RE: New Member, New Practice

[Guest guest]

RE low overhead vs ultra low overhead.

This is an opportunity, but there are several issues for you to consider.

1) I'm not sure you can be certain pts will see you 10 miles away. Do you have the ability legally to invite them to see you?

2) Even if you want to have an "ultra low overhead" practice, you don't really need to feel this is incompatible with your friend. Just SHARE overhead, and keep yours low, SHARE staff (when needed).

3) I am more concerned with the decision of your friend to "take all comers" without regard to their ability to pay. You must look at the demographics of your practice (their insurance coverage?) and keep the practices separate, even if you need to have legal representation to separate if necessary. Esp the records in a joint computer system.

3 years ago, I was in your situation. Finally getting ahead but happier for it.

Feel free to email off list if you'd like.

Dr Matt Levin

Solo FP, Western PA

Using SOAPware since 1997

Using Appointmentquest.com for scheduling.

Using RelayHealth for pt communication

FTE 1.75

Sharing space in satellite with another doc

New Member, New Practice

Hello all-I am new to this list serv. In 72 hours I will begin my new solo practice. I decided to do this before looking deeply into the ideas comprising the IMP paradigm. Many of the decisions I have made occurred prior to my exposure to the IMP idea.I have worked for a hospital system for 7 years and have built a practice of about 2000 patients, whom I am tired of "feeding to the machine" (direct quote from my employing administrator). Prior to that I did urgent/acute care for several years.I am moving to a new location 10 miles away from my present one and anticipate that I will keep 70-85% of my patients.I will be sharing office space (that I have bought into) and EMR (new to me, I've only used paper in the past) with a long-time friend who was formerly with my present employer as well, before quiting and forming his own solo practice two years ago. He has been using EMR (Medinformatics) for 4 years and I will be using his server and buying my own licenses. He is definitely not working in IMP mode in that he 1)has 3 staff employees, 2) offers outpatient lab and many other high overhead services, 3) takes new patients with no questions asked, including walk ins. Nonetheless, he is a fine family physician who carries on in the best of our traditions, and I like and respect him greatly. He works extremely hard and does not have the income to show for it.Many of the choices I have already made in this undertaking (with the counsel & guidance of other my friend and other local solo docs) do not fit the IMP paradigm, as I fear I already have a higher-overhead, more complex situation forming, largely because of the purchase of office real estate.I met and discussed this with Dr Gordon last week at the AAFP Assembly, and listened carefully to all that he said. As I have bought into a new office with my friend to share workspace, I am not exactly looking at a low overhead situation. I am also heavily influenced by my friend and future partner who has "blazed the way" for me so to speak. That notwithstanding, I am an independent thinker and find great appeal in the IMP ideas I heard about at the assembly last week and the articles I have read over the past year or two written by or about Gordon.I realize that my situation has me straddling the fence a bit, and as I have talked of the IMP ideas to my friend and future partner, I am not finding an entirely welcome attitude. This makes this process even more difficult than it otherwise would be.Anyway, I would welcome any thoughts, words, suggestions, encouragement, chastising, or other responses. Thanks for letting me ramble on.Jim

[Guest guest]

Hi Jim-I started my practice too without the benefit of this group, though not in as big a way as you. Through the advice/following the culture of the group, after finishing out my two year lease in an office that was way too big and expensive, I moved to a way smaller much cheaper space, which has helped a bunch in the battle against overhead bloat. I think that though you are more enmeshed financially in many ways than I was, if you find that your new situation really does not allow you to practice the way that you want to practice, you will find the courage to move again towards what you want for you and your patients. Sounds like even though your partner is a great guy, he is not interested in doing things differently and it's a hard sell to try to convince other people to think in different ways- probably not worth the effort. In the meantime, maybe if you highly automate your office, you can cut down a little on staff so that you don't have to run so hard on the hamster wheel. Good luck and thanks for sharing your situation- I'm sure others on the list will have a lot to add. Lynn HoTo: From: jimbury@...Date: Fri, 12 Oct 2007 22:07:09 -0700Subject: New Member, New Practice

Hello all-I am new to this list serv. In 72 hours I will begin my new solo practice. I decided to do this before looking deeply into the ideas comprising the IMP paradigm. Many of the decisions I have made occurred prior to my exposure to the IMP idea.I have worked for a hospital system for 7 years and have built a practice of about 2000 patients, whom I am tired of "feeding to the machine" (direct quote from my employing administrator). Prior to that I did urgent/acute care for several years.I am moving to a new location 10 miles away from my present one and anticipate that I will keep 70-85% of my patients.I will be sharing office space (that I have bought into) and EMR (new to me, I've only used paper in the past) with a long-time friend who was formerly with my present employer as well, before quiting and forming his own solo practice two years ago. He has been using EMR

