RE: Re: Rural practice issues -- solo/small group survival on low overhead

September 21, 2006

RE survival billing, etc.

Appreciate everyone's openness RE challenges here.

After being open for almost 2 years, but 9.5 miles on the other side of town from where my hospital owned practice is still present, I'm only 1/2 way to where I need to be in volume.

Good news is that I can do this on about 30 pts a week (yep, that's my overhead).

Bad news is that my growth is too slow, or if I want to be depressed, stagnated.

I'm following up on our fellow listservers' ideas, such as getting to the local newspaper's editor to get an article -- think that should help. Prob is that there are several large FP groups near me that seem to manage fairly well, even though I think I do it better as a solo, with continuity outpt, follow up care, availability.

Yes, that's what I continue to promote.

Perhaps the real problem is that I have 2.5 FTEs (1 is my wife, and 1 is clinical staff, with 0.5 FTE for a parttime reception person), as well as outsourcing billing. Possible to insource billing if overhead reliable, but not yet.

Am now exploring additional income streams both traditional (did do workmans comp for several companies, approaching some again now that I'm 2 years out of restrictive covenant, yes, it's legal in my area), as well as regular moonlighting. I'm looking into doing this instead of nursing home, which I fear would pull me into an oncall issue, which would defeat my primary care model.

Anyway, it looks to me like we split up into 2 main groups in our goals to success:

1) Those who have billing difficulties (my ave cash retrieval per visit is $80/visit average).

-- this is most likely fixable with some training, but the higher the volume, the more efficient you'll need to get to track the denials, etc, as well as the more time you'll need to give to this. Think of perhaps a parttime biller to help???

2) Those who have volume problems (too few vs others who are burning out trying to do it "all").

-- sorry to say, I needed to get the word out better. One way would have been to track pts more closely for clinical needs, such as "you needed to get the lipid profile and follow up in office 3 months ago, reschedule?" but can't do this as it's been 1.5 years ago that the pt didn't follow up, and sending a note now is probably really self-defeating.

-- better marketing, either with alternative treatments such as Dr Vargas (?sp) accupunture; or a more effective ad campaign (other than direct to current pt mailing, don't know if there is a better way on a budget).

What do others think?

Dr Matt Levin

Solo with 2 FTE support staff.

Soapware user since 1997.

Opened solo office Dec 2004

Finished residency 1988

East of Pittsburgh, PA

Re: Re: Rural practice issues

Our hospital is a critical access hospital. The hospital already has 2 ob/gyns on salary as well as a general surgeon. The two clinics in town are negotiating a buy out by the hospital in return for being reimbursed on a RVU basis. The idea is that, since it is critical access, the RVU's can be reimbursed higher. The math actually looks good, the egos are another thing! My own micro practice (with one employee...what do I call myself now?) is doing well, but, at 3 1/2 days a week, I'm not pulling in $150,000. My average, once the cash flow improves, should be about $100,000. I'm seeing between 15 and 20 folks a day, plus hospital work and OB. I think that the models vary just like doctor's personalities vary. I am convinced now, after 4.5 months solo, that high producers need a higher overhead to keep them efficient. Those of us who produce by increased E & M codes vs extra patients, need a minimal amount of overhead. Somehow, helping docs figure out which they fit in and helping them succeed in that niche should help all, but especially rural practices. Conventional wisdom said that a 'part-time female FP doing OB' shouldn't be solo. Welp, it seems to be going okay so far.

Gordon,Thank you for the excellent question. This topic represents a large silent segment of our nation's under- or poorly-served, especially seniors.I am solo-solo, opted out of everything and do no hospital work or call. My practice is very small, but I have not advertised since opening up to FP patients in January. But I also do medical acupuncture and part time medical directorship of our local hospice as well as urgent care moonlighting, so I do not depend on my FP practice for my income. I am still developing my operational infrastructure, buying bits and pieces of Soapware, as well as hardware, as I can afford them. I am also getting trained in a variety of integrative/complementary modes of treatments. My angle is that I will offer the benefits of a IMP with the added services of integrative, holistic medicine on a cash-only basis. I suspect I will get a loyal, and hopefully sizeable, following of patients, but I have not launched my ideas yet. Lately I have posted questions about advertising, Dragon speech ware, laptop carts, etc. I am also struggling with charges. My brain says be smart; my heart says be charitable. So I have enlisted the help of a friend and mentor to help me explore many issues of self-identity, spiritual awareness, etc. at the http://www.thefulfilledlife.com/ website.I admit my setup is just about as risky as anyone could make it, but somehow I am OK with it--in fact, I feel confident, but I do not have numbers to back me up--only my gut. Anyway, I am open to ideas and am willing to enlist my practice in any kind of study to not only participate in my own experiment but also watch its unfolding.I do care about my practice, but I do not feel emotionally vulnerable within it. In other words, I have a detached concern. Gordon, if there is a place in your research for practices such as mine, let me know. I feel nearly ready to "launch," but I am still defining what I will do and offer.Thanks again,Charlie Vargas lin, NC-- Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

September 21, 2006

I think that is a reasonable split for any of us who are having troubles.

