Re: EMRs

[Guest guest]

Toby,

Please compare e-MD's to AC.

With special emphasis on how a integrated system is " worth the

additional cost " .

Thank you

Uday Mehta

> >

> > I've been following the group since July, 05 and I'm getting

near

> to opening by solo, no staff office.

> > I plan on using AC and EZ claims. For me, the only way to start

> is totally solo, I could not afford the extra expense, and I

> actually want to answer the phone. Will I add staff later? I

> don't , maybe.

> > I have had 2 spontaneous offers to manage my start up practice.

> One of those had experience

> > with start-ups. The last one he was involved in, the physician

> took out a $100,000 loan to start

> > the practice. I kindly declined his offer.

> >

> > With that said, I have a few questions.

> >

> > Those of you who are taking insurances, are you accepting HMOs

and

> how has this impacted income? I'm in western PA and I think it's

> vital for my new practice to be on those panels. One of

> > insurance carriers will do an on-site inspection prior to

issuing

> contracts. What will they be looking

> > for? How should I be prepared?

> >

> > As for as Medicare is concerned, I have also decided to

> participate. After I send in the appropriate

> > form(cms855i?) and am waiting for a reply, can I begin to see

> medicare patients and then bill for those services after I've been

> approved? Or can I charge them fee for service prior to receiving

> approval (I'm assuming no on the latter.) I have practiced in

this

> area for 7 years, and the only thing that is changing is my

> address. I left a practice where I was an employee. How long

does

> it take CMS to process this form (several months?)?

> >

> > Concerning selling this style of practice to residents, I plan

on

> making myself available to local residency programs for rotations

or

> to present what I'm doing to a group of residents or med.

students,

> once the practice is running well. I think that some of you are

> working on a power point presentation that maybe others of us

could

> use and/or adapt for this purpose. How about that, I haven't seen

> one patient in my new practice, yet I'm very confident that this

is

> going to work for me.

> >

> > Of course none of this would be possible if it were not for the

> willingness of this group to openly

> > discuss what you have and are going through. As I said, I've

been

> in practice for 7 years and during that time I learned nothing

> practical about practice management. I thank you all.

> >

> >

> > jgg1@e...

> > EarthLink Revolves Around You.

> >

> >

> >

> >

> >

> >

[Guest guest]

Brent,

you confirmed how i was thinking.

thanks and take care

Chad

-------------- Original message -------------- If I were you I would go with Amazing Charts. I use Alteer so I have no interest pushing one over another. Why?You will start slow, it is designed by a physician and works like a physcian should work. Amazing charts does not rape you financially every month. The data is yours and on your server, yes you have more responsibility for back up , get a local IT guy to help you if you must, it will be cheaper and more rewarding for you. Emds is a good product as best as I can tell. Several on this list serv use it. It is much more costly. I would be the investment is ongoing and over 30 plus years of practice that can add up. Put the money in your retirement. Amazing Charts may not be the product for a multispecialty groups with numerous physicians and various needs. It is probably ideal for a single or small group practice. So is soapware. Take a look at it. It is also designed by family doctor. It is a great product for the above reasons. It does lack the complete functionality but has other and there are billing systems that interface that will not rape you and widely used. Soapware keeps evolving as do the others where I have a feeling they will all begin to look alike one day. Brent>> I am opening my own FP practice in January with hospital backing. I > am looking at opening paperless, but torn between low overhead > (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor > into my overhead and thus take away from my bonus while I am owned by > the hospital and, of course, I would take over the lease pymt if i buy > the practice, which I plan to do. I'm 31 years old, moving back to my > hometown, and opening solo. Any input on AC vs. eMDs? Any input on > if AC has a lab interface, CCR capability, and document mgmt yet? Any > input on starting a practice in general and on opening with an EMR? > Thanks,> Chad Jumper, MD> cmjumper@c...>

[Guest guest]

I looked at the same two, but then I looked at Doctors partner which also has a subscription service but is stored on a server in your office. You should look at them, they have a really nice product and it includes the PM/billing which AC doesn't. Also, they said they don't advertise it but, they do offer an outright purchase and the would count the first 6m or year of payment on the subscription toward it. I am starting in Jan and haven't made my final decision yet either but I am leaning toward Doctors Partner.

