Clueless? Design the Front End First

Let's say you wanted to start a web-based business but did not have any web design, programing or software engineering experience, you might think that it would be impossible to proceed with your plan.

You'd be wrong.

Using simple and inexpensive software, such as Balsamiq or even MS Publisher, you can actually build your site from the front end first, ie from the experience of the user. Then, you just have to find a coder to build you the site and then find someway to pay for it all.

If you are going into a new, solo medical practice, you can adopt this type of backwards planning strategy to achieve your ultimate goal even if you lack the knowledge to see the all the details involved in the project.

For example, perhaps you want to leave a group practice to start your own one, but have no experience with the business aspects of medical practice, you can use your knowledge of how you want to experience life in your practice and then step by step find out how to accomplish the seeming impossible. You may know that you want to see 20 patients a day, take insurance, do in-office procedures, major surgery in the hospital, and have a lab. Using this knowledge, you can back-step the route to the goal.

This strategy takes some practice, but you'll be amazed at what can be accomplished by using it.

Good luck and let me know how it goes.

The IU.

Is it time for a contrarian approach?

I spent last week in Florida. One fine day on the beach, I witnessed an interesting natural event. Some beach goers began to toss bread into the air and immediately 30 to 40 seagulls flew over to get some food. It was a frenzy and the birds seemed to be fighting each other over food. It reminded me of life as a doctor in NY.

Then I saw something amazing.

One bird--and only one bird--stopped participating in the melee and instead flew in the opposite direction toward the sea. Once there, beyond the cresting waves, this bird hovered and then made several dives and pulled out a fish. While his competitors were fighting over crumbs and hand-outs, this contrarian bird went solo and came out ahead.

It got me thinking. Do I fly with the other birds and fight like mad for some scraps. Or do I go the other way, beyond the cresting waves, so I can feed in the blue waters of no competition.

It was a nice day on the beach!

Going Solo? The Turnkey Medical Practice: 2.0 Style

I know I have written previously about how to start a practice from the embryo stage on up, but here it is again, parred down to its bare essentials:

1. Get or develop a detailed business plan that will serve as a blueprint.
2. Get a mentor or coach or other such trusted adviser.
   
3. Get credentialed with insurances, hospitals, et al.
4. Get professional liability insurance.
   
5. Get a phone number.
6. Get a web-presence.
7. Get office-space; sublease, lease, or purchase depending on your unique situation.
   
8. Get a good EMR-PM system.
9. Get a payroll service (also does statutory insurances for small businesses).
10. Get an employee.

That is the list. Easier said than done and each step has many and multiple sub-parts. Still, just 10 steps.

Good luck.

Dr S

A reader question: How long to positive cash flow in start-up?

One of my readers (not my mom) asked me a question that deserves an answer. Hopefully, she will read this post.
The question was:

When does the
cash-flow usually come in after starting a practice?


Answer: Depends

Medical practice is a business and start-up is start-up. Most start-ups will fail in the first year for one simple reason; they run out of money before cash flow can cover expenses. When these businesses will run out of money depends on a variety of factors. The most important factors are access to capital, type of business, competition, and payer mix. Business that start-out with less than $5000 cash will usually fail in the first year, while those that have access to $100,000 or greater, will most likely live beyond their one year anniversary. If you want to survive, I recommend raising money, and lot's-o-it.

The type of practice you have makes a difference as well. Some practice's have inherently high start-up costs while others can be started with significantly less money. For example, I started my urology practice with $40,000 down and access to $150,000 in case the unowhat hit the fan. An internist may be able to start-up for even less, while an OB-Gyn in NY will need in excess of $200,000 to start-up. But the start-up costs only tell part of the story. A urologist may have high costs compared to an internist, but we also have higher revenue potential. A plastic surgeon or dermatologist in start-up can have very low up-front costs yet have a high earning potential and could thus become cash positive in a very short time. Contrast that to a primary care physician: they'll have relatively low initial costs but very little real income generation potential in today's climate. Plus, as they get busier, their costs escalate much faster than their revenue.

The third factor is competition. If you are the only urologist in town, you'll do well. If you are like me, one of 100s, you'll have to struggle a bit more to make money. A plastic surgeon in start-up on Long Island may have lower costs than, say, I did, but he/she has much fiercer competition than I faced. As for primary care; out here they are dime-a-dozen.

