Monday, December 30, 2013

Year in review for the IU

It was a great year professionally.  My practice grew substantially. 

I added over 1000 new patients.  
I did almost 300 vasectomies. 
I upgraded my office procedure room substantially. 
I invested in a high quality, high optics OR microscope.  
I started a microsurgical training lab. 
I did 10 vasectomy reversal surgeries in the office.  
I was elevated to the board of directors of my IPA
I upgraded my andrology lab.   
I enhanced my offices electronic infrastructure. 
I streamlined check in, check out, and billing processes.  
I successfully enhanced my office to be compliant under Omnibus HIPAA. 

And more.  All in all a good year.  Personally I mourned the loss of my father but thanks to my family and friends, I got though it.  
Here's to 2014. 
The IU

Thursday, December 12, 2013

I am looking for beta testers for my ICD-10 search program. Contact me now.

For a limited time, I will be giving away for free the ICD-10 search program I developed.  Why?  I need beta testers.

If you are interested, please complete the form: 

Dr Schoor

Monday, December 09, 2013

Dude, my ICD-10 Search Program Totally Works.

It works.  And it works well.
Shout out to my programmer.  Nice job Ben Barret.

I am looking for beta-testers.  Please contact me if you are interested.  Use this email:

Dr Schoor

Sunday, December 08, 2013

5 things you should do today to advance your practice

1: post to your blog (don't have one, start one). 
2: learn 2 things about ICD10
3: write a script for a 2 minute video
4: post to your Facebook practice page (don't have, get)
5: set one professional goal to accomplish by end of year

You ready.   Go.  

Monday, December 02, 2013

From the Official ICD-10 Rule book

P. Encounters for general medical examinations with abnormal findings
The subcategories for encounters for general medical examinations, Z00.0-, provide codes for with and without abnormal findings. Should a general medical examination result in an abnormal finding, the code for general medical examination with
ICD-10-CM Official Guidelines for Coding and Reporting
Page 105 of 117
abnormal finding should be assigned as the first-listed diagnosis. A secondary code for the abnormal finding should also be coded. 

For example: patient is referred to me, the urologist, with an elevated PSA.

Problem With No-Shows? Try An ACP approach.

No shows can cost a practices thousands of dollars in lost revenue.  People no show for a variety of reasons but the most common is that they simply forget.  When ever your no show rate exceeds 10% for any given day, your confirmation process did not work.  Happens to me as well.

In November I started a new approach to no shows.  I call it the the ACP--Aggressive Confirmation Protocol.  My no-show rates has since plummeted to essentially zero.

Here's how it works:

  • Monday and Tuesday confirmation begin to happen on Wednesday of the previous week and continue through Friday evening. 
  • Tuesday continues through Monday.
  • Wednesday starts Monday and continues through Tuesday.
  • Thursday starts Monday and continues through Wednesday.
  • Friday starts Tuesday and continues through Friday. 
Confirmations attempts come by phone and elecronic communication.
We don't stop until we get a live person.  

A bit aggressive?  Yes.
Potentially annoying to clients?  Maybe.
Effective at reducing no shows?  Absolutely.  
Expensive?  Nope. 

Try it out and let me know how it goes.

The IU.

Wednesday, November 27, 2013

These are interesting ICD10 codes

Activities involving computer technology and electronic devices
activity, electronic musical keyboard or instruments (Y93.J-)
Activity, computer keyboarding
Activity, electronic game playing using keyboard or other stationary device
Activity, hand held interactive electronic device
Activity, cellular telephone and communication device
Activity, electronic game playing using interactive device
activity, electronic game playing using keyboard or other stationary device (Y93.C1)

Tuesday, November 26, 2013

My ICD10 Search Program-Coming Shortly

Some ICD-10 Derm Codes

L20.84L20.84 Intrinsic (allergic) eczema
L20.81L20.81 Atopic neurodermatitis
L21L21 Seborrheic dermatitis

Friday, November 15, 2013

The ICD-10 Tabular Sections

Certain infectious and parasitic diseases (A00-B99)
Neoplasms (C00-D49)
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
Endocrine, nutritional and metabolic diseases (E00-E89)
Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
Diseases of the nervous system (G00-G99)
Diseases of the eye and adnexa (H00-H59)
Diseases of the ear and mastoid process (H60-H95)
Diseases of the circulatory system (I00-I99)
Diseases of the respiratory system (J00-J99)
Diseases of the digestive system (K00-K95)
Diseases of the skin and subcutaneous tissue (L00-L99)
Diseases of the musculoskeletal system and connective tissue (M00-M99)
Diseases of the genitourinary system (N00-N99)
Pregnancy, childbirth and the puerperium (O00-O9A)
Certain conditions originating in the perinatal period (P00-P96)
Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Injury, poisoning and certain other consequences of external causes (S00-T88)
External causes of morbidity (V00-Y99)
Factors influencing health status and contact with health services (Z00-Z99)

Wednesday, November 13, 2013

Preparing for ICD-10

This is causing me the following:
Nervous tension

Lot of stuff.  Good luck and start now.

