Re: Getting new patients

[Guest guest]

I just started last week and have had no patients so far (*sigh*), so

put me in the " slow start " category. Although lots of local friends

encouraging me and saying what a great idea it is and how they told

their friends. I was hoping to get at least one patient after my ad

came out in the local paper, but no. It is as Gordon and Jim in KC

described in earlier posts, I will have to be patient and expand my

marketing efforts. Part of me hoped that the " If you build it, they

will come " myth would come true, but I am in a suburban community where

there is not a shortage of doctors, so I guess I shouldn't be

surprised. Plus I am not a participant in any third-party plans yet,

had to wait until final approval of hospital privileges 2 days ago.

Fortunately I am still working part-time at Kaiser, so I will have some

income.

Seto . . .

waiting . . .

in . . .

South Pasadena, CA

> notes it took her almost 6 months to come close to filling her

> panel. 

> Just as a matter of comparison: typical trajectory from nothing to

> full is 24 months.

> How is it we routinely beat not only " typical " but end up " best in

> show? "

>

> " I can see you today (with no need to convince me based on " urgency " )

> I will see you on time (no more waits and delays)

> We'll have all the time you need (no time pressure built on shaky

> finances)

> I won't force you to see someone else "

>

> Here is a quote from Kate Lorig at Stanford, who has done extensive

> research on office practices and patients:

> " The real issue that  what many folks have talked about is how much do

> you trust patients.  If there is no trust--then you must " protect "

> them or " they will not do the right thing " .  If you do trust them,

> then you become partners and respect that both you and them will

> sometimes make mistakes but on the whole things will be better for

> everyone.  A big part of the problem is systems.  I come for a visit

> and if I leave without the possible med I think I might need I am very

> unhappy as this means at best another phone call with phone tag hell,

> somehow getting the prescription to someone who can fill it and then

> hoping that this step goes correctly.   Most systems I have been

> involved in recently are very patient unfriendly and are set up for

> the convenience of the health professionals and billing.”

>

> Gordon

>

> At 12:33 AM 2/6/2004, you wrote:

>

> it still has taken 6 months to come close to filling my panel. I

> wasn't really busy on an everyday until 3-4 months after I went

> fulltime. Word of mouth takes a while, and getting around to seeing a

> doctor, even a good one, isn't always high on people's lists.

>

> Good luck,

> Guinn

>

>

>

>

[Guest guest]

Hang in there. My first month (May 2003),

I saw a grand total of 37 patients. Now, although I’m not where I had

idealistically predicted I would be, I am at least making ends meet and looking

to cut off to new patients in another 5-6 months. I do believe in the “if

you build it they will come” mantra. Unfortunately, no one said how long

it would take for them to come J.

Re:

Getting new patients

I just started last week and have had no patients so

far (*sigh*), so put me in the " slow start " category. Although lots

of local friends encouraging me and saying what a great idea it is and how they

told their friends. I was hoping to get at least one patient after my ad came

out in the local paper, but no. It is as Gordon and Jim in KC described in

earlier posts, I will have to be patient and expand my marketing efforts. Part

of me hoped that the " If you build it, they will come " myth would come

true, but I am in a suburban community where there is not a shortage of

doctors, so I guess I shouldn't be surprised. Plus I am not a participant in

any third-party plans yet, had to wait until final approval of hospital

privileges 2 days ago. Fortunately I am still working part-time at Kaiser, so I

will have some income.

Seto . . .

waiting . . .

in . . .

South Pasadena, CA

notes it took her almost 6 months to come close

to filling her panel.

Just as a matter of comparison: typical trajectory from nothing to full is 24

months.

How is it we routinely beat not only " typical " but end up " best

in show? "

" I can see you today (with no need to convince me based on

" urgency " )

I will see you on time (no more waits and delays)

We'll have all the time you need (no time pressure built on shaky finances)

I won't force you to see someone else "

Here is a quote from Kate Lorig at Stanford, who has done extensive research on

office practices and patients:

" The real issue that what many

folks have talked about is how much do you trust patients. If there is no

trust--then you must " protect " them or " they will not do the

right thing " . If you do trust them, then you become partners and

respect that both you and them will sometimes make mistakes but on the whole

things will be better for everyone. A big part of the problem is

systems. I come for a visit and if I leave without the possible med I

think I might need I am very unhappy as this means at best another phone call

with phone tag hell, somehow getting the prescription to someone who can fill

it and then hoping that this step goes correctly. Most systems I

have been involved in recently are very patient unfriendly and are set up for

the convenience of the health professionals and billing.”

