Re: wake up call

[Guest guest]

Some other options include looking for insurance through a larger group (local

medical society or chamber of commerce might offer packages). Also, instead of

providing complete coverage, you can say that you would reimburse for the first

$100 a month (every little bit helps). This is the reason the number of

uninsured in the country is going up--health insurance is simply getting too

expensive for small businesses to afford. Good luck!

[Guest guest]

We started practice last Nov. We are a group of two trying to do an

off shoot of Gordons model.

So far in our 3rd month and no longer going to the bank to make

payroll or pay expenses. Insurance is a big ticket item. Our med

mal wanted it all up front. For fp class one it was 9000. The

other fp doing ob was 17000 right up front.

Health insurance was also expensive. We pay 200 of each employees

premium, and pay ours. For my family that never uses it , cost 600

a month.

If you are not going to busy right out of the shoot, it is better to

work into these costs or eliminate them.

Costs to set up a 401k about 200. Costs to set up a benefit plan

about 600.

Costs in our area to be in telephone book, yellow pages with small

add about 80 a month. Costs for telephone and dsl about 500 a

month.

My projections for costs were not high enough when budgeting. I

never dreamed the first month that supplies would cost around 5000.

It has dropped to about 3000 a month now.

Brent

> Some other options include looking for insurance through a larger

group (local medical society or chamber of commerce might offer

packages). Also, instead of providing complete coverage, you can say

that you would reimburse for the first $100 a month (every little

bit helps). This is the reason the number of uninsured in the

country is going up--health insurance is simply getting too

expensive for small businesses to afford. Good luck!

>

[Guest guest]

Greetings,

Re: Re: wake up call

<The only feasible way to go into practice today is with the retainer model.>

This is not a correct statement. The reason I am on this listserv, is that after hearing Dr. in New Orleans, I saw an alternative.

Attached are some preliminary spreadsheets looking at my potential income using Dr. 's model. I am not really ready to release this data, it still has some tweaking to do. But of course, it will be ongoing data anyway, as 'REAL' numbers come into play.

As an update:

Everything is a go here for opening my practice on January 19th, except for the office remodeling (checking on this again tomorrow). Have MedMal quotes of $7300 and $5000 first year, still awaiting one more quote.

I am following 's solo/solo model, setting up in an apartment in a senior housing project. Trying to keep my start-up costs below $10,000 and so far am making it.

<The only feasible way to go into practice today is with the retainer model.>

This very well may be true with the type of practice you are wanting to open, utilizing Mutltiple employees. Corporate healthcare will tell you that the single biggest cost to a clinic is the physician. But as a physician owned company, which we are talking about, the biggest cost is employees.

My second clinic, I opened with 3000 square feet of space, 3 exam rooms, treatment room, waiting room, receptionist area, nurses area, personal office, and room to expand. Rent was high but not the reason it took me three years to start seeing a profit. My employees were the reason. I had a receptionist, an LPN, and a PA. None had health benefits as it was in a military town and all had benefits through the military. The PA's salary was subsidized for the first year through an OccMed contract.

I worked 4 Jobs to keep the clinic afloat and bring in $70k a year for three years. The OccMed contract for one year, Medical Review Officer for a drug testing company, admission and on-call physician for two Psych hospitals (one adult, one adolescent), and 60-100 hours a month of ED work.

I began seeing a profit when I let the PA, and receptionist go, and downgrading the LPN to a Med Tech. I was just beginning to let some of the jobs go, when I went through a bloody divorce, which caused me to declare bankruptcy, because the courts took the attitude that since I am an MD, I "MUST" be rich, and that if I can't show how rich I am, that I must be hiding it very carefully. Federal bankruptcy was what it took to prove that I was in debt (hmmmm can't find an adjective deep enough).

Anyway the upshot to all this diatribe is that <The only feasible way to go into practice today is with the retainer model.> is not a true statement and all the modifiers need to be added to make it a true statement. Possibly like this:

<The only feasible way to go into a [high overhead, multiple employee, low flow, high quality] practice today is [possibly] with the retainer model.>

Sincerely,

Scroggins

PS: Please see the attachements, while not totally complete or 100% proofed, I feel they are indicative of true expectations.

[Guest guest]

No wonder your numbers don't match up. I could never afford a lawyer, a

consultant, and an accountant. And, after 2.5 years of solo practice, I have

not needed any of these professions, except for tax preparation.

Greg Hinson

----- Original Message -----

> I will form a reasonable/legal plan and will

> implement it with Gordon's and my own spirit at heart.

> I will commission a lawyer and a consultant and

> accountant to help me do it right. Will keep everyone

> posted.

>

>

[Guest guest]

It is especially important for those starting out in practice to heed

those who have been doing it for a while, have had the gumption to try

something new, and have worked more than one model.

Gordon

At 12:10 AM 1/10/2004, you wrote:

Greetings,

Re: Re: wake up call

<The only feasible way to go into practice today is with the retainer model.>

This is not a correct statement. The reason I am on this listserv, is that after hearing Dr. in New Orleans, I saw an alternative.

