Re: efficiency and income, sustainability- year end report

[Guest guest]

Lynn,

Thanks for your great input!

I also love emailing patients results and getting their appreciative comments.

Am considering Instant Medical History. Do your patients complete from home or in office and how long does it take them?

What do you pay your poster/biller to argue with insurance companies?

Thanks again.

Janice Pegels

Binghamton, NY

efficiency and income, sustainability- year end report

Two years into the micropractice, my personal office efficiency seems to have made significant improvements over the past 3 months with your ideas, THANKS to all of you who sent helpful tips and lent moral support.I was unable to keep track of where those wasted hours went, the logs were just too difficult to keep, but I now no longer have to stay up until 2-3-4AM once a week just to get caught up on the billing. My out of work- work hours are now much saner (maybe financial stuff, taxes, reconciling accounts, paying bills one weekend a month, some desultory bidding on eBay for cheap office and medical stuff, etc.) and I feel much less burned out. I think I can manage and enjoy this style of practice for a long time (some years, I'm thinking); it appears doable AND sustainable for me.Here's a solo - solo list of the things that got changed in the past 3 months, that really seemed to help me LOTS, not really in any ranking order:1) NEVER answer the phone, pretty much ALWAYS let the machine take a message. I was letting the phone interrupt me before- takes some training to just let it ring, but the payoff is big. Also, be meaner about having patients come in- less phone medicine and more face to face medicine makes me feel less put upon.2) Try to avoid calling any results, TRY to email all the results possible, a close second leaving messages on an answering machine, paper the 3rd most useful method (but takes longer); leaving a message on a machine is also fine, but you can't predict when you call if someone is going to be home or not! the worst of all is being stuck on the phone for 'by the way' questions from a patient.3) Electronic billing is great! Much faster and easier than paper (may save me 2-4 hours per week upfront) but more importantly, on the downstream side, doesn't allow those smarmy insurances to get away without paying because you didn't catch them before 6 months expires- provides proof of submission date. I Almost like billing now. Why didn't I do this before?4) Hired a poster/biller to argue with the insurance companies, 5-6 hours every 1-2 weeks. Thank goodness and worth every penny, for the peace of mind alone.5) Instant Medical History- really a time saver, documents and does it well, often more completely than I would have done, patient does the work, made all my paper rating scales obsolete. I REALLY appreciate it by the ends of the days when I sometimes would get way overwhelmed and feel late, even though I wasn't, and essentially not document anything in a complicated note, then (groan) have a complicated note to finish after the visit. (this is NOT happening any more!) Gives me a great start on the note, reminds me of details/problems that I did ask about but forgot completely about and would never have documented in my past methods, doesn't get tired by the end of the day like I do. Now without even a guilty start, I am easily billing just about all 99214s. Audit me! For $50 a month, much cheaper than a medical assistant and has one hell of a medical background. I'd highly recommend it.6) Other helpful things- 1) more patients are using appointment quest and making their appointments online, it's a matter of training but means lots less time on the phone for me; 2) new patient volume is tightly controlled and ratcheted down, less abstracting of old records has to happen, also the 'more mature' patient population is requiring less training and effort; 3) my technology has stopped jerking me around, for the moment- haven't had a major issue in almost 3 months, just have to keep my fingers crossed, really don't want to add any more technology pieces now or ever (but I suppose I'll have to as time goes on); 4) paperless office and workflow it generates really contribute to efficiency in general.What is great about the ultrasolo IMP style is that I can just decree to myself to change the above processes, and it happens. If they don't work, they get improved on or chucked out. The results are immediate, dramatic and telling, and there is no chain of command. I really like that!The other side of 'sustainable' for me is income, and for some reason that seems to be improving too. Now paying myself $6000/month (I think you could count it as $7000, if you look at retirement contributions) and it seems as if that is still increasing. That would be for about 40 booked appointments a week, mostly 99214s and some preventive care, in a state with about average reimbursement but where preventive+e/m code visits are bundled, and where the major insurers will not pay extended visit codes.I think my malpractice rates will fall for 2 reasons: I am changing to a cheaper carrier and I may qualify (I hope) for part time malpractice rates, from about $12000 to about $8000. (I used your letter, , -thanks!- about considering my practice as a part time practice despite the greater than part-time hours, and preliminarily, it seems that they are going to bite.)I did knock down my rent/utilities payments to $1050 per month from $1700, goaded into this move to cheaper/smaller space by looking at the overhead breakdown for IMPs in general and realizing mine was way out of whack.Lastly, I think my accounts receivables will improve by a lot over the next 6 months due to electronic billing- I'm sure I've missed a pile of $$ but I'm not going to go back and try to mine them- too frustrating and it will make me too angry. Forward is the way to go at this point.I think my income will settle somewhere in the 8-9K range a month including retirement benefits, at about the 40 visits a week/ 25 booked patient hours, which for me will be fine. It's more than I've ever made before, but certainly not at the FP 'average', but then I am not working in a patient mill, I am also not doing hospital work and my schedule is not crammed and AAHHH -at this acceptable-for-me income level, the satisfaction of the way the practice runs trumps all.Future things I will probably work on- take more (at least some) vacation and find more compatible coverage; proselytize for an IMP partner?; get a more complex patient registry going and some population management; ?group visits - I will have to gear up to fight about reimbursement, RI is so backwards!; learn and practice motivational interviewing techniques, to move people a little bit further along; RELAX a little mentally, as things actually appear to be working out.So things are looking up! Thank you all for being the crowd that you are, and for just being out there. Could not have done this without you all, and the inspiration and experience that you - provide/share. (Solo-solo would have killed me off by now, probably about 6 months ago.)Here's hoping for the coming year, if you are a new IMP, that you begin to settle as reasonably as I have done over the past few months, or if you have already established and attained a sustainable spot, that you can maintain it despite predicted stormy health care weather. Happy New Year!Lynn Ho__________________________________________________________Fixing up the home? Live Search can help http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US & source=hmemailtaglinenov06 & FORM=WLMTAG

[Guest guest]

Lynn-thank you so much for this great summary. I think it's useful

to every body. I find it especially useful in my job for the AAFP

for helping solo and small practices. I'm going to try to get you a

discount on instant medical history (I'm going to try to get

everyone on this listserv a discount)-by e-mailing Alan Wenner. Do

you mind if I copy your comments to him?

