$200,000 per year

[Guest guest]

Page 26 of Brady's start-up guide lists data Debbie and Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per month. Overhead doesn't change when you don't see patients; so overhead is 12 x $6,400 = $76,800 per year. Current average patient panel is 800. Total receipts should be $76,800 + $200,000 = $276,800 per year, but they aren't.If I'm the average imp under the current payment model, each of my 2,208 patient visits per year would need to bring in $125 per patient to reach my goal of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider 'no-shows'. Consider I'm the average imp. I'm not coming close to my $276,800 collections. If my average reimbursement per patient is only $87, as listed, I either need a raise of $38 per patient visit ($125 minus $87), or I must raise the difference some other way. Should I collect an 'administrative' fee on every one of the 800 patients on my panel to make up the difference? Right now my average $87 per patient visit with 2,208 patient visits per year collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm coming up short $276,800 - $192,096 = $84,704 per year. Given my 'average' panel of 800 patients, an administrative fee of $84,704/800 = $106 on every one of my 800 patients would make up the difference. Restructuring the way patients pay for their care would certainly change utilization but I can't predict how. As a start, to move toward my goal, without change in utilization, every patient on my panel would need to cough up $110 per year as a membership or administrative fee. This doesn't sound like an unreasonable beginning. Maybe a marketing brochure designed by our researchers would help us approach small business owners who would like to provide their employees with traditional health insurance, but can't afford it.

What do you think, Gordon??? ;-)If the average patient contact hours per week is 23, I would assume the other

17 hours are spent in keeping up your reading, working on learning more

IT and gadgetry, marketing, planning? , does this make any sense??I'm beginning to crystallize a way to offer small employers the opportunity to 'enroll' their employees and their family members in an imp practice that is intending to move in this direction. Shirley---------------------------------------------

Gordon mentioned at the IMP conference that the ideal would be to set

up the IMP model and reimbursement system such that the take home pay

for an IMP would be $200,000 per year.

Just some thoughts on that concept...

If a doc sees patients 48 weeks per year (5-days/week) = 240 days.

And sees 10-20 patient visits per day.

Then that would be 240 days x 10-20 visits/day

Equals --> 2400-4800 visits per year.

So each patient visit on average to make the $200,000/year would have

to be...

$200,000/year divided by 2400-4800 visits/year

Equals --> $42-83 per visit

Now this is assuming 0% overhead.

So add on whatever % of overhead you have to the $42-83/visit average

to make up for overhead costs.

I'm not sure what all this means -- but I suppose it's a goal.

Thoughts?

Locke, MD

[Guest guest]

Yes, I see what you are saying Shirley.

Gordon had a comment while I was at the conference that the ultimate goal is to avoid the concept of "visits" being the driving force of how we are paid.

So there could be a blend of e-visits, office visits, group visits, administrative pay, or some such, so that office visits aren't the only or even the major way we get paid.

But for now -- visits are the reality.

Thanks for the post.

Locke

From: [mailto: ] On Behalf Of Shirley PigottSent: Monday, July 02, 2007 9:11 PMTo: YahooFMSubject: $200,000 per year

