give out their e-mail address to their patients. There seem to be as many ways to run a medical practice as there are medical practitioners. I just want to point out that in each of our practices, our systems are perfectly designed to give us the results we are seeing. So if you don't like the results you are seeing, then you must change your system somehow. SetoSouth Pasadena, CA That’s definitely the problem with blanket e-mail access. You get stupid e-mails and then you feel obligated to respond. On the other hand, with a phone/answering message that says if it’s an emergency go to the ER, otherwise wait til Monday, you relax better because you put it in the patient’s ball court, where it ought to be. I have given e-mail access to a handful of patients and I universally regret doing so. Having done so, I have a problem to solve. WK From: Gordon Sent: Friday, January 20, 2012 4:50 PMTo: practiceimprovement1 Subject: just need to express myself i may be annoyed because friday is my early day and i've been at the office since 715 but in the past 20 minutes i've had an email, a general voice mail and now a call on my urgent line from someone wanting to know what to do about their blood pressure being 135/80 and feeling tired... sorry to intrude on your day as we all get too many emails to start=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19100)http://www.pctools.com=======