Lou Spikol

>

> Two years into the micropractice, my personal office efficiency

seems to

> have made significant improvements over the past 3 months with

your ideas,

> THANKS to all of you who sent helpful tips and lent moral support.

>

> I was unable to keep track of where those wasted hours went, the

logs were

> just too difficult to keep, but I now no longer have to stay up

until

> 2-3-4AM once a week just to get caught up on the billing. My out

of work-

> work hours are now much saner (maybe financial stuff, taxes,

reconciling

> accounts, paying bills one weekend a month, some desultory bidding

on eBay

> for cheap office and medical stuff, etc.) and I feel much less

burned out.

> I think I can manage and enjoy this style of practice for a long

time (some

> years, I'm thinking); it appears doable AND sustainable for me.

>

> Here's a solo - solo list of the things that got changed in the

past 3

> months, that really seemed to help me LOTS, not really in any

ranking

> order:

> 1) NEVER answer the phone, pretty much ALWAYS let the machine

take a

> message. I was letting the phone interrupt me before- takes some

training

> to just let it ring, but the payoff is big. Also, be meaner about

having

> patients come in- less phone medicine and more face to face

medicine makes

> me feel less put upon.

> 2) Try to avoid calling any results, TRY to email all the results

possible,

> a close second leaving messages on an answering machine, paper the

3rd most

> useful method (but takes longer); leaving a message on a machine

is also

> fine, but you can't predict when you call if someone is going to

be home or

> not! the worst of all is being stuck on the phone for 'by the way'

questions

> from a patient.

> 3) Electronic billing is great! Much faster and easier than

paper (may

> save me 2-4 hours per week upfront) but more importantly, on the

downstream

> side, doesn't allow those smarmy insurances to get away without

paying

> because you didn't catch them before 6 months expires- provides

proof of

> submission date. I Almost like billing now. Why didn't I do this

before?

> 4) Hired a poster/biller to argue with the insurance companies, 5-

6 hours

> every 1-2 weeks. Thank goodness and worth every penny, for the

peace of mind

> alone.

> 5) Instant Medical History- really a time saver, documents and

does it

> well, often more completely than I would have done, patient does

the work,

> made all my paper rating scales obsolete. I REALLY appreciate it

by the

> ends of the days when I sometimes would get way overwhelmed and

feel late,

> even though I wasn't, and essentially not document anything in a

complicated

> note, then (groan) have a complicated note to finish after the

visit. (this

> is NOT happening any more!) Gives me a great start on the note,

reminds me

> of details/problems that I did ask about but forgot completely

about and

> would never have documented in my past methods, doesn't get tired

by the end

> of the day like I do. Now without even a guilty start, I am easily

billing

> just about all 99214s. Audit me! For $50 a month, much cheaper

than a

> medical assistant and has one hell of a medical background. I'd

highly

> recommend it.

>

> 6) Other helpful things- 1) more patients are using appointment

quest and

> making their appointments online, it's a matter of training but

means lots

> less time on the phone for me; 2) new patient volume is tightly

controlled

> and ratcheted down, less abstracting of old records has to happen,

also the

> 'more mature' patient population is requiring less training and

effort; 3)

> my technology has stopped jerking me around, for the moment-

haven't had a

> major issue in almost 3 months, just have to keep my fingers

crossed, really

> don't want to add any more technology pieces now or ever (but I

suppose I'll

> have to as time goes on); 4) paperless office and workflow it

generates

> really contribute to efficiency in general.

>

> What is great about the ultrasolo IMP style is that I can just

decree to

> myself to change the above processes, and it happens. If they

don't work,

> they get improved on or chucked out. The results are immediate,

dramatic

> and telling, and there is no chain of command. I really like

that!

>

> The other side of 'sustainable' for me is income, and for some

reason that

> seems to be improving too. Now paying myself $6000/month (I think

you could

> count it as $7000, if you look at retirement contributions) and

it seems as

> if that is still increasing. That would be for about 40 booked

appointments

> a week, mostly 99214s and some preventive care, in a state with

about

> average reimbursement but where preventive+e/m code visits are

bundled, and

> where the major insurers will not pay extended visit codes.

> I think my malpractice rates will fall for 2 reasons: I am

changing to a

> cheaper carrier and I may qualify (I hope) for part time

malpractice rates,

> from about $12000 to about $8000. (I used your letter, , -

thanks!-

> about considering my practice as a part time practice despite the

greater

> than part-time hours, and preliminarily, it seems that they are

going to

> bite.)

> I did knock down my rent/utilities payments to $1050 per month

from $1700,

> goaded into this move to cheaper/smaller space by looking at the

overhead

> breakdown for IMPs in general and realizing mine was way out of

whack.

> Lastly, I think my accounts receivables will improve by a lot over

the next

> 6 months due to electronic billing- I'm sure I've missed a pile

of $$ but

> I'm not going to go back and try to mine them- too frustrating and

it will

> make me too angry. Forward is the way to go at this point.

