RE: Re: Practice Startup Questions- ACCESS

May 25, 2012

In terms of access, I think the key is making sure your demand and supply for

slots is approximately matched. Excess demand for a scarce number of slots will

lead to an unhappy stressed system

Not enough demand and you will underpaid or out of business.

There are multiple ways to match supply and demand- Jim's open access book as

you go, 's mostly scheduled carve out blocks, 's prescheduling up to a

year in advance.

I am doing whatever the patient wants - if they want to prebook, they can, if

they want to book up right up the hour they can. Sometimes I have 12 on the

schedule the night before for the follwing day and sometimes 0.

Makes for a wild ride but evens out to about 40 per week. This way seems to

take less effort direction and shaping from me, which is good because my energy

supply for managing things is limited and patients get what they want.

I think the key would be looking at the HowsYourHealth question about access

How easy is it for you to get medical care when you need it?

Very Easy

Easy

Somewhat Difficult

Very Difficult

I have not needed medical care

if the numbers for your practice's access are high, then whatever you're doing

it and however you're doing it, it must be right!

Lynn

________________________________

> To:

> From: theneighbors@...

> Date: Fri, 25 May 2012 08:03:32 -0500

> Subject: RE: Re: Practice Startup Questions

>

> With my automated reminder system I can make appointments a year in

> advance and rarely have a missed appointment. Of course I leave slots

> open for daily patient needs. I suspect that much of what open access

> is about is based on not having an automated way of communicating with

> patients. With my system, patients get up to four reminders beginning

> a week before an appointment with multiple opportunities to cancel or

> reschedule. The success of advanced scheduling depends on how well you

> remind patients.

>

> Neighbors, MD

>

> Huntsville, Alabama

>

> Solo using FlexMedical EMR/Billing since 2/2009

>

> Attested MU in 2011

>

> From:

> [mailto: ] On Behalf Of Kennedy, Jim

> Sent: Thursday, May 24, 2012 6:45 PM

> To:

> Subject: RE: Re: Practice Startup Questions

>

> ,

>

> Open access is really not booking any appointments until the day you

> open your books. You are really doig advanced access. Seems like a moot

> or insignificant point, buty it is not. The problem with " saving

> appointments slots " rather than open access is that there is always

> creep and then you end up with ovefbookingand no slots. Maybe you are

> better than elsewhere I have been.

>

> We stick to advanced access and never make appointments more than a day

> or two out. Often I come in with one appointment and leave having seen

> 10-15. I never had no shows, and can usually handle " walk-ins " better

> known as appointmentless patients. We wil schedule anything any time,

> no restirctions on type of visit.

>

> Has worked for 7 years, getting " todays work done today. "

>

> ________________________________

>

> From:

>

<mailto: \

>

> [ ] On Behalf Of Pratt

> [kpratt.1022@...]

> Sent: Thursday, May 24, 2012 11:20 AM

> To:

>

<mailto: \

>

> Subject: Re: Re: Practice Startup Questions

>

> Welcome, Newbie!

>

> You will need to establish some sort of organization for your new

> office - corporation, partnership, sole proprietorship - and then you

> need to apply for an NPI for that organization (unless you opt to do

> Sole Prop, which I am NOT sure how you bill for that). Then, when

> bills go out for your new office, they get paid to your new

> organization. When bills go out for your current organization, then

> they get paid under their organizational NPI.

>

> You can limit your practice (and, in fact, you should) to any % of

> patients you want per insurance. So, if you reach your 10% limit, then

> you close to new patients for that type of insurance. I will advise,

> however, that you might want to beware of this when you first start

> out. There will be attrition. Some patients will come to you, and

> never come back, or may come infrequently, so in reality, even though

> by sheer numbers you hit 10%, if those patients do not frequent your

> office, then in $$, the % will be lower. Our practice closed for a bit

> to new Medicare patients, but we are now accepting all new patients.

> We do not take Medicaid, either as primary or secondary insurance. We

> are also not contracted for all plans for all insurers (Blue Shield of

> CA has just come out with some very unreasonable contracts that we were

> not willing to contract with). It is up to the PATIENT to determine

> whether or not we are participating in their plan or not because it is

> much too difficult for us to keep track for them.

>

> Open Access scheduling takes a lot of finesse. Something I am still

> trying to teach our assistants. We try to schedule not more than 4

> extended visits per day (new patients or physicals), and we try to

> leave open 4-6 slots per day for same-day visits. Sometimes, we have

> wide open days (last week on Monday, we had 9 slots go unused, but

> today we are completely booked, and it is only 10:15am, and tomorrow I

> am limited to 4 walk-in slots, which the staff will have to be very

> careful about booking - we have a total of 18 slots per day, with

> extended visits using 2-3 slots each). If you are doing your own

> scheduling, you will get to know which patients require more or less

> time, and you can try to fit them in accordingly. We have patients now

> who were patients from the beginning of our practice, when they could

> say exactly the day and time they wanted to come in and we could

> accommodate that, but even though we can still offer them a same-day

> appt, they get torqued when they can't come in when they dictate. Just

> a caution...

