I would PM Love Machine on here. His wife had her own practice down by you
We spoke today. Thank you for putting me in contact with him and Bill, thank you for talking with me!!!
Here's a plug:
http://www.lovemachinemarine.com/ :sifone:
I have a friend here in toledo (Doctor) that has his own practice with privliges in 2 local hospitals. He is REALLY starting to feel the squeeze right now. The trend around here right now is that there are basically 2 hospital "chains" in town and each has seperate insurance affiliations. The best way to describe it is that he is a mom and pop store being squeezed between 2 different wall marts. He believes the days of the true independent private practice is short for this world. Its also getting harder and harder for him to get on ins. companies provider list since he is independent and not in their happy little network...
80% of the people in my area have either one of the flavors of Blue Cross/Blue Shield or Medicaid (medical assistance for women/children). You HAVE to accept those two or don't even bother turning the lights on. The rest, kind of pick and choose. Where she's at right now, they take all but Humana and Kaiser Permanente (not sure why they don't take those but they just don't but I could find out if it mattered). This is where we'd get our moneys worth from the office manager and the billing company. They make sure you bill correctly and get the insurance to pay in a timely fashion.
She has privileges at our closest hospital but that's it. That is all most in the area have unless they have at least 2 offices or 3-4+ providers on their staff. Her Doctor boss is only at our local hospital for instance. If it is a SERIOUS issue, she sends most her patients to Georgetown University Hospital where she has to be a clinical instructor for the last 5 years. She can visit her patients there but doesn't have privileges, but most of the staff know her and let's just say it all works out pretty well.
i think theres a big future need for a place like your thinking but make it cash or payment only accept no insurance theres a very large group of us outside of the medical nightmare we are undrugged and un plugged we live healthy and if we get cancer we won,t chemo or cook ourselves with radiation to live a few more months i accept i choose to die quick i,m ok with that and very comfortable accepting it !! i got to close to the modern medical monster taking care of my dad the machine will stop at nothing to keep you alive if theres money to be made it was 2 years of pure hell!
Sorry to hear about your Dad. I think health care is broken but I have to keep my personal feelings out of this so will only respond on this particular thread about the business side of it.
No offense, but most people that don't have insurance aren't the patients one wants anyway. They complain about every thing, think every one is out to rip them off, always want some thing for free/coupon cost, etc. You may not be this way but speaking in general. Now on the other side of this, hypothetical of course, but the person that does her hair and nails may or may not have been seen for no charge in my living room and be given free samples of medicines or antibiotics and we may or may not get free hair cuts, massages and manicures in return. Can't keep the doors open getting weekly massages but works out in certain situations.
I appreciate your opinions and do read your post on how you handle your health care. I can't say if I didn't have free health care from work that I may only have carry coverage for a big event and pay out of pocket for runny noses or the like. HUGE problem would be if one came down with some thing and was diagnosed for it, they would then are denied coverage. Bye bye life as one knew it- would financially ruin most..
What's the difference education-wise between an PhD NP and a Doctor of Osteopathy?
Not sure, checking. I read the wiki difference but not sure the real world differrence.
Back to the topic- How many patients does she have sitting in the waiting room the day she opens? How many on day 2 and so on? You need to do projections on how you're going to get patients in the door. And then you have to chart that against her present income. Maybe she makes an extra $50K a year. But if it takes her 5 years to get there, you have to look at what she'd be investing in the practice and her loos of income weighed against that. It may take her a decade to break even on the shift.
And those 4-day workweeks are probably gone. Her day off, evenings and weekends are now going to be spent looking for patients. From visiting nursing homes to schools to working a table at the mall. and what doesn't go there gets absorbed in paperwork. The other thing she'll be dealing with in her small business is no staff cushion. She'll have two employees that will be getting sick/pregnant/auto accident/sick kid/divorced/found better job/ and so on with no one else ther to do their jobs. Not fun. But everyone in a smal business deals with it.
How many patients a day?
"Well visits" are allotted at 30 minutes, a "sick visit" is allotted 15 minutes.
August - September she's busy with school stuff. Physicals, shot records, etc so will see more well visits than sick then.
October-March she's busy with sick visits. More people inside because of the weather, holidays people see people they aren't normally around and pass different strains of germs around and both parties get sick even though they weren't sick from the strain they were carrying, etc.
May- June- July are the slower months.
Her day starts at 9 and ends at 5 with an hour lunch. So 7 hour work day but they only start out booking her 6 hours of that. That gives her 1 hour for people that call in that day or just show up as well as the hour for lunch. Keeps wait times down- 90%+ of the time you will be in an exam room within 5 minutes of your appointment time, the same person that took you to the room takes your vitals and so on and then her (or the Doctor if you are his patient) will be in within 5 minutes of that. Customer service! Patients with that time slot have priority so being late for your appointment doesn't put you at the top of the list, but how they book makes it where they can fit people in without disturbing the whole schedule.
