Re: Re: Practice Startup Questions

May 24, 2012

Welcome, Newbie!

You will need to establish some sort of organization for your new office - corporation, partnership, sole proprietorship - and then you need to apply for an NPI for that organization (unless you opt to do Sole Prop, which I am NOT sure how you bill for that). Then, when bills go out for your new office, they get paid to your new organization. When bills go out for your current organization, then they get paid under their organizational NPI.

You can limit your practice (and, in fact, you should) to any % of patients you want per insurance. So, if you reach your 10% limit, then you close to new patients for that type of insurance. I will advise, however, that you might want to beware of this when you first start out. There will be attrition. Some patients will come to you, and never come back, or may come infrequently, so in reality, even though by sheer numbers you hit 10%, if those patients do not frequent your office, then in $$, the % will be lower. Our practice closed for a bit to new Medicare patients, but we are now accepting all new patients. We do not take Medicaid, either as primary or secondary insurance. We are also not contracted for all plans for all insurers (Blue Shield of CA has just come out with some very unreasonable contracts that we were not willing to contract with). It is up to the PATIENT to determine whether or not we are participating in their plan or not because it is much too difficult for us to keep track for them.

Open Access scheduling takes a lot of finesse. Something I am still trying to teach our assistants. We try to schedule not more than 4 extended visits per day (new patients or physicals), and we try to leave open 4-6 slots per day for same-day visits. Sometimes, we have wide open days (last week on Monday, we had 9 slots go unused, but today we are completely booked, and it is only 10:15am, and tomorrow I am limited to 4 walk-in slots, which the staff will have to be very careful about booking - we have a total of 18 slots per day, with extended visits using 2-3 slots each). If you are doing your own scheduling, you will get to know which patients require more or less time, and you can try to fit them in accordingly. We have patients now who were patients from the beginning of our practice, when they could say exactly the day and time they wanted to come in and we could accommodate that, but even though we can still offer them a same-day appt, they get torqued when they can't come in when they dictate. Just a caution...

You do not necessarily need to re-credential if you are already credentialed with most insurance companies. Contact the Provider Rep and tell them your plans and find out what you need to do. First things first, you need to determine the type of organization that you want to open, and then sign contracts. But since you, the provider, are already credentialed, it should be a little quicker than if you were relocating to another state and starting from scratch.

Lots of info here.....read, re-read, listen to what everyone on the IMP list has to offer, and pick and choose what you think will work best for you. And don't be afraid to make changes as time goes by so that you are happy :-)

Good luck in your new endeavour!!

Pratt

Thanks for sharing your story, Adolfo! I am assuming you can put an effective date on the new contracts? What my concern is, I may have to stay on part time with my current employer (1 day a week) doing manipulation/sports medicine as that is my " niche " and they don't have anyone else to do that as a way to " compensate " them for paying off a huge chunk of my student loans. In my contract, I get x amount " forgiven " for what they have paid on my behalf for every year I stay on. This was spread out over 6 years. No way in hell I'm gonna make it 6 years so I'm on the hook for whatever is left--at this point $125k. My thinking is, if I say I will stay on 1 day a week doing this for them, maybe we can work something out where I can still leave and do my own practice and not have to get a loan to pay them off.

Back to my concern--what if we both take the same insurances--me in my IMP and then working as a " specialist " there? How would that work? >> Dear newbie, we are newbies too. we have so many questions and we always ask. I found this IMP list like an oasis because I can always find

> many helping hands for my doubts. > Â > Regarding questions number 1, I am not a lawyer but you make decisions Â regarding the limit of your patients.

> We opened Orange Doc in November 2011 ( you see newbie). We are 2 mojicans jejejejeje, my wife Ardiana ( my rock) a pediatric NP and I a family doc. > She loves kids and I told her follow your Passion so she makes my practice vibrant and active when I heard crying on her room.

> I made the decisionÂ to not accept medicaid only for adults, I do as a secondary of medicare. I learned that medicaid always refused to pay me when is second in line.

