Re: Re: Update and questions

April 5, 2006

Padma,Regarding EMR - I use one I developed myself just using Apple computer and text edit filesMy charts are automatically alphabetized, I set it up the way I want it and BEST part FREEEEEE!Yep, no money, no cost and works great!! Call me if you want more info..... Regarding staff. My patients are DELIGHTED with my service. They have direct access to me and it is no burden on my lifestyle (rare after hours calls - almost NONE!) They are AMAZED when I answer the phone and say things lie...."WOW!!! I CAN'T BELIEVE I AM ACTUALLY SPEAKING WITH THE DOCTOR!! I have tried to reach my doctor during office hours for YEARS without success and you answered the phone on Friday night at 10 pm!!!!"I was simply working on my computer at my home office and picked up the phone when it rang- THIS IS AN INCREDIBLE ASSET that other offices simply can not provide in the SHOVE model (SuperHigh Overhead Volume Eployment) model.I recommend no staff and easy direct access for patients to YOU. You will BLOW THEM AWAY!!They will love you forever!Call me and I'll share more...PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...www.idealmedicalpractice.orgOn Apr 5, 2006, at 1:10 PM, padma8332 wrote: Hi, I am new to this group too, and looking to start my own solo practice in a couple of months. Would like to keep it as paperless as possible and use no/one staff if possible--what EMR systems/computer software have you or any of the others researched? How expensive are they. If anyone has found a system they like, could you please write about the pros/cons/expense involved. Also about a receptionist--how do you think patients will respond to not having a human on the other side taking care of scheduling etc right away. I have been strongly advised against starting without at least a receptionist, as it would be a disadvantage for me given the immediate responses and services provided by some others in the area. Thanks, Padma > > Hi. I am new to this group, having been told of its existence by > Clemenson. I am currently hospital employed but am opening my new office > this fall which will be completely computerized and run with no staff. I am > working on my website and would like to see some of yours. So if you have a > website (and you think it's good!) could you send the web address so I can > check it out for ideas? Thanks so much! > > > > Kerry Graff, MD > > jkmully@... > > > > _____ > > From: > [mailto: ] On Behalf Of bradleybroker > Sent: Tuesday, April 04, 2006 12:23 PM > To: > Subject: Update and questions > > > > Hi All. Thought I'd continue the update chain and I've got a > question or two for you. > > First, I'm one month in to my solo practice and have been mostly > pleased. There have been some conflicts with my "roommates," which > include another doc (from whom I'm renting space) and our shared > staff. Some of those conflicts are making me reconsider the rent > part of the low-cost model and moving into my own space. While my > expenses will increase, I will be better able to initiate office > systems, EMRs, etc. -- which is more difficult as a solo practice > moving into an established office that is resistant to change. > > My question is regarding practice size. What are some milestones > you've had regarding number of patients? One month? One year? > Have you been satisfied with your progress? > > Thanks. > > Brad > > > > > > > > >

April 5, 2006

We use Alteer office as our EMR & it is pretty good at billing & at being

tight & integrated but is not so good at the clinical encounter part & is

horrible at tracking chronic disease (ie, diabetes flow sheets, growth

curves in peds, vaccination flowsheets, etc) or running reports (ie, finding

all patients with a dx of diabetes). I hear good things about

eclinicalworks & others. I had a hospital income guarantee so I was not so

concerned about the $30,000+ price tag. As for staffing, I think it is

nearly impossible to get by with zero staff & is just not worth the tradeoff

of lower overhead for the increased hassle factor. I have one receptionist,

just no other clinical staff. My wife is office mgr & does all billing.

For me, it's everything in moderation, & striving for a ridiculously low

overhead by struggling along with zero staff is just too extreme for me. I

think the general concept of running a relatively lower overhead/lower

volume practice is great. Again, moderation is best, somewhere in between a

traditional high overhead/high volume practice and a truly 100% solo-solo

ultra low overhead/low volume practice.

