Re: getting back on the hamster wheel

July 4, 2007

RE IMP spirit of.

Is it better to do it all yourself and not pay yourself the extra money and survive hand to mouth without any time? or delegate and pay good people to help you?

Each his own.

Think Gordon has discussed this before -- ultra lite vs wise overhead.

If you have no family responsibilities, then maybe working 10 hour days works OK, but maybe not?

Low overhead practices have different definitions.

Can we agree to disagree here?

Matt Levin, MD

$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

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July 4, 2007

you are correct. it's not one or the other, it's what works for any individual. an open mind, experimentation and incremental change will help each of us do that, and to share our experience among ourselves.i point out that low overhead did not appear in your parameters.yes, there are some things worth paying for, others to pay oneself, and that is an individual calculus.without consideration of low overhead, i wonder that you may be stepping onto the hamster wheel, and question whether it may tend to degrade patient care and/or your ability to recharge and renew.me? i went to see minor league baseball and fireworks tonight, had a great time.happy fourth!LLDr Levin wrote: RE IMP spirit of. Is it better to do it all yourself and not pay yourself the extra money and survive hand to mouth without any time? or delegate and pay good people to help you? Each his own. Think Gordon has discussed this before -- ultra lite vs wise overhead. If you have no family responsibilities, then maybe working

10 hour days works OK, but maybe not? Low overhead practices have different definitions. Can we agree to disagree here? Matt Levin, MD $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 Yahoo! oneSearch: Finally, mobile search that gives answers, not web links.

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July 4, 2007

nice little analysis you got here and i am following very closely.

and i agree to agree with you that paying and delegating is better

than doing everything myself. makes the bolts and nuts in my head

run and roll smoothly.

we are about the same though i do not have a satellite. husband is

another FTE but just really came on as one so that his pay becomes

the IRA. so i am 2.5 as well. he does not care anyway as long as he

gets his weekday golf.

with EMR, we definitely did not want to outsource billing right off

the bat. defeats the purpose. sending claims out yourself is too

easy - or so he says. neither he nor i did not know anything about

billing. even bought a billing book to start but what helped us the

most was pay a good biller from another IM practice (with md's

blessing of course) higher $$ an hour for 1-4 hours a week for first

4-6 weeks to just help us figure quirks and pretty soon now

our " billing " team does not really need her as we know more. i do

all coding as we all should. and he does the calling and posting as

billers all should. almost none are written off as small bills are

his golf money too

we fixed up a space that is cheapest in town. we have the levis with

paint on to prove it. construction was all around us. had advertised

at 6th month for a week but will never do it again. word of mouth

has done it for me. i just talk too much to the patients and that

works for them.

will definitely follow your color coded analyses. appreciate

everyone's input here.

my problem is: still accepting new patients, how is it i am being

told that i should still? my wait for new is about 6 weeks, no

attachments or guilt involved for people i dont know yet. but still

offer same day.

grace

as

> 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 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

>

> -------------------------------------------------------------------

-----------

> Yahoo! oneSearch: Finally, mobile search that gives answers, not

web links.

>

July 4, 2007

RE accepting new pts a problem?

Not sure what problem is for you--

1) 6 weeks' wait -- is this the problem that it is taking 6 weeks to get a new pt in? Then you are actually closed to new pts.

2) Access -- do you have enough same day appt time, if taking 6 weeks to get a new pt in?

3) Do you really have enough pts? -- if you have enough cash flow, then don't worry about new pts, you have enough.

4) If you want new pts, then you need to accommodate for more. Is there a cash flow problem? May need to cut some insurance acceptance. Do you take too much time for a pt? I find that in most cases, 2 chronic pts an hour is just fine, with a third being seen for acute needs.

Do you use EMR?

Issues ongoing... let's keep talking here.

Dr Matt Levin

$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 > > > > > > > > > ---------------------------------------------------------------------> Yahoo! oneSearch: Finally, mobile search that gives answers, not web links.>

July 4, 2007

I have closed to new patients officially because

of the reason Grace mentioned. I am very booked and we can’t get

new patient’s in. I have closed my panels with insurance companies

and can now pick and choose who I let in and who I don’t. The

hardest thing is the 90 days notice. NJ HMO Medicaid wouldn’t let

me close my panel until I had 50 people on it (about 6% of active

patients). Suddenly my panel jumped to over 80 and we sent the letter and

called that day, but they are still letting people on. If patient’s

call, we tell them we are closed but the insurance hasn’t processed

it. We tell them about the long wait for the appt. Advise them to

try to switch primaries.

