Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 RE Branching out and increasing revenue in solo/ultra-solo practices 1) Volume dependent -- if you have enough pt flow, then you have the choice of alternative care or changing your demographics ie better payor insurance. 2) Be sure you are doing all you can for each pt -- reminders for follow up, well care with -25 modifier. 3) Stop giving care to pts with insurance that is poorest payor. So if you have the max number of pts in a fixed time period, I'd look very closely at the insurer class, and consider dropping the poorest payor. You may catch up a few pts who will see you out of network, but I'd bet this depends on the pts you see and the competition in the area. I'd also seriously look at the number of additional procedures and other services you provide. My example is that probably next year, I'll start to offer flu shots again, after looking at cost per shot, as well as reimbursement per shot. We will ask pts to "preregister" so we will be absolutely sure of their payor class prior to visit, and insist on payment on receipt up front where those pts have no coverage. Good luck on your new venture. Dr Matt Levin Solo east of Pittsburgh, PA FP Branching out Group, I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested. Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics. What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time. Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year. Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality! Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works. As always, I look forward to your comments! 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Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 RE Branching out and increasing revenue in solo/ultra-solo practices 1) Volume dependent -- if you have enough pt flow, then you have the choice of alternative care or changing your demographics ie better payor insurance. 2) Be sure you are doing all you can for each pt -- reminders for follow up, well care with -25 modifier. 3) Stop giving care to pts with insurance that is poorest payor. So if you have the max number of pts in a fixed time period, I'd look very closely at the insurer class, and consider dropping the poorest payor. You may catch up a few pts who will see you out of network, but I'd bet this depends on the pts you see and the competition in the area. I'd also seriously look at the number of additional procedures and other services you provide. My example is that probably next year, I'll start to offer flu shots again, after looking at cost per shot, as well as reimbursement per shot. We will ask pts to "preregister" so we will be absolutely sure of their payor class prior to visit, and insist on payment on receipt up front where those pts have no coverage. Good luck on your new venture. Dr Matt Levin Solo east of Pittsburgh, PA FP Branching out Group, I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested. Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics. What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time. Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year. Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality! Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works. As always, I look forward to your comments! 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Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , I think that your investment was short sided from a practical stand point. I believe that there are plenty of services that you could have invested in that would have been medically beneficial to your pt and play upon your expertise (i.e. you are a physician). There are many things that you could do that you could do besides aesthetics (or cosmotology) that could be beneficial, less time consuming and MAYBE even be reimbursed by insurance. For instance, ABI, Weight loss, ncv, cryosurgery, Echocardiography. Yearly complete skin surveys with cryosurgery and biopsying any suspicious lesions would be beneficial to your patients, lucrative(minimal investment) and a valid service. Do the Math!!!! By the way this is also recommended by the American Derm association any way!!! Beck, M.D. --- " Brady, MD " wrote: > Group, > I wanted to let everyone know that after months of > contemplation I have > decided to start offering aesthetics in my practice. > I have purchased a > McCue Ultra VPL and will begin offering permanent > hair reduction, > photofacials, and spider vein removal in > mid-December. I wanted to share > my thought processes as to why I decided to go in > this direction in case > others are interested. > Why aesthetics? As of the end of September, I had > billed for $16,000 > more and had seen about 200 more patients this year > than last. > Unfortunately, I had collected about $500 less. When > researching why, I > found out I was making between $7-$9 less per claim > this year even > though the breakdown of the E & M codes and the CPT > codes were similar. > So, the insurances are either paying me less or my > population has > shifted to a lower paying insurance or both. At the > same time, I have > come to the conclusion that I don't want to be > busier in the office. > Since the beginning of the year, my schedule has > been relatively full. I > would say that we usually run at 80% capacity and > have had to swell to > 100% periodically to meet demand during busier > times. Financially, we > are making ends meet, but we certainly could not > afford it if anything > went wrong (ex. I got sick and missed a week, etc). > So the question is > how can I bring in more income without getting much > busier? I obviously > cannot rely on insurances to keep me afloat as they > have never even kept > up with the cost of living. I don't want to charge a > retainer fee as I > am concerned about the legality of it and I fear the > loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my > office is that my > nurse will do the initial consultation and perform > the actual procedure. > (I plan to quickly introduce myself to the patient > and glance at any > moles or other lesions prior to any procedure to > make sure there is > nothing worrisome). If she is doing a treatment > (average <30 minutes), I > will do my best to continue seeing scheduled > patients and answer the > phone. As my office is in a renovated house, we > already have an unused > room upstairs which will serve as a perfect > aesthetics room. The VPL was > not cheap ($65,000) but financed over 60 months > equates to about > $1400/month. So, total cost is really only the cost > of the machine as > the room is already there, there is no billing, I > will continue seeing > patients as before and my one employee is excited > about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have > not yet figured out my > fee schedule, most people I have talked to who do > this said that they > average $300/treatment. So, given this is up front > cash, only 5 > treatments a month would be necessary to break even. > Also remember that > most people need 3-5 treatments, so really only > about 20 people/year (5 > people being treated each month for 3 months X 4 > cycles of 3 months > each) are needed to break even. I already have been > open for 3.5 years, > and when I sent out a newsletter to my patients > stating that I was > thinking of doing this, I got 11 patients who stated > they were " very > interested. " I also have 2 patients who own salons > and both state they > have a lot of clients who they are sure would want > to have one of these > procedures done, but they have not had anyone to > refer them to. In > short, I can't imagine not having 20 patients > interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My > overhead is definitely > increased, but, assuming the machine pays for > itself, the time I spend > with the patient and the quality of care I can offer > should remain the > same as it has been over the past 3.5 years. If > anything, I am > approaching this as an alternative way of financing > the rest of my > practice in order to insulate it from the whims of > the insurance world. > We might even be able to generate enough income to > get a part time > chronic care nurse which would actually improve the > quality! > Anyway, as of next month, I am starting at zero > patients in my > aesthetics practice and I will keep everyone abreast > of how it develops. > I know Tim is doing this already (so I am not alone > in my quest to see > if this works), but I think he started off with both > the aesthetics and > the IMP practice. My IMP practice is closed to new > patients, but will > hopefully be able to feed the aesthetics practice. > We will see how/if > this works. > As always, I look forward to your comments! > > > ________________________________________________________________________________\ ____ Sponsored Link Online degrees - find the right program to advance your career. Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , I think that your investment was short sided from a practical stand point. I believe that there are plenty of services that you could have invested in that would have been medically beneficial to your pt and play upon your expertise (i.e. you are a physician). There are many things that you could do that you could do besides aesthetics (or cosmotology) that could be beneficial, less time consuming and MAYBE even be reimbursed by insurance. For instance, ABI, Weight loss, ncv, cryosurgery, Echocardiography. Yearly complete skin surveys with cryosurgery and biopsying any suspicious lesions would be beneficial to your patients, lucrative(minimal investment) and a valid service. Do the Math!!!! By the way this is also recommended by the American Derm association any way!!! Beck, M.D. --- " Brady, MD " wrote: > Group, > I wanted to let everyone know that after months of > contemplation I have > decided to start offering aesthetics in my practice. > I have purchased a > McCue Ultra VPL and will begin offering permanent > hair reduction, > photofacials, and spider vein removal in > mid-December. I wanted to share > my thought processes as to why I decided to go in > this direction in case > others are interested. > Why aesthetics? As of the end of September, I had > billed for $16,000 > more and had seen about 200 more patients this year > than last. > Unfortunately, I had collected about $500 less. When > researching why, I > found out I was making between $7-$9 less per claim > this year even > though the breakdown of the E & M codes and the CPT > codes were similar. > So, the insurances are either paying me less or my > population has > shifted to a lower paying insurance or both. At the > same time, I have > come to the conclusion that I don't want to be > busier in the office. > Since the beginning of the year, my schedule has > been relatively full. I > would say that we usually run at 80% capacity and > have had to swell to > 100% periodically to meet demand during busier > times. Financially, we > are making ends meet, but we certainly could not > afford it if anything > went wrong (ex. I got sick and missed a week, etc). > So the question is > how can I bring in more income without getting much > busier? I obviously > cannot rely on insurances to keep me afloat as they > have never even kept > up with the cost of living. I don't want to charge a > retainer fee as I > am concerned about the legality of it and I fear the > loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my > office is that my > nurse will do the initial consultation and perform > the actual procedure. > (I plan to quickly introduce myself to the patient > and glance at any > moles or other lesions prior to any procedure to > make sure there is > nothing worrisome). If she is doing a treatment > (average <30 minutes), I > will do my best to continue seeing scheduled > patients and answer the > phone. As my office is in a renovated house, we > already have an unused > room upstairs which will serve as a perfect > aesthetics room. The VPL was > not cheap ($65,000) but financed over 60 months > equates to about > $1400/month. So, total cost is really only the cost > of the machine as > the room is already there, there is no billing, I > will continue seeing > patients as before and my one employee is excited > about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have > not yet figured out my > fee schedule, most people I have talked to who do > this said that they > average $300/treatment. So, given this is up front > cash, only 5 > treatments a month would be necessary to break even. > Also remember that > most people need 3-5 treatments, so really only > about 20 people/year (5 > people being treated each month for 3 months X 4 > cycles of 3 months > each) are needed to break even. I already have been > open for 3.5 years, > and when I sent out a newsletter to my patients > stating that I was > thinking of doing this, I got 11 patients who stated > they were " very > interested. " I also have 2 patients who own salons > and both state they > have a lot of clients who they are sure would want > to have one of these > procedures done, but they have not had anyone to > refer them to. In > short, I can't imagine not having 20 patients > interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My > overhead is definitely > increased, but, assuming the machine pays for > itself, the time I spend > with the patient and the quality of care I can offer > should remain the > same as it has been over the past 3.5 years. If > anything, I am > approaching this as an alternative way of financing > the rest of my > practice in order to insulate it from the whims of > the insurance world. > We might even be able to generate enough income to > get a part time > chronic care nurse which would actually improve the > quality! > Anyway, as of next month, I am starting at zero > patients in my > aesthetics practice and I will keep everyone abreast > of how it develops. > I know Tim is doing this already (so I am not alone > in my quest to see > if this works), but I think he started off with both > the aesthetics and > the IMP practice. My IMP practice is closed to new > patients, but will > hopefully be able to feed the aesthetics practice. > We will see how/if > this works. > As always, I look forward to your comments! > > > ________________________________________________________________________________\ ____ Sponsored Link Online degrees - find the right program to advance your career. Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 I have considered this and even taken a course (so that I am “certified”). The problem is that you have to mix up 100u of botox at once and will likely use 30-50u on a face. The rest is only good for a day or so, so either you need to line up 2-3 patients in a day, or you will lose money. Also, my malpractice would go up $3000/year if I did these procedures and I would have to do them (taking time away from my other patients). For those reasons, I decided to start with the laser. Note: I do believe that many of the same people who come in for the photofacial will also desire botox. I will likely keep a list and when it appears that it will be profitable, I will reconsider it. Re: Branching out , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 I have considered this and even taken a course (so that I am “certified”). The problem is that you have to mix up 100u of botox at once and will likely use 30-50u on a face. The rest is only good for a day or so, so either you need to line up 2-3 patients in a day, or you will lose money. Also, my malpractice would go up $3000/year if I did these procedures and I would have to do them (taking time away from my other patients). For those reasons, I decided to start with the laser. Note: I do believe that many of the same people who come in for the photofacial will also desire botox. I will likely keep a list and when it appears that it will be profitable, I will reconsider it. Re: Branching out , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , can you expand on these procedures ( ABI, Weight loss, ncv, cryosurgery, Echocardiography.), i.e. initial cost and equipment, time demand, diagnosis that support, procedure codes/reimbursement and how you incorporate them into your daily practice. Thanks Mike Jewett Re: Branching out ,I think that your investment was short sided froma practical stand point. I believe that there areplenty of services that you could have invested inthat would have been medically beneficial to your ptand play upon your expertise (i.e. you are aphysician). There are many things that you could dothat you could do besides aesthetics (or cosmotology)that could be beneficial, less time consuming andMAYBE even be reimbursed by insurance. For instance,ABI, Weight loss, ncv, cryosurgery, Echocardiography.Yearly complete skin surveys with cryosurgery andbiopsying any suspicious lesions would be beneficialto your patients, lucrative(minimal investment) and avalid service. Do the Math!!!! By the way this is alsorecommended by the American Derm association anyway!!! Beck, M.D.--- " Brady, MD"<drbradythevillagedoctor (DOT) hrcoxmail.com> wrote:> Group,> I wanted to let everyone know that after months of> contemplation I have> decided to start offering aesthetics in my practice.> I have purchased a> McCue Ultra VPL and will begin offering permanent> hair reduction,> photofacials, and spider vein removal in> mid-December. I wanted to share> my thought processes as to why I decided to go in> this direction in case> others are interested.> Why aesthetics? As of the end of September, I had> billed for $16,000> more and had seen about 200 more patients this year> than last.> Unfortunately, I had collected about $500 less. When> researching why, I> found out I was making between $7-$9 less per claim> this year even> though the breakdown of the E & M codes and the CPT> codes were similar.> So, the insurances are either paying me less or my> population has> shifted to a lower paying insurance or both. At the> same time, I have> come to the conclusion that I don't want to be> busier in the office.> Since the beginning of the year, my schedule has> been relatively full. I> would say that we usually run at 80% capacity and> have had to swell to> 100% periodically to meet demand during busier> times. Financially, we> are making ends meet, but we certainly could not> afford it if anything> went wrong (ex. I got sick and missed a week, etc).> So the question is> how can I bring in more income without getting much> busier? I obviously> cannot rely on insurances to keep me afloat as they> have never even kept> up with the cost of living. I don't want to charge a> retainer fee as I> am concerned about the legality of it and I fear the> loss of my> patients. And so, I decided to look at aesthetics.> What is the cost? The way the system will work in my> office is that my> nurse will do the initial consultation and perform> the actual procedure.> (I plan to quickly introduce myself to the patient> and glance at any> moles or other lesions prior to any procedure to> make sure there is> nothing worrisome). If she is doing a treatment> (average <30 minutes), I> will do my best to continue seeing scheduled> patients and answer the> phone. As my office is in a renovated house, we> already have an unused> room upstairs which will serve as a perfect> aesthetics room. The VPL was> not cheap ($65,000) but financed over 60 months> equates to about> $1400/month. So, total cost is really only the cost> of the machine as> the room is already there, there is no billing, I> will continue seeing> patients as before and my one employee is excited> about doing the> procedures which do not take a huge amount of time.> Can you make that much per month? Although I have> not yet figured out my> fee schedule, most people I have talked to who do> this said that they> average $300/treatment. So, given this is up front> cash, only 5> treatments a month would be necessary to break even.> Also remember that> most people need 3-5 treatments, so really only> about 20 people/year (5> people being treated each month for 3 months X 4> cycles of 3 months> each) are needed to break even. I already have been> open for 3.5 years,> and when I sent out a newsletter to my patients> stating that I was> thinking of doing this, I got 11 patients who stated> they were "very> interested." I also have 2 patients who own salons> and both state they> have a lot of clients who they are sure would want> to have one of these> procedures done, but they have not had anyone to> refer them to. In> short, I can't imagine not having 20 patients> interested in the next> year. > Is it Anti-IMP? Actually, I don't think so. My> overhead is definitely> increased, but, assuming the machine pays for> itself, the time I spend> with the patient and the quality of care I can offer> should remain the> same as it has been over the past 3.5 years. If> anything, I am> approaching this as an alternative way of financing> the rest of my> practice in order to insulate it from the whims of> the insurance world.> We might even be able to generate enough income to> get a part time> chronic care nurse which would actually improve the> quality!> Anyway, as of next month, I am starting at zero> patients in my> aesthetics practice and I will keep everyone abreast> of how it develops.> I know Tim is doing this already (so I am not alone> in my quest to see> if this works), but I think he started off with both> the aesthetics and> the IMP practice. My IMP practice is closed to new> patients, but will> hopefully be able to feed the aesthetics practice.> We will see how/if> this works.> As always, I look forward to your comments!> > > __________________________________________________________Sponsored LinkOnline degrees - find the right program to advance your career.Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 , can you expand on these procedures ( ABI, Weight loss, ncv, cryosurgery, Echocardiography.), i.e. initial cost and equipment, time demand, diagnosis that support, procedure codes/reimbursement and how you incorporate them into your daily practice. Thanks Mike Jewett Re: Branching out ,I think that your investment was short sided froma practical stand point. I believe that there areplenty of services that you could have invested inthat would have been medically beneficial to your ptand play upon your expertise (i.e. you are aphysician). There are many things that you could dothat you could do besides aesthetics (or cosmotology)that could be beneficial, less time consuming andMAYBE even be reimbursed by insurance. For instance,ABI, Weight loss, ncv, cryosurgery, Echocardiography.Yearly complete skin surveys with cryosurgery andbiopsying any suspicious lesions would be beneficialto your patients, lucrative(minimal investment) and avalid service. Do the Math!!!! By the way this is alsorecommended by the American Derm association anyway!!! Beck, M.D.--- " Brady, MD"<drbradythevillagedoctor (DOT) hrcoxmail.com> wrote:> Group,> I wanted to let everyone know that after months of> contemplation I have> decided to start offering aesthetics in my practice.> I have purchased a> McCue Ultra VPL and will begin offering permanent> hair reduction,> photofacials, and spider vein removal in> mid-December. I wanted to share> my thought processes as to why I decided to go in> this direction in case> others are interested.> Why aesthetics? As of the end of September, I had> billed for $16,000> more and had seen about 200 more patients this year> than last.> Unfortunately, I had collected about $500 less. When> researching why, I> found out I was making between $7-$9 less per claim> this year even> though the breakdown of the E & M codes and the CPT> codes were similar.> So, the insurances are either paying me less or my> population has> shifted to a lower paying insurance or both. At the> same time, I have> come to the conclusion that I don't want to be> busier in the office.> Since the beginning of the year, my schedule has> been relatively full. I> would say that we usually run at 80% capacity and> have had to swell to> 100% periodically to meet demand during busier> times. Financially, we> are making ends meet, but we certainly could not> afford it if anything> went wrong (ex. I got sick and missed a week, etc).> So the question is> how can I bring in more income without getting much> busier? I obviously> cannot rely on insurances to keep me afloat as they> have never even kept> up with the cost of living. I don't want to charge a> retainer fee as I> am concerned about the legality of it and I fear the> loss of my> patients. And so, I decided to look at aesthetics.> What is the cost? The way the system will work in my> office is that my> nurse will do the initial consultation and perform> the actual procedure.> (I plan to quickly introduce myself to the patient> and glance at any> moles or other lesions prior to any procedure to> make sure there is> nothing worrisome). If she is doing a treatment> (average <30 minutes), I> will do my best to continue seeing scheduled> patients and answer the> phone. As my office is in a renovated house, we> already have an unused> room upstairs which will serve as a perfect> aesthetics room. The VPL was> not cheap ($65,000) but financed over 60 months> equates to about> $1400/month. So, total cost is really only the cost> of the machine as> the room is already there, there is no billing, I> will continue seeing> patients as before and my one employee is excited> about doing the> procedures which do not take a huge amount of time.> Can you make that much per month? Although I have> not yet figured out my> fee schedule, most people I have talked to who do> this said that they> average $300/treatment. So, given this is up front> cash, only 5> treatments a month would be necessary to break even.