> I think my income will settle somewhere in the 8-9K range a month

including

> retirement benefits, at about the 40 visits a week/ 25 booked

patient

> hours, which for me will be fine. It's more than I've ever made

before, but

> certainly not at the FP 'average', but then I am not working in a

patient

> mill, I am also not doing hospital work and my schedule is not

crammed and

> AAHHH -at this acceptable-for-me income level, the satisfaction of

the way

> the practice runs trumps all.

>

> Future things I will probably work on- take more (at least some)

vacation

> and find more compatible coverage; proselytize for an IMP

partner?; get a

> more complex patient registry going and some population

management; ?group

> visits - I will have to gear up to fight about reimbursement, RI

is so

> backwards!; learn and practice motivational interviewing

techniques, to move

> people a little bit further along; RELAX a little mentally, as

things

> actually appear to be working out.

>

> So things are looking up! Thank you all for being the crowd that

you are,

> and for just being out there. Could not have done this without

you all, and

> the inspiration and experience that you - provide/share. (Solo-

solo would

> have killed me off by now, probably about 6 months ago.)

> Here's hoping for the coming year, if you are a new IMP, that you

begin to

> settle as reasonably as I have done over the past few months, or

if you have

> already established and attained a sustainable spot, that you can

maintain

> it despite predicted stormy health care weather. Happy New Year!

>

> Lynn Ho

>

> _________________________________________________________________

> Fixing up the home? Live Search can help

> http://imagine-windowslive.com/search/kits/default.aspx?

kit=improve & locale=en-US & source=hmemailtaglinenov06 & FORM=WLMTAG

>

[Guest guest]

Great post!

Thank you , thank you , thank you!

It is incredibly helpful to me as I keep trying to improve from month to

month. Much of what you describe are details of the practice I'm needing

to address. It's great to know that on-going improvement efforts really

make such a difference (too bad we can't get CME credits for CPI =

continuing practice improvement!! ;-).

I'm only 9months in and I've set the goal off adjusting a few things like

you have been over the next 3 months so I hit year 2 in a great

position... still trying to visualize actually " enjoying " billing like

Gwen describes -- it's goal to be reached though!

Thanks again for sharing all that info and insight.

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

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message, including attachments.

> Two years into the micropractice, my personal office efficiency seems to

> have made significant improvements over the past 3 months with your

> ideas, THANKS to all of you who sent helpful tips and lent moral

> support.

>

> I was unable to keep track of where those wasted hours went, the logs

> were just too difficult to keep, but I now no longer have to stay up

> until 2-3-4AM once a week just to get caught up on the billing. My out

> of work- work hours are now much saner (maybe financial stuff, taxes,

> reconciling accounts, paying bills one weekend a month, some desultory

> bidding on eBay for cheap office and medical stuff, etc.) and I feel

> much less burned out. I think I can manage and enjoy this style of

> practice for a long time (some years, I'm thinking); it appears doable

> AND sustainable for me.

>

> Here's a solo - solo list of the things that got changed in the past 3

> months, that really seemed to help me LOTS, not really in any ranking

> order:

> 1) NEVER answer the phone, pretty much ALWAYS let the machine take a

> message. I was letting the phone interrupt me before- takes some

> training to just let it ring, but the payoff is big. Also, be meaner

> about having patients come in- less phone medicine and more face to

> face medicine makes me feel less put upon.

> 2) Try to avoid calling any results, TRY to email all the results

> possible, a close second leaving messages on an answering machine,

> paper the 3rd most useful method (but takes longer); leaving a message

> on a machine is also fine, but you can't predict when you call if

> someone is going to be home or not! the worst of all is being stuck on

> the phone for 'by the way' questions from a patient.

> 3) Electronic billing is great! Much faster and easier than paper (may

> save me 2-4 hours per week upfront) but more importantly, on the

> downstream side, doesn't allow those smarmy insurances to get away

> without paying because you didn't catch them before 6 months expires-

> provides proof of submission date. I Almost like billing now. Why

> didn't I do this before? 4) Hired a poster/biller to argue with the

> insurance companies, 5-6 hours every 1-2 weeks. Thank goodness and

> worth every penny, for the peace of mind alone.

> 5) Instant Medical History- really a time saver, documents and does it

> well, often more completely than I would have done, patient does the

> work, made all my paper rating scales obsolete. I REALLY appreciate it

> by the ends of the days when I sometimes would get way overwhelmed and

> feel late, even though I wasn't, and essentially not document anything

> in a complicated note, then (groan) have a complicated note to finish

> after the visit. (this is NOT happening any more!) Gives me a great

> start on the note, reminds me of details/problems that I did ask about

> but forgot completely about and would never have documented in my past

> methods, doesn't get tired by the end of the day like I do. Now without

> even a guilty start, I am easily billing just about all 99214s. Audit

> me! For $50 a month, much cheaper than a medical assistant and has

> one hell of a medical background. I'd highly recommend it.

>

> 6) Other helpful things- 1) more patients are using appointment quest

> and making their appointments online, it's a matter of training but

> means lots less time on the phone for me; 2) new patient volume is

> tightly controlled and ratcheted down, less abstracting of old records

> has to happen, also the 'more mature' patient population is requiring

> less training and effort; 3) my technology has stopped jerking me

> around, for the moment- haven't had a major issue in almost 3 months,

> just have to keep my fingers crossed, really don't want to add any more

> technology pieces now or ever (but I suppose I'll have to as time goes

> on); 4) paperless office and workflow it generates really contribute to

> efficiency in general.

>

> What is great about the ultrasolo IMP style is that I can just decree to

> myself to change the above processes, and it happens. If they don't

> work, they get improved on or chucked out. The results are immediate,

> dramatic and telling, and there is no chain of command. I really like

> that!

