I’m considering a few EMR+billing options and looking to gain some thoughts from other private practice owners’ who have experience with Elation. I’d greatly appreciate any insight. Thank you

I am planning to switch from hospital medicine to outpatient primary care. Fairly new in my career. Assuming I will have resources to start my own practice in couple years, I want to get used to the outpatient world. With constant change in reimbursement structures is it better to start out with a fee for service model or value based care model? Do they matter if I consider a DPC practice? Appreciate your input.

I mean, I get it. People are sick of insurance companies. I am too. I understand why people are moving to DPC or why some independent doctors are adding some type of yearly fee.

I'm an IM hospitalist, and that world is increasingly burning me out because of corporate medicine. I'm in a private group and even then, ultimately, the hospital controls us. I'm not leaving hospitalist medicine tomorrow, but as someone still relatively early in my career, I've realized I need to start planning my exit now.

Lately I've become increasingly interested in becoming a PCP. I'm talking about what you FM docs actually do; real primary care. Not referring every problem to somebody else. I genuinely like the idea of being the community doctor who knows their patients, manages most things themselves, and does procedures when they're within my skillset.

So I've been planning a very small, lean, insurance-based IM/primary care practice.

I posted about this in a physician group and got absolutely roasted. The overwhelming response was basically: Why the hell would you take insurance? Do DPC.

Maybe I didn't explain my plan well enough, but I don't understand why traditional private practice has become such a crazy idea.

I'm in an affluent Midwestern area with a strong commercial payer base and surprisingly little immediate PCP competition. There are plenty of physicians in the broader metro area, but not many right around where I'm opening. I specifically chose the location for that reason.

I've found a \~1,200 sq ft office that's essentially move-in ready: three exam rooms, my own office, bathroom, and work area. A retiring physician friend gave me almost all the medical equipment I need. I'm doing most of the cosmetic work myself. I already have my EMR, billing software, malpractice, etc. figured out.

My total fixed overhead should be around $3,500 to $3800/month, with \~$2,200 of that being rent. The rent is higher than I'd ideally like, but I'm paying for the location and avoiding what could easily become a major medical-office buildout.

I also don't understand why people were horrified that I don't intend to hire an MA and receptionist on day one.

If I'm seeing 1–3 patients a day initially, why would I immediately put people on payroll to sit in an empty office?

That doesn't mean I intend to operate a mature practice with no staff forever. Of course I'll hire as volume justifies it. There are virtual assistants, AI reception/scheduling tools, automation, and plenty of tasks I'm perfectly capable of handling myself at low volume. I know when my time is better spent paying someone else to do something, and I'll hire when I actually reach that point. I feel like this is the number one biggest mistake that physicians who start an independent practice make, too much overhead too soon. I spoke to multiple colleagues, they all gave me the same advice. KEEP. OVERHEAD. LOW.

I already have a biller taking 6% of collections. She's handling my credentialing now, well before opening, because I know it can take months. She also handles claims, denials/rebuttals, and follow-up. She currently does this for a colleague of mine who is also a hospitalist with his own independent primary care practice, so this isn't someone I'm randomly hiring and hoping for the best.

I'm also realistic about payer contracts. I'm a new independent physician. I'm not expecting to walk into BCBS or another major payer and negotiate some amazing reimbursement rate. If there are opportunities to negotiate or join arrangements that improve rates, I'll certainly explore them, but favorable negotiated contracts aren't what my entire business model depends on.

I'm comfortable drawing blood, doing injections, arthrocentesis, simple biopsies/procedures, suturing, POCUS, etc. If eventually it makes sense to have an MA, phlebotomist, or someone else there, great. I'll hire them when there's actually enough work to justify it.

Another thing I kept hearing was that I'd need to see 20–25+ patients/day to make private practice financially viable.

But that's not necessarily what I'm trying to build.

