Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on "financials." I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I average 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00Sent: Monday, September 18, 2006 3:09 PMTo: Subject: Re: money Dr Ellsworth, Dr Brock and others,Sorry for long post and getting back a little late.I should have clarified that my days are 11 or 12 hr days.I do Family Medicine and Urgent Care.I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri.The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change).All I do is treat the patients.At the end of the day my eyes are often bleary from too much computer surfing.I kept my old job for moon lighting 2 days a month.I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr).These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27)At the end of the day I feel satisfied that I did a good job and kept my skills up.Total salary approx 127,000/ yr. (104,000 + 23,000)Working 180 days per year. Not including approx 22 days paid leave per year.What does an average Family Medicine Doctor make?http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000052.htmlThe summary is below:Base Pay only:25 th Percentile – 137,803.Median - 156,119.75th Percentile - 183,281.Total Cash Compensation (Base + Bonus)25th percentile – 140,838.Median – 160,044.75th percentile - 188541Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701.The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include:Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %).Of course this web site could have incorrect information and things do change constantly.I feel these numbers are quite accurate. Benefits do count (20 % conservatively).I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift).There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are1) Average IMP take home is below average non IMP in spite of working hard.This may change though as "The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled".2) For the Average non IMP: Financial reward is a great motivator for working hard.This is why they keep up with all the extra hours and lack of family time.3) It boils down to time and money. Do you want more time off or more money?For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder).4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP.6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life.7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end.One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it).These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great.Uday Mehta, Age 46.Bellevue, WA> >> > I have been thinking about the same things lately, Larry. > Unfortunately, I> > only paid myself $45,000 last year (my second year of solo, low > volume> > practice) However, my numbers are still not as good as yours. I > think I> > average about 8 patients a day. But I also only work about 36 > hours a week.> > I am definately curious about what others have to say on this issue> > Marie Christensen MD> > > > _____ > > > > From: Practiceimprovement <mailto:%40yahoogroups.com>> 1 > > [mailto:Practiceimprovement> <mailto:%40yahoogroups.com> 1 ] On Behalf> Of > Brock DO> > Sent: Wednesday, September 13, 2006 2:23 PM> > To: Practiceimprovement <mailto:%40yahoogroups.com>> 1 > > Subject: RE: money> > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full> > gamut of FP & usually high volumes. The typical FP still likely > does AM> > inpatient work, sees 30+ office patients, sees nursing home > patients, works> > 60 hrs per week. It is hard to expect an IMP low volume practice > to match> > that because I personally am not working nearly that hard! I do > not do> > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 -> > 15 pts/day), so of course I am not going to make $160,000, but > that is a> > lifestyle tradeoff have chosen. At least that is the way I have> > rationalized not making "average" income in my mind.> > > > > > > > > > > > > > > > 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> >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. 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 > > $160.000/yr. How many of you are making more than the median FP > > income and what are you doing to make that much. If the > micropractice > > model is not capable of producing enough income to provide at > least > > the median income it is probably not going to be a viable model. > > Larry Lindeman MD > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. -----Original Message----- From: [mailto: ] On Behalf Of Gwen Hanson Sent: Monday, September 18, 2006 11:15 PM To: Subject: RE: Re: money and ODLE Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on " financials. " I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth <jellsworth92> wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I avera! ge 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group ! is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00 Sent: Monday, September 18, 2006 3:09 PM To: S! ubject: Re: money Dr Ellsworth, Dr Brock and others, Sorry for long post and getting back a little late. I should have clarified that my days are 11 or 12 hr days. I do Family Medicine and Urgent Care. I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri. The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change). All I do is treat the patients. At the end of the day my eyes are often bleary from too much computer surfing. I kept my old job for moon lighting 2 days a month. I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr). These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27) At the end of the day I feel satisfied that I did a good job and kept my skills up. Total salary approx 127,000/ yr. (104,000 + 23,000) Working 180 days per year. Not including approx 22 days paid leave per year. What does an average Family Medicine Doctor make? http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_nation al_HC07000052.html The summary is below: Base Pay only: 25 th Percentile – 137,803. Median - 156,119. 75th Percentile - 183,281. Total Cash Compensation (Base + Bonus) 25th percentile – 140,838. Median – 160,044. 75th percentile - 188541 Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701. The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include: Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %). Of course this web site could have incorrect information and things do change constantly. I feel these numbers are quite accurate. Benefits do count (20 % conservatively). I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift). There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are 1) Average IMP take home is below average non IMP in spite of working hard. This may change though as " The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled " . 2) For the Average non IMP: Financial reward is a great motivator for working hard. This is why they keep up with all the extra hours and lack of family time. 3) It boils down to time and money. Do you want more time off or more money? For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder). 4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP. 6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life. 7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end. One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it). These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great. Uday Mehta, Age 46. Bellevue, WA > > > > I have been thinking about the same things lately, Larry. > Unfortunately, I > > only paid myself $45,000 last year (my second year of solo, low > volume > > practice) However, my numbers are still not as good as yours. I > think I > > average about 8 patients a day. But I also only work about 36 > hours a week. > > I am definately curious about what others have to say on this issue > > Marie Christensen MD > > > > _____ > > > > From: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > [mailto:Practiceimprovement > <mailto:%40yahoogroups.com> 1 ] On Behalf > Of > Brock DO > > Sent: Wednesday, September 13, 2006 2:23 PM > > To: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > Subject: RE: money > > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full > > gamut of FP & usually high volumes. The typical FP still likely > does AM > > inpatient work, sees 30+ office patients, sees nursing home > patients, works > > 60 hrs per week. It is hard to expect an IMP low volume practice > to match > > that because I personally am not working nearly that hard! I do > not do > > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 - > > 15 pts/day), so of course I am not going to make $160,000, but > that is a > > lifestyle tradeoff have chosen. At least that is the way I have > > rationalized not making " average " income in my mind. > > > > > > > > > > > > > > > > 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 > > $160.000/yr. How many of you are making more than the median FP > > income and what are you doing to make that much. If the > micropractice > > model is not capable of producing enough income to provide at > least > > the median income it is probably not going to be a viable model. > > Larry Lindeman MD > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 jessica, Have you had any problems being outside the bell curve for coding? Some docs have gotten nasty letters for doing too many 99214's even when the documentation warrants the code. Just curious. Locke, MDBasalt, COUniversity of Kansas Medical School 1991Eau (WI) Family Medicine Residency 19945 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany]Alpine Medical Group -- Private Group Practice since 1999http://www.alpinemedical.mdJob Share w/ WifeAMG went independent from hospital MSO 10/04AMG made downpayment on Centricity EMR 12/04AMG went "live" with Centricity EMR 15 April 2005 From: [mailto: ] On Behalf Of EllsworthSent: Tuesday, September 19, 2006 9:10 AMTo: Subject: RE: Re: money and ODLE I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DOSent: Tuesday, September 19, 2006 7:43 AMTo: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. 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> >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I always get a lot of backlash whenever I bring up the coding curves, but it makes me suspicious whenever someone says “I rarely code anything less than a level 4 visit.” If someone has a skin lesion they want looked at, you see it & decide in 2 seconds it is a wart & needs nothing other than reassurance how do you code that? That is a 99212 any way you slice it. I think the point most people miss when it comes to coding is the medical decision making part. They tend to say to themselves that “I only need 2 out of the 3 for an established code, & my history & exam met that, so I’m set.” The error therein is that medical decision has always been intended as the basis for choosing a code. Yes, technically the chart might pass an audit if you document a long history & long exam on every visit, but you will be “flagged” as an upcoder if the medical decision making criteria is not there. They will forever be watching you more closely. Now, granted a moderate complexity medical decision making is not too difficult to obtain (and code a level 4), but a level 5 visit is a whole other ball game. Every coding lecture I have been to says the same thing: be very wary of using a level 5 code more than on rare occasion. Most non IMP docs do the work of a level 4 visit, chart a level 2 visit, and code it a level 3 visit, while we generally do the work of a level 4 AND code a level 4. Still, many visits should be a level 3 based on medical decision making. By the way, I have never coded a 99205, ever. I’ve coded 99215 maybe 5 times total. Am I undercoding? Maybe, but I doubt it. 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 How do you code a presurgical clearance eval for medicare ? I am doing my billing and have 2 new patients who came for presurgical clearance from ortho and ophtalmo. > I always get a lot of backlash whenever I bring up the coding curves, > but it makes me suspicious whenever someone says “I rarely code > anything less than a level 4 visit.â€Â If someone has a skin lesion > they want looked at, you see it & decide in 2 seconds it is a wart & > needs nothing other than reassurance how do you code that? That is a > 99212 any way you slice it. I think the point most people miss when > it comes to coding is the medical decision making part. They tend to > say to themselves that “I only need 2 out of the 3 for an established > code, & my history & exam met that, so I’m set.