>

> The other side of 'sustainable' for me is income, and for some reason

> that seems to be improving too. Now paying myself $6000/month (I think

> you could count it as $7000, if you look at retirement contributions)

> and it seems as if that is still increasing. That would be for about

> 40 booked appointments a week, mostly 99214s and some preventive care,

> in a state with about average reimbursement but where preventive+e/m

> code visits are bundled, and where the major insurers will not pay

> extended visit codes.

> I think my malpractice rates will fall for 2 reasons: I am changing to

> a cheaper carrier and I may qualify (I hope) for part time malpractice

> rates, from about $12000 to about $8000. (I used your letter, ,

> -thanks!- about considering my practice as a part time practice despite

> the greater than part-time hours, and preliminarily, it seems that they

> are going to bite.)

> I did knock down my rent/utilities payments to $1050 per month from

> $1700, goaded into this move to cheaper/smaller space by looking at the

> overhead breakdown for IMPs in general and realizing mine was way out

> of whack. Lastly, I think my accounts receivables will improve by a lot

> over the next 6 months due to electronic billing- I'm sure I've missed

> a pile of $$ but I'm not going to go back and try to mine them- too

> frustrating and it will make me too angry. Forward is the way to go at

> this point.

> I think my income will settle somewhere in the 8-9K range a month

> including retirement benefits, at about the 40 visits a week/ 25

> booked patient hours, which for me will be fine. It's more than I've

> ever made before, but certainly not at the FP 'average', but then I am

> not working in a patient mill, I am also not doing hospital work and my

> schedule is not crammed and AAHHH -at this acceptable-for-me income

> level, the satisfaction of the way the practice runs trumps all.

>

> Future things I will probably work on- take more (at least some)

> vacation and find more compatible coverage; proselytize for an IMP

> partner?; get a more complex patient registry going and some population

> management; ?group visits - I will have to gear up to fight about

> reimbursement, RI is so backwards!; learn and practice motivational

> interviewing techniques, to move people a little bit further along;

> RELAX a little mentally, as things actually appear to be working out.

>

> So things are looking up! Thank you all for being the crowd that you

> are, and for just being out there. Could not have done this without

> you all, and the inspiration and experience that you - provide/share.

> (Solo-solo would have killed me off by now, probably about 6 months

> ago.)

> Here's hoping for the coming year, if you are a new IMP, that you begin

> to settle as reasonably as I have done over the past few months, or if

> you have already established and attained a sustainable spot, that you

> can maintain it despite predicted stormy health care weather. Happy

> New Year!

>

> Lynn Ho

>

> _________________________________________________________________

> Fixing up the home? Live Search can help

>

http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US\

& source=hmemailtaglinenov06 & FORM=WLMTAG

>

>

>

>

>

[Guest guest]

Thank you for this Lynn

lots of good news

and practical scenarioes

and a nice set of problem solving to see there is hope out there

i was gonna post my own two yr report But I have to wait. Till I have been

open 2 yrs!

efficiency and income, sustainability- year

end report

Two years into the micropractice, my personal office efficiency seems to

have made significant improvements over the past 3 months with your

ideas,

THANKS to all of you who sent helpful tips and lent moral support.

I was unable to keep track of where those wasted hours went, the logs

were

just too difficult to keep, but I now no longer have to stay up until

2-3-4AM once a week just to get caught up on the billing. My out of

work-

work hours are now much saner (maybe financial stuff, taxes, reconciling

accounts, paying bills one weekend a month, some desultory bidding on

eBay

for cheap office and medical stuff, etc.) and I feel much less burned

out.

I think I can manage and enjoy this style of practice for a long time

(some

years, I'm thinking); it appears doable AND sustainable for me.

Here's a solo - solo list of the things that got changed in the past 3

months, that really seemed to help me LOTS, not really in any ranking

order:

1) NEVER answer the phone, pretty much ALWAYS let the machine take a

message. I was letting the phone interrupt me before- takes some

training

to just let it ring, but the payoff is big. Also, be meaner about having

patients come in- less phone medicine and more face to face medicine

makes

me feel less put upon.

2) Try to avoid calling any results, TRY to email all the results

possible,

a close second leaving messages on an answering machine, paper the 3rd

most

useful method (but takes longer); leaving a message on a machine is also

fine, but you can't predict when you call if someone is going to be home

or

not! the worst of all is being stuck on the phone for 'by the way'

questions

from a patient.

3) Electronic billing is great! Much faster and easier than paper (may

save me 2-4 hours per week upfront) but more importantly, on the

downstream

side, doesn't allow those smarmy insurances to get away without paying

because you didn't catch them before 6 months expires- provides proof of

submission date. I Almost like billing now. Why didn't I do this before?

4) Hired a poster/biller to argue with the insurance companies, 5-6

hours

every 1-2 weeks. Thank goodness and worth every penny, for the peace of

mind

alone.

5) Instant Medical History- really a time saver, documents and does it

well, often more completely than I would have done, patient does the

work,

made all my paper rating scales obsolete. I REALLY appreciate it by the

ends of the days when I sometimes would get way overwhelmed and feel

late,

even though I wasn't, and essentially not document anything in a

complicated

note, then (groan) have a complicated note to finish after the visit.

(this

is NOT happening any more!) Gives me a great start on the note, reminds

me

of details/problems that I did ask about but forgot completely about and

would never have documented in my past methods, doesn't get tired by the

end

of the day like I do. Now without even a guilty start, I am easily

billing

just about all 99214s. Audit me! For $50 a month, much cheaper than a

medical assistant and has one hell of a medical background. I'd highly

recommend it.