I'm in a " lean " period (6mos out) and am improving my billing, etc, to

come out of it. But the practice is building on track... now seeing just

over 5 per day. And I'm now getting calls from potential patients who

were told about me by recently new patients! ... another big advantage is

being about 10 miles east of Gordon, who is full, and every week or two

another interested pt is referred from his full practice (thanks Gordon!).

The two points I want to stress are that, in my opinion, if you are trying

to do IMP for the money you likely will need to work really, really hard

or you'll be disappointed b/c primary care is simply not paid for quality

but by quantity based on the standard model... and yes, I'm a pessimist

that insurances will change how they pay us. So I suggest giving awesome

care for the patients' well-being and your professional satisfaction.

Then, see enough patients so most bills can be paid. But if you need more

money, you may need to moonlight or pick up other services (... see

previous examples... for me, I'm trying skin aesthetic laser and skin

treatments).

Now, about promoting ourselves, I think Matt makes a good point that it

may be necessary. Any free marketing is good with the papers, etc. But

promotion is a full time job and you have to be ready to " market " yourself

at any moment if you bump into people at a store or a party, etc. So take

some time and study marketing strategies and develop some " lines " you can

repeat over and over and which help explain what you do. But remember,

doctor talk won't do. For me, I've told every single patient (or anyone

else who listens) that I'm trying to run the practice so there are " no

barriers, no delays and no waits " , that is, that there is no staff so pts

work/communicate directly with me and the scheduling/access will strive to

be open and on time. Also, I like to say the IMP model allows me to focus

on " offering quality of care AND increase value in every contact a patient

has with the office. "

For me, these work and I say/explain the " lines " a few times every day or

any time someone asks about my practice and then shows an inkling of

interest that it's " different. "

We need to have realistic (but as big as possible) dreams about finances.

But then sell ourselves confidently so the world can start to notice the

great opportunity they have with us around!!!

Tim

PS -- for my laser work, to contrast with the spas where patients rarely

see a doc, I'm marketing the angle that at Skin Sense Laser you get

" personalized care by a physician " and the ads have a big smiling Tim with

stethoscope around my neck (cover of local Pennysaver that is sent free to

every house and business in the town)... I'll see if it works.

.... Remember, we can't market a service, a person or an office... we must

market a SOLUTION to a (perceived at times) problem.... like communication

problem with pt and doc, access, timliness, etc.

Tim

> RE survival billing, etc.

>

> Appreciate everyone's openness RE challenges here.

>

> After being open for almost 2 years, but 9.5 miles on the other side of

> town from where my hospital owned practice is still present, I'm only

> 1/2 way to where I need to be in volume.

>

> Good news is that I can do this on about 30 pts a week (yep, that's my

> overhead). Bad news is that my growth is too slow, or if I want to be

> depressed, stagnated.

>

> I'm following up on our fellow listservers' ideas, such as getting to

> the local newspaper's editor to get an article -- think that should

> help. Prob is that there are several large FP groups near me that seem

> to manage fairly well, even though I think I do it better as a solo,

> with continuity outpt, follow up care, availability.

>

> Yes, that's what I continue to promote.

>

> Perhaps the real problem is that I have 2.5 FTEs (1 is my wife, and 1 is

> clinical staff, with 0.5 FTE for a parttime reception person), as well

> as outsourcing billing. Possible to insource billing if overhead

> reliable, but not yet.

>

> Am now exploring additional income streams both traditional (did do

> workmans comp for several companies, approaching some again now that I'm

> 2 years out of restrictive covenant, yes, it's legal in my area), as

> well as regular moonlighting. I'm looking into doing this instead of

> nursing home, which I fear would pull me into an oncall issue, which

> would defeat my primary care model.

>

> Anyway, it looks to me like we split up into 2 main groups in our goals

> to success:

>

> 1) Those who have billing difficulties (my ave cash retrieval per visit

> is $80/visit average).

> -- this is most likely fixable with some training, but the

> higher the volume, the more efficient you'll need to get to

> track the denials, etc, as well as the more time you'll need

> to give to this. Think of perhaps a parttime biller to

> help???

>

> 2) Those who have volume problems (too few vs others who are burning

> out trying to do it " all " ).