Dr Schoor

Tuesday, November 12, 2013

Right from the ICD-10 2014 code set

Testicular hypofunction
Defective biosynthesis of testicular androgen NOS
5-delta-Reductase deficiency (with male pseudohermaphroditism)
Testicular hypogonadism NOS

Start coding now.  Get the hang of it.

Monday, November 11, 2013

Start ICD-10 Coding Now

ICD-10 is coming whether or not you are ready or whether or not you believe it is coming.  October 1 2014 is the date for compliance.  On and after this date, all diagnosing coding must be done on using the ICD-10 code set.

Here is what to do:

  1. Get the ICD-10 code set.  You can either buy it or get it free here.  
  2. Familiarize yourself with the codes.
  3. Watch some videos on Youtube--there are tons and some great ones even.
  4. Take 5 charts per week and code them using ICD-10.
How do you actually find the codes?
  • The diagnoses are found in the index which then tells the coder where to find the code itself
  • The specifics of each code, exclusions, additions, etc, are located in the tabular section.
Is not rocket science.

Try it.

Tuesday, October 29, 2013

I am leaving medicine because of ObamaCare. NOT!

While many things make it challenging to maintain a solo, indendent practice, "ObamaCare" isn't really one of them.  So when I hear things like health providers leaving health care as a result of "ObamaCare" I have to laugh.  What a joke.  I find it hard to believe that "ObamaCare" had anything to do with their problems or that it was even the straw that broke the camel's back.

What is difficult about independent practice?  Let me count the ways.

  • Competition for patients
  • IT costs
  • Compliance with federal, state, and local laws
  • Human resource management
  • Paying bills
  • Getting paid
  • Managing cash flow
  • Managing the phones
and virtually anything else that has to do with running a small business. 

 "ObamaCare" is no where in this list.

I would like people to stop blaming "ObamaCare" for what are likely their own shortcomings.  

The IU.

Thursday, October 17, 2013

ICD-10 is Very Specific

Here are some pretty cool codes that exemplify the level of detail im ICD-10:

The injury codes Y92.149 refer to injuries that happen in prison.  Biut the specific gets down to the level of where in the prison the injury occured.

  • Bathroon-Y92.142
  • Cell-Y92.143
  • Courtyard-Y92.1147
  • Dining Room-Y92.141
  • Kitchen-Y92.140
Now that is amazing.  

ICD10, bring it on!

Tuesday, October 15, 2013

5 charts with ICD10

I randomly selected 5 charts today and codes them using ICD10.  

Getting the hang of it.  Actually may even become intuitive.  The codes encompass every possible diagnosis.   Pretty cool.  

Good luck. 

Sunday, October 06, 2013

ICD-10: Get Ready Now

Like it or not, ICD-10 is coming.  I just came back from a meeting and let me tell you, ICD10 is a bear! ICD10 is not a simple conversion of ICD-9 to the corresponding codes in ICD10.  Far from it.  ICD 10 to ICD9 is like Chinese to English.  It is a distinct and complex language of its own and while one can translate Chinese to English and vise-versa, much information gets lost in the translation when one does this.  Same with ICD9 to 10.

I recommend that you start familiarizing yourself now for ICD10.  Get the ICD10-CM book.  Take a course or courses.  Think about how you will need to update your process to accomodate this new language in your practice, because on October 1, 2014 ICD10 becomes the official language of medical finance transaction in the United States.

I'll be posting updates on my progress over the next 12 months here.  Wish me luck and good luck to you.

Dr Schoor

Thursday, September 26, 2013

The New HIPAA Form for HIPAA Omnibus 2013


Richard A ASchoor MD PC Urology Practice

Notice Of Privacy Practices
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and modified by the HIPAA Omnibus Final Rule of 2013




Our practice is dedicated to maintaining the privacy of your individually identifiable health information, also described as “protected health information (PHI).  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  Some of these records may be on paper and some may be in electronic media. We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.  By federal and state law, we must follow the terms of the notice of privacy practices that we are in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your PHI
Your privacy rights in your PHI
Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by our practice.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future.  Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.