> We made the decision to allow medicaid only for kids, since there are a lot medicaid kids in the area. She only has to see 30% of her patient population to qualify for uncle sam money. I think you are the one making the decision to open or close the doors in that matter.

> Deep in my heart I can tell you that I really do not care about uncle sam money. I think there is not such a thing like a free lunch. I think uncle same will make sure to make your life miserable in the future so you will pay with your blood for the pennies that he will give you. I think all the committees of the uncle sam will make sure that the quantity of requirements will quadruple and you or your office will have a hard time to full fill the requirements ( I think that the nature of the beast).

> Â > regarding your questions about the scheduling, I have appointments and also patient portal's appointments. I can tell you what I do:> New patients I spent like 45 minutes the first visit, I make sure I got all the info and questions answered. I want to know when was the last colon eval , mammo etc.

> I make sure that I listen to them and give them undivided attention. Also I make a full physical exam,head to toes. > I noticed that when they come back to follow up I do not have to spent the same amount of time gathering the info. I am quickerÂ with the F/Us. > Our plans is to see patients and not practice treadmill medicine, that is the goal of IMP type of practice. > We are getting fuller day by day, sometimes I have 1 patient in my schedule and them 5-7 call wants to be seeing. I can tell you that sometimes I see 12-11 patients in day.

> We are open M,W and F only. I am doing urgent care and my wife still working as NICU RN. Our goal is to go to M-F soon and quit our side gigs,when? I do not know. > I can tell you that we were asking every month to the bank money to operate the clinic. I think that last time that I asked the bank money was in January. Orange Doc is paying itself ( except our salaries, we are not getting paid) every month.

> My wife is holding the fort because she deals with the phone calls from every body, she does the billing and the pain in neck insurances. She does not have a lot of experience but she work hard to make sure we get paid. She also see her patients part time. We have no staff working for us for now.

> I think we are going to have gaps for same day appointments for those patients that need to be seeing now. > Â > Regarding the questions about the credentialing process, I was in your shoes before not wanting my employer to know about my plans,it is very stressful dealing with that. > I can tell you that my experience with corporate America is not the best. I think God bless me because I got laid off from a previous Urgent care where I got betrayed by my employer and then I found this new UC job and the guy was fulling around with me and he gave me a part time only.

> I took the part time and bite the bullet and look around my town for the correct place until I found it. I made my corporation and I look for a person to help me with the credentialing part. I know a lot of people in the list would tell you that you can do it only via CAHQ something, I hire that person and she started the process since 08/2011. You have to have a physical location to start the process you can not use a P.O. Box. I spoke to my future land Lord and told him that I needed to rent the office 3 months before I open the doors and I asked him to give me those 3 moths free ( what the heck what I had to loose).

> He did not give it to me for fee but he cut 50% > My credentialing person did all the paper work believe me it is worse then buying a house, do you have time for that? I did not so I hire her.> You have to create new contracts with the health insurances since you are working under a different umbrella or corporation.

> I had to submit a form to Blue cross of FL to divorce a previous practice that takes time.> Basically you have to make sure that you have the time and money to be able to make the jump. > Â > Dealing with the banks is another 200's pages story. > Â > anyway my 1/2 cent. If you want contact me off the list and we can chat I can tell you my experiences. > Adolfo> you can find us in Youtube : OrangeDoc > you can see our tour video of my practice .

> www.orangedocfamilymedicine.com> Â > > > To: > Sent: Thursday, May 24, 2012 9:32 AM> Subject: Practice Startup Questions

> > > Â

> I just want to say what a blessing this group has been! I look forward to seeing emails from the listserve pop up on my phone as I always learn so much! > > I am hoping to start my own IMP within the next two years (preferably as soon as possible). Here's some questions I have for the group (and please forgive my ignorance and naivety):

> > 1) Is it legal to limit the amount of medicare/medicaid you will accept? That is, I want to limit my practice to 5 or 10% medicaid as it pays so poorly here (TN) but I have patients who have established with me in my current practice that I would like to continue to take care of but I want to be financially viable, which I can't be if I leave the doors wide open to all comers.