> -- sorry to say, I needed to get the word out better. One way

> would have been to track pts more closely for clinical needs,

> such as " you needed to get the lipid profile and follow up in

> office 3 months ago, reschedule? " but can't do this as it's

> been 1.5 years ago that the pt didn't follow up, and sending a

> note now is probably really self-defeating. -- better

> marketing, either with alternative treatments such as Dr

> Vargas (?sp) accupunture; or a more effective ad campaign

> (other than direct to current pt mailing, don't know if there

> is a better way on a budget).

>

> What do others think?

>

> Dr Matt Levin

> Solo with 2 FTE support staff.

> Soapware user since 1997.

> Opened solo office Dec 2004

> Finished residency 1988

> East of Pittsburgh, PA

>

> Re: Re: Rural practice issues

>

> Our hospital is a critical access hospital. The hospital already has 2

> ob/gyns on salary as well as a general surgeon. The two clinics in

> town are negotiating a buy out by the hospital in return for being

> reimbursed on a RVU basis. The idea is that, since it is critical

> access, the RVU's can be reimbursed higher. The math actually looks

> good, the egos are another thing! My own micro practice (with one

> employee...what do I call myself now?) is doing well, but, at 3 1/2

> days a week, I'm not pulling in $150,000. My average, once the cash

> flow improves, should be about $100,000. I'm seeing between 15 and 20

> folks a day, plus hospital work and OB. I think that the models vary

> just like doctor's personalities vary. I am convinced now, after 4.5

> months solo, that high producers need a higher overhead to keep them

> efficient. Those of us who produce by increased E & M codes vs extra

> patients, need a minimal amount of overhead. Somehow, helping docs

> figure out which they fit in and helping them succeed in that niche

> should help all, but especially rural practices. Conventional wisdom

> said that a 'part-time female FP doing OB' shouldn't be solo. Welp, it

> seems to be going okay so far.

>

> Gordon,

>

> Thank you for the excellent question. This topic represents a large

> silent segment of our nation's under- or poorly-served, especially

> seniors.

>

> I am solo-solo, opted out of everything and do no hospital work or

> call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice

> as well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

>

> I am still developing my operational infrastructure, buying bits and

> pieces of Soapware, as well as hardware, as I can afford them. I am

> also getting trained in a variety of integrative/complementary modes

> of treatments.

>

> My angle is that I will offer the benefits of a IMP with the added

> services of integrative, holistic medicine on a cash-only basis. I

> suspect I will get a loyal, and hopefully sizeable, following of

> patients, but I have not launched my ideas yet. Lately I have posted

> questions about advertising, Dragon speech ware, laptop carts, etc.

>

> I am also struggling with charges. My brain says be smart; my heart

> says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfilledlife.com/ website.

>

> I admit my setup is just about as risky as anyone could make it, but

> somehow I am OK with it--in fact, I feel confident, but I do not

> have numbers to back me up--only my gut.

>

> Anyway, I am open to ideas and am willing to enlist my practice in

> any kind of study to not only participate in my own experiment but

> also watch its unfolding.

>

> I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

>

> Gordon, if there is a place in your research for practices such as

> mine, let me know. I feel nearly ready to " launch, " but I am still

> defining what I will do and offer.

>

> Thanks again,

>

> Charlie Vargas

> lin, NC

>

> --

> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353 Flexible

> Family Care 'Modern medicine the old-fashioned way' This e-mail and

> attachments may contain information which is confidential and is only

> for the named addressee. If you have received this email in error,

> please notify the sender immediately and delete it from your computer.

>

September 21, 2006

But how

do you get pt’s to show up one yr later (or even 3 mos later)? I don’t

have time to call & remind the whole schedule of pt’s each day.

Re: Rural practice issues -- solo/small group survival on low overhead

The only growing practice

is one w a return appointment, even a year

out.

Use a reminder system built into your EMR and let the EMR help build

the practice.

Brent

> Gordon,

>

> Thank you for the excellent question. This topic represents a

large silent segment of our nation's under- or poorly-served,

especially seniors.

>

> I am solo-solo, opted out of everything and do no hospital work

or call. My practice is very small, but I have not advertised since

opening up to FP patients in January. But I also do medical

acupuncture and part time medical directorship of our local hospice

as well as urgent care moonlighting, so I do not depend on my FP

practice for my income.

>

> I am still developing my operational infrastructure, buying

bits and pieces of Soapware, as well as hardware, as I can afford

them. I am also getting trained in a variety of

integrative/complementary modes of treatments.

>

> My angle is that I will offer the benefits of a IMP with the

added services of integrative, holistic medicine on a cash-only

basis. I suspect I will get a loyal, and hopefully sizeable,

following of patients, but I have not launched my ideas yet. Lately I

have posted questions about advertising, Dragon speech ware, laptop

carts, etc.