Page 26 of Brady's start-up guide lists data Debbie and Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per month. Overhead doesn't change when you don't see patients; so overhead is 12 x $6,400 = $76,800 per year. Current average patient panel is 800. Total receipts should be $76,800 + $200,000 = $276,800 per year, but they aren't.If I'm the average imp under the current payment model, each of my 2,208 patient visits per year would need to bring in $125 per patient to reach my goal of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider 'no-shows'. Consider I'm the average imp. I'm not coming close to my $276,800 collections. If my average reimbursement per patient is only $87, as listed, I either need a raise of $38 per patient visit ($125 minus $87), or I must raise the difference some other way. Should I collect an 'administrative' fee on every one of the 800 patients on my panel to make up the difference? Right now my average $87 per patient visit with 2,208 patient visits per year collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm coming up short $276,800 - $192,096 = $84,704 per year. Given my 'average' panel of 800 patients, an administrative fee of $84,704/800 = $106 on every one of my 800 patients would make up the difference. Restructuring the way patients pay for their care would certainly change utilization but I can't predict how. As a start, to move toward my goal, without change in utilization, every patient on my panel would need to cough up $110 per year as a membership or administrative fee. This doesn't sound like an unreasonable beginning. Maybe a marketing brochure designed by our researchers would help us approach small business owners who would like to provide their employees with traditional health insurance, but can't afford it. What do you think, Gordon??? ;-)If the average patient contact hours per week is 23, I would assume the other 17 hours are spent in keeping up your reading, working on learning more IT and gadgetry, marketing, planning? , does this make any sense??I'm beginning to crystallize a way to offer small employers the opportunity to 'enroll' their employees and their family members in an imp practice that is intending to move in this direction. Shirley---------------------------------------------Gordon mentioned at the IMP conference that the ideal would be to set up the IMP model and reimbursement system such that the take home pay for an IMP would be $200,000 per year.Just some thoughts on that concept...If a doc sees patients 48 weeks per year (5-days/week) = 240 days.And sees 10-20 patient visits per day.Then that would be 240 days x 10-20 visits/dayEquals --> 2400-4800 visits per year.So each patient visit on average to make the $200,000/year would have to be...$200,000/year divided by 2400-4800 visits/yearEquals --> $42-83 per visitNow this is assuming 0% overhead.So add on whatever % of overhead you have to the $42-83/visit average to make up for overhead costs.I'm not sure what all this means -- but I suppose it's a goal.Thoughts? Locke, MD

[Guest guest]

Matt,

I keep wondering what is the definition of micropractice. How employees can you

have before you are a regular practice.

I have contacted some of you about writing some articles on micropractices. If

anyone else would like to contribute let me know. I am trying to write on what

it is we do that is different. I have some forms to gather financial and

practice charactoristics. Let me know if you would like to be a part of that.

JIm Kennedy

Winter Park.

________________________________

From: on behalf of Dr Levin

Sent: Tue 7/3/2007 8:41 AM

To:

Cc: dr-levin@...

Subject: Re: $200,000 per year

RE visit payment vs global fees.

OK, I am not privy to discussions at camp, but:

1) Global fee sounds like a health club -- pay monthly and you can come as many

times as you like. This works IF you have enough pts.

2) Overhead issues -- there has to be a " sweet spot " of how many pts you can see

in a fixed time if you're by yourself. From following the IMP listservs for

over a year now, seems like this is about 10 pts/day in order to keep up and

process needed info, esp if you take insurance (most of us have to).

3) Long term viability and service -- well, many of us DO have staff, perhaps

not as staffed as traditional, but enough. I've taken a " top down " approach of

modest staffing (2.5 FTE, outsource billing for 8% on collected dollar, doing IT

myself with EMR SOAPware since 1997--solo use since Dec 2004, recent startup of

Appointment Quest for $25/month, soon to sign contract for RelayHealth ONLY for

confidential email with pts -- no $50 for eprescribing thank you NO) and am

transitioning as resources permit to a " less paper " office with scanning as well

as test capture from my hospital database directly transfering results to PDF

files. Am also encouraging ALL pts to contact me with date of testing so I can

tap that database and avoid the scanning part, which isn't up and running yet

(bought the scanner Xerox Documate 510 at $300 at Office Depot this past weekend

16 pages per minute vs Fujitzu which isn't sold in any stores and I want to see

it thank you).

In my area, where Medicare reimbursement +10-15% is the norm for commercial

insurance fee reimbursement, I must take insurance. So I plan to boost up

volume to about 10 pts/half day if possible (plan more like 8/half day) and then

automate more and more to leverage staff. Realizing that my wife is 1.0 of the

FTE, this should work eventually to bring in the following:

8 pts/0.5 days, working now about 9 sessions = 72 pts/week.

Reimbursement ave is about $90/pt = $6480/week gross receipts.

$6480 x 4 weeks per ave month = $25,920 gross receipts in a month.

My overhead is about $14K (incl my family health insurance, malp financed

premium).

So, this ends up with about $26K-$14K = $12K net per month = $144K per year.

This appears realistic, sustainable to me.

