RE: Who is Solo-Solo? (and quick update)

March 11, 2006

For the poll (Sorry I got locked out of

Yahoo again and am too lazy to set up another account)

We are:

One doctor

One MA/Receptionist (she does mostly

receptionist work, takes vitals, draws up and administers immunizations, and

does a few nurse visits for education on cholesterol and diabetes)

One part time biller/office manager

(Me. I spend 1-3 hours a day at the office.)

We are adding another doctor in October,

but probably not another MA.

We are talking to yet another doctor who

wants to work mornings who would bring most of her patient panel with her who

would be starting in June. Between the two, I would lose my office and

our 1200 sq ft. office will be stretching at the seams.

As a side note - Last month we saw 10.5

pts. Per day. We sent out our 1000th invoice today. Yah.

Ernie

Orchards Family Medicine, Inc.

From: [mailto: ] On Behalf Of L. Gordon

Sent: Sunday, March 05, 2006 6:17

AM

To:

Subject: Re:

Who is Solo-Solo?

I've created a poll on staffing for the group.

You can take the poll on our group web site:

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

The poll will be open through 3/19

I'll email results.

Gordon

At 09:00 PM 3/4/2006, you wrote:

Hi all; it looks like Tim is

totally solo, it sounded

like Pamela Wimble is; this is my area of highest

interest to minimize headache especially at the

beginning by not having other office staff; I'm

lookig

at a location opportunity that would allow me to

have

no staff.

Any suggestions? Pro's Cons?

-Shay Hosseinion

--- Egly wrote:

> Good work Tim!

>

> " Malia, MD "

wrote:

> Hi Folks --

>

> It's time for me to do as some others have

done and

> pass along some happy

> news... my new office officially opens in two

days,

> Monday March6!

>

> First, a giant " Thank You " to

everyone for sharing

> their experiences and

> opinions on this list. Over these three years

or so

> I've learned a lot

> from all of you. And until recently I didn't

realize

> it, but it's true,

> the list does feel like a bit like family.

>

> Second, a warning... you should get another

email

> (likely on Sunday or so)

> from me with a link to a Kodak site to view

some

> photos. You do not have

> to register (unless you want to order

photos...?)

> and it's not junk email.

>

> The photos will be of my office and will

range from

> the barebones space I

> started with last month to whatever it looks

like

> tomorrow after putting

> in lots of hours this weekend.

>

> About the office... about 50 patients have

already

> had their medical

> records copied and sent to me. I have

about 25

> patients already

> registered on RelayHealth. I have four

patients

> booked for Monday... for

> five appts (one is a Workers Comp follow up

who is

> also diabetic so he's

> got two appts to bill each with different

> insurance). Interestingly, 3 of

> the 4 patients are Deaf... but that is one of

my

> clinical interest areas

> as I know sign language and have served large

> numbers of Deaf patients for

> many years.

>

> I have 10 appts booked on AppointmentQuest

for the

> next two weeks... five

> were set up by the patient him/herself and

the

> others by me with patient

> on the phone. I think that ratio is a

good sign,

> though I admit the

> earliest registered patients may be more

tech-savvy

> so it may be a

> statistical glitch.

>

> My technology stuff has held up pretty well

through

> my first week of

> having all the pieces together... a

" loaded " Toshiba

> Tecra convertible

> laptop-tablet with a port at the office for

easy

> connection to everything

> there... HP color laser printer (on sale for

> $299)... Panasonic scanner

> (expensive, but it's worked GREAT so far --

dealer

> is a local small

> businessman who is has already referred his

son to

> me and has been a good

> link to the local community, so the extra

expense of

> the machine has

> already paid off as opposed to buying online)

....

> EMR= AC... OneBox.com

> for voice mails, faxes and some emails (has

worked

> great so far and VM is

> fast with my DSL line and computer) ...

single tel

> line with all

> calls/faxes sent to OneBox.com (btw, tel

company rep

> on the phone I've

> worked with to set up line and DSL, after

regular

> calls back and forth, is

> becoming my patient too!)... Treo 700W (new

and I'm

> just getting started

> with it, but it's been good so far)... about

to tie

> in voice recognition

> with local highly-recommended

" training " company.

