Re: my #s

August 31, 2012

Hi PJ! This is a very impressive launch particularly starting this 6 months after residency. I love the fact you are working with the underserved community and doing such a wonderful job. Numbers look great! Well done! Are you coming to IMPCamp? I would love to meet. From: [mailto: ] On Behalf Of practiceimprovementaliasSent: Thursday, August 30, 2012 7:48 PMTo: Subject: my #s Ran into Gordon M. last night, told him about my 6 month old IMP, and he suggested I post some numbers. At 6 months old, it seems to be meeting all milestones.We're in Denver, started 6 mo after residency which I finished 1 year ago. It is 1 md (me) and 1 MA. She does check in, most eligibility, phones, reminders, phlebotomy, shots, and other clia labs (ua, upt, ubt, etc). I do vitals, see patients, referrals, arrange interpreters, billing, some eligibility, and go to all sorts of meetings for people who are caring for underserved folks (mostly for the free food). Our mission is helping the local refugee communities: Only 15% are white, hispanic, or african american. The other 85% are not (largest groups Nepali, Burmese, Somali, etc). Half speak enough English, 40% bring a family to interpret, and for the remaining few I have a cadre of ethnic pre-health students from the local U who volunteer on phone.Patient base came from location with (and advertising to) the local refugee agencies, as well as all manner of shamless local ads: local schools, ethnic markets, local hospitals...reached new lows when I put an ad on the telephone pole out front.I'm an LLC, I suppose I will file as a disregarded entity (aka myself), unless someone here teaches me to do otherwise (and I fill out that form 8838? before the end of the year). We are not a nonprofit, and get no grants...and couldn't get a free drug rep lunch if we wanted because they know our payer mix.60% medicaid, 2% mcr, 18% self pay ($45 for visit, extra for blood draw/shots/procedures), 5% free, 15% private (bc, cigna, aetna, humana, rockymt, uhc). That is 83% MCD or uninsured. Avg 11 patients per day, this increases by about 1.5/month - as you guys have observed, 11 or 12 is comfortable for me also. Days with 18 is taxing. I spend as much time as I want with every patient: 15 to 45 min (I dont think patients care to spend more than 45 min w me!). Have seen about 750 visits of about 500 unique patients so far. I work on avg 4 days a week - meaning 5 days when in town, and less when I take long weekend trips. Googlevoice routes to my cell when we're not in (or to my MA if I'm on a mountain). I'll take 3-4 weeks off this year. When I'm in town, I do work at home many evenings, but that is on many aspects of the business - I do not find this extra time draining. I would otherwise spend some of that time making spreadsheets about less useful things, and facebooking too much. This is a good hobby for now.$ Out: Expenses: $5-6k per month. Half of which is the MA salary (+taxes, yay Intuit online), about 1k is shots (which get reimbursed of course), exactly 1k is rent (actually have too much space and sublet half of it for half the rent cost), and the rest few hundred/month is all other expensesAverage $ in per patient: about $83. This is hard to tell sometimes when trying to do receivables (eg subtracting out vaccine reimbursement).Total in is about 15k/mo now. The difference between in and out is for me. I am quite happy with this salary and it is above what the local FQHCs offered me (add 1-2 more pt per day and it is even above FQHC pay + loan repayment). I consider the FQHCs to be my opportunity cost, as I would be working to serve low income folks regardless. Or maybe MSF is the opportunity cost.Actually I just started paying myself, at 6 months open. We started with zero patients so had negative net for a few months (as in any business, obviously). Then a couple months to pay back that deficit, and another one to build some buffer in the bank. Oh, there were a few upfront costs, probably less than $2k. Found everything on Craigslist (from a guy named Craig, really) or handmedowns, including 2 free EKGs from someone who sets up marijuana shops in former doctor offices, and 2 more free EKGs and a NST machine as my former residency upgraded. Yes I have 4 EKGs, but only do about 2 EKGs a month...and an NST machine but don't do OB here. Of course it helps that my malpractice is $900 this year, as I am in 1st year out of residency (recognizing this will level at 8k/yr in 4 years). I would rank my satisfaction very high, both with the practice and the pay. Of course I have the local flavor of frustrations with payers, but I am not jaded about this yet--I'm still mildly entertained by it. When I get jaded I will go find something else to do with myself. I will post #s again, maybe at 1 year. I have read this forum for years, and I know that reading other folks #s was very helpful, which is why I am posting mine. If I play with xcel long enough I can refine any of these numbers, if anyone cares. Pivot Tables are my friend: I can make lists like which ethnicities I bill more level 4s on (nepali), what % of patients from DRC need interpreters, and other similar wonderfully useless conclusions.any thoughts are appreciated.:-)P.J.