Gordon

At 12:33 AM 2/6/2004, you wrote:

it still has taken 6 months to come close to filling my panel. I wasn't really

busy on an everyday until 3-4 months after I went fulltime. Word of mouth takes

a while, and getting around to seeing a doctor, even a good one, isn't always

high on people's lists.

Good luck,

Guinn

Yahoo!

Groups Sponsor

ADVERTISEMENT

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<image.tiff>

[Guest guest]

I got only two patients from my ad. My patients have come from, in order of

numbers:

1. Director of local physical rehabilitation center

2. owner of local health food store and coffee shop

3. wife of local pastor who is involved in many community activities

4. a high school athlete who got me another ten high school athletes

etc.

getting out and active in the community is the key

it helps that is is a physician shortage area!

Rothe DO

379 Piney Branch Way

Burnsville, NC 28714

(828)273-2889

[Guest guest]

One of my best sources has been a physician whose practice panel is full. Her staff was delighted to haveing a name to give to anyone who called to establish. Perhaps there's someone in the commenity that you know from past practice or training that you could talk to about this.

Also, because I'm a physician in a number of HMOs, I got automatic referrals from patients in my neighborhood who wanted to establish. The HMOs I deal with are frankly, no more painful that the PPOs. Many require referrals that aren't called in, just written on a prescription or note sheet. My reimbursement is usually correct for the contracted rate, and rarely involves deductibles or other hassles. Not to sound positive about HMOs, it's just that they work out to usually as simple for me as most PPOs. They are all insurance companies, which pretty much says it all. . .

I'm sure it's very community dependent.

Guinn

Albuquerque

[Guest guest]

You are so right LL...hard as it is to digest, most people are too scared of

catastrophies to go without insurance (myself included). Though we are in a

pitiful state it is true. I have only been open four months and stopped taking

new patients three weeks ago. Hopefully when I cross the learning curve of this

new software I can pick up a couple hundred more, but now I am at 250 and too

busy...because I accept insurance. It was a hassle for the three months it took

to get contracted, some are definately better than others, but now it's fine and

I feel good that at least these patients are getting something worthwhile for

their premiums!

Rothe DO

379 Piney Branch Way

Burnsville, NC 28714

(828)273-2889

[Guest guest]

Do I read that correctly, that you are closing your patient panel at 250? That sounds very, very low to me. Are you coding every visit as a 99215?

On Tue, 2 Mar 2004 17:37:37 -0500 (EST) writes:

everyone please look up simplecare .com on the web this seems like a goodsystem has anyone tried it G>> You are so right LL...hard as it is to digest, most people are too> scared of catastrophies to go without insurance (myself included).> Though we are in a pitiful state it is true. I have only been open four> months and stopped taking new patients three weeks ago. Hopefully when> I cross the learning curve of this new software I can pick up a couple> hundred more, but now I am at 250 and too busy...because I accept> insurance. It was a hassle for the three months it took to get> contracted, some are definately better than others, but now it's fine> and I feel good that at least these patients are getting something> worthwhile for their premiums! Rothe DO> 379 Piney Branch Way> Burnsville, NC 28714> (828)273-2889>>>>

[Guest guest]

everyone please look up simplecare .com on the web this seems like a good

system has anyone tried it G

>

> You are so right LL...hard as it is to digest, most people are too

> scared of catastrophies to go without insurance (myself included).

> Though we are in a pitiful state it is true. I have only been open four

> months and stopped taking new patients three weeks ago. Hopefully when

> I cross the learning curve of this new software I can pick up a couple

> hundred more, but now I am at 250 and too busy...because I accept

> insurance. It was a hassle for the three months it took to get

> contracted, some are definately better than others, but now it's fine

> and I feel good that at least these patients are getting something

> worthwhile for their premiums! Rothe DO

> 379 Piney Branch Way

> Burnsville, NC 28714

> (828)273-2889

>

>

>

>

[Guest guest]

Yes, I have tried Simple Care.

I visited Dr Vern Cherwatenko in Renton WA, the 'god-father' of

Simple care and by and large it is reasonable.

The trouble around here is that there are still some major employers

that everyone is trying to get coverage through ( Boeing, Alaska

Air, county and city health plans, ) and I could see that my 'cash

only' practice would have very very few patients.

I reluctantly signed on with a number of insurers and now enjoy

fairly decent checks from the payors. The payments come slowly

though and require plenty of time and expert resubmissions from

, my office manager and resident billing guru.

Personal medical health care insurance rates have to go still higher

so that most folks cannot afford coverage before they will accept

that they have to pay to see the doctor.

