Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Great job Jean. Way to go. Keep it up! Overhead of 35% is a sign of very efficient office. 9-10 a day is a full day. We see our goal of 12 patients daily or 3 every two hours in office. This allows for work-ins and phone calls and getting the job done at the time of care. We are noticing we may be missing opportunities for patient visits. CallerID shows someone called but not leaving message. PS When you are ready, I think I could help you save 8% on billing. Would push you closer to $107,000. Subject: three yr reportTo: practiceimprovement1 Date: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations!! 3 years….it’s not paper, what anniversary gift do you deserve this year? Sharon From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Subject: RE: three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 green paper sharon .the green rectangluar kind With presidents on them Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations!! 3 years….it's not paper, what anniversary gift do you deserve this year? Sharon From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Subject: RE: three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can't get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean's. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 I’ll have to see if I can find that notepad of $1,000,000 bills that Abbie has…… From: [mailto: ] On Behalf Of Jean Antonucci Sent: Thursday, July 31, 2008 11:05 AM To: Subject: Re: three yr report green paper sharon .the green rectangluar kind With presidents on them On Thu, Jul 31, 2008 at 1:59 PM, Sharon McCoy , M.D. wrote: Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations!! 3 years….it's not paper, what anniversary gift do you deserve this year? Sharon From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Subject: RE: three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can't get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean's. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 What I am thinking is just look at gross income and # of patient visits. You divide the number and get average pay/ov say around $60. This takes into account everything you do, hospital, vaccines, levels of visits, etc. Then you take your expenses: Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay for it. (10% overhead) Rent: 466 OV to pay for it. (22 %) Salaries: 416 OV (19% overhead) Billing: 250 OV (12% overhead) Office Supplies: 100 OV Medical Supplies: 453 OV Cleaning: 100 OV Professional Expenses: 50 OV Other: 75 OV (for examples here) So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, that would explain my poor income now wouldn’t it. It could also let us see if fixable. It will also let us compare apples to apples a little easier. Say someone says there overhead is 30% and you break it down to average pay/OV, # of visits/year and what the individual expenses are you might see you spend way too much on one thing. Or your costs are average but you just don’t see enough patients or you reimbursement is too lousy. Of course the more patients, the more hours you work, the higher salaries, billing expenses and supply expenses but that can be factored in too. Fudge factor of x%. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sharon McCoy , M.D. Sent: Thursday, July 31, 2008 2:00 PM To: Subject: RE: three yr report Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations!! 3 years….it’s not paper, what anniversary gift do you deserve this year? Sharon From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Subject: RE: three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 This works, except the real denominator is RVUs hard to get. This will work to show if threshold for $/visit for IMPS and should show rangeacross IMPS for each area of overhead. Efficiency is when major overhead reduced like low rent or owning building free and clear after 30 years, low staff or no staff, low malpractice. Most offices would be profitable if doctors could see patient every 40 minutes for 1980 hours pre year. Subject: RE: three yr reportTo: Date: Thursday, July 31, 2008, 1:13 PM What I am thinking is just look at gross income and # of patient visits. You divide the number and get average pay/ov say around $60. This takes into account everything you do, hospital, vaccines, levels of visits, etc. Then you take your expenses: Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay for it. (10% overhead) Rent: 466 OV to pay for it. (22 %) Salaries: 416 OV (19% overhead) Billing: 250 OV (12% overhead) Office Supplies: 100 OV Medical Supplies: 453 OV Cleaning: 100 OV Professional Expenses: 50 OV Other: 75 OV (for examples here) So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, that would explain my poor income now wouldn’t it. It could also let us see if fixable. It will also let us compare apples to apples a little easier. Say someone says there overhead is 30% and you break it down to average pay/OV, # of visits/year and what the individual expenses are you might see you spend way too much on one thing. Or your costs are average but you just don’t see enough patients or you reimbursement is too lousy. Of course the more patients, the more hours you work, the higher salaries, billing expenses and supply expenses but that can be factored in too. Fudge factor of x%. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Sharon McCoy , M.D.Sent: Thursday, July 31, 2008 2:00 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: RE: [Practiceimprovemen t1] three yr report Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations! ! 3 years….it’s not paper, what anniversary gift do you deserve this year? Sharon From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Kathy SaradarianSent: Thursday, July 31, 2008 9:56 AMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: RE: [Practiceimprovemen t1] three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AMTo: practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 But not all IMPs work on the model of no staff and malpractice isn’t actually a choice we get to make. You are correct, RVUs would be the real common denominator but too much work. I am going to try it and probably really depress myself. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Egly Sent: Thursday, July 31, 2008 2:25 PM To: Subject: RE: three yr report This works, except the real denominator is RVUs hard to get. This will work to show if threshold for $/visit for IMPS and should show rangeacross IMPS for each area of overhead. Efficiency is when major overhead reduced like low rent or owning building free and clear after 30 years, low staff or no staff, low malpractice. Most offices would be profitable if doctors could see patient every 40 minutes for 1980 hours pre year. From: Kathy Saradarian Subject: RE: three yr report To: Date: Thursday, July 31, 2008, 1:13 PM What I am thinking is just look at gross income and # of patient visits. You divide the number and get average pay/ov say around $60. This takes into account everything you do, hospital, vaccines, levels of visits, etc. Then you take your expenses: Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay for it. (10% overhead) Rent: 466 OV to pay for it. (22 %) Salaries: 416 OV (19% overhead) Billing: 250 OV (12% overhead) Office Supplies: 100 OV Medical Supplies: 453 OV Cleaning: 100 OV Professional Expenses: 50 OV Other: 75 OV (for examples here) So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, that would explain my poor income now wouldn’t it. It could also let us see if fixable. It will also let us compare apples to apples a little easier. Say someone says there overhead is 30% and you break it down to average pay/OV, # of visits/year and what the individual expenses are you might see you spend way too much on one thing. Or your costs are average but you just don’t see enough patients or you reimbursement is too lousy. Of course the more patients, the more hours you work, the higher salaries, billing expenses and supply expenses but that can be factored in too. Fudge factor of x%. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Sharon McCoy , M.D. Sent: Thursday, July 31, 2008 2:00 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: RE: [Practiceimprovemen t1] three yr report Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations! ! 3 years….it’s not paper, what anniversary gift do you deserve this year? Sharon From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Practiceimprovement 1yahoogroups (DOT) com Subject: RE: [Practiceimprovemen t1] three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement 1yahoogroups (DOT) com Subject: [Practiceimprovemen t1] three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town ..I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will .. If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 First of all, kudos to Jean-I'm looking forward to the day that I can come up to Farmington Maine, set up an IMP practice nearby and take six or eight weeks vacation and pay to cover for me! (As long as she's not also taking vacation). I actually do know my RVUs-approximately 200 per month-which works out for me working three days a week-about 95k (what the hospital pays per RVU) lately it's been pretty busy about one patient every 20 minutes or so. Just so there is no question-even if we were without hospital help- my partner and I (she works full time) grossed about 550K last year-with even a large overhead this would work out. To me, the holy Grail is getting paid to maintain health and not for patient encounters. There is an initiative starting in Pennsylvania which the hospital may be able to get onto which starts to pay for management. Perhaps Gordon has something else to say about these initiatives which I know are getting under way in New York and Pennsylvania. By the way-lately this summer I've been doing a lot of physical exams, sports physicals and school physicals-instant medical history turns out to be very valuable for these types of things. > > > Subject: RE: three yr report > To: > Date: Thursday, July 31, 2008, 1:13 PM > > What I am thinking is just look at gross income and # of patient visits. > You divide the number and get average pay/ov say around $60. This takes > into account everything you do, hospital, vaccines, levels of visits, etc. > > > > Then you take your expenses: > > Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to > pay for it. (10% overhead) > > Rent: 466 OV to pay for it. (22 %) > > Salaries: 416 OV (19% overhead) > > Billing: 250 OV (12% overhead) > > Office Supplies: 100 OV > > Medical Supplies: 453 OV > > Cleaning: 100 OV > > Professional Expenses: 50 OV > > Other: 75 OV > > > > (for examples here) > > > > So my overhead takes 2143 ov/year to cover. If I am only doing 2200 > OV/year, that would explain my poor income now wouldn't it. It could also > let us see if fixable. It will also let us compare apples to apples a > little easier. Say someone says there overhead is 30% and you break it > down to average pay/OV, # of visits/year and what the individual expenses > are you might see you spend way too much on one thing. Or your costs are > average but you just don't see enough patients or you reimbursement is too > lousy. > > > > Of course the more patients, the more hours you work, the higher salaries, > billing expenses and supply expenses but that can be factored in too. Fudge > factor of x%. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of Sharon McCoy , M.D. > Sent: Thursday, July 31, 2008 2:00 PM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Kathy, > > I think you may be onto something but can you describe in more detail what > you are talking about? > > > > > > Wow! Congratulations! ! 3 years..it's not paper, what anniversary gift do > you deserve this year? > > > > Sharon > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 9:56 AM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Nice report > > Forgot to mention that typing has improved markedly over past year too. > > > > I have been wracking my brain trying to come up with an idea of helping > compare apples to apples. It is great to hear that some docs run at 20% > overhead, 50% overhead 70% overhead but what does that really mean? > > > > So I thought that if we describe overhead in number of patient visits, it > might actually be more comparable and help point out bad business vs. bad > area. > > > > For example, you can't get a closet in NJ for $537/mo. My malpractice is > $14,000/year. So of course my overhead will be higher. Because I also > believe that my average payment for OV is probably similar to Jean's. But > we have colleagues in the South with low rent, low malpractice, low > staffing, great payments whose overhead might be higher or lower depending > on many things. > > > > Sound like an idea? > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of > Sent: Thursday, July 31, 2008 9:55 AM > To: practiceimprovement 1yahoogroups (DOT) com > Subject: [Practiceimprovemen t1] three yr report > > > > I may do these yearly reports forever.... > > Have been open just over three years Have only recently signed on to my > second commercial insurance(or I think I have, it is complicated) > > broke even at 2-3 weeks > began to feed self around 6 months > Things were tight for a long time and while > I still sorta live from paycheck to paycheck I live BETTER from > paycheck to paycheck > Actually I have saved money a few times this year I do fear for my car at > 268,000 miles and the house should be painted and I need a new furnace but I > think I c an work all that out and there is some hope we can take a warm > winter vacation this year not having done so for a while > Last summer I did nothing all day it seemed Things were dead I was very > worried This summer much different so I conclude, given that I have to > monitor which insurers I take--I cannot just FILL like a hospital practice > becasue they take all comers and get subsidized by orhto etc, probably that > comment about 2-5 yrs to maturity is dead on. > I am not in a dead zone but I am in an ill zone. > Fortunately housing here is affordable and so is malpractice moslty. > > I still haven no employees and run exactly the same arrangement as when I > opened- outsource billing ,simple phone, all in one, cellphone ,answering > machine, lap top only that I take home on weekends > > Lessons learned /things changed-- I no longer order immunizations form the > state I get them transferred from t he pediatric practice which prevents > waste not much other didfference ,but I was wasting so many it was stupid > > > > had to move a year ago very hard to find space but otherwise no big deal > to move-- becasue uh I did not actually change addresses .Small town .I > moved to a different building in t he office park. I had been 105 mt blue > circle and shared the building so the post office said I could be suite 2 > there. When I moved to 115 mt blue circle also sharing a previously > unshared, building well I called up the post office and we made another > suite 2 , dissolving the first, using the same mailbox out on a post and > I put a differnt sticky number on it > > Had to get a new lap top last fall that was one of the most painful things > I have ever done BEcasue i did not know what I was doing and lost a few > notes So now I know alot more about wher e my data is and stuff THough I > would not wan tto do it again soon.... > > Still do some outside work for which I am very grateful.Teaching at the > resdiency precepting irregulalry is tres useful -I get socialization, CME , > lunch, contributions to a SEP IRA and they have had me back now for a > second year to teach part of practice management which lets me prosletyze > about iMPS and becasue of which two 3 rd yr res cam to see my office last yr > and both came to CAMp so I hope they go on to do well > > advice/ recommendations: > be cheap! > ask someone on t he l ist serv if you need help. the variety of > situations we encounter and the willingness to share is rich and varied > > > > Hospital colleagues have no idea what I do and have shown no interest. > When the hospital's PA teaches Tai chi locally and is in t he paper or > some xray tech gets certified in something it goes on the bulletin board > When I am in t he paper or publish or in medical economics-not. > > oh and vacations The most I have been away is a week. I just take the > cellphone and or call my machine twice a d ay-having left the message I will > . If someone need to be seen I scrounge around and find someone- so far ha > s been workable If I can afford three weeks in Paris I will let you know > what I come up with > > would I go back to a " job? " nope > > Do I do a good job? > Hope so HYH numbers pretty good -can improve. > LAst summer had a clot of people leave mostly the unhappy " Searchers " > always looking > Two have come back > one I still get the notes for form specialist and she is on no different > treatment that I had given. > One I see has her home up for sale so has left the area > I get new patient requests more now that a year ago and actually am probably > closed or closing > I admit I now cherry pick But not on the basis of money necessarily .. I > saw a new 10 yr old two days ago on mediciad because I see her parents and > I want kids.( in the practice. Wouldn't want the noisy little things to > come home with me) > I turned down a guy with good insurance becasue it was back pain and I was > busy. > I turned down a family of 4 dual eligbles-all 4- because I thought I could > not stand it emotionally the day they called. > I took an insurance well woman because I see grandmother etc PIcking and > choosing case by case is likely how I will slow to a crawl > > How much do I make? > Less than Lou Spikol . > > > Hope any of this helps other wise how fun I got to type.My favorite thing. > > > overhead about 35% > malpractice about 8,000 > > space about 125 sq ft > rent about 537.00 a month > > registered patients ?who knows? the number is 758 but many were skilled > nursing home patients who rehab'd and went home that work is minimal now > due to difficult changes at the nursing home > > Like to see genreally up to 8-10 a day but not quite every day still yet > > > business model is solid and has held up when like yesterday i saw 9 > people only 1 wiih medicaid, i do very well thank you. The model says if I > fill every day with the right mix I can make about 107,000 > > EMR-Have welford chart notes outsource billing 8% > Jean > > > > > > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 If you want to compare yourself to average physicians in your specialty, one good source of data is MGMA. Just for example, I’ll give you some FP numbers ( Can’t do a lot of this – MGMA has a copyright, but the published data is not too expensive, if you need it) 2007 medians: Charges per FTE physician - $770,444 Revenue per FTE Physician $530,880 Operating cost per FTE physician $315,782 Number of patients 2,099 Number of encounters 5,467 Number of RVUs 9,677 Support staff 4.31 Overhead % 59% A micro-practice will NOT look like the numbers above!!! But you might be able to compare yourself favorably on some of the measures below. Few people realize that the actual revenue per RVU for FPs is HIGHER than for a lot of specialties, but FPs also have much higher operating cost. If you can cut operating cost (by, for example, staying out-of-network for commercial payers) you might come out way ahead of the game. Note also that it is third-party payment that keeping the charges so much higher than revenues. Out-of-network providers can either offer prompt-payment discounts or just cut standard charge down to a level closer to what they actually expect to receive. In dollars per RVU, the median FP practice looks like this: Charge per RVU $70.86 Revenue per RVU $54.78 Operating cost per RVU $34.85 (Note – this is NOT total cost. Total cost INCLUDES payment to the physician. If you want to calculate your RVUs and need help, The RVU file can be downloaded for free from CMS at: http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage Use the column titled “fully Implemented non-facility total” Then just multiply the number of times you did each procedure by the # of RVUs for that procedure. Just for illustration, a 99212 is currently 1.03 and a 99213 is currently 1.71. Hope this helps someone! Donna B. Kinney, CPA Texas Medical Association donna.kinney@... From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 1:14 PM To: Subject: RE: three yr report What I am thinking is just look at gross income and # of patient visits. You divide the number and get average pay/ov say around $60. This takes into account everything you do, hospital, vaccines, levels of visits, etc. Then you take your expenses: Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay for it. (10% overhead) Rent: 466 OV to pay for it. (22 %) Salaries: 416 OV (19% overhead) Billing: 250 OV (12% overhead) Office Supplies: 100 OV Medical Supplies: 453 OV Cleaning: 100 OV Professional Expenses: 50 OV Other: 75 OV (for examples here) So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, that would explain my poor income now wouldn’t it. It could also let us see if fixable. It will also let us compare apples to apples a little easier. Say someone says there overhead is 30% and you break it down to average pay/OV, # of visits/year and what the individual expenses are you might see you spend way too much on one thing. Or your costs are average but you just don’t see enough patients or you reimbursement is too lousy. Of course the more patients, the more hours you work, the higher salaries, billing expenses and supply expenses but that can be factored in too. Fudge factor of x%. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sharon McCoy , M.D. Sent: Thursday, July 31, 2008 2:00 PM To: Subject: RE: three yr report Kathy, I think you may be onto something but can you describe in more detail what you are talking about? Wow! Congratulations!! 3 years….it’s not paper, what anniversary gift do you deserve this year? Sharon From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, July 31, 2008 9:56 AM To: Subject: RE: three yr report Nice report Forgot to mention that typing has improved markedly over past year too. I have been wracking my brain trying to come up with an idea of helping compare apples to apples. It is great to hear that some docs run at 20% overhead, 50% overhead 70% overhead but what does that really mean? So I thought that if we describe overhead in number of patient visits, it might actually be more comparable and help point out bad business vs. bad area. For example, you can’t get a closet in NJ for $537/mo. My malpractice is $14,000/year. So of course my overhead will be higher. Because I also believe that my average payment for OV is probably similar to Jean’s. But we have colleagues in the South with low rent, low malpractice, low staffing, great payments whose overhead might be higher or lower depending on many things. Sound like an idea? Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Thursday, July 31, 2008 9:55 AM To: practiceimprovement1 Subject: three yr report I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Improving the Health of All Texans Texas Medical Associationwww.texmed.org401 W. 15th StreetAustin, TX 78701 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Donna- This looks about right except the number of RVUs per year. 9000 plus looks to be excessively high as the top producers in our group max out at about five or 6000. > > If you want to compare yourself to average physicians in your specialty, one > good source of data is MGMA. Just for example, I'll give you some FP numbers > ( Can't do a lot of this - MGMA has a copyright, but the published data is > not too expensive, if you need it) > > > > 2007 medians: > > Charges per FTE physician - $770,444 > > Revenue per FTE Physician $530,880 > > Operating cost per FTE physician $315,782 > > Number of patients 2,099 > > Number of encounters 5,467 > > Number of RVUs 9,677 > > Support staff 4.31 > > Overhead % 59% > > A micro-practice will NOT look like the numbers above!!! > > > > But you might be able to compare yourself favorably on some of the measures > below. Few people realize that the actual revenue per RVU for FPs is HIGHER > than for a lot of specialties, but FPs also have much higher operating cost. > If you can cut operating cost (by, for example, staying out-of- network for > commercial payers) you might come out way ahead of the game. Note also that > it is third-party payment that keeping the charges so much higher than > revenues. Out-of-network providers can either offer prompt- payment discounts > or just cut standard charge down to a level closer to what they actually > expect to receive. > > > > In dollars per RVU, the median FP practice looks like this: > > Charge per RVU > $70.86 > > Revenue per RVU > $54.78 > > Operating cost per RVU $34.85 > > > (Note - this is NOT total cost. Total cost INCLUDES payment > to the physician. > > > > If you want to calculate your RVUs and need help, > > The RVU file can be downloaded for free from CMS at: > > > > http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage > > > > Use the column titled " fully Implemented non-facility total " > > Then just multiply the number of times you did each procedure by the # of > RVUs for that procedure. Just for illustration, a 99212 is currently 1.03 > and a 99213 is currently 1.71. > > > > Hope this helps someone! > > > > Donna B. Kinney, CPA > > Texas Medical Association > > > > donna.kinney@... > > > > From: > [mailto: ] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 1:14 PM > To: > Subject: RE: three yr report > > > > What I am thinking is just look at gross income and # of patient visits. You > divide the number and get average pay/ov say around $60. This takes into > account everything you do, hospital, vaccines, levels of visits, etc. > > > > Then you take your expenses: > > Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay > for it. (10% overhead) > > Rent: 466 OV to pay for it. (22 %) > > Salaries: 416 OV (19% overhead) > > Billing: 250 OV (12% overhead) > > Office Supplies: 100 OV > > Medical Supplies: 453 OV > > Cleaning: 100 OV > > Professional Expenses: 50 OV > > Other: 75 OV > > > > (for examples here) > > > > So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, > that would explain my poor income now wouldn't it. It could also let us see > if fixable. It will also let us compare apples to apples a little easier. > Say someone says there overhead is 30% and you break it down to average > pay/OV, # of visits/year and what the individual expenses are you might see > you spend way too much on one thing. Or your costs are average but you just > don't see enough patients or you reimbursement is too lousy. > > > > Of course the more patients, the more hours you work, the higher salaries, > billing expenses and supply expenses but that can be factored in too. Fudge > factor of x%. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypractice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: > [mailto: ] On Behalf Of Sharon McCoy > , M.D. > Sent: Thursday, July 31, 2008 2:00 PM > To: > Subject: RE: three yr report > > > > Kathy, > > I think you may be onto something but can you describe in more detail what > you are talking about? > > > > > > Wow! Congratulations!! 3 years....it's not paper, what anniversary gift do > you deserve this year? > > > > Sharon > > > > From: > [mailto: ] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 9:56 AM > To: > Subject: RE: three yr report > > > > Nice report > > Forgot to mention that typing has improved markedly over past year too. > > > > I have been wracking my brain trying to come up with an idea of helping > compare apples to apples. It is great to hear that some docs run at 20% > overhead, 50% overhead 70% overhead but what does that really mean? > > > > So I thought that if we describe overhead in number of patient visits, it > might actually be more comparable and help point out bad business vs. bad > area. > > > > For example, you can't get a closet in NJ for $537/mo. My malpractice is > $14,000/year. So of course my overhead will be higher. Because I also > believe that my average payment for OV is probably similar to Jean's. But we > have colleagues in the South with low rent, low malpractice, low staffing, > great payments whose overhead might be higher or lower depending on many > things. > > > > Sound like an idea? > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypractice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: > [mailto: ] On Behalf Of Jean Antonucci > Sent: Thursday, July 31, 2008 9:55 AM > To: practiceimprovement1 > Subject: three yr report > > > > I may do these yearly reports forever.... > > Have been open just over three years Have only recently signed on to my > second commercial insurance(or I think I have, it is complicated) > > broke even at 2-3 weeks > began to feed self around 6 months > Things were tight for a long time and while > I still sorta live from paycheck to paycheck I live BETTER from paycheck > to paycheck > Actually I have saved money a few times this year I do fear for my car at > 268,000 miles and the house should be painted and I need a new furnace but I > think I c an work all that out and there is some hope we can take a warm > winter vacation this year not having done so for a while > Last summer I did nothing all day it seemed Things were dead I was very > worried This summer much different so I conclude, given that I have to > monitor which insurers I take--I cannot just FILL like a hospital practice > becasue they take all comers and get subsidized by orhto etc, probably that > comment about 2-5 yrs to maturity is dead on. > I am not in a dead zone but I am in an ill zone. > Fortunately housing here is affordable and so is malpractice moslty. > > I still haven no employees and run exactly the same arrangement as when I > opened- outsource billing ,simple phone, all in one, cellphone ,answering > machine, lap top only that I take home on weekends > > Lessons learned /things changed-- I no longer order immunizations form the > state I get them transferred from t he pediatric practice which prevents > waste not much other didfference ,but I was wasting so many it was stupid > > > > had to move a year ago very hard to find space but otherwise no big deal to > move-- becasue uh I did not actually change addresses .Small town .I moved to > a different building in t he office park. I had been 105 mt blue circle and > shared the building so the post office said I could be suite 2 there. When I > moved to 115 mt blue circle also sharing a previously unshared, building > well I called up the post office and we made another suite 2 , dissolving > the first, using the same mailbox out on a post and I put a differnt > sticky number on it > > Had to get a new lap top last fall that was one of the most painful things I > have ever done BEcasue i did not know what I was doing and lost a few notes > So now I know alot more about wher e my data is and stuff THough I would > not wan tto do it again soon.... > > Still do some outside work for which I am very grateful.Teaching at the > resdiency precepting irregulalry is tres useful -I get socialization, CME , > lunch, contributions to a SEP IRA and they have had me back now for a second > year to teach part of practice management which lets me prosletyze about > iMPS and becasue of which two 3 rd yr res cam to see my office last yr and > both came to CAMp so I hope they go on to do well > > advice/ recommendations: > be cheap! > ask someone on t he l ist serv if you need help. the variety of > situations we encounter and the willingness to share is rich and varied > > > > Hospital colleagues have no idea what I do and have shown no interest. > When the hospital's PA teaches Tai chi locally and is in t he paper or some > xray tech gets certified in something it goes on the bulletin board When I > am in t he paper or publish or in medical economics-not. > > oh and vacations The most I have been away is a week. I just take the > cellphone and or call my machine twice a d ay-having left the message I will > . If someone need to be seen I scrounge around and find someone- so far ha s > been workable If I can afford three weeks in Paris I will let you know what > I come up with > > would I go back to a " job? " nope > > Do I do a good job? > Hope so HYH numbers pretty good -can improve. > LAst summer had a clot of people leave mostly the unhappy " Searchers " always > looking > Two have come back > one I still get the notes for form specialist and she is on no different > treatment that I had given. > One I see has her home up for sale so has left the area > I get new patient requests more now that a year ago and actually am probably > closed or closing > I admit I now cherry pick But not on the basis of money necessarily .. I > saw a new 10 yr old two days ago on mediciad because I see her parents and I > want kids.( in the practice. Wouldn't want the noisy little things to come > home with me) > I turned down a guy with good insurance becasue it was back pain and I was > busy. > I turned down a family of 4 dual eligbles-all 4- because I thought I could > not stand it emotionally the day they called. > I took an insurance well woman because I see grandmother etc PIcking and > choosing case by case is likely how I will slow to a crawl > > How much do I make? > Less than Lou Spikol . > > > Hope any of this helps other wise how fun I got to type.My favorite thing. > > > overhead about 35% > malpractice about 8,000 > > space about 125 sq ft > rent about 537.00 a month > > registered patients ?who knows? the number is 758 but many were skilled > nursing home patients who rehab'd and went home that work is minimal now > due to difficult changes at the nursing home > > Like to see genreally up to 8-10 a day but not quite every day still yet > > business model is solid and has held up when like yesterday i saw 9 people > only 1 wiih medicaid, i do very well thank you. The model says if I fill > every day with the right mix I can make about 107,000 > > EMR-Have welford chart notes outsource billing 8% > Jean > > > > > > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > > > > > > -------------------------------------------------------- > > Improving the Health of All Texans > > > Texas Medical Association > www.texmed.org > 401 W. 15th Street > Austin, TX 78701 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Lou: Your group probably report just the physician component which would be about right. Subject: Re: three yr reportTo: Date: Thursday, July 31, 2008, 2:57 PM Donna-This looks about right except the number of RVUs per year. 9000 plus looks to be excessively high as the top producers in our group max out at about five or 6000.