Home Forums Discussions General Discussion Hello From IMP Camp, Rochester, How's Branson!

Hello Guys,
How is everybody out there? Are you having fun yet. It's late and I'm banging away at the keys for a few moments. We have met some very nice and interesting people here. As much as I socially wanted to finally meet all my "E" friends from the board here, I am really glad Nancy and I came here. We are among friends here with similar concerns, problems, hopes and dreams.

Bert, You would have loved it in one of the smaller break out groups on one of the powerpoint presentation they were showing different docs IMP sytled practices, and the quote of his under himself was classic, it was Howard Beales from Network: "i'm mad as hell, and I'm not gonna take it anymore!"

An nice guy that Brian and Jon both know who alphas and betas for Jon is here and he is struggling with many of the piss poor trade offs that we all are, his name is Larry Lyons and he gave a very nice demo of Dragon Naturally Speaking which for at least half to a whole year I have beeb trying to get nancy to try the thing. So Larry has a mellow nice well spoken and Dragon is just smooth as silk for him. So Nancy walks in after her joint injectios thing and starts razzing Larry that there is no way that this machine can do accurate work with her bronx voice. So Larry make Nancy do all the voice training and righ off the bat Nancy and this device are creating a note with an old but decent mic. I could have kissed him!!! She waas deleting, and templating in just about 15 minutes! "Take my wife please"

So please tell us all about Branson, how 3.7 is looking (Larry was using it in his demo so we were able to see a few interesting features like they patient instructions at the end of the visit. What kind of great ideas have come from the groups? What kind of new things are you learning or features yet to come.

Anyway sleep is coming on fast, real fast after skating two nights in a row, five games in all.... Send everyone our regardss.....

Paul and Nancy, Loggging in From Roshester NY

Paul I will have to say that almost everyone here has seen at least one feature of AC that they never knew existed. It has been very useful to see how others are working around lifes little issues.
Martin
(ps, tornado in Springfield on Friday, Everyone out of the Pool for two hours in Branson, (electrical storm) but Brandon and I travelled 1,600 miles by motorcycles and got not one drop of rain!)

DocM,
I just heard that Bert never made it out there. What a shame, as he has so much to share on all of this. I'll tell all of you Branson Folks that almost all of the PCP's in small and cetainly Solo practice should try and get involved with this IMP movement thing. Here is a great bunch of folks that all have come to basically the same conclusion about the insanity of the present dysfunctional employer based health insurance model of healthcare, and are trying one practice at a time to save themselves and their patients from it.

Now Nancy and I made an honest assessment of the situation. Almost everyone there has a way or reason to be able to live on a fairly modest amount of income from their practice. Almost everyone there had spouses with another job whose job probably at least doubled their income if not better, and that spouses job probably supplied bennies including a health insurance policy for them and their familys. Well there is at least $10-$12K saved for themselves and the practice a year right there. Where as whatever Nancy and I pull out of the practice is for both of us combined.

I'm not a school teacher pulling down good money with bennies, an engineer, some mid-level manager myself. Well I am but for us not for some decent outside employer. I think if many of the IMP folks actually had to feed their entire famly and handle all of their other expenses and debts like we do on only the practice they would be much more disheartened and strapped like we are. Now obviously this is a generalization as no two people or practices are the same, but so many of them have this extra cushion built into their lives, while we are flying without a net and barely staying afloat.

But the perspective of trying to bust thru the garbage and actually remember why they became docs, trying to hold strong to certain basic ideals, and find ways out from under the oppressive thumb of the repressive and greedy carriers is wonderful to see and be around. But it was funny how much I already knew and how in many ways the things that guys like me and Wayne know as NYS practice managers actually had me in the position of advicing and explain things to many other practices and docs. Like a certain NYS carrier, comp, disablity, no-fault and a few other things as well.

And here is a phrase we need to spread around the country and personally I feel there are probably a whole bunch of places that fit this basic concept that until this weekend, Nancy and I had never heard, one that the AMA, the AAP, the AAFP nor the medcial society never speak to and that is what they refer to as "Dead Zones". Much like certain areas of the ocean that have been so polluted, that nothing can grow, these are areas of the country that the carriers have done such incredible damage to healthcare and providers that basically almost no providers can make a decent living and almost no practice can survive. The fees are so low and the managed care so oppressive that nothing can grow. CNY with 70% one carrier that has now converted with the unfair control of the market, have converted all of their products into managed care products is soon going to be if we are not already, such a dead zone.

And they are one of the first that I have ever seen that have real data on the average payments for various codes around the country. It is just sickening to see how different payments are from place to place. No wonder PCP's are going under all over the place.

Anyway, I think we need to bring more of our AC people together we the IMP's people. So many AC'ers are probably sort of IMP already and just don't know it yet, don't have a name for it yet. So many of us really are. And this needs to be a thing of momentum and numbers and the sharing of ideas, support, solutions. And we need to stand together against this aweful tide and push back, all while surviving at the same time. And viable and sustainable model of practice, that supports the best in patient care.