We have the Simple care fee schedule in Alteer all ready to be used

but have had little use for it over the past year.

Dr Dennis Galvon

-- In , <gthomson@p...> wrote:

> everyone please look up simplecare .com on the web this seems like

a good

> system has anyone tried it G

>

> >

> > You are so right LL...hard as it is to digest, most people are

too

> > scared of catastrophies to go without insurance (myself

included).

> > Though we are in a pitiful state it is true. I have only been

open four

> > months and stopped taking new patients three weeks ago.

Hopefully when

> > I cross the learning curve of this new software I can pick up a

couple

> > hundred more, but now I am at 250 and too busy...because I accept

> > insurance. It was a hassle for the three months it took to get

> > contracted, some are definately better than others, but now it's

fine

> > and I feel good that at least these patients are getting

something

> > worthwhile for their premiums! Rothe DO

> > 379 Piney Branch Way

> > Burnsville, NC 28714

> > (828)273-2889

> >

> >

> >

> >

[Guest guest]

yes but it is an interesting approach

Here is a quick read on the subject:

The SimpleCare Story

by Vern S. Cherewatenko (March 26, 2002)

Summary: We developed SimpleCare from a clean slate, creating a

common-sense, no-hassle system for seeing patients and getting reimbursed

fairly, without penalizing patients who pay for their visit before leaving

the office--just as they do for the vast majority of goods and services

they buy.

[www.CapitalismMagazine.com] I graduated from the University of Washington

and am a board-certified Family Physician. I owned five family

medicine-integrated medical clinics in the Seattle, Washington area, and

as a consequence was very involved with all medical insurances--including

Medicare, welfare, L & I, and several managed care contracts, in addition to

a regular menu of insurance company patients.

My partner, Mac, DO had recently joined me in practice. Dr.

Mac is a highly respected board-certified Family Physician with an

impeccable academic background.

A physician-colleague had a similar family practice, with multiple health

care providers in five clinics open 365 days a year.

Both of our groups were dedicated to providing comprehensive, integrated

medical wellness care for our patients. We both were extremely busy, never

at a loss for patients. We created and founded the largest IPA in

Washington State, in an attempt to protect the practice of independent

medicine and assure continuity of care for the Medicaid and Medicare

patients we had served over the years.

What Were We Doing Wrong?

Needless to say, we created a monster. The IPA was born out of our passion

to " stay alive " --we wanted to stay in business. The IPA, however, began to

eat us alive instead!

On a Sunday morning about 18 months ago, Dr. Mac and I sat down to

figure out why, when we couldn't be busier, were we losing so much money?

Why were we rapidly flying our businesses straight into the ground . . .

not to mention the usual " where has the fun gone " stuff.

We both had excellent business staffs and business-wise ran a very tight

ship. Our combined practice billings totaled over $10 million--not a tiny

operation by anyone's definition. Yet we calculated we were losing

approximately $7 per patient or $80,000 per month.

That loss could not be made up in volume. The standard managed care

response-- " You just need more patients to win at the capitation

game " --couldn't have been farther from the truth! Believe me . . . we

tried. Between the two clinic systems we took care of approximately 75,000

patients a year with 55 providers between us. The losses continued, and we

depleted our total net worth and assets over a two-year period.

We knew we were losing money on several insurance types--Medicare,

welfare, L & I, Pacific Care, Aetna, NylCare--virtually every managed care

plan. We feared we could not suddenly cancel all managed care contracts .

... . but the reality was we couldn't remain viable if we continued with

them.

The Paper Chase

Our practice was literally being exterminated by an expanding amount of

paperwork intended to " improve care and hold down costs. " At one time we

needed six medical records clerks, up from two, just to photocopy the

records of patients who, on a monthly basis, transferred in and out of our

care on these various managed care plans.

We took a look at an average patient charge:

My charge for a 10-minute patient visit was $79. The insurance companies

typically reimbursed $43. Costs of collection were anywhere from $5 to $20

depending on the staff time, billing system, etc. All doctors know they

don't get reimbursed the full amount they charge for a visit, but most

doctors completely overlook what it costs to collect even the discounted

reimbursement. By our calculation, then, I was actually being reimbursed

$23 for a $79 office visit charge! Add in the overhead for the exam room

(the national average is $30), and we discovered we were losing about $7

on each of the 75,000 patients we were seeing annually!

We could not cut our overhead any further--we had been doing that for the

past two years (cheaper photocopy paper, less-fancy patient info, fewer

nurses, fewer receptionists, no more " pantry stocking, " and so on). We

were running as lean as we could . . . practically on bare bones.

