Time to Jump

[Guest guest]

I joined this group 8 years ago, and this is probably my first post in 6. Yet,

reading through some of the recent messages, I still recognize a lot of the

names. Like old friends.

My story is a familiar one. When I joined, I had a small, solo practice in a

high-need area. I was trying to live by many of the IMP principles, but I lost

control. Ultimately, my practice grew, and grew, took on a partner, that didn't

work out, on the brink of poverty, joined a large multi-specialty group and

allowed my 1 Dr, 1 MA, and 1 receptionist practice grow to a 2 Dr, 2 NP, 2 RN, 2

MA, 1 receptionist, and 1 manager (and we still outsource billing). And it's out

of control. We have a several week waiting list and are directing many patients

to the ER during office hours. And I am having trouble finishing my notes in a

timely manner, and my employers are screaming about red ink.

So...

It's time to jump. I cannot do this anymore.

I actually just came to this conclusion on Monday. Lots of decisions yet to be

even thought of! Direct pay or membership or traditional insurance? Keep billing

in-house or outsource? Finding a location.

The big questions are to come. But, for now, a couple of little nagging ones

that have me wondering about the upcoming business plan...

1) We now have a full-time medical assistant who simply handles prior

authorizations and pre-approvals. Maybe this is somehow unique to my location,

but has this hassle effected the IMPs in a bad way? I watch her on hold for 20

minutes to get someone to approve the MRI I want to order. How does this work in

a low-overhead, no-help practice?

2) If I were to go to a cash practice, and I am not listed as the PCP for all of

the local HMO practices, and these patients need services like PT or radiology,

would they be left responsible for these bills because I was the doctor that

ordered them? I know now that my family practice often gets calls from patients

that I have not seen for a particular problem needing our office to get

pre-approval for something like PT that was ordered by a local ortho. (Drives me

crazy!)

Thanks for your help!