Re: money

[Guest guest]

The lab thing is quite regional though. When I first started in practice in Ohio after leaving the Navy, we could bill for most labs with a few companies. Both those done in house and those sent to the lab that we did the billing on and had negotiated a good rate for. That was about 5-6yrs ago. For the past several years none of the companies have been reimbursing for most of these services. There are of course exceptions, but even then the reimbursement is very small.

[Guest guest]

Yes,

that $130,000 for 14 “light” days/month needs clarification for

us. How do you do that? Also, is that really in the lower 1/3 of FP

incomes? There are still a lot of FP’s making a lot less than

that. I would think $130,000 is actually close to the middle.

money

>

>

>

> Recently I have had money on my mind. After 2 years in my new

> practice I an finally close to making $150,000 which is still less

> than I made at my old job. However I am finding it difficult to

> figure out how to make anymore than that since I don't think that

I

> can see any more patients in a day. The median income of FP's is

over

> $160.000/yr. How many of you are making more than the median FP

> income and what are you doing to make that much. If the

micropractice

> model is not capable of producing enough income to provide at

least

> the median income it is probably not going to be a viable model.

> Larry Lindeman MD

>

[Guest guest]

The lab

truly does a comprehensive metabolic panel for $7? I do not see how they can

afford to do that, that has to be a money loser. Our little in-office CLIA waived

PT/INR pays almost that much!

Re: money

quite easily. You will

have to tie the lab code to the dx. Our lab

charges around 100 for a pap , more w hpv testing, heck if you charge

50 everybody comes out ahead. Our local hospital will charge 60 plus

for a cbc, who knows for a comp. You can not bill medicaid and

medicare due to the way their system is set up unless you do the lab

directly.

Brent

> > >

> > > Recently I have had money on my mind. After 2 years in my

> > new

> > > practice I an finally close to making $150,000 which is still

less

> > > than I made at my old job. However I am finding it difficult to

> > > figure out how to make anymore than that since I don't think

that I

> > > can see any more patients in a day. The median income of FP's

is

> > over

> > > $160.000/yr. How many of you are making more than the median FP

> > > income and what are you doing to make that much. If the

> > micropractice

> > > model is not capable of producing enough income to provide at

least

> > > the median income it is probably not going to be a viable

model.

> > > Larry Lindeman MD

> > >

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > >

> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > > Get your own web address for just $1.99/1st yr. We'll help.

Yahoo!

> > Small Business.

> > >

> > > ---------------------------------

> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.

> > >

> >

> >

> >

>

[Guest guest]

I was very disappointed when I saw the current FP incomes on the aafp web site. No wonder so few people are going into Family medicine. I seems that quite a few people on the list are making quite a bit lower than this. Even though many people are enjoying medicine more in this model unless the income is higher I don't think that it will be an attractive type of practice for many. My income it seems is at the higher end of this group. I think the reason is that I have not used the solo solo model. When I started 2 years ago I started in solo practice with a medical assistant. 6 months ago I added a 1/2 time doctor and a 10 hour per week receptionist. In July a nearby doctor retired and told all his patients to come to us. With some trepidation we replaced our receptionist with an almost full time LPN. I have always had an outside biller although I review the eob's. The extra staff allows me to see more patients and bring in more income. Our LPN has started to help with care management. I  have 100 appointment slots per week but my target is 80. My partner has 40 slots and a 32 visit target. I have been running a little over my target. I am usually at the office 9 hours per day which includes a 30 minute lunch break and 60-90 minutes of paperwork time. We have debated closing our practice, adding an enrollment fee of $350/yr like Egly suggested or stopping accepting low paying insurance. I think that we have decided on the last. In small practices like ours that gives great service and are full, it makes sense that people will be willing to pay a little more to get that kind of care. Right now there is a 40% difference between our lowest and highest payor. I am going to try to encourage our patients to sign up with the higher paying insurances or if they can't, to see us on a cash basis.Have others in this list serve transitioned to a cash practice or started to add an enrollment fee.Larry LIndeman MDYes, that $130,000 for 14 “light” days/month needs clarification for us.  How do you do that?  Also, is that really in the lower 1/3 of FP incomes?  There are still a lot of FP’s making a lot less than that.  I would think $130,000 is actually close to the middle.   money> > > > Recently I have had money on my mind. After 2 years in my new > practice I an finally close to making $150,000 which is still less > than I made at my old job. However I am finding it difficult to > figure out how to make anymore than that since I don't think that I > can see any more patients in a day. The median income of FP's is over > $160.000/yr. How many of you are making more than the median FP > income and what are you doing to make that much. If the micropractice > model is not capable of producing enough income to provide at least > the median income it is probably not going to be a viable model.> Larry Lindeman MD>