â€Â The error therein is > that medical decision has always been intended as the basis for > choosing a code. Yes, technically the chart might pass an audit if > you document a long history & long exam on every visit, but you will > be “flagged†as an upcoder if the medical decision making criteria is > not there. They will forever be watching you more closely. Now, > granted a moderate complexity medical decision making is not too > difficult to obtain (and code a level 4), but a level 5 visit is a > whole other ball game. Every coding lecture I have been to says the > same thing: be very wary of using a level 5 code more than on rare > occasion. Most non IMP docs do the work of a level 4 visit, chart a > level 2 visit, and code it a level 3 visit, while we generally do the > work of a level 4 AND code a level 4. Still, many visits should be a > level 3 based on medical decision making. By the way, I have never > coded a 99205, ever. I’ve coded 99215 maybe 5 times total. Am I > undercoding? Maybe, but I doubt it. > >  > > > >  > > 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 >> > > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I usually use both their problem codes (ie, HTN, diabetes, obesity, COPD, etc) as well as code v72.83 (preoperative exam, other). I believe I have generally listed the v72.83 code first & it does get paid (but certainly not $250 as has been recently quoted here!). If I do a related EKG I attach a -25 modifier to the 99243 consult code. Basically, if any other doctor sends you a patient for “clearance”, opinion, etc., that is a consult. You have to send a letter/note back to the referring physician (usually the “H & P” with a discussion section is all I send). 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 Thank you. Do you have to use modifier 25 for any EKG, or just the one for presurgical ? > I usually use both their problem codes (ie, HTN, diabetes, obesity, > COPD, etc) as well as code v72.83 (preoperative exam, other). I > believe I have generally listed the v72.83 code first & it does get > paid (but certainly not $250 as has been recently quoted here!). If I > do a related EKG I attach a -25 modifier to the 99243 consult code. > Basically, if any other doctor sends you a patient for “clearanceâ€, > opinion, etc., that is a consult. You have to send a letter/note back > to the referring physician (usually the “H & P†with a discussion > section is all I send). > >  > > > >  > > 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 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I'm jealous of your average reimbursement. We need to help the rest of the country figure out how to support excellent practices so as to avoid all good docs moving to the northwest! Gordon At 12:15 AM 9/19/2006, you wrote: >Hi , > >Thanks for being a former PTA Co-president at Odle! My youngest >daughter is there along with Uday's nephew! Also, I can't believe >you're seeing 15-20 patients a day with no help. How do you do >this??? If you give me your efficiency secrets, I'll try to put >them in the WIKI. > >I just looked at my IMP numbers in Bellevue, WA after being open 21 >months. I'm purposely keeping my hours down to spend time with my >husband and 3 teenage daughters. I used Gordon's spread sheet which >is an awesome financial snapshot for those that want to know but >don't spend much time on " financials. " > >I'm being reimbursed an average of $137 per visit, I see a whopping >22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! > >Gwen Hanson > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2006 Report Share Posted September 19, 2006 I personally use the 25 modifier anytime I do any procedure, EKG, PFT, etc in addition to the E/M, though some would argue that it is not needed that often. 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 > > $160.000/yr. How many of you are making more than the median FP > > income and what are you doing to make that much. If the > micropractice > > model is not capable of producing enough income to provide at > least > > the median income it is probably not going to be a viable model. > > Larry Lindeman MD > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2006 Report Share Posted September 20, 2006 I haven’t, knock on wood. Blue Cross has asked for pt records twice in past 6 months, otherwise I haven’t heard a word. UHC has decided I’m a preferred evidence-based provider because of some numbers they crunched. From: [mailto: ] On Behalf Of Locke's in Colorado Sent: Tuesday, September 19, 2006 9:52 AM To: Subject: RE: Re: money and ODLE jessica, Have you had any problems being outside the bell curve for coding? Some docs have gotten nasty letters for doing too many 99214's even when the documentation warrants the code. Just curious. Locke, MD Basalt, CO University of Kansas Medical School 1991 Eau (WI) Family Medicine Residency 1994 5 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany] Alpine Medical Group -- Private Group Practice since 1999 http://www.alpinemedical.md Job Share w/ Wife AMG went independent from hospital MSO 10/04 AMG made downpayment on Centricity EMR 12/04 AMG went " live " with Centricity EMR 15 April 2005 From: [mailto: ] On Behalf Of Ellsworth Sent: Tuesday, September 19, 2006 9:10 AM To: Subject: RE: Re: money and ODLE I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. -----Original Message----- From: [mailto: ] On Behalf Of Gwen Hanson Sent: Monday, September 18, 2006 11:15 PM To: Subject: RE: Re: money and ODLE Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on " financials. " I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth <jellsworth92> wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I avera! ge 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group ! is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00 Sent: Monday, September 18, 2006 3:09 PM To: S! ubject: Re: money Dr Ellsworth, Dr Brock and others, Sorry for long post and getting back a little late. I should have clarified that my days are 11 or 12 hr days. I do Family Medicine and Urgent Care. I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri. The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change). All I do is treat the patients. At the end of the day my eyes are often bleary from too much computer surfing. I kept my old job for moon lighting 2 days a month. I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr). These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27) At the end of the day I feel satisfied that I did a good job and kept my skills up. Total salary approx 127,000/ yr. (104,000 + 23,000) Working 180 days per year. Not including approx 22 days paid leave per year. What does an average Family Medicine Doctor make? http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_nation al_HC07000052.html The summary is below: Base Pay only: 25 th Percentile – 137,803. Median - 156,119. 75th Percentile - 183,281. Total Cash Compensation (Base + Bonus) 25th percentile – 140,838. Median – 160,044. 75th percentile - 188541 Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701. The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include: Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %). Of course this web site could have incorrect information and things do change constantly. I feel these numbers are quite accurate. Benefits do count (20 % conservatively). I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift). There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are 1) Average IMP take home is below average non IMP in spite of working hard. This may change though as " The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled " . 2) For the Average non IMP: Financial reward is a great motivator for working hard. This is why they keep up with all the extra hours and lack of family time. 3) It boils down to time and money. Do you want more time off or more money? For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder). 4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP. 6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life. 7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end. One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it). These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great. Uday Mehta, Age 46. Bellevue, WA > > > > I have been thinking about the same things lately, Larry. > Unfortunately, I > > only paid myself $45,000 last year (my second year of solo, low > volume > > practice) However, my numbers are still not as good as yours. I > think I > > average about 8 patients a day. But I also only work about 36 > hours a week. > > I am definately curious about what others have to say on this issue > > Marie Christensen MD > > > > _____ > > > > From: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > [mailto:Practiceimprovement > <mailto:%40yahoogroups.com> 1 ] On Behalf > Of > Brock DO > > Sent: Wednesday, September 13, 2006 2:23 PM > > To: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > Subject: RE: money > > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full > > gamut of FP & usually high volumes. The typical FP still likely > does AM > > inpatient work, sees 30+ office patients, sees nursing home > patients, works > > 60 hrs per week. It is hard to expect an IMP low volume practice > to match > > that because I personally am not working nearly that hard! I do > not do > > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 - > > 15 pts/day), so of course I am not going to make $160,000, but > that is a > > lifestyle tradeoff have chosen. At least that is the way I have > > rationalized not making " average " income in my mind. > > > > > > > > > > > > > > > > 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2006 Report Share Posted September 20, 2006 There's a piece in the coding articles in Family Practice Management - try searching on the site. It's a 99243 or 44 or 45 depedning on the patient, no distinction between new and old. This is our one big chance to charge for consults, like specialists do, which is probably why I get such a kick out of it. The ICD 9 is V72.81-V72.84, depending on the case, followed by the ICD 9 for the reason for the surgery, followed by ICD-9's for disease conditions, such as heart disease, pulmonary disease, etc. It does pay very well. (At least that's the way I code it.)How do you code a presurgical clearance eval for medicare ? I am doing my billing and have 2 new patients who came for presurgical clearance from ortho and ophtalmo. I always get a lot of backlash whenever I bring up the coding curves, but it makes me suspicious whenever someone says “I rarely code anything less than a level 4 visit.â€Â If someone has a skin lesion they want looked at, you see it & decide in 2 seconds it is a wart & needs nothing other than reassurance how do you code that? That is a 99212 any way you slice it. I think the point most people miss when it comes to coding is the medical decision making part. They tend to say to themselves that “I only need 2 out of the 3 for an established code, & my history & exam met that, so I’m set.â€Â The error therein is that medical decision has always been intended as the basis for choosing a code. Yes, technically the chart might pass an audit if you document a long history & long exam on every visit, but you will be “flagged†as an upcoder if the medical decision making criteria is not there. They will forever be watching you more closely. Now, granted a moderate complexity medical decision making is not too difficult to obtain (and code a level 4), but a level 5 visit is a whole other ball game. Every coding lecture I have been to says the same thing: be very wary of using a level 5 code more than on rare occasion. Most non IMP docs do the work of a level 4 visit, chart a level 2 visit, and code it a level 3 visit, while we generally do the work of a level 4 AND code a level 4. Still, many visits should be a level 3 based on medical decision making. By the way, I have never coded a 99205, ever. I’ve coded 99215 maybe 5 times total. Am I undercoding? Maybe, but I doubt it.  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 > > >  > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2006 Report Share Posted September 20, 2006 When I spend 90 minutes with a patient, I charge a 99354 and get the full 91.70 which I charge from most but not all insurers in addition to the 99214. Also, when I do a level visit along with a physical I code 99354-25 and 99396 or whatever the physical exam code is. Most insurers pay for both. In fact, Aetna went BACK and paid for both in patients billed that way before Feb 06 when then started covering both. So I'm spending a LOT of time with many patients and often getting paid for it. I NEVER charge 99215...too scared. Gwen Guinn wrote: There's a piece in the coding articles in Family Practice Management - try searching on the site. It's a 99243 or 44 or 45 depedning on the patient, no distinction between new and old. This is our one big chance to charge for consults, like specialists do, which is probably why I get such a kick out of it. The ICD 9 is V72.81-V72.84, depending on the case, followed by the ICD 9 for the reason for the surgery, followed by ICD-9's for disease conditions, such as heart disease, pulmonary disease, etc. It does pay very well. (At least that's the way I code it.) How do you code a presurgical clearance eval for medicare ? I am doing my billing and have 2 new patients who came for presurgical clearance from ortho and ophtalmo. I always get a lot of backlash whenever I bring up the coding curves, but it makes me suspicious whenever someone says “I rarely code anything less than a level 4 visit.â€Â If someone has a skin lesion they want looked at, you see it & decide in 2 seconds it is a wart & needs nothing other than reassurance how do you code that? That is a 99212 any way you slice it. I think the point most people miss when it comes to coding is the medical decision making part. They tend to say to themselves that “I only need 2 out of the 3 for an established code, & my history & exam met that, so I’m set.