August 31, 2012

Very impressive, PJ! From [mailto: ] On Behalf Of Dr. BradySent: Thursday, August 30, 2012 4:56 PMTo: Subject: RE: my #s Hi PJ! This is a very impressive launch particularly starting this 6 months after residency. I love the fact you are working with the underserved community and doing such a wonderful job. Numbers look great! Well done! Are you coming to IMPCamp? I would love to meet. From: [mailto: ] On Behalf Of practiceimprovementaliasSent: Thursday, August 30, 2012 7:48 PMTo: Subject: my #s Ran into Gordon M. last night, told him about my 6 month old IMP, and he suggested I post some numbers. At 6 months old, it seems to be meeting all milestones.We're in Denver, started 6 mo after residency which I finished 1 year ago. It is 1 md (me) and 1 MA. She does check in, most eligibility, phones, reminders, phlebotomy, shots, and other clia labs (ua, upt, ubt, etc). I do vitals, see patients, referrals, arrange interpreters, billing, some eligibility, and go to all sorts of meetings for people who are caring for underserved folks (mostly for the free food). Our mission is helping the local refugee communities: Only 15% are white, hispanic, or african american. The other 85% are not (largest groups Nepali, Burmese, Somali, etc). Half speak enough English, 40% bring a family to interpret, and for the remaining few I have a cadre of ethnic pre-health students from the local U who volunteer on phone.Patient base came from location with (and advertising to) the local refugee agencies, as well as all manner of shamless local ads: local schools, ethnic markets, local hospitals...reached new lows when I put an ad on the telephone pole out front.I'm an LLC, I suppose I will file as a disregarded entity (aka myself), unless someone here teaches me to do otherwise (and I fill out that form 8838? before the end of the year). We are not a nonprofit, and get no grants...and couldn't get a free drug rep lunch if we wanted because they know our payer mix.60% medicaid, 2% mcr, 18% self pay ($45 for visit, extra for blood draw/shots/procedures), 5% free, 15% private (bc, cigna, aetna, humana, rockymt, uhc). That is 83% MCD or uninsured. Avg 11 patients per day, this increases by about 1.5/month - as you guys have observed, 11 or 12 is comfortable for me also. Days with 18 is taxing. I spend as much time as I want with every patient: 15 to 45 min (I dont think patients care to spend more than 45 min w me!). Have seen about 750 visits of about 500 unique patients so far. I work on avg 4 days a week - meaning 5 days when in town, and less when I take long weekend trips. Googlevoice routes to my cell when we're not in (or to my MA if I'm on a mountain). I'll take 3-4 weeks off this year. When I'm in town, I do work at home many evenings, but that is on many aspects of the business - I do not find this extra time draining. I would otherwise spend some of that time making spreadsheets about less useful things, and facebooking too much. This is a good hobby for now.$ Out: Expenses: $5-6k per month. Half of which is the MA salary (+taxes, yay Intuit online), about 1k is shots (which get reimbursed of course), exactly 1k is rent (actually have too much space and sublet half of it for half the rent cost), and the rest few hundred/month is all other expensesAverage $ in per patient: about $83. This is hard to tell sometimes when trying to do receivables (eg subtracting out vaccine reimbursement).Total in is about 15k/mo now. The difference between in and out is for me. I am quite happy with this salary and it is above what the local FQHCs offered me (add 1-2 more pt per day and it is even above FQHC pay + loan repayment). I consider the FQHCs to be my opportunity cost, as I would be working to serve low income folks regardless. Or maybe MSF is the opportunity cost.Actually I just started paying myself, at 6 months open. We started with zero patients so had negative net for a few months (as in any business, obviously). Then a couple months to pay back that deficit, and another one to build some buffer in the bank. Oh, there were a few upfront costs, probably less than $2k. Found everything on Craigslist (from a guy named Craig, really) or handmedowns, including 2 free EKGs from someone who sets up marijuana shops in former doctor offices, and 2 more free EKGs and a NST machine as my former residency upgraded. Yes I have 4 EKGs, but only do about 2 EKGs a month...and an NST machine but don't do OB here. Of course it helps that my malpractice is $900 this year, as I am in 1st year out of residency (recognizing this will level at 8k/yr in 4 years). I would rank my satisfaction very high, both with the practice and the pay. Of course I have the local flavor of frustrations with payers, but I am not jaded about this yet--I'm still mildly entertained by it. When I get jaded I will go find something else to do with myself. I will post #s again, maybe at 1 year. I have read this forum for years, and I know that reading other folks #s was very helpful, which is why I am posting mine. If I play with xcel long enough I can refine any of these numbers, if anyone cares. Pivot Tables are my friend: I can make lists like which ethnicities I bill more level 4s on (nepali), what % of patients from DRC need interpreters, and other similar wonderfully useless conclusions.any thoughts are appreciated.:-)P.J.

