Re: Re: efficiency and income, sustainability- year end report

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Pam --

I'd love to know an acronym for the key questions for motivational

interviewing. Could you post to the group?

Thanks

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

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> CONGRATULATIONS!! It is so exciting to live your " dream practice " Let

> me know if you want some great items on motivational interviewing. I

> taught a mini class on this for an IPA I was in and have a great

> acronym to remember how to ask the key questions. I'll be glad to email

> it to ya. I think I posted it here before about 7000 messages ago.

>

> Pamela

>

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@...

> www.idealmedicalpractice.org

>

>

>>

>> Two years into the micropractice, my personal office efficiency seems

>> to have made significant improvements over the past 3 months with

>> your ideas, THANKS to all of you who sent helpful tips and lent moral

>> support.

>>

>> I was unable to keep track of where those wasted hours went, the logs

>> were just too difficult to keep, but I now no longer have to stay up

>> until 2-3-4AM once a week just to get caught up on the billing. My

>> out of work- work hours are now much saner (maybe financial stuff,

>> taxes, reconciling accounts, paying bills one weekend a month, some

>> desultory bidding on eBay for cheap office and medical stuff, etc.)

>> and I feel much less burned out. I think I can manage and enjoy this

>> style of practice for a long time (some years, I'm thinking); it

>> appears doable AND sustainable for me.

>>

>> Here's a solo - solo list of the things that got changed in the past 3

>> months, that really seemed to help me LOTS, not really in any

>> ranking order:

>> 1) NEVER answer the phone, pretty much ALWAYS let the machine take a

>> message. I was letting the phone interrupt me before- takes some

>> training to just let it ring, but the payoff is big. Also, be meaner

>> about having patients come in- less phone medicine and more face to

>> face medicine makes me feel less put upon.

>> 2) Try to avoid calling any results, TRY to email all the results

>> possible, a close second leaving messages on an answering machine,

>> paper the 3rd most useful method (but takes longer); leaving a

>> message on a machine is also fine, but you can't predict when you

>> call if someone is going to be home or not! the worst of all is being

>> stuck on the phone for 'by the way' questions from a patient.

>> 3) Electronic billing is great! Much faster and easier than paper

>> (may save me 2-4 hours per week upfront) but more importantly, on

>> the downstream side, doesn't allow those smarmy insurances to get

>> away without paying because you didn't catch them before 6 months

>> expires- provides proof of submission date. I Almost like billing

>> now. Why didn't I do this before? 4) Hired a poster/biller to argue

>> with the insurance companies, 5-6 hours every 1-2 weeks. Thank

>> goodness and worth every penny, for the peace of mind alone.

>> 5) Instant Medical History- really a time saver, documents and does

>> it well, often more completely than I would have done, patient does

>> the work, made all my paper rating scales obsolete. I REALLY

>> appreciate it by the ends of the days when I sometimes would get way

>> overwhelmed and feel late, even though I wasn't, and essentially not

>> document anything in a complicated note, then (groan) have a

>> complicated note to finish after the visit. (this is NOT happening

>> any more!) Gives me a great start on the note, reminds me of

>> details/problems that I did ask about but forgot completely about and

>> would never have documented in my past methods, doesn't get tired by

>> the end of the day like I do. Now without even a guilty start, I am

>> easily billing just about all 99214s. Audit me! For $50 a month,

>> much cheaper than a medical assistant and has one hell of a medical

>> background. I'd highly recommend it.

>>

>> 6) Other helpful things- 1) more patients are using appointment quest

>> and making their appointments online, it's a matter of training but

>> means lots less time on the phone for me; 2) new patient volume is

>> tightly controlled and ratcheted down, less abstracting of old

>> records has to happen, also the 'more mature' patient population is

>> requiring less training and effort; 3) my technology has stopped

>> jerking me around, for the moment- haven't had a major issue in

>> almost 3 months, just have to keep my fingers crossed, really don't

>> want to add any more technology pieces now or ever (but I suppose I'll

>> have to as time goes on); 4) paperless office and workflow it

>> generates really contribute to efficiency in general.

>>

>> What is great about the ultrasolo IMP style is that I can just decree

>> to myself to change the above processes, and it happens. If they

>> don't work, they get improved on or chucked out. The results are

>> immediate, dramatic and telling, and there is no chain of command.

>> I really like that!