A more accurate volume would be expressing it in how many 15 minute time slots she is booked a day vs how many patients. She's booked about 30 time slots a day on average or about 7.5 hours a day. Then she gets 1-2 phone calls an evening, some are simple things, some she has them come to our house or meets them at the office or meets them in a parking lot or restaurant, some she tells them to go to the ER, some she tells do this and come in 1st thing the next morning. Just depends on what they are calling for. Phone calls can be billed as office visits or some thing along those lines as well- so may not charge a co-pay but still get paid for them. So far nobody has taken advantage of the system by calling at 5:01 every time they need to talk to her to get out of paying the co-pay but could be an issue in the future. That's how it was at the place she worked 2 years ago- 5PM phone rang off the hook so she quit answering it, but that was working for someone else and not in her job. She had no problem answering for some but since her boss wouldn't do any thing about the chronic callers she quit answering for them.
When we are some place other than our living room, someone is going to come up to her. One of my good friends is a boat mechanic. I always told him it must be a pain in the rear boating since there has never been a time he set foot on a pier and made it to the bar without someone having a "not to bother you, BUT my blank blank blank is doing this, any idea what it could be or could you take a quick look at it". Well.... being a primary provider is 10 times worse! Not to mention the boat is right there in that example, patients expect you to know their medical history on the spot and then know in 30 seconds what's wrong with you now.
Patients aren't in short supply and don't think she'll have any issues filling her schedule. She's not looking for a job and has 2-3 Doctors at any given time offering her to jump ship to work for them.
So I guess to sum it all up- for the same job and hours she puts in now, she would have made a little over $310K plus close to another $100K in co-pays, plus the other $50K in other things- netipots, diabetes machines ($300 a pop and sells about 2 a week) and so on. So say $460K, minus what she makes now ($105K, 3 weeks vakay, 4 day work week, 50% health care paid, malpractice insurance paid 100% so say $150K a year total package on high end) leaves the original $310K figure to run an office with a staff of 2. I just can't see how the numbers can't work, even if she only had 50% of the patients she does now she would be even. Patients aren't hard to come by- we have a 87% primary care shortage in our area so if the open sign is on, people will come if nothing more than because you can see them. Provide good medicine with good service- line starts to the left.
For sake of conversation, let's pretend the numbers look some thing like this for the last few months. These numbers, if they did exist, don't count co-pays, diabetic aids (obesity rate is making this a HUGE number!) and so on. These also would be what a NP bills and is paid which is only 80-85% of what a Doctor could charge.
$40,193 billed $22,117 paid Aug 09
$46,588 billed $27,249 paid Sept 09
$58,120 billed $35,989 paid Oct 09
$52,388 billed $28,067 paid Nov 09
$44,758 billed $26,193 paid Dec 09
My Bro-in-law's a surgeon. He ended up combining his practice with three other surgeons to even out the workload and be able to keep the group busy.The ups and downs were too steep, and this way they could represent all the hospitals in the area instead of just one.
He can also take vacations and have coverage......:sifone:
Few different options here. We normally take long weekends vs weeks off so would only need coverage for "sick" visits vs "well visits". That being said, there are a few local walk-in clinic type places, few Doctors where their day-to-day practices are providing coverage, that is all the do. It seems like it is fairly easy to get coverage since every one else wants some one they can send their patients to when they are off as well. We've thought about this one, one of the biggest things was how much more would she be tied to her job. I'm basing all the numbers off what she is currently doing hours and staff and patient wise, more time at work means more money (you would think but not always the case..). The way things work is her patients are her patients, her boss has his patients and they are his patients. In the hospital, she is the one making her rounds for her patients; not him but he will cover for her if you will and she will do the same. We've thought about just asking him to 50/50 what he's paid off her services and haven't given up on maybe that option yet either.
My partner and i are purchasing the property our business is on. (commercial storage lot 1.5 mil) Our local bank 45% of loan at 7.5 % plus SBA 45% at 5% and us 10% down. The problem was we had to show about a 1 mil in assets. If we had an extra mil laying around we wouldnt have needed a loan. In the end we got creative and showed them what they wanted, now waiting on a closing date. I will forward you our SBA guys info if you want.
btw tick tock tick tock.
Send me the info. I'll tell them to piggyback us on your account and I'll drop the check for my part of it in the mail tomorrow? Start up costs don't look to be that much so we have that going for us and can self finance (esp if our dear dead generous friends don't go cheap on our wedding presents; hint hint...) if needed.
tick tock tick tock.... Tell me about it!!