Before, working for a hospital system, I was paid similarly, but now I call the

shots. Was seeing >20+ pts/day, this ends up with about 16 pts/day, 2/hour and

works sustainably. Have been able to moonlight for another organization for the

last 3 months, staff kept office running and this worked.

I'm looking for sustainable.

This will be the basis for an article concept I've submitted to Family Practice

Management.

I support ANY lower overhead ideas as well as give 24/7 service to pts, but look

for lifelong sustainability.

Comments, questions?

Dr Matt Levin

Western PA, east of Pittsburgh

Solo since Dec 2004

Residency trained grad 1988

SOAPware user since 1997

Outpt work, refer to another FP for inpt but am on staff

$200,000 per year

Page 26 of Brady's start-up guide lists data Debbie and

Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show

the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or

46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per

month. Overhead doesn't change when you don't see patients; so overhead is 12 x

$6,400 = $76,800 per year. Current average patient panel is 800.

Total receipts should be $76,800 + $200,000 = $276,800 per year, but they

aren't.

If I'm the average imp under the current payment model, each of my 2,208

patient visits per year would need to bring in $125 per patient to reach my goal

of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider

'no-shows'.

Consider I'm the average imp. I'm not coming close to my $276,800 collections.

If my average reimbursement per patient is only $87, as listed, I either need a

raise of $38 per patient visit ($125 minus $87), or I must raise the difference

some other way. Should I collect an 'administrative' fee on every one of the

800 patients on my panel to make up the difference?

Right now my average $87 per patient visit with 2,208 patient visits per year

collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm

coming up short $276,800 - $192,096 = $84,704 per year.

Given my 'average' panel of 800 patients, an administrative fee of $84,704/800

= $106 on every one of my 800 patients would make up the difference.

Restructuring the way patients pay for their care would certainly change

utilization but I can't predict how.

As a start, to move toward my goal, without change in utilization, every

patient on my panel would need to cough up $110 per year as a membership or

administrative fee. This doesn't sound like an unreasonable beginning. Maybe a

marketing brochure designed by our researchers would help us approach small

business owners who would like to provide their employees with traditional

health insurance, but can't afford it.

What do you think, Gordon??? ;-)

If the average patient contact hours per week is 23, I would assume the other

17 hours are spent in keeping up your reading, working on learning more IT and

gadgetry, marketing, planning?

, does this make any sense??

I'm beginning to crystallize a way to offer small employers the opportunity to

'enroll' their employees and their family members in an imp practice that is

intending to move in this direction.

Shirley

---------------------------------------------

Gordon mentioned at the IMP conference that the ideal would be to set

up the IMP model and reimbursement system such that the take home pay

for an IMP would be $200,000 per year.

Just some thoughts on that concept...

If a doc sees patients 48 weeks per year (5-days/week) = 240 days.

And sees 10-20 patient visits per day.

Then that would be 240 days x 10-20 visits/day

Equals --> 2400-4800 visits per year.

So each patient visit on average to make the $200,000/year would have

to be...

$200,000/year divided by 2400-4800 visits/year

Equals --> $42-83 per visit

Now this is assuming 0% overhead.

So add on whatever % of overhead you have to the $42-83/visit average

to make up for overhead costs.

I'm not sure what all this means -- but I suppose it's a goal.

Thoughts?

Locke, MD

[Guest guest]

Jim

you have talked to gordon yes?

bunch of articles coming out-- FPM later this yr.

Re: $200,000 per year

RE visit payment vs global fees.

OK, I am not privy to discussions at camp, but:

1) Global fee sounds like a health club -- pay monthly and you can come

as many times as you like. This works IF you have enough pts.

2) Overhead issues -- there has to be a " sweet spot " of how many pts you

can see in a fixed time if you're by yourself. From following the IMP

listservs for over a year now, seems like this is about 10 pts/day in

order to keep up and process needed info, esp if you take insurance

(most of us have to).