August 31, 2012

Very impressive P.J.We opened our sop in dec last year.We are working 3 days a week only ( M,W and F).U did not say anything about EmR,ndo u have one? Cost is not included in ur numbers.U were lucky because u found used cheap stuff that made a difference.We are getting fuller gradually , word of mouth of our practice is spreading slowly in town.Sometimes I see between 12-15 patients a day ( Ardiana and I). We don't have a receptionist yet, Ardiana is dealing with that.We use Emds hosted on the web, we are not happy with the hosting company.We are not getting paid yet, I work urgent care on the side whenever I can, I drive 1 hour south of my town. I have to pay my rice and beans.We have some cash patients, Ardiana see Medicaid kids, I see Medicare big kids and private insurance.I will make some changes with hosting EmR situation soon that will cost me like 5 k.Anyway I'm so happy for u, u are brave, just out residency wow, blessings to ur wayAdolfo E. Teran,MD

Ran into Gordon M. last night, told him about my 6 month old IMP, and he suggested I post some numbers. At 6 months old, it seems to be meeting all milestones.

We're in Denver, started 6 mo after residency which I finished 1 year ago. It is 1 md (me) and 1 MA. She does check in, most eligibility, phones, reminders, phlebotomy, shots, and other clia labs (ua, upt, ubt, etc). I do vitals, see patients, referrals, arrange interpreters, billing, some eligibility, and go to all sorts of meetings for people who are caring for underserved folks (mostly for the free food).

Our mission is helping the local refugee communities: Only 15% are white, hispanic, or african american. The other 85% are not (largest groups Nepali, Burmese, Somali, etc). Half speak enough English, 40% bring a family to interpret, and for the remaining few I have a cadre of ethnic pre-health students from the local U who volunteer on phone.

Patient base came from location with (and advertising to) the local refugee agencies, as well as all manner of shamless local ads: local schools, ethnic markets, local hospitals...reached new lows when I put an ad on the telephone pole out front.

I'm an LLC, I suppose I will file as a disregarded entity (aka myself), unless someone here teaches me to do otherwise (and I fill out that form 8838? before the end of the year). We are not a nonprofit, and get no grants...and couldn't get a free drug rep lunch if we wanted because they know our payer mix.

60% medicaid, 2% mcr, 18% self pay ($45 for visit, extra for blood draw/shots/procedures), 5% free, 15% private (bc, cigna, aetna, humana, rockymt, uhc). That is 83% MCD or uninsured.

Avg 11 patients per day, this increases by about 1.5/month - as you guys have observed, 11 or 12 is comfortable for me also. Days with 18 is taxing. I spend as much time as I want with every patient: 15 to 45 min (I dont think patients care to spend more than 45 min w me!). Have seen about 750 visits of about 500 unique patients so far.

I work on avg 4 days a week - meaning 5 days when in town, and less when I take long weekend trips. Googlevoice routes to my cell when we're not in (or to my MA if I'm on a mountain). I'll take 3-4 weeks off this year. When I'm in town, I do work at home many evenings, but that is on many aspects of the business - I do not find this extra time draining. I would otherwise spend some of that time making spreadsheets about less useful things, and facebooking too much. This is a good hobby for now.

