being able to determine financial viability, among other things.

[Guest guest]

it may seem to be an either/or situation, but i don't think anyone has yet answered the question. to come to any conclusions, we need to examine who's reporting what, and what are their circumstances. as i have stated before, and more than once, we have to define our parameters and gather the data. until and unless we do that, we have only have the anecdotes and balance sheets of those who offer them, specific to their circumstances, which may not convince anybody other than those who take our purpose and methods on faith, or those whose circumstances exactly match. some time ago, i asked us to do exactly that, and a few people responded. since that time, i've talked to gary seto about a poll with specific parameters. my understanding of our conversation-- he was concerned that many on this listserv are merely lurking, that a

poll was limited to thirty items, and that it was a lot of work. even so, we came up with a set of parameters to begin a poll, but it hasn't been posted. i talked to gordon moore about gathering data with specific parameters. my understanding of our conversation-- he was concerned that this group may be too diverse to gather such data, that another, more specific subset of practices may be appropriate, and there may not be enough of such practices to gather data, and that he was thinking about pursuing this data through some other venue. so here are, about a year later after at least first beginning to discuss this topic, and we still only have anecdotal data, and at best, apples to oranges comparisons. in the meantime, our group has continued to grow, more people have more data, and more of us are asking for best practices, and some evidence that this method of low overhead

really does work. i think we can demonstrate some data, and make some conclusions, whatever and however limited they may be. some all-encompassing study/survey through the institute for healthcare improvement, aafp, ama, or some other organization, and a presentation of the results, related to pay for performance would be great, however it may leave a whole group of interested doctors and others by the wayside until that happens. in addition, information we share here certainly helps us improve our own practices. we don't need some great study; we can start incrementally, and to gather sets of data through manageable thirty item polls, or some other method. it's not that hard-- what is the question(s) we want to answer? what are the criteria of participation (to participate in the study/survey)? what information needs to

gathered? how will the information be gathered? what are the results of the study/survey? what conclusions can be drawn from the results? was the question answered? if not, what has to be done to answer the question? if yes, what other questions need to be answered? in research, no single study has all the answers. i wouldn't expect us to have them all, either. it's not rocket science, it's the scientific method, something in which we've all been trained. if we start, we may find, for example, commonality with michelle eads, and how she communicates with patients by email, and gets paid for it. wouldn't at least some of us want to see how we could do that? happy new year, logically. LL drbrock@... wrote: So, in short: a moderately high volume coupled with office efficiency seems to be the formula to IMP success. Unfortunately, it seems there is still no substitute for relative volume of patients. Efficiency only takes us so far and then there has to be some volume. 30 pt's/day? Maybe not, but it sounds like 15 - 20/day is the sweet spot if you want to make a decent living. Super low volumes just can not equate to anywhere near an average income, unless you live in a very unique

microcosym practice environment like Pamela Wible in Oregon (ie, 99.9 percentile reimbursement rates vs the rest of us, super low malpractice rates, very motivated & unique patients). > > From: Larry Lindeman <llindemanmac>> Date: 2007/01/01 Mon PM 01:12:32 EST> To: > Subject: Re: financial viability> > Sorry for the delay in answering this. I was waiting to close out the > books on 2006 to give you an accurate answer.> My opinions on keys to financial success,> 1. Keep overhead low but spend what you need to make money> 2. See enough patients. In solo-solo model Gordon's initial plan was > to see 60 patients per week, in a 1 staff per doctor model you need > to see about

80-85/wk> 3. Code very accurately and make sure you don't miss procedure codes > and codes such as specimen prep which some insurances pay.> 4. Constantly improve your efficiency. You will never be able to see > the patients you need if you are not very efficient.> 5. Get good contracts or dump that insurance. I had a range from > below medicare rates to 140% above Medicare. I am in the process of > becoming nonparticipating in my bottom 3 payors.> > In Chicago it is very difficult for primary care to make a living. I > know 5 docs who have either gone out of business or moved to another > state in the last 18 months. My malpractice is $30,000/yr, my 1/2 > time partner pays 18,000/yr. Rents and staff costs are very high. (My > MA makes $15/hr,my LPN makes $20/hr)> In my 2nd full year in practice I payed myself $146,000 which does > not include retirement or health

insurance ( we get that through my > wife) I paid $12,000 for repayment of my startup loan. My budget for > next year is for me to make $30,000 more. My volume has only reached > the 80/wk level in the last 2 months. Medicare pays $90 for a 99214. > I average $108/visit. I tend to bill about 70% 14's and the rest 13's > with some 5's thrown in I do a moderate amount of skin procedures in > my office such as mole removals which pay well. We do a lot of > pediatrics. The shots raise both my collections and my overhead a > lot. We also bill some insurances for labs and have the lab bill us. > This also inflates both our collections and overhead.> My overhead right now is higher than most of you at 50%> > Larry Lindeman MD> > > > > So Larry> > your practice is such a good example to learn from> >

You have a micropractice as it is small, and you make a good> > salary mostly ? I guess becasue you can do the volume which you> > can do becasue of staff?> > Is that correct?> > Or do you also in addtion live in a place where the reimbursemetn> > situation is good- like we hear from Orregon and I think> > Washington also?> > Successful practices are such a hard- to- predict combo of all> > this stuff.> >> > Do you know w hat your overhead is byplease?> > And please which tasks are done by other than docotrs?-Billing,> > scheduling how about comunicating test results ordering> > supplies etc?> >> > Finally Dr Successful, Do you know and are you willing to> > share you average charges per patietn and or average reimbursment> > per patietn? Tahnks!> >> >> > > >

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