3) Long term viability and service -- well, many of us DO have staff,

perhaps not as staffed as traditional, but enough. I've taken a " top

down " approach of modest staffing (2.5 FTE, outsource billing for 8% on

collected dollar, doing IT myself with EMR SOAPware since 1997--solo use

since Dec 2004, recent startup of Appointment Quest for $25/month, soon

to sign contract for RelayHealth ONLY for confidential email with pts --

no $50 for eprescribing thank you NO) and am transitioning as resources

permit to a " less paper " office with scanning as well as test capture

from my hospital database directly transfering results to PDF files. Am

also encouraging ALL pts to contact me with date of testing so I can tap

that database and avoid the scanning part, which isn't up and running

yet (bought the scanner Xerox Documate 510 at $300 at Office Depot this

past weekend 16 pages per minute vs Fujitzu which isn't sold in any

stores and I want to see it thank you).

In my area, where Medicare reimbursement +10-15% is the norm for

commercial insurance fee reimbursement, I must take insurance. So I

plan to boost up volume to about 10 pts/half day if possible (plan more

like 8/half day) and then automate more and more to leverage staff.

Realizing that my wife is 1.0 of the FTE, this should work eventually to

bring in the following:

8 pts/0.5 days, working now about 9 sessions = 72 pts/week.

Reimbursement ave is about $90/pt = $6480/week gross receipts.

$6480 x 4 weeks per ave month = $25,920 gross receipts in a month.

My overhead is about $14K (incl my family health insurance, malp

financed premium).

So, this ends up with about $26K-$14K = $12K net per month = $144K per

year.

This appears realistic, sustainable to me.

Before, working for a hospital system, I was paid similarly, but now I

call the shots. Was seeing >20+ pts/day, this ends up with about 16

pts/day, 2/hour and works sustainably. Have been able to moonlight for

another organization for the last 3 months, staff kept office running

and this worked.

I'm looking for sustainable.

This will be the basis for an article concept I've submitted to Family

Practice Management.

I support ANY lower overhead ideas as well as give 24/7 service to pts,

but look for lifelong sustainability.

Comments, questions?

Dr Matt Levin

Western PA, east of Pittsburgh

Solo since Dec 2004

Residency trained grad 1988

SOAPware user since 1997

Outpt work, refer to another FP for inpt but am on staff

$200,000 per year

Page 26 of Brady's start-up guide lists data Debbie and

Wasson at Dartmouth have collected from the IMPs in the cohorts.

The data show the 'average' imp sees 46 patients per week. Goal is 48

weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current

average overhead is $6,400 per month. Overhead doesn't change when you

don't see patients; so overhead is 12 x $6,400 = $76,800 per year.

Current average patient panel is 800.

Total receipts should be $76,800 + $200,000 = $276,800 per year, but

they aren't.

If I'm the average imp under the current payment model, each of my 2,208

patient visits per year would need to bring in $125 per patient to reach

my goal of 2,208 visits per year x $125 per visit = $276,000. This

doesn't consider 'no-shows'.

Consider I'm the average imp. I'm not coming close to my $276,800

collections.

If my average reimbursement per patient is only $87, as listed, I either

need a raise of $38 per patient visit ($125 minus $87), or I must raise

the difference some other way. Should I collect an 'administrative' fee

on every one of the 800 patients on my panel to make up the difference?

Right now my average $87 per patient visit with 2,208 patient visits per

year collects $87 x 2,208 = $192,096. But I need to collect $276,800.

So, I'm coming up short $276,800 - $192,096 = $84,704 per year.

Given my 'average' panel of 800 patients, an administrative fee of

$84,704/800 = $106 on every one of my 800 patients would make up the

difference.

Restructuring the way patients pay for their care would certainly change

utilization but I can't predict how.

As a start, to move toward my goal, without change in utilization, every

patient on my panel would need to cough up $110 per year as a membership

or administrative fee. This doesn't sound like an unreasonable

beginning. Maybe a marketing brochure designed by our researchers would

help us approach small business owners who would like to provide their

employees with traditional health insurance, but can't afford it.

What do you think, Gordon??? ;-)

If the average patient contact hours per week is 23, I would assume the

other 17 hours are spent in keeping up your reading, working on learning

more IT and gadgetry, marketing, planning?

, does this make any sense??

I'm beginning to crystallize a way to offer small employers the

opportunity to 'enroll' their employees and their family members in an

imp practice that is intending to move in this direction.

