RE: Thanks for the input, Keep it coming.

October 29, 2006

ok.

If the power goes out a second time int he middle of this I give up (I

have solar panels but thuhnderstorms this summer de fibrillated the

inverter and the electrician needs to come over and fix things)

Do very few labs.

I have also thought alot about what to offer patietns but it is not our

job to solve all the problems of health care.

I ahve worked in far more rural areas and of course patietns want

conveneince- xray and lab .

But patietns do not pay for them and in genrela they are poorly reimbursed

The equipment takes time space money and up keep and personell. If you

a re near the hospital then hospitals provide these services quite

efficiently TEACH PATIENTS WHY you cannot aford to fund their convenience

Someday you will meet a aptietn who cares enough to help you change

healthcare.

My opinion- do urinalayis preg test strep test. I do also microalbmins.

I note that TWICE all my pregnanyc tests have disapperarsd From a closed

bathroom cabinet Now they live in my lab coat pocket for pete's sake.

Thanks for the input, Keep it coming.

I just want to thank everyone for the input. I think I may move

forward with a contract lawyer and see how it goes from there.

Things I need an opinion from thos more experienced so I may sleep

better at night...

1. given that my practice will be very close to the new hospital I

will be able to send virtually all pts to their rad/lab for tests

and could limit my initial overhead. On the other hand I want to

provide as much for my pts as I can. I know I can grow a limited lab

in my office but not sure what I should start with. Coming from

residency, I have no clue what lab services are financially feasible

and what are not. There are lots of new " minimalist " lab equipment

from very small machines, to just fancy clia waived dip tests for

all kinds of things. Can you guys help me come up with a start up

plan for this stuff?

2. Not quite the micro practice, but here is my theoretical startup

plan. Start-up with eMDs and an office " manager " type person (a good

friend of mine who I can trust, is an accountant and can be very

flexible with $/time and willing to learn) to help with phones,

billing, pt check in, etc. And a medical assistant. With clear cut

job descriptions that everybody does everything as it needs done.

Does that sound good or like too much?

3. As someone mentioned before, I will have to take all insurance

plans/payors that the hospital takes " within reason. " But the town

has a good payor mix. Near Dallas, ~50% of the working pop commutes

to work in the city. The other half works in the many large

corporations that are located in/just outside the city. City is

growing quickly and has a good portion of young working people. This

is the good thing about the whole area around the DFW metroplex..it

is growing rapidly and there are alot of workers making it do so.

Now the whole billing/collecting process is where I know I will

likely be burned and learn the hard way...but I will do my best to

plan for that. The medical office consultant is actually to help me

to negotiate insurance contracts...I can use them as needed. This

may sound like a waste to you, but since I really don't have working

experience with this I would rather invest in getting the help to

try to do this right, esp since it will be paid for as part of

my " loan " to be paid of with time in the town. (4 yrs after

guarantee yr). I feel like I should take advantage of this help.

...have much more to ask, but just got a page...gotta go round on

some cardiology patients! Have a good Sunday. God bless you

all! ...and keep the opinions/thoughts coming.

November 4, 2006

I do UA's, urine preg, strep. Also do hemocue glc and hgb (I do alot of peds and ob) as well as hgb a-1-c's. I tend to use the A-1-C's as a screen for DM instead of a 3hrGTT, because 1) better pt compliance and 2) it gives me the information I'm after (just how bad has your sugar been?). I bought a second-hand microscope because I just couldn't stand trying to dx vaginitis without a slide. Won't break even on it for years I'm sure, but decided I deserved at least one $500 luxury. I also bought a pocket pulse oximeter and acquired a used nebulizer. My reference lab set me up with everything needed, including centrifuge, for me to draw blood and their courier comes daily to get it. Acute labs go to the hospital (3 min car ride). Why are you hiring both a MA and a receptionist? MA's trained to do both. Use your friend to help with more complex tasks prn. Few insurance companies with negotiate anymore FYI.

