Re: To take insurance or not. & other ways to make it work financially

[Guest guest]

I joined recently and have read every post with fascination (well,

most). Thank you all, I'm enjoying it.

The issue is not necessarily about taking insurance or not as an

absolute, but being VERY selective about which to take. You might

find this strange in other areas of the country, but I take

traditional Medicare almost exclusively, refusing everything else.

All others pay less now, here in my patient population. I couldn't

have the high quality time-intensive practice that I have any other

way.

I do, however, find other ways to supplement my income, and have done

so since I started in practice 14 years ago. All of those ways are

FUN and low-overhead. They include nursing home and outpatient rehab

physician administration, program development, paid lectures, hospice

medical directorship and medical expert witness. Every one of them

takes real time and effort, not just " kick-backs for patient

referrals " kind of money. But it's a good way to be able to pay the

bills if patient visits aren't enough, or you want to limit your

practice volume. Plus, it has allowed me to enact quality changes at

a systemic level, not just at the individual patient level.

I am a geriatric rehab doc who specializes in the most frail,

complex, disabled elderly. Every person who gave me advice before I

started in practice told me I'd never make it financially. They were

all wrong- I made a profit from day one! I just did things very

differently from the norm, like most of the people in this group of

docs. I have no employees and no office, and I started that way in

1994 (back then it was because I was down to my last $500 & couldn't

get a loan).

I'm curious, though, how many of the docs on this listserv are

specialists? I've only seen a couple of posts from neurologists.

There is great potential for micropractice beyond primary care. Think

big, bigger! The patients who need the most time, the elderly, need

all sorts of quality docs; the only way they'll have them is through

the low-overhead movement.

Think outside the box, you people are great!

Rotenberg, MD

Melbourne, Florida

>

> Thanks for the advice! I've heard the 6 mo breakeven point talked

about, but

> nice to hear you needed year two to get there. I would love to get

a part

> time UC job but they are not close to home and family situation

makes it

> difficult (we have 4 adopted children and the youngest has

autism.so lots of

> demands on me, esp. weekends). (Anyone know of anything docs can do

from

> home to make $?) I am still considering it, though. I am trying to

either

> refinance my loan or get another line of credit.

>

>

>

> Interestingly, I haven't had any of my pts who have insurance see

any other

> PCP's besides me, so maybe your struggle is a regional thing. You

may want

> to consider if there is a nice way to remind them that it's really

not good

> for their care when they fragment it. In fact, it can be

dangerous.isn't

> that one of the reasons we all believe so strongly in the medical

home? I

> don't think pts really understand how it hurts their care when

they're

> seeing all these different docs.

>

>

>

> What I think is just a hoot is when Medicare pts choose to see me

and pay

> cash. They still see specialists, but proudly say, " YOU'RE my

doctor.I don't

> mind paying to see you because you always have time for me and you

know

> what's going on with my other doctors. " Some people get it. We just

have to

> keep preaching the gospel to the others!

>

>

>

> Gretchen Reis MD

>

> Wellspring Family Medicine

>

> Circleville, OH

>

>

>

>

>

>

>

> _____

>

> From:

> [mailto: ] On Behalf Of RGMS

> Sent: Monday, January 07, 2008 10:14 PM

> To:

> Subject: RE: To take insurance or not...that

is the

> question

>

>

>

> 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 :-)) 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

>

> <http://www.baycrossingfamilymedicine.com>

> 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

>