Enter the YOUR plan to improve your practice and win an Amazon Gift Card!

See the December 29 post and enter your practice’s goals for 2009.  Include a plan by which your will achieve the goals.  The best plan wins a $15 gift card from Amazon.

Don’t Write Off E-prescribing

I may appear to be somewhat of a troglodyte, but I actually have  committed myself to learning to love technology.  I am the proud owner of a smart phone, have mastered my email, and actually use two different EMRs.  So, you see, this qualified me as an expert on EMRs and e-prescribing (wipe that smirk off your face!)

It was with interest that I read “Effect of Electronic Prescribing With Formulary decision Support On Medication Use and Cost” in the December 8/22 2008 issu3e of Archives Of Internal Medicineby Michael Fischer, MD, MS et al.  The authors describe a study in which physicians using e-prescribing with formulary decision support were compared with physicians using traditional paper prescriptions with respect to prescribing tier 1 medications.  When prescribing electronically, the physicians were more likely to choose the lower cost generic tier 1 medication.  There was a 3.3% increase in tier 1 prescribing, with a decrease in tier 2 and 3 prescriptions.  Fischer et al estimate that this would result in an $845,000 savings per 100,000 patients, based on the assumption that each patient filled one prescription per month.

I love saving money, but what was the cost of saving money?  According to the authors, “government estimates of approximate first year costs were $3000 per prescriber.”  In the study, Blue Cross Blue Shield supplied the software to the physicians, along with a free wireless device, access to a secure Web portal, licensing and wireless carrier.  So, the cost was not borne by the participating physicians.

I think as a first step toward an EMR, e-prescribing makes sense.  I do not think that every insurance company should provide physicians with it’s wireless device.  Can you imagine, five different devices for five different insurance companies?!

So what is to be done?  The federal government must mandate one SINGLE e-prescription system that we all should use, and insurance companies should bear the cost, based on percentage of patients enrolled in each plan.  Why should health insurance plans pay?  Because they are the ones that will enjoy the savings!  I think this would be an effective way to usher in the beginnings of an EMR.  Mr. Obama and Mr. Daschle, are you listening?

As physicians, we must look for ways that we can use e-prescribing efficiently and effectively.  We must commit to learning all the bells and whistles, and using it to our advantage.  So, stop hiding behind your prescription pad, and make way for what is inevitable.  Get out there and lobby for what should be done, rather than whining when we get handed the bill for something that will most benefit the health insurance industry!

TightMD Gazette II: 11 More Tips to Tighten the Belt

All right, Dr. Practice Owner, here are more tips to keep you practice’s head above water in these turbulent times:

  • Share staff.  If you have an excess of staff, could they be shared with another office rather than laid off?  You  get to retain a valued staff member, the staff member keeps their job, and everyone wins.
  • Enlist your staff for help.  Everyone is anxious about keeping their jobs.  Set up a brain storming session for ways to save money, and ask your staff for input.  Once they realize they can directly impact how the practice runs, they will be diligent in finding ways to keep the doors open!
  • Pay bills on line.  You can pay bills closer to the due date, and keep the money in your account longer.  (See “sweep account” in previous post.)
  • Get a free energy audit.  Your local power company will do this for free, and can give you information on where the energy is going, and how to improve the leaks.
  • Turn off your computer at night and on weekends.  Ditto the lights.  (Duh, but did I turn off my computer last night?!)
  • Evaluate your payroll company.  Payroll companies must guarantee accuracy in withholding and tax filing.   (Penalties are huge for mess ups!)  However, make sure you are not paying for services you are not using–if there is just three of you, do you really need the Human Relations functions?  Also, examine direct deposit.  See if you can get your payroll service to do it for free.  Direct deposit saves the payroll company money–which should you be paying for it?
  • Make sure you take all the tax deductions you are entitled to.  Keep receipts as if they were gold.  If you haven’t done this during 2008, make it a top priority for 2009.
  • Tax tips continued: ( http://smallbusinessonlinecommunity.bankofamerica.com/blogs/Taxes/2008/03/20/five-tax-filing-mistakes-to-avoid)     

–If you started a qualified retirement plan, you can claim a credit of $500 per year for the first three years to offset the administrative start up costs (e.g., educating your employees about their participation in the plan).
–If you conducted scientific research, you may qualify for a 20% tax credit for these research activities.
–If you hired someone from certain targeted groups, such as a disabled veteran or long-time family assistance recipient, you can claim a credit for a portion of their wages.