Update and questions

>

> Hi All. Thought I'd continue the update chain and I've got a

> question or two for you.

>

> First, I'm one month in to my solo practice and have been mostly

> pleased. There have been some conflicts with my " roommates, "

which

> include another doc (from whom I'm renting space) and our shared

> staff. Some of those conflicts are making me reconsider the rent

> part of the low-cost model and moving into my own space. While my

> expenses will increase, I will be better able to initiate office

> systems, EMRs, etc. -- which is more difficult as a solo practice

> moving into an established office that is resistant to change.

>

> My question is regarding practice size. What are some milestones

> you've had regarding number of patients? One month? One year?

> Have you been satisfied with your progress?

>

> Thanks.

>

> Brad

>

April 6, 2006

I think that having no staff is easier if you are subletting an office from another doctor so that there are staff around if you need a chaperone for pelvics etc. I chose to have another staff person because of this reason, also I thought that I would be lonely without another person to talk to. Also I am not a detail person and having someone double check that I have truly entered all of the charges for the things that I have done probably paid for the salary of my MA. However, at the beginning when you are sitting around doing nothing it would be painful to have to pay the salary for someone else to sit around doing nothing also.Family practice management had an article recently about budget emr's that you probably would find helpful. One of the emr's listed is free shareware.Larry Lindeman MD Padma,Regarding EMR - I use one I developed myself just using Apple computer and text edit filesMy charts are automatically alphabetized, I set it up the way I want it and BEST part FREEEEEE!Yep, no money, no cost and works great!! Call me if you want more info..... Regarding staff. My patients are DELIGHTED with my service. They have direct access to me and it is no burden on my lifestyle (rare after hours calls - almost NONE!) They are AMAZED when I answer the phone and say things lie...."WOW!!! I CAN'T BELIEVE I AM ACTUALLY SPEAKING WITH THE DOCTOR!! I have tried to reach my doctor during office hours for YEARS without success and you answered the phone on Friday night at 10 pm!!!!"I was simply working on my computer at my home office and picked up the phone when it rang- THIS IS AN INCREDIBLE ASSET that other offices simply can not provide in the SHOVE model (SuperHigh Overhead Volume Eployment) model.I recommend no staff and easy direct access for patients to YOU. You will BLOW THEM AWAY!!They will love you forever!Call me and I'll share more...PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...www.idealmedicalpractice.orgOn Apr 5, 2006, at 1:10 PM, padma8332 wrote: Hi, I am new to this group too, and looking to start my own solo practice in a couple of months. Would like to keep it as paperless as possible and use no/one staff if possible--what EMR systems/computer software have you or any of the others researched? How expensive are they. If anyone has found a system they like, could you please write about the pros/cons/expense involved. Also about a receptionist--how do you think patients will respond to not having a human on the other side taking care of scheduling etc right away. I have been strongly advised against starting without at least a receptionist, as it would be a disadvantage for me given the immediate responses and services provided by some others in the area. Thanks, Padma > > Hi. I am new to this group, having been told of its existence by > Clemenson. I am currently hospital employed but am opening my new office > this fall which will be completely computerized and run with no staff. I am > working on my website and would like to see some of yours. So if you have a > website (and you think it's good!) could you send the web address so I can > check it out for ideas? Thanks so much! > > > > Kerry Graff, MD > > jkmully@... > > > > _____ > > From: > [mailto: ] On Behalf Of bradleybroker > Sent: Tuesday, April 04, 2006 12:23 PM > To: > Subject: Update and questions > > > > Hi All. Thought I'd continue the update chain and I've got a > question or two for you. > > First, I'm one month in to my solo practice and have been mostly > pleased. There have been some conflicts with my "roommates," which > include another doc (from whom I'm renting space) and our shared > staff. Some of those conflicts are making me reconsider the rent > part of the low-cost model and moving into my own space. While my > expenses will increase, I will be better able to initiate office > systems, EMRs, etc. -- which is more difficult as a solo practice > moving into an established office that is resistant to change. > > My question is regarding practice size. What are some milestones > you've had regarding number of patients? One month? One year? > Have you been satisfied with your progress? > > Thanks. > > Brad > > > > > > > > >