[Guest guest]

Yes, I

am starting to think the same way. I don’t want to be too much of a

pessimist, but I do not think the pure IMP model can remain viable if the

incomes are significantly below average, lifestyle benefits

notwithstanding. I know a few on this list have extraordinary

reimbursements in their area, super low malpractice premiums, or code

many tiers above the norm (ie, I give great care so I can code most visits as a

99215 or extended code), etc so that they can make a decent income. In

general though, I think only the underlying themes of running a leaner lower

overhead practice can survive. Super low staff/low volumes just are very

difficult to do & have a good income. In the end, moderate to

moderately high patient volumes are required to make an average FP income.

money

>

>

>

> Recently I have had money on my mind. After 2

years in my new

> practice I an finally close to making

$150,000 which is still less

> than I made at my old job. However I am

finding it difficult to

> figure out how to make anymore than that

since I don't think that

I

> can see any more patients in a day. The

median income of FP's is

over

> $160.000/yr. How many of you are making more

than the median FP

> income and what are you doing to make that

much. If the

micropractice

> model is not capable of producing enough

income to provide at

least

> the median income it is probably not going to

be a viable model.

> Larry Lindeman MD

>

[Guest guest]

I think these are all reasonable issues to consider. Certainly money is

something I personally considered as I " made the leap " and chose the

solo-solo model with a twist (adding other services that pay better... I

like to call it the " Robin Hood " model) as I hope it allows me to practice

medicine the way I want, have greater flexibility with life/work and still

make good income (need it for student loans... and in 4 yrs college

tuition!).

At this point I wonder if the salary issue +/- doctor satisfaction is part

of the research Gordon is doing with the IMP group. I think they've

published some info already about the first batches of data, so I wonder

if there is more info about these issues.

Tim

> Yes, I am starting to think the same way. I don't want to be too much

> of a pessimist, but I do not think the pure IMP model can remain viable

> if the incomes are significantly below average, lifestyle benefits

> notwithstanding. I know a few on this list have extraordinary

> reimbursements in their area, super low malpractice premiums, or code

> many tiers above the norm (ie, I give great care so I can code most

> visits as a 99215 or extended code), etc so that they can make a decent

> income. In general though, I think only the underlying themes of

> running a leaner lower overhead practice can survive. Super low

> staff/low volumes just are very difficult to do & have a good income.

> In the end, moderate to moderately high patient volumes are required to

> make an average FP income.

>

>

>

>

>

>

>

> money

>>

>>

>>

>> Recently I have had money on my mind. After 2 years in my new

>> practice I an finally close to making $150,000 which is still less

>> than I made at my old job. However I am finding it difficult to

>> figure out how to make anymore than that since I don't think that

> I

>> can see any more patients in a day. The median income of FP's is

> over

>> $160.000/yr. How many of you are making more than the median FP

>> income and what are you doing to make that much. If the

> micropractice

>> model is not capable of producing enough income to provide at

> least

>> the median income it is probably not going to be a viable model. Larry

>> Lindeman MD

>>

>

>

[Guest guest]

,

I agree with what you are saying, but

therein lies the problem. Most of us made the leap to this form of practice to

provide higher quality care and have more professional satisfaction, and hoped

the money would flow in as well. Insurances pay for quantity and so this has

not been entirely the case, and as we add and see more patients, the time spent

with each patient declines and at some point (I don’t know where) the

doctor-patient relationship begins to falter and the quality begins to drop. At

the same time, increasing chaos in the office (from more employees, more phone

calls, etc) further destroys quality. So, following this line of thought, the

only way to provide high quality medicine is to not accept insurances, which

then alienates us from the majority of people who don’t want to pay

privately. So, in our lovely society, in order to financially make ends meet we

have to lower our standards, increasing our risk of getting sued and increasing

our overhead further. So, the insurances have really become the force driving

poor quality. Ironically, then the same companies send letters saying that they

are enrolling your diabetics in special case manager classes to ensure quality.

