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eClinical works and making this work

  • 1.  eClinical works and making this work

    Posted 04-19-2018 16:27
    Hello,
    I am a med/ped in western mass and I am now been in solo practice for 3-1/2 years after spending many years in increasingly impersonal group practices.  I am very inefficient which I know will add more time to my days, but I feel like I can never catch up and I'm at the point of just throwing in the towel.

    I have used E clinical works with my practice since its inception and I am finding it incredibly frustrating with a very poor level of customer support and lots of hidden charges. I believe until May of this year I can change to another EMR with no charge from eClinical because of the lawsuit they lost by fudging they're meaningful use information. I badgered them for decrease in these as I was almost up to $800 per month, and now I am somewhere in the 650-$700 depending on whether I use a lot of reminder calls or not. Has anyone gone from eClinical works to another EMR which was less costly or even open source? I do not want to sign and other long-term contract (mine with eClinical was 5 years I am in my fourth year).

    My other issues are around incomeand time. I do all of my own call which is only burdensome because of my lack of back up the actual call  get pretty infrequent. I bring in about $250,00 per year, but I am still earning less then I did as a resident 25 years ago. My income is about 75% from Medicare and Medicaid. I do make half-hour appointments and I do not work full time but it seems that with all that I do that I should have both a little more free time and some income. My t billing company is excellent, but otherwise everything else is handled in house but payroll by myself or my 2 employees. I did not have the volume to need to do MIPS, but there is still a fair amount of reporting to participate in a number of the insurances. My rent is 2250, my utilities/emr are about 1200, insurances about another 1200. I do  procedures. spirometry, and EKGs and clia waived labs without blood draws. I see about 40 patient's per week. Do I just do not see enough volume, orders or something different I should be doing?

    Thank you very much for your comments
    Naomi

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    naomi rosenberg
    primary care medicine and pediatrics, llc
    Westfield MA
    413 562-1650
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  • 2.  RE: eClinical works and making this work

    Posted 04-20-2018 04:52
    Please be ap aying member of IMP if you are not, to access our expertise

    The obvious thing is your overhead which is huge with that rent
     and two employees It may not be worth it to do all the spirometry ekg etc..
     Small space good gizmos and 1 employee  is prob best  in the current environment   Depeends of course on many local factors  but you collect lots of money My over head is 28%..

     efficiency is a different topic and if you specify - and join IMP- we can help perhaps.
    best
    Jean

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    Jean Antonucci
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  • 3.  RE: eClinical works and making this work

    Posted 04-20-2018 05:39
    see more pts.

    really. I see this notion on here often. that we want to spend long appointments with every pt, then we wonder why our income is low.  Imho, not every pt wants to see you for 30min or more.  Many want you to take care of their sick kid or UTI or physical, and get out, in 5 minutes if they can. Streamline your workflow to allow this, and folks walk in unscheduled and/or create some shorter time slots. it doesn't feel as much like a hamster wheel when you own the cage. just my 2 cents.

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    PJ Parmar
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  • 4.  RE: eClinical works and making this work

    Posted 04-22-2018 14:07
    I think PJ makes a good point.  I knew a guy that started his own practice in Southern Illinois in a small town with no doc.  There was a lot of Medicaid and uninsured but he didn't care- he took all the plans and worked a sliding scale for those w/o insurance.  He got a place with 6 exam rooms and hired an MA for each one.  They would fill out the note (paper), essentially serving as a scribe, but also calling in scripts and arranging referrals and tests.  Generally patients were kept to one problem per visit, but he always got them in the day they called, and he followed his patients at the nearest hospital.  He never called anyone with test results; they had to come back for another visit.  I think he often saw 50-60 patients per day.  He hired a biller who did a good job managing the accounts receivable.  This style obviously involves some compromises, but the folks in the town liked him, and he was fond of boasting that he rarely went home later than 5pm.  He made a lot of money.  His practice was one of the bigger businesses in town.