The fourth factor is payer mix. If your patients are insured, and you have enough of them, you'll start to make money. If you practice in a very well-off area and can go "out of network" you'll make the same money with less work and in less time. If you deal with predominantly Medicaid, you'll probably have to move because you'll never get there.

As for me, my cash flow turned positive after 9 months of hemorrhage.

I started in April 06 with a $40,000 initial investment and was prepared to pour another $150,000 of my own money into the practice to "float it" in a worse case scenario. Initially I estimated a loss of $30-50K in year one and a break even point by end of year 2. I felt that by end of year three I'd start to make in excess of $100K per year. In actuality, I broke even by end of year one and made a modest, yet respectable, profit by end of year 2. This year I have been doing quite well. While I had to dip into my savings, I repaid those loans quickly.

Caveat:

While I have already recovered my initial investment and have been making some money, I am still greater than $200,000 in the hole if you factor in loss of income during my first 2+ years of start-up compared to what I'd have earned had I stayed an employee. So be forewarned: the freedom to be your own boss comes at great cost.

So good luck Rose and please feel free to contact me.

The IU.

MS Word & Your DIY EMR

Here are some features of MS Word 2007 that make it so attractive for a homegrown EMR:

• Insert signature line: once inserted, you can sign it with the stylus. The program then locks the document to prevent any changes.
• Built in PDR conversion tool: No need to buy acrobat. PDF is a great format for an EMR for a variety of reasons.
• Insert inbedded files: The user can easily insert inbedded files, like bitmaps, with things such as illustrations, photos, notes, etc.
• Change tracking: This feature is also on older Word versions. Allows the user to make changes with cross-outs, rather than erases. Makes for good transparency, ie spoliation accusation resistant.
• Can easily create templates and record macros.
• Phrase finishing: user can train program to complete phrases and sentences. Useful when documenting encounters quickly.
• User friendly: very little training required.
• Ubiquitous: Is pre-installed on most computers, and is compatatble with google documents and MAC OS.
• Inexpensive.

In other words, it is an excellent tool for the homegrown EMR. AND, from what I've seen from many vendor sold EMR's, the basic platform that they use in their products. Kevin's right: why pay so much more?

The IU.

Cost Containment: Here's some tricks

With declining reimbursements, the only way to to remain viable is through revenue generation coupled with cost containment. I'd like to talk a bit about costs, and some obvious--and not-so-obvious-ways to minimize them.

Fixed Costs: These are items like rent and insurance. While you probably have little negotiating power in this area, with regard to rent you can keep costs down the following ways:

• Maximize productive use of space. I pay $26 per square foot, and use all of it productively. An EMR helps here, because I don't need to dedicate several hundred square feet to chart storage. Also, mobile units, such as portable sonogram machines, client computers, and portable lab equipment, also helps. And of course, I have VPN, because it essentially converts my house or Starbucks, or anywhere with an internet connection into an extension of the office.
• Maximize revenue generation areas of the office. These areas include exam rooms, your office, and the lab. Back office functions, such as insurance claims submissions and billing work, can be virtual, via your VPN, yet remain "in-house" as opposed to being outsourced. With a well networked office, exam rooms can serve as exit offices while you go to the patient in the adjacent room.
• On-demand Supply Ordering and Smart Storage: Closets = Square footage = $$. With some thought and planning, shelving, exam tables, cabinets, and closet space can be used for maximal storage at minimal square foot usage. In addition, I order supplies as needed, since my vendor, PSS Worldwide Medical, always delivers next day.

Variable costs: These include costs for items such as medical supplies, payroll, utilities, stamps, etc, and can be determined by examining the profit-loss statements prepared by the accountant. here are some ways to keep variable costs down.