> > 2) For those of you who have " niche servicess " within your practice - i.e. accupuncture, etc. how do you handle the open access for these patients for whom you are not providing PCP care with those patients for whom you are the PCP? I currently do manipulation (OMT) and plan on adding accupuncture services in the future.

> > 3) With open access scheduling, how do you control your schedule in the beginning when the majority of your patients will be new? At what point do you restrict your new patient appts to maintain 24-48 hr availability for those who are established? I know it varies between practices, but what % of appts do you schedule out vs leave open?

> > 4) I am currently employed and contracted with several plans some of which I will continue to accept when I am on my own...how is it handled when you continue to work under the plan in one practice while you are trying to open another practice? I have not yet told my current employer that I plan to leave as I want to have as much as possible thought out/arranged ahead of time before I make the leap. I do have to give 6 months notice and will do that, but I know the recredentialing can sometimes take awhile and I'd like to move as smoothly as possible from one to the other as I can't afford to take a large amount of time off.

> > Thanks for the input! I'm sure there will be a ton more questions as I pursue this journey!>

-- Pratt

May 24, 2012

it seems that you are in a hard spot when you said: "No way in hell I'm gonna make it 6 years".

I do not how that work, I never had students loans, I gave my government free labor for 2 years to pay for medical school expenses.

I do not know how may years you stayed already, I do not know if you contract with the loan forgiveness is 6 years or nothing?

if you stay 5 years and not 6 years then you have to pay all the money back.

If you are not happy in your situation like: No way in hell I'm gonna make it 6 years, then you have to figure out a way to leave it.

Maybe consulting a lawyer to eval options.

I think like mentioned when you open your shingle you have to get a NPI for it.

When I opened my practice I was still at another clinic in Blue cross file ( I was not physically working there)

I had to send the form to divorce the other clinic, I got all my payments under my practice NPI.

It is a royal pain because we saw patients while we were in the credentialing process and they denied payment.

what are you gonna do? wait 6-8 months until you are full approved? or bite the bullet and get patients.

it is really hard.

adolfo

To: Sent: Thursday, May 24, 2012 12:55 PMSubject: Re: Practice Startup Questions

Thanks for sharing your story, Adolfo! I am assuming you can put an effective date on the new contracts? What my concern is, I may have to stay on part time with my current employer (1 day a week) doing manipulation/sports medicine as that is my "niche" and they don't have anyone else to do that as a way to "compensate" them for paying off a huge chunk of my student loans. In my contract, I get x amount "forgiven" for what they have paid on my behalf for every year I stay on. This was spread out over 6 years. No way in hell I'm gonna make it 6 years so I'm on the hook for whatever is left--at this point $125k. My thinking is, if I say I will stay on 1 day a week doing this for them, maybe we can work something out where I can still leave and do my own practice and not have to get a loan to pay them off. Back to my concern--what if we both take the same insurances--me in my IMP and then working as a "specialist" there? How

would that work?>> Dear newbie, we are newbies too. we have so many questions and we always ask. I found this IMP list like an oasis because I can always find> many helping hands for my doubts. > Ã‚ > Regarding questions number 1, I am not a lawyer but you make decisions Ã‚ regarding the limit of your patients. > We opened Orange Doc in November 2011 ( you see newbie). We are 2 mojicans jejejejeje, my wife Ardiana ( my rock) a pediatric NP and I a family doc. > She loves kids and I told her follow your Passion so she makes my practice vibrant

