efficiency and income, sustainability- year end report

[Guest guest]

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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