Home Forums Discussions General Discussion Seeking advice for solo practice startup

Good Morning Everyone,

I have been an AC user and "closet" reader of these discussion boards for about a year, but this is my 1st post.

I am in the process of moving from an employed situation to a solo practice. I want to keep expenses as low as possible and want to avoid as many mistakes/bad decisions as possible. What are the top 3 or 4 things that I should be sure to do/not do? Is it worthwhile hiring a consultant to help me get up and running, and if so, who would you recommend?

Thank you in advance for any and all thoughts!

Here are my suggestions:
1. Hire a billing/office manager who can apply for your Medicare and other insurance numbers at least 3 months before your intended start time. Keep your billing in-house. No one cares more about your money than you.
2. Hire staff who are already or are willing to cross-train. Billers who can bring patients back and answer the phone, receptionists who can post charges and payments. Preferably older women whose children are grown and out of the house.
3. Treat your employees like they are your business partners...they can make or break you and unhappy employees tend to take it out on your patients who then tend to go elsewhere. Reward your staff when things are good (take trips, buy lunch, give them ball tickets) and accept your share of the blame when things are bad. Let them know you value and encourage their opinions and suggestions...most of the times they are right. Remember how you felt/feel being an employee.
4. In today's market, buy don't rent your office space. I wish I had done this 20 years ago.
5. Do not hire a consultant. The worst decisions we made when I belonged to a large group were at the urging of a consultant...actually led to the eventual break-up of the group.
No one knows better than you how you want to combine your career with your home life. No one knows better than you how much money you need to make and how hard you want to work to make it. You will now have the ability to do that. And, by the way, money isn't everything. You have to be able to live with yourself, deal with your conscience, balance The Golden Rule with fiscal solvency and sleep at night.
Run your office like you would like see your personal doctor's office run. If you are low-keyed and enjoy humor, don't be afraid to reflect that in your decor and office operation. If you are more traditional, keep yourself comfortable by running your office on the straight and narrow.
6. Constantly follow-up....do it yourself. Check insurance reports, AR reports, aging reports, procedure profitability, which patients are falling behind in payments, etc. Pay your bills yourself. This keeps you constantly updated on costs which might be changing too quickly and makes you re-examine every time you make a payment whether that service or product is really necessary. Go online and compare medical suppliers prices for various products. I use Esurge, Moore Medical, Henry Schein a lot. Doing this yourself humbles you and gives you motivation to question an employee's request for a special kind of pen or your habit of using sterile tongue blades.
7. OK, so this ended up being more than 3-4 but lastly, keep your head on your shoulders and your ego in check. There is nothing wrong with being a "small office". There are more and more of us opening up all the time. Don't strive to impress your patients or your peers...it usually ends up costing you more money. Settle for the mundane. Start out with only the bare necessities and add technology only as your practice grows and only if you can definitely conclude it will improve your bottom line or enhance your medicolegal security.
And welcome to our elite group...the Solo Physician. If you can make it here, you can make it anywhere. And I know you will live a happier and more rewarding life.

Leslie

Try to find a friendly banker who actually cares about you and your practice, not someone who wants to put you in their portfolio to show off for the boss. Rates are low, get something that is locked in. And as Leslie said, keep costs low so you only have to finance as little as possible. In today's reimbursement rates, feeding the bank can kill you.

Get yourself exposure to free and cheap sources like having the local paper do a write up on your new practice. Nothing made our phones ring early on like those good articles in the paper. It adds an air of legitimacy to you. Anyone can run an ad, but you must be some how more worthy if some journalist wrote an article about you. Heck in one or two of the really small, secondary papers, they even basically let me write the darn thing. Now I tried to approach it as I learned in intro to journalism all while putting in the items that I wanted to hit that I thought made us stand out.

Go as cheap and as small as you can until you must add staff or equipment. And be real careful about buying extra equipment.. See financing and debt above. We love our MidMark ECG and even the Spirometer, but we just don't do enough spirometry to justify the cost and the added expense of the financing of it. At best should have only bought the ECG to start as it is all software based and could have added the other tests if we felt that the traffic justified their purchase... It's all software based which is already half installed anyway once we bought the first unit...

Sign up for this Yahoo listserv:

http://health.groups.yahoo.com/group/Practiceimprovement1/

This is the Ideal Medical Practice discussion group -- lots of good solo practice discussion there.

Documents related to Ideal Medical Practice:
http://www.aafp.org/fpm/20020300/25goin.html
http://www.impmo.org/FPM_Moore_Wasson_Sept_2007.pdf

Thank you all. Wow Leslie, what a well thought out response and one that immediately resonates with me.
Brian, i am a member of the IMP listserv and agree that there is a lot of great information there. In fact, I am thinking of attending their "camp" in Rochester in June.
I welcome anyone else who has something to add.

You are young and therefore computer literate? Then your 'intranet' should not pose a problem. Two or Three workstations, the Amazing Charts working "peer to peer" and you in the room with a basic (<$1,000) laptop? I would not scrimp on the 'all in one' as the larger, (more expensive initially) commercial units will have substantially lower operating costs and greater durability. Look at HP 2840 (about $900.00) and then try to find something even better. (LOL)

Agree ABSOLUTELY on the EKG and Spiro. My spirometer is nearly 20 years old, but I don't think it has paid off yet. I would replace it immediately if it breaks, because I can afford to and I like the info it gives me. But I could do all I need in the office with the pulse Ox (get one) and a peak flow meter. Send the patient to the hospital for the PFT's.