and active when I heard crying on her room. > I made the decisionÃ‚ to not accept medicaid only for adults, I do as a secondary of medicare. I learned that medicaid always refused to pay me when is second in line. > We made the decision to allow medicaid only for kids, since there are a lot medicaid kids in the area. She only has to see 30% of her patient population to qualify for uncle sam money. I think you are the one making the decision to open or close the doors in that matter. > Deep in my heart I can tell you that I really do not care about uncle sam money. I think there is not such a thing like a free lunch. I think uncle same will make sure to make your life miserable in the future so you will pay with your blood for the pennies that he will give you. I think all the committees of the uncle sam will make sure that the quantity of requirements will quadruple and you or your office will have a hard time to full fill the requirements ( I think that the nature of the beast).> Ã‚ > regarding your questions about the scheduling, I have appointments and also patient portal's appointments. I can tell you what I do:> New patients I spent like 45 minutes the first visit, I make sure I got all the info and questions answered. I want to know when was the last colon eval , mammo etc. > I make sure that I listen to them and give them undivided attention. Also I make a full physical exam,head to toes. > I noticed that when they come back to follow up I do not have to spent the same amount of time gathering the info. I am quickerÃ‚ with the F/Us.> Our

plans is to see patients and not practice treadmill medicine, that is the goal of IMP type of practice. > We are getting fuller day by day, sometimes I have 1 patient in my schedule and them 5-7 call wants to be seeing. I can tell you that sometimes I see 12-11 patients in day.> We are open M,W and F only. I am doing urgent care and my wife still working as NICU RN. Our goal is to go to M-F soon and quit our side gigs,when? I do not know. > I can tell you that we were asking every month to the bank money to operate the clinic. I think that last time that I asked the bank money was in January. Orange Doc is paying itself ( except our salaries, we are not getting paid) every month. > My wife is holding the fort because she deals with the phone calls from every body, she does the billing and the pain in neck insurances. She does not have a lot of experience but she work hard to make sure we

get paid. She also see her patients part time. We have no staff working for us for now. > I think we are going to have gaps for same day appointments for those patients that need to be seeing now. > Ã‚ > Regarding the questions about the credentialing process, I was in your shoes before not wanting my employer to know about my plans,it is very stressful dealing with that. > I can tell you that my experience with corporate America is not the best. I think God bless me because I got laid off from a previous Urgent care where I got betrayed by my employer and then I found this new UC job and the guy was fulling around with me and he gave me a part time only.> I took the part time and bite the bullet and look around my town for the correct place until I found it. I made my corporation and I look for a person to help me with the credentialing part. I know a lot of people in the

list would tell you that you can do it only via CAHQ something, I hire that person and she started the process since 08/2011. You have to have a physical location to start the process you can not use a P.O. Box. I spoke to my future land Lord and told him that I needed to rent the office 3 months before I open the doors and I asked him to give me those 3 moths free ( what the heck what I had to loose).> He did not give it to me for fee but he cut 50% > My credentialing person did all the paper work believe me it is worse then buying a house, do you have time for that? I did not so I hire her.> You have to create new contracts with the health insurances since you are working under a different umbrella or corporation. > I had to submit a form to Blue cross of FL to divorce a previous practice that takes time.> Basically you have to make sure that you have the time and money to be

able to make the jump. > Ã‚ > Dealing with the banks is another 200's pages story. > Ã‚ > anyway my 1/2 cent. If you want contact me off the list and we can chat I can tell you my experiences. > Adolfo> you can find us in Youtube : OrangeDoc > you can see our tour video of my practice . > www.orangedocfamilymedicine.com> Ã‚ > > > To: > Sent: Thursday, May 24, 2012 9:32 AM> Subject: Practice Startup Questions> > > Ã‚ >