• On-demand supply ordering. DELL Computers uses this concept. I do as well, just make sure you don't run out of Foley drainage bags after you've already placed the Foley.
• Part-time employees: Simple. They cost less than full time employees, plus no overtime.
• On-demand staffing: I staff heaviest on the busiest days. Plus, since I am capable and willing to pick-up slack on days that we are inadvertently short staffed, this method works out well. Busy days or light days, open or closed, phones are always!!! staffed.
• Amortization of utility payouts. Most utility companies will estimate a fixed monthly cost for you to pay based on a prior years consumption. I like it for cash-flow management.
• Have your phones (VOIP), cellphones, & internet on fixed plans, so that costs do not soar with usage. Get the maximum minutes for cell phones, since the incremental costs of the plan are much less than overage payments. VOIP is cheap, plus never varies with usage. On the balance, I've been happy with it, yes, even for the "mission critical" functions. I'm talking to you, Sunrise.
• Fax. Why snail mail when you can fax the referral letter. Not only is it faster, more efficient, and trackable, it is cheaper. I love my fax. Yeh, yeh, yeh, I know, HIPAA. But it can be done and still be in compliance

Direct costs: These are costs that are directly involved in patient care. Here's how to minimize these costs.

• Everyone does everything. MA's do data entry, answer phones, clean rooms etc. The docs answer phones (if they are not seeing patients) when needed, clean rooms, order supplies, schedule patients, e-file labs. Again, an EMR and a VPN helps here as well.
• Part time employees and on-demand staffing: see above.
• Creative patient scheduling: Figure out which works best for you; clinic, open access, proportional, or wave scheduling, and then determine minimal staff requirements for your office hours.
• Ergonomic room design. I have rigged my rooms so that I can do a many procedures without an assistant present. I learned these skills as a surgery resident in central line clinic. In fact, I can prep with my left hand, place the scope with my right hand, and simultameously do a UA with my toes (kidding!). If you have 2 hands, a brain, and a Mayo Stand, you can make it work as well, and in the mean time, you'll free up staff to answer phones and book new patients or enter claims.
• Training and process management: Training employees well and developing efficient processes of doing business will allow you and your employees to work smarter and with less mistakes and to get the job done right the first time. This simply saves money.

Indirect costs: These costs cover non-patient care activities, such as back-office staff and billers. Here's how to minimize these costs.

• See direct costs.
• VPN
• EMR
• Embrace technology
• Multi-task
• See training and process management

Hope you enjoyed the post and thanks for listening. And Seaspray, thanks for the baby card. Unexpected and appreciated.

The IU.

The Box-Method Revisited

Last November, 2006, I wrote about the Box Method, an easy, yet not-oft-recommended way to store important documents easily and without fear of document mis-files. I wish to update you on how my box method is doing.

As I said in the that post, I first learned of the box method at freshman orientation at the University of Maryland, College Park, my Alma mater. In essence, the box method is an easy way to secure important papers in one location and is so easy to do, a disorganized frat boy can do it, and never lose the proof he needs regarding that dropped course.

Here's how it works. Every time you get important mail, like monthly bank statements, bills, credit card statements, etc, just put them in a box. Don't try to organize anything. Just throw them into the box. At the end of the quarter, you can then organize the papers into appropriate sections in an accordion folder so that your accountant can go through them do your quarterly income and cost statement. Read the earlier post in which I explain it in more detail.

When I first started my solo urology and male infertility practice, the box method worked fine. At that time, I was seeing ~20-25 patients per week and operating once per month. I had no call. I went to one hospital, no lithotripsy center or surgi-centers, and had huge gaps in my schedule. When it came time for my quartely accountant meetings back then, I had time to organize the box prior to the meeting. Back then, the box method worked well.

Now I see 40-50 patients per week, and do ~10 surgeries per month at my local hospital in Smithtown. In addition I do another 10 cases per month, such as sperm retrievals, litho's etc, at a variety of places, like the lithotripsy center, the surgi-center, or the IVF centers. My days in the office still have breaks, though not long ones as in November 2006, and when I am not seeing patients, I am transporting my younger girl to and from camp/school, making bank runs, writing, planning, & thinking (yes, I schedule "thinking" time--very important), or helping out with the new born at home. On top of that, I am on call for St Catherine's Medical Center in Smithtown, and have been busy with ER and hospital consults. So now, does the box method work?

You betcha! Works better than ever. You see, the busier you get, the more you need the box method. My accountant meeting is tomorrow, and I organized my box in less than 30 minutes while I watched a promo video for a cool new health website called http://www.organizedwisdom.com/.

Get the box. Don't listen to the nay-sayers. It works great.

Thanks,

The IU.