Shirley

---------------------------------------------

Gordon mentioned at the IMP conference that the ideal would be to set

up the IMP model and reimbursement system such that the take home pay

for an IMP would be $200,000 per year.

Just some thoughts on that concept...

If a doc sees patients 48 weeks per year (5-days/week) = 240 days.

And sees 10-20 patient visits per day.

Then that would be 240 days x 10-20 visits/day

Equals --> 2400-4800 visits per year.

So each patient visit on average to make the $200,000/year would have

to be...

$200,000/year divided by 2400-4800 visits/year

Equals --> $42-83 per visit

Now this is assuming 0% overhead.

So add on whatever % of overhead you have to the $42-83/visit average

to make up for overhead costs.

I'm not sure what all this means -- but I suppose it's a goal.

Thoughts?

Locke, MD

[Guest guest]

RE visit payment vs global fees.

OK, I am not privy to discussions at camp, but:

1) Global fee sounds like a health club -- pay monthly and you can come as many times as you like. This works IF you have enough pts.

2) Overhead issues -- there has to be a "sweet spot" of how many pts you can see in a fixed time if you're by yourself. From following the IMP listservs for over a year now, seems like this is about 10 pts/day in order to keep up and process needed info, esp if you take insurance (most of us have to).

3) Long term viability and service -- well, many of us DO have staff, perhaps not as staffed as traditional, but enough. I've taken a "top down" approach of modest staffing (2.5 FTE, outsource billing for 8% on collected dollar, doing IT myself with EMR SOAPware since 1997--solo use since Dec 2004, recent startup of Appointment Quest for $25/month, soon to sign contract for RelayHealth ONLY for confidential email with pts -- no $50 for eprescribing thank you NO) and am transitioning as resources permit to a "less paper" office with scanning as well as test capture from my hospital database directly transfering results to PDF files. Am also encouraging ALL pts to contact me with date of testing so I can tap that database and avoid the scanning part, which isn't up and running yet (bought the scanner Xerox Documate 510 at $300 at Office Depot this past weekend 16 pages per minute vs Fujitzu which isn't sold in any stores and I want to see it thank you).

In my area, where Medicare reimbursement +10-15% is the norm for commercial insurance fee reimbursement, I must take insurance. So I plan to boost up volume to about 10 pts/half day if possible (plan more like 8/half day) and then automate more and more to leverage staff. Realizing that my wife is 1.0 of the FTE, this should work eventually to bring in the following:

8 pts/0.5 days, working now about 9 sessions = 72 pts/week.

Reimbursement ave is about $90/pt = $6480/week gross receipts.

$6480 x 4 weeks per ave month = $25,920 gross receipts in a month.

My overhead is about $14K (incl my family health insurance, malp financed premium).

So, this ends up with about $26K-$14K = $12K net per month = $144K per year.

This appears realistic, sustainable to me.

Before, working for a hospital system, I was paid similarly, but now I call the shots. Was seeing >20+ pts/day, this ends up with about 16 pts/day, 2/hour and works sustainably. Have been able to moonlight for another organization for the last 3 months, staff kept office running and this worked.

I'm looking for sustainable.

This will be the basis for an article concept I've submitted to Family Practice Management.

I support ANY lower overhead ideas as well as give 24/7 service to pts, but look for lifelong sustainability.

Comments, questions?