>

> I am also struggling with charges. My brain says be smart; my

heart says be charitable. So I have enlisted the help of a friend and

mentor to help me explore many issues of self-identity, spiritual

awareness, etc. at the http://www.thefulfilledlife.com/

website.

>

> I admit my setup is just about as risky as anyone could make

it, but somehow I am OK with it--in fact, I feel confident, but I do

not have numbers to back me up--only my gut.

>

> Anyway, I am open to ideas and am willing to enlist my practice

in any kind of study to not only participate in my own experiment but

also watch its unfolding.

>

> I do care about my practice, but I do not feel emotionally

vulnerable within it. In other words, I have a detached concern.

>

> Gordon, if there is a place in your research for practices such

as mine, let me know. I feel nearly ready to " launch, " but I am still

defining what I will do and offer.

>

> Thanks again,

>

> Charlie Vargas

> lin, NC

>

> --

> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

Flexible Family Care 'Modern medicine the old-fashioned way' This e-

mail and attachments may contain information which is confidential

and is only for the named addressee. If you have received this email

in error, please notify the sender immediately and delete it from

your computer.

>

September 21, 2006

I usually call some during the " dead " days and ask them how they are

doing, any problems...and remind them that they need a recheck...or

just mail a letter with the same thing.

> But how do you get ptâ€™s to show up one yr later (or even 3 mos

> later)?Â I donâ€™t have time to call & remind the whole schedule of ptâ€™s

> each day.

>

> Â

>

> Â

>

> Re: Rural practice issues --

> solo/small group survival on low overhead

>

> Â

>

> The only growing practice is one w a return appointment, even a year

> out.

> Use a reminder system built into your EMR and let the EMR help build

> the practice.

> Brent

>

> > Gordon,

> >

> > Thank you for the excellent question. This topic represents a

> large silent segment of our nation's under- or poorly-served,

> especially seniors.

> >

> > I am solo-solo, opted out of everything and do no hospital work

> or call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice

> as well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

> >

> > I am still developing my operational infrastructure, buying

> bits and pieces of Soapware, as well as hardware, as I can afford

> them. I am also getting trained in a variety of

> integrative/complementary modes of treatments.

> >

> > My angle is that I will offer the benefits of a IMP with the

> added services of integrative, holistic medicine on a cash-only

> basis. I suspect I will get a loyal, and hopefully sizeable,

> following of patients, but I have not launched my ideas yet. Lately I

> have posted questions about advertising, Dragon speech ware, laptop

> carts, etc.

> >

> > I am also struggling with charges. My brain says be smart; my

> heart says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfilledlife.com/ website.

> >

> > I admit my setup is just about as risky as anyone could make

> it, but somehow I am OK with it--in fact, I feel confident, but I do

> not have numbers to back me up--only my gut.

> >

> > Anyway, I am open to ideas and am willing to enlist my practice

> in any kind of study to not only participate in my own experiment but

> also watch its unfolding.

> >

> > I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

> >

> > Gordon, if there is a place in your research for practices such

> as mine, let me know. I feel nearly ready to " launch, " but I am still

> defining what I will do and offer.

> >

> > Thanks again,

> >

> > Charlie Vargas

> > lin, NC

> >

> > --

> > Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

> mail and attachments may contain information which is confidential

> and is only for the named addressee. If you have received this email

> in error, please notify the sender immediately and delete it from

> your computer.

> >

>

September 21, 2006

Yes, I do that too but he was talking

about actually not letting anyone leave the office without setting up another

follow up appt, even it is in 1 year. I think the compliance on that in my

practice would be dismal.

Re: Rural practice issues -- solo/small group survival

on low overhead

The only growing

practice is one w a return appointment, even a year

out.

Use

a reminder system built into your EMR and let the EMR help build

the

practice.

Brent

---

In ,

" Levin "

wrote:

>

RE survival billing, etc.

>

Appreciate everyone's openness RE challenges here.

>

After being open for almost 2 years, but 9.5 miles on the other

side

of town from where my hospital owned practice is still present,

I'm

only 1/2 way to where I need to be in volume.

>

Good news is that I can do this on about 30 pts a week (yep, that's

my

overhead).

>

Bad news is that my growth is too slow, or if I want to be

depressed,

stagnated.

>

I'm following up on our fellow listservers' ideas, such as getting

to

the local newspaper's editor to get an article -- think that

should

help. Prob is that there are several large FP groups near me

that

seem to manage fairly well, even though I think I do it better

as

a solo, with continuity outpt, follow up care, availability.

>

Yes, that's what I continue to promote.