" Cash Only " Solution

In April 1998, we looked again at the $80,000-a-month loss, concluding we

both were destined to be bankrupt in six months.

Looking around the country to see if we were alone in our struggle, we

were alarmed to find doctors everywhere were beginning to file bankruptcy

in increasing numbers.

We concluded that a new system was the only way we and many of our

colleagues could possibly survive.

As we searched for solutions, it quickly became apparent that if people

would pay us for our services today, at the time of service, we could

immediately cut fees in half . . . and begin to get out of those

ridiculous insurance contracts. They were either bad because they didn't

pay enough, bad because they created too much paperwork and bureaucracy,

or bad because they set us up for a fraud/felony charge when " examining

parties " didn't agree with the way we coded something.

We re-explored the " cash only " concept by asking ourselves, " How many

health consumers in the U.S. represent the 'cash-paying' public? " The

answer? Nearly 50 million Americans (1/5th of the country) are uninsured,

and most would be very willing to pay a reasonable fee for their care, if

they could find doctors who would accept payment in full at the time of

service.

Trust me on this--we've been doing it and our patients are delighted!

SimpleCare Is Born

It was with great pride that we founded " SimpleCare " :

100 percent patient-focused care

No lists of who can and can't see us

No lists of what patients can and cannot have

No confusing and changing CPT codes

No insurance or patient billing

100 percent bureaucracy-free

Hassle-free medicine!

SimpleCare is a " different animal " --no insurance billing, no extensive

" document for the insurance company " chart notes. Just real medicine, real

time with patients, real money paid before the patient leaves the office,

and patients charged based on a simple coding system: Short, Medium, or

Long.

We're also working to establish a nonprofit organization, the American

Association of Patients and Providers (AAPP), representing patients and

providers of health care who want to work together to fix the health care

system. Rather than insurers, attorneys, and special-interest groups, why

not patients and doctors as the agents of change?

Our nonprofit application is pending, but the organization is up and

running. The membership fee is between $20 and $35 a year--inexpensive,

because we want to attract a large activist membership quickly.

Common-Sense Coding

We developed SimpleCare from a clean slate, creating a common-sense,

no-hassle system for seeing patients and getting reimbursed fairly,

without penalizing patients who pay for their visit before leaving the

office--just as they do for the vast majority of goods and services they

buy.

We created a simple coding system: just three codes rather than the 7,500

+/- codes found in the CPT manual. The CPT scheme was designed for

billing; since we weren't billing anyone, we didn't need (and didn't want)

to use the overly complex CPT scheme. One physician asked, " But is this

legal? " I can't tell you how many doctors think the CPT manual is a legal

document; it's not. It is nothing more than a joint venture between the

American Medical Association and the Health Care Financing Administration

(now the Centers for Medicare and Medicaid), for coding uniformity only.

Our three SimpleCare codes are S-M-L: 10 minutes is an S (Short); 20

minutes is an M (Medium); and 30 minutes is an L (Long). Our clinic

charges $35 for an S, $65 for an M, and $95 for an L. A reasonable

fee--without the paperwork costs--is assigned to specific procedures, lab

work, x-rays, etc.

Other doctors across the country have employed SimpleCare and have adopted

the S-M-L system using their own fee structures. We do not tell doctors

what to charge for their respective S-M-L or procedures. Individual

doctors set their own fees and agree to take the SimpleCare Pledge:

" I will give my patients, that pay in full at time of service, my best

price. "

Highly Satisfied

We've developed a few SimpleCare office forms, but we're no longer

burdened by thousands of dollars for administrative hardware, software,

staff time, down time, re-bill time, fight time, denial time, etc. Because

we aren't burdened by these costs, our patients aren't either. It would be

completely unethical, of course, to charge patients for CPT-related

billing services that aren't being used because patients are paying in

full at the time of service.

We even saved the $49 it would have cost us for a new CPT book and

determined SimpleCare was immediately Y2K-compliant. Within three months,

we went from losing $80,000 a month to making $10,000 a month. According

to AAPP estimates, if the entire U.S. health care system were converted to

SimpleCare, American patients would eventually save some $300 billion

annually!

The cash-paying patients love SimpleCare: There's less wait before seeing

the doctor, and they no longer have to pay exorbitant fees pushed up by

excessive administrative costs. We were able to reverse our

" patient-to-paperwork ratio " from 1:7 (1 minute with the patient, 7

minutes on paperwork) to 7:1 (7 minutes with the patient and 1 on

paperwork).

