Aug 01 2007
Health Care Practice - 1 year later
Happy Anniversary Aberdeen Primary Care
We opened our doors August 1, 2006 and this past year has literally flown by. I’ve learned a lot of good things, and things I could’ve passed on. Either way it has been an incredible learning and growing experience. My initial goal was to be able to meet all my practice and personal expenses. I’m happy to say, that I’ve achieved that goal.
I thought I’d share some of the things that I’ve learned in this past year. Some of it has been wonderful, and other pieces we’ve truly could’ve done without.
- Some of your patients will be incredibly wonderful, honest, and supporting.
- A small percentage of your patients turn out to be liars, cheats, and unfortunately thieves.
- While a long workday is a given – especially in the beginning, it is essential for you as a provider, to take time out to take care of you. Otherwise your practice can eat you alive.
- I have learned more about billing and coding than I ever wanted to know.
- Unless you found someone absolutely extraordinary, your employees will never be attached to your business like you are.
- Despite having good working relationships with physicians in the community, your presence as an individual healthcare office will generally cause some offices to be a bit suspect or even uptight about your presence. Other offices may totally ignore you, and some will refer to you continuously.
- You will find support where you least expect it.
- And you will lose support where you least expect it.
- Not all nurses, NP’s or PA’s will support you in your practice.
- If you set realistic goals, it really isn’t too hard to meet them.
- It’s important to remember to breathe.
- Your patients will always be your biggest advocates.
- Insurance companies are not in business to pay your claims.
- They are also not in business to make sense.
- A big surprise to me was to learn how many people will seek you out in order to obtain narcotics. They are often the ones I refer to in #2 above.
- Staff and patient turn over are inevitable.
- You control your own schedule, and thus can determine how many people you will see each day as well as take a day off when you want to.
- Taking call 24/7 is not too bad when your patients understand that you are the one always on call. Often after hour needs can be handled proactively.
- There is no such thing as a paperless office.
- The paper flow through the office increases significantly with each computer you obtain.
- You do not have to purchase NEW on all equipment…gently used equipment is often perfect and you avoid that “new” sticker shock.
- Make friends with your local lab, they often will bend over backwards to help. Ours helped me out when I forgot to order alcohol pads when we opened. I found out as I was preparing an injection.
- You will make mistakes. Keep going.
- Discharging a patient from your practice is often the best thing you can do for yourself, your staff, office karma, and the growth of your practice.
- Government health care programs, in part, survive because we as health care provider carry some of the cost.
My goals for this next year include working less hours (meaning I’m truly off on days off) and taking a real vacation, while growing the practice. I’m also exploring alternative ways to increase revenue as well as adding another provider, perhaps a psych NP. I’ll keep you posted.
Tag: General
Congratulations Barbara on your one year anniversary! Your practice sounds like it got off to a great start and albeit with normal pitfalls is still doing well. I have a question. I have opened 2 mos ago, and still have no phone calls from patients at all. I have had two newspaper ads, and passed out brochures to local businesses, and joined chamber. I know all the marketing things, and I am continuing on with that, as far as joining other organizations, and will be attending meetings and networking. The local pharmacist stopped by and thought the clinic was beautiful, and larger than he imagined (but it is small)..he said he will send everyone over. I know it is still new, and I am not yet credentialed with any insurance companies, but it seems odd that the phone does not ring, with the exception of solicitors to sell equipment to new business. I do have some friends saying they are going to come to me, for the “simple stuff”, as they all have providers, but I am wondering if it is because I am not yet credentialed? I do know people do not know about me, as I had a “regular” patient that followed me to two clinics and came in almost every day, and she does not know I am there…so I guess it will take time, but I am now where I must work 3 days a week to survive, which takes me away from the clinic…any ideas to generate “instant” business? I am still playing phone tag with the Care Oregon (medicaid) credentialing person, who wants to meet me, and get me going, and also phone tag with a woman who is in charge of two school districts, as we met briefly, but it takes a lot of face to face contact I believe..I am not in a rural area, almost everyone has insurance, and almost all have providers already within 10 miles..but I think I know the answers, I just need to somehow be very available while also working to support myself, and give it time.. Once people come in one time, they are happy. But I am starting from scratch with no following. So I guess patience is the key. Carla Congrats again!
Carla,
Thank you! It was a strange day indeed yesterday….my entire after was filled with one family and one additional person. The entire family cancelled and the last person was a no-show - so on my one year anniversary, I actually saw less people than my first day in practice!