Richard A Schoor MD PC
285 E Main St, Suite 207
Smithtown NY 11787


The following categories describe the different ways in which we may use and disclose your PHI.

1.  Treatment.  Our practice may use your PHI to treat you.  For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis.  We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you.  Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment.  Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents.
Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2.  Payment.  Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your PHI to bill you directly for services and items.  We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.

3.  Health Care Operations.  Our practice may use and disclose your PHI to operate our business.  As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.  We may disclose your PHI to other health care providers and entities to assist in their health care operations.
a. Business Associates – Our health care operations may involve the use of other contractors to assist us in billing, collection, record-keeping or other facets of our business operations. All of our business associates are required to protect the privacy of your PHI and are not allowed to use or disclose any information other than as specified in our Business Associate contract with them.

4.  Appointment Reminders.  Our practice may use and disclose your PHI to contact you and remind you of an appointment.

5.  Treatment Options.  Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

6.  Health-Related Benefits and Services.  Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.

7.  Release of Information to Family/Friends.  Unless you object, our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.  For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold.  In this example, the babysitter may have access to this child’s medical information.

8.  Disclosures Required By Law.  Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.


The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1.  Public Health Risks.  Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:

maintaining vital records, such as births and deaths
reporting child abuse or neglect
preventing or controlling disease, injury or disability
notifying a person regarding potential exposure to a communicable disease
notifying a person regarding a potential risk for spreading or contracting a disease or condition
reporting reactions to drugs or problems with products or devices
notifying individuals if a product or device they may be using has been recalled
notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2.  Health Oversight Activities.  Our practice may disclose your PHI to a health oversight agency for activities authorized by law.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Notifications of Data Breaches. Our practice may use and disclose your PHI to meet the requirements under the HIPAA rules to notify you and government agencies of any data breach that could potentially result in unintended disclosures of your PHI.

4.  Lawsuits and Similar Proceedings.  Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

5.  Law Enforcement.  We may release PHI if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
Concerning a death we believe has resulted from criminal conduct
Regarding criminal conduct at our offices
In response to a warrant, summons, court order, subpoena or similar legal process
To identify/locate a suspect, material witness, fugitive or missing person
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

6.  Deceased Patients.  Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.  If necessary, we also may release information in order for funeral directors to perform their jobs.

7.  Organ and Tissue Donation.  Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

8.  Research.  Our practice may use and disclose your PHI for research purposes in certain limited circumstances.  We will obtain your written authorization to use your PHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following:  (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following:  (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.

9. Marketing of our Services. Our practice may use and disclose your PHI for purposes of marketing our services to others but only if we have obtained your written authorization to use specified information for this purpose. You have a right to revoke this authorization at any time in writing. Any transaction that occurs prior to such revocation will not be considered an unauthorized disclosure.

Sale of Aggregate Data. Our practice may sell and disclose your PHI to other covered entities but only if we have obtained your written authorization prior to doing so. You have a right to revoke this authorization at any time in writing. Any transaction that occurs prior to such revocation will not be considered an unauthorized disclosure.

Serious Threats to Health or Safety.  Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military.  Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

13.  National Security.  Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law.  We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

14.  Inmates.  Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

15.  Workers’ Compensation.  Our practice may release your PHI for workers’ compensation and similar programs.


You have the following rights regarding the PHI that we maintain about you:

1.  Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to Dr Schoor at 631-326-6035specifying the requested method of contact, or the location where you wish to be contacted.  Our practice will accommodate reasonable requests.  You do not need to give a reason for your request.

2.  Requesting Restrictions.  You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends.  We are not required to agree to your request with certain exceptions (see below). If we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Dr Schoor at 631-326-6035.  Your request must describe in a clear and concise fashion:

the information you wish restricted;
whether you are requesting to limit our practice’s use, disclosure or both; and
to whom you want the limits to apply.
You have a right to revoke such restrictions in writing to the same representative of our practice.