    So he made it work by going 'all in' on the volume model.  He had the support staff and processes to make it work.  The problem with the volume model is the middle ground where most practices exist.  The doc is seeing about 25 pts/day without adequate support and poor processes.  In this situation everyone is miserable and outcomes are poor.  In my experience making small changes in the number of patients one sees can require big changes in practice structure.  Otherwise the doctor just works a lot harder for the extra income.






  • 5.  RE: eClinical works and making this work

    Posted 04-23-2018 12:28
    We have had some success with designated times on the schedule for quick/easy/acute visits.  This gives us time for more complicated patients and I am not twiddling my thumbs for 25 minutes after a stable ADHD f/u.  I indicate on discharge paperwork which patients should be scheduled on the "high volume clinic". More often than not it works well. Occasionally everyone shows up and the front desk schedules a complicated hospital discharge follow up, and I get pretty far behind.  To some extent I agree with PJ, most days this turns out to be my most enjoyable session of the week, which I did not expect.  Spending 30-45 minutes with a patient who is complicated or has 5 complaints can sometimes be just as exhausting as seeing 2-3 straight forward patients in the same amount of time.

    We take government programs and we spend forever with patients so something had to give financially.  I think this has made a difference, in addition to having a low tolerance for "no shows".

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    Thomas Weiner
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  • 6.  RE: eClinical works and making this work

    Posted 04-20-2018 06:45
    Hi Dr. Naomi,

    Thanks for sharing and sorry to hear about the stress?

    Have you considered dropping insurance and just going to a membership model? ie direct primary care?  $50/pt/mo x 100 pts is $60k/yr...so maybe 200 patients to cover overhead and increase your salary...anything after that is gravy.

    We've helped over 400 docs convert to dpc in the last few years...all for free...i'd love to help if you'd like.

    Feel free to contact me directly anytime either by email or cell. drjosh@atlas.md and C 316.734.8096​

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    Josh Umbehr
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  • 7.  RE: eClinical works and making this work

    Posted 04-20-2018 07:33
    Naomi:

    This may be tough to do but you need to trim your costs, sounds like your expenses are way too high.  Consider- 

    • stop taking Medicare- these patients take a huge amount of time and the fee for service money is not enough
    • without Medicare you may be able to let one or both of your employees go
    • stop using eClinical works and switch to something much simpler like using a word processor with macros or paper charts
    • move to a cheaper space, consider renting a room from another doctor
    • decide if your location is viable; some places are just too toxic to work; it might be better to close up shop and start from scratch somewhere else
    • think about switching to a direct care or cash only model for at least part of your panel
    Good luck.  I'm glad you posted.  We're happy to help.





  • 8.  RE: eClinical works and making this work

    Posted 04-20-2018 11:23
    Don't throw in the towel , it's a special towel you invested a lot  In making.

    I use use Ecw and do have a lot of similarities but no peds just medicine.

    the emr is not the only problem but how we use it, figuring out which element glitch or piss you off is step one-three.

    Income wise the numbers tell tell the story, you need more coding or more cpt's; overhead does not seem the problem. there are many coding pearls like coding on time that trumps complexity that might apply. Also the outsource or in house work is important. Open access might improve flow as long as people know you're squeezing them in.

    you might benefit from a phone call to troubleshoot the list of issues and make a plan. Happy to help or at least try
    Adam Schwarz
    603-443-6978

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    Adam Schwarz
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  • 9.  RE: eClinical works and making this work

    Posted 04-26-2018 13:04
    Naomi -I did exactly that for 5 years. Brought in about $300K and saw 40-50 patients per week. It's not enough.
    My rent was $4000 but free EHR which is similar to your overhead.
    I threw in the towel and when I got to the new practice realized it is about double the volume and better contracts.
    They schedule all follows including well child as 15 minute slots.
    They bring complicated patients in every 3 months for sure.

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    Mamatha Agrawal, MD
    Shah and Associates
    Cary, NC
    Live in Raleigh, NC
    -Solo IMP 2012-2018
    -Back to the model I had 2002-2011 but I am no longer the owner.
    eclinicalworks
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