RE: Closing down to new patients

[Guest guest]

,

Congratulations on being successful enough to be able to close to new

patients. If I recall, it was a slow start for you. It certainly has

been for me, although it's starting to pick up now, 6 months into my

practice. How long have you been at it, and what do you think made the

biggest impact, advertising/marketing or word of mouth or something

else? So far, about half of the patients I've seen came to me through

word of mouth. What criteria are you using to judge when to close your

practice, number of visits per week, total patient panel, how late you

get home, etc?

Seto

South Pasadena, CA

> I am currently getting ready to close my practice to new patients. I

> realize I have to notify the HMO groups to be taken off their lists,

> but do I need to notify the ppo insurers (Medicare, BCBS, PHCS, etc),

> or can I simply tell patients who call that I cannot take them on

> (without fear of repercussion from the insurer). Is there a legal

> obligation involved? Thanks!

>

>

>

>

>

[Guest guest]

I opened for patients May 1, 2003. I am looking to close at 1200 or so patients. As I have one nurse

in addition to me, I figured on 15-18 established patients a day and kind of

extrapolated from there to reach an arbitrary number of 1200. Right now,

I’m seeing 12-15 a day, but that includes new patients so it can get a

bit hectic. My hope is with the upcoming winter months, I will be plenty busy

with the population I already have (and I fear what the practice would look

like come March if I don’t close). The reality is that although 1200 is

arbitrary, based on my current overhead and what I wanted to see, it seems like

it will be right on.

What I’m finding is that there is a

relatively fine line between making ends meet and getting too full. Also, the desire

to pay off loans tends to push me in the direction of wanting to see more now

to get the money in now. But if I give in to this feeling, my practice would be

too busy and I would hate myself in 1-2 years. With my current schedule,

I’m home at 5:30 every night and with

only 3-5 calls on the average weekend, I’ve actually been using my

“free time” to train for my first marathon (Baltimore on 10/16/04).

As for what worked the best for me, I

would have to say word of mouth…and a newspaper article about me doing

home visits. Marketing is more complicated than I ever thought it would be

because your spending money you don’t really have trying to make more

money in the long run. It seems crazy to run an advertisement in the paper when

you can’t find the money to pay the rent, but that’s exactly why

you need to run the ad. Talk about conflicts! But, by approaching a reporter

for the local paper (as opposed to the advertising department), I was able to

convince her that returning to the basics of the Dr-Patient relationship is

still possible (and what we’re doing is newsworthy), and she did the

article--which was better than any advertisement I could have bought. I would

encourage everyone to try this method.

Re:

Closing down to new patients

,

Congratulations on being successful enough to be able to close to new patients.

If I recall, it was a slow start for you. It certainly has been for me,

although it's starting to pick up now, 6 months into my practice. How long have

you been at it, and what do you think made the biggest impact,

advertising/marketing or word of mouth or something else? So far, about half of

the patients I've seen came to me through word of mouth. What criteria are you

using to judge when to close your practice, number of visits per week, total

patient panel, how late you get home, etc?

Seto

South Pasadena, CA

I am

currently getting ready to close my practice to new patients. I realize I have

to notify the HMO groups to be taken off their lists, but do I need to notify

the ppo insurers (Medicare, BCBS, PHCS, etc), or can I simply tell patients who

call that I cannot take them on (without fear of repercussion from the

insurer). Is there a legal obligation involved? Thanks!

Yahoo!

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[Guest guest]

I too had figured on closing at between

1000 & 1200 pts. I just opened 4 months ago so I am not nearly there

yet, but I’m growing quickly. You mentioned that you have a

nurse. By “nurse” do you mean an R.N.? Who answers

phones, does billing, collects co-pays, etc? These are the issues I’m

struggling with now. Right now it is just me & my wife (she does all

billing, phones, etc, just no clinical stuff). I am not sure if I were to

hire just other person if it would be better to get a clinical person (M.A.,

L.P.N, R.N.) or a billing/receptionist person.

Re:

Closing down to new patients

,

Congratulations on being successful enough to be able to close to new patients.

If I recall, it was a slow start for you. It certainly has been for me,

although it's starting to pick up now, 6 months into my practice. How long have

you been at it, and what do you think made the biggest impact,

advertising/marketing or word of mouth or something else? So far, about half of

the patients I've seen came to me through word of mouth. What criteria are you

using to judge when to close your practice, number of visits per week, total

patient panel, how late you get home, etc?