It really sucks!

Sorry for being disgruntled, but having “climbed

the mountain and looked down into the promised land,”

I hate that others might not join us in the journey. Maybe something will

change somewhere…..

money

>

>

>

> Recently I have had money on my mind. After 2

years in my new

> practice I an finally close to making

$150,000 which is still less

> than I made at my old job. However I am

finding it difficult to

> figure out how to make anymore than that

since I don't think that

I

> can see any more patients in a day. The median

income of FP's is

over

> $160.000/yr. How many of you are making more

than the median FP

> income and what are you doing to make that

much. If the

micropractice

> model is not capable of producing enough

income to provide at

least

> the median income it is probably not going to

be a viable model.

> Larry Lindeman MD

>

[Guest guest]

Well said. I agree.

money

>

>

>

> Recently I have had money on my mind. After 2

years in my new

> practice I an finally close to making

$150,000 which is still less

> than I made at my old job. However I am

finding it difficult to

> figure out how to make anymore than that

since I don't think that

I

> can see any more patients in a day. The

median income of FP's is

over

> $160.000/yr. How many of you are making more

than the median FP

> income and what are you doing to make that

much. If the

micropractice

> model is not capable of producing enough

income to provide at

least

> the median income it is probably not going to

be a viable model.

> Larry Lindeman MD

>

[Guest guest]

That is what they charge me for the test, if I do the billing. TSH is 10$, lipid panel is 6$. I told them that I will change from the previous lab, if they help me with my cash patients. Sometimes even my patients with high deductible will use the cash deal.The lab truly does a comprehensive metabolic panel for $7?  I do not see how they can afford to do that, that has to be a money loser.  Our little in-office CLIA waived PT/INR pays almost that much!  -----Original Message-----From: [mailto: ] On Behalf Of brenthrabikSent: Thursday, September 14, 2006 10:42 PMTo: Subject: Re: money quite easily. You will have to tie the lab code to the dx. Our lab charges around 100 for a pap , more w hpv testing, heck if you charge 50 everybody comes out ahead. Our local hospital will charge 60 plus for a cbc, who knows for a comp. You can not bill medicaid and medicare due to the way their system is set up unless you do the lab directly. Brent> > >> > > Recently I have had money on my mind. After 2 years in my> > new> > > practice I an finally close to making $150,000 which is still less> > > than I made at my old job. However I am finding it difficult to> > > figure out how to make anymore than that since I don't think that I> > > can see any more patients in a day. The median income of FP's is> > over> > > $160.000/yr. How many of you are making more than the median FP> > > income and what are you doing to make that much. If the> > micropractice> > > model is not capable of producing enough income to provide at least> > > the median income it is probably not going to be a viable model.> > > Larry Lindeman MD> > >> > >> > >> > >> > >> > > ---------------------------------> > >> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.> > >> > >> > >> > >> > >> > >> > >> > >> > >> > > ---------------------------------> > > Get your own web address for just $1.99/1st yr. We'll help. Yahoo!> > Small Business.> > >> > > ---------------------------------> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.> > >> >> > > >>

[Guest guest]

That is what they charge me for the test, if I do the billing. TSH is 10$, lipid panel is 6$. I told them that I will change from the previous lab, if they help me with my cash patients. Sometimes even my patients with high deductible will use the cash deal.The lab truly does a comprehensive metabolic panel for $7?  I do not see how they can afford to do that, that has to be a money loser.  Our little in-office CLIA waived PT/INR pays almost that much!  -----Original Message-----From: [mailto: ] On Behalf Of brenthrabikSent: Thursday, September 14, 2006 10:42 PMTo: Subject: Re: money quite easily. You will have to tie the lab code to the dx. Our lab charges around 100 for a pap , more w hpv testing, heck if you charge 50 everybody comes out ahead. Our local hospital will charge 60 plus for a cbc, who knows for a comp. You can not bill medicaid and medicare due to the way their system is set up unless you do the lab directly. Brent> > >> > > Recently I have had money on my mind. After 2 years in my> > new> > > practice I an finally close to making $150,000 which is still less> > > than I made at my old job. However I am finding it difficult to> > > figure out how to make anymore than that since I don't think that I> > > can see any more patients in a day. The median income of FP's is> > over> > > $160.000/yr. How many of you are making more than the median FP> > > income and what are you doing to make that much. If the> > micropractice> > > model is not capable of producing enough income to provide at least> > > the median income it is probably not going to be a viable model.> > > Larry Lindeman MD> > >> > >> > >> > >> > >> > > ---------------------------------> > >> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.> > >> > >> > >> > >> > >> > >> > >> > >> > >> > > ---------------------------------> > > Get your own web address for just $1.99/1st yr. We'll help. Yahoo!> > Small Business.> > >> > > ---------------------------------> > > Stay in the know. Pulse on the new Yahoo.com. Check it out.> > >> >> > > >>