Email and the solo doc

Email is a great way for a doctor to communicate with patients, despite it's drawbacks. In my practice, patients have been using email more and more frequently, and I think it is a good thing and welcome it. It makes me more accessible to my patients and is less intrusive on my own life. For example, in Father's Day, 2 patients had quick questions for non-emergent conditions and sent me emails. Since I have a habit of hitting "send/receive" every time I pass my MAC, i got the messages promptly and replied. No biggy. As I said, I like communication with email.

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.

Thanks,

The IU.

More on EMR's

I have been having discussions recently, with knowledgeable people, on one of my favorite topics: the EMR. One person, a patient of mine, was an EMR purchaser for a major hospital, so I think she may know something. Here are some salient points we came up with that you may want to consider before committing to an EMR.

• 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.

The IU.

PS: Thanks SeaSpray for the Father's Day Wish.

Going solo? Have phone drills.

I overheard 3 recent phone call encounters. Here's how they went:

• "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?"


• etc

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!

Thanks,

The IU.

Minimize phone lines-Maximize phone power.

The phones are your practices life's blood. You must keep the phone lines open for callers, yet your staff must be on the phones for a variety of important reasons, such as to confirm patient appointments or call insurance companies regarding claims. Thanks to VOIP and PC calling, you can have relatively few expensive phone lines, such as from Verizon or ATT, etc, but have a several PC phones on every computer. I use a service called SKYPE. SKYPE used to be free--100% free--but due to its popularity, it began to charge a whopping $29 per year--YEAR!!!--for unlimited PC to phone calls anywhere in the USA and Canada. SKYPE to SKYPE, anywhere in the world, is still free, and will always be free. I use SKYPE in my office frequently and have it on each computer. My staff and I use SKYPE to make all outgoing calls to insurance companies and doctors offices, any place where you may be placed on hold for a long time.

Just a little pearl of wisdom from the IU to U.

More on answering the phone after-hours.

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.

The IU.

Hiring

Well, here comes the summer. For most people that means a nice time to kick-back, slow down, and enjoy the weather. For me, it means "summer hours." Unlike many businesses, however, I actually expand my hours in the summer--or at least adjust them--so I can help provide transportation to my daughters' day camps. In the summer, I start my days at ~7AM, take a mid-day break, and start up again in the late afternoon.

My 2 current employees, who have been with me from the beginning, cannot work that early or that late. So I have to hire an additional person. Always a joy! Here's how it went.

I posted a job ad on Craig's List for general office worker, and described the position, the location of the job, the pay, and the essential skills needed. Within 20 minutes of posting the ad, I had ~100 responses, which became 200 by the time I was able to read any of them. Of the 200 respondents, I was able to knock off 180 because they simply lived too far away or lacked transportation. One person said he was from Saratoga, which happens to be 9 hours by car from Smithtown. Maybe he has a plane. Others were from Brooklyn and lacked private transportation. Smithtown is suburban and we really don't have adequate public transportation. Brooklyn by car can take 1 1/2 hours. By public transport; 4 hours.

Twenty applicants were local and thus possible contenders. 4-5 did not attach or post resumes, so I excluded them immediately. One applicant used a computer program to publish her resume that I did not have and I was unable to open the attachment. I suppose I could have purchased the software that she used, but instead I axed her. That left 13 0r 14 resumes to review. Several people had obnoxious or annoying email names, like lovekitten69 or anglestar, so I axed them. I did not want my wife to know that I hired lovekitten69. One person's email address was--I kid you not--2good4U. I thought that was a bit presumptuous, so, by-by.

That left approximately 10 people to call. The phone is an amazing device. Not only is it the life's blood of any business, it is the best, safest, and easiest facilitator of first impressions. So I like to call the applicants personally; get a feel for their "phone voice" and personalties, etc. For 1 or 2 people, I was sent to voicemail. OK, not great, but OK. 1 person had an annoying song on their voicemail greeting. NEXT. I left a message on the other person's and they called back promptly. She seemed OK and had a nice voice and demeanor. I asked her some preliminary questions, she answered them well and I asked her to come in for an interview. Ultimately I called 8 people and brought in 6.

One candidate had 6 jobs in 18 months. Sorry, I won't be number 7.

One candidate was really intense and was, I'm sorry to say, too qualified. There would have
been no way I could have kept her happy, financially, and retained her. Sorry. Good luck.

One candidate said she could only work 2 days a week, after 1PM. Hey, whose hiring who?

