Re: New doctor in CHICAGO, already getting discouraged-should I accept HMO's?

[Guest guest]

I am 100 miles south of Chicago in Forrest, IL. I

have been in practice for 10 years, 8 as a solo doc.

I'd be willing to help you if you like.

For Capitation to make any sense economically, you

have to have a big enough patient population to make

it work. Not exactly what a low volume personalized

practice is looking for I would think.

It only works well if the patients come in

infrequently. If you receive $120 a year per patient

and they have chronic illness you're going to be

seeing them at least 4 times a year. The average

person will come in at least twice. One of these will

be a comprehensive new patient visit that's worth more

than $120 on many insurances.

I bet $30 a visit might almost cover your overhead

this year with nothing left for profit. Next year

when your malpractice goes up your cost per visit will

increase and you'll be losing money on each of these

patients. $10 per patient per month is about what

capitated plans were paying when I got out of

residency 10 years ago.

Filling your practice with low margin business doesn't

make sense to me.

Ben

--- PC wrote:

> Ok, so I was already crazy enough to open my solo

> family practice

> clinic last month in a lower/middle working class

> suburb of Chicago

> after completing residency July '07. Now I'm

> wondering if I should

> join my hospital's PHO? I'm getting many many

> opinions, and couldn't

> hurt to have more. There is no fee for service, the

> capitation is $10

> per patient per month, and are there ANY OTHER

> questions I should ask

> the group about compensation? It's 6000 lives, not

> sure of the bonus

> structure, and otherwise a typical PHO. Since I'm

> new and a fairly

> empty clinic, the hospital says it would be great if

> I joined the

> physician run program so I build " traffic " in my

> clinic and get a

> monthly " guaranteed " income, although another

> physician in the PHO

> says these patients tend to be train recks.

> Currently, I have no

> staff, not sure if I need to hire anybody now since

> I don't have high

> volume. I'm already accepting Medicare and Medicaid.

> Would love some

> advice. Also, does anybody know of a solo " support "

> group in Chicago

> that a young physician like me can join for help?

> I didn't realize how lonely and disheartening this

> quest would be.

>

>

________________________________________________________________________________\

____

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[Guest guest]

if i were me in your shoes, i would consider the following:am i living where i want?if i were living where i want, would i have the social support i need?can i afford to live where i want?are there patients with the types of payers i want who pay what i want in the area i want to live?i think you get the drift; did you ask yourself the questions and measure the market before making the leap?sounds like you left residency wanting to heal the masses (not a bad thing); i think it's reasonable to say at this point that the IMP model, in such circumstances you describe, does not survive.there are other models which seem to, one is the robert forrester "benefactor" model, another is the joanne holland model.if you wish to heal the masses, don't go it alone.one option is to close, and temporarily work for someone/something else, and then when you have a better idea of what/where/how, to reopen where and how you want.or some

combination-- if you do some other work, you can continue to keep your office, but can slowly learn how to do it, without accepting patients/payers you don't want.don't be afraid that you've made some mistakes, that's how we learn, from making our own, and sharing our experience.LLPC wrote: Ok, so I was already crazy enough to open my solo family practice clinic last month in a lower/middle working class suburb of Chicago after completing residency July '07. Now I'm wondering if I should join my hospital's

PHO? I'm getting many many opinions, and couldn't hurt to have more. There is no fee for service, the capitation is $10 per patient per month, and are there ANY OTHER questions I should ask the group about compensation? It's 6000 lives, not sure of the bonus structure, and otherwise a typical PHO. Since I'm new and a fairly empty clinic, the hospital says it would be great if I joined the physician run program so I build "traffic" in my clinic and get a monthly "guaranteed" income, although another physician in the PHO says these patients tend to be train recks. Currently, I have no staff, not sure if I need to hire anybody now since I don't have high volume. I'm already accepting Medicare and Medicaid. Would love some advice. Also, does anybody know of a solo "support" group in Chicago that a young physician like me can join for help? I didn't realize how lonely and disheartening this quest would be.

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[Guest guest]

PC:

You are not alone in Chicago. We are nearby and can help. What is your name and where do you practice?