(Medinformatics) for 4 years and I will be using his server and buying my own licenses. He is definitely not working in IMP mode in that he 1)has 3 staff employees, 2) offers outpatient lab and many other high overhead services, 3) takes new patients with no questions asked, including walk ins. Nonetheless, he is a fine family physician who carries on in the best of our traditions, and I like and respect him greatly. He works extremely hard and does not have the income to show for it.Many of the choices I have already made in this undertaking (with the counsel & guidance of other my friend and other local solo docs) do not fit the IMP paradigm, as I fear I already have a higher-overhead, more complex situation forming, largely because of the purchase of office real estate.I met and discussed this with Dr Gordon last week at the AAFP Assembly, and listened carefully to all that he said. As I have

bought into a new office with my friend to share workspace, I am not exactly looking at a low overhead situation. I am also heavily influenced by my friend and future partner who has "blazed the way" for me so to speak. That notwithstanding, I am an independent thinker and find great appeal in the IMP ideas I heard about at the assembly last week and the articles I have read over the past year or two written by or about Gordon.I realize that my situation has me straddling the fence a bit, and as I have talked of the IMP ideas to my friend and future partner, I am not finding an entirely welcome attitude. This makes this process even more difficult than it otherwise would be.Anyway, I would welcome any thoughts, words, suggestions, encouragement, chastising, or other responses. Thanks for letting me ramble on.Jim

Peek-a-boo FREE Tricks Treats for You! Get 'em!

[Guest guest]

Jim,

Congratulations on opening your new

office. I wish you all the success (personal and professional) you hope for. Here

are my thoughts:

1) Low overhead is a means to the end of high quality care, not the

end itself. With that said, overhead is the millstone around your neck that you

carry every month. Overhead does not care if you took vacation or if the seasonal

variation left you a few patients shorter for the month—it feeds itself

anyway. And as a small business owner, you have to feed the overhead before you

can feed yourself. In an insurance-based practice (which I assume you are

opening), that directly reflects how many patients you will have to see in a

day. Most docs can comfortably see 20-30 patients a day (and do). The problem

is that the patient begins to suffer and technically they are the one with the

problem. In order to run that many patients through a financially inflexible

practice, some aspect of Patient Centered Collaborative Care (PCCC)—access

(can I get in), efficiency (is my time wasted), continuity (do I know my

provider and does (s)he know me), and great

information—gets compromised. When PCCC begins to go down, quality begins

to suffer.

2) You expect 70-85% of you patients to follow you. Be very cautious

of this estimate. Although you may be right, trying to predict patient behavior

is not that exact. Remember, you are asking patients to travel 10 miles

(depending on traffic that might be 25-30 minutes) out of their way to see you.

These are the same people who won’t give you 10 minutes of exercise a

day. Even with my satisfaction scores (65% say they receive perfect care), I would not expect more than 50% to follow me 10 miles.

3) “He works extremely hard but does not have the income to show

for it.” I don’t know any details about this, but what makes you

think you will be more successful? This is a classic burnout statement. This

one sentence has DANGER written all through it. Great docs are not necessarily

great businessmen, and financial difficulties can quickly erode a good

relationship.

My suggestions:

1) Great communication between staff members can trump the chaos of the

office. This results in a much better patient experience.

2) Meet with your staff every other week initially to determine how

things are going. Focus on lines of communication, building/implementing of

great ideas, and chemistry between the staff. Always

place emphasis on the tenants of PCCC and how you can make them work better.

3) Ask your partner if you can share staff. 3 staff is not outrageous.

5 for 2 people is even better

4) Make sure you code correctly! This is far more complex with in

house lab, but with an ehr it should be doable, and you

should therefore be able to augment your income better. If you outsource

billing, watch this like a hawk. Bad/unethical billing has cost many docs a lot

of money.

5) Try to get an article about your new practice in the paper (I don’t

mean place an ad in the paper). Also make sure you let ERs and pharmacies know

where you are and always carry cards with you! This will give you huge exposure

and ramp up your practice much faster decreasing the likelihood of failure.

6) After ramping up for a few months, join an IMP cohort.

7) Enjoy the fact that you are practicing medicine your way and are a

small business owner in your community!! Remain idealistic. Be happy. Be proud

of what you are doing. You have broken from the machine, that

makes you special. Congratulations!

New Member, New Practice

Hello all-

I am new to this list serv. In 72 hours I will begin my new solo

practice.

I decided to do this before looking deeply into the ideas comprising the IMP

paradigm. Many of the decisions I have made occurred prior to my

exposure to the IMP idea.

I have worked for a hospital system for 7 years and have built a practice of

about 2000 patients, whom I am tired of " feeding to the machine "

(direct quote from my employing administrator). Prior to that I did

urgent/acute care for several years.

