Herd Wisdom - Business Model Decision

[jmj11]

So, I've had my clinic for 3 1/2 years.  I think we have finally reached a "critical mass" where demand will never be a problem again. We are booked out for 2 months in one clinic and 6 weeks in the other, plus there are some changes coming (too complicated to talk about here) that will almost double our demand.

 

So here's the problem.  Despite the demand, we remain a relatively poor practice. Additionally I'm exhausted.  I've been on call 24-7 for 3 1/2 years for chronic pain patients. Our typical patient is coming from further and further away and are more and more complex.

 

I really feel I need a major change in our business model to finally increase revenues and decrease my constant stress.  I'm poised for model 1 (below) but some have suggested model 2.  What do you think?

 

Model 1: Hire a full time scribe/ma to shadow me (I do most of this myself) and do a lot of my paper work so I can see 7 more patients per day.  Two more patients per day would pay for the new position.

 

Model 2: Lay off my one office manager and biller.  Work like an independent psychologist where I do everything, but only see about 4-5 patients per day. There would be fewer phone calls. It may even be within reach (if I cut way back) of seeing cash only, but that is a pipe dream that may not be supported by reality (studies show that if you cash only you loose 80% of your panel).

 

But the present situation is not sustainable.  Which would you choose?

 

 

[EMEDPA]

part of what works with your current business model is the personal connection you make with patients. I would be concerned that you might lose that with a scribe in the room. it's one reason I never use them. you would also end up reviewing all your notes and editing them. scribes really don't save all that much time unless you don't care what your note looks like, and I know you do.

any way you could teach billing to your office manager and make that 1 position? with <10 pts/day I don't imagine(although I might be wrong) that it would take much time. you could even give her a raise for the extra work with some of the funds saved from laying off the biller.

[ventana]

scribe/ma

hire more support staff

 

maximize the # of patients you see

 

learning this as we speak

 

(I had started small and did everything - realizing that I am capped at 80k in that model and that is with some also long hours and essentially zero overhead - office in basement and doing house calls)

[jmj11]

The option of making my office manager also the biller is not viable right now.  My office manger works 40 hours per week and is stress out from the phones that constantly ring and her work load.  She is involved with some billing now. However, my biller puts in another 35 hours per week.  I met with my biller this week about why so many hours (she started out with 20), but the reality is, and I've heard it from every practice, that insurance companies are creating more and more nightmares that billers have to waste hours untangling. 

 

I could charge 75% less if I did not have to waste so much energy with insurance companies.  Something has to give to change this healthcare landscape.