One candidate said she could work any hours for the pay I was providing and was flexible in terms of number of hours per week. Not bad. She made round 3.

One candidate said she was flexible with hours but upon further questioning, she would need the schedule a month in advance, because her other job "at the hospital" took precedent.

One candidate could work the hours for the pay and was flexible with the schedule, and spoke Spanish to boot. Therefore, on to round 3.

So I am now in round 3, and round 3 is a secret. But I will say to all the candidates who applied for work in Dr Schoor's office, thanks for applying. Just, in the future, try not to stand out in such a negative way. Especially U, 2good.

Thanks,

The IU.

Need new patients? Put your money where the mouth is.

When it comes to marketing and marketing dollars, there seems to be no limit to the possibilities or the costs. Professional marketers will tell you that marketing "should" cost you nothing. By this, they mean that if done correctly, 1 marketing dollar should yield 3-5 in return.

Oh that it is was that easy!

After 14 months on my own, I have come to the conclusion that only one type of marketing works for physicians, with the exception of plastic and LASIK surgeons.

Word of mouth.

W.O.M.

Word of mouth is, and has always been, the best form of marketing for any business, but for doctors it is perhaps the only form of effective marketing. Far from a passive endeavor, word of mouth marketing is an active and continuous process. WOM, I have come to realize, is the most active form of marketing and while it may cost the least in terms of money, it costs the most in terms of effort and time.

There actually is a science behind word of mouth marketing and methods exist that allow marketers to enhance and maximize the effectiveness of the program and to track, scientifically, results.

So there you have it. Put your money where the mouth is!

The IU.

Going solo? Stay away from the crepe hangers

"Stay away from the crepe hangers." This is something my dad used to always tell me. And life is full of them. What is a crepe hanger? Crepe hangers are, among other things, pessimistic people. They always see the downside, the problems, the negative forecasts. They are real downers and they are poison. Stay away.

The term "crepe hanger" is an historic term and comes from a period in history when people used to drape all the mirrors and windows of their homes with black crepe following the death of a loved one.

Medicine is full of crepe hangers. These are the physicians who speak about nothing other than rising costs and falling reimbursements. They speak only of the problems, never the solutions, and are always negative. They are all over the hospital.

I saw one the other day. Nice person. Good doc. I bumped into him in the physician lounge and said, "hey, how's it going?" He replied, "Ahh, you know. Now I'm paying $160K per year in insurance, next year it's going to be $180K. I don't know."

Crepe hanger. He ruined my day. Got me thinking about my problems and made my mood negative.

Crepe hangers. Stay away! They are poison.

Thanks

The IU

Going Solo? Have a fire drill.

Unexpected things happen, well, unexpectedly. If you want the least amount of disruption and damage to your practice, drill for these unexpected occurrences. Here are some "fire drills" you may want to do in your office.

1: A fire drill: Do you know where the fire extinguisher is? Is the pin still in it? Has it been used already? To where does the 911 call get routed, an issue with VOIP. To find out, tell your staff you are going to have a fire drill and have one.

2: Computer crash drill: What are you going to do if your computers go down? Simulate it and find out. You'll be surprised regarding the strengths and weaknesses of your systems. What have you backed up and where? Do you know where key passwords are kept? Do you keep key phone numbers on paper. Can you run the office on paper for at least a short time?

3: Phone down drill: The phone is the life-line of the practice and being without one even for a few hours can kill. Does your phone system have back-up call forwarding? Can patients get through no matter what?

4: Patient collapse drill: With VOIP, 911 may, or may not, go to the nearest emergency station. Where does yours go? Try it out, just make sure you tell the operator it is a drill. Also, do have oxygen? An crash cart? Aspirin? Maybe you do or maybe you don't, but you should know what you have and where it is kept.

5: Angry patient drill: Unfortunately, some patients get angry and can make a scene in your office. very disruptive. Roll play different scenarios to figure what works for you and your office in a variety of situations.

That's it. Hope this may come in handy one day.

The IU.

Need new patients? Go to talks.

I have written posts on the positive aspect of giving talks to groups of people, but there is an even easier way. Simply go to a talk. Choose a talk on a topic in which you have interest and t one that will be given by a speaker you like, or know personally, or who can "pack'em in." Then simply go to the talk with a smile, some small talk, and some business cards. It makes for an easy way to get some face to face time with other doctors and nurse practitioners; any one who may be in a position to refer. It does not cost anything, though it does take time away from family. I do it 2-3 times per year and have picked up a few new patients as a result. Nothing spectacular, but "not nothin neither."