[Guest guest]

Chad:

I use eMDs after a hospital startup. I bought eMDs instead of hiring staff. 1.5 years later my wife and I still do not have any staff, but the EMR lets us practice the way we want. We are paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

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[Guest guest]

I also use e-mds

and it allows me to do my own billing far more accurately (by building the note

based on the bullets needed for E & M coding) and easily (it automatically

transfers to the code to the billing section of the system). This aspect alone has

paid for the system over the past 2 years. I also like that it comes with a

database which easily gives reports (ex. I was able to quickly generate a

letter to all my patients b/w the ages of 6-24 months, >65 years, and all

those with a diagnosis of asthma and send them a letter informing them about how

we were doing flu shots this year and that they were considered high risk for

complications associated with the flu). I’m not certain what Amazing

Charts does in terms of database analysis, but e-mds

is pretty extensive.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I’m still trying to convince myself

that the no staff model is smart business. What do you say to someone

that tells you that you are really paying your biller/EKG technician/lab tech/receptionist/etc

(assuming you are doing these things yourself) $150- $200 per hour instead of

$8 - $12? Yes, I agree keeping over head low is very important but I can

also see the other view point; namely, a doctor can bill $250/hr & a

receptionist/biller, etc can not. Some would argue that if we can

currently see “x” number of patients/day on the no staff model,

then we could easily see “x + 5” or more by hiring other staff

& it would more than pay for itself. I’m just playing devil’s

advocate a bit here because these are some of the counterarguments I’ve

been presented with. Of course, I also realize that running a lower total

volume practice has other benefits such as fewer refills/after hours calls/more

time with each patient/etc.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am

opening my own FP practice in January with hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Chad, I'll put my 2 cents in. I haven't used either but I've been researching EMRs for years in preparation for a solo opening in February. AC is a good product, but the reason to choose it over eMDs is not that it is designed by a physician. Both are designed by physicians, as are about 50% of the others. Both products are at the top of their respective categories, namely low and mid priced emrs. For low priced the other one to consider is Soapware, which is highly received and has a major revision around the corner. For mid priced the other integrated one with similar reviews is eClinicalWorks. If you search emrupdate, you'll find almost everyone universally likes both AC and eMDs. If you get AC you'll need an interface with PMS that needs to be maintained every year. But even with that it will be substantially cheaper. I think it's like comparing a Corolla and an Acura.

They're both solid, but one does a lot more and costs a lot more. I say do a demo of each every week until you decide. (AC lets you download it for free).chadjumper wrote:

I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

,

I think you raise an excellent point. Why

am I doing my own billing if I can instead be seeing patients and making much

more money? The answer is twofold. First, the initial billing is done after hours

(when I would not be seeing patients) and takes all of 10 minutes and results

in about 95% of claims being paid. The secondary and tertiary billing is what

takes a lot of time. Although I am looking into contracting to have my claims

>120 days done for me (at 8% of collections), getting the initial stuff off

really takes little time and saves a lot of money. The second reason is that

you learn a lot about your patients by keeping up with the billing. Knowing who

owes me money gives me insight into who might not be

able to afford medications or other procedures, who may not be able to get food

regularly, etc. I am also sure that there are very few billing mistakes (which erodes patient satisfaction). Distancing ourselves from

doing the “menial” tasks of medicine due to a perception of

cost-savings leads to an erosion of the doctor/patient relationship which has

caused medicine to be in the state its in today, but

that’s just my feeling.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

actually, i drive a chevy prizm, which is a toyota corolla in disguise (they came out of the same factory). i have air conditioning, cruise control, remote entry, automatic transmission, airbags, antilock brakes and good gas mileage (30-40 mpg). in addition, i bought it used.

car comparisons aside, i believe that AC is the best bang for the buck, however each must make their own decision based on their preferences.

two key features, data mining and the ccr are already part of AC. i have used the data mining feature when vioxx was taken off the market.

i save scanned documents in pdf and they are attached to the chart; the only problem is that the scanned data in pdf is too big to uploaded with AC currently, which is easily fixed by using an external hard drive backup. jon bertman is aware of this. i believe it is an adobe pdf problem rather than an AC problem.

the lab interface and practice management/billing are in development. the lab interface will also facilitate the registry.

in addition, knowbrainer, a var of dragon naturally speaking, is about four weeks away from developing a set of commands specific to AC, to be able to navigate and command the AC gui.

when i chose an emr, i matched available features and cost to my use and budget, and with an eye to the future regarding additional development.