Attached are some preliminary spreadsheets looking at my potential income using Dr. 's model. I am not really ready to release this data, it still has some tweaking to do. But of course, it will be ongoing data anyway, as 'REAL' numbers come into play.

As an update:

Everything is a go here for opening my practice on January 19th, except for the office remodeling (checking on this again tomorrow). Have MedMal quotes of $7300 and $5000 first year, still awaiting one more quote.

I am following 's solo/solo model, setting up in an apartment in a senior housing project. Trying to keep my start-up costs below $10,000 and so far am making it.

<The only feasible way to go into practice today is with the retainer model.>

This very well may be true with the type of practice you are wanting to open, utilizing Mutltiple employees. Corporate healthcare will tell you that the single biggest cost to a clinic is the physician. But as a physician owned company, which we are talking about, the biggest cost is employees.

My second clinic, I opened with 3000 square feet of space, 3 exam rooms, treatment room, waiting room, receptionist area, nurses area, personal office, and room to expand. Rent was high but not the reason it took me three years to start seeing a profit. My employees were the reason. I had a receptionist, an LPN, and a PA. None had health benefits as it was in a military town and all had benefits through the military. The PA's salary was subsidized for the first year through an OccMed contract.

I worked 4 Jobs to keep the clinic afloat and bring in $70k a year for three years. The OccMed contract for one year, Medical Review Officer for a drug testing company, admission and on-call physician for two Psych hospitals (one adult, one adolescent), and 60-100 hours a month of ED work.

I began seeing a profit when I let the PA, and receptionist go, and downgrading the LPN to a Med Tech. I was just beginning to let some of the jobs go, when I went through a bloody divorce, which caused me to declare bankruptcy, because the courts took the attitude that since I am an MD, I " MUST " be rich, and that if I can't show how rich I am, that I must be hiding it very carefully. Federal bankruptcy was what it took to prove that I was in debt (hmmmm can't find an adjective deep enough).

Anyway the upshot to all this diatribe is that <The only feasible way to go into practice today is with the retainer model.> is not a true statement and all the modifiers need to be added to make it a true statement. Possibly like this:

<The only feasible way to go into a [high overhead, multiple employee, low flow, high quality] practice today is [possibly] with the retainer model.>

Sincerely,

Scroggins

PS: Please see the attachements, while not totally complete or 100% proofed, I feel they are indicative of true expectations.

[Guest guest]

I will be using Amazing Charts to begin with. The cost of $500, 90 days from now is too attractive to pass up during this start up phase. If it doesn't work well enough, I will change later. I will bill the insurance companies directly from home, using either paper or electronic.

From Amazingcharts.com (not an endorsement, just info)

<Amazing Charts contains all the functionality of other programs for a tiny fraction of the cost. Perhaps most amazing, is that Amazing Charts includes complete office scheduling, interoffice messaging, advanced patient search abilities, ICD and CPT coding, prescription writing, and much more! Other programs charge additional hundreds to thousands of dollars for these extras, if they even offer them at all. We can even do your billing for 4% of collections!>

TAS

Re: wake up call

which emr and how much is it to buy ? do you bill insurance? does the eemrhave a practice managemnet system

[Guest guest]

Dear -

About staff expenses: I share an office space and one skilled employee with two friends. We've been doing this for 9 months and it works very well. One is a family therapist, the other is a myofascial therapist. We share PM software and electronic billing, 2 phone lines and a fax line. We bought the software and one computer and a printer/fax/copier together. We share basic the charges for the accountant, copier paper, file folders, paper clips, etc. The employee answers the phone, takes copays and does electronic billing. If she's not there, I do everything but the electronic billing myself. If the phones are busy, then voice mail answers and patients leave messages on my phone. I do alot of the work that a nurse or assistant would do - all of my own lab calls, refills, call backs, blood pressures, etc, but that's the idea behind a low-cost practice.

I was describing this because it's not very expensive. We pay for her insurance. Her husband is insured through his job. My portion of the staff costs are about $500. every two weeks. It's no more expensive than my malpractice. I sympathize with the costs of health insurance for your family - now that my 6 month "cobra" coverage is over, it's beginning to look like we can't get insurance for my husband at any reasonable price. He may join the ranks of those waiting for Medicare to kick in. . . ironic. I do think, though, if you've developed a model that involves seeing 30-some patients a day, then it's no advantage over employment in a clinic.

Guinn

Albuquerque

[Guest guest]

Sorry to go into a consultant diatribe - but when you are trying to do things outside of the normal model, a consultant will box you in. I talked to one guy here who pulled out the same tired charts over and over again about my practice costs without listening to anything I was saying. He wanted a minimum of $800. a month to show me how to do it his way - which was just the usual model with a ton of staff. He just didn't understand what I was proposing. When he was done laughing at me, he did me one great favor, which was give me the name of a doctor "who was trying the same crazy thing." It was my conversation with that very happy doctor who convinced me it was all possible. Reread Gordon's original articles, then start thinking very cheap. My start-up costs were less than $10,000 cash. Reread the old postings from LLyon about his start-up.

Guinn (Thanks, I feel better.)