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I just Submitted my resignation letter!

  • 1.  I just Submitted my resignation letter!

    Posted 09-17-2018 15:32
    Hello IMP people!

    I wanted to introduce myself and say hello to everyone. I have been reading and eating up the forum. I appreciate how interactive and involved people are.

    I am a family physician and graduating my fellowship in integrative medicine. New mom, breastfeeding on demand. I couldn't imagine how I could go back to my old PCP job after having my baby.. So yeah taking the plunge!

    I have a couple of beginners questions on setting up my practice. Feel free to comment or advise to any of these..

    1. LLC vs sole proprietorship

    2. So far my computation for overhead is about 28-30% - is this low enough?

    3.I will OPT OUT- yey or nay?

    4. what bill payment you use? square? stripe?

    5. EMR- anybody with experience on:
    MDHQ and Power2practice
    atlas MD vs practice fusion
    Elation
    Talk EHR
    One touch

    i have heard other DPC just do their own word document--- im tempted to do this for cost

    6. My MAIN PERSONAL BURNING QUESTION IS.... i dont know if ill do JUST integrative / functional consultancy not be PCP vs primary care
    --- i love to practice primary care-- but just thinking of how to do referrals / labs/ hospital records keeping---
    in case i do Primary care, how does that work? how do i do the referrals
    labs -- i see other DPC websites offering LOWER prices on their labs and they do it in the clinic-- what does this mean?? they bargained with lab corp and quest? or they buy equipment?

    7. any highly recommended accountants and lawyers that you care to share their info?

    8. price points? how do you compute for this -- are you transparent in your website? --- i am leaning towards transparency because i like seeing the cost in everything before i engage ..
    anybody that could email me if you dont want to post how much you charge?

    9. for claim submission- how can i look for independent biller in case patient wants to submit?

    whew that's a lot!

    Thank you in advance for responding...







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    patricia petralba, MD
    Tucson AZ
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  • 2.  RE: I just Submitted my resignation letter!

    Posted 09-18-2018 14:52

    Hi Dr. Patricia,

     

    Happy to help answer any questions.

     

    1. LLC that files to an S corp – is what we are and generally recommend to other docs, but a good accountant can help.
    2. Yes, that's a good percentage for an overhead
      1. But also important to look at the total cost for overhead
      2. We've seen docs with $500 to $5000 in rent etc
    3. Great question
      1. Resource for opting out http://www.aapsonline.org/index.php/article/opt_out_medicare/
      2. Resource for opted-out moonlighting https://www.dpcfrontier.com/opted-out-moonlighting/
      3. Opt out – can still see medicare patients and charge anything you want

                                                                   i.      May be harder to get some moonlighting work

      1. Opt in – can see medicare patients CANNOT charge anything extra

                                                                   i.      May be easier to get moonlighting work

    1. We use stripe.com through our emr www.atlas.md
    2. The emr is a tool and every doctor has a different vision of the ideal tool
      1. But happy to answer any questions about our emr, www.atlas.md
    3. I think integrative can be a narrow(er) niche to start with
      1. If you want to max growth, max your value, at least while your growing to stay sustainable.

                                                                   i.      After you have a few hundred patients then its easy to fine tune from there

                                                                 ii.      I love primary care in the DPC model – the referrals and such really isn't that burdensome

          1. Labs – client bill for best cash price, our cbc is $1.65
            1. Happy to email you our lab prices for quest and labcorp
    1. Lawyer
      1. our healthcare attorney Luanne Leeds, would be helpful.  She helped us launch and is helping countless other doctors/clinics across the country.  She's an excellent resource.  You can reach out to her by email, leedslua@gmail.com or 785.354.0727
      2. Reid Hash R.Hash@ssccpas.com is our accountant and has helped LOTS of dpc docs
    2. Prices
      1. A good general formula for starting is: goal salary + overhead + 30% for wiggle room = amount yr / 12 = amount per month / patient panel size

                                                                   i.      Ie 200k salary but 120k overhead = 30% = 360 / 12 = 30k / 600 pts = $50/pt/mo average

      1. Definitely be transparent on your prices on your website
    1. We don't submit any claims

     

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

     

    Josh






  • 3.  RE: I just Submitted my resignation letter!

    Posted 09-19-2018 06:29

    I am glad to help out.  Feel free to contact me directly at jbloomer@yourmedicalhome.com or 603-418-6310 if you wish.

    We are a 'hybrid' practice of about 2000 patients, two FTE providers.  We ask for $125 per year per adult  pt as a 'noncovered services fee'.  About 60% of our revenue comes from straight insurance, and the other 40% from the yearly fees and medicare monthly fees. (We 'opted out' of medicare) We only contract with three insurers and have been up and running for a little over 10 years.  Could not be happier.  We went with Athena when Soapware went under and have been very happy with it so far (now 10 months into it).

    Jim Bloomer






  • 4.  RE: I just Submitted my resignation letter!

    Posted 09-19-2018 12:08
    Dr. Patricia,

    First, congratulations. 
    I'd second most of what Josh Umbehr said. I run a DPC practice, and could not imagine going back to any other way of doing things.

    I have a couple of niches in addition to primary care: Addiction Medicine, and Type 1 Diabetes. I have found having these niches helped to build the practice. For many of the patients with with an addiction or type 1, I end up doing their primary care for them as well, because they see me, they know me, and I can.

    The frustrating parts of primary care (labs, referrals, etc) are much different in a DPC model. I find I order about 80% less tests, referrals, etc,. because
    1. The patient volume/day is lower
    2. I have time in an appointment to actually figure out what is going on. Much less reflexive ordering, much more discussion. 
    3. I am 100% positive that if things doing go well, the patient can get a hold of me, see me right away. I am much more comfortable not ordering tests to reassure myself or someone else because they can reach me that night, see me in the office tomorrow, etc. 

    The other comment about a price point is to understand what you are offering relative to prices in the community. Looking at other integrative medicine practices can provide a starting point, then drop it by 30-50%, and you are probably both making more money, and offering a really compelling value proposition to patients.

    Feel free to reach out directly as well: jaltschuler@sequoiamd.com, or give me a call at the office: 916-668-7164

    Good luck!

    Justin
     





  • 5.  RE: I just Submitted my resignation letter!

    Posted 09-26-2018 06:32
    So now for an  answer form a non DPC non fee taking non "integrative alternative"(I have yet to have an alternative patient) All primary care is"integrative" in my opinion  And good slow careful followup primary care is desperately needed Practice it .
    I am an original imp My overhead is 28% and that is the key to  success to avoid the treadmill

    if you do not  take insurance you can order labs and xr but not CT and MRI unless for medicare plain and mediciad   Same for referrals  States vary in how well they pay mediciad  but you can limit how many you take  Do Medicaid Do some good in the world   why  did you go to medical school?? Do  not add to the fragmentation by only seeing people who have money
    medicare is fine  I could live off medicare though its codes are annoying
     there are two  kinds of referrals 1 required  for payment The other because specialists may not see a patient  unless sent by  PCP
     If you went to med school to do  primary care then for pete sake do it
    I have been at his pracitce for 13.5 yrs in the oldest state  in the union in a poor area of the state     I make more money every yr pretty much( it goes to  health insurance !)
     Know your processes   test an EMR for how YOU work      keep your space and staff small     HAve other work for a while esp if you can control it- decide your own shifts or when to precept or review charts etc.

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    Jean Antonucci
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