â€Â The error therein is that medical decision has always been intended as the basis for choosing a code. Yes, technically the chart might pass an audit if you document a long history & long exam on every visit, but you will be “flagged†as an upcoder if the medical decision making criteria is not there. They will forever be watching you more closely. Now, granted a moderate complexity medical decision making is not too difficult to obtain (and code a level 4), but a level 5 visit is a whole other ball game. Every coding lecture I have been to says the same thing: be very wary of using a level 5 code more than on rare occasion. Most non IMP docs do the work of a level 4 visit, chart a level 2 visit, and code it a level 3 visit, while we generally do the work of a level 4 AND code a level 4. Still, many visits should be a level 3 based on medical decision making. By the way, I have never coded a 99205, ever. I’ve coded 99215 maybe 5 times total. Am I undercoding? Maybe, but I doubt it.   -----Original Message----- From: [mailto: ] On Behalf Of Ellsworth Sent: Tuesday, September 19, 2006 11:10 AM To: Subject: RE: Re: money and ODLE  I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out,  And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies.  As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes.   I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up†before and after. So It is still fun, but the fun definitely wanes as the hour progresses.  That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes.   From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE  I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12   99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled.   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  > >  >  > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2006 Report Share Posted September 20, 2006 I just charged my first 99215 yesterday, ever, ever ever in 12 yrs of practice. My patient is a 40 yr old who has had 8 cva's since April, uncontrolled htn and dm and hyperlipidemia, recent fall with right wrist pain, insomnia and some paperwork to be completed. I used my stat e and m coder on my PDA and decided to go for it. I remember hearing a pro coder saying at a lecture that something like 5% or 10% of your codes should be 99215, same for 99211. I do occasionally code a 99211 (its not NEVER), so , I decided to dive in. I'll let you know if I get paid or if it triggers the apocalypse. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2006 Report Share Posted September 20, 2006 5% 99215 visits may be appropriate, but not 10% in my opinion. Also, I thought a 99211 was for a non-physician visit ONLY (ie, nurse visit) & should not even be used if the doctor entered the exam room. I don’t have a nurse/MA/LPN & so I do not think I even have 99211 on my superbill. However, I do occasionally code 99212/99202. I know Anthem BCBS requires notes be sent automatically if you code a level 5 visit before they will pay it. Re: Re: money and ODLE I just charged my first 99215 yesterday, ever, ever ever in 12 yrs of practice. My patient is a 40 yr old who has had 8 cva's since April, uncontrolled htn and dm and hyperlipidemia, recent fall with right wrist pain, insomnia and some paperwork to be completed. I used my stat e and m coder on my PDA and decided to go for it. I remember hearing a pro coder saying at a lecture that something like 5% or 10% of your codes should be 99215, same for 99211. I do occasionally code a 99211 (its not NEVER), so , I decided to dive in. I'll let you know if I get paid or if it triggers the apocalypse. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 , I’m chiming in as I’m in CO like you, and code similarly to , although I do a lot more -15s and less -04/-05’s than she dose. I haven’t been audited yet, but am expecting it. I’m only contracted with Kaiser, United, and Pacificare. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Locke's in Colorado Sent: Tuesday, September 19, 2006 10:52 AM To: Subject: RE: Re: money and ODLE jessica, Have you had any problems being outside the bell curve for coding? Some docs have gotten nasty letters for doing too many 99214's even when the documentation warrants the code. Just curious. Locke, MD Basalt, CO University of Kansas Medical School 1991 Eau (WI) Family Medicine Residency 1994 5 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany] Alpine Medical Group -- Private Group Practice since 1999 http://www.alpinemedical.md Job Share w/ Wife AMG went independent from hospital MSO 10/04 AMG made downpayment on Centricity EMR 12/04 AMG went " live " with Centricity EMR 15 April 2005 From: [mailto: ] On Behalf Of Ellsworth Sent: Tuesday, September 19, 2006 9:10 AM To: Subject: RE: Re: money and ODLE I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. -----Original Message----- From: [mailto: ] On Behalf Of Gwen Hanson Sent: Monday, September 18, 2006 11:15 PM To: Subject: RE: Re: money and ODLE Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on " financials. " I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth <jellsworth92> wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I avera! ge 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group ! is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00 Sent: Monday, September 18, 2006 3:09 PM To: S! ubject: Re: money Dr Ellsworth, Dr Brock and others, Sorry for long post and getting back a little late. I should have clarified that my days are 11 or 12 hr days. I do Family Medicine and Urgent Care. I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri. The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change). All I do is treat the patients. At the end of the day my eyes are often bleary from too much computer surfing. I kept my old job for moon lighting 2 days a month. I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr). These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27) At the end of the day I feel satisfied that I did a good job and kept my skills up. Total salary approx 127,000/ yr. (104,000 + 23,000) Working 180 days per year. Not including approx 22 days paid leave per year. What does an average Family Medicine Doctor make? http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_nation al_HC07000052.html The summary is below: Base Pay only: 25 th Percentile – 137,803. Median - 156,119. 75th Percentile - 183,281. Total Cash Compensation (Base + Bonus) 25th percentile – 140,838. Median – 160,044. 75th percentile - 188541 Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701. The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include: Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %). Of course this web site could have incorrect information and things do change constantly. I feel these numbers are quite accurate. Benefits do count (20 % conservatively). I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift). There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are 1) Average IMP take home is below average non IMP in spite of working hard. This may change though as " The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled " . 2) For the Average non IMP: Financial reward is a great motivator for working hard. This is why they keep up with all the extra hours and lack of family time. 3) It boils down to time and money. Do you want more time off or more money? For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder). 4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP. 6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life. 7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end. One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it). These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great. Uday Mehta, Age 46. Bellevue, WA > > > > I have been thinking about the same things lately, Larry. > Unfortunately, I > > only paid myself $45,000 last year (my second year of solo, low > volume > > practice) However, my numbers are still not as good as yours. I > think I > > average about 8 patients a day. But I also only work about 36 > hours a week. > > I am definately curious about what others have to say on this issue > > Marie Christensen MD > > > > _____ > > > > From: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > [mailto:Practiceimprovement > <mailto:%40yahoogroups.com> 1 ] On Behalf > Of > Brock DO > > Sent: Wednesday, September 13, 2006 2:23 PM > > To: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > Subject: RE: money > > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full > > gamut of FP & usually high volumes. The typical FP still likely > does AM > > inpatient work, sees 30+ office patients, sees nursing home > patients, works > > 60 hrs per week. It is hard to expect an IMP low volume practice > to match > > that because I personally am not working nearly that hard! I do > not do > > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 - > > 15 pts/day), so of course I am not going to make $160,000, but > that is a > > lifestyle tradeoff have chosen. At least that is the way I have > > rationalized not making " average " income in my mind. > > > > > > > > > > > > > > > > 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 > > $160.000/yr. How many of you are making more than the median FP > > income and what are you doing to make that much. If the > micropractice > > model is not capable of producing enough income to provide at > least > > the median income it is probably not going to be a viable model. > > Larry Lindeman MD > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 , I’m chiming in as I’m in CO like you, and code similarly to , although I do a lot more -15s and less -04/-05’s than she dose. I haven’t been audited yet, but am expecting it. I’m only contracted with Kaiser, United, and Pacificare. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Locke's in Colorado Sent: Tuesday, September 19, 2006 10:52 AM To: Subject: RE: Re: money and ODLE jessica, Have you had any problems being outside the bell curve for coding? Some docs have gotten nasty letters for doing too many 99214's even when the documentation warrants the code. Just curious. Locke, MD Basalt, CO University of Kansas Medical School 1991 Eau (WI) Family Medicine Residency 1994 5 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany] Alpine Medical Group -- Private Group Practice since 1999 http://www.alpinemedical.md Job Share w/ Wife AMG went independent from hospital MSO 10/04 AMG made downpayment on Centricity EMR 12/04 AMG went " live " with Centricity EMR 15 April 2005 From: [mailto: ] On Behalf Of Ellsworth Sent: Tuesday, September 19, 2006 9:10 AM To: Subject: RE: Re: money and ODLE I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. -----Original Message----- From: [mailto: ] On Behalf Of Gwen Hanson Sent: Monday, September 18, 2006 11:15 PM To: Subject: RE: Re: money and ODLE Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on " financials. " I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth <jellsworth92> wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I avera! ge 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group ! is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00 Sent: Monday, September 18, 2006 3:09 PM To: S! ubject: Re: money Dr Ellsworth, Dr Brock and others, Sorry for long post and getting back a little late. I should have clarified that my days are 11 or 12 hr days. I do Family Medicine and Urgent Care. I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri. The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change). All I do is treat the patients. At the end of the day my eyes are often bleary from too much computer surfing. I kept my old job for moon lighting 2 days a month. I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr). These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27) At the end of the day I feel satisfied that I did a good job and kept my skills up. Total salary approx 127,000/ yr. (104,000 + 23,000) Working 180 days per year. Not including approx 22 days paid leave per year. What does an average Family Medicine Doctor make? http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_nation al_HC07000052.html The summary is below: Base Pay only: 25 th Percentile – 137,803. Median - 156,119. 75th Percentile - 183,281. Total Cash Compensation (Base + Bonus) 25th percentile – 140,838. Median – 160,044. 75th percentile - 188541 Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701. The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include: Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %). Of course this web site could have incorrect information and things do change constantly. I feel these numbers are quite accurate. Benefits do count (20 % conservatively). I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift). There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are 1) Average IMP take home is below average non IMP in spite of working hard. This may change though as " The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled " . 2) For the Average non IMP: Financial reward is a great motivator for working hard. This is why they keep up with all the extra hours and lack of family time. 3) It boils down to time and money. Do you want more time off or more money? For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder). 