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  • Avatar nephron 
    Participant
    Status: Physician
    Posts: 265
    Joined: 05/09/2019

    We probably have some 50% no show rate, and avg some 10% no shows in follow ups.   We give the primary care physicians office a time for new patients to be seen when they are referred, a lot just decide not to come or don’t know to come? I imagine.    We never “fire” any patients from our clinic, the patients who do not make their appointments, take their medications, etc are usually the ones that are much more likely to need dialysis and actually need our services.   We have a real shortage of primary care physicians in my area as well, even my patients with private insurance tell me that they cannot find anyone accepting new patients locally.

    #221424 Reply
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 201
    Joined: 05/02/2017

    I’m in fam med too.  I had  to stop seeing new patients – I was getting pretty far on to burnout.  We definitely have a primary care shortage in our area too (a symptom of our system, where I can walk in and say “Yup, AK, 10 seconds of liquid nitrogen, done” and get paid more than HTN/DM/HLD/Depression/etc/etc/etc).   Our system lets APP’s be PCP’s but no one in my relatively affluent suburb wants that (they will go see APP’s in a more under-resourced suburb in the hospital system).  At one point, I had a 7 month wait for new patients too.

    Lordosis – if you can’t “turn off” new patients, you can certainly effectively do that by adjusting your template. If you have 100% control of your template (enjoy it while you do!) – just change to 1 new per week or 1 new per month or whatever to keep your workload manageable.  I once worked with an awesome practice manager who dynamically adjusted templates – he did stuff like cluster physicals in the slow summer months, have more acutes in winter, have fewer physicals and more acute/routines around the times of when you went on vacation, block some slots until 1/2 way through your vacation, so you could get people plugged in who needed you right when you got back, etc.   An evening clinic of school/sports physicals when there would be demand.  He kept a pretty close eye on panel size and 3rd next available for different slot types. Alas, I don’t have that in my practice now.

    As for a collections model, you now have a lot of incentive to see more private pay than medicare than medicaid than self-pay.  We put informal caps on different insurance types.  Worth keeping an eye on, if someone can run those numbers for you.  OTOH, I used to volunteer in free clinics, now I don’t.  So I don’t sweat it too much if I see a few more, or if I fudge down and pretty much never bill a 99214 to a self-pay patient.   I did find out I have a ridiculous % of medicare patients, so successfully lobbied to have no new medicare, though I do still accept my own patients who age in.    Your collections only model may also change -we moved to a $/wrvu model, which is fairer.  We all know a medicaid 99214 is harder than a BCBS 99214, but the collections for medicaid suck.  I get the sense you know what you’re doing, but learning to code and learning what pays well and what doesn’t will definitely do you well.

    As for APPs, I completely  agree that it’s all in the experience, training, and fit between supervising physician and APP.  Most PA’s I’ve worked with have been good, most older NP’s (experienced nurses before brick and mortar NP programs) are good.  I’ve got good relationships and trust now with the 2 I supervise.  It’s the college -RN – straight to online program NP that scares me, as  they oftentimes don’t know what they don’t know, and don’t have “sick / not sick” judgement.   I saw a patient who was just out of nursing school, 6 months experience on wards, already doing an online program, and getting her clinical hours with another APP who had done the same kind of track, with less than 2 years experience as an APP.  No thank you to hiring her on.

    and, enough rambling.

    #221443 Reply
    Liked by Tim, Lordosis
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 2113
    Joined: 02/11/2019

    I have a lot if freedom in some things but limited in others. We have some rule that if a patient on the list to be seen has an acute issue they need to be seen in 3 days. It is so dumb. So basically anyone can come in for a new patient appointment if they have an acute issue. I have argued this several times but supposedly it come from the insurers.

    I have no say what insurance I take. I have a good mix. Maybe a little heavy on Medicare. I don’t have a ton of Medicaid but they come in the most.
    One of the few decent things about NY is that the reimbursement is not terrible.

    I am happy with my model for now. Basically I keep 55% and that let’s me earn a very good wage seeing a reasonable amount of patients. We also get to keep incentives from the insurances. I also do work with our nursery and get separate money for that.

    I was a Jew before I was a doc so whenever I see AK I always think of this.
    https://jel.jewish-languages.org/words/15

    I agree with your assessment of APPs.
    Thanks for the comments

    “Never let your sense of morals prevent you from doing what is right.”

    #221488 Reply
    Liked by Tim
    Avatar Antares 
    Participant
    Status: Physician
    Posts: 512
    Joined: 01/20/2016
    Splash Refinancing Bonus

    As a psychiatrist, I’d respond, but the answer would be ridiculous and not helpful. At this point I think my existing practice will be plenty for the rest of my career, and new patients are where potential major stress lies. I want to see three letters of reference for any potential new patient, and preferably review psychological testing results before doing an evaluation 😉

    #222148 Reply
    Liked by Tim
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 2113
    Joined: 02/11/2019

    Good place to be!

    “Never let your sense of morals prevent you from doing what is right.”

    #222254 Reply
    Liked by Antares
    Avatar Physician Finance Basics 
    Participant
    Status: Physician
    Posts: 37
    Joined: 06/02/2019

    You are a conscientious doctor, your patients are lucky to have you! You would be great if you decided to hang your own shingle, too. Maybe you’d even do better than 45% overhead?

    Love your signature

    Blogging and videocasting about the basics of personal finance at http://physicianfinancebasics.com

    #222428 Reply
    Liked by Lordosis
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3286
    Joined: 09/18/2018

    Interesting perspectives. I was pleasantly surprised that it focused upon managing volume rather than marketing for additional revenue.

    Antares seems the most restrictive and rather exclusive. The vetting process must be stressful. (TIC).

    #222519 Reply
    Avatar Antares 
    Participant
    Status: Physician
    Posts: 512
    Joined: 01/20/2016

    Interesting perspectives. I was pleasantly surprised that it focused upon managing volume rather than marketing for additional revenue.

    Antares seems the most restrictive and rather exclusive. The vetting process must be stressful. (TIC).

    Click to expand…

    Yes, but on the other hand I’m 60 and in the last years of practice. It’s somewhat akin to going part time, as my need for income isn’t as great as it once was. Exclusivity is a privilege of age in my case…

    #222574 Reply
    Liked by Tim
    Avatar EntrepreneurMD 
    Participant
    Status: Physician
    Posts: 390
    Joined: 06/10/2019

    In my experience dealing with insurers, it seems most do want acute patients to be seen within 2-3 days and, routine checks in 2-4 weeks. I believe they prefer this whether they are new or established.

    We try to do same or next day for acute, and within 1-2 week for general check-ups. Otherwise they end up at an urgent care – how long can you wait for a UTI or a respiratory infection? 6 months is a long time for new patients, we often get new patients that are hospital follow-ups so per guidelines 1-2 weeks is preferred if non-acute. To do that your employer needs to provide adequate resources (ie support staff) because you are a team, it’s better from a patient care standpoint and for capturing new patients rather than them go elsewhere.

    I think most PCP’s i talk to, myself included allow roughly 4-10 new patients a day. If you have a younger/healthier demographic, probably toward the upper number but less for a more complicated demographic. Sometimes the visits are not complicated so if you you streamline the intake (our patients download new patient paperwork online so they can complete before coming in) and as long as your staff can enter their information into the EMR efficiently, you should be able to see more without much intrusion to your schedule.

    Our demographic is mostly commercial and about 30% Medicare, no Medicaid, 5% cash pay.

    #222693 Reply

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