$ Out: Expenses: $5-6k per month.

Half of which is the MA salary (+taxes, yay Intuit online),

about 1k is shots (which get reimbursed of course),

exactly 1k is rent (actually have too much space and sublet half of it for half the rent cost),

and the rest few hundred/month is all other expenses

Average $ in per patient: about $83.

This is hard to tell sometimes when trying to do receivables (eg subtracting out vaccine reimbursement).

Total in is about 15k/mo now. The difference between in and out is for me. I am quite happy with this salary and it is above what the local FQHCs offered me (add 1-2 more pt per day and it is even above FQHC pay + loan repayment). I consider the FQHCs to be my opportunity cost, as I would be working to serve low income folks regardless. Or maybe MSF is the opportunity cost.

Actually I just started paying myself, at 6 months open. We started with zero patients so had negative net for a few months (as in any business, obviously). Then a couple months to pay back that deficit, and another one to build some buffer in the bank. Oh, there were a few upfront costs, probably less than $2k. Found everything on Craigslist (from a guy named Craig, really) or handmedowns, including 2 free EKGs from someone who sets up marijuana shops in former doctor offices, and 2 more free EKGs and a NST machine as my former residency upgraded. Yes I have 4 EKGs, but only do about 2 EKGs a month...and an NST machine but don't do OB here. Of course it helps that my malpractice is $900 this year, as I am in 1st year out of residency (recognizing this will level at 8k/yr in 4 years).

I would rank my satisfaction very high, both with the practice and the pay. Of course I have the local flavor of frustrations with payers, but I am not jaded about this yet--I'm still mildly entertained by it. When I get jaded I will go find something else to do with myself.

I will post #s again, maybe at 1 year. I have read this forum for years, and I know that reading other folks #s was very helpful, which is why I am posting mine. If I play with xcel long enough I can refine any of these numbers, if anyone cares. Pivot Tables are my friend: I can make lists like which ethnicities I bill more level 4s on (nepali), what % of patients from DRC need interpreters, and other similar wonderfully useless conclusions.

any thoughts are appreciated.

:-)

P.J.

=

August 31, 2012

PJ

you are too funny... which is why this kind of thing (or whatever thing you do)

will always work...

it takes a certain kind of breed to be self employed --- and with a sprinkle of

a sense of humor... youve just taken yourself over the top... kudos !!!!!!!!

grace

>

> > Ran into Gordon M. last night, told him about my 6 month old IMP, and he

suggested I post some numbers. At 6 months old, it seems to be meeting all

milestones.

> >

> > We're in Denver, started 6 mo after residency which I finished 1 year ago.

It is 1 md (me) and 1 MA. She does check in, most eligibility, phones,

reminders, phlebotomy, shots, and other clia labs (ua, upt, ubt, etc). I do

vitals, see patients, referrals, arrange interpreters, billing, some

eligibility, and go to all sorts of meetings for people who are caring for

underserved folks (mostly for the free food).

> >

> > Our mission is helping the local refugee communities: Only 15% are white,

hispanic, or african american. The other 85% are not (largest groups Nepali,

Burmese, Somali, etc). Half speak enough English, 40% bring a family to

interpret, and for the remaining few I have a cadre of ethnic pre-health

students from the local U who volunteer on phone.

> >

> > Patient base came from location with (and advertising to) the local refugee

agencies, as well as all manner of shamless local ads: local schools, ethnic

markets, local hospitals...reached new lows when I put an ad on the telephone

pole out front.

> >

> > I'm an LLC, I suppose I will file as a disregarded entity (aka myself),

unless someone here teaches me to do otherwise (and I fill out that form 8838?

before the end of the year). We are not a nonprofit, and get no grants...and

couldn't get a free drug rep lunch if we wanted because they know our payer mix.

> >

> > 60% medicaid, 2% mcr, 18% self pay ($45 for visit, extra for blood

draw/shots/procedures), 5% free, 15% private (bc, cigna, aetna, humana, rockymt,

uhc). That is 83% MCD or uninsured.