Dr Matt Levin

Western PA, east of Pittsburgh

Solo since Dec 2004

Residency trained grad 1988

SOAPware user since 1997

Outpt work, refer to another FP for inpt but am on staff

$200,000 per year

Page 26 of Brady's start-up guide lists data Debbie and Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per month. Overhead doesn't change when you don't see patients; so overhead is 12 x $6,400 = $76,800 per year. Current average patient panel is 800. Total receipts should be $76,800 + $200,000 = $276,800 per year, but they aren't.If I'm the average imp under the current payment model, each of my 2,208 patient visits per year would need to bring in $125 per patient to reach my goal of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider 'no-shows'. Consider I'm the average imp. I'm not coming close to my $276,800 collections. If my average reimbursement per patient is only $87, as listed, I either need a raise of $38 per patient visit ($125 minus $87), or I must raise the difference some other way. Should I collect an 'administrative' fee on every one of the 800 patients on my panel to make up the difference? Right now my average $87 per patient visit with 2,208 patient visits per year collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm coming up short $276,800 - $192,096 = $84,704 per year. Given my 'average' panel of 800 patients, an administrative fee of $84,704/800 = $106 on every one of my 800 patients would make up the difference. Restructuring the way patients pay for their care would certainly change utilization but I can't predict how. As a start, to move toward my goal, without change in utilization, every patient on my panel would need to cough up $110 per year as a membership or administrative fee. This doesn't sound like an unreasonable beginning. Maybe a marketing brochure designed by our researchers would help us approach small business owners who would like to provide their employees with traditional health insurance, but can't afford it. What do you think, Gordon??? ;-)If the average patient contact hours per week is 23, I would assume the other 17 hours are spent in keeping up your reading, working on learning more IT and gadgetry, marketing, planning? , does this make any sense??I'm beginning to crystallize a way to offer small employers the opportunity to 'enroll' their employees and their family members in an imp practice that is intending to move in this direction. Shirley---------------------------------------------Gordon mentioned at the IMP conference that the ideal would be to set up the IMP model and reimbursement system such that the take home pay for an IMP would be $200,000 per year.Just some thoughts on that concept...If a doc sees patients 48 weeks per year (5-days/week) = 240 days.And sees 10-20 patient visits per day.Then that would be 240 days x 10-20 visits/dayEquals --> 2400-4800 visits per year.So each patient visit on average to make the $200,000/year would have to be...$200,000/year divided by 2400-4800 visits/yearEquals --> $42-83 per visitNow this is assuming 0% overhead.So add on whatever % of overhead you have to the $42-83/visit average to make up for overhead costs.I'm not sure what all this means -- but I suppose it's a goal.Thoughts? Locke, MD

[Guest guest]

Looks like a good proforma

[Practiceimprovemen t1] $200,000 per year

Page 26 of Brady's start-up guide lists data Debbie and Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per month. Overhead doesn't change when you don't see patients; so overhead is 12 x $6,400 = $76,800 per year. Current average patient panel is 800. Total receipts should be $76,800 + $200,000 = $276,800 per year, but they aren't.If I'm the average imp under the current payment model, each of my 2,208 patient visits per year would need to bring in $125 per patient to reach my goal of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider 'no-shows'. Consider I'm the average imp. I'm not coming close to my $276,800 collections. If my average reimbursement per patient is only $87, as listed, I

either need a raise of $38 per patient visit ($125 minus $87), or I must raise the difference some other way. Should I collect an 'administrative' fee on every one of the 800 patients on my panel to make up the difference? Right now my average $87 per patient visit with 2,208 patient visits per year collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm coming up short $276,800 - $192,096 = $84,704 per year. Given my 'average' panel of 800 patients, an administrative fee of $84,704/800 = $106 on every one of my 800 patients would make up the difference. Restructuring the way patients pay for their care would certainly change utilization but I can't predict how. As a start, to move toward my goal, without change in utilization, every patient on my panel would need to cough up $110 per year as a membership or administrative fee. This doesn't sound like an

unreasonable beginning. Maybe a marketing brochure designed by our researchers would help us approach small business owners who would like to provide their employees with traditional health insurance, but can't afford it. What do you think, Gordon??? ;-)If the average patient contact hours per week is 23, I would assume the other 17 hours are spent in keeping up your reading, working on learning more IT and gadgetry, marketing, planning? , does this make any sense??I'm beginning to crystallize a way to offer small employers the opportunity to 'enroll' their employees and their family members in an imp practice that is intending to move in this direction. Shirley------------ --------- --------- --------- ------Gordon mentioned at the IMP conference that the ideal would be to set up the IMP model and reimbursement system such that the take home pay for an IMP

would be $200,000 per year.Just some thoughts on that concept...If a doc sees patients 48 weeks per year (5-days/week) = 240 days.And sees 10-20 patient visits per day.Then that would be 240 days x 10-20 visits/dayEquals --> 2400-4800 visits per year.So each patient visit on average to make the $200,000/year would have to be...$200,000/year divided by 2400-4800 visits/yearEquals --> $42-83 per visitNow this is assuming 0% overhead.So add on whatever % of overhead you have to the $42-83/visit average to make up for overhead costs.I'm not sure what all this means -- but I suppose it's a goal.Thoughts? Locke, MD

Luggage? GPS? Comic books?