Just outside Chicago in Sandwhich, IL

New doctor in CHICAGO, already getting discouraged-should I accept HMO's?

Ok, so I was already crazy enough to open my solo family practiceclinic last month in a lower/middle working class suburb of Chicagoafter completing residency July '07. Now I'm wondering if I shouldjoin my hospital's PHO? I'm getting many many opinions, and couldn'thurt to have more. There is no fee for service, the capitation is $10per patient per month, and are there ANY OTHER questions I should askthe group about compensation? It's 6000 lives, not sure of the bonusstructure, and otherwise a typical PHO. Since I'm new and a fairlyempty clinic, the hospital says it would be great if I joined thephysician run program so I build "traffic" in my clinic and get amonthly "guaranteed" income, although another physician in the PHOsays these patients tend to be train recks. Currently, I have nostaff, not sure if I need to hire anybody now since I don't have highvolume. I'm already accepting Medicare and

Medicaid. Would love someadvice. Also, does anybody know of a solo "support" group in Chicagothat a young physician like me can join for help? I didn't realize how lonely and disheartening this quest would be.

Looking for last minute shopping deals? Find them fast with Yahoo! Search.

[Guest guest]

, I'm in Stone Park, IL (a very small suburb surrounded by northlake, franklin park, melrose park, maywood, bellwood). My info is below. Thanks for getting back to me. Egly wrote: PC: You are not alone in Chicago. We are nearby and can help. What is your name and where do you practice? Just outside Chicago in Sandwhich, IL New doctor in CHICAGO, already getting discouraged-should I accept HMO's? Ok, so I was already crazy enough to open my solo family practiceclinic last month in a lower/middle working class suburb of Chicagoafter completing residency July '07. Now I'm wondering if I shouldjoin my hospital's PHO? I'm getting many many opinions, and couldn'thurt to have more. There is no fee for service, the capitation is $10per patient per month, and are there ANY OTHER questions I should askthe group about compensation? It's 6000 lives, not sure of the bonusstructure, and otherwise a typical PHO. Since I'm new and a fairlyempty clinic, the hospital says it would be great if I joined thephysician run program so I build "traffic" in my clinic and get amonthly "guaranteed" income, although another physician in the PHOsays these patients tend to be train recks. Currently, I have nostaff, not sure if I need to hire anybody now since I don't have highvolume. I'm already accepting Medicare and Medicaid. Would love someadvice. Also, does anybody know of a solo "support" group in Chicagothat a young physician like me can join for help? I didn't realize how lonely and disheartening this quest would be. Looking for last minute shopping deals? Find them fast with Yahoo! Search. Professionally yours, Chirag Patel, DOABC Medical1550 N Mannheim Rd Unit CStone Park, IL 60165P F

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[Guest guest]

Chicagoland is an expensive place to practice and live. Malpractice

rates are horrific, cost of living is high. Primary care capitation

of $10 was inadequate even 15 years ago and isn't worth the paperwork as

others have noted. Rates like that have the implicit message:

" Go ahead and run a mill for all we care. " I don't

see how one can deliver quality care at those rates.

Get in touch with some of your local experts: & Egly,

Larry Lindeman. They know their stuff and can help. Read

through the basics on

www.IMPCenter.org

especially the business model stuff to see how you measure up on

practice expenses.

Many find that the can still shave a lot from expenses when they let

their sacred cows go to pasture.

Hiring staff makes sense when the revenue exists to more than cover the

expense and you have a solid set of processes you can teach an

employee. Hiring and training employees takes time and skill &

few of us have the training to do this well.

I agree with the others. First step is to step back, re-assess the

fundamentals and see if what you're after is even possible in your

current environment.

Gordon

At 10:24 AM 1/3/2008, you wrote:

PC,

Sorry to hear things are not going as you

had hoped. This group is a great resource for you, and a way to

circumvent loneliness. Larry has some good responses that you

should ponder if you haven’t already. You only opened a month ago,

and it takes time to build a practice. I would not recommend staff

yet. Have you been marketing yourself (speaking at local functions,

library, churches, wherever your prospective patients would be,

etc)? Are your prices set too high for your area? Are you

being killed by high cost of leasing your space? The PHO could be a

partial solution, but only a temporary one IMHO.