>

Perhaps the real problem is that I have 2.5 FTEs (1 is my wife, and

1

is clinical staff, with 0.5 FTE for a parttime reception person),

as

well as outsourcing billing. Possible to insource billing if

overhead

reliable, but not yet.

>

Am now exploring additional income streams both traditional (did do

workmans

comp for several companies, approaching some again now that

I'm

2 years out of restrictive covenant, yes, it's legal in my area),

as

well as regular moonlighting. I'm looking into doing this instead

of

nursing home, which I fear would pull me into an oncall issue,

which

would defeat my primary care model.

>

Anyway, it looks to me like we split up into 2 main groups in our

goals

to success:

>

1) Those who have billing difficulties (my ave cash retrieval per

visit

is $80/visit average).

>

-- this is most likely fixable with some training, but

the

higher the volume, the more efficient you'll need to get to track

the

denials, etc, as well as the more time you'll need to give to

this.

Think of perhaps a parttime biller to help???

>

2) Those who have volume problems (too few vs others who are

burning

out trying to do it " all " ).

>

-- sorry to say, I needed to get the word out better.

One

way would have been to track pts more closely for clinical needs,

such

as " you needed to get the lipid profile and follow up in office

3

months ago, reschedule? " but can't do this as it's been 1.5 years

ago

that the pt didn't follow up, and sending a note now is probably

really

self-defeating.

>

-- better marketing, either with alternative treatments

such

as Dr Vargas (?sp) accupunture; or a more effective ad campaign

(other

than direct to current pt mailing, don't know if there is a

better

way on a budget).

>

What do others think?

>

Dr Matt Levin

>

Solo with 2 FTE support staff.

>

Soapware user since 1997.

>

Opened solo office Dec 2004

>

Finished residency 1988

>

East of Pittsburgh, PA

>

Re: Re: Rural practice issues

>

Our hospital is a critical access hospital. The hospital already

has

2 ob/gyns on salary as well as a general surgeon. The two clinics

in

town are negotiating a buy out by the hospital in return for being

reimbursed

on a RVU basis. The idea is that, since it is critical

access,

the RVU's can be reimbursed higher. The math actually looks

good,

the egos are another thing! My own micro practice (with one

employee...what

do I call myself now?) is doing well, but, at 3 1/2

days

a week, I'm not pulling in $150,000. My average, once the cash

flow

improves, should be about $100,000. I'm seeing between 15 and 20

folks

a day, plus hospital work and OB. I think that the models vary

just

like doctor's personalities vary. I am convinced now, after 4.5

months

solo, that high producers need a higher overhead to keep them

efficient.

Those of us who produce by increased E & M codes vs extra

patients,

need a minimal amount of overhead. Somehow, helping docs

figure

out which they fit in and helping them succeed in that niche

should

help all, but especially rural practices. Conventional wisdom

said

that a 'part-time female FP doing OB' shouldn't be solo. Welp,

it

seems to be going okay so far.

>

Gordon,

>

Thank you for the excellent question. This topic represents a

large

silent segment of our nation's under- or poorly-served,

especially

seniors.

>

I am solo-solo, opted out of everything and do no hospital work

or

call. My practice is very small, but I have not advertised since

opening

up to FP patients in January. But I also do medical

acupuncture

and part time medical directorship of our local hospice

as

well as urgent care moonlighting, so I do not depend on my FP

practice

for my income.

>

I am still developing my operational infrastructure, buying

bits

and pieces of Soapware, as well as hardware, as I can afford

them.

I am also getting trained in a variety of

integrative/complementary

modes of treatments.

>

My angle is that I will offer the benefits of a IMP with the

added

services of integrative, holistic medicine on a cash-only

basis.

I suspect I will get a loyal, and hopefully sizeable,

following

of patients, but I have not launched my ideas yet. Lately I

have

posted questions about advertising, Dragon speech ware, laptop

carts,

etc.

>

I am also struggling with charges. My brain says be smart; my

heart

says be charitable. So I have enlisted the help of a friend and

mentor

to help me explore many issues of self-identity, spiritual

awareness,

etc. at the http://www.thefulfilledlife.com/

website.

>

I admit my setup is just about as risky as anyone could make

it,

but somehow I am OK with it--in fact, I feel confident, but I do

not

have numbers to back me up--only my gut.

>

Anyway, I am open to ideas and am willing to enlist my practice

in

any kind of study to not only participate in my own experiment but

also

watch its unfolding.

>

I do care about my practice, but I do not feel emotionally

vulnerable

within it. In other words, I have a detached concern.

>

Gordon, if there is a place in your research for practices such

as

mine, let me know. I feel nearly ready to " launch, " but I am still

defining

what I will do and offer.