3.  Inspection and Copies.  You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  This includes your right to an electronic copy of any electronic medical records that we maintain.  You may request this electronic copy be transmitted to you or to any other individual or entity that you designate. We will make reasonable efforts to transmit this electronic copy in the format you request. However, if the PHI is not readily producible in this format, we will provider your record in our standard electronic format or in hard copy. You must submit your request in writing to Dr Schoor 631-326-6035 in order to inspect and/or obtain a copy of your PHI.  We have 30 days to comply with your request. Our practice may charge a reasonable fee for the costs of copying, mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4.  Amendment.  You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.  To request an amendment, your request must be made in writing and submitted to Dr Schoor at 631-326-6035.  You must provide us with a reason that supports your request for amendment.  Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5.  Accounting of Disclosures.  All of our patients have the right to request an “accounting of disclosures.”  An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI, outside of those  for treatment, payment or  health care operations purposes.  Use of your PHI as part of the routine patient care in our practice is not required to be documented.  For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing to Dr Schoor at 631-326-6035. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period.  Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to Notice of Data Breach. In accordance with specifications of the U. S. Department of Health and Human Services, you have the right to be notified by us of a data breach that unintentionally discloses any or all of unsecured electronic PHI to an unauthorized party.

7. Right to Restrict Disclosures of Services Paid “Out of Pocket”. You have a right to forego a filing of insurance claims and restriction of disclosures to your health plan for any specific service that you pay for out of pocket. This request will be honored by us as long as the full payment is received at the time of service.

8.  Right to a Paper Copy of This Notice.  You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, contact Dr Schoor at 631-326-6035.

9.  Right to File a Complaint.  If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact Dr Schoor at 631-326-6035. All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

10.  Right to Provide an Authorization for Other Uses and Disclosures.  Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.  Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Dr Schoor Privacy Officer 631-326-6035.

Thursday, September 12, 2013

Drudgery in Medical Practice and How to Reduce It

Medical care is very labor intensive.  Most everything about it is, in fact, labor intensive.  Some of that is labor of love, ie the actually delivery of medical care: advice and treatments.  But most of it is drudgery. How can one diminish the amout of drudgery while simultaneously enhancing both the quality of care and the enjoyement of day for the doctors and employees?

The answer: automation, robotics, electronics

  • Data entry: patients can enter their own data via a kiosk system and medical staff/doctor reviews it.  
  • Prescription management: no human should ever place pen to pad.  All prescriptions must be done electronically and either e-prescribed or printed.
  • Charting and filing: no human should ever do this.  EHR is the solution.
  • Phone tag: this is when a patient calls the doc, doc can't talk and when calls back gets voice mail and the cycle repeats.  Drudgery and frustration ensue.  Solution: online secure messaging. 
  • Urine analysis: some practices still manually dip stick urine.  Not only is this a waste of human effort, it is less accurate and reliable then automated analyzers.  Just don't do it.  Same for most other laboratory tests, including semen analysis.
  • Medication history: while it may be easy to just get a list of the patient medications, getting the dosages and strengths can be both difficult and time consuming.  Drudgery.  Fortunately computers can assist here as well.  With proper software, one can download a patient's comprehensive medication history directly from the pharmacy benefit website.  Saves time, reduces errors, and is easy.  
  • Results management:  direct HL-7 connections to all labs enables automatic download of results data into EMR.  Saves time, reduces error.  
  • Scanning: while this may be essential it can be labor intensive.  Keep it too a minimum.  Use high capacity professional grade scanners, never consumer ones.  Scanners ought to be linked into the EHR, if possible.  One can use barcode to ensure that the documents get to the right chart without human intervention.  To reduce scanning, have the documents faxed to your office and configure the fax so that the fax is recieved in an electronic format, such as a PDF file.  All desktop computers already have this capability.  
  • Documenting: handwriting has some many issues and is so fraught with problems that it should never be done.  Plus, it is very tiring for the writer.  Perhaps when doctors were seeing 5 patients a day and could write 2 words as a note it was ok.  But no longer.  Now it is far better to use well designed EMR templates with macros, voice recognition software, and tablet/stylus computing.  Very quick.  very efficiant.  Tireless and effortless.  Plus more accurate.  
While on the above suggestions have high costs, not implementing them has a higher cost in terms of productivity, mistakes, burnout, and unhappiness.  

Saturday, July 20, 2013

Tuesday, July 09, 2013

Independents can vacation

You just need the right technology.  

Strategies to Remain Independent

Times are tough for independent docs and only getting more difficult.  Here are some strategies you can employ to counter the stresses on your independent practice:
1: Cultivate a cash pay practice, ie cosmetics, fertility, concierge. 
2: Join an IPA
3: Join a GPO (group purchasing organization)
4: Selectively contract with managed care, not all payers
5: Cherry pick easy diagnoses and refer out the rest

Anything else?   Let me know.  