6) Other helpful things- 1) more patients are using appointment quest

and

making their appointments online, it's a matter of training but means

lots

less time on the phone for me; 2) new patient volume is tightly

controlled

and ratcheted down, less abstracting of old records has to happen, also

the

'more mature' patient population is requiring less training and effort;

3)

my technology has stopped jerking me around, for the moment- haven't had

a

major issue in almost 3 months, just have to keep my fingers crossed,

really

don't want to add any more technology pieces now or ever (but I suppose

I'll

have to as time goes on); 4) paperless office and workflow it generates

really contribute to efficiency in general.

What is great about the ultrasolo IMP style is that I can just decree to

myself to change the above processes, and it happens. If they don't

work,

they get improved on or chucked out. The results are immediate, dramatic

and telling, and there is no chain of command. I really like that!

The other side of 'sustainable' for me is income, and for some reason

that

seems to be improving too. Now paying myself $6000/month (I think you

could

count it as $7000, if you look at retirement contributions) and it seems

as

if that is still increasing. That would be for about 40 booked

appointments

a week, mostly 99214s and some preventive care, in a state with about

average reimbursement but where preventive+e/m code visits are bundled,

and

where the major insurers will not pay extended visit codes.

I think my malpractice rates will fall for 2 reasons: I am changing to a

cheaper carrier and I may qualify (I hope) for part time malpractice

rates,

from about $12000 to about $8000. (I used your letter, , -thanks!-

about considering my practice as a part time practice despite the

greater

than part-time hours, and preliminarily, it seems that they are going to

bite.)

I did knock down my rent/utilities payments to $1050 per month from

$1700,

goaded into this move to cheaper/smaller space by looking at the

overhead

breakdown for IMPs in general and realizing mine was way out of whack.

Lastly, I think my accounts receivables will improve by a lot over the

next

6 months due to electronic billing- I'm sure I've missed a pile of $$

but

I'm not going to go back and try to mine them- too frustrating and it

will

make me too angry. Forward is the way to go at this point.

I think my income will settle somewhere in the 8-9K range a month

including

retirement benefits, at about the 40 visits a week/ 25 booked patient

hours, which for me will be fine. It's more than I've ever made before,

but

certainly not at the FP 'average', but then I am not working in a

patient

mill, I am also not doing hospital work and my schedule is not crammed

and

AAHHH -at this acceptable-for-me income level, the satisfaction of the

way

the practice runs trumps all.

Future things I will probably work on- take more (at least some)

vacation

and find more compatible coverage; proselytize for an IMP partner?; get

a

more complex patient registry going and some population management;

?group

visits - I will have to gear up to fight about reimbursement, RI is so

backwards!; learn and practice motivational interviewing techniques, to

move

people a little bit further along; RELAX a little mentally, as things

actually appear to be working out.

So things are looking up! Thank you all for being the crowd that you

are,

and for just being out there. Could not have done this without you all,

and

the inspiration and experience that you - provide/share. (Solo-solo

would

have killed me off by now, probably about 6 months ago.)

Here's hoping for the coming year, if you are a new IMP, that you begin

to

settle as reasonably as I have done over the past few months, or if you

have

already established and attained a sustainable spot, that you can

maintain

it despite predicted stormy health care weather. Happy New Year!

Lynn Ho

__________________________________________________________

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[Guest guest]

Lynn,

Thanks for sharing this with us...you are another inspiration to us new

IMP's. Your practical ideas will be very useful, and also the

reminder of the power we have to continue to change our practices for the

better all the time (without committees or meetings).

May 2007 be an even better year for you and your practice.

Sharon

At 05:27 AM 12/27/2006, you wrote:

Two years into the

micropractice, my personal office efficiency seems to

have made significant improvements over the past 3 months with your

ideas,

THANKS to all of you who sent helpful tips and lent moral

support.

I was unable to keep track of where those wasted hours went, the logs

were

just too difficult to keep, but I now no longer have to stay up until

2-3-4AM once a week just to get caught up on the billing. My out of work-

work hours are now much saner (maybe financial stuff, taxes, reconciling

accounts, paying bills one weekend a month, some desultory bidding on

eBay

for cheap office and medical stuff, etc.) and I feel much less burned

out.

I think I can manage and enjoy this style of practice for a long time

(some

years, I'm thinking); it appears doable AND sustainable for me.

Here's a solo - solo list of the things that got changed in the past 3

months, that really seemed to help me LOTS, not really in any ranking

order:

1) NEVER answer the phone, pretty much ALWAYS let the machine take a

message. I was letting the phone interrupt me before- takes some training

to just let it ring, but the payoff is big. Also, be meaner about having

patients come in- less phone medicine and more face to face medicine

makes

me feel less put upon.

2) Try to avoid calling any results, TRY to email all the results

possible,

a close second leaving messages on an answering machine, paper the 3rd

most

useful method (but takes longer); leaving a message on a machine is also

fine, but you can't predict when you call if someone is going to be home

or

not! the worst of all is being stuck on the phone for 'by the way'

questions

from a patient.

3) Electronic billing is great! Much faster and easier than paper (may

save me 2-4 hours per week upfront) but more importantly, on the

downstream

side, doesn't allow those smarmy insurances to get away without paying

because you didn't catch them before 6 months expires- provides proof of

submission date. I Almost like billing now. Why didn't I do this

before?

4) Hired a poster/biller to argue with the insurance companies, 5-6 hours

every 1-2 weeks. Thank goodness and worth every penny, for the peace of

mind

alone.

5) Instant Medical History- really a time saver, documents and does it

well, often more completely than I would have done, patient does the

work,

made all my paper rating scales obsolete. I REALLY appreciate it by the

ends of the days when I sometimes would get way overwhelmed and feel

late,

even though I wasn't, and essentially not document anything in a

complicated

note, then (groan) have a complicated note to finish after the visit.