I am moving to a new location 10 miles away from my present one and anticipate

that I will keep 70-85% of my patients.

I will be sharing office space (that I have bought into) and EMR (new to me,

I've only used paper in the past) with a long-time friend who was

formerly with my present employer as well, before quiting and forming his own

solo practice two years ago. He has been using EMR (Medinformatics) for 4

years and I will be using his server and buying my own licenses. He is

definitely not working in IMP mode in that he 1)has 3 staff employees, 2)

offers outpatient lab and many other high overhead services, 3) takes new

patients with no questions asked, including walk ins. Nonetheless, he is

a fine family physician who carries on in the best of our traditions, and

I like and respect him greatly. He works extremely hard and does not have

the income to show for it.

Many of the choices I have already made in this undertaking (with the counsel

& guidance of other my friend and other local solo docs) do not

fit the IMP paradigm, as I fear I already have a higher-overhead, more complex

situation forming, largely because of the purchase of office real estate.

I met and discussed this with Dr Gordon last week at the AAFP Assembly,

and listened carefully to all that he said.

As I have bought into a new office with my friend to share workspace, I

am not exactly looking at a low overhead situation. I am also heavily

influenced by my friend and future partner who has " blazed the way "

for me so to speak. That notwithstanding, I am an independent thinker and

find great appeal in the IMP ideas I heard about at the assembly last week and

the articles I have read over the past year or two written by or about Gordon.

I realize that my situation has me straddling the fence a bit, and as I have

talked of the IMP ideas to my friend and future partner, I am not finding an

entirely welcome attitude. This makes this process even more

difficult than it otherwise would be.

Anyway, I would welcome any thoughts, words, suggestions, encouragement,

chastising, or other responses.

Thanks for letting me ramble on.

Jim

[Guest guest]

Agree with below.

Also, sadly, don't be afraid to drop bad payors once you're busy enough.

Sadly, my area I no longer take medical assistance pts... the hospital supported practices just have to. Did this once I had 2+ no shows on 2 new MA pts in June, just had enough.

I do take cash paying pts and give 10% same day payors, with a credit card machine.

Good stuff here on business.

Finally, if you're working and renting from this doc, make it VERY CLEAR that you are ALSO paying part of each person's salary, or they will see that they have 2 bosses, and perhaps will favor the other fellow. You may need some help organizing how to do that, at least from an accountant, for payroll taxes, etc, which will reduce your tax burden.

Good luck!

Matt from Western PA

RE: New Member, New Practice

Jim,

Congratulations on opening your new office. I wish you all the success (personal and professional) you hope for. Here are my thoughts:

1) Low overhead is a means to the end of high quality care, not the end itself. With that said, overhead is the millstone around your neck that you carry every month. Overhead does not care if you took vacation or if the seasonal variation left you a few patients shorter for the month—it feeds itself anyway. And as a small business owner, you have to feed the overhead before you can feed yourself. In an insurance-based practice (which I assume you are opening), that directly reflects how many patients you will have to see in a day. Most docs can comfortably see 20-30 patients a day (and do). The problem is that the patient begins to suffer and technically they are the one with the problem. In order to run that many patients through a financially inflexible practice, some aspect of Patient Centered Collaborative Care (PCCC)—access (can I get in), efficiency (is my time wasted), continuity (do I know my provider and does (s)he know me), and great information—gets compromised. When PCCC begins to go down, quality begins to suffer.

2) You expect 70-85% of you patients to follow you. Be very cautious of this estimate. Although you may be right, trying to predict patient behavior is not that exact. Remember, you are asking patients to travel 10 miles (depending on traffic that might be 25-30 minutes) out of their way to see you. These are the same people who won’t give you 10 minutes of exercise a day. Even with my satisfaction scores (65% say they receive perfect care), I would not expect more than 50% to follow me 10 miles.

3) “He works extremely hard but does not have the income to show for it.” I don’t know any details about this, but what makes you think you will be more successful? This is a classic burnout statement. This one sentence has DANGER written all through it. Great docs are not necessarily great businessmen, and financial difficulties can quickly erode a good relationship.

My suggestions:

1) Great communication between staff members can trump the chaos of the office. This results in a much better patient experience.

2) Meet with your staff every other week initially to determine how things are going. Focus on lines of communication, building/implementing of great ideas, and chemistry between the staff. Always place emphasis on the tenants of PCCC and how you can make them work better.

3) Ask your partner if you can share staff. 3 staff is not outrageous. 5 for 2 people is even better

4) Make sure you code correctly! This is far more complex with in house lab, but with an ehr it should be doable, and you should therefore be able to augment your income better. If you outsource billing, watch this like a hawk. Bad/unethical billing has cost many docs a lot of money.

5) Try to get an article about your new practice in the paper (I don’t mean place an ad in the paper). Also make sure you let ERs and pharmacies know where you are and always carry cards with you! This will give you huge exposure and ramp up your practice much faster decreasing the likelihood of failure.