Good luck and keep us informed.

A. Eads,

M.D.

Pinnacle Family

Medicine, PLLC

phone

fax

P.O. Box

7275

Woodland Park,

CO 80863

www.PinnacleFamilyMedicine.com

From:

[

mailto: ] On Behalf Of

lawrence lyon

Sent: Thursday, January 03, 2008 8:07 AM

To:

Subject: Re: New doctor in CHICAGO, already

getting discouraged-should I accept HMO's?

if i were me in your shoes, i would

consider the following:

am i living where i want?

if i were living where i want, would i have the social support i

need?

can i afford to live where i want?

are there patients with the types of payers i want who pay what i want in

the area i want to live?

i think you get the drift; did you ask yourself the questions and measure

the market before making the leap?

sounds like you left residency wanting to heal the masses (not a bad

thing); i think it's reasonable to say at this point that the IMP model,

in such circumstances you describe, does not survive.

there are other models which seem to, one is the robert forrester

" benefactor " model, another is the joanne holland model.

if you wish to heal the masses, don't go it alone.

one option is to close, and temporarily work for someone/something else,

and then when you have a better idea of what/where/how, to reopen where

and how you want.

or some combination-- if you do some other work, you can continue

to keep your office, but can slowly learn how to do it, without accepting

patients/payers you don't want.

don't be afraid that you've made some mistakes, that's how we learn, from

making our own, and sharing our experience.

LL

PC wrote:

Ok, so I was already crazy enough

to open my solo family practice

clinic last month in a lower/middle working class suburb of

Chicago

after completing residency July '07. Now I'm wondering if I

should

join my hospital's PHO? I'm getting many many opinions, and

couldn't

hurt to have more. There is no fee for service, the capitation is

$10

per patient per month, and are there ANY OTHER questions I should

ask

the group about compensation? It's 6000 lives, not sure of the

bonus

structure, and otherwise a typical PHO. Since I'm new and a

fairly

empty clinic, the hospital says it would be great if I joined

the

physician run program so I build " traffic " in my clinic and

get a

monthly " guaranteed " income, although another physician in

the PHO

says these patients tend to be train recks. Currently, I have no

staff, not sure if I need to hire anybody now since I don't have

high

volume. I'm already accepting Medicare and Medicaid. Would love

some

advice. Also, does anybody know of a solo " support " group

in Chicago

that a young physician like me can join for help?

I didn't realize how lonely and disheartening this quest would be.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile.

Try it now.

[Guest guest]

PC,

The first step is to NOT get discouraged. Talk to all the other Solo

docs in your area to see what the insurance mix is and which ones to

avoid. The reimbursements in your area does not sound very good. But

most other local practitioners will share their experiences, and help

you make a decision as to whether it is doable.

Working for someone else temporarily since you just got out of

residency will help you get some experience while getting a

guaranteed income. If you do that, focus heavily on learning billing

and coding--extremely important so you can collect what is due to

you. Then try to narrow down a location where solo practice has a

chance---real estate agents can tell you which areas are growing,

demographics, etc.

However you could still make this work by immediately getting

yourself a moonlighting position somewhere. I opened 1.5 yr ago, in

an area with mostly NY State employees, moonlighted for the

hopitalists for several months, and still doing nursing home work.

This will also make it possible for you to grow slowly with good

payors. Without income for an extended period, negative feelings will

surely overwhelm you. Though advertising raises overhead, it more

than paid off in my case--help me build up rapidly.

Good Luck!