> Also remember that> most people need 3-5 treatments, so really only> about 20 people/year (5> people being treated each month for 3 months X 4> cycles of 3 months> each) are needed to break even. I already have been> open for 3.5 years,> and when I sent out a newsletter to my patients> stating that I was> thinking of doing this, I got 11 patients who stated> they were "very> interested." I also have 2 patients who own salons> and both state they> have a lot of clients who they are sure would want> to have one of these> procedures done, but they have not had anyone to> refer them to. In> short, I can't imagine not having 20 patients> interested in the next> year. > Is it Anti-IMP? Actually, I don't think so. My> overhead is definitely> increased, but, assuming the machine pays for> itself, the time I spend> with the patient and the quality of care I can offer> should remain the> same as it has been over the past 3.5 years. If> anything, I am> approaching this as an alternative way of financing> the rest of my> practice in order to insulate it from the whims of> the insurance world.> We might even be able to generate enough income to> get a part time> chronic care nurse which would actually improve the> quality!> Anyway, as of next month, I am starting at zero> patients in my> aesthetics practice and I will keep everyone abreast> of how it develops.> I know Tim is doing this already (so I am not alone> in my quest to see> if this works), but I think he started off with both> the aesthetics and> the IMP practice. My IMP practice is closed to new> patients, but will> hopefully be able to feed the aesthetics practice.> We will see how/if> this works.> As always, I look forward to your comments!> > > __________________________________________________________Sponsored LinkOnline degrees - find the right program to advance your career.Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Responses: 1) Agreed, but flexibility is important as well. If I have 100 patients change from an insurance that pays $100 per visit to an insurance that pays $90 per visit, is it better to try and find another 100 patients or just try and work without the extra $10/visit? 2) Sounds good, but we only book ½ the patients ahead of time and these typically come in pretty well. For some reason, a fair number of the same day patients no show (go figure) but this does not affect the payment per visit. About the -25 modifier. I have only found one insurance in this area that will pay for the physical and the E & M with the modifier. The others will pay the lesser of the codes (likely the 99213/4) and write off the difference so I will actually make less money than if I had just coded for the physical. Yes, I could spend hours on the phone arguing this, but then I lose money because I’m on the phone and not seeing patients. This is likely a regional issue. 3) I just dropped UHC (which was the poorest payor here). Actually, they dropped me because I refused resign their contract. As I only had 25 or so patients of theirs, I was just going to keep seeing them, but UHC wanted me to take more. No way. Most of the other insurers are clumped around Medicare reimbursement rates. I could drop some of these, but then I am losing a lot of patients and I am moving away from one of my original concepts which was to try and provide care to Hilton Village (my neighborhood) and not discriminate based on insurance. I realize this is idealistic, but I would like to at least continue trying. 4) In adding more procedures I look at it from as many angles as possible. Is it going to increase my malpractice? How much extra billing time/training is it going to take? How often am I going to use it? Does it take up space? How long does doing the procedure take? What is the cost of the supplies vs. return on investment? Currently, I offer joint and trigger point injections, small skin stuff including suturing, immunizations (only slightly profitable when the injection fee is included), rapid strep tests, u/a dips, and pregnancy tests. But that is one reason I wanted to look at some other form of income. Every year, I look forward to the flu shots because I know I will make $3000-$5000 extra over the months of October, November and December. Imagine if I could make that every month without changing the flow of the practice. That is the attraction to me. Re: Branching out RE Branching out and increasing revenue in solo/ultra-solo practices 1) Volume dependent -- if you have enough pt flow, then you have the choice of alternative care or changing your demographics ie better payor insurance. 2) Be sure you are doing all you can for each pt -- reminders for follow up, well care with -25 modifier. 3) Stop giving care to pts with insurance that is poorest payor. So if you have the max number of pts in a fixed time period, I'd look very closely at the insurer class, and consider dropping the poorest payor. You may catch up a few pts who will see you out of network, but I'd bet this depends on the pts you see and the competition in the area. I'd also seriously look at the number of additional procedures and other services you provide. My example is that probably next year, I'll start to offer flu shots again, after looking at cost per shot, as well as reimbursement per shot. We will ask pts to " preregister " so we will be absolutely sure of their payor class prior to visit, and insist on payment on receipt up front where those pts have no coverage. Good luck on your new venture. Dr Matt Levin Solo east of Pittsburgh, PA FP Branching out Group, I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested. Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics. What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time. Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year. Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality! Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works. As always, I look forward to your comments! 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Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Responses: 1) Agreed, but flexibility is important as well. If I have 100 patients change from an insurance that pays $100 per visit to an insurance that pays $90 per visit, is it better to try and find another 100 patients or just try and work without the extra $10/visit? 2) Sounds good, but we only book ½ the patients ahead of time and these typically come in pretty well. For some reason, a fair number of the same day patients no show (go figure) but this does not affect the payment per visit. About the -25 modifier. I have only found one insurance in this area that will pay for the physical and the E & M with the modifier. The others will pay the lesser of the codes (likely the 99213/4) and write off the difference so I will actually make less money than if I had just coded for the physical. Yes, I could spend hours on the phone arguing this, but then I lose money because I’m on the phone and not seeing patients. This is likely a regional issue. 3) I just dropped UHC (which was the poorest payor here). Actually, they dropped me because I refused resign their contract. As I only had 25 or so patients of theirs, I was just going to keep seeing them, but UHC wanted me to take more. No way. Most of the other insurers are clumped around Medicare reimbursement rates. I could drop some of these, but then I am losing a lot of patients and I am moving away from one of my original concepts which was to try and provide care to Hilton Village (my neighborhood) and not discriminate based on insurance. I realize this is idealistic, but I would like to at least continue trying. 4) In adding more procedures I look at it from as many angles as possible. Is it going to increase my malpractice? How much extra billing time/training is it going to take? How often am I going to use it? Does it take up space? How long does doing the procedure take? What is the cost of the supplies vs. return on investment? Currently, I offer joint and trigger point injections, small skin stuff including suturing, immunizations (only slightly profitable when the injection fee is included), rapid strep tests, u/a dips, and pregnancy tests. But that is one reason I wanted to look at some other form of income. Every year, I look forward to the flu shots because I know I will make $3000-$5000 extra over the months of October, November and December. Imagine if I could make that every month without changing the flow of the practice. That is the attraction to me. Re: Branching out RE Branching out and increasing revenue in solo/ultra-solo practices 1) Volume dependent -- if you have enough pt flow, then you have the choice of alternative care or changing your demographics ie better payor insurance. 2) Be sure you are doing all you can for each pt -- reminders for follow up, well care with -25 modifier. 3) Stop giving care to pts with insurance that is poorest payor. So if you have the max number of pts in a fixed time period, I'd look very closely at the insurer class, and consider dropping the poorest payor. You may catch up a few pts who will see you out of network, but I'd bet this depends on the pts you see and the competition in the area. I'd also seriously look at the number of additional procedures and other services you provide. My example is that probably next year, I'll start to offer flu shots again, after looking at cost per shot, as well as reimbursement per shot. We will ask pts to " preregister " so we will be absolutely sure of their payor class prior to visit, and insist on payment on receipt up front where those pts have no coverage. Good luck on your new venture. Dr Matt Levin Solo east of Pittsburgh, PA FP Branching out Group, I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested. Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics. What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time. Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year. Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality! Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works. As always, I look forward to your comments! 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Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Tim, First, don’t underestimate how much appearance affects your patients and their well being. Why are people willing to spend so much on “silly” things like haircuts, color, creams, make-up, etc? Is it simply because they are all shallow and need therapy? What about my patient who came up to me this week pleading for me to get her in for a photofacial as soon as possible. She has rosacea and states that every time she looks in the mirror she sees her alcoholic father, and she believes that everyone thinks she is one as well. Is this shallow of her? I see my job as a physician as simply to assist my patients is living the happiest and healthiest life they can. Looking and feeling good (even if it is superficial) is part of that. Secondly, don’t assume because the machine removes hair it cannot do “medical” stuff. I will be able to treat warts with one quick shot of light (less painful and caustic than freezing), and I will be able to (ultimately) use the light to activate acid (sorry, I don’t remember which one) to do photorejuvination. This will work much like effudex (with much less “down time”) to get rid of precancerous lesions all the while taking out brown and red lesions and evening out the skin tone. So now we will be able to prevent the skin cancers before they come up, which goes right along with what we are supposed to do in primary care. I already do weight loss counseling on everyone with a BMI > 24 that comes through my door. Investment in an Echo machine is substantial and you need a tech and likely malpractice increases would occur. Yes, I could increase my dermatology procedures (and I may), but that takes some time and there is the cost of supplies. Perhaps my purchase was short-sighted. But the last time I was informed I was being short-sighted was when I went against the grain and opened up an IMP practice. Except for some financial hiccups, I think that has gone very well. Re: Branching out , I think that your investment was short sided from a practical stand point. I believe that there are plenty of services that you could have invested in that would have been medically beneficial to your pt and play upon your expertise (i.e. you are a physician). There are many things that you could do that you could do besides aesthetics (or cosmotology) that could be beneficial, less time consuming and MAYBE even be reimbursed by insurance. For instance, ABI, Weight loss, ncv, cryosurgery, Echocardiography. Yearly complete skin surveys with cryosurgery and biopsying any suspicious lesions would be beneficial to your patients, lucrative(minimal investment) and a valid service. Do the Math!!!! By the way this is also recommended by the American Derm association any way!!! Beck, M.D. --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of > contemplation I have > decided to start offering aesthetics in my practice. > I have purchased a > McCue Ultra VPL and will begin offering permanent > hair reduction, > photofacials, and spider vein removal in > mid-December. I wanted to share > my thought processes as to why I decided to go in > this direction in case > others are interested. > Why aesthetics? As of the end of September, I had > billed for $16,000 > more and had seen about 200 more patients this year > than last. > Unfortunately, I had collected about $500 less. When > researching why, I > found out I was making between $7-$9 less per claim > this year even > though the breakdown of the E & M codes and the CPT > codes were similar. > So, the insurances are either paying me less or my > population has > shifted to a lower paying insurance or both. At the > same time, I have > come to the conclusion that I don't want to be > busier in the office. > Since the beginning of the year, my schedule has > been relatively full. I > would say that we usually run at 80% capacity and > have had to swell to > 100% periodically to meet demand during busier > times. Financially, we > are making ends meet, but we certainly could not > afford it if anything > went wrong (ex. I got sick and missed a week, etc). > So the question is > how can I bring in more income without getting much > busier? I obviously > cannot rely on insurances to keep me afloat as they > have never even kept > up with the cost of living. I don't want to charge a > retainer fee as I > am concerned about the legality of it and I fear the > loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my > office is that my > nurse will do the initial consultation and perform > the actual procedure. > (I plan to quickly introduce myself to the patient > and glance at any > moles or other lesions prior to any procedure to > make sure there is > nothing worrisome). If she is doing a treatment > (average <30 minutes), I > will do my best to continue seeing scheduled > patients and answer the > phone. As my office is in a renovated house, we > already have an unused > room upstairs which will serve as a perfect > aesthetics room. The VPL was > not cheap ($65,000) but financed over 60 months > equates to about > $1400/month. So, total cost is really only the cost > of the machine as > the room is already there, there is no billing, I > will continue seeing > patients as before and my one employee is excited > about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have > not yet figured out my > fee schedule, most people I have talked to who do > this said that they > average $300/treatment. So, given this is up front > cash, only 5 > treatments a month would be necessary to break even. > Also remember that > most people need 3-5 treatments, so really only > about 20 people/year (5 > people being treated each month for 3 months X 4 > cycles of 3 months > each) are needed to break even. I already have been > open for 3.5 years, > and when I sent out a newsletter to my patients > stating that I was > thinking of doing this, I got 11 patients who stated > they were " very > interested. " I also have 2 patients who own salons > and both state they > have a lot of clients who they are sure would want > to have one of these > procedures done, but they have not had anyone to > refer them to. In > short, I can't imagine not having 20 patients > interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My > overhead is definitely > increased, but, assuming the machine pays for > itself, the time I spend > with the patient and the quality of care I can offer > should remain the > same as it has been over the past 3.5 years. If > anything, I am > approaching this as an alternative way of financing > the rest of my > practice in order to insulate it from the whims of > the insurance world. > We might even be able to generate enough income to > get a part time > chronic care nurse which would actually improve the > quality! > Anyway, as of next month, I am starting at zero > patients in my > aesthetics practice and I will keep everyone abreast > of how it develops. > I know Tim is doing this already (so I am not alone > in my quest to see > if this works), but I think he started off with both > the aesthetics and > the IMP practice. My IMP practice is closed to new > patients, but will > hopefully be able to feed the aesthetics practice. > We will see how/if > this works. > As always, I look forward to your comments! > > > __________________________________________________________ Sponsored Link Online degrees - find the right program to advance your career. Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Tim, First, don’t underestimate how much appearance affects your patients and their well being. Why are people willing to spend so much on “silly” things like haircuts, color, creams, make-up, etc? Is it simply because they are all shallow and need therapy? What about my patient who came up to me this week pleading for me to get her in for a photofacial as soon as possible. She has rosacea and states that every time she looks in the mirror she sees her alcoholic father, and she believes that everyone thinks she is one as well. Is this shallow of her? I see my job as a physician as simply to assist my patients is living the happiest and healthiest life they can. Looking and feeling good (even if it is superficial) is part of that. Secondly, don’t assume because the machine removes hair it cannot do “medical” stuff. I will be able to treat warts with one quick shot of light (less painful and caustic than freezing), and I will be able to (ultimately) use the light to activate acid (sorry, I don’t remember which one) to do photorejuvination. This will work much like effudex (with much less “down time”) to get rid of precancerous lesions all the while taking out brown and red lesions and evening out the skin tone. So now we will be able to prevent the skin cancers before they come up, which goes right along with what we are supposed to do in primary care. I already do weight loss counseling on everyone with a BMI > 24 that comes through my door. Investment in an Echo machine is substantial and you need a tech and likely malpractice increases would occur. Yes, I could increase my dermatology procedures (and I may), but that takes some time and there is the cost of supplies. Perhaps my purchase was short-sighted. But the last time I was informed I was being short-sighted was when I went against the grain and opened up an IMP practice. Except for some financial hiccups, I think that has gone very well. Re: Branching out , I think that your investment was short sided from a practical stand point. I believe that there are plenty of services that you could have invested in that would have been medically beneficial to your pt and play upon your expertise (i.e. you are a physician). There are many things that you could do that you could do besides aesthetics (or cosmotology) that could be beneficial, less time consuming and MAYBE even be reimbursed by insurance. For instance, ABI, Weight loss, ncv, cryosurgery, Echocardiography. Yearly complete skin surveys with cryosurgery and biopsying any suspicious lesions would be beneficial to your patients, lucrative(minimal investment) and a valid service. Do the Math!!!! By the way this is also recommended by the American Derm association any way!!! Beck, M.D. --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of > contemplation I have > decided to start offering aesthetics in my practice. > I have purchased a > McCue Ultra VPL and will begin offering permanent > hair reduction, > photofacials, and spider vein removal in > mid-December. I wanted to share > my thought processes as to why I decided to go in > this direction in case > others are interested. > Why aesthetics? As of the end of September, I had > billed for $16,000 > more and had seen about 200 more patients this year > than last. > Unfortunately, I had collected about $500 less. When > researching why, I > found out I was making between $7-$9 less per claim > this year even > though the breakdown of the E & M codes and the CPT > codes were similar. > So, the insurances are either paying me less or my > population has > shifted to a lower paying insurance or both. At the > same time, I have > come to the conclusion that I don't want to be > busier in the office. > Since the beginning of the year, my schedule has > been relatively full. I > would say that we usually run at 80% capacity and > have had to swell to > 100% periodically to meet demand during busier > times. Financially, we > are making ends meet, but we certainly could not > afford it if anything > went wrong (ex. I got sick and missed a week, etc). > So the question is > how can I bring in more income without getting much > busier? I obviously > cannot rely on insurances to keep me afloat as they > have never even kept > up with the cost of living. I don't want to charge a > retainer fee as I > am concerned about the legality of it and I fear the > loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my > office is that my > nurse will do the initial consultation and perform > the actual procedure. > (I plan to quickly introduce myself to the patient > and glance at any > moles or other lesions prior to any procedure to > make sure there is > nothing worrisome). If she is doing a treatment > (average <30 minutes), I > will do my best to continue seeing scheduled > patients and answer the > phone. As my office is in a renovated house, we > already have an unused > room upstairs which will serve as a perfect > aesthetics room. The VPL was > not cheap ($65,000) but financed over 60 months > equates to about > $1400/month. So, total cost is really only the cost > of the machine as > the room is already there, there is no billing, I > will continue seeing > patients as before and my one employee is excited > about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have > not yet figured out my > fee schedule, most people I have talked to who do > this said that they > average $300/treatment. So, given this is up front > cash, only 5 > treatments a month would be necessary to break even. > Also remember that > most people need 3-5 treatments, so really only > about 20 people/year (5 > people being treated each month for 3 months X 4 > cycles of 3 months > each) are needed to break even. I already have been > open for 3.5 years, > and when I sent out a newsletter to my patients > stating that I was > thinking of doing this, I got 11 patients who stated > they were " very > interested. " I also have 2 patients who own salons > and both state they > have a lot of clients who they are sure would want > to have one of these > procedures done, but they have not had anyone to > refer them to. In > short, I can't imagine not having 20 patients > interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My > overhead is definitely > increased, but, assuming the machine pays for > itself, the time I spend > with the patient and the quality of care I can offer > should remain the > same as it has been over the past 3.5 years. If > anything, I am > approaching this as an alternative way of financing > the rest of my > practice in order to insulate it from the whims of > the insurance world. > We might even be able to generate enough income to > get a part time > chronic care nurse which would actually improve the > quality! > Anyway, as of next month, I am starting at zero > patients in my > aesthetics practice and I will keep everyone abreast > of how it develops. > I know Tim is doing this already (so I am not alone > in my quest to see > if this works), but I think he started off with both > the aesthetics and > the IMP practice. My IMP practice is closed to new > patients, but will > hopefully be able to feed the aesthetics practice. > We will see how/if > this works. > As always, I look forward to your comments! > > > __________________________________________________________ Sponsored Link Online degrees - find the right program to advance your career. Www.nextag.