6) After ramping up for a few months, join an IMP cohort.

7) Enjoy the fact that you are practicing medicine your way and are a small business owner in your community!! Remain idealistic. Be happy. Be proud of what you are doing. You have broken from the machine, that makes you special. Congratulations!

-----Original Message-----From: [mailto: ] On Behalf Of Jim BurySent: Saturday, October 13, 2007 1:07 AMTo: Subject: New Member, New Practice

Hello all-I am new to this list serv. In 72 hours I will begin my new solo practice. I decided to do this before looking deeply into the ideas comprising the IMP paradigm. Many of the decisions I have made occurred prior to my exposure to the IMP idea.I have worked for a hospital system for 7 years and have built a practice of about 2000 patients, whom I am tired of "feeding to the machine" (direct quote from my employing administrator). Prior to that I did urgent/acute care for several years.I am moving to a new location 10 miles away from my present one and anticipate that I will keep 70-85% of my patients.I will be sharing office space (that I have bought into) and EMR (new to me, I've only used paper in the past) with a long-time friend who was formerly with my present employer as well, before quiting and forming his own solo practice two years ago. He has been using EMR (Medinformatics) for 4 years and I will be using his server and buying my own licenses. He is definitely not working in IMP mode in that he 1)has 3 staff employees, 2) offers outpatient lab and many other high overhead services, 3) takes new patients with no questions asked, including walk ins. Nonetheless, he is a fine family physician who carries on in the best of our traditions, and I like and respect him greatly. He works extremely hard and does not have the income to show for it.Many of the choices I have already made in this undertaking (with the counsel & guidance of other my friend and other local solo docs) do not fit the IMP paradigm, as I fear I already have a higher-overhead, more complex situation forming, largely because of the purchase of office real estate.I met and discussed this with Dr Gordon last week at the AAFP Assembly, and listened carefully to all that he said. As I have bought into a new office with my friend to share workspace, I am not exactly looking at a low overhead situation. I am also heavily influenced by my friend and future partner who has "blazed the way" for me so to speak. That notwithstanding, I am an independent thinker and find great appeal in the IMP ideas I heard about at the assembly last week and the articles I have read over the past year or two written by or about Gordon.I realize that my situation has me straddling the fence a bit, and as I have talked of the IMP ideas to my friend and future partner, I am not finding an entirely welcome attitude. This makes this process even more difficult than it otherwise would be.Anyway, I would welcome any thoughts, words, suggestions, encouragement, chastising, or other responses. Thanks for letting me ramble on.Jim

[Guest guest]

Dear Jim, Welcome and congratulations. You've received such good advice from Lynn and (and Gordon) that nothing more need be added at this time. Be patient with yourself on the EMR - no one anticipates the learning curve and it is not faster than paper at first.Let us know how it's going.  GuinnAlbuquerque Hello all-I am new to this list serv.  In 72 hours I will begin my new solo practice.   I decided to do this before looking deeply into the ideas comprising the IMP paradigm. Many of the decisions I have made  occurred prior to  my exposure to the IMP idea.I have worked for a hospital system for 7 years and have built a practice of about 2000 patients, whom I am tired of "feeding to the machine" (direct quote from my employing administrator).  Prior to that I did urgent/acute care for several years.I am moving to a new location 10 miles away from my present one and anticipate that I will keep 70-85% of my patients.I will be sharing office space (that I have bought into) and EMR (new to me, I've only used paper in the past) with  a long-time friend who was formerly with my present employer as well, before quiting and forming his own solo practice two years ago.  He has been using EMR (Medinformatics) for 4 years and I will be using his server and buying my own licenses.  He is definitely not working in IMP mode in that he 1)has 3 staff employees, 2) offers outpatient lab and many other high overhead services, 3) takes new patients with no questions asked, including walk ins.  Nonetheless, he is a fine family physician who carries on  in the best of our traditions, and I like and respect him greatly.  He works extremely hard and does not have the income to show for it.Many of the choices I have already made in this undertaking (with the counsel & guidance of other my friend and other  local solo docs)  do not fit the IMP paradigm, as I fear I already have a higher-overhead, more complex situation forming, largely because of the purchase of office real estate.I met and discussed this with Dr Gordon last week at the AAFP Assembly, and listened carefully to all that he said. As I have bought into a new office with my friend to share workspace, I am not exactly looking at a low overhead situation.  I am also heavily influenced by my friend and future partner who has "blazed the way" for me so to speak.  That notwithstanding, I am an independent thinker and find great appeal in the IMP ideas I heard about at the assembly last week and the articles I have read over the past year or two written by or about Gordon.I realize that my situation has me straddling the fence a bit, and as I have talked of the IMP ideas to my friend and future partner, I am not finding an entirely welcome attitude.  This makes this process even  more difficult than it otherwise would be.Anyway, I would welcome any thoughts, words, suggestions, encouragement, chastising, or other responses.  Thanks for letting me ramble on.Jim

[Guest guest]

1 ramble anytime

2 welcome where are you

3 low overhead is the tool to breathing room which is the tool to more time

with patitns/better access etc which are the tools to superb care Do superb

care and WE do not care what you bills are!

