Member Forum

1.  Closing my solo practice

Posted 05-19-2017 12:10
Melissa asked me to post some of my reasons for closing my practice

In no particular order,

1. Increasing narrow networks and decreased visibility for solo physicians. The bigger groups have gotten smart, with their portals and their seo is now overwhelming our visibility.
2. Same network fragmentation has lead to lots of patient interactions about money. So many don't understand their plan, get mad at us, post bad reviews ( even affecting patient satisfaction bonuses). I have had insurance company representatives tell patients one thing on the phone and tell us something else entirely regarding patient benefits. Too much health care delivery management, too little health care. I need a buffer from all that now.
3.Support staff overstepping their scope of practice. About 3 times a week we get home health care / pharmacy / discharge planner suggestions for medications that we then have to refuse, because they really have no idea what they are talking about. Patients are now very confused about who said what and when. Not that being employed may decrease that, but there will be more of a buffer AND hopefully respect for a larger institution. I am hoping some of the volume of messages with little or no context will decrease as the organisation I am joining is more integrated.

4. Payment models based on data management: about 40 % of my patients are HMO capitation model and payment is heading towards 40% metrics based.I need a more robust EMR with more data integrations to do that and /or in-house labs/xrays/consults/urgent care ( Although the robust EMRs are not physician friendly)

5. and finally I no longer have to be home at a certain time for the kids, so the day has opened up.

The way I see it, I am tired of one set of problems and no longer want to be exposed to it. I am well aware that I will likely be running into a whole another set of problems, but maybe the change/new challenges will keep me distracted/ busy

2.  RE: Closing my solo practice

Posted 05-21-2017 06:53
We are blessed as American doctors that we can change our situation if we want to.
If you don't like your situation, Sangeetha, you can change it again and if you move locally, your patients will follow (I hope there is no stiff non compete clause)

Doctors work as locums, house call physicians, medical directors, academic physicians, private practice solo or group, employed physicians, part-time or full time, concierge, med spa, physician weight loss, functional medicine/holistic. They can pick up shifts at urgent care or moonlighting in hospitals. They can move to the private sector in healthcare technology. They can work on the insurance side and become a doctor for Blue Cross utilization! The can become medical writers, stay at home moms, student health physicians at universities or become a TV star like Dr. Ken.

We can vary our scope of practice from inpatient to outpatient to OB cradle to grave or just geriatrics.

We should not feel defeated and we should feel there are many options and niches.

Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD

3.  RE: Closing my solo practice

Posted 05-24-2017 01:26
I agree- insurance companies are abusive.
What kind of capitation rates were you getting? (I'm not using them to negotiate, so no 'antitrust issues.'
How much were you working to get insurance claims paid? (Or how hard to get paid?)
What were fee schedules like? vs MCR?

What kind of "metrics" were you being graded on?  (Most of them are nonsense.)

What was your staffing like?

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA

4.  RE: Closing my solo practice

Posted 05-25-2017 09:02
Actually, all of that was very good.

Caps from 15 to 45  based on age, and the utilization ratio is 75% compared to mcr rates, meaning, I provide services 75% of what I am paid
Claims going through smoothly enough ( I resumed my billing in December after Kareo's bad behavior)
IPA negotiated some really good fee schedules

ahhh metrics. I am getting really good at this too. Its the usual diabetes, bp control. preventive tests, urgent care usage, emergency room usage, patient satisfaction, medication compliance( this is a bad one esp in san diego , where everyone gets their meds across the border or at the base) etc. But such a waste of time.

No its the fragmentation. If its cigna, send xray order to imaging outfit xyz, get auth from online auto outfit abc, if its anthem, its pqr and lmn
I could likely manage with more staffing, but I am not a good people manager.

And looking to the future- narrow networks and BlueShield has 180 plans, I participate in 150 apparently and cannot tell the patient for sure whether I am in or out of network, and then there is more confusion.
and so on...

I agree- insurance companies are abusive.
What kind of capitation rates were you getting? (I'm not using them to negotiate, so no 'antitrust issues.'
How much were you working to get insurance claims paid? (Or how hard to get paid?)
What were fee schedules like? vs MCR?

Sangeetha Murthy

5.  RE: Closing my solo practice

Posted 05-25-2017 09:05
Edited by Sangeetha Murthy 05-25-2017 09:05
And the practice I am joining is actually very very good. Foundation model, meaning only physician admin, good contracts , good reputation and I get to take my current patients with me - anything less, I might have balked

Sangeetha Murthy