>> If you want to compare yourself to average physicians in your specialty, one> good source of data is MGMA. Just for example, I'll give you some FP numbers> ( Can't do a lot of this - MGMA has a copyright, but the published data is> not too expensive, if you need it) > > > > 2007 medians: > > Charges per FTE physician -$770,444> > Revenue per FTE Physician $530,880> > Operating cost per FTE physician $315,782> > Number of patients 2,099> > Number of encounters 5,467> > Number of RVUs 9,677> > Support staff 4.31> > Overhead % 59%> > A micro-practice will NOT look like the numbers above!!!> > > > But you might be able to compare yourself favorably on some of the measures> below. Few people realize that the actual revenue per RVU for FPs is HIGHER> than for a lot of specialties, but FPs also have much higher operating cost.> If you can cut operating cost (by, for example, staying out-of-network for> commercial payers) you might come out way ahead of the game. Note also that> it is third-party payment that keeping the charges so much higher than> revenues. Out-of-network providers can either offer prompt-payment discounts> or just cut standard charge down to a level closer to what they actually> expect to receive. > > > > In dollars per RVU, the median FP practice looks like this:> > Charge per RVU> $70.86> > Revenue per RVU> $54.78> > Operating cost per RVU $34.85> > > (Note - this is NOT total cost. Total cost INCLUDES payment> to the physician. > > > > If you want to calculate your RVUs and need help, > > The RVU file can be downloaded for free from CMS at:> > > > http://www.cms. hhs.gov/Physicia nFeeSched/ PFSRVF/list. asp#TopOfPage> > > > Use the column titled "fully Implemented non-facility total"> > Then just multiply the number of times you did each procedure by the # of> RVUs for that procedure. Just for illustration, a 99212 is currently 1.03> and a 99213 is currently 1.71. > > > > Hope this helps someone! > > > > Donna B. Kinney, CPA> > Texas Medical Association> > > > donna.kinney@ ...> > > > From: Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Kathy Saradarian> Sent: Thursday, July 31, 2008 1:14 PM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: RE: [Practiceimprovemen t1] three yr report> > > > What I am thinking is just look at gross income and # of patient visits. You> divide the number and get average pay/ov say around $60. This takes into> account everything you do, hospital, vaccines, levels of visits, etc.> > > > Then you take your expenses:> > Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay> for it. (10% overhead) > > Rent: 466 OV to pay for it. (22 %)> > Salaries: 416 OV (19% overhead)> > Billing: 250 OV (12% overhead)> > Office Supplies: 100 OV> > Medical Supplies: 453 OV> > Cleaning: 100 OV> > Professional Expenses: 50 OV> > Other: 75 OV> > > > (for examples here)> > > > So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year,> that would explain my poor income now wouldn't it. It could also let us see> if fixable. It will also let us compare apples to apples a little easier.> Say someone says there overhead is 30% and you break it down to average> pay/OV, # of visits/year and what the individual expenses are you might see> you spend way too much on one thing. Or your costs are average but you just> don't see enough patients or you reimbursement is too lousy.> > > > Of course the more patients, the more hours you work, the higher salaries,> billing expenses and supply expenses but that can be factored in too. Fudge> factor of x%.> > > > > > Kathy Saradarian, MD> > Branchville, NJ> > www.qualityfamilypr actice.com> > Solo 4/03, Practicing since 9/90> > Practice Partner 5/03> > Low staffing> > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Sharon McCoy> , M.D.> Sent: Thursday, July 31, 2008 2:00 PM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: RE: [Practiceimprovemen t1] three yr report> > > > Kathy,> > I think you may be onto something but can you describe in more detail what> you are talking about?> > > > > > Wow! Congratulations! ! 3 years....it' s not paper, what anniversary gift do> you deserve this year?> > > > Sharon > > > > From: Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Kathy Saradarian> Sent: Thursday, July 31, 2008 9:56 AM> To: Practiceimprovement 1yahoogroups (DOT) com> Subject: RE: [Practiceimprovemen t1] three yr report> > > > Nice report > > Forgot to mention that typing has improved markedly over past year too.> > > > I have been wracking my brain trying to come up with an idea of helping> compare apples to apples. It is great to hear that some docs run at 20%> overhead, 50% overhead 70% overhead but what does that really mean?> > > > So I thought that if we describe overhead in number of patient visits, it> might actually be more comparable and help point out bad business vs. bad> area. > > > > For example, you can't get a closet in NJ for $537/mo. My malpractice is> $14,000/year. So of course my overhead will be higher. Because I also> believe that my average payment for OV is probably similar to Jean's. But we> have colleagues in the South with low rent, low malpractice, low staffing,> great payments whose overhead might be higher or lower depending on many> things.> > > > Sound like an idea?> > > > > > Kathy Saradarian, MD> > Branchville, NJ> > www.qualityfamilypr actice.com> > Solo 4/03, Practicing since 9/90> > Practice Partner 5/03> > Low staffing> > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of > Sent: Thursday, July 31, 2008 9:55 AM> To: practiceimprovement 1yahoogroups (DOT) com> Subject: [Practiceimprovemen t1] three yr report> > > > I may do these yearly reports forever....> > Have been open just over three years Have only recently signed on to my> second commercial insurance(or I think I have, it is complicated)> > broke even at 2-3 weeks> began to feed self around 6 months> Things were tight for a long time and while > I still sorta live from paycheck to paycheck I live BETTER from paycheck> to paycheck> Actually I have saved money a few times this year I do fear for my car at> 268,000 miles and the house should be painted and I need a new furnace but I> think I c an work all that out and there is some hope we can take a warm> winter vacation this year not having done so for a while> Last summer I did nothing all day it seemed Things were dead I was very> worried This summer much different so I conclude, given that I have to> monitor which insurers I take--I cannot just FILL like a hospital practice> becasue they take all comers and get subsidized by orhto etc, probably that> comment about 2-5 yrs to maturity is dead on.> I am not in a dead zone but I am in an ill zone.> Fortunately housing here is affordable and so is malpractice moslty.> > I still haven no employees and run exactly the same arrangement as when I> opened- outsource billing ,simple phone, all in one, cellphone ,answering> machine, lap top only that I take home on weekends> > Lessons learned /things changed-- I no longer order immunizations form the> state I get them transferred from t he pediatric practice which prevents> waste not much other didfference ,but I was wasting so many it was stupid> > > > had to move a year ago very hard to find space but otherwise no big deal to> move-- becasue uh I did not actually change addresses .Small town .I moved to> a different building in t he office park. I had been 105 mt blue circle and> shared the building so the post office said I could be suite 2 there. When I> moved to 115 mt blue circle also sharing a previously unshared, building> well I called up the post office and we made another suite 2 , dissolving> the first, using the same mailbox out on a post and I put a differnt> sticky number on it > > Had to get a new lap top last fall that was one of the most painful things I> have ever done BEcasue i did not know what I was doing and lost a few notes> So now I know alot more about wher e my data is and stuff THough I would> not wan tto do it again soon....> > Still do some outside work for which I am very grateful.Teaching at the> resdiency precepting irregulalry is tres useful -I get socialization, CME ,> lunch, contributions to a SEP IRA and they have had me back now for a second> year to teach part of practice management which lets me prosletyze about> iMPS and becasue of which two 3 rd yr res cam to see my office last yr and> both came to CAMp so I hope they go on to do well> > advice/ recommendations:> be cheap!> ask someone on t he l ist serv if you need help. the variety of> situations we encounter and the willingness to share is rich and varied> > > > Hospital colleagues have no idea what I do and have shown no interest.> When the hospital's PA teaches Tai chi locally and is in t he paper or some> xray tech gets certified in something it goes on the bulletin board When I> am in t he paper or publish or in medical economics-not.> > oh and vacations The most I have been away is a week. I just take the> cellphone and or call my machine twice a d ay-having left the message I will> . If someone need to be seen I scrounge around and find someone- so far ha s> been workable If I can afford three weeks in Paris I will let you know what> I come up with> > would I go back to a "job?" nope> > Do I do a good job?> Hope so HYH numbers pretty good -can improve.> LAst summer had a clot of people leave mostly the unhappy "Searchers" always> looking> Two have come back> one I still get the notes for form specialist and she is on no different> treatment that I had given.> One I see has her home up for sale so has left the area> I get new patient requests more now that a year ago and actually am probably> closed or closing> I admit I now cherry pick But not on the basis of money necessarily .. I> saw a new 10 yr old two days ago on mediciad because I see her parents and I> want kids.( in the practice. Wouldn't want the noisy little things to come> home with me)> I turned down a guy with good insurance becasue it was back pain and I was> busy.> I turned down a family of 4 dual eligbles-all 4- because I thought I could> not stand it emotionally the day they called.> I took an insurance well woman because I see grandmother etc PIcking and> choosing case by case is likely how I will slow to a crawl> > How much do I make?> Less than Lou Spikol . > > > Hope any of this helps other wise how fun I got to type.My favorite thing.> > > overhead about 35%> malpractice about 8,000> > space about 125 sq ft > rent about 537.00 a month> > registered patients ?who knows? the number is 758 but many were skilled> nursing home patients who rehab'd and went home that work is minimal now> due to difficult changes at the nursing home> > Like to see genreally up to 8-10 a day but not quite every day still yet > > business model is solid and has held up when like yesterday i saw 9 people> only 1 wiih medicaid, i do very well thank you. The model says if I fill> every day with the right mix I can make about 107,000 > > EMR-Have welford chart notes outsource billing 8% > Jean> > > > > > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/> please note the new email address.