>

> I've tried to think about and come to good

decisions

> along the way for

> where to spend money and thusfar I'm

satisfied the

> few times I've put out

> larger sums. Each time I can see a

reason and have

> already seen some

> benefit with referrals and good advise about

other

> businesses/resourses.

>

> I didn't realize it, but this world of small

> business does run on

> handshakes and relationships. A good

financial deal

> at one point may not

> benefit you later. But a good relationship

with a

> colleague can keep

> growing with time. Financial choices

are not just

> about the current

> dollars but are " investments " for

the future. At

> this point however, I'm

> mostly all set so there won't be many more

outlays

> of money.

>

> Anyway, I've not run the numbers but I'd

estimate my

> start up costs are

> about $25,000 and I've been able to

arrange for

> some of that to delay

> payment (no interest) which will help my

early cash

> flow but require me to

> keep track and be sure I have cash available

when

> they come due. I've got

> a $50,000 small business loan with a low

interest

> rate and my minimum

> payment is 1% a month. I only pay what

I take out

> of it too... thus far

> $20,000. My technology overhead (www,

online

> messaging, online

> scheduling, cell phone, etc) is about

$450/month and

> I doubt I'll go over

> the limits for use with the way I set the

contracts.

> I've got no staff...

> one of my mottos is, " it's just me, the

patients,

> our computers and our

> phones! "

>

> Now I've got to go and finish painting trim

(have

> put it off all week),

> put up some shelving, paint a few last pieces

of

> funiture, move my last

> two pieces of furniture and straighten up the

> office...!

>

> I'm sure many of you recall the feeling, but

right

> now the office feels

> like a jigsaw puzzle with all the pieces

spread on

> the table. At this

> point they are all faced right-side-up but

only

> small bunches are all

> attached... I've got the border and some

bunches of

> similar colors, but

> really it is still not put together!

;-)

>

> Overall, this feels good! The mild anxiety is

mixed

> with joy.

>

> Thanks to you all for helping me get here.

> I'll be sending the pictures and will share

with the

> group any thoughts or

> observations about office or practice as time

goes

> on.

>

> 7:40... time to get to the office as I hit

the

> homestretch!!!

> Tim

>

March 11, 2006

10.5 patients a day in 2 hours a day??? How did you do that? GwenErnie Leland wrote: For the poll (Sorry I got locked out of Yahoo again and am too lazy to set up another account) We

are: One doctor One MA/Receptionist (she does mostly receptionist work, takes vitals, draws up and administers immunizations, and does a few nurse visits for education on cholesterol and diabetes) One part time biller/office manager (Me. I spend 1-3 hours a day at the office.) We are adding another doctor in October, but probably not another MA. We are talking to yet another doctor who wants to work mornings who would bring most of her patient panel with her who would be starting in June. Between the two, I would lose my office and our 1200 sq ft. office will be stretching at the seams. As a side note - Last month we saw 10.5 pts. Per day. We sent out our 1000th invoice today. Yah. Ernie Orchards Family Medicine, Inc. From: [mailto: ] On Behalf Of L. Gordon Sent: Sunday, March 05, 2006 6:17 AMTo: Subject: Re: Who is Solo-Solo? I've created a poll on staffing for the group.You can take the poll on our group web site:http://health.groups.yahoo.com/group//pollsThe poll will be open through 3/19I'll email results.GordonAt 09:00 PM 3/4/2006, you wrote: Hi all; it looks like Tim is totally solo, it soundedlike Pamela Wimble is; this is my area of highestinterest to minimize headache

especially at thebeginning by not having other office staff; I'm lookigat a location opportunity that would allow me to haveno staff.Any suggestions? Pro's Cons?-Shay Hosseinion--- Egly wrote:> Good work Tim!> > > > " Malia, MD" wrote:> Hi Folks -->

