Guest guest Posted March 11, 2012 Report Share Posted March 11, 2012 Welcome!Jean et al I'm yet another lurker... I have posted here once or twice, but mostly just absorbed for the last 5 years in med school and residency--I finished last summer, fam med).... I hung my shingle up last month, and am up to 4 patients a day, which my math says pays my expenses (but not me). Any more is mine :-)... See www.ardasclinic.com, I have my components listed there (Practice Fusion rocks), and my name (I'm too shy of web search bots to post it here). We are a reincarnation of a nonprofit clinic that is going under. However I'm an LLC, not 501c3. We are 60% Medicaid (average $70 reimbursement in this state), 35% no insurance (or this terrible local program called CICP), and 5% insured or MCR. We basically serve the local refugee population (they get MCD 8 months), and I have a pile of interpreters, volunteer local undergrad pre-health students. We'll see how long this lasts, but thanks to all you guys for the inspiration...oh , please add me to the map if you are still keeping it up! -P -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2012 Report Share Posted March 11, 2012 PJ,Congratulations on getting your practice started! I have added your practice to the IMP Map. Some comments and suggestions:1. You have a nice website, but I think it is too wordy, especially if a large part of your target patient population are non-native English speakers/readers. For example, while we on the listserv might appreciate that you use Kareo, SuperSAAS, and RingCentral, I don't think most of your patients would care or even understand what your tools are, as long as they work.2. For marketing purposes, best to stay positive. You don't have to say stuff like, "This is not a collection of irregular volunteers." That is like saying, "We are not brain-eating zombies." No need to conjure up bad imagery that is unnecessary. How about, "You will see the same doctor every time you come in." People will appreciate that simple sentence without you having to explain that it is "important for continuity of care". 3. I don't think you need to post the CPT codes for labs and vaccines. They are just a source of confusion for most people (even native English speakers with advanced degrees). 4. I think most of your posted prices are lower than what insurance will allow. For example, your price for Tdap is $36. Anthem pays me about $45. Your price for Hep B is $61. Anthem pays me about $72. Of course, Anthem's rates will be different in your area, but you get the idea. If you bill insurance $36 for Tdap, they will only pay you $36 even though they would've paid you up to their allowed amount. This is one of the dilemmas we physicians have. We don't want to charge uninsured patients too much, but we have to charge more than what insurance will pay otherwise we will be losing money. Since you probably don't know what insurance will pay, many doctors base their fees on a percentage of what Medicare allows, since Medicare posts their fees publicly. 5. Under the section that says "Private Insurance", you state that "if you have one of these [insurance plans], and were previously seen at CAHEP clinic, then we will see you for FREE for now (no copay)." This could cause potential problems for you. If you are non-participating with those insurances, then their insurance plan may not cover out-of-network visits, in which case you would get nothing from the insurance company. And if you told the patient you'd see them for FREE (for now), it'd be hard to ask them to pay you later because you said you'd see them for FREE. If you are in-network with those insurance plans, then it is a violation of your contract to not attempt to collect the copay. 6. Can you really sustain a practice based on your posted fees? Most of your fees seem just a little above your cost for supplies. If you can't pay yourself a decent salary, your practice will not survive for very long. If your payments come mainly from low-paying Medicaid or self-pay fees, the only way you will be able to make enough money will be by seeing more patients. If you see more patients, you will have less time to spend with them, which is the opposite of what the IMP model is. There is a saying that should be the motto of every IMP: "No margin, no mission" where "margin" = "profit margin". Perhaps you should consider attracting more than 5% of your patients with 3rd party insurance to help boost your income so that you can continue your mission of helping uninsured, low-income patients. One extreme but successful practice model is St. Luke's Family Practice in Modesto, CA which uses what has been called the "Robin Hood model". This model has benefactors pay for personalized primary care with an annual fee similar to a retainer or concierge fee, and these fees directly fund medical care for those with no insurance.http://www.stlukesfp.org/I'm not saying you should adopt this model. I'm just pointing out that "those who have" are the ones who end up paying for "those who have not". And if they don't, it will be you paying in the end. Hopefully, you can figure out how to make enough money to pay yourself a good salary and keep your practice going for a long time. Best of luck to you in your new venture! SetoSouth Pasadena, CA et al I'm yet another lurker... I have posted here once or twice, but mostly just absorbed for the last 5 years in med school and residency--I finished last summer, fam med).... I hung my shingle up last month, and am up to 4 patients a day, which my math says pays my expenses (but not me). Any more is mine :-)... See www.ardasclinic.com, I have my components listed there (Practice Fusion rocks), and my name (I'm too shy of web search bots to post it here). We are a reincarnation of a nonprofit clinic that is going under. However I'm an LLC, not 501c3. We are 60% Medicaid (average $70 reimbursement in this state), 35% no insurance (or this terrible local program called CICP), and 5% insured or MCR. We