As Larry and I were saying this afternoon, there is so much money being spent on healthcare and yet PCP's especially are not getting their resaonable share, we are not able to get to the spigout to get life sustaining water.

Hope you are all having a great time out there for the rest of us. Please post all the great things you are learning, suggesting, and what Jon seems to be interested in. We are all very curious. Have a safe trip home one and all, and try to know where the storm cellars are.... "Auntie M, Auntie M!!!"

Paul

Paul -- I had a feeling you would find a lot of kindred spirits at the IMP camp; they really are a great group. I am so glad that you went.

Here's their website:
http://health.groups.yahoo.com/group/Practiceimprovement1/

Larry Lyon is a prince of a guy who has been registered on this User Board since the beginning, but doesn't post very often.

Useless trivia:

bert (user #4) Registered 09/27/03
larry (user #7) Registered 10/24/03

When Larry and I met, we found out we were both working on voice recognition talks concurrently. I sent him a batch of my early voice commands, and he sent me a microphone headset as a present. Super guy!

Brian,
He really seems down in the dumps about his practice. He seems to really like and respect you too. So if you could as I suggested, drop him a line when you can. I tried my best but I wasn't getting thru at the time.

I wish some how we could have co-joined the two events. I'm sure that most PCP AC users are already half if not full IMP's even if they don't know they are yet or know the term for what they are. I wish you all could have seen Larry and my Stubborn wife as she was training the thing with the Dave Barry thing and charting in 3.7 up there on the stage. Like I said before, I could have practically kissed him. Practically, he's not my type.... lol

But yes, if I haven't said it enough already, Thank you very much for a timely and wonderful suggestion. You will not be forgotten for that one. Thanks.

I have talked with Larry and we will talk again.

Unfortunately, these are hard times for primary care. Some of you may know that I closed my practice a few months ago, and joined up with a group of FPs, trying to lower overhead.

I am interested to hear how Nancy comes along with Dragon. There was a lady at our conference the full Medical version (which is the best) at a discount to Amazing Charts users.

Tina Bolick, MS, RHIA, LPC
President
VOHIS Technologies, Inc.
Salado, TX 76571
(254) 760-5542
www.speech4me.com

Brian,
Not sure she is going to run with it, but at least I got the horse to the water tray and got her to drink at least once. That was amazing enough. Oh she was being such a wise@$$, throwing her best Bronx accent all around and Larry basically made her eat crow. 15 minutes and charting.

Now man I am really sorry to hear about you and your practice. Now not to make you feel bad, but as these groups tend to grow in size, the facts from the IMP Camp that you yourself turned me onto, seem to support, that these larger practices have to see those large numbers of patients everyday because their overhead is even worse. With a referal person, and a this and a that. Up to 70% of all revenue raised just goes to feeding the system, the beast! That is just insane too. I hope this batch of you isn't too large because I just don't think that is you at all.

As one who is down in the dumps myself about the aweful state of affairs in this business for PCP's, I certainly understand the need to eat and pay one's bills. We are certainly not doing very well ourselves right now, although there is a ray of hope on the horizon with a few new twists coming soon.

To think the man who sent us to IMP Camp himself has joined a larger group... I hope this works out for you, really I do. None of you hard working solos should be treated this way. One day we will look back on these dark days with shame for what they really are... Much like the strike busters and the 10-12 hour work day on the 6 day work week with child labor. These are dark days indeed. Break a leg in what ever you do...

Hey are you still using AC in this new practice? Or are you just glad to still hang out with the crazy group of nuts none the less??? Be well.
Paul

Don't feel bad about my practice. Amazing Charts allowed me to get it so organized, I was able to see the holes in it. I figured out that I could not reform my practice, and it needed to pass peacefully from the scene.

The docs I am with now are just a few family-oriented types willing to share overhead. I have been using AC in a paper-chart clinic which has been weird. I am hoping to turn the whole clinic on to AC. We shall see.

Break a leg and god's speed my friend. Yeah, go into the office one weekend and set up AC, even P2P on all of their machines and just see what happens. They are allowed to test drive for a few months anyway. And I'm sure Jon would support you in trying to win over your new partners anyway. Ya never know. Plant the seeds and see what happens. Gotta run...

Paul I want to look up the event you have been talking about. What is the link, or what does IMP stand for?
Martin

Martin: Did your son make it back to Ca with you or did his new acquaintance change his plans?

Ideal Medical practices, www.idealmedicalpractices.org

It was great to meet you. Thanks for your passion on the EMR issue and electronic docmentation.