AC works for me, and the development of additional features parallels the development of my practice, at a price that's affordable.

hope that's helpful.

no financial attachment to AC, labcorp, knowbrainer, dragon naturally speaking, vioxx, chevrolet or toyota.

LL

postrio wrote:

Chad, I'll put my 2 cents in. I haven't used either but I've been researching EMRs for years in preparation for a solo opening in February. AC is a good product, but the reason to choose it over eMDs is not that it is designed by a physician. Both are designed by physicians, as are about 50% of the others. Both products are at the top of their respective categories, namely low and mid priced emrs. For low priced the other one to consider is Soapware, which is highly received and has a major revision around the corner. For mid priced the other integrated one with similar reviews is eClinicalWorks. If you search emrupdate, you'll find almost everyone universally likes both AC and eMDs. If you get AC you'll need an interface with PMS that needs to be maintained every year. But even with that it will be substantially cheaper. I think it's like comparing a Corolla and an Acura.

They're both solid, but one does a lot more and costs a lot more. I say do a demo of each every week until you decide. (AC lets you download it for free).chadjumper wrote: I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

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[Guest guest]

– how are you doing billing in

that short amount of time???

Lowell

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MD

Sent: Thursday, October 20, 2005

8:02 AM

To:

Subject: RE:

EMRs

,

I think you raise an excellent point. Why am

I doing my own billing if I can instead be seeing patients and making much more

money? The answer is twofold. First, the initial billing is done after hours

(when I would not be seeing patients) and takes all of 10 minutes and results

in about 95% of claims being paid. The secondary and tertiary billing is what

takes a lot of time. Although I am looking into contracting to have my claims

>120 days done for me (at 8% of collections), getting the initial stuff off

really takes little time and saves a lot of money. The second reason is that

you learn a lot about your patients by keeping up with the billing. Knowing who

owes me money gives me insight into who might not be able to afford medications

or other procedures, who may not be able to get food regularly, etc. I am also

sure that there are very few billing mistakes (which erodes patient

satisfaction). Distancing ourselves from doing the “menial” tasks

of medicine due to a perception of cost-savings leads to an erosion of the

doctor/patient relationship which has caused medicine to be in the state its in

today, but that’s just my feeling.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I assume that he means just sending out

that day’s bills takes 10 minutes, not entering EOB’s, etc?

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am

opening my own FP practice in January with hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

See response to ’s statement J

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

,

Yes, that amount of time is getting out

today’s bills and does not include entering EOBs

or doing the secondary or tertiary billing. Entering EOBs

takes about 1 hour a week (maybe 1 ½ hours if it was a busy week), and the

following up of bills >120 days takes significantly more time. My point was,

however, if you can collect 90% of billing through 1st pass (at 10

min a day), is it worth while paying $20,000-$30,000/year for someone to do it

for you (particularly if it is not as accurate or patient friendly). My hope is

to allow technology to input the EOBs for me

(hopefully coming in later versions of e-mds) and

hire out the f/u of long term invoices not paid after 90-120 days. To me, that

minimizes the output of money to someone else and keeps me in the billing loop,

but also minimizes the hours of time spent trying to figure out claims which

are likely not getting paid anyway.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Greetings from Drain, Oregon

I am using Soapware, and interfacing with Lytec for billing. I am delighted with Soapware, which works wonderfully for me. I bought the package so I have a year's upgrades and support as well as the very flexable system. Over the first three months I started by just typing a soap note, have moved to using some of their templates, started writing my own templates and I'll be moving to dragon voice input before long. I have a long way to go before I use all their options to the maximum, but I am over-joyed with the functionality of their system.

Billing takes about 5 minutes here, if you are talking about sending the bill electronically to the tracking group I hired (Zirmed). Lytec is also very quick to access all the bills, corrolate all the insurance information and to get all variations of billing information. I chose to use a billing system that focuses on just billing and doesn't try to be part of an EMR.

The issue is that these are two different complex problems, and if you want one system that does both the medical records and the billing as well, you have to pay for it and all the updates which could come at different times for the two different issues. I wanted the billing system to be on one computer for various reasons, HIPPA amoung them, but I wanted the EMR to be flexable, cheap, easily modifiable and on any computer I wanted to use, so I chose to separate EMR and billing functions. I think Lytec cost about a thousand dollars and the manpower who set it up from the company I purchased it from about another $800. If you choose to do it, you can buy an interface capable of allowing Lytec to talk to Soapware so you don't have to enter the stuff by hand for each patient visit.

