Business Plan, This is a compilation of several business plans cobbled together

[Guest guest]

Below is a business plan, let me know what you think? Do any of you

see any fatal flaws or something left out since several of you are

already doing this.

Please feel free to modify this and use as needed.

Business plan and outline as of 6/14/2003

• A colleague still in solo practice, who wants to cut his

expenses by renting 2 exam rooms for $1000 per month along with space

for a desk, small computer network. He will have his staff initially

help with the phone system. As Dr. recommends, I will have no

employees (and no payroll hassles, deductions, W-2 forms or Workers'

Compensation insurance costs) or part time, I may sublease some of

his employees as needed. For sensitive exams (perhaps 2 or 3 times a

day), the present nursing staff that are his employees will step in.

The present business office will do the billings and collections for

6 percent of gross collections with the Program Medical Manager. If

that is not possible, for practice management, I am looking at

Medrium (www.medrium.com), which is an ASP (Internet-based) service

that charges $0.75 per claim for electronic billing, claims error

cleanup, claims follow-up, and balance billing of patients and

printing these billing statements in my office. If I don't want to

bother with statements, Medrium will print and mail them to my

patients itself, including postage, for about the same extra per bill

sent. Immediate electronic eligibility verification is also extra.

The program is run through your Web browser, and you type the basic

information into boxes on the monitor screen. You can do posting of

mailed-in payments and printing/saving aged accounts-receivable

reports at home with the same password-protected Web site. The

monthly charge is automatically deducted from your credit card, with

a $25 minimum. The site is password-protected and your billing data

is encrypted in transit and securely backed up daily for HIPAA

purposes. I am also looking at simply using a local billing company

not web based and simply faxing superbills made with soapware with

all the diagnosis information etc. where they will do all billing,

fu, deal with all billing phone calls. At the present time I am

hopeful the other doctor will let me piggy back on his system for a

percentage and save me the hassle. I believe this will cost around

1500-2000 a month at 6 percent of collections. It will be a lot less

initially. I will have my money deposited in a locked box account

with a bank and simply provide the eobs to the billing staff.

Another option I am seriously considering is the Alteer system using

group one as a billing professional. They will charge roughly 6

percent, but I expect my billing to be somewhat difficult due to x-

ray, ultrasound, lab, ekg charges. It will not be all just

professional fees.

• I am doing this because I feel the present system is broken,

numbers driven to the point of craziness, has a corporate mentality

that supports the insurance system that no one can afford and the

need to capture the patient with a high copay or very high deductible

in my practice to do preventive care and try to keep them healthy to

minimize their hassles in life.

• My upin number will remain the same so that will go with me.

• I will write letters to each insurance carrier explaining

briefly my intention to transfer my existing credentialing to my new

tax ID number along with address and phone number. This should also

mention my old location and past number if possible billing was being

done. This will need to include the date of change and a W2or W9

form with the tax info.

• I will need to decide which insurance carriers to take , I

may be able to negotiate that 6 percent down wo accepting Medicaid.

I may opt out of medicare after the first year depending on business.

• Will need to go to the city offices to get my business

license.

• I will change my medical licensure information with the

state medical board.

• I will have business cards and other medical stationery

printed. I will take my own call 24/7, with the assistance of a cell

phone and switch able 2-outgoing-message answering machine, as Dr.

does. I am bringing in 3 phone lines, two voice and one

fax/DSL. I'll be using a cordless phone system with built-in

mailboxes, and answering machine (Panasonic KX-TG2000B) or others

readily available at the local staples store. My wife will have one

computer in the reception area for scheduling/med renewals/lab result

calls, and there will be a

computer in the exam room and one in my office.

• I will establish a merchant credit card swipe system with a

local bank to accept credit card payments, with a bank branch nearby

for my cash and check deposits.

• Will need to establish my own medical liability insurance

thru the local medical society.

• I already have my own practice Web site (which I will soon

modify to represent my new situation), through Academy of Family

Physicians. I have a website that uses medem.com for secure email.

I will need to update them.

• I am already familiar with soapware. It is cheap, easy to

use and can be used to go totally paperless. I will need start a

small network and get fax capabilities in the computer along with

high speed scanning. I will probably go with a Fujitisi scanner that

can do at least 50-60 pages per min. I will build it to the specs of

Alteer incase my model does not work and I have to go to a higher

cost emr. I will use IMH to help with the documentation and cut and

paste it into the emr. I will use Griffith's handouts available on

cd on each computer for instant patient handout. I will have access

to free websites provided to physicians in exam room such as md

consult and will continue to use epocrates. I may use the alteer

system since it is seamless depending on how the transition goes.