I just want to say what a blessing this group has been! I look forward to seeing emails from the listserve pop up on my phone as I always learn so much! > > I am hoping to start my own IMP within the next two years (preferably as soon as possible). Here's some questions I have for the group (and please forgive my ignorance and naivety):> > 1) Is it legal to limit the amount of medicare/medicaid you will accept? That is, I want to limit my practice to 5 or 10% medicaid as it pays so poorly here (TN) but I have patients who have established with me in my current practice that I would like to continue to take care of but I want to be financially viable, which I can't be if I leave the doors wide open to all comers.> > 2) For those of you who have "niche servicess" within your practice - i.e. accupuncture, etc. how do you handle the open access for these patients for whom you are not providing PCP care with those patients for whom you are the PCP? I currently do manipulation (OMT) and plan on adding accupuncture services in the future.> > 3) With open access scheduling, how do you control your schedule in the beginning when the majority of your patients will be new? At what point do you restrict your new patient appts to maintain 24-48 hr availability for those who are established? I know it varies between practices, but what % of appts do you schedule out vs leave open?> > 4) I am currently employed and contracted with several plans some of which I will continue to accept when I am on my own...how is it handled when you continue to work under

the plan in one practice while you are trying to open another practice? I have not yet told my current employer that I plan to leave as I want to have as much as possible thought out/arranged ahead of time before I make the leap. I do have to give 6 months notice and will do that, but I know the recredentialing can sometimes take awhile and I'd like to move as smoothly as possible from one to the other as I can't afford to take a large amount of time off.> > Thanks for the input! I'm sure there will be a ton more questions as I pursue this journey!>

May 25, 2012

,

Open access is really not booking any appointments until the day you open your books. You are really doig advanced access. Seems like a moot or insignificant point, buty it is not. The problem with " saving appointments slots " rather

than open access is that there is always creep and then you end up with ovefbookingand no slots. Maybe you are better than elsewhere I have been.

We stick to advanced access and never make appointments more than a day or two out. Often I come in with one appointment and leave having seen 10-15. I never had no shows, and can usually handle " walk-ins " better known as appointmentless

patients. We wil schedule anything any time, no restirctions on type of visit.

Has worked for 7 years, getting " todays work done today. "

From: [ ] On Behalf Of Pratt [kpratt.1022@...]

Sent: Thursday, May 24, 2012 11:20 AM

To:

Subject: Re: Re: Practice Startup Questions

Welcome, Newbie!

You will need to establish some sort of organization for your new office - corporation, partnership, sole proprietorship - and then you need to apply for an NPI for that organization (unless you opt to do Sole Prop, which I am NOT sure how you bill for

that). Then, when bills go out for your new office, they get paid to your new organization. When bills go out for your current organization, then they get paid under their organizational NPI.

You can limit your practice (and, in fact, you should) to any % of patients you want per insurance. So, if you reach your 10% limit, then you close to new patients for that type of insurance. I will advise, however, that you might want to beware of this

when you first start out. There will be attrition. Some patients will come to you, and never come back, or may come infrequently, so in reality, even though by sheer numbers you hit 10%, if those patients do not frequent your office, then in $$, the % will

be lower. Our practice closed for a bit to new Medicare patients, but we are now accepting all new patients. We do not take Medicaid, either as primary or secondary insurance. We are also not contracted for all plans for all insurers (Blue Shield of CA

has just come out with some very unreasonable contracts that we were not willing to contract with). It is up to the PATIENT to determine whether or not we are participating in their plan or not because it is much too difficult for us to keep track for them.

Open Access scheduling takes a lot of finesse. Something I am still trying to teach our assistants. We try to schedule not more than 4 extended visits per day (new patients or physicals), and we try to leave open 4-6 slots per day for same-day visits.

Sometimes, we have wide open days (last week on Monday, we had 9 slots go unused, but today we are completely booked, and it is only 10:15am, and tomorrow I am limited to 4 walk-in slots, which the staff will have to be very careful about booking - we have

a total of 18 slots per day, with extended visits using 2-3 slots each). If you are doing your own scheduling, you will get to know which patients require more or less time, and you can try to fit them in accordingly. We have patients now who were patients

from the beginning of our practice, when they could say exactly the day and time they wanted to come in and we could accommodate that, but even though we can still offer them a same-day appt, they get torqued when they can't come in when they dictate. Just

a caution...

