Friday, June 29, 2007
I don't purchase toys for my practice. If I had a need to surf the web on my phone while seeing patients, I'd buy an Iphone. If I became lost in my 1100 square foot office, and needed GPS, I'd buy an Iphone. If I became bored when consulting with a patient and felt like listening to some music, I'd buy an Iphone.
But there is one thing I could use te Iphone for: email. Of course, I don't need an Iphone to do mobile email. But perhaps that is a good enough reason to justify the purchase. . .
Wednesday, June 27, 2007
"Hi, it's Dr Schoor. I'm calling with your biopsy results."
"Oh, thanks doc, I'm really stressing over this."
"OK, the biopsy was" click.
Somehow, I don't think that that'll end up in one of their commercials. Though I still, on the balance, have liked VONAGE.
Thanks, The IU
Sunday, June 24, 2007
I was having a discussion this weekend about the nature of private practice vs academic practice on my way back from the city and I'd like to share my thoughts with all 4 of my readers, plus mom.
As I see it, there are 4 types of urologist--or any physician for that matter. The 4 types may be classified as follows:
1: The academic hot-shot: this is the superstar academic physician. This doctor has NIH money as well as pharma dollars and is a consultant for many companies, either pharma or medical device or both. This doctor does very well financially and has a very secure future, since he or she can take their credentials with them wherever they go. These docs are the leaders of the specialty and influence, for better or worse, how the rest of us practice.
2: The typical academic physician: this physician sees the patients in an academic urology practice. They can get some pharma dollars or serve as consultants to medical device companies, but this is really not a significant source of income for them. These doctors are the worker bees of the academic practice, and to an extent, support the galavanting superstars. This type of typical academic physician serves at the whim of the chairman and/or board of governors and can be canned quite easily and mercilessly. These doctors grumble quite a bit.
3: The typical private practitioner: The most common type of urologist. Very hard working and very competent, these doctors roll with the punches and constantly adapt to the changing market place. They will always do well, yet they never feel in control, and complain quite often. The react to changes in the medical marketplace, though some react faster than others. Many, someplace along the line, lose their passion for the field and consider their specialty as a job. Que' lastima!
4: The private practice superstar: This is the go to guy, the urologist's urologist. This doctor sees only people on an out-of-network basis and commands high fees, yet has high volume as well. This type of urologist/doctor has extraordinary vision, foresight and business saavy. They have the ability to develop a practice that seems impervious the problems that plague the rest of us. These docs do very, very well.
5: The doc who thinks he/she is the superstar and yet is not. Of course, this is the largest of the categories.
Just some food for thought.
Thursday, June 21, 2007
- "Would you like to pay your co-pay now or later?" 5/5 will say, "later."
- "Would you like to pay your co-pay now, or should we bill you later." 4/5, in my experience-->"bill later."
- "How would you like to pay your co-pay?" Too open ended. Open ended questions are great during a medical history, but not when you are trying to collect money.
- And of course the worst way is to see the patient first and then say, "Ok thanks" and then just send the bill for the co-pay. Oh, yes, this happens in many offices because the staff is just too busy and does not understand the importance of the co-pay.
Here is how to ask for a co-pay:
- "I see that your co-pay is x-dollars. Will that be cash or check today." And of course, it is collected BEFORE the patient is seen.
That is the best way.
Of course, we don't deny people service because they can't pay the co-pay right then and there, but it does serve to let the patients know that we take co-pays seriously and that they will receive a bill in the mail, and that they will be expected to pay it.
PS: How would you like to pay for this practice management tip, bank check or credit card?
Tuesday, June 19, 2007
Here is how I deal with emails.
Patients are given the option to communicate by email, but they must sign an email consent form first. The consent discusses all the possible negative consequences of email communication and If you'd like mine, just shoot me an email.
When patients send me emails, I reply, then I save the initial question and my reply in the patients folder under correspondence. I save the email as a text file and date the file as well.
And that is it. Nothing fancy. Totally simple.
Monday, June 18, 2007
- Up-front cost: Of course this is important and obviously so, yet people still get mesmerized by the bells and whistles of a system and the vendor's claims of "ROI." Here's the real deal. If you are a primary care physician who makes, on average, $35 per encounter, you will need to see an additional 4285.7 patient visits to offset the cost of the $150,000 EMR featured in this NYTimes article. In other words, a primary care doc will need to see 12 additional patients per day x 7 days per week just to pay for the initial EMR cost.
- Up-grade costs: Have you ever wondered why Windows keeps changing it's perfectly good operating system, for example from XP to Vista, every couple of years. Windows does this to make money. Of course, when you have a personal computer, you are under no obligation or professional stress to up-grade, plus, as a consumer, the up-grades are relatively inexpensive. Now consider your EMR that you purchased for $5000 to $150,000, up-front. Every 6 to 12 months, without question, the vendor will hit you for an upgrade. Perhaps upgrades in the first year or 2 will be free, but they won't be free forever. Sooner or later, they'll get you for possibly thousands per year in upgrade costs. And what are you going to do; not pay it and let your system crash? Will you switch to another vendor and start again? I don't think so. You will be held hostage!
- Service contracts: Have you ever called, for example Dell Computers. If you don't have a service contract, they can charge $100 per 15 minutes. Dell has great customer service and their setrvice contracts are cheap: ~$250 per 3 years. Now consider this; have you ever seen anything "for medical use" be cheap? Absolutely not! Service contracts for EMR's typically start in the $500 per 6 month range and go upwards. I know of one that costs $12,000 per year. That is more than some docs pay for liability insurance. And you have to pay this because the systems break down--even the "good" ones.
