Now that I have vented/ranted/opined on the demise of primary care, let’s move to some survival tips. Following are PookieMD’s two fundamental. most important, and most loathsome rules of survival in primary care medicine.
The money is in the numbers.
Time is money.
Yes, you have to see patients to make money, and given today’s reimbursement you have to see a fair amount of them. This is a given, a fact, a law. If you don’t want to see 20 (or more) patients a day, go in to psychiatry. If you are in primary care, you probably are looking for a way to make a dollar go a bit further. Don’t laugh, you might spot something useful here!
- Get a set back thermostat. No, these aren’t just for home use. If you are paying your utilities, why are you heating the office at night?
- Learn to be efficient. I have previously blogged on being efficient. Running yourself ragged to see more patients is a recipe for burn out (if you are not already there!) Look for ways to become more efficient.
- Use your EMR to the fullest. For heaven’s sake, if you bought the thing, use it! Learn every bell and whistle it has, every dot command, every work around, every reminder system. . It will make you more efficient. Reminder: USE the perscribing feature (CMS will be rewarding this, and then penalizing you if you DON’T use it!
- If you don’t have an EMR use preprinted check box forms when possible. Write in the extras but the check box forms will save you time, and are usually more legible.
- Have your receptionist call and remind patients of their appointments. An empty slot in your day doesn’t generate revenue.
- Look at how you use your space. Could you rent a spare exam room to a occupational or physical therapist?
- Consider extended or weekend hours. You are paying the rent whether you are open or not. Consider opening a half day on Saturdays for urgent care appointments. Don’t let Walmart take away YOUR business!
- Consider using medical assistants during their internship. Lots of local MA schools are looking for practices that will take on a student. These students are usually in the later part of their training and can extend your man power for free! Beware, your nurse or MA should supervise them.
- Make sure you are billing for in-office procedures. Train your staff to check off ua’s, strep tests, pregnancy tests etc. You should then double check when you are filling out the superbill. You are doing ’em, get paid for ’em.
- Shop at big ware houses, like Costco. Get toilet paper, and office supplies at a discount.
- Make sure you charge for vaccination admission and the vaccine itself.
- Use those freebie exam table coverings. (Yeah, I’m not fond of laying down on an exam table with a paper covered with Viagra logos, but hey, what a poor primary care doc to do?)
- Don’t buy new–buy used equipment when possible. (Checked Ebay lately?)
- Consider remote deposit capture. If you have a big enough volume of checks that come in, you can scan and electronically send the images to your bank to get instant deposits. Cash flow is king!
- Consider ancillary services. See previous post on ancillary services. See what you can stomach.
- Consider group appointments.
- Utilize your staff to the fullest. See previous rants. Yes, I’m talking to you.
Look, this stuff isn’t fun. However, if you want to survive, your business (note, I didn’t say PRACTICE), must have revenues greater than expenses. This is the law of keeping the doors open. Maybe things will change for the better. Maybe not. But if you are doing primary care, it’s up to you how you handle your BUSINESS, and how you keep the doors open so you can see patients.