--Padma

>

> Ok, so I was already crazy enough to open my solo family practice

> clinic last month in a lower/middle working class suburb of Chicago

> after completing residency July '07. Now I'm wondering if I should

> join my hospital's PHO? I'm getting many many opinions, and couldn't

> hurt to have more. There is no fee for service, the capitation is

$10

> per patient per month, and are there ANY OTHER questions I should

ask

> the group about compensation? It's 6000 lives, not sure of the bonus

> structure, and otherwise a typical PHO. Since I'm new and a fairly

> empty clinic, the hospital says it would be great if I joined the

> physician run program so I build " traffic " in my clinic and get a

> monthly " guaranteed " income, although another physician in the PHO

> says these patients tend to be train recks. Currently, I have no

> staff, not sure if I need to hire anybody now since I don't have

high

> volume. I'm already accepting Medicare and Medicaid. Would love some

> advice. Also, does anybody know of a solo " support " group in Chicago

> that a young physician like me can join for help?

> I didn't realize how lonely and disheartening this quest would be.

>

>

>

>

>

> _____

>

> Be a better friend, newshound, and know-it-all with Yahoo! Mobile.

Try

>

<http://us.rd.yahoo.com/evt=51733/*http:/mobile.yahoo.com/;_ylt=Ahu06i

62sR8H

> DtDypao8Wcj9tAcJ%20> it now.

>

[Guest guest]

I live in Chicago and I am familiar with some of the hospital's PHO's. There are huge differences in the reimbursement. Please give me a call before you sign up with any. I am with 1 PHO that also has great PPO contracts and a generous bonus. The capitation is also higher. $10 is too low for Chicago. It should be 12-14.  Larry Lindeman M.D.Roscoe Village Family Medicine2255 W. RoscoeChicago, Illinois 60618 Ok, so I was already crazy enough to open my solo family practiceclinic last month in a lower/middle working class suburb of Chicagoafter completing residency July '07. Now I'm wondering if I shouldjoin my hospital's PHO? I'm getting many many opinions, and couldn'thurt to have more. There is no fee for service, the capitation is $10per patient per month, and are there ANY OTHER questions I should askthe group about compensation? It's 6000 lives, not sure of the bonusstructure, and otherwise a typical PHO. Since I'm new and a fairlyempty clinic, the hospital says it would be great if I joined thephysician run program so I build "traffic" in my clinic and get amonthly "guaranteed" income, although another physician in the PHOsays these patients tend to be train recks. Currently, I have nostaff, not sure if I need to hire anybody now since I don't have highvolume. I'm already accepting Medicare and Medicaid. Would love someadvice. Also, does anybody know of a solo "support" group in Chicagothat a young physician like me can join for help? I didn't realize how lonely and disheartening this quest would be. 

[Guest guest]

PC,Which suburb are you in? I left Chicagoland 7 years ago for SE Wisconsin in part for greener pastures, both medically and personally.FIrst I applaud you on going solo right out of training; I couldn't have found the courage to do that. 2nd, my memory of capitation in the Chicago are was that it was a nightmare. One of my friends worked for a heavily capitated group in the late 90's and quit after a year mainly b/c of the ethical issues he encountered in that system. I think it created a practice style of hamster wheeling.Don't be discouraged, you are not alone, this list serv has been a lifeline for me since going on my own 3 mos ago. (I worked for a hospital for 7 yrs previously). I think it is better to grow your practice carefully and with control, than to increase "traffic" jsut for its own sake and deal with a load of unexpected problems.JimSolo2 FTEMedinformatix

EMRInpt/OutptStill on early part of learning curvePC wrote: Ok, so I was already crazy enough to open my solo family practice clinic last month in a lower/middle working class suburb of Chicago after completing residency July '07. Now I'm wondering if I should join my hospital's PHO? I'm getting many many opinions, and couldn't hurt to have more. There is no fee for service, the capitation is $10 per patient per month, and are there ANY OTHER questions I should ask the group about compensation? It's 6000

lives, not sure of the bonus structure, and otherwise a typical PHO. Since I'm new and a fairly empty clinic, the hospital says it would be great if I joined the physician run program so I build "traffic" in my clinic and get a monthly "guaranteed" income, although another physician in the PHO says these patients tend to be train recks. Currently, I have no staff, not sure if I need to hire anybody now since I don't have high volume. I'm already accepting Medicare and Medicaid. Would love some advice. Also, does anybody know of a solo "support" group in Chicago that a young physician like me can join for help? I didn't realize how lonely and disheartening this quest would be.