Hope I helped someone with this post.



The IU

Need new patients? Beat their expectations.

When you first go solo, obviously, you do not have an established practice to build upon. This takes time. However, whenever this happens, you can use your existing patients to build your reputation and, hence, your new patient business by providing stellar, beat-their-expectations-service. Here are some tips.

• Call back when you said you would


• Run on time


• Call when they don't expect you it


• Open "special" hours, just for them


• Book a referral, such as for a CT scan, for them


• If they are having a problem, squeeze them in today or tomorrow, no matter what


• Have copies of articles you authored and awards in the waiting room


• Keep a copy of of CME certificates in a nicely bound book in the waiting room

Good luck and enjoy the growth.

The IU.

Similarities between physicians and body shops

A few months ago, a sign post unexpectadedly came out of nowhere and dented the entire passenger side of my honda. I won't say who was driving. In any case, my wife and I did not want to put the repair through insurance, fearing, as most of us do, our insurance company. So I took the car to a few body shops for estimates. Most were in the 3-4 grand range since this was cash pay, and thus full price. In addition, these body shops did not contract with our auto-insurance carrier. In the end, fearing run-away costs, I contacted our insurance company and put the claim through the insurance. I had the car fixed for a fraction of the self-pay estimates (total cost, including deductible) and it was fixed just fine. So that got me thinking about body shops and doctors and the similarities between the 2 occupations. Here are some:

• Most people cannot afford auto body work as a cash pay. Most people can't afford health care as a cash pay.


• Most people use body shops that contract with their insurance company to save money. Most people choose doctors in their plan, to save money.


• Some people have collision insurance that allows them to use any body shop, but the deductibles can vary. Some patients have "out-of-network" benefits, though the co-pays can vary.


• Mechanics in the "out-of-network" shops promised me that they would accept my deductible and not balance bill me for any "extra" charges not covered by the insurance. My hand surgeon did this exact same thing. He promised not to balance bill me for the difference between his fee and the 30% of "usual and customary."


• Auto body shops don't waive deductibles. Doctors don't (or should not) wave co-pays.


• Auto body shops wait for the reimbursement checks. So do we.


• The car insurance company publishes a list of sanctioned auto body shops in my vicinity. The health insurance companies do this as well.


• The car insurance company pays the auto body shop a lower rate in exchange for the promise of higher volume and thus more money. Same in medicine.


• Auto body shops need to fix lots of cars in a short time period to make money. Doctors need to see lots of patients in a short time period to make money.


• Auto body shops use expensive tools to help them align parts and ensure that the repair is adequate. Doctors use expensive tools to diagnose and treat disease.


• Some people are not happy with the result of the auto repair. Some patients are not happy with their outcomes either.


• Auto body shops have manuals with standardized parts and labor reimbursement rates. Doctors have CPT and ICD-9 books.


• Contracted auto body shops can't balance bill you. In-network doctors can't balance-bill either.


• Auto body shops that cater to Porches and Ferraris can charge a lot more than typical auto body shops. Plastic surgeons in Beverly Hills can charge a lot more than a general urologist can in Suffolk County NY.

So there they are. It sucks too admit it, but it is true. We are really just glorified auto body shops with $200,000 in education debt and $30,000 plus per year in malpractice insurance premiums. Don't get me wrong. I love what I do and I treat every patient to my utmost ability and effort. I just understand my place in the grand scheme of things.

Sorry if I offended and I hope you enjoyed the post.

The IU.

Need new patients? Look to your existing patients.

You want new patients, right? So do I. New patient business means everything--growth, success, stability, the future. But don't ignore your existing patients for they are your best source of new patient business. All you need to do is to figure out how to harness the power of your existing patients to generate new patient business. Here are some things you can do and some things you must do.

• Keep your existing patients happy (A Must!)


• Mail fliers periodically with new procedures you wish to promote


• Send them business cards or magnets periodically


• Publish a news letter quarterly


• Ask them to "tell-a-friend"


• Direct patients to your blog and tell them to refer others to it.

Thanks.

The IU.