[Guest guest]

Larry Lindeman,

How do you make nearly 150? How many pts do you see per day, how many days per week, geographic location and malpractice insurance. I am finding it difficult to see how I would ever make anywhere near that.

Naureen Mohamed

[Guest guest]

Larry Lindeman,

How do you make nearly 150? How many pts do you see per day, how many days per week, geographic location and malpractice insurance. I am finding it difficult to see how I would ever make anywhere near that.

Naureen Mohamed

[Guest guest]

I think that the 3 most important things that are helping me are: 1) Having a good medical assistant to help with the many chores that need to be done in the office allowing me to see 16-18 patients per day. 2) Having a good outside biller who I talk to at least once a week on coding or reimbursement issues. 3) Learning everything I can about coding. Do you know how much you can reimbursed for splint application or using a global fracture code for a broken toe or rib instead of an e & m code?For many people it is the right choice to start with the solo solo model to minimize start up costs. However after a practice starts to get busy many people might want to expand to having an assistant even though this means a higher overhead. I think that you might find medicine more enjoyable and profitable spending more time with patients and a little less on paper work. Limiting your staff to 1 or 1.5 still keeps the practice small enough that you will still know every patient well. Another thing that I am just starting this week is comparing  the reimbursement of every insurance company. In January we are going to stop participating with the 2 lowest payorsI practice in Chicago, Malpractice is $30,000/yr. I see 75-80 patients/week, I work 5 days per week. I do minimal hosp work and will probably give that up. We draw blood, we bill for labs done at quest if the reimbursement is good enough,do ecgs, I do minor skin surgery in the office. We have 10,500sq ft office for 1.5 docsLarry Lindeman MDLarry Lindeman MDLarry Lindeman,How do you make nearly 150?  How many pts do you see per day, how many days per week, geographic location and malpractice insurance.  I am finding it difficult to see how I would ever make anywhere near that.Naureen Mohamed

[Guest guest]

Thanks for the explanation... really great points you are making.

But, please tell me your office is 1,500 sq ft and not 10,500! ;-)

Because your overhead in Chicago for 10,500 sq ft would be huge I imagine.

LOL

Tim

> I think that the 3 most important things that are helping me are: 1)

> Having a good medical assistant to help with the many chores that need

> to be done in the office allowing me to see 16-18 patients per day. 2)

> Having a good outside biller who I talk to at least once a week on

> coding or reimbursement issues. 3) Learning everything I can about

> coding. Do you know how much you can reimbursed for splint application

> or using a global fracture code for a broken toe or rib instead of an

> e & m code?

>

> For many people it is the right choice to start with the solo solo

> model to minimize start up costs. However after a practice starts to

> get busy many people might want to expand to having an assistant even

> though this means a higher overhead. I think that you might find

> medicine more enjoyable and profitable spending more time with

> patients and a little less on paper work. Limiting your staff to 1 or

> 1.5 still keeps the practice small enough that you will still know

> every patient well.

> Another thing that I am just starting this week is comparing the

> reimbursement of every insurance company. In January we are going to

> stop participating with the 2 lowest payors

>

> I practice in Chicago, Malpractice is $30,000/yr. I see 75-80

> patients/week, I work 5 days per week. I do minimal hosp work and will

> probably give that up. We draw blood, we bill for labs done at quest

> if the reimbursement is good enough,do ecgs, I do minor skin surgery

> in the office. We have 10,500sq ft office for 1.5 docs

>

> Larry Lindeman MD

>

> Larry Lindeman MD

>

>

>>

>> Larry Lindeman,

>> How do you make nearly 150? How many pts do you see per day, how

>> many days per week, geographic location and malpractice insurance.

>> I am finding it difficult to see how I would ever make anywhere near

>> that.