Tom
Creston, Iowa

Martin,
Tom is correct, it stands for Ideal Medical (Micro) Practice and it is mainly a PCP, primary care, Family Practice kind of thing. There were some internal med folks there, one "naturopath" which kind of struck me as odd, and not any Ped's that I could tell. One or two NP practices I think, but don't hold me to that. But again like 90% FP's if I were to guess.

It's really about being mean, lean in terms of business and useable affordable tech, like AC for example (many folks had other small programs, but I'd say AC was probably number 1) while getting back to why most PCP's went into medicine and primary care in the first place, to care, have a positive relationship with your patients and really have a positive effect on outcomes and change people's lives thru good old fashioned good practice and care. No drive by visits allowed.

The word seemed to be left coast next year which might mean we make this more of an every other year event, but we shall see. It was the first time I think either Nancy and I were in a room full of docs where we didn't sort of feel like the oddballs sticking out and not fitting in, with attitudes so thick you could cut them with a knife. Tie dye tee shirts, laid back attitudes, similar perspective on life and medicine and a passion to take it back from the @$$holes who have ruined it for all of us and our patients.

So now we are IMP's!!! Very cool. Thanks again Brian. I want to help you be an IMP again one day too....

Paul

Ah, the MicroPractice. Extremely low overhead model. If you are willing & able to do alot of things yourself and take a little drop in overall profits, they can work. You'll see fewer patients, but you don't have to pay as much staff. You really need to use as much low-cost automation as you can.

But even if the Micro-P isn't for you, some of the techniques can help you lower your overhead or just become more efficient.

Yeah... As Nancy said we are probably one of the larger one there at least in terms of the size of our office space and perhaps even our patient panel. But then again the cost of our space is not bad at all. Much cheaper than many other spaces per square foot. We have about 1100 well laid out sq ft. And it was built out for us before we got there. It used to be a back cracker's office before us. We just had to tear up the rugs and do hard floor (ourselves) for the examrooms, and then I hired a carpenter friend to help me install the cabinets in the examrooms. I even reused the small sinks the previous tenent had in there and just installed nicer, newer single handled faucets for Nancy. The Cabinets and tops are Home Depot. No "medical" branded cabinets at 2-3 times the prices.

Probably should have gone used on the tables and exam equipment if they were there to be had. And then the MidMark Ritter ECG and Spirometry were pricey as was our first mistake in EMR's. That's where we could have saved some serious coin and therefore interest in the long run... Live and learn. But at two family members who share one salary and then one real full-time employee, I think we are pretty IMP'ish.

AC certainly is a big part of using tech that saves efforts as FAP is becoming now too. Our MA is no longer a file clerk for almost anything anymore as I just sit, scan, click and gone. Very cool. "Look Momma, no more paper."

Let me run as last night, this morning was brutal. I left my keys to the car I should have driven home in the car Nancy drove home in. So at 4 am I had to huff it home, 2 miles at 95% humidity and about 68 degrees. Temp was OK, but I was seriously sticking to myself by the time I got home. 20 minute mile though, that's supposed to be a pretty decent pace, yes? Took about 40 minutes to get home and it is just about a perfect 2 miles door to door.... Anyway, I burnt, more from a lack of sleep than anything else...

Be well....
Paul

Thanks for the info on IMP. I always learn so much from this board. Although I'm more traditional in practice structure and size (multiple plans, 3.66 employees and about 2000 patients)I yearn to run leaner and perhaps one day come "off the grid" completely, going back to old fashioned fee for service with maybe a modest annual fee to cover misc services such as refills. I don't like the concept of a high priced concierge practice (I didn't become a doctor to just treat rich people). I'm only in my second year of solo practice(11 years total internal medicine practice however)so I'm still evolving my practice. We do have an extra employee to handle referrals, prior auths and so on. While I hate the concept, I have a wonderful person in that position and would not let her go without a fight. Besides, my philosophy includes running a business for the benefit of all the employees and not just for the owner. I wish I could pay them more, yet that is nearly impossible with the current overhead and low reimburesements (we provide a health plan and 401k retirement). A question I always ponder is "How much is a primary care physician truly worth?" I feel 130-150k is a decent salary, yet I do get envious when I see procedural and hospital based colleagues make 2-3 times that much, especially since my wife and I essentially live off my earnings (she is my part time office manager). I'd love to hear other people's thoughts.

For HockeyRef Paul: AC has really helped organize messaging within the office yet I do find it has slowed me down considerably on notating. I can still dictate faster on my Palm Pilot than with Dragon yet I'm sure if I learned/programmed some macros I'd be faster. I continue to plug away with Dragon since I know the more I use it the "smarter" the program becomes and the faster I will be. Encourage your wife to try it for some of her notes each week. I use the $200 version of Dragon and NOT the medical version. The medical vocabulary in the professional version is pretty good. The secret to Dragon working well is the power of your hardware. Faster processors and especially more memory are very crucial. Good luck.