Will you be using howsyourhealth to get at this?

If Brady can help you in any way do not hesitate to call on him....

New Member, New Practice

Hello all-

I am new to this list serv. In 72 hours I will begin my new solo

practice.

I decided to do this before looking deeply into the ideas comprising the

IMP paradigm. Many of the decisions I have made occurred prior to my

exposure to the IMP idea.

I have worked for a hospital system for 7 years and have built a

practice of about 2000 patients, whom I am tired of " feeding to the

machine " (direct quote from my employing administrator). Prior to that

I did urgent/acute care for several years.

I am moving to a new location 10 miles away from my present one and

anticipate that I will keep 70-85% of my patients.

I will be sharing office space (that I have bought into) and EMR (new to

me, I've only used paper in the past) with a long-time friend who was

formerly with my present employer as well, before quiting and forming

his own solo practice two years ago. He has been usin g EMR

(Medinformatics) for 4 years and I will be using his server and buying

my own licenses. He is definitely not working in IMP mode in that he

1)has 3 staff employees, 2) offers outpatient lab and many other high

overhead services, 3) takes new patients with no questions asked,

including walk ins. Nonetheless, he is a fine family physician who

carries on in the best of our traditions, and I like and respect him

greatly. He works extremely hard and does not have the income to show

for it.

Many of the choices I have already made in this undertaking (with the

counsel & guidance of other my friend and other local solo docs) do

not fit the IMP paradigm, as I fear I already have a higher-overhead,

more complex situation forming, largely because of the purchase of

office real estate.

I met and discussed this with Dr Gordon last week at the AAFP

Assembly, and listened carefully to all that he said.

As I have bought into a new office with my friend to share workspace, I

am not exactly looking at a low overhead situation. I am also heavily

influenced by my friend and future partner who has " blazed the way " for

me so to speak. That notwithstanding, I am an independent thinker and

find great appeal in the IMP ideas I heard about at the assembly last

week and the articles I have read over the past year or two written by

or about Gordon.

I realize that my situation has me straddling the fence a bit, and as I

have talked of the IMP ideas to my friend and future partner, I am not

finding an entirely welcome attitude. This makes this process even

more difficult than it otherwise would be.

Anyway, I would welcome any thoughts, words, suggestions, encouragement,

chastising, or other responses.

Thanks for letting me ramble on.

Jim

[Guest guest]

Thank you for your kind reply.I am in the SE corner of Wisconsin, office will be in Paddock Lake, WI.I am just now investigating How's Your Health.I don't know who Brady is.Thanks again--Jim wrote: 1 ramble anytime 2 welcome where are you 3 low overhead is the tool to breathing room which is the tool to more time with patitns/better access etc which are the tools to superb care Do superb care and WE do not care what you bills are! Will you be using

howsyourhealth to get at this? If Brady can help you in any way do not hesitate to call on him.... New Member, New Practice Hello all- I am new to this list serv. In 72 hours I will begin my new solo practice. I decided to do this before looking deeply into the ideas comprising the IMP paradigm. Many of the decisions I have made occurred prior to my exposure to the IMP idea. I have worked for a hospital system for 7 years and have built a practice of about 2000 patients, whom I am tired of "feeding to the machine" (direct quote from my employing administrator). Prior to that I did urgent/acute care for several years. I am moving to a new

location 10 miles away from my present one and anticipate that I will keep 70-85% of my patients. I will be sharing office space (that I have bought into) and EMR (new to me, I've only used paper in the past) with a long-time friend who was formerly with my present employer as well, before quiting and forming his own solo practice two years ago. He has been usin g EMR (Medinformatics) for 4 years and I will be using his server and buying my own licenses. He is definitely not working in IMP mode in that he 1)has 3 staff employees, 2) offers outpatient lab and many other high overhead services, 3) takes new patients with no questions asked, including walk ins. Nonetheless, he is a fine family physician who carries on in the best of our traditions, and I like and respect him greatly. He works extremely hard and does not have the income to show for it. Many of the choices I have already made in this

undertaking (with the counsel & guidance of other my friend and other local solo docs) do not fit the IMP paradigm, as I fear I already have a higher-overhead, more complex situation forming, largely because of the purchase of office real estate. I met and discussed this with Dr Gordon last week at the AAFP Assembly, and listened carefully to all that he said. As I have bought into a new office with my friend to share workspace, I am not exactly looking at a low overhead situation. I am also heavily influenced by my friend and future partner who has "blazed the way" for me so to speak. That notwithstanding, I am an independent thinker and find great appeal in the IMP ideas I heard about at the assembly last week and the articles I have read over the past year or two written by or about Gordon. I realize that my situation has me straddling the fence a bit, and as I have talked of the