>> Naureen Mohamed

>>

>>

[Guest guest]

Thanks for the explanation... really great points you are making.

But, please tell me your office is 1,500 sq ft and not 10,500! ;-)

Because your overhead in Chicago for 10,500 sq ft would be huge I imagine.

LOL

Tim

> I think that the 3 most important things that are helping me are: 1)

> Having a good medical assistant to help with the many chores that need

> to be done in the office allowing me to see 16-18 patients per day. 2)

> Having a good outside biller who I talk to at least once a week on

> coding or reimbursement issues. 3) Learning everything I can about

> coding. Do you know how much you can reimbursed for splint application

> or using a global fracture code for a broken toe or rib instead of an

> e & m code?

>

> For many people it is the right choice to start with the solo solo

> model to minimize start up costs. However after a practice starts to

> get busy many people might want to expand to having an assistant even

> though this means a higher overhead. I think that you might find

> medicine more enjoyable and profitable spending more time with

> patients and a little less on paper work. Limiting your staff to 1 or

> 1.5 still keeps the practice small enough that you will still know

> every patient well.

> Another thing that I am just starting this week is comparing the

> reimbursement of every insurance company. In January we are going to

> stop participating with the 2 lowest payors

>

> I practice in Chicago, Malpractice is $30,000/yr. I see 75-80

> patients/week, I work 5 days per week. I do minimal hosp work and will

> probably give that up. We draw blood, we bill for labs done at quest

> if the reimbursement is good enough,do ecgs, I do minor skin surgery

> in the office. We have 10,500sq ft office for 1.5 docs

>

> Larry Lindeman MD

>

> Larry Lindeman MD

>

>

>>

>> Larry Lindeman,

>> How do you make nearly 150? How many pts do you see per day, how

>> many days per week, geographic location and malpractice insurance.

>> I am finding it difficult to see how I would ever make anywhere near

>> that.

>> Naureen Mohamed

>>

>>

[Guest guest]

All this whining about quick care. How long does it take to see

somebody for an ear infection, get a fairly complete history , Social

history: update medication list and explain things to patient. It

does not take long. If it takes some volume to make a living , then

do some volume. There are different ways to do volume. It was once

said the only growing practice is one that has a return appointment

for something, even a year away.

There is gold in guidelines. Every diabetic needs regular care and

intervention along with lab.

Obesity and dysmetabolic syndrome is rampant.

Hypertension guidelines and getting people to goal is cumbersome and

requires frequent visits, not something you can do in just hour long

appointments.

Many diabetic appointments and hypertension checks can be done

quickly with the computerized data sets we are all keeping now.

You can easily see 25 a day, working a total of 8 hours a day with

some help. You can not answer the phone, do all scheduling, make

phone calls to specialist to schedule appts and do this volume if you

consider that to be critical to care, but you can have an assistant

do that. You have to have face to face time.

Studies have shown that for the doctor to really get to know you ,

you would need to be seen 3-4 times a year for chronic ongoing health

problems. Maybe this would be less in this model.

Brent

> Recently I have had money on my mind. After 2 years in my

new

> practice I an finally close to making $150,000 which is still less

> than I made at my old job. However I am finding it difficult to

> figure out how to make anymore than that since I don't think that I

> can see any more patients in a day. The median income of FP's is

over

> $160.000/yr. How many of you are making more than the median FP

> income and what are you doing to make that much. If the

micropractice

> model is not capable of producing enough income to provide at least

> the median income it is probably not going to be a viable model.

> Larry Lindeman MD

>

>

>

>

>

>

> ---------------------------------

> Stay in the know. Pulse on the new Yahoo.com. Check it out.

>

[Guest guest]

All this whining about quick care. How long does it take to see

somebody for an ear infection, get a fairly complete history , Social

history: update medication list and explain things to patient. It

does not take long. If it takes some volume to make a living , then

do some volume. There are different ways to do volume. It was once

said the only growing practice is one that has a return appointment

for something, even a year away.

There is gold in guidelines. Every diabetic needs regular care and

intervention along with lab.

Obesity and dysmetabolic syndrome is rampant.

Hypertension guidelines and getting people to goal is cumbersome and

requires frequent visits, not something you can do in just hour long

appointments.

Many diabetic appointments and hypertension checks can be done

quickly with the computerized data sets we are all keeping now.