> It's time for me to do as some others have done and> pass along some happy> news... my new office officially opens in two days,> Monday March6!> > First, a giant "Thank You" to everyone for sharing> their experiences and> opinions on this list. Over these three years or so> I've learned a lot> from all of you. And until recently I didn't realize> it, but it's true,> the list does feel like a bit like

family.> > Second, a warning... you should get another email> (likely on Sunday or so)> from me with a link to a Kodak site to view some> photos. You do not have> to register (unless you want to order photos...?)> and it's not junk email.> > The photos will be of my office and will range from> the barebones space I> started with last month to whatever it looks like> tomorrow after putting> in lots of hours this weekend.> > About the office... about 50 patients have already> had their medical> records copied and sent to me. I have about 25> patients already> registered on RelayHealth. I have four patients> booked for Monday... for> five appts (one is a Workers Comp follow up who is> also diabetic so he's> got two appts to bill each with different> insurance). Interestingly, 3 of> the 4 patients are Deaf... but that is one of my> clinical interest areas> as I know sign language and have served large> numbers of Deaf patients for> many years.> > I have 10 appts booked on AppointmentQuest for the> next two weeks... five> were set up by the patient him/herself and the> others by me with patient> on the phone. I think that ratio is a good sign,> though I admit the>

earliest registered patients may be more tech-savvy> so it may be a> statistical glitch.> > My technology stuff has held up pretty well through> my first week of> having all the pieces together... a "loaded" Toshiba> Tecra convertible> laptop-tablet with a port at the office for easy> connection to everything> there... HP color laser printer (on sale for> $299)... Panasonic scanner> (expensive, but it's worked GREAT

so far -- dealer> is a local small> businessman who is has already referred his son to> me and has been a good> link to the local community, so the extra expense of> the machine has> already paid off as opposed to buying online) ...> EMR= AC... OneBox.com> for voice mails, faxes and some emails (has worked> great so far and VM is> fast with my DSL line and computer) ... single tel> line with all> calls/faxes sent to

OneBox.com (btw, tel company rep> on the phone I've> worked with to set up line and DSL, after regular> calls back and forth, is> becoming my patient too!)... Treo 700W (new and I'm> just getting started> with it, but it's been good so far)... about to tie> in voice recognition> with local highly-recommended "training" company.> > I've tried to think about and come to good decisions> along the way for> where to spend

money and thusfar I'm satisfied the> few times I've put out> larger sums. Each time I can see a reason and have> already seen some> benefit with referrals and good advise about other> businesses/resourses.> > I didn't realize it, but this world of small> business does run on> handshakes and relationships. A good financial deal> at one point may not> benefit you later. But a good relationship with a>

colleague can keep> growing with time. Financial choices are not just> about the current> dollars but are "investments" for the future. At> this point however, I'm> mostly all set so there won't be many more outlays> of money.> > Anyway, I've not run the numbers but I'd estimate my> start up costs are> about $25,000 and I've been able to arrange for> some of that to delay> payment (no interest) which

will help my early cash> flow but require me to> keep track and be sure I have cash available when> they come due. I've got> a $50,000 small business loan with a low interest> rate and my minimum> payment is 1% a month. I only pay what I take out> of it too... thus far> $20,000. My technology overhead (www, online> messaging, online> scheduling, cell phone, etc) is about $450/month and> I doubt I'll go over> the limits for use with the way I set the contracts.> I've got no staff...> one of my mottos is, "it's just me, the patients,> our computers and our> phones!"> > Now I've got to go and finish painting trim (have> put it off all week),> put up some shelving, paint a few last pieces of> funiture, move my last> two pieces of furniture and straighten up the> office...!> > I'm sure many of you recall the feeling, but right> now the office feels> like a jigsaw puzzle with all the pieces spread on> the table. At this> point they are all faced right-side-up but only> small bunches are all> attached... I've got the border and some bunches of> similar colors, but> really it is still not put together! ;-)> > Overall, this feels good! The mild anxiety is mixed> with joy.>

> Thanks to you all for helping me get here.> I'll be sending the pictures and will share with the> group any thoughts or> observations about office or practice as time goes> on.> > 7:40... time to get to the office as I hit the> homestretch!!!> Tim> > > > > >

>

March 11, 2006

How long have you been open to reach 10.5 pt's/day?