Seto

South Pasadena, CA

I

am currently getting ready to close my practice to new patients. I realize I

have to notify the HMO groups to be taken off their lists, but do I need to

notify the ppo insurers (Medicare, BCBS, PHCS, etc), or can I simply tell

patients who call that I cannot take them on (without fear of repercussion from

the insurer). Is there a legal obligation involved? Thanks!

Yahoo!

Groups Links

•

To visit your group on the web, go to:

http://groups.yahoo.com/group//

• To

unsubscribe from this group, send an email to:

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[Guest guest]

I actually have an LPN which I “stole”

from my previous office. She is great because she can answer clinical questions

(after 5 years, she knows all my answers), but she also answers the phone, take

co-pays, does referrals, calls in rxns, sets up

appointments and yes, when I’m at the nursing home, she cleans the office.

I explained to her before we opened that much of the responsibilities would be

administrative in nature and would involve less actual nursing

responsibilities, but she was excited about the concept and has done everything

possible to help it work. In return, I pay her well,

give her health insurance, dental insurance, and a liability insurance policy.

She also gets a bonus once a quarter based on the “profits” of the

business. Hopefully, in the next year, we’ll set up a retirement plan

that will also help her out. Although having another employee has cost me a lot

of money (need more space, needed a server for my emr,

her salary and benefits), she is worth every penny. As for the billing, I do

all of that.

Re:

Closing down to new patients

,

Congratulations on being successful enough to be able to close to new patients.

If I recall, it was a slow start for you. It certainly has been for me,

although it's starting to pick up now, 6 months into my practice. How long have

you been at it, and what do you think made the biggest impact,

advertising/marketing or word of mouth or something else? So far, about half of

the patients I've seen came to me through word of mouth. What criteria are you

using to judge when to close your practice, number of visits per week, total

patient panel, how late you get home, etc?

Seto

South Pasadena, CA

I am

currently getting ready to close my practice to new patients. I realize I have

to notify the HMO groups to be taken off their lists, but do I need to notify

the ppo insurers (Medicare, BCBS, PHCS, etc), or can I simply tell patients who

call that I cannot take them on (without fear of repercussion from the

insurer). Is there a legal obligation involved? Thanks!

Yahoo!

Groups Links

•

To visit your group on the web, go to:

http://groups.yahoo.com/group//

• To

unsubscribe from this group, send an email to:

-unsubscribe

• Your

use of Yahoo! Groups is subject to the Yahoo!

Terms of Service.

[Guest guest]

Great story.

Thanks for including some numbers, so others can get a more specific idea

about what's working for you.

In time, if you feel up to sharing a case study along the line of

Eads, that would also be a great help.

On closing to new:

My impression is that it is based on the conflicting needs of getting

home on time and bringing home a reasonable income after expenses.

is right to caution against the desire to ramp up the money with too

many patients early on. It is monumentally difficulty to ramp back

from an over-saturated practice.

Letting too many folks in the door will eventually land you back in the

practice you left.

I've been closed for two years and get calls every week from patients

looking to get in to my practice. I feel like I have to be very

hard and fast, turning down family members, spouses, etc.

Turning these folks down is very hard.

The lesson I've learned is that we usually wait too long to close to new

patients, and that our fear that this is going to result in a lack of

patient demand is unfounded.

Gordon

At 09:58 AM 8/31/2004, you wrote:

I

opened for patients May 1, 2003. I am looking to close at 1200 or so

patients. As I have one nurse in addition to me, I figured on 15-18

established patients a day and kind of extrapolated from there to reach

an arbitrary number of 1200. Right now, I’m seeing 12-15 a day, but that

includes new patients so it can get a bit hectic. My hope is with the

upcoming winter months, I will be plenty busy with the population I

already have (and I fear what the practice would look like come March if

I don’t close). The reality is that although 1200 is arbitrary, based on

my current overhead and what I wanted to see, it seems like it will be

right on.

What I’m finding is that there is a relatively fine line between making

ends meet and getting too full. Also, the desire to pay off loans tends

to push me in the direction of wanting to see more now to get the money

in now. But if I give in to this feeling, my practice would be too busy

and I would hate myself in 1-2 years. With my current schedule, I’m home

at 5:30 every night and with only 3-5 calls on the average weekend, I’ve

actually been using my “free time” to train for my first marathon

(Baltimore on 10/16/04).