It takes a while to get Lytec up to speed because everything has to be hand entered to start with and it is not as intuitive as Soapware, which I could use out of the box. You start by inputing any code you want to use into Lytec, and check them with the Soapware codes if you are going to interface: Soapware has them but some of them are out of date or more generic than I use. I chose the Lytec billing system because it was used in a practice I worked in, and once it is set up it is very fast. I think the physician's wife who did the billing said her total billing time (including secondarys) was about 2 hours a week. She spent more time on the overall financial books of the practice.

Joanne Holland DVM/MD

postrio wrote:

Chad, I'll put my 2 cents in. I haven't used either but I've been researching EMRs for years in preparation for a solo opening in February. AC is a good product, but the reason to choose it over eMDs is not that it is designed by a physician. Both are designed by physicians, as are about 50% of the others. Both products are at the top of their respective categories, namely low and mid priced emrs. For low priced the other one to consider is Soapware, which is highly received and has a major revision around the corner. For mid priced the other integrated one with similar reviews is eClinicalWorks. If you search emrupdate, you'll find almost everyone universally likes both AC and eMDs. If you get AC you'll need an interface with PMS that needs to be maintained every year. But even with that it will be substantially cheaper. I think it's like comparing a Corolla and an Acura.

They're both solid, but one does a lot more and costs a lot more. I say do a demo of each every week until you decide. (AC lets you download it for free).chadjumper wrote: I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

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Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

:

The doctors at my last practice sold their assets to a large healthcare company. After the sale they had to pay rent on the fixed assests and cover overhead. Visit counts went up for a typical internist from 18 per day on a 4.5 day work week to 28 per day. Interestingly overhead and frindge benefits also rose for the increased staffing needs, but incomes remained flat. Yes we saw x+10 but made the same income. We were more efficient. We saw more paitients in less time, but patient care sufferred and satisfaction also did.

You may be right that a receptionist at $8 is cost effective when you are billing $250 every hour, but I find I don't have 40 hours of receptionist time, nurse time, and MA, time, and biller time each week. Not to mention my baby sitter makes $10/hour and then there would be benefits like health insurance. I suppose a accountant or MBA could tell me what the break even point is, but for now I do my own scheduling, billing, and injections. My wife and I have found a way to cover overhead seeing 28 patients per week. For estimated $125,000 take home plus additional fringe benefits of car, phone, insurance, etc of additional $20,000 we will need to increase patient flow to 50/week.

I was seeing 22-28 patients a day collecting 22-25000 per month but taking home 95,000 at my former practice.

There is a optinmal income for a given patient flow somewhere between 28per day and 28 per week.

We are currently collecting $100/ patient visit roughly per hour. 40% overhead. So a nurse with benefits might run $36000/year. That 600 extra visits I would have to see to just pay the salary. Thats 15 40hour weeks. Not for me not yet.

P.S. If you can find someone who only wants to work on an hourly basis for short periods of time, I might hire them. Brock DO wrote:

I’m still trying to convince myself that the no staff model is smart business. What do you say to someone that tells you that you are really paying your biller/EKG technician/lab tech/receptionist/etc (assuming you are doing these things yourself) $150- $200 per hour instead of $8 - $12? Yes, I agree keeping over head low is very important but I can also see the other view point; namely, a doctor can bill $250/hr & a receptionist/biller, etc can not. Some would argue that if we can currently see “x” number of patients/day on the no staff model, then we could easily see “x + 5” or more by hiring other staff & it would more than pay for itself. I’m just playing devil’s advocate a bit here because these are some of the counterarguments I’ve been presented with. Of course, I also realize that running a lower total volume practice has

other benefits such as fewer refills/after hours calls/more time with each patient/etc.

-----Original Message-----From: [mailto: ] On Behalf Of EglySent: Thursday, October 20, 2005 7:50 AMTo: Subject: Re: EMRs

Chad:

I use eMDs after a hospital startup. I bought eMDs instead of hiring staff. 1.5 years later my wife and I still do not have any staff, but the EMR lets us practice the way we want. We are paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC

vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

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[Guest guest]

How many bills do you have a week? I have

around 125 and there is no way that would take me a few hours a week just to

send out the statements and post the easy EOBs, not to mention the hard ones.