April 6, 2006

The problem with an EMR like that is that

it is basically just electronic data storage & not a practice management

software (It is basically just changing a paper chart over to an electronic

version). In other words, it won’t automatically generate a superbill

& allow charges to be submitted electronically, to integrate scheduling,

etc.. That is what increases my efficiency, not so much the simple fact that I’m

able to avoid storing paper charts on site, though that is of course helpful

too. Again though, you can probably make anything seem to work in your

practice because you are ultra low volume. When you a small enough number

per day just about any system will seem to work out. Of course,

yours was free & that is nice if someone is trying to start a truly low

overhead solo practice. However, personally I still advocate the income

guarantee model though, with financial assistance for a set period from a local

hospital. That is what I did & therefore my EMR is top of the line

but basically was “free” in a sense. I just will owe tax on

that & am obligated to this practice for 3.5 yrs total as foregiveness.

Pretty darn good deal in my mind.

Update and

questions

>

> Hi All. Thought I'd continue the update

chain and I've got a

> question or two for you.

>

> First, I'm one month in to my solo practice

and have been mostly

> pleased. There have been some conflicts

with my " roommates, "

which

> include another doc (from whom I'm renting

space) and our shared

> staff. Some of those conflicts are

making me reconsider the rent

> part of the low-cost model and moving into my

own space. While my

> expenses will increase, I will be better able

to initiate office

> systems, EMRs, etc. -- which is more

difficult as a solo practice

> moving into an established office that is

resistant to change.

>

> My question is regarding practice size.

What are some milestones

> you've had regarding number of

patients? One month? One year?

> Have you been satisfied with your

progress?

>

> Thanks.

>

> Brad

>

April 6, 2006

I don't know about the darn good deal. From your earlier posts, your patients

don't want to do a single damned thing, don't want to pay anything, do anything

or think about anything. I think my head would explode if I were in that

situation.

Charlie Vargas

lin, NC

Date: Thu Apr 06 07:48:23 CDT 2006

To:

Subject: RE: Re: Update and questions

The problem with an EMR like that is thatit is basically just electronic data

storage & not a practice managementsoftware (It is basically just changing a

paper chart over to an electronicversion). In other words, it won’t

automatically generate a superbill & allow charges to be submitted

electronically, to integrate scheduling,etc.. That is what increases my

efficiency, not so much the simple fact that I’mable to avoid storing paper

charts on site, though that is of course helpfultoo. Again though, you can

probably make anything seem to work in yourpractice because you are ultra low

volume. When you a small enough numberper day just about any system will seem

to work out. Of course,yours was free & that is nice if someone is trying to

start a truly lowoverhead solo practice. However, personally I still advocate

the incomeguarantee model though, with financial assistance for a set period

from a localhospital. That is what I did & therefore my EMR is top of the

linebut basically was “free” in a sense. I just will owe tax onthat & am

obligated to this practice for 3.5 yrs total as foregiveness. Pretty darn good

deal in my mind.

Update andquestions

>

> Hi All. Thought I'd continue the updatechain and I've got a

> question or two for you.

>

> First, I'm one month in to my solo practiceand have been mostly

> pleased. There have been some conflictswith my " roommates, "

which

> include another doc (from whom I'm rentingspace) and our shared

> staff. Some of those conflicts aremaking me reconsider the rent

> part of the low-cost model and moving into myown space. While my

> expenses will increase, I will be better ableto initiate office

> systems, EMRs, etc. -- which is moredifficult as a solo practice

> moving into an established office that isresistant to change.

>

> My question is regarding practice size. What are some milestones

> you've had regarding number ofpatients? One month? One year?

> Have you been satisfied with yourprogress?

>

> Thanks.

>

> Brad

>

April 6, 2006