You know, insurance may be playing a huge part in why you are not seeing folks right now…at least that is so in my practice. I see very few cash patients. An NP I know, opened her practice with the idea of doing cash only…and her prices were extremely reasonable. She found that even with that…people who had insurance, wanted to use it, and those without, still wanted her to waive her cost.
The majority of people I see have insurance and will not come in and be seen if they have to pay for something entirely out of pocket. For example, the family I mentioned were all coming in for well child exams. I told the mother they may not be covered, as it appeared the kids all had exams within a 12 month period. And sure enough, when she checked that was exactly the case.
Keep calling the insurance companies and make sure your application is moving along the proper channels and not getting stuck on someone’s desk. As far as Medicare/Medicaid, I know of nothing that will move them along any faster. Keep records of who you talk with and when. This may help if things seem to get “lost”.
With school starting the end of August or September (depending on the location), you might think about doing a special for sports exams (those are not usually a covered benefit anyway). Along those lines, see about contracting with some of the trucking firms, delivery firms etc for doing CDL exams (also never a covered benefit for insurance purposes). Can you perhaps set yourself up to do drug screens and/or pre-employment exams for a local company?
Have you sent letters to your former patients (assuming it does not break some agreement you had with your former employer)? If you are having to work, is it a situation you can let people know what you also have your own practice? In my last position before opening my practice, I often had patients ask me where else they could see me since I was only there part time.
I’m sure others will have some suggestions as well.
Good Luck to you.
Hi Barbara,
Your suggestions are good. Providence, United and Regence BCBS seem to be moving along..but ironically Medicaid (Care Oregon) has never answered her phone directly, it goes straight to voicemail, and the two time she called me, I was at my part time job, and my phone went to voice mail. She said “she was going to put my credentialing on hold if I could not be available 24/7 for the medicaid pts. That seemed unreasonable as many practices I know, doctors or otherwise, are not open 7 days a week. She knows I am physically open and present at the office 5 days a week, and two days a week, I am avail by phone, and can see patients in the evening on the days I work at the other job. I live 4 min from the practice and am willing to drive right in, or do housecalls. That does not seem unreasonable, so I am not sure what she means. Her call went to voice mail, but I called her back within 30 min of her call. I also have another NP who has had her practice 27 yrs, who is willing to share call, and I gave her that information. I would think she would want a clinic that takes Medicaid..I just had a call from someone who works in the newspaper, and another patient asking if I take “Lifewise yet”, so yes the insurance is a holdup. But I cannot live on zero income for 6 mos during credentialing, and most people told me they worked part time for quite a while and worked second jobs. I am going to a chamber meeting for new guests at the Marquis assisted living, and even though the Chamber of Commerce obviously is not filled with Medical people I am glad it is at a medical facility. That is in 2 weeks. I missed this years Cancer relay, and Kiwanas club run with the children due to my dads death and ceremony, but next year… That will help a lot. I just do not want to feel that when I am working at this other job, that I am torn, and that the insurance companies turn me down because of it. I also know that the NP wishes me to become a permanent fixture at her place, but she had her dream, and I have mine. My dream is to have a much lower overhead as well, to keep costs down. I firmly believe that Wilsonville is going to be a land of opportunity. I just read that the Tualatin Valley Fire and Rescue is moving their headquarters to Wilsonville, and they are building an 8.7 million dollar command post and business operations center here. The fire department is a tremendous source of reference and networking. Regarding drug screenings, there are 3 large companies that do pre employment screening. I could do the individual patrons for physicals, but I am not sure about the large contracts. One trucking company just went with Concentra, which is all they do. Thanks for the tips. It is just Medicaid that has me bummed, I need to be able to speak to this woman directly. CRA
Carla,
Most of the time, when they want you available 24/7, they mean by phone, not in the office. My office hours are Tues-Friday…so we are not even there on Monday. However, you or someone else needs to be on call. Take a look at what your voice mail says.
I think in another post I mentioned how I manage call. But briefly, after hours my office phone is forwarded to my cell phone. The message on their is strictly for the office and tells people if they need to speak with “the provider on call” to leave a voice message with their “name, phone number where you can be reached, and the nature of your call”.
I’ve never gotten any grief about that from patients, other provers or even insurance companies.
Barbara
Hi Barb,
I do have my office phone forwarded to my voice mail, but two days a week, I am working at another job, so if a care oregon patient wants to be seen by me at the clinic that day, they would have to wait til the evening. My question is, the days that you are out of the office, do you have to have a live person sitting in the office to triage, or can you just have the phone calls forwarded to the provider… I can certainly call them back, and if urgent they know to go to an urgent care or call 911. I was told a live person has to be in the office 7 days a week, for Care Oregon medicaid, but I do not know of another clinic that does that in real life.. I am not worried about the patients, it is the Care Oregon that I am concerned about, as I am single, no other income, and until I start seeing 6 patients a day, I will need to work another job.. at this point I have seen 5 patients in 2 months time, so I cannot afford to live on that. I am meeting with the medical credentialing person next week, and I will have my biller and a medical assistant there, so hopefully we will pass muster. C
Carla,
NO ONE has someone sitting at their office 7 days per week. I’ve never had anyone ask me to do this..only to have a way for patients to contact a provider on call.