> Remember that e-mail may not be entirely secure/> MD> > > ph 207 778 3313 fax > > > > > > ------------ --------- --------- --------- --------- --------> > Improving the Health of All Texans> > > Texas Medical Association> www.texmed.org> 401 W. 15th Street> Austin, TX 78701> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Kathy-- At the risk of sounding obnoxious-these are not your actual numbers are they? > > > Subject: RE: three yr report > To: > Date: Thursday, July 31, 2008, 1:13 PM > > What I am thinking is just look at gross income and # of patient visits. > You divide the number and get average pay/ov say around $60. This takes > into account everything you do, hospital, vaccines, levels of visits, etc. > > > > Then you take your expenses: > > Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to > pay for it. (10% overhead) > > Rent: 466 OV to pay for it. (22 %) > > Salaries: 416 OV (19% overhead) > > Billing: 250 OV (12% overhead) > > Office Supplies: 100 OV > > Medical Supplies: 453 OV > > Cleaning: 100 OV > > Professional Expenses: 50 OV > > Other: 75 OV > > > > (for examples here) > > > > So my overhead takes 2143 ov/year to cover. If I am only doing 2200 > OV/year, that would explain my poor income now wouldn't it. It could also > let us see if fixable. It will also let us compare apples to apples a > little easier. Say someone says there overhead is 30% and you break it > down to average pay/OV, # of visits/year and what the individual expenses > are you might see you spend way too much on one thing. Or your costs are > average but you just don't see enough patients or you reimbursement is too > lousy. > > > > Of course the more patients, the more hours you work, the higher salaries, > billing expenses and supply expenses but that can be factored in too. Fudge > factor of x%. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of Sharon McCoy , M.D. > Sent: Thursday, July 31, 2008 2:00 PM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Kathy, > > I think you may be onto something but can you describe in more detail what > you are talking about? > > > > > > Wow! Congratulations! ! 3 years..it's not paper, what anniversary gift do > you deserve this year? > > > > Sharon > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 9:56 AM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Nice report > > Forgot to mention that typing has improved markedly over past year too. > > > > I have been wracking my brain trying to come up with an idea of helping > compare apples to apples. It is great to hear that some docs run at 20% > overhead, 50% overhead 70% overhead but what does that really mean? > > > > So I thought that if we describe overhead in number of patient visits, it > might actually be more comparable and help point out bad business vs. bad > area. > > > > For example, you can't get a closet in NJ for $537/mo. My malpractice is > $14,000/year. So of course my overhead will be higher. Because I also > believe that my average payment for OV is probably similar to Jean's. But > we have colleagues in the South with low rent, low malpractice, low > staffing, great payments whose overhead might be higher or lower depending > on many things. > > > > Sound like an idea? > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ > yahoogroups. com] On Behalf Of > Sent: Thursday, July 31, 2008 9:55 AM > To: practiceimprovement 1yahoogroups (DOT) com > Subject: [Practiceimprovemen t1] three yr report > > > > I may do these yearly reports forever.... > > Have been open just over three years Have only recently signed on to my > second commercial insurance(or I think I have, it is complicated) > > broke even at 2-3 weeks > began to feed self around 6 months > Things were tight for a long time and while > I still sorta live from paycheck to paycheck I live BETTER from > paycheck to paycheck > Actually I have saved money a few times this year I do fear for my car at > 268,000 miles and the house should be painted and I need a new furnace but I > think I c an work all that out and there is some hope we can take a warm > winter vacation this year not having done so for a while > Last summer I did nothing all day it seemed Things were dead I was very > worried This summer much different so I conclude, given that I have to > monitor which insurers I take--I cannot just FILL like a hospital practice > becasue they take all comers and get subsidized by orhto etc, probably that > comment about 2-5 yrs to maturity is dead on. > I am not in a dead zone but I am in an ill zone. > Fortunately housing here is affordable and so is malpractice moslty. > > I still haven no employees and run exactly the same arrangement as when I > opened- outsource billing ,simple phone, all in one, cellphone ,answering > machine, lap top only that I take home on weekends > > Lessons learned /things changed-- I no longer order immunizations form the > state I get them transferred from t he pediatric practice which prevents > waste not much other didfference ,but I was wasting so many it was stupid > > > > had to move a year ago very hard to find space but otherwise no big deal > to move-- becasue uh I did not actually change addresses .Small town .I > moved to a different building in t he office park. I had been 105 mt blue > circle and shared the building so the post office said I could be suite 2 > there. When I moved to 115 mt blue circle also sharing a previously > unshared, building well I called up the post office and we made another > suite 2 , dissolving the first, using the same mailbox out on a post and > I put a differnt sticky number on it > > Had to get a new lap top last fall that was one of the most painful things > I have ever done BEcasue i did not know what I was doing and lost a few > notes So now I know alot more about wher e my data is and stuff THough I > would not wan tto do it again soon.... > > Still do some outside work for which I am very grateful.Teaching at the > resdiency precepting irregulalry is tres useful -I get socialization, CME , > lunch, contributions to a SEP IRA and they have had me back now for a > second year to teach part of practice management which lets me prosletyze > about iMPS and becasue of which two 3 rd yr res cam to see my office last yr > and both came to CAMp so I hope they go on to do well > > advice/ recommendations: > be cheap! > ask someone on t he l ist serv if you need help. the variety of > situations we encounter and the willingness to share is rich and varied > > > > Hospital colleagues have no idea what I do and have shown no interest. > When the hospital's PA teaches Tai chi locally and is in t he paper or > some xray tech gets certified in something it goes on the bulletin board > When I am in t he paper or publish or in medical economics-not. > > oh and vacations The most I have been away is a week. I just take the > cellphone and or call my machine twice a d ay-having left the message I will > . If someone need to be seen I scrounge around and find someone- so far ha > s been workable If I can afford three weeks in Paris I will let you know > what I come up with > > would I go back to a " job? " nope > > Do I do a good job? > Hope so HYH numbers pretty good -can improve. > LAst summer had a clot of people leave mostly the unhappy " Searchers " > always looking > Two have come back > one I still get the notes for form specialist and she is on no different > treatment that I had given. > One I see has her home up for sale so has left the area > I get new patient requests more now that a year ago and actually am probably > closed or closing > I admit I now cherry pick But not on the basis of money necessarily .. I > saw a new 10 yr old two days ago on mediciad because I see her parents and > I want kids.( in the practice. Wouldn't want the noisy little things to > come home with me) > I turned down a guy with good insurance becasue it was back pain and I was > busy. > I turned down a family of 4 dual eligbles-all 4- because I thought I could > not stand it emotionally the day they called. > I took an insurance well woman because I see grandmother etc PIcking and > choosing case by case is likely how I will slow to a crawl > > How much do I make? > Less than Lou Spikol . > > > Hope any of this helps other wise how fun I got to type.My favorite thing. > > > overhead about 35% > malpractice about 8,000 > > space about 125 sq ft > rent about 537.00 a month > > registered patients ?who knows? the number is 758 but many were skilled > nursing home patients who rehab'd and went home that work is minimal now > due to difficult changes at the nursing home > > Like to see genreally up to 8-10 a day but not quite every day still yet > > > business model is solid and has held up when like yesterday i saw 9 > people only 1 wiih medicaid, i do very well thank you. The model says if I > fill every day with the right mix I can make about 107,000 > > EMR-Have welford chart notes outsource billing 8% > Jean > > > > > > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Average for only the work component is less than 5,000. 6,000 would be about the 75th percentile – meaning that only 25% of practices report more than that. So that would make your practice more productive than average if you are reporting 6,000 WORK RVUs. Donna B. Kinney, CPA Texas Medical Association donna.kinney@... From: [mailto: ] On Behalf Of Egly Sent: Thursday, July 31, 2008 3:02 PM To: Subject: Re: Re: three yr report Lou: Your group probably report just the physician component which would be about right. From: l_spikol Subject: Re: three yr report To: Date: Thursday, July 31, 2008, 2:57 PM Donna- This looks about right except the number of RVUs per year. 9000 plus looks to be excessively high as the top producers in our group max out at about five or 6000. > > If you want to compare yourself to average physicians in your specialty, one > good source of data is MGMA. Just for example, I'll give you some FP numbers > ( Can't do a lot of this - MGMA has a copyright, but the published data is > not too expensive, if you need it) > > > > 2007 medians: > > Charges per FTE physician - $770,444 > > Revenue per FTE Physician $530,880 > > Operating cost per FTE physician $315,782 > > Number of patients 2,099 > > Number of encounters 5,467 > > Number of RVUs 9,677 > > Support staff 4.31 > > Overhead % 59% > > A micro-practice will NOT look like the numbers above!!! > > > > But you might be able to compare yourself favorably on some of the measures > below. Few people realize that the actual revenue per RVU for FPs is HIGHER > than for a lot of specialties, but FPs also have much higher operating cost. > If you can cut operating cost (by, for example, staying out-of- network for > commercial payers) you might come out way ahead of the game. Note also that > it is third-party payment that keeping the charges so much higher than > revenues. Out-of-network providers can either offer prompt- payment discounts > or just cut standard charge down to a level closer to what they actually > expect to receive. > > > > In dollars per RVU, the median FP practice looks like this: > > Charge per RVU > $70.86 > > Revenue per RVU > $54.78 > > Operating cost per RVU $34.85 > > > (Note - this is NOT total cost. Total cost INCLUDES payment > to the physician. > > > > If you want to calculate your RVUs and need help, > > The RVU file can be downloaded for free from CMS at: > > > > http://www.cms. hhs.gov/Physicia