Long Time No Post - Practice Update

[Guest guest]

I think this is my first time on the board in about 3 months so a big happy holidays to everyone.  I don't think i have the time or energy to go back and review 3 months worth of posts so if there has been big news in the IMP world, either good or bad, my congrats and condolences wherever it is appropriate.  I never heard in the papers that congress turned health care reform over to Gordon so I guess the world's not quite perfect yet.

I wanted to again thank everyone for all the help getting my new IMP off the ground.  It was also great to finally put some faces with names in Seattle.  Are we still thinking Denver/Boulder for IMP Camp 2010?

I figured I'd give a update on my situation with some of the numbers I've accumulated at this point.  I'll make a few separate posts on some specific topics to keep things clear on the list serve.  I've never been one for being brief but I'll try to do this is bullet point format

Denver, Coloradowas in hospital owned practice with 1 partner since 8/2003 (right out of residency) - decided on move to solo IMP 11/08July 1 - sent out approx 2000 letters to patients saying I was moving to new address and starting a " unique " type of practice - letter didn't go into much detail but referred people to website

Website had link to google online form where patients could give name, phone and email if they planned to join new practices - website also had FAQ with main practice philosophy and logisticsModel is insurance based (all major plans and mcare) with $100 yearly non-covered benefits fee (or $10/month option).  No fee for those under 25 (I'm int med though so that is minimal). Doing this for all patients (know I'm on a little thin ice with MCare)

sent out reminder post card to about 600 folks that I though would have interest in new practice that had not signed up showing interest about 9/1Received about 550 people showing interest over the summer on listsent out email to everyone on list (or mail to those w/out email) approx 9/24 with attachments of all necessary forms/practice policies/FAQ and instructions to join - stated on my website and in that letter that I could only provide emergency care until patients formally registered

Opened up new practice 10/1 (new phone, address and fax) - due to the hospital for whom I used to work, there was no forwarding/message on old phone # or even on front door of old practice which dissolvedReceived ~ 80 registrations late September, ~ 240 in October, and ~ 75 in September

Change my website and phone message thanksgiving weekend saying I'm closed to new registrations even if you were prior patient (simultaneously did send out about 50 letters to folks I'd like to keep and whom I think just slipped through the cracks giving them about 3 extra weeks to get paperwork and fee in) - also gave about 3 weeks notice to those that had incomplete registration packets and set up waiting list on my website

Think for the meantime that #500 patients will be OK and I can later adjust - will likely accept some younger patient on individualized basis to help balance out #'s (see below).  It's a bit older of a population that which I was shooting for - I expect the bulk of the last 50-100 patients I accept however to be <50

breakdown of patients about 2 weeks ago as follows:

<25

6

1%

25-34

35

9%

35-44

64

16%

45-54

78

19%

55-64

107

26%

65-74

67

16%

75-84

35

9%

>85

16

4%

BCBS

108

26%

UHC

62

15%

AETNA

34

8%

CIGNA

20

5%

HUMANA

11

3%

PCARE

7

2%

MCARE

94

23%

MCARE+

24

6%

other

49

12%

Current Patient Hours ScheduleMon 730-12, 2-4Tues 2-7 (grand rounds at hospital 1215-115)Wed 9-12, 2-4Fri 9-1230, 2-3Thurs and other times as neededTaken a few single days off hear and there but nothing extended as of yet

Patient Visits: 81 in October, 101 in NovemberNo staff - wife handling entering patients in prac mgmt database and also in quickbooks (doing $100 NCBF through that) - I do everything elseshare 1050 sq foot space with chiropractor/acupunturist - we share trade name and website but keep everything else separate

currently using only 1 of my 2 rooms in space as I have office and exam room together - have not needed other room for anything but storage at this point and briefly using computer when someone is changingNo Land Line - Cell phone and virtual PBX (www.phone.com - post to come later with review)

EMR Allscripts (had at prior practice x 5 years and purchased all software and hardware with all my patient data intact for ~$10,000)Serve hosted off site (for now)Online scheduler: www.genbook.com (post to come later with review)

Mainly using email/phone at this point but plan to give a trial to Medfusion portal in next 1-2 months (as it now interfaces with Allscripts software)Billing via 3rd party (taking long time to get setup due to problems with Allscripts and actually first bills will be sent this coming Monday)

Start up expenses roughly about $15,000, nearly all of which was purchasing and setup of technology/computers and EMRTrying to shoot for yearly expenses (not counting my salary and any taxes) of around 40-50,000 (see attached 2 year profit/loss predictions) and think that is pretty reasonable at this point, especially at the lower end

That is some of the nuts and bolts.  Most importantly is how I'm doing and I think that answer is, good.  ly that last 2-3 months at my old practice while trying to set up the new, and the transfer of all the software/data was basically horrific so part of my feeling good might just be in comparison to the summer and early fall.  Also, I really did not enjoy working under the corporate structure and just being away from that is immense.  But, its definitely more than just being better than what I had.  I think my patients are enjoying my new setup.  I definitely feel my time spent counseling and listening to my patients is better.  I really like the no staff model, where I know everything that is happening with my patients and know there time is never wasted when dealing with the office.  I love the concept of online scheduling and communication electronically.  Only two months in I definitely feel a sense of optimism about the future.  I would not say things are exactly as I want them now but definitely feels I'm in a sustainable situation and after 12-24 months of fine tuning, I'll be pretty close to some type of utopia.  Again, the transition and the first 2-3 weeks of the new practice almost brought me to the breaking point but then things just were setup and a lot of that just melted away.  Despite the fairly limited patient hours, I'm easily working 50-60+ hours a week right now (i think but haven't counted), which I'd like to wean down a bit.  Also, right now in those hours I'm basically just keeping up with the general patient work (visits, notes, labs, msgs, refills, etc) and the general office stuff.  I'd really like to start having some time to expand my own education, expand my website with a lot of patient education, start doing more proactive care, and using my EMR which has a phenomenal registry/tracking/reports functionality.  But again, it's only been 2 months.

Sorry for the length, but after all the help I've gotten from this group, anything I can do to give insight to others I will gladly share.  Again, I'll do some separate posts on this like my PBX, scheduler, portal (when its active) since they are one's that were not terribly common from what I gathered on this board.

I hope everyone is having and continues to have an outstanding holiday season (i cant believe we broke down and are getting my kids a Wii for Hanukkah).And though its a painful time for us athletically...GO BRUINS (for gary, karen, and steve)

Dave Gordonwww.intmedcc.com

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IMCC - Revenue - Expense Projections.xls