>

> You do not necessarily need to re-credential if you are already

> credentialed with most insurance companies. Contact the Provider Rep

> and tell them your plans and find out what you need to do. First

> things first, you need to determine the type of organization that you

> want to open, and then sign contracts. But since you, the provider,

> are already credentialed, it should be a little quicker than if you

> were relocating to another state and starting from scratch.

>

> Lots of info here.....read, re-read, listen to what everyone on the IMP

> list has to offer, and pick and choose what you think will work best

> for you. And don't be afraid to make changes as time goes by so that

> you are happy :-)

>

> Good luck in your new endeavour!!

>

> Pratt

>

> On Thu, May 24, 2012 at 9:55 AM, impnewbie

> > wrote:

>

> Thanks for sharing your story, Adolfo!

>

> I am assuming you can put an effective date on the new contracts?

>

> What my concern is, I may have to stay on part time with my current

> employer (1 day a week) doing manipulation/sports medicine as that is

> my " niche " and they don't have anyone else to do that as a way to

> " compensate " them for paying off a huge chunk of my student loans. In

> my contract, I get x amount " forgiven " for what they have paid on my

> behalf for every year I stay on. This was spread out over 6 years. No

> way in hell I'm gonna make it 6 years so I'm on the hook for whatever

> is left--at this point $125k. My thinking is, if I say I will stay on 1

> day a week doing this for them, maybe we can work something out where I

> can still leave and do my own practice and not have to get a loan to

> pay them off.

>

> Back to my concern--what if we both take the same insurances--me in my

> IMP and then working as a " specialist " there? How would that work?

>

> >

> > Dear newbie, we are newbies too. we have so many questions and we

> always ask. I found this IMP list like an oasis because I can always

> find

> > many helping hands for my doubts.

>

> > Â

> > Regarding questions number 1, I am not a lawyer but you make

> decisions Â regarding the limit of your patients.

>

> > We opened Orange Doc in November 2011 ( you see newbie). We are 2

> mojicans jejejejeje, my wife Ardiana ( my rock) a pediatric NP and I a

> family doc.

> > She loves kids and I told her follow your Passion so she makes my

> practice vibrant and active when I heard crying on her room.

>

> > I made the decisionÂ to not accept medicaid only for adults, I do as

> a secondary of medicare. I learned that medicaid always refused to pay

> me when is second in line.

>

> > We made the decision to allow medicaid only for kids, since there are

> a lot medicaid kids in the area. She only has to see 30% of her patient

> population to qualify for uncle sam money. I think you are the one

> making the decision to open or close the doors in that matter.

> > Deep in my heart I can tell you that I really do not care about uncle

> sam money. I think there is not such a thing like a free lunch. I think

> uncle same will make sure to make your life miserable in the future so

> you will pay with your blood for the pennies that he will give you. I

> think all the committees of the uncle sam will make sure that the

> quantity of requirements will quadruple and you or your office will

> have a hard time to full fill the requirements ( I think that the

> nature of the beast).

>

> > Â

>

> > regarding your questions about the scheduling, I have appointments

> and also patient portal's appointments. I can tell you what I do:

> > New patients I spent like 45 minutes the first visit, I make sure I

> got all the info and questions answered. I want to know when was the

> last colon eval , mammo etc.

> > I make sure that I listen to them and give them undivided attention.

> Also I make a full physical exam,head to toes.

>

> > I noticed that when they come back to follow up I do not have to

> spent the same amount of time gathering the info. I am quickerÂ with

> the F/Us.

>

> > Our plans is to see patients and not practice treadmill medicine,

> that is the goal of IMP type of practice.

> > We are getting fuller day by day, sometimes I have 1 patient in my

> schedule and them 5-7 call wants to be seeing. I can tell you that

> sometimes I see 12-11 patients in day.

> > We are open M,W and F only. I am doing urgent care and my wife still

> working as NICU RN. Our goal is to go to M-F soon and quit our side

> gigs,when? I do not know.

> > I can tell you that we were asking every month to the bank money to

> operate the clinic. I think that last time that I asked the bank money

> was in January. Orange Doc is paying itself ( except our salaries, we

> are not getting paid) every month.

> > My wife is holding the fort because she deals with the phone calls

> from every body, she does the billing and the pain in neck insurances.