Our patients receive more quality time from their physicians, and there

has been a quantum drop in complaints from our patients as we have rid

ourselves of the " busy work " of managed care. The office runs more

efficiently and " clinic stress " fell immediately. The nurses are ecstatic;

they no longer have a phone attached to their ears, listening to " hold "

music for 45 minutes as they plow through bureaucracies. They are back to

referring patients to the specialists we, or the patients themselves,

choose . . . and it now takes 30 seconds, rather than 45 minutes, for the

referral to take place.

Regaining Control

We knew the SimpleCare system was allowing us to regain control of our

destiny. We knew we were doing absolutely the right thing for our patients

and for health care in general.

With that confidence, we were able to take the next step to free ourselves

from the red-tape laden health care system. With staff input, we

identified the insurance companies that were the greatest source of

frustration for us: low reimbursements, delayed reimbursements, and/or

excessively burdensome paperwork. We began to send the problem companies

90-day cancellation notices. We were able to phase out the " bad apples "

and phase in a new population of cash-paying patients. There's a lot of

them out there.

News about this simple, fair form of health care is spreading. Over the

last year articles about SimpleCare have appeared in the Wall Street

Journal, Puget Sound Business Journal, South County Journal, and Medical

Marketing News. Dr. Mac and I have told the SimpleCare story to

national radio talk show audiences from New York to Washington--including

National Public Radio, the HealthMax Health Hour, and the Medicine Man

Show. We've gained the attention of several state medical associations,

the Association of American Physicians and Surgeons, and many small and

large businesses. Dr. Mac and I have been giving seminars to many

community organizations, all with very positive ( " It's about time! " )

responses.

A Call to Action

SimpleCare is not theoretical, " chalk-board " talk. We've tested the

program and continue to expand it daily in clinical practice . . . and in

the process have managed to save a small family medical practice in

Renton, Washington from becoming extinct. SimpleCare has given us the

power to rid ourselves of the red tape burden imposed by more than a dozen

insurance companies, with more on the chopping block. It's allowed us to

get back to the business at hand: caring for our patients, rather than

caring for their insurance companies. We are getting paid a fair price for

our services and spending much more quality and productive time with our

patients.

If you sincerely and passionately wish, as I did, to regain control of

your professional career, your patients, your life, your practice, your

income, and your ability to practice unencumbered medicine, then

SimpleCare is that solution.

We now have nationally licensed clinical laboratories ready to go, with

pharmacies and radiology groups joining in. Many people with whom we have

discussed SimpleCare feel it is the quickest, simplest, most ethical, and

most common-sense approach currently on the table to fix the uninsured,

under-insured, and poorly insured (high cost-low value) problem in this

country. That is precisely why we are escalating the national expansion of

this plan.

I welcome you to be part of the solution!

> Yes, I have tried Simple Care.

> I visited Dr Vern Cherwatenko in Renton WA, the 'god-father' of

> Simple care and by and large it is reasonable.

> The trouble around here is that there are still some major employers

> that everyone is trying to get coverage through ( Boeing, Alaska

> Air, county and city health plans, ) and I could see that my 'cash

> only' practice would have very very few patients.

> I reluctantly signed on with a number of insurers and now enjoy

> fairly decent checks from the payors. The payments come slowly

> though and require plenty of time and expert resubmissions from

> , my office manager and resident billing guru.

>

> Personal medical health care insurance rates have to go still higher so

> that most folks cannot afford coverage before they will accept that

> they have to pay to see the doctor.

> We have the Simple care fee schedule in Alteer all ready to be used but

> have had little use for it over the past year.

>

> Dr Dennis Galvon

>

>

>

> -- In , <gthomson@p...> wrote:

>> everyone please look up simplecare .com on the web this seems like

> a good

>> system has anyone tried it G

>>

>> >

>> > You are so right LL...hard as it is to digest, most people are

> too

>> > scared of catastrophies to go without insurance (myself

> included).

>> > Though we are in a pitiful state it is true. I have only been

> open four

>> > months and stopped taking new patients three weeks ago.

> Hopefully when

>> > I cross the learning curve of this new software I can pick up a

> couple

>> > hundred more, but now I am at 250 and too busy...because I accept

>> insurance. It was a hassle for the three months it took to get

>> contracted, some are definately better than others, but now it's

> fine

>> > and I feel good that at least these patients are getting

> something

>> > worthwhile for their premiums! Rothe DO

>> > 379 Piney Branch Way

>> > Burnsville, NC 28714

>> > (828)273-2889

>> >

>> >

>> >

>> >