Are you familiar with the "Medical Home" concept of health care. Adopted by the academy of Family Practice about 2002 (I think) this is really a big deal. You can't achieve it without an EMR (in my opinion) and your ability to practice quality care in the 21'st century is limited without it. That should be your hook for the Newspaper story. What is a "Medical Home", why it is important, what it will do for the patient and what you are doing to provide it. Some aspects of this are not easy for the lay person to grasp. When I explain that we are attempting to manage ALL RECORDS, including the CT Scan done in Las Vegas when they fell and hit their head on that slot machine, and now that I have all the records, including meds, allergies, consults, surgical history and the last EKG, and I can get access 24-7 and FAX those records to an Emergency Room anywhere in the U.S. I can see the recognition spread across the patients face. This is really a big deal, a huge change in the tools that we can bring to the practice of medicine. An EMR is every bit as important a tool for the practice of medicine as a stethoscope and that is not hyperbole.
As for marketing, just think how many Drs. in your town are being quoted as saying, "EMR? Why would I, I'm going to retire before I would ever get any return on that investment." Bingo, you have planted a seed that will have a high yield for your practice.

Finally, GOOD LUCK and try to have fun with it!

Leslie hit this one directly on the head. A Home Run!

You do just exactly what she said and you'll be fine.

Exactly. She did.




Except for the practice consultant. I couldn't have done it without her. Still can't.

Thanks again to all who have responded! Being a happy, successful Physician these days seems more challenging every day and I am so appreciative to have found this group.

By way of introduction, I am BC in Neurology and Headache Medicine and am the only such beast in my region. 6 years ago, I moved here from Birmingham, AL to start a Headache Center (as an employee of a Rehabilitation Hospital). The 1st 3 years were the happiest of my 20 year career. Patient volume grew, I started doing clinical trials, published a couple of case reports and articles (neither of which had I done previously), and earned a very positive reputation in the medical & lay community. Over the past 3 years, unfortunately, my employer and I have different ideas of how to grow this practice and it is time to go.

I am excited and a little (maybe more than a little) concerned about the myriad of considerations and decisions that must be made.

Bert, what did your practice consultant do for you that you couldn't have done yourself?

Leslie, I agree 100% that no one cares about your $ as you do, but it seems outsourcing billing would be easier and perhaps more cost effective than hiring someone, with all the associated costs of employment. What do others think? Do any of you use a billing company that you would recommend?

Thank you all. Have a great day, and "Be careful out there."

We outsource billing and have been quite happy with the arrangement. Medical Practice Made Perfect is who we use http://www.mpmp.us/ Only problem is that when we migrated to using AC they haven't been able to use a MSexcel file as input - they still rely on printed face sheets like in the old days of paper charts. Not really a problem on my end but it is somewhat inefficient to not leverage the ability to keep the data all electronic. I end up FTP'ing a bunch of face sheets in PDF format and then they manually enter the data into their system. They also do all our credentialing as part of bargain.

Also, we send copies of all EOBs and other correspondence back to our billing company via FTP. We just scan it in as it comes in and then upload to their secure FTP site. We use a lockbox at a bank so all checks are deposited without delay.

Both Bert and I have in-house billing.

Yes there is employee cost, but there is higher cost in outsourcing billing. Plus, my own biller is highly motivated to collect my money. She also collects better than outsourcers do.

Everything. I could have never started a practice without my consultant. But, that's just I. I would have had no idea how to do that. I went from leaving one practice to opening my practice in under two months. She is basically like an office manager. You would have to work with her to understand. I would say if there were a multitasking competition, she would win hands down. So, mainly all of the business stuff.

hire the consultant I am up and running finally and will start to officially see patients next week. I have had a few walk ins and have gone ahead and seen them which is good, it is allowing me to figure out AC under a little less pressure. The medical aspect of the office was a breeze but... the business and the legal issues were a major headache and I so wish we had someone to walk us through the whole process instead of the way we did it. Just my 2 cents

Use the consultant. Big mistake to go without one.
You know the medicine, so you don't need someone telling you how to do that. But you (nor did I) know the business of medicine. Would anyone let their secretary treat patients? Not hardly.
So the doctor should not be handling all of the business and legal issues by him/herself.

However that's NOT to say you do not have ownership of decisions.
My advice is this, surround yourself with very capable people and give them license to figure out stuff. You give them direction, you tell them where the operation is going to go. Afterall you are the boss. however, allow them the freedom to make it happen.

I tell my consultant, "I want to participate w/ Anthem." But I don't fill out the application forms, she did it. Now we are on CAQH, a national database for insurance credentialling, and I attest to updates every 3 months.

I tell my consultant, "I need to hire a new M.A." and she deals w/ the ads, application screening, initial interviews, etc. Bert will be quick to add that she (we share the same consultant) has yet to actually find us staff that we've held onto for a long time. That just makes the point that good people are hard to find.