• I will need very little additional medical equipment, since

almost everything I need is already in the office. I will pay to

install a DSL line for broadband Internet access for my server that

will be accessible in each exam room. At the present time it is

already available in the office and I would just have to hook it up

and pay half the cost.

• My major start-up expenses will therefore be buying a

multifunction printer/fax/copier/scanner, an answering machine, DSL

installation, office stationery, a simple start-up local newspaper

announcement of my location and practice philosophy (repeated a few

times if needed), phone system, computer network and rent.

• Some other pearls including having the pt initial superbill

that insurance is correct, dismiss pt when send them to collections,

copy/scan both ins card and drivers license (easier for collections,

and to verify who you are seeing), keep (paper) EOB's for 5 years,

scan EOB if it is unusual (pt has a deductible, pt has multiple ins

companies, or denial pending investigation), have Alteer set up your

superbill during your training session, and spend time with Alteer

when they are setting up the billing – preloading the insurance

rates – know this well (I'm not sure why). For printing out the

prescriptions, they found a paper that is micro perforated into

froths and lines up with the quarter-page set up

• Develop a Professional corporation, a local atty has to

contact the licensing board to get permission to change name under

which I practice to Name, MD PC

• Have alteer develop my superbill with group ones help since I

am paying the fees using my existing data. I have print outs to

frequency of code use, etc. Also have printout to number of times

each insurance carrier is used. Having a central billing exchange

may eliminate many of the hassles that Gordon has had with trying to

get paid. I am going to try to concentrate on the interaction with

the patient, quality time.

• get several of the publications from aafp on new practice

start up and get their forms to scan into the system for ease of use

into soapware and or alteer and get the data to automatically fill

out.

• get listed in the two local phone books along with web

addresses

• Develop a practice logo, philosophy etc. This is difficult.

The practice philosophy is Gordons, same day appts, complete high

quality medical care, attention to the details, interaction,

education of the patients. I will simply operate under my name. I

have been in practice in the local community for about 3 years so

things are fairly solid.

• I will provide a lab service to the private pay and insurance

companies to help with quality care and screening. I will send the

Medicare patient down the hall to the hospital for lab, xray due to

poor reimbursement.

• I will set up a network for xray , ultrasound, ekg across

the hall at another IM office so I will have no out of pocket

expense, I will set it up on a pay as you use it approach, 10 for

ekg, 100 for Ultrasound of any type, 100 for echo, 25 for xray of any

type with interpretation , 15 wo interpretation, 75 for holter, 20

for pfts, etc.

• I will use a commercial lab for profiles. I will try to

provide this at a fair fee, especially for the self pay

• I am consider a 10 percent fee cut if paid in full at time of

service.

NOTE: This plan is a meld of several other out there, cut and pasted

and modified to fit my own personal situation. In some areas , not

even the words have been changed.

[Guest guest]

> • Some other pearls including having the pt initial superbill

> that insurance is correct, dismiss pt when send them to

collections...

Gingerich, an FP in Indiana, implemented a nice idea which

seems to support goals of patient-centeredness, effectiveness and

equity. He doesn't dismiss patients who get behind on their

accounts, per se, nor send their accounts to collections but tries

to make an opportunity for an important health intervention:

He still will see these patients for cash up front but, more

importantly, he also promises to forgive their accounts completely

and resume normal care and billing if those patients start and

complete a local chamber of commerce course in personal financial

management.

Good luck in your new practice.

Max Yarowsky, MD, FMR3

U of Rochester FPRP

Reproductive Health Fellow 7/03

[Guest guest]

At 03:25 PM 6/15/2003 +0000, you wrote:

>Below is a business plan, let me know what you think? Do any of you

>see any fatal flaws or something left out since several of you are

>already doing this.

>Please feel free to modify this and use as needed.

>• I am already familiar with soapware. It is cheap, easy to

>use and can be used to go totally paperless. I will need start a

>small network and get fax capabilities in the computer along with

>high speed scanning. I will probably go with a Fujitisi scanner that

>can do at least 50-60 pages per min. I will build it to the specs of

>Alteer incase my model does not work and I have to go to a higher

>cost emr. I will use IMH to help with the documentation and cut and

>paste it into the emr. I will use Griffith's handouts available on

>cd on each computer for instant patient handout. I will have access

>to free websites provided to physicians in exam room such as md

>consult and will continue to use epocrates. I may use the alteer

>system since it is seamless depending on how the transition goes.

You may want to verify that the Fujitsu scanner will work with SOAPWare.

Although they claim that any TWAIN compliant scanner will work, this is not

always the case (ie, with some Visioneer scanners). I am currently using

SOAPWare and will start scanning in documents soon. But realize that

SOAPWare has file size limits that can be exceeded, necessitating

converting the databases to Microsoft SQL Server, which is neither

inexpensive nor self-explanatory. I am pretty concerned about this,

although I have heard several large groups have successfully done this.