As for what worked the best for me, I would have to say word of mouth…and

a newspaper article about me doing home visits. Marketing is more

complicated than I ever thought it would be because your spending money

you don’t really have trying to make more money in the long run. It seems

crazy to run an advertisement in the paper when you can’t find the money

to pay the rent, but that’s exactly why you need to run the ad. Talk

about conflicts! But, by approaching a reporter for the local paper (as

opposed to the advertising department), I was able to convince her that

returning to the basics of the Dr-Patient relationship is still possible

(and what we’re doing is newsworthy), and she did the article--which was

better than any advertisement I could have bought. I would encourage

everyone to try this method.

Re: Closing down to new

patients

,

Congratulations on being successful enough to be able to close to new

patients. If I recall, it was a slow start for you. It certainly has been

for me, although it's starting to pick up now, 6 months into my practice.

How long have you been at it, and what do you think made the biggest

impact, advertising/marketing or word of mouth or something else? So far,

about half of the patients I've seen came to me through word of mouth.

What criteria are you using to judge when to close your practice, number

of visits per week, total patient panel, how late you get home,

etc?

Seto

South Pasadena, CA

<?fontfamily><?param Arial><?x-tad-bigger>I am

currently getting ready to close my practice to new patients. I realize I

have to notify the HMO groups to be taken off their lists, but do I need

to notify the ppo insurers (Medicare, BCBS, PHCS, etc), or can I simply

tell patients who call that I cannot take them on (without fear of

repercussion from the insurer). Is there a legal obligation involved?

Thanks!

<?/x-tad-bigger><?/fontfamily><?fontfamily><?param

Arial><?x-tad-bigger>

<?/x-tad-bigger><?/fontfamily><?smaller>Yahoo!

Groups Links<?/smaller>

• To visit your group

on the web, go to:

<?color><?param

0000,0000,FFFF>http://groups.yahoo.com/group//<?/color>

•

[Guest guest]

Gordon, I am fairly new to the list so

forgive me if I missed a previous discussion on the topic. I wanted to

ask how many pts do you have? You said you had been closed for 2 yrs.

Are you still doing all billing, scheduling, phone calls, etc yourself?

Did you reach your income goals with your practice or are you still working

part time in your office and part time at Idealized Health? Thanks for

any info you can provide!

Re:

Closing down to new patients

,

Congratulations on being successful enough to be able to close to new patients.

If I recall, it was a slow start for you. It certainly has been for me,

although it's starting to pick up now, 6 months into my practice. How long have

you been at it, and what do you think made the biggest impact,

advertising/marketing or word of mouth or something else? So far, about half of

the patients I've seen came to me through word of mouth. What criteria are you

using to judge when to close your practice, number of visits per week, total

patient panel, how late you get home, etc?

Seto

South Pasadena, CA

<?fontfamily><?param Arial><?x-tad-bigger>I am currently

getting ready to close my practice to new patients. I realize I have to notify

the HMO groups to be taken off their lists, but do I need to notify the ppo

insurers (Medicare, BCBS, PHCS, etc), or can I simply tell patients who call

that I cannot take them on (without fear of repercussion from the insurer). Is

there a legal obligation involved? Thanks!

<?/x-tad-bigger><?/fontfamily><?fontfamily><?param

Arial><?x-tad-bigger>

<?/x-tad-bigger><?/fontfamily><?smaller>Yahoo!

Groups Links<?/smaller>

• To

visit your group on the web, go to:

<?color><?param

0000,0000,FFFF>http://groups.yahoo.com/group//<?/color>

• To

unsubscribe from this group, send an email to:

<?color><?param

0000,0000,FFFF>-unsubscribe <?/color>

• Your

use of Yahoo! Groups is subject to the <?color><?param

0000,0000,FFFF>Yahoo! Terms of Service<?/color>.

[Guest guest]

I'm only 1/3 practice, with the rest of my time spent as faculty with the

Institute for Healthcare Improvement and in a Rochester NY initiative

(see my web site for details:

www.idealhealthnetwork.com).

My patient panel is about 450.

Since April, I've been working with a 32 hr per week RN, Judy

Zettek. I asked Judy to come on to help with two things.

1: I was getting heat from patients that my travel (about twice per

month) and time in meetings was getting to be a problem for access.

Judy keeps the place going when I'm not physically present, Lee and

others have kindly offered to provide visit care for patients Judy and I

have screened.

2: Judy and I are testing the limits of planned care.

She's running our group visits (which are totally cool, patients love

them, fun to do).

She's running the Healthy Shots immunization registry

She's running the DocSite registry for chronic disease

She's doing a lot of phone follow up for those with chronic disease to

help them problem-solve and achieve their goals.