IMP ideas to my friend and future partner, I am not finding an entirely welcome attitude. This makes this process even more difficult than it otherwise would be. Anyway, I would welcome any thoughts, words, suggestions, encouragement, chastising, or other responses. Thanks for letting me ramble on. Jim

[Guest guest]

Jim,

Lots of good ideas here already, I think. As I started up over the

past year, I was amazed at the walls of blank stares and negative

responses I ran into when I brought up IMP ideas, even among solo docs

running practices in many ways very similar to mine. It seems that

there tends to be a lot of hidden ties/references/recordings inside

people attached to these ideas, and it's hard to know where others'

responses are really coming from.

It sounds to me that you have a plan underway that is very good in

many ways, and that focusing on being successful at your startup and

collegial relationship is most important right now. If you can afford

to keep some breathing room, you'll be able to explore how to apply

some of the successful IMP initiatives shortly. I hope for you that

the hamster wheel doesn't get spinning too fast to have the time for that.

My $0.02. All the best.

Haresch

[Guest guest]

,Thank you for you response. It is well taken.Jim Haresch wrote: Jim, Lots of good ideas here already, I think. As I started up over the past year, I was amazed at the walls of blank stares and negative responses I ran into when I brought up IMP ideas, even among solo docs running practices in many ways very similar to mine. It seems that there tends to be a lot of hidden ties/references/recordings inside people attached to these ideas, and it's hard to

know where others' responses are really coming from. It sounds to me that you have a plan underway that is very good in many ways, and that focusing on being successful at your startup and collegial relationship is most important right now. If you can afford to keep some breathing room, you'll be able to explore how to apply some of the successful IMP initiatives shortly. I hope for you that the hamster wheel doesn't get spinning too fast to have the time for that. My $0.02. All the best. Haresch

[Guest guest]

RE Jim's differences

OK, Jim, what are the "differences" for the I(deal) M(icro) P(ractice) in your opinion, other than:

1) No staff other than yourself.

2) You do all of your own billing.

3) Advanced open access scheduling insuring same day/next day appts.

4) No payroll, since you're the only one working.

Please enlighten me, at least! :-)

Matt from Western PA

PS You see, I'm all for improving efficiencies, but I believe that jumping off one hampster wheel onto another (yes, financially more lucrative) of NO redundancy, less time for self, can be damaging. I'm not saying it can't be done, but I'm saying that someone doing this all themselves should not underestimate the challenges, as well as the regional differences in reimbursement, patient populations, and costs.

M

Re: New Member, New Practice

Jim,Lots of good ideas here already, I think. As I started up over thepast year, I was amazed at the walls of blank stares and negativeresponses I ran into when I brought up IMP ideas, even among solo docsrunning practices in many ways very similar to mine. It seems thatthere tends to be a lot of hidden ties/references/recordings insidepeople attached to these ideas, and it's hard to know where others'responses are really coming from.It sounds to me that you have a plan underway that is very good inmany ways, and that focusing on being successful at your startup andcollegial relationship is most important right now. If you can affordto keep some breathing room, you'll be able to explore how to applysome of the successful IMP initiatives shortly. I hope for you thatthe hamster wheel doesn't get spinning too fast to have the time for that.My $0.02. All the best. Haresch

[Guest guest]

I don't mean to be supporting others' posts without adding much to the discussion.

But I think 's comments below are worth reading again. Not only do I think

what he says is 100% true, I also appreciate how well and succinctly he wrote it.His 3 points are 3 bullseyes.Understand overhead's effect on business,

especially since insurance determines how much we are paid and thus the primary way

to increase pay for a doc is to see more patients (and thus the vicious cycle

begins if the overhead is too great!).Jim -- I moved 10 miles and about

25 % of my patients followed me. That actually was what I predicted as I think

I'd heard that number before. Where? I don't recall, perhaps this list. (?)So

do be careful with estimates if it'll effect your planning and income.Interestingly the patients who followed were disproportionately the

" busiest " for care. Meaning they were the folks with problems that

had regular follow up (DM, htn, chol, etc). And I think that was because

shortly after I left they needed care and realized it was a different situation, so

they transferred to me. Thus the first year I think I was averaging a 2% of

patients a day for appts. The more usual number is about 1% And mine has

settled down now that I'm 18 months in and my panel has re-adjusted itself.Good luck with your venture.Tim---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

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Jim,

Congratulations on opening your newoffice. I wish you all the success (personal and professional) you hope for.