[Guest guest]

Do not be fearful of going to the sql enviroment. We did it. It is

so much faster that it is well worth the investment. A local

computer guy is familiar with this and did it for us. We have about

30 different computers acessing soapware, several scanning things in

at the present time.

Brent

-- In , Tom Mydosh <tmydosh@f...>

wrote:

> At 03:25 PM 6/15/2003 +0000, you wrote:

> >Below is a business plan, let me know what you think? Do any of

you

> >see any fatal flaws or something left out since several of you are

> >already doing this.

> >Please feel free to modify this and use as needed.

>

>

> >• I am already familiar with soapware. It is cheap, easy to

> >use and can be used to go totally paperless. I will need start a

> >small network and get fax capabilities in the computer along with

> >high speed scanning. I will probably go with a Fujitisi scanner

that

> >can do at least 50-60 pages per min. I will build it to the specs

of

> >Alteer incase my model does not work and I have to go to a higher

> >cost emr. I will use IMH to help with the documentation and cut

and

> >paste it into the emr. I will use Griffith's handouts available on

> >cd on each computer for instant patient handout. I will have

access

> >to free websites provided to physicians in exam room such as md

> >consult and will continue to use epocrates. I may use the alteer

> >system since it is seamless depending on how the transition goes.

>

> You may want to verify that the Fujitsu scanner will work with

SOAPWare.

> Although they claim that any TWAIN compliant scanner will work,

this is not

> always the case (ie, with some Visioneer scanners). I am currently

using

> SOAPWare and will start scanning in documents soon. But realize

that

> SOAPWare has file size limits that can be exceeded, necessitating

> converting the databases to Microsoft SQL Server, which is neither

> inexpensive nor self-explanatory. I am pretty concerned about this,

> although I have heard several large groups have successfully done

this.

[Guest guest]

Sounds like you have done a lot of planning.

as mentioned earlier, look at all your costs (health insurance,malpractice,CME,

business tax, professional fees...etc..)

don't necessarily discount medicare as their are some " positives "

1. no significant hassles with formularies, preauthorizations, contractual

revisions that need to be scrutinized evry time a new contract is

issued....

2. fees: what is lost in low reimbursement for the standard 99213 or 99214

codes can be made up by the annual preventative visit code. Medicare

does not recognize the annual preventative visit and you directly bill

this visit fee to the patient. Medicare will allow you to bill out some

of the fee to medicare if it pertains to acute illness or necessary review

and management of chronic medical problems. You can charge whatever you want

for the preventative portion. my charges have gone up for this visit every

year and I anticipate a 200 dollar fee range per CPE in the next few years.

Initially patients were upset about this once per annual charge but since have

come to accept it. Perhaps 1 pt out of 10 stopped seeing me because of my

requirement to do annual CPE's in adults over age 55. the bottom line is that

if you charge appropiately for the annual preventative visit , medicare is not

a bad insurer.

[Guest guest]

This actually sounds like another pearl. I truly enjoy caring for the

elderly population. I have forgotten about the preventive codes.

They were so unpopular with patients in the corporate type of

enviroment that I had set them aside.

So far I will also will implement the friendlier notion of no

collection agency. I do this already but am questioned on each

account. It would be easier to write it off and suggest they find

another doctor.

Business plans for dummies is another pearl.

Brent

-- In , nudoc@a... wrote:

>

> Sounds like you have done a lot of planning.

> as mentioned earlier, look at all your costs (health

insurance,malpractice,CME,

> business tax, professional fees...etc..)

>

> don't necessarily discount medicare as their are some " positives "

> 1. no significant hassles with formularies, preauthorizations,

contractual

> revisions that need to be scrutinized evry time a new contract

is

> issued....

> 2. fees: what is lost in low reimbursement for the standard 99213

or 99214

> codes can be made up by the annual preventative visit code.

Medicare

> does not recognize the annual preventative visit and you

directly bill

> this visit fee to the patient. Medicare will allow you to bill

out some

> of the fee to medicare if it pertains to acute illness or

necessary review

> and management of chronic medical problems. You can charge

whatever you want

> for the preventative portion. my charges have gone up for this

visit every

> year and I anticipate a 200 dollar fee range per CPE in the next

few years.

> Initially patients were upset about this once per annual charge but

since have

> come to accept it. Perhaps 1 pt out of 10 stopped seeing me

because of my

> requirement to do annual CPE's in adults over age 55. the bottom

line is that

> if you charge appropiately for the annual preventative visit ,

medicare is not

> a bad insurer.

>

>