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 ,Thanks for sharing your thoughts with the rest of us, and I wish you great success in this venture. I also have noticed that reimbursements from several insurance companies have been gradually creeping downward. For example, Blue Shield used to pay me $93.40 for a 99214. This year, it's only $89.76. United Healthcare had a bigger drop from $93.40 to $73.45. I recently sent a letter to Great-West Healthcare saying that I would drop them unless they raised their reimbursement. I'm not holding my breath.It seems inevitable that reimbursements will only get lower, not higher. To stay within our current system can only mean decreasing income for the same amount of work or more work to maintain the same level of income.Therefore, like you, I have been contemplating alternative means of income. I've considered:- adding aesthetics (I think it would do well in my community, but my wife is worried what it would do to my malpractice rates)- offering acupuncture (but I'd have to learn it first, plus there seem to be plenty of acupuncturists nearby)- adding a retainer/administrative fee (though only a small one, don't want to lose existing patients)- going to a cash only practice (also don't want to lose existing patients)- offering some kind of prepaid plan for doctor visits (but I think there are laws against doctors offering insurance in my state)- Bob Forester's "Robin Hood" non-profit model (seems like a lot of work to set up the non-profit)- opening a side business selling vitamins. Through the years, it has occurred to me that the easiest way for a doctor to get rich is to sell vitamins a la Dr. n Whitaker (http://www.drwhitaker.com/). There is no malpractice to worry about, and there is no shortage of people looking for "natural" treatments. Of course, there are ethical issues involved, such as the conflict of interest in promoting your products to your patients. I think it works better if you have little or no sense of shame, but that's just my opinion. There is actually a company that has been running radio ads in my area with a physician talking about how he needed something to supplement his income, and starting a side business with West Coast Wellness was the answer (http://coasttocoastwellness.com/). No idea how legitimate they are, but they are looking for partners/pigeons, depending on your point of view.- opening a Chinese restaurant as a side business (with every annual physical, you get a free egg roll! OK, that's just a joke we used to tell each other when my parents used to own a restaurant).I have no financial interests in any of the above, but I mention them because somebody might be interested. It's sad that primary care physicians have such a hard time making a living doing what we are trained to do. I am fortunate to have a physician spouse whose income makes up for my lack of one, so I don't have the financial pressure of being the sole provider for my family. But I would definitely like to make a reasonable income for what I do. Right now I'm waiting to see how much more income I can collect since adding a part-time biller to my practice. SetoSouth Pasadena, CAGroup,I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested.Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics.What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time.Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year.Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality!Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works.As always, I look forward to your comments! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 ,Thanks for sharing your thoughts with the rest of us, and I wish you great success in this venture. I also have noticed that reimbursements from several insurance companies have been gradually creeping downward. For example, Blue Shield used to pay me $93.40 for a 99214. This year, it's only $89.76. United Healthcare had a bigger drop from $93.40 to $73.45. I recently sent a letter to Great-West Healthcare saying that I would drop them unless they raised their reimbursement. I'm not holding my breath.It seems inevitable that reimbursements will only get lower, not higher. To stay within our current system can only mean decreasing income for the same amount of work or more work to maintain the same level of income.Therefore, like you, I have been contemplating alternative means of income. I've considered:- adding aesthetics (I think it would do well in my community, but my wife is worried what it would do to my malpractice rates)- offering acupuncture (but I'd have to learn it first, plus there seem to be plenty of acupuncturists nearby)- adding a retainer/administrative fee (though only a small one, don't want to lose existing patients)- going to a cash only practice (also don't want to lose existing patients)- offering some kind of prepaid plan for doctor visits (but I think there are laws against doctors offering insurance in my state)- Bob Forester's "Robin Hood" non-profit model (seems like a lot of work to set up the non-profit)- opening a side business selling vitamins. Through the years, it has occurred to me that the easiest way for a doctor to get rich is to sell vitamins a la Dr. n Whitaker (http://www.drwhitaker.com/). There is no malpractice to worry about, and there is no shortage of people looking for "natural" treatments. Of course, there are ethical issues involved, such as the conflict of interest in promoting your products to your patients. I think it works better if you have little or no sense of shame, but that's just my opinion. There is actually a company that has been running radio ads in my area with a physician talking about how he needed something to supplement his income, and starting a side business with West Coast Wellness was the answer (http://coasttocoastwellness.com/). No idea how legitimate they are, but they are looking for partners/pigeons, depending on your point of view.- opening a Chinese restaurant as a side business (with every annual physical, you get a free egg roll! OK, that's just a joke we used to tell each other when my parents used to own a restaurant).I have no financial interests in any of the above, but I mention them because somebody might be interested. It's sad that primary care physicians have such a hard time making a living doing what we are trained to do. I am fortunate to have a physician spouse whose income makes up for my lack of one, so I don't have the financial pressure of being the sole provider for my family. But I would definitely like to make a reasonable income for what I do. Right now I'm waiting to see how much more income I can collect since adding a part-time biller to my practice. SetoSouth Pasadena, CAGroup,I wanted to let everyone know that after months of contemplation I have decided to start offering aesthetics in my practice. I have purchased a McCue Ultra VPL and will begin offering permanent hair reduction, photofacials, and spider vein removal in mid-December. I wanted to share my thought processes as to why I decided to go in this direction in case others are interested.Why aesthetics? As of the end of September, I had billed for $16,000 more and had seen about 200 more patients this year than last. Unfortunately, I had collected about $500 less. When researching why, I found out I was making between $7-$9 less per claim this year even though the breakdown of the E & M codes and the CPT codes were similar. So, the insurances are either paying me less or my population has shifted to a lower paying insurance or both. At the same time, I have come to the conclusion that I don’t want to be busier in the office. Since the beginning of the year, my schedule has been relatively full. I would say that we usually run at 80% capacity and have had to swell to 100% periodically to meet demand during busier times. Financially, we are making ends meet, but we certainly could not afford it if anything went wrong (ex. I got sick and missed a week, etc). So the question is how can I bring in more income without getting much busier? I obviously cannot rely on insurances to keep me afloat as they have never even kept up with the cost of living. I don’t want to charge a retainer fee as I am concerned about the legality of it and I fear the loss of my patients. And so, I decided to look at aesthetics.What is the cost? The way the system will work in my office is that my nurse will do the initial consultation and perform the actual procedure. (I plan to quickly introduce myself to the patient and glance at any moles or other lesions prior to any procedure to make sure there is nothing worrisome). If she is doing a treatment (average <30 minutes), I will do my best to continue seeing scheduled patients and answer the phone. As my office is in a renovated house, we already have an unused room upstairs which will serve as a perfect aesthetics room. The VPL was not cheap ($65,000) but financed over 60 months equates to about $1400/month. So, total cost is really only the cost of the machine as the room is already there, there is no billing, I will continue seeing patients as before and my one employee is excited about doing the procedures which do not take a huge amount of time.Can you make that much per month? Although I have not yet figured out my fee schedule, most people I have talked to who do this said that they average $300/treatment. So, given this is up front cash, only 5 treatments a month would be necessary to break even. Also remember that most people need 3-5 treatments, so really only about 20 people/year (5 people being treated each month for 3 months X 4 cycles of 3 months each) are needed to break even. I already have been open for 3.5 years, and when I sent out a newsletter to my patients stating that I was thinking of doing this, I got 11 patients who stated they were “very interested.” I also have 2 patients who own salons and both state they have a lot of clients who they are sure would want to have one of these procedures done, but they have not had anyone to refer them to. In short, I can’t imagine not having 20 patients interested in the next year.Is it Anti-IMP? Actually, I don’t think so. My overhead is definitely increased, but, assuming the machine pays for itself, the time I spend with the patient and the quality of care I can offer should remain the same as it has been over the past 3.5 years. If anything, I am approaching this as an alternative way of financing the rest of my practice in order to insulate it from the whims of the insurance world. We might even be able to generate enough income to get a part time chronic care nurse which would actually improve the quality!Anyway, as of next month, I am starting at zero patients in my aesthetics practice and I will keep everyone abreast of how it develops. I know Tim is doing this already (so I am not alone in my quest to see if this works), but I think he started off with both the aesthetics and the IMP practice. My IMP practice is closed to new patients, but will hopefully be able to feed the aesthetics practice. We will see how/if this works.As always, I look forward to your comments! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Its my understanding, the mixed botox is good for 2 weeks. I have used some on friends that was 4 weeks old and worked fine. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Brady, MD Sent: Saturday, November 18, 2006 6:39 AM To: Subject: RE: Branching out I have considered this and even taken a course (so that I am “certified”). The problem is that you have to mix up 100u of botox at once and will likely use 30-50u on a face. The rest is only good for a day or so, so either you need to line up 2-3 patients in a day, or you will lose money. Also, my malpractice would go up $3000/year if I did these procedures and I would have to do them (taking time away from my other patients). For those reasons, I decided to start with the laser. Note: I do believe that many of the same people who come in for the photofacial will also desire botox. I will likely keep a list and when it appears that it will be profitable, I will reconsider it. -----Original Message----- From: [mailto: ] On Behalf Of Rocky Patel Sent: Saturday, November 18, 2006 6:46 AM To: Subject: Re: Branching out , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Its my understanding, the mixed botox is good for 2 weeks. I have used some on friends that was 4 weeks old and worked fine. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Brady, MD Sent: Saturday, November 18, 2006 6:39 AM To: Subject: RE: Branching out I have considered this and even taken a course (so that I am “certified”). The problem is that you have to mix up 100u of botox at once and will likely use 30-50u on a face. The rest is only good for a day or so, so either you need to line up 2-3 patients in a day, or you will lose money. Also, my malpractice would go up $3000/year if I did these procedures and I would have to do them (taking time away from my other patients). For those reasons, I decided to start with the laser. Note: I do believe that many of the same people who come in for the photofacial will also desire botox. I will likely keep a list and when it appears that it will be profitable, I will reconsider it. -----Original Message----- From: [mailto: ] On Behalf Of Rocky Patel Sent: Saturday, November 18, 2006 6:46 AM To: Subject: Re: Branching out , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2006 Report Share Posted November 18, 2006 Wow! Great information. Thanks! Re: Branching out , Are you going to offer Botox and dermal fillers? People like one stop shopping and both are pretty easy to do. good luck rocky --- " Brady, MD " <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > Group, > I wanted to let everyone know that after months of contemplation I > have > decided to start offering aesthetics in my practice. I have purchased > a > McCue Ultra VPL and will begin offering permanent hair reduction, > photofacials, and spider vein removal in mid-December. I wanted to > share > my thought processes as to why I decided to go in this direction in > case > others are interested. > Why aesthetics? As of the end of September, I had billed for $16,000 > more and had seen about 200 more patients this year than last. > Unfortunately, I had collected about $500 less. When researching why, > I > found out I was making between $7-$9 less per claim this year even > though the breakdown of the E & M codes and the CPT codes were similar. > So, the insurances are either paying me less or my population has > shifted to a lower paying insurance or both. At the same time, I have > come to the conclusion that I don't want to be busier in the office. > Since the beginning of the year, my schedule has been relatively > full. I > would say that we usually run at 80% capacity and have had to swell > to > 100% periodically to meet demand during busier times. Financially, we > are making ends meet, but we certainly could not afford it if > anything > went wrong (ex. I got sick and missed a week, etc). So the question > is > how can I bring in more income without getting much busier? I > obviously > cannot rely on insurances to keep me afloat as they have never even > kept > up with the cost of living. I don't want to charge a retainer fee as > I > am concerned about the legality of it and I fear the loss of my > patients. And so, I decided to look at aesthetics. > What is the cost? The way the system will work in my office is that > my > nurse will do the initial consultation and perform the actual > procedure. > (I plan to quickly introduce myself to the patient and glance at any > moles or other lesions prior to any procedure to make sure there is > nothing worrisome). If she is doing a treatment (average <30 > minutes), I > will do my best to continue seeing scheduled patients and answer the > phone. As my office is in a renovated house, we already have an > unused > room upstairs which will serve as a perfect aesthetics room. The VPL > was > not cheap ($65,000) but financed over 60 months equates to about > $1400/month. So, total cost is really only the cost of the machine as > the room is already there, there is no billing, I will continue > seeing > patients as before and my one employee is excited about doing the > procedures which do not take a huge amount of time. > Can you make that much per month? Although I have not yet figured out > my > fee schedule, most people I have talked to who do this said that they > average $300/treatment. So, given this is up front cash, only 5 > treatments a month would be necessary to break even. Also remember > that > most people need 3-5 treatments, so really only about 20 people/year > (5 > people being treated each month for 3 months X 4 cycles of 3 months > each) are needed to break even. I already have been open for 3.5 > years, > and when I sent out a newsletter to my patients stating that I was > thinking of doing this, I got 11 patients who stated they were " very > interested. " I also have 2 patients who own salons and both state > they > have a lot of clients who they are sure would want to have one of > these > procedures done, but they have not had anyone to refer them to. In > short, I can't imagine not having 20 patients interested in the next > year. > Is it Anti-IMP? Actually, I don't think so. My overhead is definitely > increased, but, assuming the machine pays for itself, the time I > spend > with the patient and the quality of care I can offer should remain > the > same as it has been over the past 3.5 years. If anything, I am > approaching this as an alternative way of financing the rest of my > practice in order to insulate it from the whims of the insurance > world. > We might even be able to generate enough income to get a part time > chronic care nurse which would actually improve the quality! > Anyway, as of next month, I am starting at zero patients in my > aesthetics practice and I will keep everyone abreast of how it > develops. > I know Tim is doing this already (so I am not alone in my quest to > see > if this works), but I think he started off with both the aesthetics > and > the IMP practice. My IMP practice is closed to new patients, but will > hopefully be able to feed the aesthetics practice. We will see how/if > this works. > As always, I look forward to your comments! > > > Rakesh Patel MD Arizona Sun Family Medicine, P.C. 633 East Ray Road, #101 Gilbert, Arizona 85296 www.azsunfm.com PLEASE NOTE: Email is not a secure form of communication. It should not be used for urgent or sensitive messages. Email may be done securely through our web portal. If you have a medical emergency go to an Emergency Room or call 911. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 - Wow. I am quite dismayed that you feel/think this way about the financial potential of a standard IMPish primary care practice (financial dead end/potential only for shrinking reimbursement), though I fear you are right and the writing is on the wall; and I am worried that if YOU can't make it work, how will a less business savvy (and less omniscient) person like myself do it? But anyway hooray for Robin Hood and I do wish you success with your new line. Lynn _________________________________________________________________ Talk now to your Hotmail contacts with Windows Live Messenger. http://clk.atdmt.com/MSN/go/msnnkwme0020000001msn/direct/01/?href=http://get.liv\ e.com/messenger/overview Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 - Wow. I am quite dismayed that you feel/think this way about the financial potential of a standard IMPish primary care practice (financial dead end/potential only for shrinking reimbursement), though I fear you are right and the writing is on the wall; and I am worried that if YOU can't make it work, how will a less business savvy (and less omniscient) person like myself do it? But anyway hooray for Robin Hood and I do wish you success with your new line. Lynn _________________________________________________________________ Talk now to your Hotmail contacts with Windows Live Messenger. http://clk.atdmt.com/MSN/go/msnnkwme0020000001msn/direct/01/?href=http://get.liv\ e.com/messenger/overview Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 Mike, first of all, you need to do a feasibility study to see what the numbers will look like. IE how much does medicare pay for the procedure. How much does the equipment cost? Look for maintenance loop holes! Look at the LMRP and see what diagnoses support these procedures and look at how many people in your office have or potentially could have that diagnoses. For instance, ABI cost $2000 takes 15 minutes from trained staff or you. Medicare reimburses $100 dollars. LMRP states that any vascular disease diagnoses will support this procedure. Recent press push to look and treat this disease! Need to do 20 to get original investment back! Have your supplier delay your bill for 60 days. Order one a day! It is payed for quickly! Make some good diagnoses!! Treat pt for PAD!!! You are quickly benefitting from this procedure both financially and professionally! By starting ACEI, Statin and encouraging brisk daily walking for PAD you improve someone's life and maybe avert the grim reaper, momentarily!! You go to sleep that night feeling good about your accomplishment and the heating bill is paid. That is how I scrutinize any service. Is it helpful, legal, ethical and profitable? Beck, M.D. --- goatsrkids2@... wrote: > , can you expand on these procedures ( ABI, > Weight loss, ncv, cryosurgery, Echocardiography.) > , i.e. initial cost and equipment, time demand, > diagnosis that support, procedure > codes/reimbursement and how you incorporate them > into your daily practice. Thanks Mike Jewett > Re: Branching out > > > , > I think that your investment was short sided from > a practical stand point. I believe that there are > plenty of services that you could have invested in > that would have been medically beneficial to your > pt > and play upon your expertise (i.e. you are a > physician). There are many things that you could > do > that you could do besides aesthetics (or > cosmotology) > that could be beneficial, less time consuming and > MAYBE even be reimbursed by insurance. For > instance, > ABI, Weight loss, ncv, cryosurgery, > Echocardiography. > Yearly complete skin surveys with cryosurgery and > biopsying any suspicious lesions would be > beneficial > to your patients, lucrative(minimal investment) > and a > valid service. Do the Math!!!! By the way this is > also > recommended by the American Derm association any > way!!! > > Beck, M.D. > > --- " Brady, MD " > wrote: > > > Group, > > I wanted to let everyone know that after months > of > > contemplation I have > > decided to start offering aesthetics in my > practice. > > I have purchased a > > McCue Ultra VPL and will begin offering > permanent > > hair reduction, > > photofacials, and spider vein removal in > > mid-December. I wanted to share > > my thought processes as to why I decided to go > in > > this direction in case > > others are interested. > > Why aesthetics? As of the end of September, I > had > > billed for $16,000 > > more and had seen about 200 more patients this > year > > than last. > > Unfortunately, I had collected about $500 less. > When > > researching why, I > > found out I was making between $7-$9 less per > claim > > this year even > > though the breakdown of the E & M codes and the > CPT > > codes were similar. > > So, the insurances are either paying me less or > my > > population has > > shifted to a lower paying insurance or both. At > the > > same time, I have > > come to the conclusion that I don't want to be > > busier in the office. > > Since the beginning of the year, my schedule has > > been relatively full. I > > would say that we usually run at 80% capacity > and > > have had to swell to > > 100% periodically to meet demand during busier > > times. Financially, we > > are making ends meet, but we certainly could not > > afford it if anything > > went wrong (ex. I got sick and missed a week, > etc). > > So the question is > > how can I bring in more income without getting > much > > busier? I obviously > > cannot rely on insurances to keep me afloat as > they > > have never even kept > > up with the cost of living. I don't want to > charge a > > retainer fee as I > > am concerned about the legality of it and I fear > the > > loss of my > > patients. And so, I decided to look at > aesthetics. > > What is the cost? The way the system will work > in my > > office is that my > > nurse will do the initial consultation and > perform > > the actual procedure. > > (I plan to quickly introduce myself to the > patient > > and glance at any > > moles or other lesions prior to any procedure to > > make sure there is > > nothing worrisome). If she is doing a treatment > > (average <30 minutes), I > > will do my best to continue seeing scheduled > > patients and answer the > > phone. As my office is in a renovated house, we > > already have an unused > > room upstairs which will serve as a perfect > > aesthetics room. The VPL was > > not cheap ($65,000) but financed over 60 months > > equates to about > > $1400/month. So, total cost is really only the > cost > > of the machine as > > the room is already there, there is no billing, > I > > will continue seeing > > patients as before and my one employee is > excited > > about doing the > > procedures which do not take a huge amount of > time. > > Can you make that much per month? Although I > have > > not yet figured out my > > fee schedule, most people I have talked to who > do > > this said that they > > average $300/treatment. So, given this is up > front > > cash, only 5 > > treatments a month would be necessary to break > even. > > Also remember that > > most people need 3-5 treatments, so really only > > about 20 people/year (5 > > people being treated each month for 3 months X 4 > > cycles of 3 months > > each) are needed to break even. I already have > been > > open for 3.5 years, > > and when I sent out a newsletter to my patients > > stating that I was > > thinking of doing this, I got 11 patients who > stated > > they were " very > > interested. " I also have 2 patients who own > salons > > and both state they > > have a lot of clients who they are sure would > want > > to have one of these > > procedures done, but they have not had anyone to > > refer them to. In > > short, I can't imagine not having 20 patients > > interested in the next > > year. > > Is it Anti-IMP? Actually, I don't think so. My > > overhead is definitely > > increased, but, assuming the machine pays for > > itself, the time I spend > > with the patient and the quality of care I