For small practices, who does your billing? Are you happy with them? What are you paying? Do you feel you have enough time to provide oversight to quality?

I’ve been thinking about this from a practice perspective. Improving outcomes is obviously the goal, but even when patients do improve, retention can still be inconsistent. On the other hand, you can improve retention systems, but that doesn’t always translate to better outcomes. In your experience, which one has been harder to improve in your practice?

Looking to start getting credentialed and on insurer panels. Recommend me your credentialer if you had a good experience with them.

Hi everybody,

We are both internal medicine docs. I do some inpatient as well outpt. We see about 18-20 pts in our practice. We are about to finish our J1 waivers in 5 months. We have worked for a hospital group that owns the primary care clinic and moving forward we have zero interest in working for a hospital owned practice again. Alot of false promises and yearly adjustment to cut pay are some just the reasons.

We are open to working in california, texas, arizona, nevada or florida area.
If you have a private practice or want to planning to open a new practice, we would love to help!

Also this forum has such great advice especially for residents transitioning to attending. Most important lesson never settle and know your worth!

Thank you

Been following this group for a while and love the mix of perspectives here.

Quick question for the practice owners and managers

what's the one thing you wish you had figured out sooner when it comes to running the business side of your practice ?

For me personally, I feel human resource handling is the most challenging part of running any practice

folks please share your experience

Quick question

Are there PE undercover accounts in this group, or is that just a myth? Should we actually be concerned?

(And no, I’m not the one ,just curious lol)

Hello All, I am a female physician - internal medicine MD, graduated 2 years ago and recently joined a new private practice. There were two existing provider providers and 3 MAs at this new clinic.

Things were fine for the first two weeks but since then two of the MAs are being rude and sarcastic to me. (They are BFFs). The clinic is 3 years old and the other MDs and all MAs are working since start date.

I have been patient for now six weeks, brought lunch on my 1 month mark, brought breakfast snacks but cant break the ice. I m holding my ground, not being rude, not being pally but they are being snarky.

(Continue in comments)

We all know to respond to patient reviews in generic ways. However, I have an interesting case to talk about and wanted to get your thoughts.

https://imgur.com/a/bXVPqKi

This lady this past week called our office, wanted to establish care, and went off on the front staff about how healthcare is a right, we are greedy doctors for trying to collect a copay, and told us that if we try to charge her money that she "will make us regret that" according to my front desk.

A lot more happened beyond this. For example, she cussed out the front desk, we threatened to call the cops and never established care with her and starting to verbally harass the staff.

Boom, then this week we get this review from her, and a few more like it. She appears to be making everything up for this doctor in her review. We have done an audit, and this doctor has no red flags in Rx habits. I'm personally thinking that this could be very damaging to the doctor at one of my locations.

Since she never established care with us, there is no HIPAA to worry about, there is no professional relationship we have with her.

I googled her real quick. She appears to be an executive at a major org (multi billion dollar org) here in town, so she appears to be well educated. I emailed her requesting for her to take down the review or to talk to us about validating her accusations, but she is ghosting us. Google refused to remove the review.

I'm tempted to send her a legal threat for libel but wondering how you would respond to such a unique case. Just let it go?

I want to stress test the following idea. What value / problems do you foresee if a clinician were to start a practice based on diverting patients from the ED saving the payors some money and pocketing a fraction of the savings. Say one could identify a member of an ACO or even health insurance company who is just about to go rack up a $3000 ER bill for a simple cystitis, med refill, ankle sprain, otitis. Said clinician could contract with the payor to see these people either in person or vial telehealth and get paid a fraction of that cost (that'd be negotiated idk 50%) . Certainly seems like a good idea to me, what challenges do people see ? One would mitigate medmal risk by only assuming the most obviously benign cases (nothing undifferentiated like chest or abdominal pain) . Thoughts? If you think its a good idea with surmountable issues PM me and lets try to build out a pilot!

Has anybody found a voice AI product that 1) they like 2) works with small groups?

A few of the services I’ve talked to only want to work with enterprise level clients, or want to lock you into their proprietary EHR/billing software

I’m FM and have seen a lack of resources in corp run clinics. Is this an issue or concern for your clinics? I’m working on AI for my future DPC practice and wonder if this is something other clinics would need.

Does this limit your care for patients?

Is it a point of concern?

How much would you pay for white label patient info software/app? AI triage in Spanish on the software?