You do not necessarily need to re-credential if you are already credentialed with most insurance companies. Contact the Provider Rep and tell them your plans and find out what you need to do. First things first, you need to determine the type of organization

that you want to open, and then sign contracts. But since you, the provider, are already credentialed, it should be a little quicker than if you were relocating to another state and starting from scratch.

Lots of info here.....read, re-read, listen to what everyone on the IMP list has to offer, and pick and choose what you think will work best for you. And don't be afraid to make changes as time goes by so that you are happy :-)

Good luck in your new endeavour!!

Pratt

On Thu, May 24, 2012 at 9:55 AM, impnewbie

wrote:

Thanks for sharing your story, Adolfo!

I am assuming you can put an effective date on the new contracts?

What my concern is, I may have to stay on part time with my current employer (1 day a week) doing manipulation/sports medicine as that is my " niche " and they don't have anyone else to do that as a way to " compensate " them for paying off a huge chunk of my student

loans. In my contract, I get x amount " forgiven " for what they have paid on my behalf for every year I stay on. This was spread out over 6 years. No way in hell I'm gonna make it 6 years so I'm on the hook for whatever is left--at this point $125k. My thinking

is, if I say I will stay on 1 day a week doing this for them, maybe we can work something out where I can still leave and do my own practice and not have to get a loan to pay them off.

Back to my concern--what if we both take the same insurances--me in my IMP and then working as a " specialist " there? How would that work?

>

> Dear newbie, we are newbies too. we have so many questions and we always ask. I found this IMP list like an oasis because I can always find

> many helping hands for my doubts.

> Â

> Regarding questions number 1, I am not a lawyer but you make decisions Â regarding the limit of your patients.

> We opened Orange Doc in November 2011 ( you see newbie). We are 2 mojicans jejejejeje, my wife Ardiana ( my rock) a pediatric NP and I a family doc.

> She loves kids and I told her follow your Passion so she makes my practice vibrant and active when I heard crying on her room.

> I made the decisionÂ to not accept medicaid only for adults, I do as a secondary of medicare. I learned that medicaid always refused to pay me when is second in line.

> We made the decision to allow medicaid only for kids, since there are a lot medicaid kids in the area. She only has to see 30% of her patient population to qualify for uncle sam money. I think you are the one making the decision to open or

close the doors in that matter.

> Deep in my heart I can tell you that I really do not care about uncle sam money. I think there is not such a thing like a free lunch. I think uncle same will make sure to make your life miserable in the future so you will pay with your blood for the pennies

that he will give you. I think all the committees of the uncle sam will make sure that the quantity of requirements will quadruple and you or your office will have a hard time to full fill the requirements ( I think that the nature of the beast).

> Â

> regarding your questions about the scheduling, I have appointments and also patient portal's appointments. I can tell you what I do:

> New patients I spent like 45 minutes the first visit, I make sure I got all the info and questions answered. I want to know when was the last colon eval , mammo etc.

> I make sure that I listen to them and give them undivided attention. Also I make a full physical exam,head to toes.

> I noticed that when they come back to follow up I do not have to spent the same amount of time gathering the info. I am quickerÂ with the F/Us.

> Our plans is to see patients and not practice treadmill medicine, that is the goal of IMP type of practice.

> We are getting fuller day by day, sometimes I have 1 patient in my schedule and them 5-7 call wants to be seeing. I can tell you that sometimes I see 12-11 patients in day.

> We are open M,W and F only. I am doing urgent care and my wife still working as NICU RN. Our goal is to go to M-F soon and quit our side gigs,when? I do not know.

> I can tell you that we were asking every month to the bank money to operate the clinic. I think that last time that I asked the bank money was in January. Orange Doc is paying itself ( except our salaries, we are not getting paid) every month.

> My wife is holding the fort because she deals with the phone calls from every body, she does the billing and the pain in neck insurances. She does not have a lot of experience but she work hard to make sure we get paid. She also see her patients part time.

We have no staff working for us for now.

> I think we are going to have gaps for same day appointments for those patients that need to be seeing now.