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MD

Sent: Thursday, October 20, 2005

11:38 AM

To:

Subject: RE:

EMRs

,

Yes, that amount of time is getting out

today’s bills and does not include entering EOBs or doing the secondary

or tertiary billing. Entering EOBs takes about 1 hour a week (maybe 1 ½ hours

if it was a busy week), and the following up of bills >120 days takes

significantly more time. My point was, however, if you can collect 90% of

billing through 1st pass (at 10 min a day), is it worth while paying

$20,000-$30,000/year for someone to do it for you (particularly if it is not as

accurate or patient friendly). My hope is to allow technology to input the EOBs

for me (hopefully coming in later versions of e-mds) and hire out the f/u of

long term invoices not paid after 90-120 days. To me, that minimizes the output

of money to someone else and keeps me in the billing loop, but also minimizes

the hours of time spent trying to figure out claims which are likely not getting

paid anyway.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I usually average 60-70 invoices a week.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease payment

on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

It would be interesting to compare amounts

collected per claim, on average. I am not positive, but I suspect I am

averaging about $90-$95/claim. I am using a billing company and am spending

about 35k/year doing so. I have always been under the impression that my

collections with a billing company would be greater than doing it by myself.

Lowell

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MD

Sent: Thursday, October 20, 2005

3:36 PM

To:

Subject: RE:

EMRs

I usually average 60-70 invoices a week.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not have

any staff, but the EMR lets us practice the way we want. We are paperless

once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I would guess I am averaging about the

same amount per claim. The key to doing billing yourself is to keep it simple.

I generally only use the E & M codes and use very few procedural codes. Yes,

I probably lose money by not drawing blood (or billing for it), not doing EKGs

in the office, and only doing a nominal amount of CLIA waved tests (Strep, Urine preg, dip U/A), but

I don’t have to try and figure out all the ins and outs of billing. In

general, the E & M coding remains the same so keeping up with this is not

that difficult. Yes, every once in a while I mess up (ex. I took off a toenail

on someone with medicare), and trying to figure out how

to code the procedure quickly becomes crazy, but I then have some wonderfully

nice coders I can call to try and figure out what I should do. The emr makes the whole process easy and after the first month

or so it becomes rather rote. Most of the denied claims are for the same

reasons (so they are generally really easy to fix). Yes, I do have a larger A/R

>120 days than I would like to have (around $12,000 after 2 ½ years) and

would like to outsource that out, but I am still collecting >97% of

allowable. I can’t compare what I’m doing to what a billing company

can offer (I never looked into using one), but most are probably not going to

be quite that good. After all, they are looking to do a job, while I’m

looking to try and feed my family.

Note: One of the differences is that I do

have anxiety that everything I’m doing is wrong and I might end up being

sued for insurance fraud. But again, keeping it simple seems to minimize that

risk.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I could not run my office without doing

EKGs/U/A’s/Streps etc. How are you managing your diabetics,

hypertensives, CHF’s? Are you ordering the EKGs through another location?

Also, if you are basically just using

E & M then your visits must be mostly 99214 and 99215s. Is this correct?

Lowell

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MD

Sent: Friday, October 21, 2005

9:02 AM

To:

Subject: RE:

EMRs

I would guess I am averaging about the

same amount per claim. The key to doing billing yourself is to keep it simple.

I generally only use the E & M codes and use very few procedural codes. Yes,

I probably lose money by not drawing blood (or billing for it), not doing EKGs

in the office, and only doing a nominal amount of CLIA waved tests (Strep,

Urine preg, dip U/A), but I don’t have to try and figure out all the ins

and outs of billing. In general, the E & M coding remains the same so keeping

up with this is not that difficult. Yes, every once in a while I mess up (ex. I

took off a toenail on someone with medicare), and trying to figure out how to

code the procedure quickly becomes crazy, but I then have some wonderfully nice

coders I can call to try and figure out what I should do. The emr makes the

whole process easy and after the first month or so it becomes rather rote. Most

of the denied claims are for the same reasons (so they are generally really

easy to fix). Yes, I do have a larger A/R >120 days than I would like to

have (around $12,000 after 2 ½ years) and would like to outsource that out, but

I am still collecting >97% of allowable. I can’t compare what

I’m doing to what a billing company can offer (I never looked into using

one), but most are probably not going to be quite that good. After all, they

are looking to do a job, while I’m looking to try and feed my family.

Note: One of the differences is that I do

have anxiety that everything I’m doing is wrong and I might end up being

sued for insurance fraud. But again, keeping it simple seems to minimize that

risk.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

What about eClinicalworks?

