Comments on: Micro Health Care Practices http://npbusiness.org/2007/08/03/micro-health-care-practices/ Resources for NPs in Business Sun, 20 Jul 2008 22:48:42 +0000 http://wordpress.org/?v=2.1.3 By: Carla Anderson http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-159 Carla Anderson Sat, 04 Aug 2007 18:17:03 +0000 http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-159 Excellent article on micro practice. This is exactly my philosophy and goal. I also have wondered about the feedback mechanisms to keep preventative and state of the art medicince for each patient and keeping disease registries. I think by using a ehr, that keeps your preventative medicine and pmh current, you can keep track. This is excellent. There is no difference between what the doctor in the article did, and what I am doing. Thank you for sharing. I am running a micro practice. It just has never been done around this area, but the retail clinics are in essence doing the same thing, except without the follow up, and primary care home aspect. Carla Excellent article on micro practice. This is exactly my philosophy and goal. I also have wondered about the feedback mechanisms to keep preventative and state of the art medicince for each patient and keeping disease registries. I think by using a ehr, that keeps your preventative medicine and pmh current, you can keep track. This is excellent. There is no difference between what the doctor in the article did, and what I am doing. Thank you for sharing. I am running a micro practice. It just has never been done around this area, but the retail clinics are in essence doing the same thing, except without the follow up, and primary care home aspect. Carla

]]> By: Laura Hoeman http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-178 Laura Hoeman Sat, 18 Aug 2007 04:32:04 +0000 http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-178 Interesting. I guess I'm running a micro-practice. I always felt a little ashamed that I did everything myself--my own billing, reception stuff, answering the phone, taking my own-call all the time, everything. Now I'm proud I can give it a name! I'm a psychiatric nurse practitioner so in some ways it's easier for me to do everything myself, but many in my specialty do not. My office phone rings in my bedroom after hours, which has always struck me as a ridiculous decision on my part guaranteed to facilitate burnout, but since I have a smaller practice now it's actually funny to answer the office phone at 2 am and shock my clients...pleasantly shock them. When I had a larger practice I was very resentful of the ringing phone after hours, so it's not really something I'd recommend if you have a large practice. I can do med. refills quickly via fax. The thing that's hardest for me is supplying medical records to everyone who asks. I'm really bad at that. If I had a receptionist it'd be so much easier! But that's the only problem. Interesting. I guess I’m running a micro-practice. I always felt a little ashamed that I did everything myself–my own billing, reception stuff, answering the phone, taking my own-call all the time, everything. Now I’m proud I can give it a name! I’m a psychiatric nurse practitioner so in some ways it’s easier for me to do everything myself, but many in my specialty do not. My office phone rings in my bedroom after hours, which has always struck me as a ridiculous decision on my part guaranteed to facilitate burnout, but since I have a smaller practice now it’s actually funny to answer the office phone at 2 am and shock my clients…pleasantly shock them. When I had a larger practice I was very resentful of the ringing phone after hours, so it’s not really something I’d recommend if you have a large practice. I can do med. refills quickly via fax. The thing that’s hardest for me is supplying medical records to everyone who asks. I’m really bad at that. If I had a receptionist it’d be so much easier! But that’s the only problem.

]]> By: Carla Anderson http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-185 Carla Anderson Mon, 20 Aug 2007 07:12:16 +0000 http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-185 I am still feeling that a micro practice is the way to go. My practice is definitely this, and I identified this to Oregon Medicaid officials who came to evaluate the office prior to a site visit. They loved the "quaint" cozy living room feel, instead of the larger sterile medical offices with a lot of clutter you often see. I need more creative storage to keep this look. I also noticed, that though I really can only afford my own services, I would like an office manager consultant to come in and put the files/labels and computer up to speed, and all of the coding sheets, and equipment and files, and billing in neatly organized labeled sections. I am not the best at handling the details. I do love Amazing charts. The more I have used it, the simpler I find the templates that can be moved over, into hpi, ros, plan etc, with one click, or it is so simple to make your own, label it with your initials, such as strep throat plan, ca 9/07.. Then when I get the next strep throat, I just upload it in 5 seconds, into the plan, and tweak any individual changes. There is also a simple feature for writing a letter to patient or consultants. It stores your info, so if you have a cardiologist, put in his info, and when you write a letter, your practice address is at the top, and then all the info for the cardiologist comes up, and it is very professional. Much easier, then some incredibly expensive programs such as E-MD that I have been tackling at a part time job. I would like to focus on women's health, menopause, and on family planning, sports physicals, adolescent medicine and episodic care. I just love this neighborhood. I just need a year more of heavy advertising. The chamber has meetings every month, and these are fantastic networking tools. I have gone to one, and it was very fruitful. Regarding medical records, mine just print out so quickly, and can go to the patient and any provider. I would like to encourage as I have an ehr, that most patients keep their records at home. I am still working on the 18 page site visit, and have a few things to get spiffed up. I do have a spanish provider that will take call, if I need a bilingual person on the phone. I have found a bilingual medical cleaning service that can start one day a month, then every two weeks as I get busier. I also have a language service for telephone interpretation that can handle any language, and only bills for the phone call. My hippa form is laminated, and I am in the process of translating into spanish. Thats it for now. I am up to a patient per week. Now. Regards, Carla I am still feeling that a micro practice is the way to go. My practice is definitely this, and I identified this to Oregon Medicaid officials who came to evaluate the office prior to a site visit. They loved the “quaint” cozy living room feel, instead of the larger sterile medical offices with a lot of clutter you often see. I need more creative storage to keep this look. I also noticed, that though I really can only afford my own services, I would like an office manager consultant to come in and put the files/labels and computer up to speed, and all of the coding sheets, and equipment and files, and billing in neatly organized labeled sections. I am not the best at handling the details.