You can easily see 25 a day, working a total of 8 hours a day with

some help. You can not answer the phone, do all scheduling, make

phone calls to specialist to schedule appts and do this volume if you

consider that to be critical to care, but you can have an assistant

do that. You have to have face to face time.

Studies have shown that for the doctor to really get to know you ,

you would need to be seen 3-4 times a year for chronic ongoing health

problems. Maybe this would be less in this model.

Brent

> Recently I have had money on my mind. After 2 years in my

new

> practice I an finally close to making $150,000 which is still less

> than I made at my old job. However I am finding it difficult to

> figure out how to make anymore than that since I don't think that I

> can see any more patients in a day. The median income of FP's is

over

> $160.000/yr. How many of you are making more than the median FP

> income and what are you doing to make that much. If the

micropractice

> model is not capable of producing enough income to provide at least

> the median income it is probably not going to be a viable model.

> Larry Lindeman MD

>

>

>

>

>

>

> ---------------------------------

> Stay in the know. Pulse on the new Yahoo.com. Check it out.

>

[Guest guest]

Do you

know where I can find any of those studies?

I would love to see some objective data to support what I know from

experience to be the truth.

Annie

Re: money

àStudies have

shown that for the doctor to really get to know you ,

you would need to be seen 3-4 times a year for chronic ongoing health

problems. Maybe this would be less in this model.

Brent

[Guest guest]

Larry, did you start alone or you had a medical assistant from day 1 ?

> I think that the 3 most important things that are helping me are: 1)

> Having a good medical assistant to help with the many chores that need

> to be done in the office allowing me to see 16-18 patients per day. 2)

> Having a good outside biller who I talk to at least once a week on

> coding or reimbursement issues. 3) Learning everything I can about

> coding. Do you know how much you can reimbursed for splint application

> or using a global fracture code for a broken toe or rib instead of an

> e & m code?

>

> For many people it is the right choice to start with the solo solo

> model to minimize start up costs. However after a practice starts to

> get busy many people might want to expand to having an assistant even

> though this means a higher overhead. I think that you might find

> medicine more enjoyable and profitable spending more time with

> patients and a little less on paper work. Limiting your staff to 1 or

> 1.5 still keeps the practice small enough that you will still know

> every patient well. 

> Another thing that I am just starting this week is comparing  the

> reimbursement of every insurance company. In January we are going to

> stop participating with the 2 lowest payors

>

> I practice in Chicago, Malpractice is $30,000/yr. I see 75-80

> patients/week, I work 5 days per week. I do minimal hosp work and will

> probably give that up. We draw blood, we bill for labs done at quest

> if the reimbursement is good enough,do ecgs, I do minor skin surgery

> in the office. We have 10,500sq ft office for 1.5 docs

>

> Larry Lindeman MD

>

> Larry Lindeman MD

>

>

>>

>> Larry Lindeman,

>> How do you make nearly 150?  How many pts do you see per day, how

>> many days per week, geographic location and malpractice insurance.  I

>> am finding it difficult to see how I would ever make anywhere near

>> that.

>> Naureen Mohamed

>>

>

>

>

[Guest guest]

My officer is 1,050  sq ftLarry LindemanThanks for the explanation... really great points you are making.But, please tell me your office is 1,500 sq ft and not 10,500! ;-)Because your overhead in Chicago for 10,500 sq ft would be huge I imagine.LOLTim> I think that the 3 most important things that are helping me are: 1)> Having a good medical assistant to help with the many chores that need> to be done in the office allowing me to see 16-18 patients per day. 2)> Having a good outside biller who I talk to at least once a week on> coding or reimbursement issues. 3) Learning everything I can about> coding. Do you know how much you can reimbursed for splint application> or using a global fracture code for a broken toe or rib instead of an> e & m code?>> For many people it is the right choice to start with the solo solo> model to minimize start up costs. However after a practice starts to> get busy many people might want to expand to having an assistant even> though this means a higher overhead. I think that you might find> medicine more enjoyable and profitable spending more time with> patients and a little less on paper work. Limiting your staff to 1 or> 1.5 still keeps the practice small enough that you will still know> every patient well.> Another thing that I am just starting this week is comparing the> reimbursement of every insurance company. In January we are going to> stop participating with the 2 lowest payors>> I practice in Chicago, Malpractice is $30,000/yr. I see 75-80> patients/week, I work 5 days per week. I do minimal hosp work and will> probably give that up. We draw blood, we bill for labs done at quest> if the reimbursement is good enough,do ecgs, I do minor skin surgery> in the office. We have 10,500sq ft office for 1.5 docs>> Larry Lindeman MD>> Larry Lindeman MD> >>>>> Larry Lindeman,>> How do you make nearly 150? How many pts do you see per day, how>> many days per week, geographic location and malpractice insurance.>> I am finding it difficult to see how I would ever make anywhere near>> that.>> Naureen Mohamed>>>>