>

Thanks again,

>

Charlie Vargas

>

lin, NC

>

--

>

Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

Flexible

Family Care 'Modern medicine the old-fashioned way' This e-

mail

and attachments may contain information which is confidential

and

is only for the named addressee. If you have received this email

in

error, please notify the sender immediately and delete it from

your

computer.

>

September 21, 2006

I'd estimate about 80% of my patients have email (... ask them... many

have email though I wouldn't have guessed they did... older folks, etc)

and since I use AppointmentQuest, they get a notification when I set the

appt and then a reminder a few days before.

I also use RelayHealth and send out a reminder for getting labs done if we

planned for them later.

Once the reminders are set, the systems do the work.

For those without email/computer/internet, I give printed appt sheet or

lab with with date written on it and a sticky with date to do test

paperclipped to it. Beyond that I don't have a reminder system, but I'm

not getting too many no-shows, so the methods seem to work.

I agree about the importance of re-booking. I can book 12 months out and

that has already helped to book a pap for next year and another patient

who will be in Florida from Oct to April so booked f/u appt in May.

Tim

> But how do you get pt's to show up one yr later (or even 3 mos later)?

> I don't have time to call & remind the whole schedule of pt's each day.

>

> Re: Rural practice issues -- solo/small

> group survival on low overhead

>

> The only growing practice is one w a return appointment, even a year

> out.

> Use a reminder system built into your EMR and let the EMR help build

> the practice.

> Brent

>

>> Gordon,

>>

>> Thank you for the excellent question. This topic represents a

> large silent segment of our nation's under- or poorly-served,

> especially seniors.

>>

>> I am solo-solo, opted out of everything and do no hospital work

> or call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice as

> well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

>>

>> I am still developing my operational infrastructure, buying

> bits and pieces of Soapware, as well as hardware, as I can afford them.

> I am also getting trained in a variety of

> integrative/complementary modes of treatments.

>>

>> My angle is that I will offer the benefits of a IMP with the

> added services of integrative, holistic medicine on a cash-only

> basis. I suspect I will get a loyal, and hopefully sizeable,

> following of patients, but I have not launched my ideas yet. Lately I

> have posted questions about advertising, Dragon speech ware, laptop

> carts, etc.

>>

>> I am also struggling with charges. My brain says be smart; my

> heart says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfi

> <http://www.thefulfilledlife.com/> lledlife.com/ website.

>>

>> I admit my setup is just about as risky as anyone could make

> it, but somehow I am OK with it--in fact, I feel confident, but I do

> not have numbers to back me up--only my gut.

>>

>> Anyway, I am open to ideas and am willing to enlist my practice

> in any kind of study to not only participate in my own experiment but

> also watch its unfolding.

>>

>> I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

>>

>> Gordon, if there is a place in your research for practices such

> as mine, let me know. I feel nearly ready to " launch, " but I am still

> defining what I will do and offer.

>>

>> Thanks again,

>>

>> Charlie Vargas

>> lin, NC

>>

>> --

>> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

> mail and attachments may contain information which is confidential and

> is only for the named addressee. If you have received this email in

> error, please notify the sender immediately and delete it from your

> computer.

>>

>

September 21, 2006

Right, I agree with him. If a patient has chronic issues, or an acute

issue that deserves follow up, I think it is paramount that we get that

appt set when they are in the office. It communicates to the patient that

the plans are important and deserve monitoring/follow up. And it's more

efficient for the office. The system I have then does the follow up

notification/reminder automatically.

Human nature would mean that many patients won't set a follow up appt if

they have to do something later... I know that is true for me personally

too!

The only way you can know if compliance in your office would be dismal is

to try it and see. It's kind of like comparing double-blinded controlled

research with expert opinion when considering medical treatments.

Sometimes what we expect and what really happens are very, very different.

Tim

> Yes, I do that too but he was talking about actually not letting anyone

> leave the office without setting up another follow up appt, even it is

> in 1 year. I think the compliance on that in my practice would be

> dismal.

>

> Re: Rural practice issues -- solo/small

> group survival on low overhead

>

> The only growing practice is one w a return appointment, even a year

> out.

> Use a reminder system built into your EMR and let the EMR help build

> the practice.

> Brent

>

>> Gordon,

>>

>> Thank you for the excellent question. This topic represents a

> large silent segment of our nation's under- or poorly-served,

> especially seniors.

>>

>> I am solo-solo, opted out of everything and do no hospital work

> or call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice as

> well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

>>

>> I am still developing my operational infrastructure, buying

> bits and pieces of Soapware, as well as hardware, as I can afford them.

> I am also getting trained in a variety of

> integrative/complementary modes of treatments.