>

> Date: 2006/03/10 Fri PM 11:28:38 EST

> To: < >

> Subject: RE: Who is Solo-Solo? (and quick update)

>

> For the poll (Sorry I got locked out of Yahoo again and am too lazy to

> set up another account)

>

> We are:

>

> One doctor

>

> One MA/Receptionist (she does mostly receptionist work, takes vitals,

> draws up and administers immunizations, and does a few nurse visits for

> education on cholesterol and diabetes)

>

> One part time biller/office manager (Me. I spend 1-3 hours a day at the

> office.)

>

> We are adding another doctor in October, but probably not another MA.

>

> We are talking to yet another doctor who wants to work mornings who

> would bring most of her patient panel with her who would be starting in

> June. Between the two, I would lose my office and our 1200 sq ft.

> office will be stretching at the seams.

>

> As a side note - Last month we saw 10.5 pts. Per day. We sent out our

> 1000th invoice today. Yah.

>

> Ernie

>

> Orchards Family Medicine, Inc.

>

> ________________________________

>

> From:

> [mailto: ] On Behalf Of L. Gordon

>

> Sent: Sunday, March 05, 2006 6:17 AM

> To:

> Subject: Re: Who is Solo-Solo?

>

> I've created a poll on staffing for the group.

> You can take the poll on our group web site:

> http://health.groups.yahoo.com/group//polls

> The poll will be open through 3/19

> I'll email results.

> Gordon

> At 09:00 PM 3/4/2006, you wrote:

>

> Hi all; it looks like Tim is totally solo, it sounded

> like Pamela Wimble is; this is my area of highest

> interest to minimize headache especially at the

> beginning by not having other office staff; I'm lookig

> at a location opportunity that would allow me to have

> no staff.

>

> Any suggestions? Pro's Cons?

> -Shay Hosseinion

>

> --- Egly wrote:

>

> > Good work Tim!

> >

> > " Malia, MD " wrote:

> > Hi Folks --

> >

> > It's time for me to do as some others have done and

> > pass along some happy

> > news... my new office officially opens in two days,

> > Monday March6!

> >

> > First, a giant " Thank You " to everyone for sharing

> > their experiences and

> > opinions on this list. Over these three years or so

> > I've learned a lot

> > from all of you. And until recently I didn't realize

> > it, but it's true,

> > the list does feel like a bit like family.

> >

> > Second, a warning... you should get another email

> > (likely on Sunday or so)

> > from me with a link to a Kodak site to view some

> > photos. You do not have

> > to register (unless you want to order photos...?)

> > and it's not junk email.

> >

> > The photos will be of my office and will range from

> > the barebones space I

> > started with last month to whatever it looks like

> > tomorrow after putting

> > in lots of hours this weekend.

> >

> > About the office... about 50 patients have already

> > had their medical

> > records copied and sent to me. I have about 25

> > patients already

> > registered on RelayHealth. I have four patients

> > booked for Monday... for

> > five appts (one is a Workers Comp follow up who is

> > also diabetic so he's

> > got two appts to bill each with different

> > insurance). Interestingly, 3 of

> > the 4 patients are Deaf... but that is one of my

> > clinical interest areas

> > as I know sign language and have served large

> > numbers of Deaf patients for

> > many years.

> >

> > I have 10 appts booked on AppointmentQuest for the

> > next two weeks... five

> > were set up by the patient him/herself and the

> > others by me with patient

> > on the phone. I think that ratio is a good sign,

> > though I admit the

> > earliest registered patients may be more tech-savvy

> > so it may be a

> > statistical glitch.

> >

> > My technology stuff has held up pretty well through

> > my first week of

> > having all the pieces together... a " loaded " Toshiba

> > Tecra convertible

> > laptop-tablet with a port at the office for easy

> > connection to everything

> > there... HP color laser printer (on sale for

> > $299)... Panasonic scanner

> > (expensive, but it's worked GREAT so far -- dealer

> > is a local small

> > businessman who is has already referred his son to

> > me and has been a good

> > link to the local community, so the extra expense of

> > the machine has

> > already paid off as opposed to buying online) ...