[Guest guest]

I started with an assistant from day 1. As a male I thought it would be good to have a female around when I do paps. I also thought that I would grow pretty quickly because I had a small practice at the residency where I had been working. The old practice ended up not telling my patients so it took them a while to find me so the first couple of months were pretty slow. Larry Lindeman MDLarry, did you start alone or you had a medical assistant from day 1 ?  I think that the 3 most important things that are helping me are: 1) Having a good medical assistant to help with the many chores that need to be done in the office allowing me to see 16-18 patients per day. 2) Having a good outside biller who I talk to at least once a week on coding or reimbursement issues. 3) Learning everything I can about coding. Do you know how much you can reimbursed for splint application or using a global fracture code for a broken toe or rib instead of an e & m code?For many people it is the right choice to start with the solo solo model to minimize start up costs. However after a practice starts to get busy many people might want to expand to having an assistant even though this means a higher overhead. I think that you might find medicine more enjoyable and profitable spending more time with patients and a little less on paper work. Limiting your staff to 1 or 1.5 still keeps the practice small enough that you will still know every patient well. Another thing that I am just starting this week is comparing  the reimbursement of every insurance company. In January we are going to stop participating with the 2 lowest payorsI practice in Chicago, Malpractice is $30,000/yr. I see 75-80 patients/week, I work 5 days per week. I do minimal hosp work and will probably give that up. We draw blood, we bill for labs done at quest if the reimbursement is good enough,do ecgs, I do minor skin surgery in the office. We have 10,500sq ft office for 1.5 docsLarry Lindeman MDLarry Lindeman MD Larry Lindeman,How do you make nearly 150?  How many pts do you see per day, how many days per week, geographic location and malpractice insurance.  I am finding it difficult to see how I would ever make anywhere near that.Naureen Mohamed    

[Guest guest]

I wrote an article a couple of years ago for the NM AAFP journal discussing physician burn out - and asked many doctors at what point in their day they experienced "empathy burn out" That's the point where we no longer care about the stories we're hearing and so we really are no longer capable of productive collaboration. Everyone gave me similar numbers "12-15 a day, after that I just want to get out of the room and go home." For all of us in regular practices, that was just the halfway point in the day. So, yes I can see many more patients per day, but I'm not sure how helpful those interactions really are. And that is the point of this IMP stuff.  

[Guest guest]

I think you were right. Me, being a female, I don't have these

problems. The only lesbian patient I have comes always with her partner

(which is my patient also). I think I will need some part time

secretary in 6 months or so. Today is my 1st year anniversary. I

thought I would need some prozac, but it was not the case. My poor

husband was better than prozac. )

On Sep 17, 2006, at 4:36 PM, Lamy patient from residencyrry Lindeman

wrote:

> I started with an assistant from day 1. As a male I thought it would

> be good to have a female around when I do paps. I also thought that I

> would grow pretty quickly because I had a small practice at the

> residency where I had been working. The old practice ended up not

> telling my patients so it took them a while to find me so the first

> couple of months were pretty slow. 

>

> Larry Lindeman MD

>

>

>> Larry, did you start alone or you had a medical assistant from day 1

>> ? 

>>

>>

>>> I think that the 3 most important things that are helping me are: 1)

>>> Having a good medical assistant to help with the many chores that

>>> need to be done in the office allowing me to see 16-18 patients per

>>> day. 2) Having a good outside biller who I talk to at least once a

>>> week on coding or reimbursement issues. 3) Learning everything I can

>>> about coding. Do you know how much you can reimbursed for splint

>>> application or using a global fracture code for a broken toe or rib

>>> instead of an e & m code?