4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP. 6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life. 7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end. One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it). These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great. Uday Mehta, Age 46. Bellevue, WA > > > > I have been thinking about the same things lately, Larry. > Unfortunately, I > > only paid myself $45,000 last year (my second year of solo, low > volume > > practice) However, my numbers are still not as good as yours. I > think I > > average about 8 patients a day. But I also only work about 36 > hours a week. > > I am definately curious about what others have to say on this issue > > Marie Christensen MD > > > > _____ > > > > From: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > [mailto:Practiceimprovement > <mailto:%40yahoogroups.com> 1 ] On Behalf > Of > Brock DO > > Sent: Wednesday, September 13, 2006 2:23 PM > > To: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > Subject: RE: money > > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full > > gamut of FP & usually high volumes. The typical FP still likely > does AM > > inpatient work, sees 30+ office patients, sees nursing home > patients, works > > 60 hrs per week. It is hard to expect an IMP low volume practice > to match > > that because I personally am not working nearly that hard! I do > not do > > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 - > > 15 pts/day), so of course I am not going to make $160,000, but > that is a > > lifestyle tradeoff have chosen. At least that is the way I have > > rationalized not making " average " income in my mind. > > > > > > > > > > > > > > > > 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 I have never had any complaints.No downgrading or coding, NO audits. And I would welcome them. It is so Easy to spend 45 minutes with new patient, especially if you actually listen to the patient and they realize they will be heard. I struggle with only coding 99204, I should be using 05 more frequently. For instance a patient typical yesterday, female age 61 establishing, her codes- Hypothyroid, Plantar Facititis, Reflux, Allergic rhinitis, dermatitis, fatigue, menopause disorder, osteoporosis –cannot tolerate bisphonates. Something has to be really simple to only spend 15 minutes on. With nothing else happening in their lives. I believe in the service I offer and its value. From: [mailto: ] On Behalf Of Eads Sent: Thursday, September 21, 2006 8:27 AM To: Subject: RE: Re: money and ODLE , I’m chiming in as I’m in CO like you, and code similarly to , although I do a lot more -15s and less -04/-05’s than she dose. I haven’t been audited yet, but am expecting it. I’m only contracted with Kaiser, United, and Pacificare. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Locke's in Colorado Sent: Tuesday, September 19, 2006 10:52 AM To: Subject: RE: Re: money and ODLE jessica, Have you had any problems being outside the bell curve for coding? Some docs have gotten nasty letters for doing too many 99214's even when the documentation warrants the code. Just curious. Locke, MD Basalt, CO University of Kansas Medical School 1991 Eau (WI) Family Medicine Residency 1994 5 Years in Air Force -- [Laughlin AFB (Del Rio, TX) // Spangdahlem AB, Germany] Alpine Medical Group -- Private Group Practice since 1999 http://www.alpinemedical.md Job Share w/ Wife AMG went independent from hospital MSO 10/04 AMG made downpayment on Centricity EMR 12/04 AMG went " live " with Centricity EMR 15 April 2005 From: [mailto: ] On Behalf Of Ellsworth Sent: Tuesday, September 19, 2006 9:10 AM To: Subject: RE: Re: money and ODLE I do not get reimbursed at 137$ a visit, however I RARELY code a 99213- its always an 04 or 14, sometimes an 05, 15. And I’m working with United Pharm to dispense meds at point of service-a lot of bugs to work out, And because menopause is my life, I also sell bioidentical hormone creams at significant less than pharmacies. As far as efficiency, its no problem getting the patients in and out, avg visit is 30 minutes. I can clean a room, package up lab samples, print the next pt’s results and move to the next room ( I run 2 rooms) in 1-2 minutes. I’m notorious for coming in early or staying late to see a pt, or squeezing them in during lunch. The problem is the work before and after. I don’t take lunch and I “catch-up” before and after. So It is still fun, but the fun definitely wanes as the hour progresses. That’s why I’m participating with the IMP group. I know I am on the burnout track and need to make changes. From: [mailto: ] On Behalf Of Brock DO Sent: Tuesday, September 19, 2006 7:43 AM To: Subject: RE: Re: money and ODLE I wish I lived nearby because I think I really need a fellow IMP to sit down & show me on paper how they are averaging $137/visit? Let’s say I see 50 pt’s in a week. Out of those I might have 10 – 12 99213’s at ~ $50 each, 30 99214’s at ~ $80 each, & maybe a few preventives at ~ $125 each. There might also be one preop consult in the mix, a few new pt E/M’s, a few waived labs, some OMT, etc. As you can see NONE of these visits would pay $137, let alone create an average of anywhere near $137! What am I missing here? How can you possibly be collecting $137 per visit? Do you ever code a 99212 or 99213? Do you have any Medicaid or Medicare? I’m baffled. -----Original Message----- From: [mailto: ] On Behalf Of Gwen Hanson Sent: Monday, September 18, 2006 11:15 PM To: Subject: RE: Re: money and ODLE Hi , Thanks for being a former PTA Co-president at Odle! My youngest daughter is there along with Uday's nephew! Also, I can't believe you're seeing 15-20 patients a day with no help. How do you do this??? If you give me your efficiency secrets, I'll try to put them in the WIKI. I just looked at my IMP numbers in Bellevue, WA after being open 21 months. I'm purposely keeping my hours down to spend time with my husband and 3 teenage daughters. I used Gordon's spread sheet which is an awesome financial snapshot for those that want to know but don't spend much time on " financials. " I'm being reimbursed an average of $137 per visit, I see a whopping 22 patients per week, and my overhead is 15%. Notice 7 weeks vacation! Gwen Hanson Ellsworth <jellsworth92> wrote: Your local county hospital- which one? Overlake was private last time I was there. I raised my kids in Bellevue and the plateau (now Sammamish). (You are talking to the former PTA co-president of Odle Middle School) Before being an IMP I did some moonlighting at a large clinic where I saw 30-35 in 7 hours, or 25 during extended hours at night. I will be able to answer your questions on money after my accountant who I just hired sifts through my financials. And my average working day is 12-14 hours(patient time is 9 hours) As an IMP, I avera! ge 15-20 patients a day without a MA or RN. However, my practice is a joy and I cannot really call it work. Sometimes…microseconds… I feel