> > EMR= AC... OneBox.com

> > for voice mails, faxes and some emails (has worked

> > great so far and VM is

> > fast with my DSL line and computer) ... single tel

> > line with all

> > calls/faxes sent to OneBox.com (btw, tel company rep

> > on the phone I've

> > worked with to set up line and DSL, after regular

> > calls back and forth, is

> > becoming my patient too!)... Treo 700W (new and I'm

> > just getting started

> > with it, but it's been good so far)... about to tie

> > in voice recognition

> > with local highly-recommended " training " company.

> >

> > I've tried to think about and come to good decisions

> > along the way for

> > where to spend money and thusfar I'm satisfied the

> > few times I've put out

> > larger sums. Each time I can see a reason and have

> > already seen some

> > benefit with referrals and good advise about other

> > businesses/resourses.

> >

> > I didn't realize it, but this world of small

> > business does run on

> > handshakes and relationships. A good financial deal

> > at one point may not

> > benefit you later. But a good relationship with a

> > colleague can keep

> > growing with time. Financial choices are not just

> > about the current

> > dollars but are " investments " for the future. At

> > this point however, I'm

> > mostly all set so there won't be many more outlays

> > of money.

> >

> > Anyway, I've not run the numbers but I'd estimate my

> > start up costs are

> > about $25,000 and I've been able to arrange for

> > some of that to delay

> > payment (no interest) which will help my early cash

> > flow but require me to

> > keep track and be sure I have cash available when

> > they come due. I've got

> > a $50,000 small business loan with a low interest

> > rate and my minimum

> > payment is 1% a month. I only pay what I take out

> > of it too... thus far

> > $20,000. My technology overhead (www, online

> > messaging, online

> > scheduling, cell phone, etc) is about $450/month and

> > I doubt I'll go over

> > the limits for use with the way I set the contracts.

> > I've got no staff...

> > one of my mottos is, " it's just me, the patients,

> > our computers and our

> > phones! "

> >

> > Now I've got to go and finish painting trim (have

> > put it off all week),

> > put up some shelving, paint a few last pieces of

> > funiture, move my last

> > two pieces of furniture and straighten up the

> > office...!

> >

> > I'm sure many of you recall the feeling, but right

> > now the office feels

> > like a jigsaw puzzle with all the pieces spread on

> > the table. At this

> > point they are all faced right-side-up but only

> > small bunches are all

> > attached... I've got the border and some bunches of

> > similar colors, but

> > really it is still not put together! ;-)

> >

> > Overall, this feels good! The mild anxiety is mixed

> > with joy.

> >

> > Thanks to you all for helping me get here.

> > I'll be sending the pictures and will share with the

> > group any thoughts or

> > observations about office or practice as time goes

> > on.

> >

> > 7:40... time to get to the office as I hit the

> > homestretch!!!

> > Tim

> >

March 12, 2006

We opened in August. To make the numbers a little more accurate, we see

about 25% CUP (Our local for-profit Medicaid carrier, which has assigned

us a lot of patients), 5% Medicaid, and 10% Medicare, 5% Tricare. The

remaining 55% are from commercial insurers. We are no longer taking new

CUP, Medicaid, Medicare, Tricare, or patients from our worse three

commercial insurers. We intend to have our percentage of state and

federal programs drop, as they reimburse the lowest and are the largest

hassle for us. I mention the ratios because we tried to front load our

lowest paying carriers, and having CUP, who assigns patients, has helped

us quickly build that part of our practice. We will likely reopen to

CUP just before we bring on our next doctor so that they can start with

enough patients for us to be able to pay them.

Ernie

Re: Who is Solo-Solo?

>

> I've created a poll on staffing for the group.

> You can take the poll on our group web site:

> http://health.groups.yahoo.com/group//polls

> The poll will be open through 3/19

> I'll email results.

> Gordon

> At 09:00 PM 3/4/2006, you wrote:

>

> Hi all; it looks like Tim is totally solo, it sounded

> like Pamela Wimble is; this is my area of highest

> interest to minimize headache especially at the

> beginning by not having other office staff; I'm lookig

> at a location opportunity that would allow me to have

> no staff.

>

> Any suggestions? Pro's Cons?

> -Shay Hosseinion

>

> --- Egly wrote:

>

> > Good work Tim!