> She does not have a lot of experience but she work hard to make sure we

> get paid. She also see her patients part time. We have no staff working

> for us for now.

> > I think we are going to have gaps for same day appointments for those

> patients that need to be seeing now.

>

> > Â

>

> > Regarding the questions about the credentialing process, I was in

> your shoes before not wanting my employer to know about my plans,it is

> very stressful dealing with that.

> > I can tell you that my experience with corporate America is not the

> best. I think God bless me because I got laid off from a previous

> Urgent care where I got betrayed by my employer and then I found this

> new UC job and the guy was fulling around with me and he gave me a part

> time only.

> > I took the part time and bite the bullet and look around my town for

> the correct place until I found it. I made my corporation and I look

> for a person to help me with the credentialing part. I know a lot of

> people in the list would tell you that you can do it only via CAHQ

> something, I hire that person and she started the process since

> 08/2011. You have to have a physical location to start the process you

> can not use a P.O. Box. I spoke to my future land Lord and told him

> that I needed to rent the office 3 months before I open the doors and I

> asked him to give me those 3 moths free ( what the heck what I had to

> loose).

> > He did not give it to me for fee but he cut 50%

> > My credentialing person did all the paper work believe me it is worse

> then buying a house, do you have time for that? I did not so I hire

> her.

> > You have to create new contracts with the health insurances since you

> are working under a different umbrella or corporation.

> > I had to submit a form to Blue cross of FL to divorce a previous

> practice that takes time.

> > Basically you have to make sure that you have the time and money to

> be able to make the jump.

>

> > Â

>

> > Dealing with the banks is another 200's pages story.

>

> > Â

>

> > anyway my 1/2 cent. If you want contact me off the list and we can

> chat I can tell you my experiences.

> > Adolfo

> > you can find us in Youtube : OrangeDoc

> > you can see our tour video of my practice .

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

>

> > Â

> >

> > >

>

> > To:

>

<mailto:%40yahoogroups.c\

om>

> > Sent: Thursday, May 24, 2012 9:32 AM

> > Subject: Practice Startup Questions

> >

>

> > Â

>

> > I just want to say what a blessing this group has been! I look

> forward to seeing emails from the listserve pop up on my phone as I

> always learn so much!

> >

> > I am hoping to start my own IMP within the next two years (preferably

> as soon as possible). Here's some questions I have for the group (and

> please forgive my ignorance and naivety):

> >

> > 1) Is it legal to limit the amount of medicare/medicaid you will

> accept? That is, I want to limit my practice to 5 or 10% medicaid as it

> pays so poorly here (TN) but I have patients who have established with

> me in my current practice that I would like to continue to take care of

> but I want to be financially viable, which I can't be if I leave the

> doors wide open to all comers.

> >

> > 2) For those of you who have " niche servicess " within your practice -

> i.e. accupuncture, etc. how do you handle the open access for these

> patients for whom you are not providing PCP care with those patients

> for whom you are the PCP? I currently do manipulation (OMT) and plan on

> adding accupuncture services in the future.

> >

> > 3) With open access scheduling, how do you control your schedule in

> the beginning when the majority of your patients will be new? At what

> point do you restrict your new patient appts to maintain 24-48 hr

> availability for those who are established? I know it varies between

> practices, but what % of appts do you schedule out vs leave open?

> >

> > 4) I am currently employed and contracted with several plans some of

> which I will continue to accept when I am on my own...how is it handled

> when you continue to work under the plan in one practice while you are

> trying to open another practice? I have not yet told my current

> employer that I plan to leave as I want to have as much as possible

> thought out/arranged ahead of time before I make the leap. I do have to

> give 6 months notice and will do that, but I know the recredentialing

> can sometimes take awhile and I'd like to move as smoothly as possible

> from one to the other as I can't afford to take a large amount of time

> off.

> >

> > Thanks for the input! I'm sure there will be a ton more questions as

> I pursue this journey!

> >

>

> --

> Pratt

>

May 25, 2012

Excellent summary Lyn

A follow up point to Lyn's summary is when You stop taking new patients

(Panel size). I personally think that you stop when you cannot see them when

they want to be seen. You keep taking new patients until the day you feel

you overstretch to see patients when they want/need. Then you close your

practice to new patients (with exceptions made for the occasional family

member [of your patients] or friend)

Izquierdo-Porrera MD PhD

Executive Director & Co-founder

Care for Your Health, Inc

Phone

Fax

www.care4yourhealth.org

" Don't ever let injustice go by unchallenged. "

Help us make our community healthy ->

http://www.care4yourhealth.org/wanttohelp.php

Practice Startup Questions