I just finished a chart review for Colon cancer Screening as part

of a possible study. The research group that I get quality reports and

tracking indicators from only counts patients in office within the past 12

months as active. They say I have close to 800 active patients. I

have younger patients who don’t come in every year so there are

more. Over 400 are over the age of 50. So my picking and choosing

is to young up the practice. I need younger healthier people that are

less labor intensive and of course allow for a change of pace.

Traditionally, doctors are afraid to close

their practices. They just make patient’s wait for an inordinate

amount of time to get an appt and figure if they are willing to wait then

OK. For some reason they are afraid that suddenly, everyone will leave

and they will have none. That need to see the full schedule for weeks out

for security. I think we need to be honest and just close our

panel. We can reopen periodically for normal turnover, losing patients to

death, moving, insurance changes. I also think that then patients are

more “satisfied” as their doctor is so busy and so good they aren’t

accepting new patients, and new patients feel “lucky” to get in and

be happy to follow “the rules”. That’s my thought

anyway.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

July 4, 2007

Kathy,

I agree with not wanting to see too many

patients/day, but be careful. I have closed my panel 3 times now and every time

I end up regretting it. Why? Because it takes about 4-6 weeks to get things

jump started again once you realize that things have slowed down too much. What

I would do instead is close to all but the best payor(s)

and then (if still to busy) only accept friends/family members with that

insurance. What this does is increase the per visit average income and keeps

the balance of patients entering and leaving the practice about the same. With

50% of your panel >50 years old, I would think your panel would drop

relatively rapidly if you shut down entirely.

RE:

Re: getting back on the hamster wheel

I have closed to new patients officially

because of the reason Grace mentioned. I am very booked and we

can’t get new patient’s in. I have closed my panels with

insurance companies and can now pick and choose who I let in and who I

don’t. The hardest thing is the 90 days notice. NJ HMO

Medicaid wouldn’t let me close my panel until I had 50 people on it

(about 6% of active patients). Suddenly my panel jumped to over 80 and we

sent the letter and called that day, but they are still letting people

on. If patient’s call, we tell them we are closed but the insurance

hasn’t processed it. We tell them about the long wait for the

appt. Advise them to try to switch primaries.

I just finished a chart review for Colon

cancer Screening as part of a possible study. The research group that I

get quality reports and tracking indicators from only counts patients in office

within the past 12 months as active. They say I have close to 800 active

patients. I have younger patients who don’t come in every year so

there are more. Over 400 are over the age of 50. So my picking and

choosing is to young up the practice. I need younger healthier people

that are less labor intensive and of course allow for a change of pace.

Traditionally, doctors are afraid to close

their practices. They just make patient’s wait for an inordinate

amount of time to get an appt and figure if they are willing to wait then

OK. For some reason they are afraid that suddenly, everyone will leave

and they will have none. That need to see the full schedule for weeks out

for security. I think we need to be honest and just close our

panel. We can reopen periodically for normal turnover, losing patients to

death, moving, insurance changes. I also think that then patients are more

“satisfied” as their doctor is so busy and so good they

aren’t accepting new patients, and new patients feel “lucky”

to get in and be happy to follow “the rules”. That’s my

thought anyway.

Kathy

Saradarian, MD

Branchville,

NJ

Solo low-staff practice

since 4/03

In practice

since 9/90

Practice

Partner User since 5/03

July 4, 2007

hey matt.

new pts are not a problem. just going back and forth between husband

and me. just that underlying fear of maybe not having enough (when

you do cut back) just to cover costs of paying back startup loans.

cashflow no problem.

again dont have an issue of having new patients wait. i do not have

any attachments to them. i still want to keep open access to current

patients because i am part of this group (you know how gordon made

us all swear to uphold etc etc.)

and nope. talk enough but not too much to take too long for each

patient. if i am behind, it would only be few minutes. really

looking closely at cutting back on one insurance carrier but

comprises about 18% of population.

and yes, i am fully paperless.

so maybe, there really is no living issue. except that i struggle to

not want to get greedy and in the end sacrifice time. but how many

patients is really enough?

> > 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 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

> >

> > ----------------------------------------------------------

> -----------

> > Yahoo! oneSearch: Finally, mobile search that gives answers,

not

> web links.

> >

>

July 4, 2007

,

I wasn’t real clear with that but

when I say “close my practice”, the insurance panels are closed to

new patients but patients can call and ask. That is what I meant with I

get to “pick and choose” who comes into my practice.

Unfortunately the best payor is Medicare which will only increase my over 50

population. So I can only pick the least worst payors.

I do not understand you comment that the

panel will drop quickly with my older population. They are chronic care

patients of high intensity but are not dying rapidly if that’s what you

meant. The majority are in that 50-70 range that should be with me until

they move to Florida or North Carolina or something.