> >

> > " Malia, MD " wrote:

> > Hi Folks --

> >

> > It's time for me to do as some others have done and

> > pass along some happy

> > news... my new office officially opens in two days,

> > Monday March6!

> >

> > First, a giant " Thank You " to everyone for sharing

> > their experiences and

> > opinions on this list. Over these three years or so

> > I've learned a lot

> > from all of you. And until recently I didn't realize

> > it, but it's true,

> > the list does feel like a bit like family.

> >

> > Second, a warning... you should get another email

> > (likely on Sunday or so)

> > from me with a link to a Kodak site to view some

> > photos. You do not have

> > to register (unless you want to order photos...?)

> > and it's not junk email.

> >

> > The photos will be of my office and will range from

> > the barebones space I

> > started with last month to whatever it looks like

> > tomorrow after putting

> > in lots of hours this weekend.

> >

> > About the office... about 50 patients have already

> > had their medical

> > records copied and sent to me. I have about 25

> > patients already

> > registered on RelayHealth. I have four patients

> > booked for Monday... for

> > five appts (one is a Workers Comp follow up who is

> > also diabetic so he's

> > got two appts to bill each with different

> > insurance). Interestingly, 3 of

> > the 4 patients are Deaf... but that is one of my

> > clinical interest areas

> > as I know sign language and have served large

> > numbers of Deaf patients for

> > many years.

> >

> > I have 10 appts booked on AppointmentQuest for the

> > next two weeks... five

> > were set up by the patient him/herself and the

> > others by me with patient

> > on the phone. I think that ratio is a good sign,

> > though I admit the

> > earliest registered patients may be more tech-savvy

> > so it may be a

> > statistical glitch.

> >

> > My technology stuff has held up pretty well through

> > my first week of

> > having all the pieces together... a " loaded " Toshiba

> > Tecra convertible

> > laptop-tablet with a port at the office for easy

> > connection to everything

> > there... HP color laser printer (on sale for

> > $299)... Panasonic scanner

> > (expensive, but it's worked GREAT so far -- dealer

> > is a local small

> > businessman who is has already referred his son to

> > me and has been a good

> > link to the local community, so the extra expense of

> > the machine has

> > already paid off as opposed to buying online) ...

> > EMR= AC... OneBox.com

> > for voice mails, faxes and some emails (has worked

> > great so far and VM is

> > fast with my DSL line and computer) ... single tel

> > line with all

> > calls/faxes sent to OneBox.com (btw, tel company rep

> > on the phone I've

> > worked with to set up line and DSL, after regular

> > calls back and forth, is

> > becoming my patient too!)... Treo 700W (new and I'm

> > just getting started

> > with it, but it's been good so far)... about to tie

> > in voice recognition

> > with local highly-recommended " training " company.

> >

> > I've tried to think about and come to good decisions

> > along the way for

> > where to spend money and thusfar I'm satisfied the

> > few times I've put out

> > larger sums. Each time I can see a reason and have

> > already seen some

> > benefit with referrals and good advise about other

> > businesses/resourses.

> >

> > I didn't realize it, but this world of small

> > business does run on

> > handshakes and relationships. A good financial deal

> > at one point may not

> > benefit you later. But a good relationship with a

> > colleague can keep

> > growing with time. Financial choices are not just

> > about the current

> > dollars but are " investments " for the future. At

> > this point however, I'm

> > mostly all set so there won't be many more outlays

> > of money.

> >

> > Anyway, I've not run the numbers but I'd estimate my

> > start up costs are

> > about $25,000 and I've been able to arrange for

> > some of that to delay

> > payment (no interest) which will help my early cash

> > flow but require me to

> > keep track and be sure I have cash available when

> > they come due. I've got

> > a $50,000 small business loan with a low interest

> > rate and my minimum

> > payment is 1% a month. I only pay what I take out

> > of it too... thus far

> > $20,000. My technology overhead (www, online

> > messaging, online

> > scheduling, cell phone, etc) is about $450/month and

> > I doubt I'll go over

> > the limits for use with the way I set the contracts.

> > I've got no staff...