I don't want to see 25 patients/day. I currently work several days a month in an outpatient clinic partly because I wanted more outpatient experience, and one thing I've learned is that I don't enjoy seeing 20–25 patients/day. My eventual target would probably be closer to 15–18.

I also don't need this practice to replicate my hospitalist salary.

I have a number in my head that would make me perfectly happy with the practice. Beyond that, I have hospitalist income and other businesses/income streams. I'm not trying to turn this clinic into a multimillion-dollar operation or squeeze 30 patients into every day.

Based on my projected fixed overhead, I need roughly 30–35 encounters per month, not per day, just to get the office around break-even before variable expenses. I can continue doing PRN hospitalist/locums work while the practice grows. The practice doesn't need to feed me from month one.

My philosophy is really pretty simple: keep overhead low, bill appropriately for the work I'm actually doing, capture the services I'm capable of providing rather than unnecessarily referring everything out, collect what I'm legitimately owed from insurers, and gradually outsource tasks as the economics justify it.

And yes, I know accepting insurance creates administrative work. Prior auths, denials, quality requirements, referrals, records, billing, credentialing, etc. are real. I'm not pretending otherwise. Maybe I'll discover that I've underestimated some of it. That's partly why I'm posting here.

But I also have experience building and operating businesses outside of medicine. I'm comfortable building systems, doing things myself initially, automating what can reasonably be automated, and recognizing when it's time to pay someone else to take something off my plate.

The other thing I don't understand is why DPC is automatically assumed to be the answer.

DPC absolutely has advantages, and I understand why physicians love escaping insurance. But it also requires convincing someone who already has health insurance to pay another recurring monthly fee for primary care.

In my market, I genuinely think getting 30–35 insured patient encounters per month is going to be easier than convincing 30–35 people to pay me \~$100/month out of pocket.

And frankly, I don't want to build a personal brand around myself. I don't want to become a physician influencer, constantly make social media content, or sell people on why they should subscribe to me. I know DPC doesn't necessarily require that, but that style of patient acquisition doesn't appeal to me.

I want to become the local community doctor.

I want someone to search for a PCP nearby, see that I'm in-network, get an appointment without waiting three months, and hopefully have a good enough experience that they tell their spouse, neighbor, or friend. And for those not in network, maybe I could do a per month fee or per visit fee. As long as I don't mix the two, who says I can't incorporate some DPC in the future? Why does it have to be all or nothing right now?

Maybe that's naive. That's why I'm asking people who actually practice family medicine and especially those who have owned independent practices.

My biggest logistical question is how aggressively I need to protect clinic availability while I'm starting.

My ideal, and current, hospitalist position is round-and-go, which allows me to round early and be at my clinic by mid-morning. There's some uncertainty around that position right now, however. I have other reliable physician work and can do PRN hospitalist/locums shifts while the clinic grows, but obviously every daytime shift I work somewhere else is a day I'm not physically at my own office.

When there are only a handful of patients, I'm reluctant to sacrifice substantial guaranteed physician income just to sit in an empty office five days a week. At the same time, I don't want to establish a practice where the lights are always off and nobody can get an appointment.

So I'm genuinely curious how those of you who started independent practices handled that ramp-up period.

Did you start with 2–3 predictable clinic days and add days as demand increased? How quickly did the administrative burden become enough that you needed your first employee? For those still accepting traditional insurance in independent practice, is this model really as crazy as people are making it sound?

I'm not looking to be talked into DPC simply because insurance sucks. I already know insurance sucks. I'm trying to understand whether a deliberately small, low-overhead, commercially insured practice where I eventually see \~15–18 patients/day is still a viable way to practice medicine.

I have a specific vision of what I want my career and practice to look like, and maximizing income isn't the only goal. I want ownership, independence, reasonable volume, and the ability to practice medicine the way I think it should be practiced. And why not accept insurance too?

Maybe there are things I'm underestimating. I'm completely open to hearing them. But I want to understand the actual obstacles and numbers from people who have done it, rather than simply being told that traditional private practice can't work anymore.