> >

> > Avg 11 patients per day, this increases by about 1.5/month - as you guys

have observed, 11 or 12 is comfortable for me also. Days with 18 is taxing. I

spend as much time as I want with every patient: 15 to 45 min (I dont think

patients care to spend more than 45 min w me!). Have seen about 750 visits of

about 500 unique patients so far.

> >

> > I work on avg 4 days a week - meaning 5 days when in town, and less when I

take long weekend trips. Googlevoice routes to my cell when we're not in (or to

my MA if I'm on a mountain). I'll take 3-4 weeks off this year. When I'm in

town, I do work at home many evenings, but that is on many aspects of the

business - I do not find this extra time draining. I would otherwise spend some

of that time making spreadsheets about less useful things, and facebooking too

much. This is a good hobby for now.

> >

> > $ Out: Expenses: $5-6k per month.

> > Half of which is the MA salary (+taxes, yay Intuit online),

> > about 1k is shots (which get reimbursed of course),

> > exactly 1k is rent (actually have too much space and sublet half of it for

half the rent cost),

> > and the rest few hundred/month is all other expenses

> >

> > Average $ in per patient: about $83.

> > This is hard to tell sometimes when trying to do receivables (eg subtracting

out vaccine reimbursement).

> >

> > Total in is about 15k/mo now. The difference between in and out is for me. I

am quite happy with this salary and it is above what the local FQHCs offered me

(add 1-2 more pt per day and it is even above FQHC pay + loan repayment). I

consider the FQHCs to be my opportunity cost, as I would be working to serve low

income folks regardless. Or maybe MSF is the opportunity cost.

> >

> > Actually I just started paying myself, at 6 months open. We started with

zero patients so had negative net for a few months (as in any business,

obviously). Then a couple months to pay back that deficit, and another one to

build some buffer in the bank. Oh, there were a few upfront costs, probably less

than $2k. Found everything on Craigslist (from a guy named Craig, really) or

handmedowns, including 2 free EKGs from someone who sets up marijuana shops in

former doctor offices, and 2 more free EKGs and a NST machine as my former

residency upgraded. Yes I have 4 EKGs, but only do about 2 EKGs a month...and an

NST machine but don't do OB here. Of course it helps that my malpractice is $900

this year, as I am in 1st year out of residency (recognizing this will level at

8k/yr in 4 years).

> >

> > I would rank my satisfaction very high, both with the practice and the pay.

Of course I have the local flavor of frustrations with payers, but I am not

jaded about this yet--I'm still mildly entertained by it. When I get jaded I

will go find something else to do with myself.

> >

> > I will post #s again, maybe at 1 year. I have read this forum for years, and

I know that reading other folks #s was very helpful, which is why I am posting

mine. If I play with xcel long enough I can refine any of these numbers, if

anyone cares. Pivot Tables are my friend: I can make lists like which

ethnicities I bill more level 4s on (nepali), what % of patients from DRC need

interpreters, and other similar wonderfully useless conclusions.

> >

> > any thoughts are appreciated.

> > :-)

> > P.J.

> >

>

August 31, 2012

I wonder if with so many cash uninsured you have less paper work? When I rarely do not have to do up the encounter form or the referral or the endles forms well gosh I love thsoe rare visits-- uti .cash. done

Very impressive P.J.We opened our sop in dec last year.We are working 3 days a week only ( M,W and F).U did not say anything about EmR,ndo u have one? Cost is not included in ur numbers.

U were lucky because u found used cheap stuff that made a difference.We are getting fuller gradually , word of mouth of our practice is spreading slowly in town.Sometimes I see between 12-15 patients a day ( Ardiana and I). We don't have a receptionist yet, Ardiana is dealing with that.

We use Emds hosted on the web, we are not happy with the hosting company.We are not getting paid yet, I work urgent care on the side whenever I can, I drive 1 hour south of my town. I have to pay my rice and beans.

We have some cash patients, Ardiana see Medicaid kids, I see Medicare big kids and private insurance.I will make some changes with hosting EmR situation soon that will cost me like 5 k.Anyway I'm so happy for u, u are brave, just out residency wow, blessings to ur way

Adolfo E. Teran,MD