> > one of my mottos is, " it's just me, the patients,

> > our computers and our

> > phones! "

> >

> > Now I've got to go and finish painting trim (have

> > put it off all week),

> > put up some shelving, paint a few last pieces of

> > funiture, move my last

> > two pieces of furniture and straighten up the

> > office...!

> >

> > I'm sure many of you recall the feeling, but right

> > now the office feels

> > like a jigsaw puzzle with all the pieces spread on

> > the table. At this

> > point they are all faced right-side-up but only

> > small bunches are all

> > attached... I've got the border and some bunches of

> > similar colors, but

> > really it is still not put together! ;-)

> >

> > Overall, this feels good! The mild anxiety is mixed

> > with joy.

> >

> > Thanks to you all for helping me get here.

> > I'll be sending the pictures and will share with the

> > group any thoughts or

> > observations about office or practice as time goes

> > on.

> >

> > 7:40... time to get to the office as I hit the

> > homestretch!!!

> > Tim

> >

March 12, 2006

Ernie -

I like that you have been open to poorer patients and have a plan that

helps you financially (at least at the start) and helps them get the care

they need. I respect that you are finding a way to serve those who come

to you (even if they are being " assigned " ) and are willing to have a

portion of your practice from some of the worse payors.

Good luck finding financial success and serving all your patients with the

balance of insurances you work with.

Tim

> We opened in August. To make the numbers a little more accurate, we see

> about 25% CUP (Our local for-profit Medicaid carrier, which has assigned

> us a lot of patients), 5% Medicaid, and 10% Medicare, 5% Tricare. The

> remaining 55% are from commercial insurers. We are no longer taking new

> CUP, Medicaid, Medicare, Tricare, or patients from our worse three

> commercial insurers. We intend to have our percentage of state and

> federal programs drop, as they reimburse the lowest and are the largest

> hassle for us. I mention the ratios because we tried to front load our

> lowest paying carriers, and having CUP, who assigns patients, has helped

> us quickly build that part of our practice. We will likely reopen to

> CUP just before we bring on our next doctor so that they can start with

> enough patients for us to be able to pay them.

> Ernie

>

> Re: Who is Solo-Solo?

>>

>> I've created a poll on staffing for the group.

>> You can take the poll on our group web site:

>> http://health.groups.yahoo.com/group//polls

>> The poll will be open through 3/19

>> I'll email results.

>> Gordon

>> At 09:00 PM 3/4/2006, you wrote:

>>

>> Hi all; it looks like Tim is totally solo, it sounded

>> like Pamela Wimble is; this is my area of highest

>> interest to minimize headache especially at the

>> beginning by not having other office staff; I'm lookig

>> at a location opportunity that would allow me to have

>> no staff.

>>

>> Any suggestions? Pro's Cons?

>> -Shay Hosseinion

>>

>> --- Egly wrote:

>>

>> > Good work Tim!

>> >

>> > " Malia, MD " wrote:

>> > Hi Folks --

>> >

>> > It's time for me to do as some others have done and

>> > pass along some happy

>> > news... my new office officially opens in two days,

>> > Monday March6!

>> >

>> > First, a giant " Thank You " to everyone for sharing

>> > their experiences and

>> > opinions on this list. Over these three years or so

>> > I've learned a lot

>> > from all of you. And until recently I didn't realize

>> > it, but it's true,

>> > the list does feel like a bit like family.

>> >

>> > Second, a warning... you should get another email

>> > (likely on Sunday or so)

>> > from me with a link to a Kodak site to view some

>> > photos. You do not have

>> > to register (unless you want to order photos...?)

>> > and it's not junk email.

>> >

>> > The photos will be of my office and will range from

>> > the barebones space I

>> > started with last month to whatever it looks like

>> > tomorrow after putting

>> > in lots of hours this weekend.

>> >

>> > About the office... about 50 patients have already

>> > had their medical

>> > records copied and sent to me. I have about 25

>> > patients already

>> > registered on RelayHealth. I have four patients

>> > booked for Monday... for

>> > five appts (one is a Workers Comp follow up who is

>> > also diabetic so he's

>> > got two appts to bill each with different

>> > insurance). Interestingly, 3 of

>> > the 4 patients are Deaf... but that is one of my

>> > clinical interest areas

>> > as I know sign language and have served large

>> > numbers of Deaf patients for

>> > many years.