I’m not sure what is going on, but please call the Nurse Practitioners of Oregon and speak with someone about this. Call (503) 293-0011.
My phones, like I said, are forwarded to a cell phone that I have set up speccifically for the practice. Right now, I carry it all the time, but one of these days, I hope to share with others.
Keep us posted.
Barbara
Carla,
When I started my practice I also struggled until credentialing was completed. Medicare did allow me to see patients and hold the billing until I was completely credentialed…call them and ask if this is stlll true. There is a lot of demand for Medicare providers. Regence was quick to credential…call and ask for an update. Fill out all of your forms as if you were in practice 5 days a week as that is your (eventual) intent. You need to be listed in provider books and on-line as a PCP and this takes time. You do offer 24 hour/7 day call if you have a phone/message line set up. Medicaid in Washington state was quick to set me up as they had/have very limited number of providers…but I also had my Medicare number by that time. By seeing Medicare patients I picked up a number of private insurance patients because Medicare patients have family members who are also looking for kind/competent providers. Word of mouth is tough at first. Call your local hospitals and see if they will refer to you. I had trouble with this because my local hospital physician referral line said “PCP means primary care physician not primary care provider” but the folks answering the phone indirectly referred to me by giving the name of my physician counterpart who was not accepting new Medicare/Medicaid clients. Contact local social workers, assisted living facilities, adult family homes for referrals…leave them lots of cards as they are constantly in contact with patients who need Medicare/medicaid providers. Hang in there. It takes up to three years to establish any new business. The rule of thumb is you lose money the first year, break even the second year and show a profit in the third year. I have found this to be true for me.
Hi Cindy,
Thanks so much for your response! So glad to have you on the site. I saw you were selling your practice in Tacoma? I have a good friend who is a massage therapist there, and I also used to work for Advanced Women’s Health (two NPs owned the practice)-will not say much..but you must be doing well. Also saw that you contribute to your Washington ARNP newsletter, way to go! I am doing a site visit for Medicaid next week, and hope I pass, I am getting my written manual in place, emergency kit, exit signs, and I do have 24 hr call by phone, the work phone has all of the language about 911, rx refills, and hours, and then for urgent calls to call my cell phone to reach the provider. After hours I roll it over, so patients would only dial one number. I am physically there 5 days a week anyway. I am contracting with a telephone interpretive service that handles russian, deaf, etc, and have spanish hippa laminated. I am one weak away from getting credentialed with Medicare. Blue Cross, ODS, Providence, Cigna, Aetna, Health Net and United and Life wise are about 2 weeks away. I also am putting an ad in a small newsletter that goes to a senior community that is very excited about me doing housecalls in their area as they are elderly, and only about 10 miles from me. I will keep the radius short. I am on my 9th patient, starting to get word of mouth. The pharmacist at Rite aid sold me a sink (normally 900.00 but he kept it in a dusty garage and it is leaking, so I will need repairs, but it is non plumbbed, on castors and when working is fantastic. Quest lab has been very helpful at sending supplies. I highly recommend e- surg if you need supplies. I have Amazing Charts and bought a back up hard drive to archive and store,so for the inspection, I can show that I can safely store the records, in case for some reason an alarmed building and two locked doors were broken into and the computer was stolen. I will take my brochures to the hospitals. The assisted livings (2 of them are awkward in town because they made hugh errors leading to my fathers demise, but I will work around that). The chamber of commerce is going to be a huge source of networking with their eye opener breakfasts and passing out business cards. I am meeting with the nurse at the two school districts in town, and I met a sales coordinator for “Anytime Fitness”, and she has a non trained person giving classes on hormones and menopause, so I am going to get my foot in there, as she cannot do womens exams or give rxs if they need compounded hormones..I am also working on a couple class ideas for the library, such as a health prevention class: the importance and difference between flu shot, pneumovax, zostavax, gardisil, dexascan, colonoscopy, Dt and Tdap, paps, mammograms, etc. So people will know what they need and be partners in their care. I am working part time, and have other issues in my life, so I am getting this done as fast as I can. My goal is to double by next month, two t o fours patients a week! Thanks for your advice. Carla