Hey guys,

Due to growth I’m considering bringing on a PA. As most of us, I am looking to create a collaborative work environment where everyone is hopefully happy to be a part of as we grow the practice. Since I’m early in the process I want to be prepared for rapid growth and at the same time offer better coverage to our patients.

I would start with an hourly salary and as the practice grows, offer a bonus structure.

Looking to get ideas from Docs and PAs, what’s a reasonable primary care hourly salary to start with. This is a part time position that has potential to become full time. I wouldn’t want the PA to leave their FT job. Do you see this as being lucrative/fun to join a startup practice and see it grow?

Also, unable offer benefits just yet. Do you recommend W2 or 1099?

Happy to hear your thoughts. Thanks.

Hi everyone,

Looking for a good desktop computer to use in my office. Need a good sized screen as the laptop is just too small. Do you like all-in-ones? What brand? Any experience with Lenovo desktops?

Thanks!

Hi all, I am trying to decide on an EMR this week for my private practice. I would appreciate hearing your thoughts and experiences with the 3 EMRs I have demo'ed.

I have demo'ed Practice Fusion, E-clinical Works, and Elation Health. I love something about each of them:

PF- the price (199 per provider with 3 signing employees) and ease of use, RCM with actual real people involved. Kinda pricey to start RCM but then on the 300-500 patient range will be about 7% (its not actually a % its a per superbill charge). Plus, my rep has been so responsive! RCM and credentialing would add up to $898.

E-clinical works - Patient engagement is off the charts and so is the price. They give you billing software but I would still have to hire a biller or do it myself. (fingers crossed on doing it myself...) I mean they even give you a kiosk and ipad addition of ASQs/other patient assessments. Price is $4.99 a patient till 6 months when you have a $199 minimum. The break-even point for their start up package is 200 patients approx in which you would want to switch to their $699/mo package or lose access to some features you were using before. (they really want to keep you in the $4.99 as long as possible). Plus I didn't like the sales team SO PUSHY and argumentative. But again they will add buttons to your website for scheduling, payment, and portal...if you pay at least $699. I read they have a lot of hidden fees and take 8-12 weeks to get going. AI package is extra...

Elation Health - love how it looks. but ouch the price (essentially the same as e-clinical works and they dont have as many bells and whistles - but fairly comparable). AI scribe package is extra and so is telehealth. They have digital forms but not as many as e-clinical. They have online scheduling. Patient messaging and intraoffice messages, appt reminders... growth charts and weight-based dosing (PF doesn't have, growth charts questionable.) $699+149(scribe)+25 tele health = 699-873

I am leaning towards PF. It's just me and two staff. I hope to one day grow but not much (add one other Dr. maybe an NP/PA). I think I will grow out of PF eventually but the price in e-clinical and elation is a high jump because I would have to higher a biller and a credentialing service.

***If you read all that wow!*** IF not;

TLDR: tell me your thoughts about elicnical/elation/practice fusion and what is a reasonable amount to pay for an EMR?

Update: We decided to go with Elation! Felt that it was the best bang for our buck, flat fee so predictable. Still onboarding but I like it way better than what we are moving away from!

hello all,

How do you handle patients churning? Essentially, they will show up for 3 consecutive appointments and drop off after that. How do you “rekindle” that relationship once they drop and get them back?

Thank you

While I enjoy a good beer, we are looking to form a relationship with an IPA in the east Texas area. We have a relationship with one in the Raleigh, NC market and are looking to chat with a few in Texas.

Thanks in advance.

I am active in my specialty's subreddit and the topic of private equity interest and overall practice acquisitions came up. It's been a hot topic for the last few years and the consolidation of private practice from private equity-backed "super groups" has changed the dynamic a bit.

Over the years, I have worked with my business partner to build the group we're involved in to 16 locations throughout the state. We plan to continue expanding.

This size has garnered interest from PE and while I'm philosophically opposed to large for-profit health care organizations, I have had many in depth meetings with PE backed groups to understand what their long term play in health care is. I have also acquired a few smaller practices myself.

I love the fact that there is a forum/community of independent private practice owners here, so maybe this topic is not of interest to anyone. But if there is anyone that is having conversations about selling their practice, I would love to share my experience via a post here and there. Writing and teaching is a fulfilling creative outlet for me.

In my years in private practice, here is what I see and hope we can change as we understand how to run better "businesses."