Check out fitting gifts for grads at Yahoo! Search.

[Guest guest]

Sure -- send off list.

Concept, mine, of "micropractice" is (appologies to Gordon:

1) Commitment to pt

2) Commitment to continuity of care, may/may not include hospital work.

3) If in multi-doc practice, committment to continuity of care.

4) Use of technology to promote access and doc-pt relationship.

5) Open access scheduling (same day/next day appts).

6) Preferred use of EMR at point of service.

It is NOT:

1 doc/1 employee (although it could be)

Low volume of 10 or less pts a day (although it could be)

Billing all done in office (although it could be).

Cash only/no insurance practices (although it could be).

I'd call these "ultra lite" practices.

My concern is that the "ultra lite" practice is NOT available or viable in all places.

It is critical for me to survive long-term; an ultralite practice would not work in my environment because:

1) 80% insurered people.

2) High malpractice ($14K+/year in western PA).

3) High Medicare population.

So what's your definition?

Dr Matt Levin

$200,000 per yearPage 26 of Brady's start-up guide lists data Debbie and Wasson at Dartmouth have collected from the IMPs in the cohorts. The data show the 'average' imp sees 46 patients per week. Goal is 48 weeks work per year, or 46 x 48 = 2,208 patient visits per year. Current average overhead is $6,400 per month. Overhead doesn't change when you don't see patients; so overhead is 12 x $6,400 = $76,800 per year. Current average patient panel is 800. Total receipts should be $76,800 + $200,000 = $276,800 per year, but they aren't.If I'm the average imp under the current payment model, each of my 2,208 patient visits per year would need to bring in $125 per patient to reach my goal of 2,208 visits per year x $125 per visit = $276,000. This doesn't consider 'no-shows'. Consider I'm the average imp. I'm not coming close to my $276,800 collections. If my average reimbursement per patient is only $87, as listed, I either need a raise of $38 per patient visit ($125 minus $87), or I must raise the difference some other way. Should I collect an 'administrative' fee on every one of the 800 patients on my panel to make up the difference? Right now my average $87 per patient visit with 2,208 patient visits per year collects $87 x 2,208 = $192,096. But I need to collect $276,800. So, I'm coming up short $276,800 - $192,096 = $84,704 per year. Given my 'average' panel of 800 patients, an administrative fee of $84,704/800 = $106 on every one of my 800 patients would make up the difference. Restructuring the way patients pay for their care would certainly change utilization but I can't predict how. As a start, to move toward my goal, without change in utilization, every patient on my panel would need to cough up $110 per year as a membership or administrative fee. This doesn't sound like an unreasonable beginning. Maybe a marketing brochure designed by our researchers would help us approach small business owners who would like to provide their employees with traditional health insurance, but can't afford it. What do you think, Gordon??? ;-)If the average patient contact hours per week is 23, I would assume the other 17 hours are spent in keeping up your reading, working on learning more IT and gadgetry, marketing, planning? , does this make any sense??I'm beginning to crystallize a way to offer small employers the opportunity to 'enroll' their employees and their family members in an imp practice that is intending to move in this direction. Shirley---------------------------------------------Gordon mentioned at the IMP conference that the ideal would be to set up the IMP model and reimbursement system such that the take home pay for an IMP would be $200,000 per year.Just some thoughts on that concept...If a doc sees patients 48 weeks per year (5-days/week) = 240 days.And sees 10-20 patient visits per day.Then that would be 240 days x 10-20 visits/dayEquals --> 2400-4800 visits per year.So each patient visit on average to make the $200,000/year would have to be...$200,000/year divided by 2400-4800 visits/yearEquals --> $42-83 per visitNow this is assuming 0% overhead.So add on whatever % of overhead you have to the $42-83/visit average to make up for overhead costs.I'm not sure what all this means -- but I suppose it's a goal.Thoughts? Locke, MD