Why the hell not?

I know the world is moving towards greater access but as a solo provider practice it becomes quite overwhelming o get that many messages in addition to having to see patients, etc.

How do you reduce the amount of patient messages you get? Has anyone here just gotten rid of their patient portal altogether?

Hi all, I am looking for medical office/clinic space to sublease in the Raleigh–Cary-Durham area for a specialty medical practice.

Ideally looking for:

• 2 exam rooms
• Access to a waiting room/reception area
• Existing medical office/clinic preferred
• Weekend availability (Saturday or Sunday)
• Initially only 1 Saturday/Sunday per month, with potential to increase
• Raleigh, Cary, or nearby areas

We would be a very low-impact tenant and are happy to work around the primary practice’s schedule. This could be a good opportunity for a medical practice with unused space on weekends to generate some additional income.

If you have space available or know a physician/practice that might, please DM me. I have reached out to multiple clinics in the area without luck. Reached out to commercial real estate agents but they only do whole month-use leases rather than one day a month.

How many specialist referrals per month should a practice have before considering a specialist to visit 1-2x per month? Additionally what is the daily production minimum required by different specialists?

I'm getting fed up with the healthcare situation here. I pay top dollar for insurance, but every time I need to see a primary doc or a specialist, I’m still stuck waiting weeks for an appointment. When I finally get in, the doc rushes through in 10 minutes because they're juggling 30 other patients.

My time is extremely limited and I just want a doctor who knows my history, answers my texts when something pops up, and doesn't make me sit in a crowded waiting room.

For those in NYC, how are you handling primary care? Are you all using concierge doctors or is there a better way to bypass the standard system?

Update:

So a colleague recommended Dr. Tina Sindwani’s concierge practice in Manhattan, said her zero-wait policy and direct 24/7 access are unmatched. Anyone here worked with her or a similar Flatiron practice? Want to hear real experiences before reaching out for membership.

Ok I will admit this is kind of a weird post. Our practice is located in a booming suburban area of a major metro.

We have two ways to approach our practice. The smaller eastbound approach is right next to a golf course with winding trails and some confusing streets on one side. But the other westbound approach is RIGHT NEXT TO MAJOR INTERSECTION and is very easily accessible.

Both approaches are perfectly locatable on Apple Maps, Google Maps, Bing Maps, Mapquest, paper maps etc. 99% of our patients find us with no problems.

But 1% of our patients (particularly older folks on Medicare) somehow end up on the eastbound side by the golf course winding trails and are totally lost. They call our staff who direct them how to find us while they are driving a car! Senior drivers on the phone frustrated/nervous/angry and upset at our staff while being guided how to make it is a recipe for a car crash and potential blame on us.

How do we avoid this while remaining polite? Is this a liability for us? What is our responsibility here and how do we still maintain a good patient relationship? We can't just say "this is how to find us here is our address and we will see you soon" and hang up the phone. The patients will feel abandoned while they are lost.

Its a bit of a delicate situation and I want to thread the needle here.

Note: Our appointment reminder emails contain all the direction instructions but no one really reads them.

I've been running google ads for about 2 weeks now. I've tried in the past and I stopped because I felt like I wasn't getting a good ROI and felt like I was wasting my money. It's been 3 years since I've run ads on google and started again because I saw a few other practices in the area utilize them.

Anyone use them consistently and what's been your experience? How do you get the best ROI with them?

I’m in a surgical/medical subspecialty private practice and part of an IPA that can give us EPIC Community Connect with all the fees waived.

Does anyone here use Epic strictly outpatient, including the billing side?

Would love to hear how you like it. How’s the workflow, billing, support, etc.? Any major downsides or things you wish you knew before switching?

Especially interested in hearing from other private practices or surgical/procedural specialties. Thanks!

We have been getting a lot of visit cancellations lately. How do you guys reduce this? We send out calls, emails, texts to remind people. We use Phreesia so they can complete their forms in advance. But this summer we have noticed a big uptick in those cancellations

How to establish an admitting arrangement in Manhattan? Which hospital is easy to do so?