(this

is NOT happening any more!) Gives me a great start on the note, reminds

me

of details/problems that I did ask about but forgot completely about and

would never have documented in my past methods, doesn't get tired by the

end

of the day like I do. Now without even a guilty start, I am easily

billing

just about all 99214s. Audit me! For $50 a month, much cheaper than a

medical assistant and has one hell of a medical background. I'd highly

recommend it.

6) Other helpful things- 1) more patients are using appointment quest and

making their appointments online, it's a matter of training but means

lots

less time on the phone for me; 2) new patient volume is tightly

controlled

and ratcheted down, less abstracting of old records has to happen, also

the

'more mature' patient population is requiring less training and effort;

3)

my technology has stopped jerking me around, for the moment- haven't had

a

major issue in almost 3 months, just have to keep my fingers crossed,

really

don't want to add any more technology pieces now or ever (but I suppose

I'll

have to as time goes on); 4) paperless office and workflow it generates

really contribute to efficiency in general.

What is great about the ultrasolo IMP style is that I can just decree to

myself to change the above processes, and it happens. If they don't work,

they get improved on or chucked out. The results are immediate, dramatic

and telling, and there is no chain of command. I really like

that!

The other side of 'sustainable' for me is income, and for some reason

that

seems to be improving too. Now paying myself $6000/month (I think you

could

count it as $7000, if you look at retirement contributions) and it seems

as

if that is still increasing. That would be for about 40 booked

appointments

a week, mostly 99214s and some preventive care, in a state with about

average reimbursement but where preventive+e/m code visits are bundled,

and

where the major insurers will not pay extended visit codes.

I think my malpractice rates will fall for 2 reasons: I am changing to a

cheaper carrier and I may qualify (I hope) for part time malpractice

rates,

from about $12000 to about $8000. (I used your letter, , -thanks!-

about considering my practice as a part time practice despite the greater

than part-time hours, and preliminarily, it seems that they are going to

bite.)

I did knock down my rent/utilities payments to $1050 per month from

$1700,

goaded into this move to cheaper/smaller space by looking at the overhead

breakdown for IMPs in general and realizing mine was way out of

whack.

Lastly, I think my accounts receivables will improve by a lot over the

next

6 months due to electronic billing- I'm sure I've missed a pile of $$ but

I'm not going to go back and try to mine them- too frustrating and it

will

make me too angry. Forward is the way to go at this point.

I think my income will settle somewhere in the 8-9K range a month

including

retirement benefits, at about the 40 visits a week/ 25 booked patient

hours, which for me will be fine. It's more than I've ever made before,

but

certainly not at the FP 'average', but then I am not working in a patient

mill, I am also not doing hospital work and my schedule is not crammed

and

AAHHH -at this acceptable-for-me income level, the satisfaction of the

way

the practice runs trumps all.

Future things I will probably work on- take more (at least some) vacation

and find more compatible coverage; proselytize for an IMP partner?; get a

more complex patient registry going and some population management;

?group

visits - I will have to gear up to fight about reimbursement, RI is so

backwards!; learn and practice motivational interviewing techniques, to

move

people a little bit further along; RELAX a little mentally, as things

actually appear to be working out.

So things are looking up! Thank you all for being the crowd that you are,

and for just being out there. Could not have done this without you all,

and

the inspiration and experience that you - provide/share. (Solo-solo would

have killed me off by now, probably about 6 months ago.)

Here's hoping for the coming year, if you are a new IMP, that you begin

to

settle as reasonably as I have done over the past few months, or if you

have

already established and attained a sustainable spot, that you can

maintain

it despite predicted stormy health care weather. Happy New Year!

Lynn Ho

__________________________________________________________

Fixing up the home? Live Search can help

http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US & source=hmemailtaglinenov06 & FORM=WLMTAG

No virus found in this incoming message.

Checked by AVG Free Edition.

Version: 7.0.409 / Virus Database: 268.15.28/604 - Release Date:

12/26/2006

Sharon McCoy , M.D.

Renaissance Family Medicine

The

Rebirth of Personal Healthcare

www.SharonMD.com

Phone Fax (949)

281-2197

No virus found in this outgoing message.

Checked by AVG Free Edition.

Version: 7.0.409 / Virus Database: 268.15.28/605 - Release Date: 12/27/2006

[Guest guest]

CONGRATULATIONS!! It is so exciting to live your " dream practice "

Let me know if you want some great items on motivational interviewing.

I taught a mini class on this for an IPA I was in and have a great

acronym to remember how to ask the key questions. I'll be glad to email

it to ya. I think I posted it here before about 7000 messages ago.

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

www.idealmedicalpractice.org

>

> Two years into the micropractice, my personal office efficiency seems to

> have made significant improvements over the past 3 months with your ideas,

> THANKS to all of you who sent helpful tips and lent moral support.

>

> I was unable to keep track of where those wasted hours went, the logs were

> just too difficult to keep, but I now no longer have to stay up until

> 2-3-4AM once a week just to get caught up on the billing. My out of work-

> work hours are now much saner (maybe financial stuff, taxes, reconciling

> accounts, paying bills one weekend a month, some desultory bidding on eBay

> for cheap office and medical stuff, etc.) and I feel much less burned out.

> I think I can manage and enjoy this style of practice for a long time (some

> years, I'm thinking); it appears doable AND sustainable for me.