>> >

>> > I have 10 appts booked on AppointmentQuest for the

>> > next two weeks... five

>> > were set up by the patient him/herself and the

>> > others by me with patient

>> > on the phone. I think that ratio is a good sign,

>> > though I admit the

>> > earliest registered patients may be more tech-savvy

>> > so it may be a

>> > statistical glitch.

>> >

>> > My technology stuff has held up pretty well through

>> > my first week of

>> > having all the pieces together... a " loaded " Toshiba

>> > Tecra convertible

>> > laptop-tablet with a port at the office for easy

>> > connection to everything

>> > there... HP color laser printer (on sale for

>> > $299)... Panasonic scanner

>> > (expensive, but it's worked GREAT so far -- dealer

>> > is a local small

>> > businessman who is has already referred his son to

>> > me and has been a good

>> > link to the local community, so the extra expense of

>> > the machine has

>> > already paid off as opposed to buying online) ...

>> > EMR= AC... OneBox.com

>> > for voice mails, faxes and some emails (has worked

>> > great so far and VM is

>> > fast with my DSL line and computer) ... single tel

>> > line with all

>> > calls/faxes sent to OneBox.com (btw, tel company rep

>> > on the phone I've

>> > worked with to set up line and DSL, after regular

>> > calls back and forth, is

>> > becoming my patient too!)... Treo 700W (new and I'm

>> > just getting started

>> > with it, but it's been good so far)... about to tie

>> > in voice recognition

>> > with local highly-recommended " training " company.

>> >

>> > I've tried to think about and come to good decisions

>> > along the way for

>> > where to spend money and thusfar I'm satisfied the

>> > few times I've put out

>> > larger sums. Each time I can see a reason and have

>> > already seen some

>> > benefit with referrals and good advise about other

>> > businesses/resourses.

>> >

>> > I didn't realize it, but this world of small

>> > business does run on

>> > handshakes and relationships. A good financial deal

>> > at one point may not

>> > benefit you later. But a good relationship with a

>> > colleague can keep

>> > growing with time. Financial choices are not just

>> > about the current

>> > dollars but are " investments " for the future. At

>> > this point however, I'm

>> > mostly all set so there won't be many more outlays

>> > of money.

>> >

>> > Anyway, I've not run the numbers but I'd estimate my

>> > start up costs are

>> > about $25,000 and I've been able to arrange for

>> > some of that to delay

>> > payment (no interest) which will help my early cash

>> > flow but require me to

>> > keep track and be sure I have cash available when

>> > they come due. I've got

>> > a $50,000 small business loan with a low interest

>> > rate and my minimum

>> > payment is 1% a month. I only pay what I take out

>> > of it too... thus far

>> > $20,000. My technology overhead (www, online

>> > messaging, online

>> > scheduling, cell phone, etc) is about $450/month and

>> > I doubt I'll go over

>> > the limits for use with the way I set the contracts.

>> > I've got no staff...

>> > one of my mottos is, " it's just me, the patients,

>> > our computers and our

>> > phones! "

>> >

>> > Now I've got to go and finish painting trim (have

>> > put it off all week),

>> > put up some shelving, paint a few last pieces of

>> > funiture, move my last

>> > two pieces of furniture and straighten up the

>> > office...!

>> >

>> > I'm sure many of you recall the feeling, but right

>> > now the office feels

>> > like a jigsaw puzzle with all the pieces spread on

>> > the table. At this

>> > point they are all faced right-side-up but only

>> > small bunches are all

>> > attached... I've got the border and some bunches of

>> > similar colors, but

>> > really it is still not put together! ;-)

>> >

>> > Overall, this feels good! The mild anxiety is mixed

>> > with joy.

>> >

>> > Thanks to you all for helping me get here.

>> > I'll be sending the pictures and will share with the

>> > group any thoughts or

>> > observations about office or practice as time goes

>> > on.

>> >

>> > 7:40... time to get to the office as I hit the

>> > homestretch!!!

>> > Tim

>> >

March 12, 2006