>>

>> My angle is that I will offer the benefits of a IMP with the

> added services of integrative, holistic medicine on a cash-only

> basis. I suspect I will get a loyal, and hopefully sizeable,

> following of patients, but I have not launched my ideas yet. Lately I

> have posted questions about advertising, Dragon speech ware, laptop

> carts, etc.

>>

>> I am also struggling with charges. My brain says be smart; my

> heart says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfilledlife.com/ website.

>>

>> I admit my setup is just about as risky as anyone could make

> it, but somehow I am OK with it--in fact, I feel confident, but I do

> not have numbers to back me up--only my gut.

>>

>> Anyway, I am open to ideas and am willing to enlist my practice

> in any kind of study to not only participate in my own experiment but

> also watch its unfolding.

>>

>> I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

>>

>> Gordon, if there is a place in your research for practices such

> as mine, let me know. I feel nearly ready to " launch, " but I am still

> defining what I will do and offer.

>>

>> Thanks again,

>>

>> Charlie Vargas

>> lin, NC

>>

>> --

>> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

> mail and attachments may contain information which is confidential and

> is only for the named addressee. If you have received this email in

> error, please notify the sender immediately and delete it from your

> computer.

>>

>

September 21, 2006

Maybe I

will try it. Of course, our personal pediatrician would not even let us

schedule the 12 month visit when we were walking out from the 9 month visit.

They do not schedule more than 2 mos out even in peds!

Re: Rural practice issues --

solo/small

> group survival on low overhead

>

> The only growing practice is one w a return appointment, even a year

> out.

> Use a reminder system built into your EMR and let the EMR help build

> the practice.

> Brent

>

>> Gordon,

>>

>> Thank you for the excellent question. This topic represents a

> large silent segment of our nation's under- or poorly-served,

> especially seniors.

>>

>> I am solo-solo, opted out of everything and do no hospital work

> or call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice as

> well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

>>

>> I am still developing my operational infrastructure, buying

> bits and pieces of Soapware, as well as hardware, as I can afford them.

> I am also getting trained in a variety of

> integrative/complementary modes of treatments.

>>

>> My angle is that I will offer the benefits of a IMP with the

> added services of integrative, holistic medicine on a cash-only

> basis. I suspect I will get a loyal, and hopefully sizeable,

> following of patients, but I have not launched my ideas yet. Lately I

> have posted questions about advertising, Dragon speech ware, laptop

> carts, etc.

>>

>> I am also struggling with charges. My brain says be smart; my

> heart says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfi

> <http://www.thefulfilledlife.com/>

lledlife.com/ website.

>>

>> I admit my setup is just about as risky as anyone could make

> it, but somehow I am OK with it--in fact, I feel confident, but I do

> not have numbers to back me up--only my gut.

>>

>> Anyway, I am open to ideas and am willing to enlist my practice

> in any kind of study to not only participate in my own experiment but

> also watch its unfolding.

>>

>> I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

>>

>> Gordon, if there is a place in your research for practices such

> as mine, let me know. I feel nearly ready to " launch, " but I am

still

> defining what I will do and offer.

>>

>> Thanks again,

>>

>> Charlie Vargas

>> lin, NC

>>

>> --

>> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

> mail and attachments may contain information which is confidential and

> is only for the named addressee. If you have received this email in

> error, please notify the sender immediately and delete it from your

> computer.

>>

>

September 21, 2006

Maybe I

will try it. Of course, our personal pediatrician would not even let us

schedule the 12 month visit when we were walking out from the 9 month visit.

They do not schedule more than 2 mos out even in peds!

Re: Rural practice issues --

solo/small

> group survival on low overhead

>

> The only growing practice is one w a return appointment, even a year

> out.

> Use a reminder system built into your EMR and let the EMR help build

> the practice.

> Brent

>

>> Gordon,

>>

>> Thank you for the excellent question. This topic represents a

> large silent segment of our nation's under- or poorly-served,

> especially seniors.

>>

>> I am solo-solo, opted out of everything and do no hospital work

> or call. My practice is very small, but I have not advertised since

> opening up to FP patients in January. But I also do medical

> acupuncture and part time medical directorship of our local hospice as

> well as urgent care moonlighting, so I do not depend on my FP

> practice for my income.

>>

>> I am still developing my operational infrastructure, buying

> bits and pieces of Soapware, as well as hardware, as I can afford them.

> I am also getting trained in a variety of

> integrative/complementary modes of treatments.

>>

>> My angle is that I will offer the benefits of a IMP with the

> added services of integrative, holistic medicine on a cash-only

> basis. I suspect I will get a loyal, and hopefully sizeable,

> following of patients, but I have not launched my ideas yet. Lately I

> have posted questions about advertising, Dragon speech ware, laptop

> carts, etc.