>

> Here's a solo - solo list of the things that got changed in the past 3

> months, that really seemed to help me LOTS, not really in any ranking

> order:

> 1) NEVER answer the phone, pretty much ALWAYS let the machine take a

> message. I was letting the phone interrupt me before- takes some training

> to just let it ring, but the payoff is big. Also, be meaner about having

> patients come in- less phone medicine and more face to face medicine makes

> me feel less put upon.

> 2) Try to avoid calling any results, TRY to email all the results possible,

> a close second leaving messages on an answering machine, paper the 3rd most

> useful method (but takes longer); leaving a message on a machine is also

> fine, but you can't predict when you call if someone is going to be home or

> not! the worst of all is being stuck on the phone for 'by the way' questions

> from a patient.

> 3) Electronic billing is great! Much faster and easier than paper (may

> save me 2-4 hours per week upfront) but more importantly, on the downstream

> side, doesn't allow those smarmy insurances to get away without paying

> because you didn't catch them before 6 months expires- provides proof of

> submission date. I Almost like billing now. Why didn't I do this before?

> 4) Hired a poster/biller to argue with the insurance companies, 5-6 hours

> every 1-2 weeks. Thank goodness and worth every penny, for the peace of mind

> alone.

> 5) Instant Medical History- really a time saver, documents and does it

> well, often more completely than I would have done, patient does the work,

> made all my paper rating scales obsolete. I REALLY appreciate it by the

> ends of the days when I sometimes would get way overwhelmed and feel late,

> even though I wasn't, and essentially not document anything in a complicated

> note, then (groan) have a complicated note to finish after the visit. (this

> is NOT happening any more!) Gives me a great start on the note, reminds me

> of details/problems that I did ask about but forgot completely about and

> would never have documented in my past methods, doesn't get tired by the end

> of the day like I do. Now without even a guilty start, I am easily billing

> just about all 99214s. Audit me! For $50 a month, much cheaper than a

> medical assistant and has one hell of a medical background. I'd highly

> recommend it.

>

> 6) Other helpful things- 1) more patients are using appointment quest and

> making their appointments online, it's a matter of training but means lots

> less time on the phone for me; 2) new patient volume is tightly controlled

> and ratcheted down, less abstracting of old records has to happen, also the

> 'more mature' patient population is requiring less training and effort; 3)

> my technology has stopped jerking me around, for the moment- haven't had a

> major issue in almost 3 months, just have to keep my fingers crossed, really

> don't want to add any more technology pieces now or ever (but I suppose I'll

> have to as time goes on); 4) paperless office and workflow it generates

> really contribute to efficiency in general.

>

> What is great about the ultrasolo IMP style is that I can just decree to

> myself to change the above processes, and it happens. If they don't work,

> they get improved on or chucked out. The results are immediate, dramatic

> and telling, and there is no chain of command. I really like that!

>

> The other side of 'sustainable' for me is income, and for some reason that

> seems to be improving too. Now paying myself $6000/month (I think you could

> count it as $7000, if you look at retirement contributions) and it seems as

> if that is still increasing. That would be for about 40 booked appointments

> a week, mostly 99214s and some preventive care, in a state with about

> average reimbursement but where preventive+e/m code visits are bundled, and

> where the major insurers will not pay extended visit codes.

> I think my malpractice rates will fall for 2 reasons: I am changing to a

> cheaper carrier and I may qualify (I hope) for part time malpractice rates,

> from about $12000 to about $8000. (I used your letter, , -thanks!-

> about considering my practice as a part time practice despite the greater

> than part-time hours, and preliminarily, it seems that they are going to

> bite.)

> I did knock down my rent/utilities payments to $1050 per month from $1700,

> goaded into this move to cheaper/smaller space by looking at the overhead

> breakdown for IMPs in general and realizing mine was way out of whack.

> Lastly, I think my accounts receivables will improve by a lot over the next

> 6 months due to electronic billing- I'm sure I've missed a pile of $$ but

> I'm not going to go back and try to mine them- too frustrating and it will

> make me too angry. Forward is the way to go at this point.

> I think my income will settle somewhere in the 8-9K range a month including

> retirement benefits, at about the 40 visits a week/ 25 booked patient

> hours, which for me will be fine. It's more than I've ever made before, but

> certainly not at the FP 'average', but then I am not working in a patient

> mill, I am also not doing hospital work and my schedule is not crammed and

> AAHHH -at this acceptable-for-me income level, the satisfaction of the way

> the practice runs trumps all.

>

> Future things I will probably work on- take more (at least some) vacation

> and find more compatible coverage; proselytize for an IMP partner?; get a

> more complex patient registry going and some population management; ?group

> visits - I will have to gear up to fight about reimbursement, RI is so

> backwards!; learn and practice motivational interviewing techniques, to move

> people a little bit further along; RELAX a little mentally, as things

> actually appear to be working out.

>

> So things are looking up! Thank you all for being the crowd that you are,

> and for just being out there. Could not have done this without you all, and

> the inspiration and experience that you - provide/share. (Solo-solo would

> have killed me off by now, probably about 6 months ago.)

> Here's hoping for the coming year, if you are a new IMP, that you begin to

> settle as reasonably as I have done over the past few months, or if you have

> already established and attained a sustainable spot, that you can maintain

> it despite predicted stormy health care weather. Happy New Year!