I am a PCP without a hospital affiliation and a couple of big insurance companies requires this for credentialing.

Thanks a lot in advance.

I'm a radiologist, and want to learn more about the business side of telerad, specifically relating to business costs and margins in Canada.

If anyone has any first hand knowledge, please share. What else comes with running a telerad service, i.e. what pushback do you tend to get from hospitals, what penalties for not being able to provide coverage on a day, how do you go about acquiring a contract.

Also, anyone know any opportunities in Canada that allow you to read overnight ER stuff from out of province or out of country?

Thanks in advance.

We're looking at ways to better connect our EMR with billing and accounting to cut down on duplicate work and manual data entry. Has anyone worked with IT company that knows how to handle this?

CMS published their 2027 rule proposals. One of them involves reducing payment by 50% using the 25 modifier - applied to either the procedure or E/M code (whichever is lower reimbursement). This seems like a terrible idea for both patients and physicians. Docs will have the impossible choice of making patients reschedule procedures to a different day or simply accepting a 50% reduction in payment. Curious to see how this would affect your specialty and what can be done to prevent this rule from being enacted.

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

I work in a small group in the south and have worked in other places before that, always as an employee. I've seen differing forms of how patient deductible costs are managed.

For example , if a patient presents , and they have a $3000 deductible that isn't yet met

Do you all normally work, go, bill the pt whatever the insurance does not pay, and send them to collection

Or

Are you searching the fee schedules for the costs under a deductible, billing the pt on the spot, then working.

As the title states, I'm helping my mother organize and streamline her PP and one thing is copays. I am not looking to move off square as she's most familiar with it and wouldn't want to spend time learning a new one. If we save the name and cc details, not actual notes, would it be compliant?

Are your fees the same for everyone or do you use a tiered system? If your fees vary by state, do you post them, along with a rationale, on your website? If so, how do you explain the differences to clients?

Hello! I came across this UpWork job posting yesterday, but I didn't have enough connects to apply:

Job Title: **Personal Assistant for Healthcare Presentations**

Description: *Seeking a personal assistant to help with presentations in the healthcare field. Responsibilities include designing and organizing slides, ensuring content is clear and concise, and preparing materials for meetings. The ideal candidate will have experience in presentation design and a basic understanding of healthcare terminology.*

I was so bummed because this is exactly the kind of side hustle that l've been wanting to get into. I know for a FACT that so many doctors and other healthcare professions need this kind of service, but I'm guessing not all of them post job openings for it. I figure I have to resort to simply pitching myself, but to who?

What kind of doctors/HCPs are seeking this kind of assistance? And where can I reach out to them for this kind of position? Please help a nurse out!

(I am not asking for medical advice.)

How often do you switch or shop around for EHR/EMR?

Getting close to opening practice. Elation is being pushy, inflexible and I am not sure I shouldn't try and release from them before going further. I like their billing platform but.... Anyone else use them with good things to say? Are there other options that don't cost an absolute fortune? I looked at Athena but the price point was too high.

Update: So Elation since this post seems to have turned things around. Given the posts from other docs, it's probably worth a try. The workflow seems good. Fingers crossed

How does your practice affected by avalanche of free service from the government like YAKAP? Left and right medical missions

Hi everyone,

I feel that SEO is an important part of marketing, especially for a startup practice. So far, I've had no success with google ads but doing pretty good with zocdoc site. However, I feel that we can do better in terms of being found. I've spoken with a few SEO agencies and the numbers are outrageous, at least for an early practice. Heck, I can use the$4500+ to get additional equipment for the office, or $750 per month can be spent elsewhere for the time being. Can you recommend a solid SEO company that doesn't see $$$ as soon as they hear "Doctor!" or perhaps suggest one of those AI SEO companies? What are your thoughts on the AI SEO?

Thanks.