- Reliability: I'm actually talking about the vendors now. EMR sales are expected to skyrocket in the next 6-7 years, so we are in a sort of gold rush, with the EMR vendors being analogous to the prospectors of 1848. Many vendors, in fact most, will not survive. Now I want you to imagine that you select an EMR for $5000--cheap for EMR's--and the software comes with free upgrades and service for 12 months. You convert everything to electronic after hours and hours of effort and money, and then the company stops answering their phones when you need them. Now what do you do? You have all this critical information that may or may not be transferable to another EMR program. In other words, choose your vendor carefully and if possible, get psychic powers.
- Ownership: Some companies are promoting use of their own EMR online services. These services are cheaper as there is no expensive software or hardware to purchase upfront, and there are no installation costs, but I have some concerns. One major concern is: who owns the records; me, the patients, or the vendor? You better read that contract carefully, or better yet, get a lawyer to read it. You may surprised. Medical charts--paper ones--that were stored in Iron Mountain Storage after a California HMO implosion in the early 1990's cost millions to retrieve, and some charts were lost forever. Personally, I don't see a difference between electronic vs paper storage. Storage is storage and physical possession is everything.
- Work-flow: Most EMR's that I have used or demo'd force the user to alter their own typical work-flow routine to fit that of the computer program, rather than vice-versa. Now this may not be a bad thing, but I know many very excellent physicians who can crank out patient visits and still leave the office on-time, with charts completed at the end of the day. For these docs, which I believe are the silent majority, EMR's would actually add inefficiency.
There, I have said my peace. And I am a staunch believer in EMR's. But they are just too expensive and if they are supposed to benefit the payers, as Senator Clinton points out, then let the payers purchase them for us. Until that happens, proceed with caution.
Hope you enjoyed the post.
PS: Thanks SeaSpray for the Father's Day Wish.
Wednesday, June 13, 2007
I can understand why. They spent too much and must not have really run the numbers. I think they purchased a very expensive toy, rather than a tool.
When buying an EMR, running the numbers and doing the analysis is everything.
Wednesday, June 06, 2007
- "Hello, Dr Schoor's office. Our address? Sure. 285 Middle Country Rd. OK, by."
- "Hello, Dr Schoor's office. No, went don't take credit cards. OK, by."
- "Hello, Dr Schoor's office. OK. By."
So my question was, what the hell was going on? I decided to ask the receptionist, one of the new hires, what the phone calls were about.
- Call 1 was from someone who asked for our address, but she did not enquire as to who was calling or for what purpose.
- Call 2 was from a person who asked if we take credit cards, but my receptionist did not know who called or why they wanted to know whether or not we take credit cards.
- Call 3 was from a person who wanted their records sent to someone, only the receptionist did not ask for the patient's name or to whom they wanted the records sent or why.
Well, that is certainly not how I want my phones answered, and I could get angry at her, but the anger should really be directed at me. See, one can not assume that someone would or could know how you want the phones answered and what information they need to get from the caller. Some training was needed and I dropped the ball. No doubt in my mind, call #2 was from a new patient, so I lost some potential income. Serves me right!
Since the phone is the life's blood of a practice and the first, and perhaps most important, encounter that people have with you and your practice, phone training is essential for new hires. I knew that, and didn't do it. Now we drill the new hires with a variety of phone scenarios. As a mystery caller, I call my own office and ask the following questions.
- "Hi, is this Dr Kim's office?"
- Is this Suffolk Urology Associates?"
- "What is your address?
- "Do you accept United Health Care?"
- "Do you do vasectomies?"
The answers to the above questions are not simply yes or no. Instead, I have trained my staff answer those questions with questions and to try to elicit from the callers their names and the reason for the call and if it turns out that the caller is a new patient, to get them in the front door.
Poor phone skills can cost money. Lots of it. Phone training is critical!
Monday, June 04, 2007
Wrong, wrong, wrong!
I have been doing exactly that for 15 months and not one patient has ever abused it. What has happened is that word of mouth regarding my availability to speak on the phone and my reach-ability has spread like wild fire and my practice has grown. Patients and their families consistently say things like, "I've never seen any other doctor be so reachable." And then they volunteer, "I'm going to refer you to my friends."
Music to my ears!
Maybe one day I'll get tired of it, but I doubt it because it really is no big deal, patients like it, and not only does it cost nothing, it makes me money. Placing less barriers between you and your patients, while counter intuitive, is actually better for everybody; patients, referring docs, and you.
Sunday, June 03, 2007
Just a little pearl of wisdom from the IU to U.
Friday, June 01, 2007
I know I risk sounding like a broken record, but it seems that 2-3 times a week I am rewarded just for answering the phone. Here are 2 of the latests successes:
- Last night a woman called at 7:45 PM to enquire about getting her husband an appointment for a vasectomy. The call was forwarded to my vonage line at home, which I anwered while trying to put my girls to bed, and booked the patient.
- A patient was given the numbers of 2 urologists for a vasectomy, me and another, established urologist. The patient called the established urologist first, but they did not answer the phone. He then called me, we answered, and I did the vasectomy yesterday. Not only that, he had such a good experience in my office, he let me know that he would tell others to come to me.
Answer the phones. It is really that important.