RE: To take insurance or not...that is the question

January 8, 2008

RE "breaking even" on insurance

The amount of time to do this will depend on your overhead AND your pt load.

If you have enough pts and full schedules AND pts who pay their bills AND/OR insurance companies who pay well, you'll do OK.

In my area, Medicaid pays $31.90 per visit, so wouldn't matter how many of these pts I saw, could never make it on this. I ultimately dropped this pt class.

M in Western PA

To take insurance or not...that is the question

Hello, everyone.I've been learning a lot since I joined the group a few weeks ago...wish I had more time to just read older messages! I opened my solo practice almost 1 year ago and I'm at a crossroads. I have one employee and a fairly big mortgage/loan payment, so overhead is about $8000/mo. I'm cash only and had slow but steady growth through October, but alas, the last 2 months have been terrible! I was on the verge of breaking even in Oct but now I'm really hurting. The last of my loan funds are almost gone, so I may not be able to pay my bills soon. I'm in a rural area and people complain all the time about paying $99 for a new pt (30min) visit (and est pt fees are less). I think I may have to take some insurance just to survive, but I am just shuddering at the thought! I've heard it takes about 6 mo to break even if taking insurance, and longer going cash only. Can anyone give me any guidelines on how long it might take? Or have others had to give up and take insur contracts again? (it feels like I'm the runaway slave going back to the master...) Any advice is appreciated!Gretchen Reis

January 8, 2008

Gretchen,

One immediate option is to work some weekend urgent

care or ER shifts to make up the difference until your

volume builds some more. I suspect your long term

solution will be found within the operations of your

practice.

How many patients are you seeing per month and what

does your practice setting and competition look like?

It occurs to me that you might lower your new patient

fee to your established patient rates at least for

12-24 months until your practice is full. Think of

it as a marketing expense.

You'll give up some money up front to attract long

term patients. Maybe your price point of entry just

isn't right for your area. I suspect this is the

case. Maybe your office hours need to be realigned or

expanded to fit around your patient's work and family

schedules.

Maybe your prospective patients don't fully appreciate

the value of your services. Maybe you aren't doing

enough to market to the patients you already have to

refer others. Who are you attracting as a patient and

why?

By now you may have some select patients in your

practice whom you trust and value. Ask their honest

opinion about how you are perceived by other

prospective patients in the community. Have your

staff person ask their peers as well.

I believe this will lead to a greater understanding of

your place in the " market " and also to your revenue

solution.

Best Regards,

Ben Brewer MD

________________________________________________________________________________\

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January 8, 2008

Gretchen,

I applaud your courage. I started my practice in 2006

and grappled with the similar decision...ultimately I

did decide to take insurance; albeit, I was very

careful which plans I enrolled in and in 1/1/2008 I

cut out two of the lowest paying insurances.

I was at a slightly better advantage because I

transitioned from a couple of part-time jobs and then

made my practice a full-time gig at the first

opportunity (actually I just couldn't take working in

the hospital and in the office anymore). It took me

about three months into the practice (full-time) to

start reaping the profits.

I would carefully study the payors around your area.

This would be a time when you should speak with your

colleagues who have been practicing for a few years

and can give you an idea of which payors are the best.

Don't get hoodwinked into signing up with EVERYTHING

because ultimately you will see that your frustrations

will increase.

One suggestion would be to make your practice

part-time until it grows more and get another

part-time position somewhere else (salaried). I know

it's not the most appealing option, but that's what I

did.

Best of luck.

Soma

January 8, 2008

I opened in November of 2005 as “cash-only”

(but also agreed to take some patients from a plan to help local underemployed

folks out of principle and to help me define my processes/work flow). Since

that time it has been a bit of a roller coaster of hope and despair…but I

am still content with my choice and “broke even” at EXACTLY year 2

(Nov 2007).

I agree with earlier responses about

getting a part time job until things pick up. I did this and it helped a

bit in the first year.

The bigger question for me has been one of

trying to truly be a medical home for my patients when many of them only come

to me for “important” things. By that, I mean they will go to

their “in network” doctor for routine and preventive exams as well

as UTIs and sinus infections. But when it comes to things like depression

and sorting out new abdominal pains, or things that require more thought and

time, they come to me. AND they often will call for advice or want me to

refill meds because they consider me “their doctor”. As much

as I am honored by the trust some of these patients have in me, it does not

help pay the bills! Result is that I recently signed up with one

insurance plan and am circling on a second…My hope is that at least with

these two plans I can build a loyal patient base who will really want me to

play the role of their medical home. The plans I chose were after great

heartaching study. I did NOT choose the largest players in the area (or

country) because my cash flow would have nose-dived fairly quickly. Our

local hospital dropped a United plan due to their employees not finding

participating doctors. They went with a small local insurance company and

I decided to climb on board as a participating provider. Dealing with

them has been like a breath of fresh air! (REAL people answer the phone…it

is like a “micro-insurance” company J) So, I am in

now in transition!

As much as I wanted to stay out of the insurance game, there simply were not

enough patients coming through my doors to make it work… I feel

sometimes like I have sold my soul to the devil by agreeing to participate. But,

this is the medical world we live in…

I think if I had lower overhead to start

with, I might have been able to stay the course. The biggest reason for

me “dancing with the devil” was to REALLY have some patients who

call my practice their medical home…(at least until they change to a new

medical insurer…) This may not be as much of an issue if you are in

an underserved area. I am not, and people around here doctor shop like

they are at Nordstrom’s!

Good luck!

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of momgareis

Sent: Monday, January 07, 2008

8:35 PM

To:

Subject: To

take insurance or not...that is the question

Hello, everyone.

I've been learning a lot since I joined the group a few weeks

ago...wish I had more time to just read older messages! I opened my

solo practice almost 1 year ago and I'm at a crossroads. I have one

employee and a fairly big mortgage/loan payment, so overhead is about

$8000/mo. I'm cash only and had slow but steady growth through October,

but alas, the last 2 months have been terrible! I was on the verge of

breaking even in Oct but now I'm really hurting. The last of my loan

funds are almost gone, so I may not be able to pay my bills soon. I'm

in a rural area and people complain all the time about paying $99 for a

new pt (30min) visit (and est pt fees are less). I think I may have to

take some insurance just to survive, but I am just shuddering at the

thought! I've heard it takes about 6 mo to break even if taking

insurance, and longer going cash only. Can anyone give me any

guidelines on how long it might take? Or have others had to give up and

take insur contracts again? (it feels like I'm the runaway slave going

back to the master...) Any advice is appreciated!

Gretchen Reis

January 8, 2008

Often in primary care, especially, we seem to have little control over our

revenue. On that side, if you can find out if patients do have insurance, you

might be better to take it. When I started this practice, no one else was taking

insurance, and this was a true competative advantage, and I was full in two

months.

What you can control is your expenses. Maybe you could renegociate your loans to

extend the period while you getting your feet on the ground. Find a local banker

who is willing to help, talk to your accountant if you have one. Maybe you need

to let that employee go, sounds like you are not busy enough to need one.

Is there an IPA that can negociate for you for reasonable rates and save you

time?

What other expenses can you ditch? Look at every line item and see what you can

get rid of for now.

________________________________

From: on behalf of momgareis

Sent: Mon 1/7/2008 6:34 PM

To:

Subject: To take insurance or not...that is the question