Hereare my thoughts:

1) Low overhead is a means to the end of high quality care, not theend

itself. With that said, overhead is the millstone around your neck that youcarry every month. Overhead does not care if you took vacation or if the

seasonalvariation left you a few patients shorter for the month—it feeds

itselfanyway. And as a small business owner, you have to feed the overhead

before youcan feed yourself. In an insurance-based practice (which I assume

you areopening), that directly reflects how many patients you will have to see

in aday. Most docs can comfortably see 20-30 patients a day (and do). The

problemis that the patient begins to suffer and technically they are the one

with theproblem. In order to run that many patients through a financially

inflexiblepractice, some aspect of Patient Centered Collaborative Care

(PCCC)—access(can I get in), efficiency (is my time wasted), continuity

(do I know myprovider and does (s)he know me), and

greatinformation—gets compromised. When PCCC begins to go down, quality

beginsto suffer.

2) You expect 70-85% of you patients to follow you. Be very cautiousof

this estimate. Although you may be right, trying to predict patient behavioris

not that exact. Remember, you are asking patients to travel 10 miles(depending

on traffic that might be 25-30 minutes) out of their way to see you.These are

the same people who won’t give you 10 minutes of exercise aday. Even

with my satisfaction scores (65% say they receive perfect care), I would not expect more than 50% to follow me 10

miles.

3) “He works extremely hard but does not have the income to showfor

it.” I don’t know any details about this, but what makes youthink

you will be more successful? This is a classic burnout statement. Thisone

sentence has DANGER written all through it. Great docs are not necessarilygreat businessmen, and financial difficulties can quickly erode a goodrelationship.

My suggestions:

1) Great communication between staff members can trump the chaos of theoffice. This results in a much better patient experience.

2) Meet with your staff every other week initially to determine howthings

are going. Focus on lines of communication, building/implementing ofgreat

ideas, and chemistry between the

staff. Alwaysplace emphasis on the tenants of PCCC and how you can make them

work better.

3) Ask your partner if you can share staff. 3 staff is not outrageous.5

for 2 people is even better

4) Make sure you code correctly! This is far more complex with inhouse

lab, but with an ehr it should be doable, and youshould therefore be able to augment your income better. If you outsourcebilling, watch this like a hawk. Bad/unethical billing has cost many docs a lotof money.

5) Try to get an article about your new practice in the paper (I don’tmean place an ad in the paper). Also make sure you let ERs and pharmacies knowwhere you are and always carry cards with you! This will give you huge exposureand ramp up your practice much faster decreasing the likelihood of

failure.

6) After ramping up for a few months, join an IMP cohort.

7) Enjoy the fact that you are practicing medicine your way and are asmall business owner in your community!! Remain idealistic. Be happy. Be proudof what you are doing. You have broken from the machine,

thatmakes you special. Congratulations!

New Member, New

Practice

Hello all-I am new to this list serv. In 72

hours I will begin my new solopractice. I decided to do this

before looking deeply into the ideas comprising the IMPparadigm. Many of the

decisions I have made occurred prior to myexposure to the IMP idea.I have worked for a hospital system for 7 years and have built a practice ofabout 2000 patients, whom I am tired of " feeding to the machine " (direct quote from my employing administrator). Prior to that I didurgent/acute care for several years.I am moving to a new location 10

miles away from my present one and anticipatethat I will keep 70-85% of my

patients.I will be sharing office space (that I have bought into) and

EMR (new to me,I've only used paper in the past) with a long-time friend who

wasformerly with my present employer as well, before quiting and forming his

ownsolo practice two years ago. He has been using EMR (Medinformatics) for

4years and I will be using his server and buying my own licenses. He isdefinitely not working in IMP mode in that he 1)has 3 staff employees, 2)offers outpatient lab and many other high overhead services, 3) takes newpatients with no questions asked, including walk ins. Nonetheless, he isa

fine family physician who carries on in the best of our traditions, andI like

and respect him greatly. He works extremely hard and does not havethe income

to show for it.Many of the choices I have already made in this

undertaking (with the counsel & guidance of other my friend and other local solo docs) do notfit the IMP paradigm, as I fear I already have a

higher-overhead, more complexsituation forming, largely because of the

purchase of office real estate.I met and discussed this with Dr Gordon

last week at the AAFP Assembly,and listened carefully to all that he

said. As I have bought into a new office with my friend to share

workspace, Iam not exactly looking at a low overhead situation. I am also

heavilyinfluenced by my friend and future partner who has " blazed the

way " for me so to speak. That notwithstanding, I am an independent

thinker andfind great appeal in the IMP ideas I heard about at the assembly

last week andthe articles I have read over the past year or two written by or

about Gordon.I realize that my situation has me straddling the fence a

bit, and as I havetalked of the IMP ideas to my friend and future partner, I

am not finding anentirely welcome attitude. This makes this process even moredifficult than it otherwise would be.Anyway, I would welcome

any thoughts, words, suggestions, encouragement,chastising, or other

responses. Thanks for letting me ramble on.Jim

[Guest guest]

