Of course I don’t plan on keeping this blog going forever, but I would like to continue writing until we are stable and on sure footing. We are poised to make our fifth payroll on Thursday, but there won’t be much left in checking afterwards. So this brings me to my first observation. If you are a PA or NP and want to start your own practice, and getting rich is one of your motivations . . . then don’t do it.
I’ve lost a lot of sleep over this issue, and this was a very difficult letter to write Dear Jane, I’ve given our situation a lot of thought this afternoon. I know it sounds that I’m a Dr. Jekyll and Mr. Hyde because just a week ago I was sending out congratulations to you and Brenda. I was really hoping that we were on the right path and I only wanted to sing your praises from that point forward.
I was sweating bullets but we did it. We made another payroll. I think the company has a little over 4 grand in the bank . . . but that’s a false security blanket. I owe 2 grand on a credit card, 2 grand for Botox and I have a bill coming in soon for about 4 grand. The good news is that we are still working very, very hard. We’ve had to fill every day’s lunch “break” for the past two weeks with work in patients. The work load is still beyond my wildest dreams . . . but the payment faucet is still cold. As of today, we’ve billed about 42 K in services. We’ve received (after 5 weeks with the doors open) about$3400. It is so hard to be patient and watch the bank account struggling to take its first breath. But it has to be weened from the vent (bank) soon. I’m praying that the money dam will soon break and the cash will start to flow. This next two weeks will be the biggest test. I add the MD to the payroll by the next pay day. There is so much going well. We had two diagnostic challenges so far (which is unusual for a headache practice). I think we performed in a stellar fashion. These were patients who had been misdiagnosed by several physicians . . . and had very serious problems (brain tumor, hydrocephalus and one with temporal arteritis). We got them diagnosed and sent to the proper care in record time. Both patients have written long letters expressing their great gratitude. I take nothing for granted. I’m still working on marketing from every angle I can. The future looks very promising but it is still tense. I’m dreaming of the day when this season of incredible stress, waiting, counting pennies and hoping for checks in the mail will end.
I picked up the mail today, the first time since Thursday. I was very happy to have about five letters from insurance companies. The first one, wow, a check for $480.00. I had a great feeling that the dam . . . I guess I should say the damn dam was about to break and the money to flow. The second letter was telling me that they were paying only $46 on a $200 bill and the patient will have to pay the difference. Even the $46 will come later. No check in that envelope. The next letter was telling me that Patient X was no long enrolled and they weren’t paying. Of course all of these rejections are just part of doing business and we will have to re-submit. Okay, I’m still feeling good. Then the next letter is from Group Health (the major insurer who is boycotting my clinic). I had asked for a meeting with their CEO and me bringing my attorney. Their letter was to inform me that the will be setting up a meeting soon. Next was a totally unexpected bill from a newspaper for $500. I really thought I had settled with them. So my daily sum was now – $20. This is another aggravating thing with vendors. Not as if I didn’t have enough to do already, but I keep getting these big bills which need to be checked over and over. I have already found several big errors . . . always in favor of the vendor. I can’t wait until I’m done doing business with all these start up entities. Then the last envelope. Another bill (for Botox) for $1050. Yeah, I will eventually get paid back for that by the insurance company . . .in a few months. But this hemorrhaging is draining the life out of me. It is hard to sleep at nights once more. So for the day I am $1070 deeper in a hole. Now that was all the bad news. As I’ve said, the reality of the clinic has far exceeded my expectations. More patient demand than I had predicted in my most optimistic expectations. On the practical level I am delighted. But if those feakin money valves would open and let the cash flow so I can pay my bills and . . . sleep at night. That’s when the dancing really starts. So if I don’t see money soon, I don’t know how I can meet my next payroll.
It has been a couple of months since I was in the middle of extreme stress. The good news has helped. In the good news section, I have exceeded my most optimistic projections. In summary, I must bill for about $25K per month to sustain the office. I had projected that we would reach this level in about October. As our first month, June, is drawing to a close, it is becoming clear that our billings in this very first month will meet those break-even projections. The worry part is that while the insurance companies presently owe me about 25K, I’ve only received $238 (that is two HUNDRED and thirty eight dollars, not twenty three thousand). Of course all of us who work in health care know that there is a long delay between billings and collections. I think if anything has caught me by surprise has been the expenses. I mentioned before that our phone system and our advertising has completely busted our budget. Once you are in the water and bleeding, the sharks start coming from all directions. I was getting bills left and right for services we never used. My office manager has been great, but it is draining having to fight with these people. For example, my office manger had to call our phone system vendor last week to set up our evening call phone (our system can screen calls and direct emergencies to my cell phone). It took about 15 minutes over the phone to set this up. Today, I got a bill for that conversation for $53. I know that’s not much. But in my other mail, I had an unexpected bill for $7,000 for our road sign. I had paid those jokers once. I know that some of their conversations had occurred with my office manager. But apparently they ran into some electrical trouble with the sign by the road (which we really needed to have). However, I never knew that this “problem” changed our agreed price from about $3500 to double that. But my most worrisome thing was I did our books. Next week I must do payroll, and pay rent at two sites. Also I have to pay, not only income tax (at the end of the year, if there is any income) but payroll tax, city tax in Bellingham, Revenue tax (like sales tax on services), labor and industry fees or tax and the list goes on and on. I wanted to get our books up to date in preparation for our book keeper who will be in on Tuesday. So in my hand I had bills for a total of about $8,500 including that sign bill and a $1,050 bill for Botox (which will take months to get paid for). However, once I balanced my computer check book I was shocked to see that the $15,000 that was sitting in my account last week was now $3005. So, how do I pay $8,500 bills with $3005? The hard thing in this is that the insurance companies presently owe me $25,000. So, I had to send an urgent e-mail to my bank. “I need $15,000 by Tuesday!” Once I make this draw, that means I have just $15,000 more to draw before they close the vault . . . forever. They made it clear that I must never ask for one cent above the total of $65,000 loan. So, I feel nervous. Ironically, on the clinical front, I’m working my ass off. I was over-booked three days this week. I’m putting in an easy 60 hours a week. But will the money come in, in time? Stay tuned while I sweat bullets for a few weeks.