can > offer > > should remain the > > same as it has been over the past 3.5 years. If > > anything, I am > > approaching this as an alternative way of > financing > > the rest of my > > practice in order to insulate it from the whims > of > > the insurance world. > > We might even be able to generate enough income > to > > get a part time > > chronic care nurse which would actually improve > the > > quality! > > Anyway, as of next month, I am starting at zero > > patients in my > > aesthetics practice and I will keep everyone > abreast > === message truncated === ________________________________________________________________________________\ ____ Sponsored Link Mortgage rates near 39yr lows. $310k for $999/mo. Calculate new payment! www.LowerMyBills.com/lre Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 Mike, first of all, you need to do a feasibility study to see what the numbers will look like. IE how much does medicare pay for the procedure. How much does the equipment cost? Look for maintenance loop holes! Look at the LMRP and see what diagnoses support these procedures and look at how many people in your office have or potentially could have that diagnoses. For instance, ABI cost $2000 takes 15 minutes from trained staff or you. Medicare reimburses $100 dollars. LMRP states that any vascular disease diagnoses will support this procedure. Recent press push to look and treat this disease! Need to do 20 to get original investment back! Have your supplier delay your bill for 60 days. Order one a day! It is payed for quickly! Make some good diagnoses!! Treat pt for PAD!!! You are quickly benefitting from this procedure both financially and professionally! By starting ACEI, Statin and encouraging brisk daily walking for PAD you improve someone's life and maybe avert the grim reaper, momentarily!! You go to sleep that night feeling good about your accomplishment and the heating bill is paid. That is how I scrutinize any service. Is it helpful, legal, ethical and profitable? Beck, M.D. --- goatsrkids2@... wrote: > , can you expand on these procedures ( ABI, > Weight loss, ncv, cryosurgery, Echocardiography.) > , i.e. initial cost and equipment, time demand, > diagnosis that support, procedure > codes/reimbursement and how you incorporate them > into your daily practice. Thanks Mike Jewett > Re: Branching out > > > , > I think that your investment was short sided from > a practical stand point. I believe that there are > plenty of services that you could have invested in > that would have been medically beneficial to your > pt > and play upon your expertise (i.e. you are a > physician). There are many things that you could > do > that you could do besides aesthetics (or > cosmotology) > that could be beneficial, less time consuming and > MAYBE even be reimbursed by insurance. For > instance, > ABI, Weight loss, ncv, cryosurgery, > Echocardiography. > Yearly complete skin surveys with cryosurgery and > biopsying any suspicious lesions would be > beneficial > to your patients, lucrative(minimal investment) > and a > valid service. Do the Math!!!! By the way this is > also > recommended by the American Derm association any > way!!! > > Beck, M.D. > > --- " Brady, MD " > wrote: > > > Group, > > I wanted to let everyone know that after months > of > > contemplation I have > > decided to start offering aesthetics in my > practice. > > I have purchased a > > McCue Ultra VPL and will begin offering > permanent > > hair reduction, > > photofacials, and spider vein removal in > > mid-December. I wanted to share > > my thought processes as to why I decided to go > in > > this direction in case > > others are interested. > > Why aesthetics? As of the end of September, I > had > > billed for $16,000 > > more and had seen about 200 more patients this > year > > than last. > > Unfortunately, I had collected about $500 less. > When > > researching why, I > > found out I was making between $7-$9 less per > claim > > this year even > > though the breakdown of the E & M codes and the > CPT > > codes were similar. > > So, the insurances are either paying me less or > my > > population has > > shifted to a lower paying insurance or both. At > the > > same time, I have > > come to the conclusion that I don't want to be > > busier in the office. > > Since the beginning of the year, my schedule has > > been relatively full. I > > would say that we usually run at 80% capacity > and > > have had to swell to > > 100% periodically to meet demand during busier > > times. Financially, we > > are making ends meet, but we certainly could not > > afford it if anything > > went wrong (ex. I got sick and missed a week, > etc). > > So the question is > > how can I bring in more income without getting > much > > busier? I obviously > > cannot rely on insurances to keep me afloat as > they > > have never even kept > > up with the cost of living. I don't want to > charge a > > retainer fee as I > > am concerned about the legality of it and I fear > the > > loss of my > > patients. And so, I decided to look at > aesthetics. > > What is the cost? The way the system will work > in my > > office is that my > > nurse will do the initial consultation and > perform > > the actual procedure. > > (I plan to quickly introduce myself to the > patient > > and glance at any > > moles or other lesions prior to any procedure to > > make sure there is > > nothing worrisome). If she is doing a treatment > > (average <30 minutes), I > > will do my best to continue seeing scheduled > > patients and answer the > > phone. As my office is in a renovated house, we > > already have an unused > > room upstairs which will serve as a perfect > > aesthetics room. The VPL was > > not cheap ($65,000) but financed over 60 months > > equates to about > > $1400/month. So, total cost is really only the > cost > > of the machine as > > the room is already there, there is no billing, > I > > will continue seeing > > patients as before and my one employee is > excited > > about doing the > > procedures which do not take a huge amount of > time. > > Can you make that much per month? Although I > have > > not yet figured out my > > fee schedule, most people I have talked to who > do > > this said that they > > average $300/treatment. So, given this is up > front > > cash, only 5 > > treatments a month would be necessary to break > even. > > Also remember that > > most people need 3-5 treatments, so really only > > about 20 people/year (5 > > people being treated each month for 3 months X 4 > > cycles of 3 months > > each) are needed to break even. I already have > been > > open for 3.5 years, > > and when I sent out a newsletter to my patients > > stating that I was > > thinking of doing this, I got 11 patients who > stated > > they were " very > > interested. " I also have 2 patients who own > salons > > and both state they > > have a lot of clients who they are sure would > want > > to have one of these > > procedures done, but they have not had anyone to > > refer them to. In > > short, I can't imagine not having 20 patients > > interested in the next > > year. > > Is it Anti-IMP? Actually, I don't think so. My > > overhead is definitely > > increased, but, assuming the machine pays for > > itself, the time I spend > > with the patient and the quality of care I can > offer > > should remain the > > same as it has been over the past 3.5 years. If > > anything, I am > > approaching this as an alternative way of > financing > > the rest of my > > practice in order to insulate it from the whims > of > > the insurance world. > > We might even be able to generate enough income > to > > get a part time > > chronic care nurse which would actually improve > the > > quality! > > Anyway, as of next month, I am starting at zero > > patients in my > > aesthetics practice and I will keep everyone > abreast > === message truncated === ________________________________________________________________________________\ ____ Sponsored Link Mortgage rates near 39yr lows. $310k for $999/mo. Calculate new payment! www.LowerMyBills.com/lre Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 Tim, Great points on the ABI. But, I guess my question is how necessary is this test really? You see, just because we have the equipment, and we get paid well, we do the test. But is it really necessary? Does it really help to diagnose someone with PAD via ABIs or would we advise any smoker with htn and increased cholesterol to exercise and start them on appropriate medical therapy? I only ask because when I worked in an office with an X-ray machine, I ordered a lot more X-rays. If I have an EKG machine, I get a lot more EKGs. If I have a spirometry, I test every smoker every year. These tests can be very helpful, but are we seeking out people to do the tests on simply to get paid more (thus increasing costs without increasing quality) or does it really help change what our course of action will be with the patient. That is one of the attractions of aesthetics to me over adding these procedures in my office. Everyone realizes that these procedures are not medically necessary. No one, including me, will be confused as to whether I am removing hair because it is truly necessary or because I will increase my income. My hope is that by using this alternative form of income, I will have the financial freedom to order what is necessary without clouding my clinical judgment with what might be unnecessary but cool and provide additional dollars. In no way am I saying that is what is happening to you, I just fear it would happen to me. Money is a great motivator. Thanks again for your insights! Re: Branching out Mike, first of all, you need to do a feasibility study to see what the numbers will look like. IE how much does medicare pay for the procedure. How much does the equipment cost? Look for maintenance loop holes! Look at the LMRP and see what diagnoses support these procedures and look at how many people in your office have or potentially could have that diagnoses. For instance, ABI cost $2000 takes 15 minutes from trained staff or you. Medicare reimburses $100 dollars. LMRP states that any vascular disease diagnoses will support this procedure. Recent press push to look and treat this disease! Need to do 20 to get original investment back! Have your supplier delay your bill for 60 days. Order one a day! It is payed for quickly! Make some good diagnoses!! Treat pt for PAD!!! You are quickly benefitting from this procedure both financially and professionally! By starting ACEI, Statin and encouraging brisk daily walking for PAD you improve someone's life and maybe avert the grim reaper, momentarily!! You go to sleep that night feeling good about your accomplishment and the heating bill is paid. That is how I scrutinize any service. Is it helpful, legal, ethical and profitable? Beck, M.D. --- goatsrkids2comcast (DOT) net wrote: > , can you expand on these procedures ( ABI, > Weight loss, ncv, cryosurgery, Echocardiography.) > , i.e. initial cost and equipment, time demand, > diagnosis that support, procedure > codes/reimbursement and how you incorporate them > into your daily practice. Thanks Mike Jewett > Re: Branching out > > > , > I think that your investment was short sided from > a practical stand point. I believe that there are > plenty of services that you could have invested in > that would have been medically beneficial to your > pt > and play upon your expertise (i.e. you are a > physician). There are many things that you could > do > that you could do besides aesthetics (or > cosmotology) > that could be beneficial, less time consuming and > MAYBE even be reimbursed by insurance. For > instance, > ABI, Weight loss, ncv, cryosurgery, > Echocardiography. > Yearly complete skin surveys with cryosurgery and > biopsying any suspicious lesions would be > beneficial > to your patients, lucrative(minimal investment) > and a > valid service. Do the Math!!!! By the way this is > also > recommended by the American Derm association any > way!!! > > Beck, M.D. > > --- " Brady, MD " > <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > > > Group, > > I wanted to let everyone know that after months > of > > contemplation I have > > decided to start offering aesthetics in my > practice. > > I have purchased a > > McCue Ultra VPL and will begin offering > permanent > > hair reduction, > > photofacials, and spider vein removal in > > mid-December. I wanted to share > > my thought processes as to why I decided to go > in > > this direction in case > > others are interested. > > Why aesthetics? As of the end of September, I > had > > billed for $16,000 > > more and had seen about 200 more patients this > year > > than last. > > Unfortunately, I had collected about $500 less. > When > > researching why, I > > found out I was making between $7-$9 less per > claim > > this year even > > though the breakdown of the E & M codes and the > CPT > > codes were similar. > > So, the insurances are either