Tuesday, May 21, 2013

", 99% accurate."

Is 99% accurate good enough in a medical business?  Let's see what 99% means.

For every 100 labs filed, one gets lost = 4 per month = 50 per year = out of business

Imagine doing the wrong procedure only 1% of the time.  I'd make this mistake 10 times per year.  This is unimaginable.

In correctly entering 1% of insurance data causes payment problems on 100% of those patients.  So for 1% of 100 patients per week = 1 patient per week = $ 100 per charge on average x 52 weeks = $5200 per year lost. (This is a very conservative estimate.  Would actually be much higher.)

How about recording the callback number wrong on 1% of people who call for test results.  I'd have difficulty calling 2 per week or 100+ per year.

An on and on...

How about in life outside of medical practice?  Is 99% good enough?

Nope.  Not here either.


An average drivers puts 12000 miles per year on the car.  If they have an accident 1% of the time, they crash the car every 120 miles.  Not too good.

Would you get on a plane that had a 1% chance of not landing?

So 99% is a good grade on a test or a good GPA.  Otherwise, not so good.

Friday, May 17, 2013

My new book is here.

Suddenly Solo Enhanced: 12 Steps to Acheiving Your Own Totally Independent Health Care Practice

Dedicated to my father.  Miss you.

My new book coming soon!

My new book, Suddenly Solo Enhanced: 12 Steps to Achieving Your Own Totally Independent Health Care Practice, is in the proof stage.  It will be out soon and available where ever fine books are sold.

Actually, will be availaible on  Or you can order it through me.

Dr Schoor

Tuesday, May 14, 2013

Like Trudging Through Mud

Sometimes office hours are effortless.   Patients arrive perfectly timed.  They all have insurance cards and co-pays at the ready.  My front desk staff looks like 12 cylinder engine with pistons cranking at full speed--no back fires.  If there are any no-shows at all, they seem to come at opportune times and are followed by a add-on vasectomy or vas reversal patient that fill the holes perfectly.  The phones ring, but with all new patients or established ones wanting to be seen.  The EHR purs like a kitten as all patients fit all templates beautifully and clicks are minimal.  The prescription printer never fails and e-prescribed prescriptions always match the formulary.  The entire office is in the zone.  It happens and when it does, I love it.  

And then there is my last 2 days; like trudging through mud.  Phones never stop, but for billing questions and pre-approval calls, and pharmacy issues.  Patients are calling for results and when I cal back, I get voice mail and cycle goes on and on and on. . .   My front office is functioning but like my '65 Mustang after I neglected to change the oil after $3000 miles.  The EHR--no pateint ever seems to come in with any complaint I have ever seen before.  The prescrition printer must be tired as it goes into sleep mode way too often.  As for e-prescribe, pharmacy issues, formulary issues or both.


Thursday, April 18, 2013

Things Only Humans Used To Be Able To Do

Times are getting tough for medical office workers who's skills can be replaced by computers:

  • Answering Phones
  • Patient Check-in
  • Filing
  • Data Entry
What is next?

The IU

Friday, April 12, 2013

I Am Blue

I am blue today.  A bit sad.  Why?  I am worried about my community and its people.  Can they support themselves?  Can it remain vital?

How are the unskilled workers supposed to support themselves?  We no longer need file clerks and receptionists.  There is now, as we speak, software that can write software.  So even programmers will have to compete with robots.

I am techophile for sure and do not advocate halting technology's progression but I am scared for my friends and family and my children's future.

The past few days I have been interviewing people for a job opening in my practice and I see their desparation.  They are competing with machines and losing.  

Just saying.  This is something I'd have spoken to my dad about but he passed.

Sunday, March 24, 2013

My hospital EHR

Docs complain but then again docs will always complain. But I love it. I can make rounds in a jiffy and post-op orders and notes are effortless and error resistant. Pre-op orders the same. Was it worth the $100 million dollar price tag? Yes, especially since I did not pay for it. But joking aside, I think the hospital will see money back in efficiency and error reduction.

Wednesday, February 20, 2013

Say no to no.

Say yes. Good things happen to people who say yes. Surround yourself with positive people. Not "yes-men", the people that always say yes but never implement anything. I mean people that have a yes attitude, a can do attitude.
Why not as opposed to here is why not.
No is easy but it leads no where.
I want yes.