>>

>> The other side of 'sustainable' for me is income, and for some reason

>> that seems to be improving too. Now paying myself $6000/month (I

>> think you could count it as $7000, if you look at retirement

>> contributions) and it seems as if that is still increasing. That

>> would be for about 40 booked appointments a week, mostly 99214s and

>> some preventive care, in a state with about average reimbursement but

>> where preventive+e/m code visits are bundled, and where the major

>> insurers will not pay extended visit codes.

>> I think my malpractice rates will fall for 2 reasons: I am changing

>> to a cheaper carrier and I may qualify (I hope) for part time

>> malpractice rates, from about $12000 to about $8000. (I used your

>> letter, , -thanks!- about considering my practice as a part time

>> practice despite the greater than part-time hours, and preliminarily,

>> it seems that they are going to bite.)

>> I did knock down my rent/utilities payments to $1050 per month from

>> $1700, goaded into this move to cheaper/smaller space by looking at

>> the overhead breakdown for IMPs in general and realizing mine was way

>> out of whack. Lastly, I think my accounts receivables will improve by

>> a lot over the next 6 months due to electronic billing- I'm sure

>> I've missed a pile of $$ but I'm not going to go back and try to mine

>> them- too frustrating and it will make me too angry. Forward is the

>> way to go at this point.

>> I think my income will settle somewhere in the 8-9K range a month

>> including retirement benefits, at about the 40 visits a week/ 25

>> booked patient hours, which for me will be fine. It's more than I've

>> ever made before, but certainly not at the FP 'average', but then I

>> am not working in a patient mill, I am also not doing hospital work

>> and my schedule is not crammed and AAHHH -at this acceptable-for-me

>> income level, the satisfaction of the way the practice runs trumps

>> all.

>>

>> Future things I will probably work on- take more (at least some)

>> vacation and find more compatible coverage; proselytize for an IMP

>> partner?; get a more complex patient registry going and some

>> population management; ?group visits - I will have to gear up to

>> fight about reimbursement, RI is so backwards!; learn and practice

>> motivational interviewing techniques, to move people a little bit

>> further along; RELAX a little mentally, as things actually appear to

>> be working out.

>>

>> So things are looking up! Thank you all for being the crowd that you

>> are, and for just being out there. Could not have done this without

>> you all, and the inspiration and experience that you - provide/share.

>> (Solo-solo would have killed me off by now, probably about 6 months

>> ago.)

>> Here's hoping for the coming year, if you are a new IMP, that you

>> begin to settle as reasonably as I have done over the past few

>> months, or if you have already established and attained a sustainable

>> spot, that you can maintain it despite predicted stormy health care

>> weather. Happy New Year!

>>

>> Lynn Ho

>>

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>

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I thinking PODCAST Pamela. kevinroxywible wrote: CONGRATULATIONS!! It is so exciting to live your "dream practice" Let me know if you want some great items on motivational interviewing.I taught a mini class on this for an IPA I was in and have a great acronym to remember how to ask the key questions. I'll be glad to emailit to ya. I think I posted it here before about 7000 messages ago.PamelaPamela Wible, MDFamily &

Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywiblecomcast (DOT) netwww.idealmedicalpractice.org>> Two years into the micropractice, my personal office efficiency seems to > have made significant improvements over the past 3 months with your ideas, > THANKS to all of you who sent helpful tips and lent moral support.> > I was unable to keep track of where those wasted hours went, the logs were > just too difficult to keep, but I now no longer have to stay up until > 2-3-4AM once a week just to get caught up on the billing. My out of work- > work hours are now much saner (maybe financial stuff, taxes, reconciling > accounts, paying bills one

weekend a month, some desultory bidding on eBay > for cheap office and medical stuff, etc.) and I feel much less burned out. > I think I can manage and enjoy this style of practice for a long time (some > years, I'm thinking); it appears doable AND sustainable for me.> > Here's a solo - solo list of the things that got changed in the past 3 > months, that really seemed to help me LOTS, not really in any ranking > order:> 1) NEVER answer the phone, pretty much ALWAYS let the machine take a > message. I was letting the phone interrupt me before- takes some training > to just let it ring, but the payoff is big. Also, be meaner about having > patients come in- less phone medicine and more face to face medicine makes > me feel less put upon.> 2) Try to avoid calling any results, TRY to email all the results possible, > a close second leaving messages on an answering machine, paper