paying me less or > my > > population has > > shifted to a lower paying insurance or both. At > the > > same time, I have > > come to the conclusion that I don't want to be > > busier in the office. > > Since the beginning of the year, my schedule has > > been relatively full. I > > would say that we usually run at 80% capacity > and > > have had to swell to > > 100% periodically to meet demand during busier > > times. Financially, we > > are making ends meet, but we certainly could not > > afford it if anything > > went wrong (ex. I got sick and missed a week, > etc). > > So the question is > > how can I bring in more income without getting > much > > busier? I obviously > > cannot rely on insurances to keep me afloat as > they > > have never even kept > > up with the cost of living. I don't want to > charge a > > retainer fee as I > > am concerned about the legality of it and I fear > the > > loss of my > > patients. And so, I decided to look at > aesthetics. > > What is the cost? The way the system will work > in my > > office is that my > > nurse will do the initial consultation and > perform > > the actual procedure. > > (I plan to quickly introduce myself to the > patient > > and glance at any > > moles or other lesions prior to any procedure to > > make sure there is > > nothing worrisome). If she is doing a treatment > > (average <30 minutes), I > > will do my best to continue seeing scheduled > > patients and answer the > > phone. As my office is in a renovated house, we > > already have an unused > > room upstairs which will serve as a perfect > > aesthetics room. The VPL was > > not cheap ($65,000) but financed over 60 months > > equates to about > > $1400/month. So, total cost is really only the > cost > > of the machine as > > the room is already there, there is no billing, > I > > will continue seeing > > patients as before and my one employee is > excited > > about doing the > > procedures which do not take a huge amount of > time. > > Can you make that much per month? Although I > have > > not yet figured out my > > fee schedule, most people I have talked to who > do > > this said that they > > average $300/treatment. So, given this is up > front > > cash, only 5 > > treatments a month would be necessary to break > even. > > Also remember that > > most people need 3-5 treatments, so really only > > about 20 people/year (5 > > people being treated each month for 3 months X 4 > > cycles of 3 months > > each) are needed to break even. I already have > been > > open for 3.5 years, > > and when I sent out a newsletter to my patients > > stating that I was > > thinking of doing this, I got 11 patients who > stated > > they were " very > > interested. " I also have 2 patients who own > salons > > and both state they > > have a lot of clients who they are sure would > want > > to have one of these > > procedures done, but they have not had anyone to > > refer them to. In > > short, I can't imagine not having 20 patients > > interested in the next > > year. > > Is it Anti-IMP? Actually, I don't think so. My > > overhead is definitely > > increased, but, assuming the machine pays for > > itself, the time I spend > > with the patient and the quality of care I can > offer > > should remain the > > same as it has been over the past 3.5 years. If > > anything, I am > > approaching this as an alternative way of > financing > > the rest of my > > practice in order to insulate it from the whims > of > > the insurance world. > > We might even be able to generate enough income > to > > get a part time > > chronic care nurse which would actually improve > the > > quality! > > Anyway, as of next month, I am starting at zero > > patients in my > > aesthetics practice and I will keep everyone > abreast > === message truncated === __________________________________________________________ Sponsored Link Mortgage rates near 39yr lows. $310k for $999/mo. Calculate new payment! www.LowerMyBills.com/lre Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 19, 2006 Report Share Posted November 19, 2006 Tim, Great points on the ABI. But, I guess my question is how necessary is this test really? You see, just because we have the equipment, and we get paid well, we do the test. But is it really necessary? Does it really help to diagnose someone with PAD via ABIs or would we advise any smoker with htn and increased cholesterol to exercise and start them on appropriate medical therapy? I only ask because when I worked in an office with an X-ray machine, I ordered a lot more X-rays. If I have an EKG machine, I get a lot more EKGs. If I have a spirometry, I test every smoker every year. These tests can be very helpful, but are we seeking out people to do the tests on simply to get paid more (thus increasing costs without increasing quality) or does it really help change what our course of action will be with the patient. That is one of the attractions of aesthetics to me over adding these procedures in my office. Everyone realizes that these procedures are not medically necessary. No one, including me, will be confused as to whether I am removing hair because it is truly necessary or because I will increase my income. My hope is that by using this alternative form of income, I will have the financial freedom to order what is necessary without clouding my clinical judgment with what might be unnecessary but cool and provide additional dollars. In no way am I saying that is what is happening to you, I just fear it would happen to me. Money is a great motivator. Thanks again for your insights! Re: Branching out Mike, first of all, you need to do a feasibility study to see what the numbers will look like. IE how much does medicare pay for the procedure. How much does the equipment cost? Look for maintenance loop holes! Look at the LMRP and see what diagnoses support these procedures and look at how many people in your office have or potentially could have that diagnoses. For instance, ABI cost $2000 takes 15 minutes from trained staff or you. Medicare reimburses $100 dollars. LMRP states that any vascular disease diagnoses will support this procedure. Recent press push to look and treat this disease! Need to do 20 to get original investment back! Have your supplier delay your bill for 60 days. Order one a day! It is payed for quickly! Make some good diagnoses!! Treat pt for PAD!!! You are quickly benefitting from this procedure both financially and professionally! By starting ACEI, Statin and encouraging brisk daily walking for PAD you improve someone's life and maybe avert the grim reaper, momentarily!! You go to sleep that night feeling good about your accomplishment and the heating bill is paid. That is how I scrutinize any service. Is it helpful, legal, ethical and profitable? Beck, M.D. --- goatsrkids2comcast (DOT) net wrote: > , can you expand on these procedures ( ABI, > Weight loss, ncv, cryosurgery, Echocardiography.) > , i.e. initial cost and equipment, time demand, > diagnosis that support, procedure > codes/reimbursement and how you incorporate them > into your daily practice. Thanks Mike Jewett > Re: Branching out > > > , > I think that your investment was short sided from > a practical stand point. I believe that there are > plenty of services that you could have invested in > that would have been medically beneficial to your > pt > and play upon your expertise (i.e. you are a > physician). There are many things that you could > do > that you could do besides aesthetics (or > cosmotology) > that could be beneficial, less time consuming and > MAYBE even be reimbursed by insurance. For > instance, > ABI, Weight loss, ncv, cryosurgery, > Echocardiography. > Yearly complete skin surveys with cryosurgery and > biopsying any suspicious lesions would be > beneficial > to your patients, lucrative(minimal investment) > and a > valid service. Do the Math!!!! By the way this is > also > recommended by the American Derm association any > way!!! > > Beck, M.D. > > --- " Brady, MD " > <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: > > > Group, > > I wanted to let everyone know that after months > of > > contemplation I have > > decided to start offering aesthetics in my > practice. > > I have purchased a > > McCue Ultra VPL and will begin offering > permanent > > hair reduction, > > photofacials, and spider vein removal in > > mid-December. I wanted to share > > my thought processes as to why I decided to go > in > > this direction in case > > others are interested. > > Why aesthetics? As of the end of September, I > had > > billed for $16,000 > > more and had seen about 200 more patients this > year > > than last. > > Unfortunately, I had collected about $500 less. > When > > researching why, I > > found out I was making between $7-$9 less per > claim > > this year even > > though the breakdown of the E & M codes and the > CPT > > codes were similar. > > So, the insurances are either paying me less or > my > > population has > > shifted to a lower paying insurance or both. At > the > > same time, I have > > come to the conclusion that I don't want to be > > busier in the office. > > Since the beginning of the year, my schedule has > > been relatively full. I > > would say that we usually run at 80% capacity > and > > have had to swell to > > 100% periodically to meet demand during busier > > times. Financially, we > > are making ends meet, but we certainly could not > > afford it if anything > > went wrong (ex. I got sick and missed a week, > etc). > > So the question is > > how can I bring in more income without getting > much > > busier? I obviously > > cannot rely on insurances to keep me afloat as > they > > have never even kept > > up with the cost of living. I don't want to > charge a > > retainer fee as I > > am concerned about the legality of it and I fear > the > > loss of my > > patients. And so, I decided to look at > aesthetics. > > What is the cost? The way the system will work > in my > > office is that my > > nurse will do the initial consultation and > perform > > the actual procedure. > > (I plan to quickly introduce myself to the > patient > > and glance at any > > moles or other lesions prior to any procedure to > > make sure there is > > nothing worrisome). If she is doing a treatment > > (average <30 minutes), I > > will do my best to continue seeing scheduled > > patients and answer the > > phone. As my office is in a renovated house, we > > already have an unused > > room upstairs which will serve as a perfect > > aesthetics room. The VPL was > > not cheap ($65,000) but financed over 60 months > > equates to about > > $1400/month. So, total cost is really only the > cost > > of the machine as > > the room is already there, there is no billing, > I > > will continue seeing > > patients as before and my one employee is > excited > > about doing the > > procedures which do not take a huge amount of > time. > > Can you make that much per month? Although I > have > > not yet figured out my > > fee schedule, most people I have talked to who > do > > this said that they > > average $300/treatment. So, given this is up > front > > cash, only 5 > > treatments a month would be necessary to break > even. > > Also remember that > > most people need 3-5 treatments, so really only > > about 20 people/year (5 > > people being treated each month for 3 months X 4 > > cycles of 3 months > > each) are needed to break even. I already have > been > > open for 3.5 years, > > and when I sent out a newsletter to my patients > > stating that I was > > thinking of doing this, I got 11 patients who > stated > > they were " very > > interested. " I also have 2 patients who own > salons > > and both state they > > have a lot of clients who they are sure would > want > > to have one of these > > procedures done, but they have not had anyone to > > refer them to. In > > short, I can't imagine not having 20 patients > > interested in the next > > year. > > Is it Anti-IMP? Actually, I don't think so. My > > overhead is definitely > > increased, but, assuming the machine pays for > > itself, the time I spend > > with the patient and the quality of care I can > offer > > should remain the > > same as it has been over the past 3.5 years. If > > anything, I am > > approaching this as an alternative way of > financing > > the rest of my > > practice in order to insulate it from the whims > of > > the insurance world. > > We might even be able to generate enough income > to > > get a part time > > chronic care nurse which would actually improve > the > > quality! > > Anyway, as of next month, I am starting at zero > > patients in my > > aesthetics practice and I will keep everyone > abreast > === message truncated === __________________________________________________________ Sponsored Link Mortgage rates near 39yr lows. $310k for $999/mo. Calculate new payment! www.LowerMyBills.com/lre Quote Link to comment Share on other sites More sharing options...
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