basically serve the local refugee population (they get MCD 8 months), and I have a pile of interpreters, volunteer local undergrad pre-health students. We'll see how long this lasts, but thanks to all you guys for the inspiration...oh , please add me to the map if you are still keeping it up! -P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2012 Report Share Posted March 11, 2012 Thanks ! I appreciate the thoughts, and have already made edits based on them. Some responses: 1. The website isn't just aimed at my patients, they can't read English or anything else for that matter. The site is aimed at other providers, the local poverty medicine community, my MA and volunteers, and me. The stuff about my components (Ring Central, etc) is indeed aimed at other current or future providers, who want to know my operation....I know that I was inspired by reading the components you guys use, but I know not all potential providers read this listserv! 2. You are right about staying positive...some comments were directed at certain audiences, based on a colorful history, but I will spare those details here. I have edited it now! 3. The CPT codes are directed at me and my MAs, this is simply our place to look when we do billing. I already have too many windows open on my computer, so I am trying to combine the functions of having a " menu of services " for customers, with my " most common used CPTs " for my own billing. 4. My posted prices are indeed lower than what insurances allow. The posted prices are for my self-pay patients, with a PATOS discount off of what I bill the insurances.... In other words, I bill the insurances an amount over what my top payer (UHC) pays, then I discount that for PATOS. The vaccines are indeed my exact cost, plus a $14 admin fee (the local VFC allowance); the blood draws are my cost (ridiculously low through a poverty clinic network I am part of) plus a $20 draw fee. 5. I'm not sure what to do about the insured folks that come in. I was seeing these patients at another practice that " went out of business " , and alot of these folks considered me their doctor. So, I saw them before, and I am seeing them now, but there is a month or two gap here while the insurance contracts come through now.... I agree this is sticky territory, but luckily it will be only a few patients (actually only one so far)... 6. I will have a " decent " salary when I get up to 10-15 patients a day. This won't take long because I am picking up my own patient base, from a practice that went out of business. 30 minute appointments still leave me time to do all my own billing and referrals. As we all know here, our individual situations are very personal, as to what we consider a " enough money " ...that's a separate philosophical discussion....I'm sure the folks on this list range in take-home pay from 30k to 300k, and even wider range if we talk $/total hour worked (would be an interesting survey?). I've checked out St Luke's previously...I think most of you guys on this list are Robin Hoods of sorts, all sacrificing some $ in the name of better care. > > > et al > > > > I'm yet another lurker... I have posted here once or twice, but mostly just absorbed for the last 5 years in med school and residency--I finished last summer, fam med).... > > > > I hung my shingle up last month, and am up to 4 patients a day, which my math says pays my expenses (but not me). Any more is mine :-)... See www.ardasclinic.com, I have my components listed there (Practice Fusion rocks), and my name (I'm too shy of web search bots to post it here). We are a reincarnation of a nonprofit clinic that is going under. However I'm an LLC, not 501c3. > > > > We are 60% Medicaid (average $70 reimbursement in this state), 35% no insurance (or this terrible local program called CICP), and 5% insured or MCR. We basically serve the local refugee population (they get MCD 8 months), and I have a pile of interpreters, volunteer local undergrad pre-health students. > > > > We'll see how long this lasts, but thanks to all you guys for the inspiration...oh , please add me to the map if you are still keeping it up! > > > > -P > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2012 Report Share Posted March 12, 2012 I think that your most interesting aspect is the volunteer staffing. It's clear to me that you don't have the budget to pay for enough staffing to see >60 patients per week. I guess you have some folks from the previous incarnation willing to help out? It seems that it would be harder to recruit volunteers to a technically for-profit outfit...but hopefully you're well enough known in the community that people are willing to work for free for you, even though you're getting paid...and that people understand that you're providing last-resort services below cost.... All the best! Keep us posted. Haresch www.onefamilydoctor.com > > et al > > I'm yet another lurker... I have posted here once or twice, but mostly just absorbed for the last 5 years in med school and residency--I finished last summer, fam med).... > > I hung my shingle up last month, and am up to 4 patients a day, which my math says pays my expenses (but not me). Any more is mine :-)... See www.ardasclinic.com, I have my components listed there (Practice Fusion rocks), and my name (I'm too shy of web search bots to post it here). We are a reincarnation of a nonprofit clinic that is going under. However I'm an LLC, not 501c3. > > We are 60% Medicaid (average $70 reimbursement in this state), 35% no insurance (or this terrible local program called CICP), and 5% insured or MCR. We basically serve the local refugee population (they get MCD 8 months), and I have a pile of interpreters, volunteer local undergrad pre-health students. > > We'll see how long this lasts, but thanks to all you guys for the inspiration...oh , please add me to the map if you are still keeping it up! > > -P > Quote Link to comment Share on other sites More sharing options...
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