Matt-Boy, I am certainly not the one to ask these things? Remember, I am a neophyte to these concepts. I guess the term ideal implies as close to perfection as is attainable. I would think that this situation may differ from one individual to another.I am hoping that the Ideal for any practice would strive to attain optimal results in the arenas of quality of care, and patient satisfaction, while allowing a satisfying and less punishing experience for the physician.I can see that there is likely not a one-size-fits-all answer to this query. I imagine others may differ.I can say that your points are well taken, and much appreciated.I apologize that I don't have better answers.JimDr Levin wrote: RE Jim's differences OK, Jim, what are the "differences" for the I(deal) M(icro) P(ractice) in your opinion, other than: 1) No staff other than yourself. 2) You do all of your own billing. 3) Advanced open access scheduling insuring same day/next day appts. 4) No payroll, since you're the only one working. Please enlighten me, at least! :-) Matt from Western PA PS You see, I'm all for improving efficiencies, but I believe that jumping off one hampster wheel onto another (yes, financially more lucrative) of NO redundancy, less time for self, can be damaging. I'm not saying it can't be done, but I'm saying that someone doing this all themselves should not underestimate the challenges, as well as the regional differences in reimbursement, patient populations, and costs. M Re: New Member, New Practice Jim,Lots of good ideas here already, I think. As I started up over thepast year, I was amazed at the walls of blank stares and negativeresponses I ran into when I brought up IMP ideas, even among solo docsrunning practices in many ways very similar to mine.

It seems thatthere tends to be a lot of hidden ties/references/recordings insidepeople attached to these ideas, and it's hard to know where others'responses are really coming from.It sounds to me that you have a plan underway that is very good inmany ways, and that focusing on being successful at your startup andcollegial relationship is most important right now. If you can affordto keep some breathing room, you'll be able to explore how to applysome of the successful IMP initiatives shortly. I hope for you thatthe hamster wheel doesn't get spinning too fast to have the time for that.My $0.02. All the best. Haresch

[Guest guest]

You don't know who Joh n Brady is??

Brady is an IMP 1 whose thoughtful posts you will see a bunch on the

list serve i alwasy like to offer his services.

In Newport news Virginia Open for 3 or 4 yreas .i think he actually supports

his family doing this.

Sings on the side.

Jean

New Member, New Practice

Hello all-

I am new to this list serv. In 72 hours I will begin my new solo

practice.

I decided to do this before looking deeply into the ideas comprising the

IMP paradigm. Many of the decisions I have made occurred prior to my

exposure to the IMP idea.

I have worked for a hospital system for 7 years and have built a

practice of about 2000 patients, whom I am tired of " feeding to the

machine " (direct quote from my employing administrator). Prior to that

I did urgent/acute care for several years.

I am moving to a new location 10 miles away from my present one and

anticipate that I will keep 70-85% of my patients.

I will be sharing office space (that I have bought into) and EMR (new to

me, I've only used paper in the past) with a long-time friend who was

formerly with my present employer as well, before quiting and forming

his own solo practice two years ago. He has been usin g EMR

(Medinformatics) for 4 years and I will be using his server and buying

my own licenses. He is definitely not working in IMP mode in that he

1)has 3 staff employees, 2) offers outpatient lab and many other high

overhead services, 3) takes new patients with no questions asked,

including walk ins. Nonetheless, he is a fine family physician who

carries on in the best of our traditions, and I like and respect him

greatly. He works extremely hard and does not have the income to show

for it.

Many of the choices I have already made in this undertaking (with the

counsel & guidance of other my friend and other local solo docs) do

not fit the IMP paradigm, as I fear I already have a higher-overhead,

more complex situation forming, largely because of the purchase of

office real estate.

I met and discussed this with Dr Gordon last week at the AAFP

Assembly, and listened carefully to all that he said.

As I have bought into a new office with my friend to share workspace, I

am not exactly looking at a low overhead situation. I am also heavily

influenced by my friend and future partner who has " blazed the way " for

me so to speak. That notwithstanding, I am an independent thinker and

find great appeal in the IMP ideas I heard about at the assembly last

week and the articles I have read over the past year or two written by

or about Gordon.

I realize that my situation has me straddling the fence a bit, and as I

have talked of the IMP ideas to my friend and future partner, I am not

finding an entirely welcome attitude. This makes this process even

more difficult than it otherwise would be.

Anyway, I would welcome any thoughts, words, suggestions, encouragement,

chastising, or other responses.

Thanks for letting me ramble on.

Jim