>

> Lynn Ho

>

> _________________________________________________________________

> Fixing up the home? Live Search can help

> http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-

US & source=hmemailtaglinenov06 & FORM=WLMTAG

>

[Guest guest]

Dear Lynn, Congratulations! It was helpful to hear a list of your major problems and solutions. I too have had a very productive 9 months of soul-searching, consultations with our board member and MBA small-business guru resulting in process modification. I am hoping to see a change in my time spent working and improved efficiency. It sounds like you have relaly turned a corner. Great work! Bob Foresterlynn ho wrote: Two years into the

micropractice, my personal office efficiency seems to have made significant improvements over the past 3 months with your ideas, THANKS to all of you who sent helpful tips and lent moral support.I was unable to keep track of where those wasted hours went, the logs were just too difficult to keep, but I now no longer have to stay up until 2-3-4AM once a week just to get caught up on the billing. My out of work- work hours are now much saner (maybe financial stuff, taxes, reconciling accounts, paying bills one weekend a month, some desultory bidding on eBay for cheap office and medical stuff, etc.) and I feel much less burned out. I think I can manage and enjoy this style of practice for a long time (some years, I'm thinking); it appears doable AND sustainable for me.Here's a solo - solo list of the things that got changed in the past 3 months, that really seemed to help me LOTS, not really in any ranking

order:1) NEVER answer the phone, pretty much ALWAYS let the machine take a message. I was letting the phone interrupt me before- takes some training to just let it ring, but the payoff is big. Also, be meaner about having patients come in- less phone medicine and more face to face medicine makes me feel less put upon.2) Try to avoid calling any results, TRY to email all the results possible, a close second leaving messages on an answering machine, paper the 3rd most useful method (but takes longer); leaving a message on a machine is also fine, but you can't predict when you call if someone is going to be home or not! the worst of all is being stuck on the phone for 'by the way' questions from a patient.3) Electronic billing is great! Much faster and easier than paper (may save me 2-4 hours per week upfront) but more importantly, on the downstream side, doesn't allow those smarmy insurances to get away without

paying because you didn't catch them before 6 months expires- provides proof of submission date. I Almost like billing now. Why didn't I do this before?4) Hired a poster/biller to argue with the insurance companies, 5-6 hours every 1-2 weeks. Thank goodness and worth every penny, for the peace of mind alone.5) Instant Medical History- really a time saver, documents and does it well, often more completely than I would have done, patient does the work, made all my paper rating scales obsolete. I REALLY appreciate it by the ends of the days when I sometimes would get way overwhelmed and feel late, even though I wasn't, and essentially not document anything in a complicated note, then (groan) have a complicated note to finish after the visit. (this is NOT happening any more!) Gives me a great start on the note, reminds me of details/problems that I did ask about but forgot completely about and would never have documented

in my past methods, doesn't get tired by the end of the day like I do. Now without even a guilty start, I am easily billing just about all 99214s. Audit me! For $50 a month, much cheaper than a medical assistant and has one hell of a medical background. I'd highly recommend it.6) Other helpful things- 1) more patients are using appointment quest and making their appointments online, it's a matter of training but means lots less time on the phone for me; 2) new patient volume is tightly controlled and ratcheted down, less abstracting of old records has to happen, also the 'more mature' patient population is requiring less training and effort; 3) my technology has stopped jerking me around, for the moment- haven't had a major issue in almost 3 months, just have to keep my fingers crossed, really don't want to add any more technology pieces now or ever (but I suppose I'll have to as time goes on); 4) paperless office and

workflow it generates really contribute to efficiency in general.What is great about the ultrasolo IMP style is that I can just decree to myself to change the above processes, and it happens. If they don't work, they get improved on or chucked out. The results are immediate, dramatic and telling, and there is no chain of command. I really like that!The other side of 'sustainable' for me is income, and for some reason that seems to be improving too. Now paying myself $6000/month (I think you could count it as $7000, if you look at retirement contributions) and it seems as if that is still increasing. That would be for about 40 booked appointments a week, mostly 99214s and some preventive care, in a state with about average reimbursement but where preventive+e/m code visits are bundled, and where the major insurers will not pay extended visit codes.I think my malpractice rates will fall for 2 reasons: I am

changing to a cheaper carrier and I may qualify (I hope) for part time malpractice rates, from about $12000 to about $8000. (I used your letter, , -thanks!- about considering my practice as a part time practice despite the greater than part-time hours, and preliminarily, it seems that they are going to bite.)I did knock down my rent/utilities payments to $1050 per month from $1700, goaded into this move to cheaper/smaller space by looking at the overhead breakdown for IMPs in general and realizing mine was way out of whack.Lastly, I think my accounts receivables will improve by a lot over the next 6 months due to electronic billing- I'm sure I've missed a pile of $$ but I'm not going to go back and try to mine them- too frustrating and it will make me too angry. Forward is the way to go at this point.I think my income will settle somewhere in the 8-9K range a month including retirement benefits, at about the 40

visits a week/ 25 booked patient hours, which for me will be fine. It's more than I've ever made before, but certainly not at the FP 'average', but then I am not working in a patient mill, I am also not doing hospital work and my schedule is not crammed and AAHHH -at this acceptable-for-me income level, the satisfaction of the way the practice runs trumps all.Future things I will probably work on- take more (at least some) vacation and find more compatible coverage; proselytize for an IMP partner?; get a more complex patient registry going and some population management; ?group visits - I will have to gear up to fight about reimbursement, RI is so backwards!; learn and practice motivational interviewing techniques, to move people a little bit further along; RELAX a little mentally, as things actually appear to be working out.So things are looking up! Thank you all for being the crowd that you are, and for

just being out there. Could not have done this without you all, and the inspiration and experience that you - provide/share. (Solo-solo would have killed me off by now, probably about 6 months ago.)Here's hoping for the coming year, if you are a new IMP, that you begin to settle as reasonably as I have done over the past few months, or if you have already established and attained a sustainable spot, that you can maintain it despite predicted stormy health care weather. Happy New Year!Lynn Ho__________________________________________________________Fixing up the home? Live Search can help http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US & source=hmemailtaglinenov06 & FORM=WLMTAG

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