I do love Amazing charts. The more I have used it, the simpler I find the templates that can be moved over, into hpi, ros, plan etc, with one click, or it is so simple to make your own, label it with your initials, such as strep throat plan, ca 9/07.. Then when I get the next strep throat, I just upload it in 5 seconds, into the plan, and tweak any individual changes. There is also a simple feature for writing a letter to patient or consultants. It stores your info, so if you have a cardiologist, put in his info, and when you write a letter, your practice address is at the top, and then all the info for the cardiologist comes up, and it is very professional. Much easier, then some incredibly expensive programs such as E-MD that I have been tackling at a part time job.

I would like to focus on women’s health, menopause, and on family planning, sports physicals, adolescent medicine and episodic care. I just love this neighborhood. I just need a year more of heavy advertising. The chamber has meetings every month, and these are fantastic networking tools. I have gone to one, and it was very fruitful. Regarding medical records, mine just print out so quickly, and can go to the patient and any provider. I would like to encourage as I have an ehr, that most patients keep their records at home. I am still working on the 18 page site visit, and have a few things to get spiffed up. I do have a spanish provider that will take call, if I need a bilingual person on the phone. I have found a bilingual medical cleaning service that can start one day a month, then every two weeks as I get busier. I also have a language service for telephone interpretation that can handle any language, and only bills for the phone call. My hippa form is laminated, and I am in the process of translating into spanish. Thats it for now. I am up to a patient per week. Now. Regards, Carla

]]> By: Carla Anderson http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-361 Carla Anderson Thu, 01 Nov 2007 06:50:38 +0000 http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-361 I would like to know what you all are doing about vaccines. I am very small, and you all may be large, but if not, do you order vaccine in bulk? For example a 10unit vial for mmr is about 500.00 so that is 50.00 a shot wholesale. I would like to order just one or two, from another NP, and buy it, but have not had anyone call me back.Public health has it, but they will not send it to me, and they said the patient will have to come see them, and become an established patient, and then they will give them the mmr, and they are booked 2 months.The patient wants to see me, and I cannot order it from the pharmacies in town, or several suppliers unless I order ten. I may end up doing that, but why cant we all co op and share vaccine as if the fridge temp goes out, all that vaccine is down the drain.I also could not get it from the travel clinic.I know if I had 10 vials, I would sell one or two to someone in need, but not sure if people want to turn it into a visit or not. If you have any ideas please let me know. I also may do a titer on her, instead. Carla/Oregon I would like to know what you all are doing about vaccines. I am very small, and you all may be large, but if not, do you order vaccine in bulk? For example a 10unit vial for mmr is about 500.00 so that is 50.00 a shot wholesale. I would like to order just one or two, from another NP, and buy it, but have not had anyone call me back.Public health has it, but they will not send it to me, and they said the patient will have to come see them, and become an established patient, and then they will give them the mmr, and they are booked 2 months.The patient wants to see me, and I cannot order it from the pharmacies in town, or several suppliers unless I order ten. I may end up doing that, but why cant we all co op and share vaccine as if the fridge temp goes out, all that vaccine is down the drain.I also could not get it from the travel clinic.I know if I had 10 vials, I would sell one or two to someone in need, but not sure if people want to turn it into a visit or not. If you have any ideas please let me know.

I also may do a titer on her, instead. Carla/Oregon

]]> By: bcp http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-364 bcp Fri, 02 Nov 2007 13:42:50 +0000 http://npbusiness.org/2007/08/03/micro-health-care-practices/#comment-364 Vaccines are very spendy, and you are not always reimbursed the cost of the vaccine. For a while, I did have a supply for children through the health department, but I dropped out of the program. (You can't charge for the vaccine, but you can charge an administration fee). I don't see that many kids and the report requirements for the vaccine made it more work that it was worth. For things like HBV, I give my adult pts a script, they pick it up at the pharmacy and bring it to the office where I will give them the injection. I do the same for Depo. Many pharmacies will not give immunizations now as well. I know two in our area now have "Immunizing Pharmacists" who can give the immunizations. I don't know if that's across state lines or just state-by-state. I'm in WA. Barbara Vaccines are very spendy, and you are not always reimbursed the cost of the vaccine.

For a while, I did have a supply for children through the health department, but I dropped out of the program. (You can’t charge for the vaccine, but you can charge an administration fee). I don’t see that many kids and the report requirements for the vaccine made it more work that it was worth.

For things like HBV, I give my adult pts a script, they pick it up at the pharmacy and bring it to the office where I will give them the injection. I do the same for Depo.

Many pharmacies will not give immunizations now as well. I know two in our area now have “Immunizing Pharmacists” who can give the immunizations. I don’t know if that’s across state lines or just state-by-state. I’m in WA.

Barbara

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