Now a caution: I'm experimenting with how a practice can achieve

phenomenal results. A 1/3 practice could never afford a full RN at

32 hours per week. I'm subsidizing the expense just to test the

system.

I'm beginning to believe that phenomenal follow-through (the core of

chronic disease management) is more likely in the context of a team, and

I choose to test that theory with Judy. So far so good.

I still do the billing. She gets the first pass on phone calls and

the rest.

I've been studying some mathematical modeling based on survey work done

by a Simon School (MBA school) professor, and early results appear to

point to a staffing ratio of about 1:1 being ideal for efficiency.

As we test this, I'll let you know.

G

At 09:47 AM 9/1/2004, you wrote:

Gordon,

I am fairly new to the list so forgive me if I missed a previous

discussion on the topic. I wanted to ask how many pts do you

have? You said you had been closed for 2 yrs. Are you still

doing all billing, scheduling, phone calls, etc yourself? Did you

reach your income goals with your practice or are you still working part

time in your office and part time at Idealized Health? Thanks for

any info you can provide!

[Guest guest]

I closed my panels to random assignments from insurance plans very early (about 500 patients) which was a good idea for my practice. My new patient visits, with spending an hour and then additional time organizing a chart in the EMR, were taking up a lot of energy every week. What now happens is that all my referrals are by word of mouth and I have the space still to take friends, family members, people in my community. The practice has grown much more "organically" that way and looks more like a community practice than I ever would have suspected in a city of 500,000. I now have about 850 patients and still have room for more.

[Guest guest]

Gordon,

In my practice, I find the ratio works perfectly.

I feel someone should “man the fort” while I’m gone. My nurse

knows all the patients and can immediately refer them to the covering doc or

schedule an appointment when I return. She checks out prior to leaving for the

day (for rxn refills or questions) and forwards the

phone to my cell phone.

Upon my return, I am brought up to date with everything that happened in 15

minutes or less. Although we have not stretched to the group visit or nurse f/u

for chronic diseases, I can see being able to do that when we shut down to new

patients (because she won’t have to spend 20 minutes getting demographic

and insurance information on everyone that walks through the door).

The only other employee I would consider

adding would be someone part-time to put the EOBs in

the computer when they return from the insurance company and sending off the

secondary insurance stuff. I have no problems getting off the initial bill

through the internet, but the follow-up process is incredibly time consuming. I’m

hoping to talk my wife into doing this, but the bribe might cost me more than

just hiring someone else. J

RE:

Closing down to new patients

I'm only 1/3 practice, with the rest of my time spent

as faculty with the Institute for Healthcare Improvement and in a Rochester NY

initiative (see my web site for details: www.idealhealthnetwork.com).

My patient panel is about 450.

Since April, I've been working with a 32 hr per week RN, Judy Zettek. I

asked Judy to come on to help with two things.

1: I was getting heat from patients that my travel (about twice per

month) and time in meetings was getting to be a problem for access. Judy

keeps the place going when I'm not physically present, Lee and others

have kindly offered to provide visit care for patients Judy and I have

screened.

2: Judy and I are testing the limits of planned care.

She's running our group visits (which are totally cool, patients love them, fun

to do).

She's running the Healthy Shots immunization registry

She's running the DocSite registry for chronic disease

She's doing a lot of phone follow up for those with chronic disease to help

them problem-solve and achieve their goals.

Now a caution: I'm experimenting with how a practice can achieve

phenomenal results. A 1/3 practice could never afford a full RN at 32

hours per week. I'm subsidizing the expense just to test the

system.

I'm beginning to believe that phenomenal follow-through (the core of chronic

disease management) is more likely in the context of a team, and I choose to

test that theory with Judy. So far so good.

I still do the billing. She gets the first pass on phone calls and the

rest.

I've been studying some mathematical modeling based on survey work done by a

Simon School (MBA school) professor, and early results appear to point to a

staffing ratio of about 1:1 being ideal for efficiency. As we test this,

I'll let you know.

G

At 09:47 AM 9/1/2004, you wrote:

Gordon, I am fairly new

to the list so forgive me if I missed a previous discussion on the topic.

I wanted to ask how many pts do you have? You said you had been closed

for 2 yrs. Are you still doing all billing, scheduling, phone calls, etc

yourself? Did you reach your income goals with your practice or are you

still working part time in your office and part time at Idealized Health?

Thanks for any info you can provide!