the 3rd most > useful method (but takes longer); leaving a message on a machine is also > fine, but you can't predict when you call if someone is going to be home or > not! the worst of all is being stuck on the phone for 'by the way' questions > from a patient.> 3) Electronic billing is great! Much faster and easier than paper (may > save me 2-4 hours per week upfront) but more importantly, on the downstream > side, doesn't allow those smarmy insurances to get away without paying > because you didn't catch them before 6 months expires- provides proof of > submission date. I Almost like billing now. Why didn't I do this before?> 4) Hired a poster/biller to argue with the insurance companies, 5-6 hours > every 1-2 weeks. Thank goodness and worth every penny, for the peace of mind > alone.> 5) Instant Medical History- really a time saver, documents and does it > well, often more

completely than I would have done, patient does the work, > made all my paper rating scales obsolete. I REALLY appreciate it by the > ends of the days when I sometimes would get way overwhelmed and feel late, > even though I wasn't, and essentially not document anything in a complicated > note, then (groan) have a complicated note to finish after the visit. (this > is NOT happening any more!) Gives me a great start on the note, reminds me > of details/problems that I did ask about but forgot completely about and > would never have documented in my past methods, doesn't get tired by the end > of the day like I do. Now without even a guilty start, I am easily billing > just about all 99214s. Audit me! For $50 a month, much cheaper than a > medical assistant and has one hell of a medical background. I'd highly > recommend it.> > 6) Other helpful things- 1) more patients are using

appointment quest and > making their appointments online, it's a matter of training but means lots > less time on the phone for me; 2) new patient volume is tightly controlled > and ratcheted down, less abstracting of old records has to happen, also the > 'more mature' patient population is requiring less training and effort; 3) > my technology has stopped jerking me around, for the moment- haven't had a > major issue in almost 3 months, just have to keep my fingers crossed, really > don't want to add any more technology pieces now or ever (but I suppose I'll > have to as time goes on); 4) paperless office and workflow it generates > really contribute to efficiency in general.> > What is great about the ultrasolo IMP style is that I can just decree to > myself to change the above processes, and it happens. If they don't work, > they get improved on or chucked out. The results are

immediate, dramatic > and telling, and there is no chain of command. I really like that!> > The other side of 'sustainable' for me is income, and for some reason that > seems to be improving too. Now paying myself $6000/month (I think you could > count it as $7000, if you look at retirement contributions) and it seems as > if that is still increasing. That would be for about 40 booked appointments > a week, mostly 99214s and some preventive care, in a state with about > average reimbursement but where preventive+e/m code visits are bundled, and > where the major insurers will not pay extended visit codes.> I think my malpractice rates will fall for 2 reasons: I am changing to a > cheaper carrier and I may qualify (I hope) for part time malpractice rates, > from about $12000 to about $8000. (I used your letter, , -thanks!- > about considering my practice as a part time

practice despite the greater > than part-time hours, and preliminarily, it seems that they are going to > bite.)> I did knock down my rent/utilities payments to $1050 per month from $1700, > goaded into this move to cheaper/smaller space by looking at the overhead > breakdown for IMPs in general and realizing mine was way out of whack.> Lastly, I think my accounts receivables will improve by a lot over the next > 6 months due to electronic billing- I'm sure I've missed a pile of $$ but > I'm not going to go back and try to mine them- too frustrating and it will > make me too angry. Forward is the way to go at this point.> I think my income will settle somewhere in the 8-9K range a month including > retirement benefits, at about the 40 visits a week/ 25 booked patient > hours, which for me will be fine. It's more than I've ever made before, but > certainly not at the FP 'average', but

then I am not working in a patient > mill, I am also not doing hospital work and my schedule is not crammed and > AAHHH -at this acceptable-for-me income level, the satisfaction of the way > the practice runs trumps all.> > Future things I will probably work on- take more (at least some) vacation > and find more compatible coverage; proselytize for an IMP partner?; get a > more complex patient registry going and some population management; ?group > visits - I will have to gear up to fight about reimbursement, RI is so > backwards!; learn and practice motivational interviewing techniques, to move > people a little bit further along; RELAX a little mentally, as things > actually appear to be working out.> > So things are looking up! Thank you all for being the crowd that you are, > and for just being out there. Could not have done this without you all, and > the

inspiration and experience that you - provide/share. (Solo-solo would > have killed me off by now, probably about 6 months ago.)> Here's hoping for the coming year, if you are a new IMP, that you begin to > settle as reasonably as I have done over the past few months, or if you have > already established and attained a sustainable spot, that you can maintain > it despite predicted stormy health care weather. Happy New Year!> > Lynn Ho> > __________________________________________________________> Fixing up the home? Live Search can help > http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US & source=hmemailtaglinenov06 & FORM=WLMTAG> __________________________________________________