>>

>> I am also struggling with charges. My brain says be smart; my

> heart says be charitable. So I have enlisted the help of a friend and

> mentor to help me explore many issues of self-identity, spiritual

> awareness, etc. at the http://www.thefulfi

> <http://www.thefulfilledlife.com/>

lledlife.com/ website.

>>

>> I admit my setup is just about as risky as anyone could make

> it, but somehow I am OK with it--in fact, I feel confident, but I do

> not have numbers to back me up--only my gut.

>>

>> Anyway, I am open to ideas and am willing to enlist my practice

> in any kind of study to not only participate in my own experiment but

> also watch its unfolding.

>>

>> I do care about my practice, but I do not feel emotionally

> vulnerable within it. In other words, I have a detached concern.

>>

>> Gordon, if there is a place in your research for practices such

> as mine, let me know. I feel nearly ready to " launch, " but I am

still

> defining what I will do and offer.

>>

>> Thanks again,

>>

>> Charlie Vargas

>> lin, NC

>>

>> --

>> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

> mail and attachments may contain information which is confidential and

> is only for the named addressee. If you have received this email in

> error, please notify the sender immediately and delete it from your

> computer.

>>

>

September 21, 2006

Yeah, in my old " big organization " office we couldn't book out more than

about 3-4 months because the various doc schedules weren't yet in the

computer to block off vacations and time away from office. We of course

were required to put in vacation plans many months ahead of time for call

schedules. But if patients are booked and a doc plans for a conference or

vacation, staff has to call and re-book everyone... and that costs time

and money... so we couldn't book out too far. I think one can argue that

risks lower quality of care -- but when does quality of care trump cost

savings in a large part of American healthcare? (sorry for the sarcasm).

Tim

> Maybe I will try it. Of course, our personal pediatrician would not

> even let us schedule the 12 month visit when we were walking out from

> the 9 month visit. They do not schedule more than 2 mos out even in

> peds!

>

> Re: Rural practice issues --

>> solo/small group survival on low overhead

>>

>> The only growing practice is one w a return appointment, even a year

>> out.

>> Use a reminder system built into your EMR and let the EMR help build

>> the practice.

>> Brent

>>

>>> Gordon,

>>>

>>> Thank you for the excellent question. This topic represents a

>> large silent segment of our nation's under- or poorly-served,

>> especially seniors.

>>>

>>> I am solo-solo, opted out of everything and do no hospital work

>> or call. My practice is very small, but I have not advertised since

>> opening up to FP patients in January. But I also do medical

>> acupuncture and part time medical directorship of our local hospice as

>> well as urgent care moonlighting, so I do not depend on my FP

>> practice for my income.

>>>

>>> I am still developing my operational infrastructure, buying

>> bits and pieces of Soapware, as well as hardware, as I can afford

>> them. I am also getting trained in a variety of

>> integrative/complementary modes of treatments.

>>>

>>> My angle is that I will offer the benefits of a IMP with the

>> added services of integrative, holistic medicine on a cash-only

>> basis. I suspect I will get a loyal, and hopefully sizeable,

>> following of patients, but I have not launched my ideas yet. Lately I

>> have posted questions about advertising, Dragon speech ware, laptop

>> carts, etc.

>>>

>>> I am also struggling with charges. My brain says be smart; my

>> heart says be charitable. So I have enlisted the help of a friend and

>> mentor to help me explore many issues of self-identity, spiritual

>> awareness, etc. at the http://www.thefulfi

>> <http://www.thefulfi <http://www.thefulfilledlife.com/> lledlife.com/>

> lledlife.com/ website.

>>>

>>> I admit my setup is just about as risky as anyone could make

>> it, but somehow I am OK with it--in fact, I feel confident, but I do

>> not have numbers to back me up--only my gut.

>>>

>>> Anyway, I am open to ideas and am willing to enlist my practice

>> in any kind of study to not only participate in my own experiment but

>> also watch its unfolding.

>>>

>>> I do care about my practice, but I do not feel emotionally

>> vulnerable within it. In other words, I have a detached concern.

>>>

>>> Gordon, if there is a place in your research for practices such

>> as mine, let me know. I feel nearly ready to " launch, " but I am still

>> defining what I will do and offer.

>>>

>>> Thanks again,

>>>

>>> Charlie Vargas

>>> lin, NC

>>>

>>> --

>>> Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353

>> Flexible Family Care 'Modern medicine the old-fashioned way' This e-

>> mail and attachments may contain information which is confidential and

>> is only for the named addressee. If you have received this email in

>> error, please notify the sender immediately and delete it from your

>> computer.

>>>

>>

>

September 21, 2006