> Â

> Regarding the questions about the credentialing process, I was in your shoes before not wanting my employer to know about my plans,it is very stressful dealing with that.

> I can tell you that my experience with corporate America is not the best. I think God bless me because I got laid off from a previous Urgent care where I got betrayed by my employer and then I found this new UC job and the guy was fulling around with me and

he gave me a part time only.

> I took the part time and bite the bullet and look around my town for the correct place until I found it. I made my corporation and I look for a person to help me with the credentialing part. I know a lot of people in the list would tell you that you can do

it only via CAHQ something, I hire that person and she started the process since 08/2011. You have to have a physical location to start the process you can not use a P.O. Box. I spoke to my future land Lord and told him that I needed to rent the office 3 months

before I open the doors and I asked him to give me those 3 moths free ( what the heck what I had to loose).

> He did not give it to me for fee but he cut 50%

> My credentialing person did all the paper work believe me it is worse then buying a house, do you have time for that? I did not so I hire her.

> You have to create new contracts with the health insurances since you are working under a different umbrella or corporation.

> I had to submit a form to Blue cross of FL to divorce a previous practice that takes time.

> Basically you have to make sure that you have the time and money to be able to make the jump.

> Â

> Dealing with the banks is another 200's pages story.

> Â

> anyway my 1/2 cent. If you want contact me off the list and we can chat I can tell you my experiences.

> Adolfo

> you can find us in Youtube : OrangeDoc

> you can see our tour video of my practice .

> www.orangedocfamilymedicine.com

> Â

>

> To:

> Sent: Thursday, May 24, 2012 9:32 AM

> Subject: Practice Startup Questions

>

> Â

> I just want to say what a blessing this group has been! I look forward to seeing emails from the listserve pop up on my phone as I always learn so much!

>

> I am hoping to start my own IMP within the next two years (preferably as soon as possible). Here's some questions I have for the group (and please forgive my ignorance and naivety):

>

> 1) Is it legal to limit the amount of medicare/medicaid you will accept? That is, I want to limit my practice to 5 or 10% medicaid as it pays so poorly here (TN) but I have patients who have established with me in my current practice that I would like to

continue to take care of but I want to be financially viable, which I can't be if I leave the doors wide open to all comers.

>

> 2) For those of you who have " niche servicess " within your practice - i.e. accupuncture, etc. how do you handle the open access for these patients for whom you are not providing PCP care with those patients for whom you are the PCP? I currently do manipulation

(OMT) and plan on adding accupuncture services in the future.

>

> 3) With open access scheduling, how do you control your schedule in the beginning when the majority of your patients will be new? At what point do you restrict your new patient appts to maintain 24-48 hr availability for those who are established? I know

it varies between practices, but what % of appts do you schedule out vs leave open?

>

> 4) I am currently employed and contracted with several plans some of which I will continue to accept when I am on my own...how is it handled when you continue to work under the plan in one practice while you are trying to open another practice? I have not

yet told my current employer that I plan to leave as I want to have as much as possible thought out/arranged ahead of time before I make the leap. I do have to give 6 months notice and will do that, but I know the recredentialing can sometimes take awhile

and I'd like to move as smoothly as possible from one to the other as I can't afford to take a large amount of time off.

>

> Thanks for the input! I'm sure there will be a ton more questions as I pursue this journey!

>

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Pratt

May 25, 2012

We have way too many patients that call,asking for an appointment " on June 11 before 2. " so we pre-schedule those. We very rarely are not able to take care of today's needs, today, but patients around here are planners, and have heavy-handed schedules to accommodate. We prefer this method instead of allowing 10-11 add-ons to the day. Patients here would rather schedule and have us run on time than come in and have to wait for something that could be scheduled ahead of time. 75% of what we do are follow-ups and routine physicals. 25% is truly urgent. Works for us. Can't imagine starting the day with only 1-2 patients on the schedule and hoping the rest of the day would fill.