>>>

>>> For many people it is the right choice to start with the solo solo

>>> model to minimize start up costs. However after a practice starts to

>>> get busy many people might want to expand to having an assistant

>>> even though this means a higher overhead. I think that you might

>>> find medicine more enjoyable and profitable spending more time with

>>> patients and a little less on paper work. Limiting your staff to 1

>>> or 1.5 still keeps the practice small enough that you will still

>>> know every patient well. 

>>> Another thing that I am just starting this week is comparing  the

>>> reimbursement of every insurance company. In January we are going to

>>> stop participating with the 2 lowest payors

>>>

>>> I practice in Chicago, Malpractice is $30,000/yr. I see 75-80

>>> patients/week, I work 5 days per week. I do minimal hosp work and

>>> will probably give that up. We draw blood, we bill for labs done at

>>> quest if the reimbursement is good enough,do ecgs, I do minor skin

>>> surgery in the office. We have 10,500sq ft office for 1.5 docs

>>>

>>> Larry Lindeman MD

>>>

>>> Larry Lindeman MD

>>>

>>>

>>>>

>>>> Larry Lindeman,

>>>> How do you make nearly 150?  How many pts do you see per day, how

>>>> many days per week, geographic location and malpractice insurance. 

>>>> I am finding it difficult to see how I would ever make anywhere

>>>> near that.

>>>> Naureen Mohamed

>>>>

>>>

>>>    

>

>

>

[Guest guest]

Now, that makes sense. And from what you and Gordon have describes really

demonstrates your low-overhead, efficient model. It's not much space for

1.5 docs and staff.

Tim

> My officer is 1,050 sq ft

> Larry Lindeman

>

>

>> Thanks for the explanation... really great points you are making.

>>

>> But, please tell me your office is 1,500 sq ft and not 10,500! ;-)

>> Because your overhead in Chicago for 10,500 sq ft would be huge I

>> imagine.

>> LOL

>>

>> Tim

>>

>> > I think that the 3 most important things that are helping me are: 1)

>> Having a good medical assistant to help with the many chores that

>> need

>> > to be done in the office allowing me to see 16-18 patients per

>> day. 2)

>> > Having a good outside biller who I talk to at least once a week on

>> coding or reimbursement issues. 3) Learning everything I can about

>> coding. Do you know how much you can reimbursed for splint

>> application

>> > or using a global fracture code for a broken toe or rib instead

>> of an

>> > e & m code?

>> >

>> > For many people it is the right choice to start with the solo solo

>> model to minimize start up costs. However after a practice starts to

>> get busy many people might want to expand to having an assistant

>> even

>> > though this means a higher overhead. I think that you might find

>> medicine more enjoyable and profitable spending more time with

>> patients and a little less on paper work. Limiting your staff to

>> 1 or

>> > 1.5 still keeps the practice small enough that you will still know

>> every patient well.

>> > Another thing that I am just starting this week is comparing the

>> reimbursement of every insurance company. In January we are going to

>> stop participating with the 2 lowest payors

>> >

>> > I practice in Chicago, Malpractice is $30,000/yr. I see 75-80

>> > patients/week, I work 5 days per week. I do minimal hosp work and

>> will

>> > probably give that up. We draw blood, we bill for labs done at quest

>> if the reimbursement is good enough,do ecgs, I do minor skin surgery

>> in the office. We have 10,500sq ft office for 1.5 docs

>> >

>> > Larry Lindeman MD

>> >

>> > Larry Lindeman MD

>> >

>> >

>> >>

>> >> Larry Lindeman,

>> >> How do you make nearly 150? How many pts do you see per day, how

>> many days per week, geographic location and malpractice insurance.

>> I am finding it difficult to see how I would ever make anywhere

>> near

>> >> that.

>> >> Naureen Mohamed

>> >>

>> >>

>>

>>

>>

[Guest guest]

We have about 1200 ft.² for two doctors (1.5 doctors). This mandates

no specific private doctors offices (which is the way I set it up

purposely-you get very good visual and auditory control of how the

flow in your office is proceeding). And guess what-I think we still

have wasted space!

Lou

> >> >

> >> >>

> >> >> Larry Lindeman,

> >> >> How do you make nearly 150? How many pts do you see per day,

how

> >> many days per week, geographic location and malpractice

insurance.

> >> I am finding it difficult to see how I would ever make anywhere

> >> near

> >> >> that.

> >> >> Naureen Mohamed

> >> >>

> >> >>

> >>

> >>

> >>

>