Micro Health Care Practices

Solo PracticeMicro-Practices is a term I believe was originally coined by Gordon Moore M.D. approximately 5 years ago. His article was originally published in Family Practice Management in 2002. (Going Solo, Making the Leap; Going Solo, One Doc, One Room,  One Year Later; Answers to Questions about Idealized Solo Practice).

This practice model is one that I hear about most often when I hear about NPs™ in practice. The idea here is to be able to see fewer patients and yet spend more time with them and still make a good income. And because your overhead is low, you really don’t have to see as many patients to cover your overhead.

As I took another look at the above articles, I wonder how this can truly work in an office that sees lots of people on managed care.

I know in our office, being that we are primary care, we often make referrals to various specialists.  With managed care being involved in every aspect of care, it becomes a nightmare for us.  It can become a time-intensive project to get referral authorizations (after finding a provider that would see them).

When we opened, we tried to make our patients responsible for making their own appointments. Amazingly enough, many of the other practices refused to allow my patients to book their own appointments. They wanted us to do it, even though we had sent them the notes, authorization, etc.

If you are the only provider/staff person/chief bottle washer, I’m not sure how much time that actually leaves you to see patients.  There is also a huge amount of time but that is spent gathering records to send off to other providers; records for disability determinations, and the myriad of pharmaceutical refill requests (even though your prescription included refills on it, the pharmacy sometimes just don’t see them).

Perhaps a micro practice will work better in a situation where you aren’t seeing a lot of patients with managed care. Perhaps with other insurances, the burden of paperwork might be reduced.

For further information on micro-practices, as well as some tools to help you with the assessment process, visit Ideal Micro Practice.

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  1. 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

  2. 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.

  3. 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

  4. 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

  5. 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

  6. I would like to know more about how to obtain amazing charts. I have yet to start my own practice, but am planning on it soon

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