guilty for being so happy with what I’m doing. I don’t have that twisted gripping in my stomach or pounding in my chest when climbing out or the car and entering the workplace that use to haunt me. The support from Gordon and from this group ! is incalculable. You are not isolated or alone. However, what you have outlined compensation-wise seems excellent. T. Ellsworth, MD sdale, Az From: [mailto: ] On Behalf Of umehta00 Sent: Monday, September 18, 2006 3:09 PM To: S! ubject: Re: money Dr Ellsworth, Dr Brock and others, Sorry for long post and getting back a little late. I should have clarified that my days are 11 or 12 hr days. I do Family Medicine and Urgent Care. I work for my local county hospital 3 days a week (Tuesday, Thursday and every other weekend) and the salary is 104,000. Yes, I am usually off every Mon, Wed and Fri. The clinic is open 1 yr and I see only about 10 pts per day. The max is 20. (This may change). All I do is treat the patients. At the end of the day my eyes are often bleary from too much computer surfing. I kept my old job for moon lighting 2 days a month. I make approximately 23,000 per yr. 80 ($ per hr) x 12 (hrs per shift) x 2(shifts per month) x 12 (months per yr). These are 12 hr days and very busy occasionally seeing up to 40 pts per day. (Mostly 27) At the end of the day I feel satisfied that I did a good job and kept my skills up. Total salary approx 127,000/ yr. (104,000 + 23,000) Working 180 days per year. Not including approx 22 days paid leave per year. What does an average Family Medicine Doctor make? http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_nation al_HC07000052.html The summary is below: Base Pay only: 25 th Percentile – 137,803. Median - 156,119. 75th Percentile - 183,281. Total Cash Compensation (Base + Bonus) 25th percentile – 140,838. Median – 160,044. 75th percentile - 188541 Total Compensation (Base + Bonus + Benefits) Only Median Reported – 205,701. The Total Compensation is an additional 23 % of the Total Cash Compensation and (the Benefits) include: Social security (4%); 401k/ 403 b (3%); Disability (2%); Healthcare (3%); Pension (3%); Time off (8 %). Of course this web site could have incorrect information and things do change constantly. I feel these numbers are quite accurate. Benefits do count (20 % conservatively). I was let go from my old (now moonlighting) job as they could hire new doctors cheaper. I grossed about 155 K working hard (although only approximately 150 shift). There I had excellent benefits, including the extremely enviable defined benefit pension plan. (They pay you a fixed amount till the latter of you or your spouse dies, like social security). Some points I would like to raise are 1) Average IMP take home is below average non IMP in spite of working hard. This may change though as " The expenses for an average non IMP keep on going up whereas with an IMP they are somewhat controlled " . 2) For the Average non IMP: Financial reward is a great motivator for working hard. This is why they keep up with all the extra hours and lack of family time. 3) It boils down to time and money. Do you want more time off or more money? For me I like the fact that I have a lot of time off. I may regret this decision in the future. (I know of no one who went to their death bed wishing they had worked harder). 4) There may be more day to day hassles with an IMP. 5) It is harder to take prolonged/overseas vacation with an IMP. 6) Why do IMP's feel better at the end of the day? It has to do with a sense of worth and a personal need being fulfilled which is hard to measure. It is not a way to be financially wealthy but a great way to contribute to the community and live an honorable life. 7) With an IMP the burn out rate may be low and one can definitely work longer years therefore financially it all may even out in the end. One of the main reasons for me to start an IMP would be to have the opportunity to work till I am able to (maybe even into my eighties). I see a lot of older people who have retired and who miss the intellectual challenge and now have no opportunity to use their skills. (If you don't use it you loose it). These are my views only. I am sure this is not the absolute truth as each case varies. If one is 80 % satisfied/happy with their career and financial situation then it's great. Uday Mehta, Age 46. Bellevue, WA > > > > I have been thinking about the same things lately, Larry. > Unfortunately, I > > only paid myself $45,000 last year (my second year of solo, low > volume > > practice) However, my numbers are still not as good as yours. I > think I > > average about 8 patients a day. But I also only work about 36 > hours a week. > > I am definately curious about what others have to say on this issue > > Marie Christensen MD > > > > _____ > > > > From: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > [mailto:Practiceimprovement > <mailto:%40yahoogroups.com> 1 ] On Behalf > Of > Brock DO > > Sent: Wednesday, September 13, 2006 2:23 PM > > To: Practiceimprovement <mailto:% 40yahoogroups.com> > 1 > > Subject: RE: money > > > > > > > > > > The problem is that the average of $160,000 includes docs that do > the full > > gamut of FP & usually high volumes. The typical FP still likely > does AM > > inpatient work, sees 30+ office patients, sees nursing home > patients, works > > 60 hrs per week. It is hard to expect an IMP low volume practice > to match > > that because I personally am not working nearly that hard! I do > not do > > inpatient, nursing homes, & only work ~ 36 - 40 hrs per week > (averaging 12 - > > 15 pts/day), so of course I am not going to make $160,000, but > that is a > > lifestyle tradeoff have chosen. At least that is the way I have > > rationalized not making " average " income in my mind. > > > > > > > > > > > > > > > > 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 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 I too would certainly code a new pt like that one as a 99204, but the majority of my new pts are not like that. Is that really your “typical” patient? Are you a geriatrician? I have some like that but I also have a lot of acute pharyngitis, URI, rash, sprained ankles, etc. Those are not 99204 type visits. Regardless, my point is that just because you take the time to sit & talk to someone for 45 – 60 minutes does not mean it is a level 4 or 5, it still has to have medical necessity. You still should have a generally bell shaped coding curve, just based on a typical patient population, as not all pts have multiple medical problems. 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 > > > > Quote Link to comment Share on other sites More sharing options...
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