Bill Striegel, MD

Ocean Springs, MS

-----Original Message-----From: [mailto: ] On Behalf Of Brady, MDSent: Thursday, October 20, 2005 8:12 AMTo: Subject: RE: EMRs

I also use e-mds and it allows me to do my own billing far more accurately (by building the note based on the bullets needed for E & M coding) and easily (it automatically transfers to the code to the billing section of the system). This aspect alone has paid for the system over the past 2 years. I also like that it comes with a database which easily gives reports (ex. I was able to quickly generate a letter to all my patients b/w the ages of 6-24 months, >65 years, and all those with a diagnosis of asthma and send them a letter informing them about how we were doing flu shots this year and that they were considered high risk for complications associated with the flu). I’m not certain what Amazing Charts does in terms of database analysis, but e-mds is pretty extensive.

-----Original Message-----From: [mailto: ] On Behalf Of EglySent: Thursday, October 20, 2005 8:50 AMTo: Subject: Re: EMRs

Chad:

I use eMDs after a hospital startup. I bought eMDs instead of hiring staff. 1.5 years later my wife and I still do not have any staff, but the EMR lets us practice the way we want. We are paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

As a user of eCW, I will only tell you about a new feature in the latest

version of eCW, which has made it much easier for me to handle these

patients. We are now able to merge templates. When I see somebody with

the classic symptoms of something like claudication, I will save the

note as a template. Very easy to do. I also have templates for things

like well-controlled NIDDM and HTN and a hyperlipidemia check.

So if someone comes in with everything I mention, I am able to click

the merge templates button and choose the parts of the 4 templates I

mentioned above. I can choose the S, O, A, and P of the PVD template;

the ROS, O, A, P of the other three templates (NIDDM, HTN,

Hyperlipidemia), and then use the resulting note as my starting point.

I will sometimes apply this even before entering the room so that, in

the room, I am only fine tuning the details of the visit.

This is a big improvement over what it was like when we had to choose

one template and add everything in from scratch.

Oh, and one other thing, for recurring visits, you can also choose a

patient-specific template, which is essentially a copy of a previous

visit.

--

spongebobpentagonpants

------------------------------------------------------------------------

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View this thread: http://valuemd.com/showthread.php?t=44545

[Guest guest]

I agree.  I have the digital EKG from Midmark

but rarely use it because of the scenarios you mentioned.  They have either

already had a baseline or they are concerning enough that I refer to cardiology

or ER anyways.  Besides, I personally think we doctors are a little too

confident in the EKG.  Remember that a certain percentage (~ 20% I think) can

have a stone cold normal EKG in the face of a full blown evolving AMI.  But,

even then I probably only order an EKG ~ once/month.  However, I do use rapid streps,

UA’s, lipids, ALT, hcg, rapid H pylori, A1C, glucose, PT/INR in the

office. 

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am

opening my own FP practice in January with hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

I find it very hard to believe the number

of people on the list that say they have a per claim reimbursement average of $90 - $100.  I do a lot of

99214’s & a fair amount of OMT (osteopathic manipulation) on top of

those.  Even with a 99214 plus 2-3 body parts of OMT I might barely make $95 in

a single visit.  But average that? 

No way am I averaging near that.  I still inevitably have some 5 – 10 minute

99213 visits too & that will really drop that average & I have very few

99215’s to raise it back up.   Maybe

the reimbursement here in Ohio is very poor compared to other states.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am

opening my own FP practice in January with hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Hi ,  Do you mind If I ask what kind

of overhead and how much equipment does it take to provide all of those office

labs? 

From: [mailto: ] On Behalf Of Brock DO

Sent: Monday, October 24, 2005

9:12 AM

To:

Subject: RE:

EMRs

I agree. I have the digital EKG from

Midmark but rarely use it because of the scenarios you mentioned. They

have either already had a baseline or they are concerning enough that I refer

to cardiology or ER anyways. Besides, I personally think we doctors are a

little too confident in the EKG. Remember that a certain percentage (~

20% I think) can have a stone cold normal EKG in the face of a full blown

evolving AMI. But, even then I probably only order an EKG ~

once/month. However, I do use rapid streps, UA’s, lipids, ALT, hcg,

rapid H pylori, A1C, glucose, PT/INR in the office.

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with

hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus

while I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

Yahoo!

Music Unlimited - Access over 1 million songs. Try it free.