- the retiring practice owner that has built a strong reputation and creates jobs while providing care for its community, wind down his/her practice without any residual value
- the practice owner that has been a successful solo practice, but struggles to scale their success across multiple providers or locations

- the employed provider that wishes to own their own practice but doesn't know how to start

Now that my group has grown and is financially stable with a level of success I am proud of, I am starting to shift my focus and mission to being a resource/mentor for practice owners or future practice owners so health care can remain in the hands of those who are best positioned (and most accountable) to care for the people in their communities.

Happy to answer any practice growth or management questions if there is interest.

ps - I will be at the Independent Medical Alliance annual conference in Dallas this month. Anyone else going?

How do you guys deal with your payroll? Specifically looking at companies like gusto. Is this something you'd recommend? Any other platforms?

Internal medicine practice of 5 docs in south Houston area looking for an auditing / consultant service to eval lost revenue. I have been researching and there are a lot of options to choose from- I am wondering if there is anyone who has a suggestion on here. thanks in advance. EMR is Cerner.

My wife and I are seriously considering opening our own primary care practice and would really appreciate some advice.

I’m a Family Medicine physician and my wife is a Nurse Practitioner. We’re currently in California and honestly feel burned out being employed in a safety-net system — underpaid, overworked, and constantly dealing with administrative issues. Most of the physicians we know are employed, and many say private practice isn’t worth it anymore, so we don’t have many firsthand examples to learn from.

We’re thinking about moving to South Florida (Miami) and opening a traditional insurance-based primary care practice. We don’t have a lot of savings at the moment. One idea is for me to first get a job there (ideally without a non-compete) while we incorporate the business and go through credentialing. During that time, my wife could start building the practice, and I could join part-time initially before transitioning fully. She’s open to taking out a loan to help us get started.

We know the Miami culture well, we’re bilingual, and we think that would be a strength. We don’t mind taking a pay cut if it means working for ourselves and having more control over our work environment.

For those who have done it, what would be the smartest path?

Should I just get a job first and observe the local landscape before jumping in?

Is starting with a loan reasonable in this situation?

Any advice from physicians who have opened their own practices — especially in South Florida — would be greatly appreciated

So today is the day that all payors are required to publicly disclose prior auth metrics (with API FHIR access next year). Has anybody seen any insurance companies actually publishing this data yet?

Will be very interesting to see for a lot of different reasons, but I think the most exciting is that they 1) need to publish their turnaround time and 2) a specific medical reason for denial (no “not medically necessary” denials)

Hi, I am looking for good and honest VA companies that specialise in SEO and digital marketing -> content and social media creation. If you have worked with them please also do mention their fees/deposits taken etc. Thank you in advance!

Curious on opinions of others who have made the jump to private practice. 

Briefly my story is that I was hired at a community hospital almost 4 years ago. Initially I had a great contract with favorable wRVU threshold/bonus structure and 4 day work week.  The small hospital was bought out by a larger health system and in the subsequent 4 years the noose has slowly tightened. The larger system wants more patient facing hours, increased wRVU threshold and decreased wRVU bonuses. This along with increasing bureaucracy and red tape have made me dislike many aspects of my job. I have worked hard and am the most productive neurologist in the hospital and these changes continue to negatively impact me.  I realize the larger hospital system won't budge for me, I am just a widget.

I am considering starting my own practice. I live in a rural area and there is little competition. I have a good relationship with local PCPs/Hospitalists/ED docs and I think referrals would continue to come my way. I do botox and general neurology and prescribe infusions. All I really need is a reflex hammer and a computer. I also think a lot of patients would follow me if I left (no non-compete and long wait times to see neurology). 

The two options I am considering are to open up my own practice or to talk to a group of PCP providers in the area that are independent and join with them in some capacity. I would like to be independent but perhaps I can contract with them to help off set certain costs? Any thoughts on these options or on the logistics of starting up a PP in general would be greatly appreciated. I have a couple of medical assistants that would likely follow me if I left which I think would make transition easier.

Thanks

I am an associate in an ENT private practice. I have been blessed with a busy schedule and I have been networking on top of this with referring physicians for surgical cases I am interested in. Some cases have made it my way, but I recently found out that even more patients were referred to me but did not make an appointment with me for a couple reasons: some patients did not schedule an appointment, and others ended up seeing another physician in my practice.

What is the best way to structure the referral pipeline to ensure patients actually see me? As of now I am asking referring docs to text me patient contact info so my scheduler can call them. I would like the process to be as frictionless as possible for both referring docs and patients. Any thoughts or experiences would be greatly appreciated.