Good luck

Lynette I Iles MD

210 South Iowa Ste 3

Washington IA 52353

Flexible Family Care

'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

November 4, 2006

I do UA's, urine preg, strep. Also do hemocue glc and hgb (I do alot of peds and ob) as well as hgb a-1-c's. I tend to use the A-1-C's as a screen for DM instead of a 3hrGTT, because 1) better pt compliance and 2) it gives me the information I'm after (just how bad has your sugar been?). I bought a second-hand microscope because I just couldn't stand trying to dx vaginitis without a slide. Won't break even on it for years I'm sure, but decided I deserved at least one $500 luxury. I also bought a pocket pulse oximeter and acquired a used nebulizer. My reference lab set me up with everything needed, including centrifuge, for me to draw blood and their courier comes daily to get it. Acute labs go to the hospital (3 min car ride). Why are you hiring both a MA and a receptionist? MA's trained to do both. Use your friend to help with more complex tasks prn. Few insurance companies with negotiate anymore FYI.

Good luck

Lynette I Iles MD

210 South Iowa Ste 3

Washington IA 52353

Flexible Family Care

'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

November 4, 2006

Lyneete thaks for the reminder about nebuizers--

check with your respiratory care co- whomever you will refer to for

home oxygen and c pap They gave me the nebuliazer AND they gave me

aluterol to put in it!

Re: Thanks for the input, Keep it coming.

I do UA's, urine preg, strep. Also do hemocue glc and hgb (I do alot of

peds and ob) as well as hgb a-1-c's. I tend to use the A-1-C's as a

screen for DM instead of a 3hrGTT, because 1) better pt compliance and

2) it gives me the information I'm after (just how bad has your sugar

been?). I bought a second-hand microscope because I just couldn't stand

trying to dx vaginitis without a slide. Won't break even on it for years

I'm sure, but decided I deserved at least one $500 luxury. I also bought

a pocket pulse oximeter and acquired a used nebulizer. My reference lab

set me up with everything needed, including centrifuge, for me to draw

blood and their courier comes daily to get it. Acute labs go to the

hospital (3 min car ride). Why are you hiring both a MA and a

receptionist? MA's trained to do both. Use your friend to help with more

complex tasks prn. Few insurance companies with negotiate anymore FYI.

Good luck

Lynette I Iles MD

210 South Iowa Ste 3

Washington IA 52353

Flexible Family Care

'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is

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

this email in error, please notify the sender immediately and delete it

from your computer.

November 5, 2006

Microscopic exam is not a CLIA-waived lab,

so beware of the increased cost of the license to do that in office. (unless

there is a change that I am unaware of since one year ago.) I use clinical

history, exam and pH paper (with an occasional send-out of a swab for lab to do

a culture or micro exam) for vaginitis for the reason of cost and “complexity”

of non-CLIA waived labs in office…

Ramona

From: [mailto: ] On Behalf Of Lynette Iles

Sent: Saturday, November 04, 2006

3:41 PM

To:

Subject: Re:

Thanks for the input, Keep it coming.

I do UA's, urine preg, strep. Also do hemocue glc and hgb (I do alot of

peds and ob) as well as hgb a-1-c's. I tend to use the A-1-C's as a screen

for DM instead of a 3hrGTT, because 1) better pt compliance and 2) it

gives me the information I'm after (just how bad has your sugar been?). I

bought a second-hand microscope because I just couldn't stand trying to dx

vaginitis without a slide. Won't break even on it for years I'm sure, but

decided I deserved at least one $500 luxury. I also bought a pocket pulse

oximeter and acquired a used nebulizer. My reference lab set me up with

everything needed, including centrifuge, for me to draw blood and their courier

comes daily to get it. Acute labs go to the hospital (3 min car ride). Why are

you hiring both a MA and a receptionist? MA's trained to do both. Use your

friend to help with more complex tasks prn. Few insurance companies with

negotiate anymore FYI.

Good luck

Lynette I Iles MD

210 South Iowa Ste 3

Washington

IA 52353

Flexible Family Care

'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is

confidential and is only for the named addressee. If you have

received this email in error, please notify the sender immediately and delete

it from your computer.

November 5, 2006