nFeeSched/ PFSRVF/list. asp#TopOfPage > > > > Use the column titled " fully Implemented non-facility total " > > Then just multiply the number of times you did each procedure by the # of > RVUs for that procedure. Just for illustration, a 99212 is currently 1.03 > and a 99213 is currently 1.71. > > > > Hope this helps someone! > > > > Donna B. Kinney, CPA > > Texas Medical Association > > > > donna.kinney@ ... > > > > From: Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 1:14 PM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > What I am thinking is just look at gross income and # of patient visits. You > divide the number and get average pay/ov say around $60. This takes into > account everything you do, hospital, vaccines, levels of visits, etc. > > > > Then you take your expenses: > > Malpractice: $14,000 (/60) and my malpractice takes 233 office visits to pay > for it. (10% overhead) > > Rent: 466 OV to pay for it. (22 %) > > Salaries: 416 OV (19% overhead) > > Billing: 250 OV (12% overhead) > > Office Supplies: 100 OV > > Medical Supplies: 453 OV > > Cleaning: 100 OV > > Professional Expenses: 50 OV > > Other: 75 OV > > > > (for examples here) > > > > So my overhead takes 2143 ov/year to cover. If I am only doing 2200 OV/year, > that would explain my poor income now wouldn't it. It could also let us see > if fixable. It will also let us compare apples to apples a little easier. > Say someone says there overhead is 30% and you break it down to average > pay/OV, # of visits/year and what the individual expenses are you might see > you spend way too much on one thing. Or your costs are average but you just > don't see enough patients or you reimbursement is too lousy. > > > > Of course the more patients, the more hours you work, the higher salaries, > billing expenses and supply expenses but that can be factored in too. Fudge > factor of x%. > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Sharon McCoy > , M.D. > Sent: Thursday, July 31, 2008 2:00 PM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Kathy, > > I think you may be onto something but can you describe in more detail what > you are talking about? > > > > > > Wow! Congratulations! ! 3 years....it' s not paper, what anniversary gift do > you deserve this year? > > > > Sharon > > > > From: Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Kathy Saradarian > Sent: Thursday, July 31, 2008 9:56 AM > To: Practiceimprovement 1yahoogroups (DOT) com > Subject: RE: [Practiceimprovemen t1] three yr report > > > > Nice report > > Forgot to mention that typing has improved markedly over past year too. > > > > I have been wracking my brain trying to come up with an idea of helping > compare apples to apples. It is great to hear that some docs run at 20% > overhead, 50% overhead 70% overhead but what does that really mean? > > > > So I thought that if we describe overhead in number of patient visits, it > might actually be more comparable and help point out bad business vs. bad > area. > > > > For example, you can't get a closet in NJ for $537/mo. My malpractice is > $14,000/year. So of course my overhead will be higher. Because I also > believe that my average payment for OV is probably similar to Jean's. But we > have colleagues in the South with low rent, low malpractice, low staffing, > great payments whose overhead might be higher or lower depending on many > things. > > > > Sound like an idea? > > > > > > Kathy Saradarian, MD > > Branchville, NJ > > www.qualityfamilypr actice.com > > Solo 4/03, Practicing since 9/90 > > Practice Partner 5/03 > > Low staffing > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Jean Antonucci > Sent: Thursday, July 31, 2008 9:55 AM > To: practiceimprovement 1yahoogroups (DOT) com > Subject: [Practiceimprovemen t1] three yr report > > > > I may do these yearly reports forever.... > > Have been open just over three years Have only recently signed on to my > second commercial insurance(or I think I have, it is complicated) > > broke even at 2-3 weeks > began to feed self around 6 months > Things were tight for a long time and while > I still sorta live from paycheck to paycheck I live BETTER from paycheck > to paycheck > Actually I have saved money a few times this year I do fear for my car at > 268,000 miles and the house should be painted and I need a new furnace but I > think I c an work all that out and there is some hope we can take a warm > winter vacation this year not having done so for a while > Last summer I did nothing all day it seemed Things were dead I was very > worried This summer much different so I conclude, given that I have to > monitor which insurers I take--I cannot just FILL like a hospital practice > becasue they take all comers and get subsidized by orhto etc, probably that > comment about 2-5 yrs to maturity is dead on. > I am not in a dead zone but I am in an ill zone. > Fortunately housing here is affordable and so is malpractice moslty. > > I still haven no employees and run exactly the same arrangement as when I > opened- outsource billing ,simple phone, all in one, cellphone ,answering > machine, lap top only that I take home on weekends > > Lessons learned /things changed-- I no longer order immunizations form the > state I get them transferred from t he pediatric practice which prevents > waste not much other didfference ,but I was wasting so many it was stupid > > > > had to move a year ago very hard to find space but otherwise no big deal to > move-- becasue uh I did not actually change addresses .Small town .I moved to > a different building in t he office park. I had been 105 mt blue circle and > shared the building so the post office said I could be suite 2 there. When I > moved to 115 mt blue circle also sharing a previously unshared, building > well I called up the post office and we made another suite 2 , dissolving > the first, using the same mailbox out on a post and I put a differnt > sticky number on it > > Had to get a new lap top last fall that was one of the most painful things I > have ever done BEcasue i did not know what I was doing and lost a few notes > So now I know alot more about wher e my data is and stuff THough I would > not wan tto do it again soon.... > > Still do some outside work for which I am very grateful.Teaching at the > resdiency precepting irregulalry is tres useful -I get socialization, CME , > lunch, contributions to a SEP IRA and they have had me back now for a second > year to teach part of practice management which lets me prosletyze about > iMPS and becasue of which two 3 rd yr res cam to see my office last yr and > both came to CAMp so I hope they go on to do well > > advice/ recommendations: > be cheap! > ask someone on t he l ist serv if you need help. the variety of > situations we encounter and the willingness to share is rich and varied > > > > Hospital colleagues have no idea what I do and have shown no interest. > When the hospital's PA teaches Tai chi locally and is in t he paper or some > xray tech gets certified in something it goes on the bulletin board When I > am in t he paper or publish or in medical economics-not. > > oh and vacations The most I have been away is a week. I just take the > cellphone and or call my machine twice a d ay-having left the message I will > . If someone need to be seen I scrounge around and find someone- so far ha s > been workable If I can afford three weeks in Paris I will let you know what > I come up with > > would I go back to a " job? " nope > > Do I do a good job? > Hope so HYH numbers pretty good -can improve. > LAst summer had a clot of people leave mostly the unhappy " Searchers " always > looking > Two have come back > one I still get the notes for form specialist and she is on no different > treatment that I had given. > One I see has her home up for sale so has left the area > I get new patient requests more now that a year ago and actually am probably > closed or closing > I admit I now cherry pick But not on the basis of money necessarily .. I > saw a new 10 yr old two days ago on mediciad because I see her parents and I > want kids.( in the practice. Wouldn't want the noisy little things to come > home with me) > I turned down a guy with good insurance becasue it was back pain and I was > busy. > I turned down a family of 4 dual eligbles-all 4- because I thought I could > not stand it emotionally the day they called. > I took an insurance well woman because I see grandmother etc PIcking and > choosing case by case is likely how I will slow to a crawl > > How much do I make? > Less than Lou Spikol . > > > Hope any of this helps other wise how fun I got to type.My favorite thing. > > > overhead about 35% > malpractice about 8,000 > > space about 125 sq ft > rent about 537.00 a month > > registered patients ?who knows? the number is 758 but many were skilled > nursing home patients who rehab'd and went home that work is minimal now > due to difficult changes at the nursing home > > Like to see genreally up to 8-10 a day but not quite every day still yet > > business model is solid and has held up when like yesterday i saw 9 people > only 1 wiih medicaid, i do very well thank you. The model says if I fill > every day with the right mix I can make about 107,000 > > EMR-Have welford chart notes outsource billing 8% > Jean > > > > > > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > > > > > > ------------ --------- --------- --------- --------- -------- > > Improving the Health of All Texans > > > Texas Medical Association > www.texmed.org > 401 W. 15th Street > Austin, TX 78701 > Improving the Health of All Texans Texas Medical Associationwww.texmed.org401 W. 15th StreetAustin, TX 78701 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 The physicians who average five or 6000 work RVUs in our system, by necessity need to see anywhere between 25 and 40 patients a day at least 4 1/2 days a week. I've done it-this is the traditional hamster wheel. Seeing 16 to 22 patients a day may seem like a lot compared to some on this list, but it's a huge difference between 25 to 40 patients a day. (And in some parts of the country it's probably necessary at this point with this reimbursement to actually make a living) > > > > If you want to compare yourself to average physicians in your > specialty, one > > good source of data is MGMA. Just for example, I'll give you some > FP numbers > > ( Can't do a lot of this - MGMA has a copyright, but the published > data is > > not too expensive, if you need it) > > > > > > > > 2007 medians: > > > > Charges per FTE physician - > $770,444 > > > > Revenue per FTE Physician > $530,880 > > > > Operating cost per FTE physician > $315,782 > > > > Number of patients 2,099 > > > > Number of encounters 5,467 > > > > Number of RVUs 9,677 > > > > Support > staff 4.31 > > > > Overhead % > 59% > > > > A micro-practice will NOT look like the numbers above!!! > > > > > > > > But you might be able to compare yourself favorably on some of the > measures > > below. Few people realize that the actual revenue per RVU for FPs > is HIGHER > > than for a lot of specialties, but FPs also have much higher > operating cost. > > If you can cut operating cost (by, for example, staying out-of- > network for > > commercial payers) you might come out way ahead of the game. > Note also that > > it is third-party payment that keeping the charges so much higher > than > > revenues. Out-of-network providers can either offer prompt- > payment discounts > > or just cut standard charge down to a level closer to what they > actually > > expect to receive. > > > > > > > > In dollars per RVU, the median FP practice looks like this: > > > > Charge per RVU > > $70.86 > > > > Revenue per RVU > > $54.78 > > > > Operating cost per > RVU $34.85 > > > > > > (Note - this is NOT total cost. Total cost > INCLUDES payment > > to the physician. > > > > > > > > If you want to calculate your RVUs and need help, > > > > The RVU file can be downloaded for free from CMS at: > > > > > > > > http://www.cms. hhs.gov/Physicia nFeeSched/ PFSRVF/list. > asp#TopOfPage > <http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage> > > > > > > > > Use the column titled " fully Implemented non-facility total " > > > > Then just multiply the number of times you did each procedure by > the # of > > RVUs for that procedure. Just for illustration, a 99212 is > currently 1.03 > > and a 99213 is currently 1.71. > > > > > > > > Hope this helps someone! > > > > > > > > Donna B. Kinney, CPA > > > > Texas Medical Association > > > > > > > > donna.kinney@ ... > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > [mailto:Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> ] On Behalf Of Kathy > Saradarian > > Sent: Thursday, July 31, 2008 1:14 PM > > To: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > Subject: RE: [Practiceimprovemen t1] three yr report > > > > > > > > What I am thinking is just look at gross income and # of patient > visits. You > > divide the number and get average pay/ov say around $60. This > takes into > > account everything you do, hospital, vaccines, levels of visits, > etc. > > > > > > > > Then you take your expenses: > > > > Malpractice: $14,000 (/60) and my malpractice takes 233 office > visits to pay > > for it. (10% overhead) > > > > Rent: 466 OV to pay for it. (22 %) > > > > Salaries: 416 OV (19% overhead) > > > > Billing: 250 OV (12% overhead) > > > > Office Supplies: 100 OV > > > > Medical Supplies: 453 OV > > > > Cleaning: 100 OV > > > > Professional Expenses: 50 OV > > > > Other: 75 OV > > > > > > > > (for examples here) > > > > > > > > So my overhead takes 2143 ov/year to cover. If I am only doing > 2200 OV/year, > > that would explain my poor income now wouldn't it. It could also > let us see > > if fixable. It will also let us compare apples to apples a little > easier. > > Say someone says there overhead is 30% and you break it down to > average > > pay/OV, # of visits/year and what the individual expenses are you > might see > > you spend way too much on one thing. Or your costs are average > but you just > > don't see enough patients or you reimbursement is too lousy. > > > > > > > > Of course the more patients, the more hours you work, the higher > salaries, > > billing expenses and supply expenses but that can be factored in > too. Fudge > > factor of x%. > > > > > > > > > > > > Kathy Saradarian, MD > > > > Branchville, NJ > > > > www.qualityfamilypr actice.com > > > > Solo 4/03, Practicing since 9/90 > > > > Practice Partner 5/03 > > > > Low staffing > > > > > > > > > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > [mailto:Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> ] On Behalf Of Sharon > McCoy > > , M.D. > > Sent: Thursday, July 31, 2008 2:00 PM > > To: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > Subject: RE: [Practiceimprovemen t1] three yr report > > > > > > > > Kathy, > > > > I think you may be onto something but can you describe in more > detail what > > you are talking about? > > > > > > > > > > > > Wow! Congratulations! ! 3 years....it' s not paper, what > anniversary gift do > > you deserve this year? > > > > > > > > Sharon > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > [mailto:Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> ] On Behalf Of Kathy > Saradarian > > Sent: Thursday, July 31, 2008 9:56 AM > > To: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > Subject: RE: [Practiceimprovemen t1] three yr report > > > > > > > > Nice report > > > > Forgot to mention that typing has improved markedly over past year > too. > > > > > > > > I have been wracking my brain trying to come up with an idea of > helping > > compare apples to apples. It is great to hear that some docs run > at 20% > > overhead, 50% overhead 70% overhead but what does that really mean? > > > > > > > > So I thought that if we describe overhead in number of patient > visits, it > > might actually be more comparable and help point out bad business > vs. bad > > area. > > > > > > > > For example, you can't get a closet in NJ for $537/mo. My > malpractice is > > $14,000/year. So of course my overhead will be higher. Because I > also > > believe that my average payment for OV is probably similar to > Jean's. But we > > have colleagues in the South with low rent, low malpractice, low > staffing, > > great payments whose overhead might be higher or lower depending > on many > > things. > > > > > > > > Sound like an idea? > > > > > > > > > > > > Kathy Saradarian, MD > > > > Branchville, NJ > > > > www.qualityfamilypr actice.com > > > > Solo 4/03, Practicing since 9/90 > > > > Practice Partner 5/03 > > > > Low staffing > > > > > > > > > > > > > > > > From: Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> > > [mailto:Practiceimprovement 1yahoogroups (DOT) com > <mailto:%40yahoogroups.com> ] On Behalf Of Jean > Antonucci > > Sent: Thursday, July 31, 2008 9:55 AM > > To: practiceimprovement 1yahoogroups (DOT) com > <mailto:practiceimprovement1%40yahoogroups.com> > > Subject: [Practiceimprovemen t1] three yr report > > > > > > > > I may do these yearly reports forever.... > > > > Have been open just over three years Have only recently signed > on to my > > second commercial insurance(or I think I have, it is complicated) > > > > broke even at 2-3 weeks > > began to feed self around 6 months > > Things were tight for a long time and while > > I still sorta live from paycheck to paycheck I live BETTER > from paycheck > > to paycheck > > Actually I have saved money a few times this year I do fear for > my car at > > 268,000 miles and the house should be painted and I need a new > furnace but I > > think I c an work all that out and there is some hope we can > take a warm > > winter vacation this year not having done so for a while > > Last summer I did nothing all day it seemed Things were dead I > was very > > worried This summer much different so I conclude, given that I > have to > > monitor which insurers I take--I cannot just FILL like a hospital > practice > > becasue they take all comers and get subsidized by orhto etc, > probably that > > comment about 2-5 yrs to maturity is dead on. > > I am not in a dead zone but I am in an ill zone. > > Fortunately housing here is affordable and so is malpractice > moslty. > > > > I still haven no employees and run exactly the same arrangement > as when I > > opened- outsource billing ,simple phone, all in one, > cellphone ,answering > > machine, lap top only that I take home on weekends > > > > Lessons learned /things changed-- I no longer order immunizations > form the > > state I get them transferred from t he pediatric practice which > prevents > > waste not much other didfference ,but I was wasting so many it > was stupid > > > > > > > > had to move a year ago very hard to find space but otherwise no > big deal to > > move-- becasue uh I did not actually change addresses .Small > town .I moved to > > a different building in t he office park. I had been 105 mt blue > circle and > > shared the building so the post office said I could be suite 2 > there. When I > > moved to 115 mt blue circle also sharing a previously unshared, > building > > well I called up the post office and we made another suite 2 , > dissolving > > the first, using the same mailbox out on a post and I put a > differnt > > sticky number on it > > > > Had to get a new lap top last fall that was one of the most > painful things I > > have ever done BEcasue i did not know what I was doing and lost a > few notes > > So now I know alot more about wher e my data is and stuff THough > I would > > not wan tto do it again soon.... > > > > Still do some outside work for which I am very grateful.Teaching > at the > > resdiency precepting irregulalry is tres useful -I get > socialization, CME , > > lunch, contributions to a SEP IRA and they have had me back now > for a second > > year to teach part of practice management which lets me > prosletyze about > > iMPS and becasue of which two 3 rd yr res cam to see my office > last yr and > > both came to CAMp so I hope they go on to do well > > > > advice/ recommendations: > > be cheap! > > ask someone on t he l ist serv if you need help. the variety of > > situations we encounter and the willingness to share is rich and > varied > > > > > > > > Hospital colleagues have no idea what I do and have shown no > interest. > > When the hospital's PA teaches Tai chi locally and is in t he > paper or some > > xray tech gets certified in something it goes on the bulletin > board When I > > am in t he paper or publish or in medical economics-not. > > > > oh and vacations The most I have been away is a week. I just take > the > > cellphone and or call my machine twice a d ay-having left the > message I will > > . If someone need to be seen I scrounge around and find someone- > so far ha s > > been workable If I can afford three weeks in Paris I will let > you know what > > I come up with > > > > would I go back to a " job? " nope > > > > Do I do a good job? > > Hope so HYH numbers pretty good -can improve. > > LAst summer had a clot of people leave mostly the > unhappy " Searchers " always > > looking > > Two have come back > > one I still get the notes for form specialist and she is on no > different > > treatment that I had given. > > One I see has her home up for sale so has left the area > > I get new patient requests more now that a year ago and actually > am probably > > closed or closing > > I admit I now cherry pick But not on the basis of money > necessarily .. I > > saw a new 10 yr old two days ago on mediciad because I see her > parents and I > > want kids.( in the practice. Wouldn't want the noisy little > things to come > > home with me) > > I turned down a guy with good insurance becasue it was back pain > and I was > > busy. > > I turned down a family of 4 dual eligbles-all 4- because I > thought I could > > not stand it emotionally the day they called. > > I took an insurance well woman because I see grandmother etc > PIcking and > > choosing case by case is likely how I will slow to a crawl > > > > How much do I make? > > Less than Lou Spikol . > > > > > > Hope any of this helps other wise how fun I got to type.My > favorite thing. > > > > > > overhead about 35% > > malpractice about 8,000 > > > > space about 125 sq ft > > rent about 537.00 a month > > > > registered patients ?who knows? the number is 758 but many were > skilled > > nursing home patients who rehab'd and went home that work is > minimal now > > due to difficult changes at the nursing home > > > > Like to see genreally up to 8-10 a day but not quite every day > still yet > > > > business model is solid and has held up when like yesterday i > saw 9 people > > only 1 wiih medicaid, i do very well thank you. The model says if > I fill > > every day with the right mix I can make about 107,000 > > > > EMR-Have welford chart notes outsource billing 8% > > Jean > > > > > > > > > > > > > > > > > > > > -- > > If you are a patient please allow up to 12 hours for a reply by > email/ > > please note the new email address. > > Remember that e-mail may not be entirely secure/ > > MD > > > > > > ph fax > > > > > > > > > > > > ------------ --------- --------- --------- --------- ------ -- > > > > Improving the Health of All Texans > > > > > > Texas Medical Association > > www.texmed.org > > 401 W. 15th Street > > Austin, TX 78701 > > > > > > > -------------------------------------------------------- > > Improving the Health of All Texans > > > Texas Medical Association > www.texmed.org > 401 W. 15th Street > Austin, TX 78701 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 Malpractice is, rent is close, Everything else made up. But unfortunately might not be too far from the truth. From: [mailto: ] On Behalf Of l_spikol Sent: Thursday, July 31, 2008 4:07 PM To: Subject: Re: three yr report Kathy-- At the risk of sounding obnoxious-these are not your actual numbers are they? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2008 Report Share Posted August 1, 2008 Yippee Jean!Congratulations.Subject: three yr reportTo: practiceimprovement1 Date: Thursday, July 31, 2008, 6:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily .. I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) comDate: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) comDate: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) comDate: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 small piece of advice? from a small female who works alone? cellphone? put 911 on speed dial and learn to do it by feel- put a little marker on the 7 or whatever number it is If your cell phone does not work in the office then put it on the desk phone ... cellphone lives on desk it is the number anyway folks call if they need me urgently so it is familiar gets played with/picked up etc as I am talking and I have rehearesed how casually i can do it Also- never have the scary person between you and the door change the room set up to avoid that. Please be careful. Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) com Date: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy " Searchers " always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 small piece of advice? from a small female who works alone? cellphone? put 911 on speed dial and learn to do it by feel- put a little marker on the 7 or whatever number it is If your cell phone does not work in the office then put it on the desk phone ... cellphone lives on desk it is the number anyway folks call if they need me urgently so it is familiar gets played with/picked up etc as I am talking and I have rehearesed how casually i can do it Also- never have the scary person between you and the door change the room set up to avoid that. Please be careful. Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) com Date: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy " Searchers " always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 What’s the name of the necklace? Did you purchase it alone or from the security company? Interesting concept that’s worth knowing about… Gretchen Reis MD Circleville, OH From: [mailto: ] On Behalf Of Myria Sent: Friday, August 01, 2008 8:41 PM To: Subject: Re: three yr report Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com> Subject: [Practiceimprovemen t1] three yr report To: practiceimprovement 1yahoogroups (DOT) com Date: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2008 Report Share Posted August 2, 2008 What’s the name of the necklace? Did you purchase it alone or from the security company? Interesting concept that’s worth knowing about… Gretchen Reis MD Circleville, OH From: [mailto: ] On Behalf Of Myria Sent: Friday, August 01, 2008 8:41 PM To: Subject: Re: three yr report Yes I'm getting that caller ID thing too -- so I called some of them back....tunred out was not patients...just sales pitches. I didn't call any more back. Anyone who really wants me will find me either by trying again or by leaving a message. Also may be borderline patients/drug seeking patients.....one kept hanging up til he got me in person. Came in for a visit. Was my first SCARY visit in an office BY MYSELF. I had put off security with one of those necklaces you push the button and security company calls police. They are coming to put in the system Tuesday -- cost 100 dollars to install and 22 a month. Will be worth every dime. From: <jnantonucci@ gmail.com> Subject: [Practiceimprovemen t1] three yr report To: practiceimprovement 1yahoogroups (DOT) com Date: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated) broke even at 2-3 weeks began to feed self around 6 months Things were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheck Actually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on. I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekends Lessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon.... Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do well advice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and varied Hospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not. oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up with would I go back to a " job? " nope Do I do a good job? Hope so HYH numbers pretty good -can improve. LAst summer had a clot of people leave mostly the unhappy " Searchers " always looking Two have come back one I still get the notes for form specialist and she is on no different treatment that I had given. One I see has her home up for sale so has left the area I get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me) I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called. I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawl How much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000 space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% Jean -- If you are a patient please allow up to 12 hours for a reply by email/ please note the new email address. Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2008 Report Share Posted August 3, 2008 I had found them on the Internet. Turns out the security company supplies it. From: <jnantonucci@ gmail.com>Subject: [Practiceimprovemen t1] three yr reportTo: practiceimprovement 1yahoogroups (DOT) comDate: Thursday, July 31, 2008, 8:54 AM I may do these yearly reports forever.... Have been open just over three years Have only recently signed on to my second commercial insurance(or I think I have, it is complicated)broke even at 2-3 weeks began to feed self around 6 monthsThings were tight for a long time and while I still sorta live from paycheck to paycheck I live BETTER from paycheck to paycheckActually I have saved money a few times this year I do fear for my car at 268,000 miles and the house should be painted and I need a new furnace but I think I c an work all that out and there is some hope we can take a warm winter vacation this year not having done so for a while Last summer I did nothing all day it seemed Things were dead I was very worried This summer much different so I conclude, given that I have to monitor which insurers I take--I cannot just FILL like a hospital practice becasue they take all comers and get subsidized by orhto etc, probably that comment about 2-5 yrs to maturity is dead on.I am not in a dead zone but I am in an ill zone. Fortunately housing here is affordable and so is malpractice moslty. I still haven no employees and run exactly the same arrangement as when I opened- outsource billing ,simple phone, all in one, cellphone ,answering machine, lap top only that I take home on weekendsLessons learned /things changed-- I no longer order immunizations form the state I get them transferred from t he pediatric practice which prevents waste not much other didfference ,but I was wasting so many it was stupid had to move a year ago very hard to find space but otherwise no big deal to move-- becasue uh I did not actually change addresses .Small town .I moved to a different building in t he office park. I had been 105 mt blue circle and shared the building so the post office said I could be suite 2 there. When I moved to 115 mt blue circle also sharing a previously unshared, building well I called up the post office and we made another suite 2 , dissolving the first, using the same mailbox out on a post and I put a differnt sticky number on it :)Had to get a new lap top last fall that was one of the most painful things I have ever done BEcasue i did not know what I was doing and lost a few notes So now I know alot more about wher e my data is and stuff THough I would not wan tto do it again soon....Still do some outside work for which I am very grateful.Teaching at the resdiency precepting irregulalry is tres useful -I get socialization, CME , lunch, contributions to a SEP IRA and they have had me back now for a second year to teach part of practice management which lets me prosletyze about iMPS and becasue of which two 3 rd yr res cam to see my office last yr and both came to CAMp so I hope they go on to do welladvice/ recommendations: be cheap! ask someone on t he l ist serv if you need help. the variety of situations we encounter and the willingness to share is rich and variedHospital colleagues have no idea what I do and have shown no interest. When the hospital's PA teaches Tai chi locally and is in t he paper or some xray tech gets certified in something it goes on the bulletin board When I am in t he paper or publish or in medical economics-not.oh and vacations The most I have been away is a week. I just take the cellphone and or call my machine twice a d ay-having left the message I will . If someone need to be seen I scrounge around and find someone- so far ha s been workable If I can afford three weeks in Paris I will let you know what I come up withwould I go back to a "job?" nope Do I do a good job?Hope so HYH numbers pretty good -can improve.LAst summer had a clot of people leave mostly the unhappy "Searchers" always lookingTwo have come back one I still get the notes for form specialist and she is on no different treatment that I had given.One I see has her home up for sale so has left the areaI get new patient requests more now that a year ago and actually am probably closed or closing I admit I now cherry pick But not on the basis of money necessarily . I saw a new 10 yr old two days ago on mediciad because I see her parents and I want kids.( in the practice. Wouldn't want the noisy little things to come home with me)I turned down a guy with good insurance becasue it was back pain and I was busy. I turned down a family of 4 dual eligbles-all 4- because I thought I could not stand it emotionally the day they called.I took an insurance well woman because I see grandmother etc PIcking and choosing case by case is likely how I will slow to a crawlHow much do I make? Less than Lou Spikol . Hope any of this helps other wise how fun I got to type.My favorite thing. overhead about 35% malpractice about 8,000space about 125 sq ft rent about 537.00 a month registered patients ?who knows? the number is 758 but many were skilled nursing home patients who rehab'd and went home that work is minimal now due to difficult changes at the nursing home Like to see genreally up to 8-10 a day but not quite every day still yet business model is solid and has held up when like yesterday i saw 9 people only 1 wiih medicaid, i do very well thank you. The model says if I fill every day with the right mix I can make about 107,000 EMR-Have welford chart notes outsource billing 8% If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
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