  • Choose the best business entity.  Partnerships, LLCs, and Corporations all have various tax benefits.  Talk to your accountant and then business attorney about what is right for your practice.  General rule: “Any business with the potential for claims against it, which includes most businesses with employees as well as those with customers who visit the business premises, should probably opt for an entity type that protects owners’ personal assets.”  (Barbara Weltman, contributing writer for Inc. magazine.)
  • Cross train your employees.  Rather than laying off, see if they can do other functions.  Beware of the training costs, but it may just save you money.
  • Don’t be Scrooge McDuck.  Get creative with perks.  Consider dress down Fridays, if appropriate, or Pizza Fridays.  Ask you staff if they want that Holiday Gala, or if they would prefer some decent lunches, or maybe just a bonus check.

My company, ExtraMD, does the following: we use a virtual assistant, we pay bills on line, we keep payroll in  house, and are looking at giving bonuses this year.  I look at our profit/loss and budget variances monthly.  We have an ace controller, and an amazing tax attorney.  Our accountant is appropriately pessimisic  (that’s what I am paying him for!)  And, yes, I print on both sides of the paper.  I promise to turn off my computer at night.

Good luck!   Keep the doors open, the employees EMPLOYED and your practice business in the black.  Remember, if you aren’t open, you can’t see patients!

The TightMD Gazette: More Ways to Save Money in Your Medical Practice

So now that we are in the spend, spend, spend season, I thought I would round up some more ways to SAVE money in medical practices.  The following tips are from the mundane to the grandiose.

  1. Get your printer cartridges refilled, rather than buying new ones.  And, hey it’s “green”!
  2. Get free forms.  Visit www.entreprenuer.com/formnet.  They have forms for collections, credit cards etc.  Better than making ’em yourself, or paying for them!
  3. Use independent contractors.  ExtraMD (my company) is made up of independent contractor physicians.  We fill in locally around town, and cost less than the big locums  companies.  Practices save because we are independent contractors, and pay our own taxes/malpractice etc.  There may be similar groups in your location.  In addition, consider independent contractors for prn nursing, front desk help etc.  CAVEAT: check with your attorney/accountant to make sure the people you are using fit the stringent IRS definitions of independent contractors.
  4. Shop around for over night mail couriers.  Boy was I shocked at the differences!  It cost about FIVE dollars less to use USPS over night versus another big company!
  5. Make sure you plan for taxes appropriately so you don’t get soaked with penalties.  My bookkeeper calls this “tax anticipation.” 
  6. Get the best credit card rates.  If you run balances, for pity’s sake get the lowest interest rates!
  7. Look at a “sweep” account. If you run large balances for 2-3 weeks at a time, a sweep account allows you to move your money in and out of an interest bearing account easily, and earn interest, rather than having your money sit in a non-interest bearing account.
  8. Ask suppliers if they will give discounts for early payments.  Hey, it doesn’t hurt to ask.
  9. Make sure your billing company is a bull dog.  Don’t let them write off claims too easily.  I will post more on this later.
  10. Get at least three bids on every purchase  (especially the big ones!)  When you DO finally purchase something, see if you can bargain, or quote a competitors price!
  11. Reassess your phone plan and the number of lines you have.
  12. Eliminate paper waste.  Copy on both sides of the page.  Why  add more to the land fill any way?
  13. Use coupons.  Don’t laugh!  Get your medical assistants to find them.  Check out www.searchalldeals.com for lots of coupons on just about any purchase.
  14. Sell equipment you aren’t using on Craigs List.  (www.craiglist.org )
  15. Make sure you are getting the best rates on business/medical/malpractice insurance.

Just try doing one or two, and see where it gets you. I will search out more ideas in the next post.  As a reminder, try to have your staff look at this list and implement a few money saving practices.  Your time should not be spent clipping coupons!  I would love to hear YOUR tips!  Also would love to hear gripes/tips/info on coding in your practice.

For more info check out these on-line articles:

http://www.entrepreneur.com/money/howtoguide/article71318.html

http://www.insidecrm.com/features/78-ways-save-economy-101408/

Survival Tips for Primary Care: How to Save Money

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!

  1. 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? 
  2. 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.
  3. 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!
  4. 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.
  5. Have your receptionist call and remind patients of their appointments.  An empty slot in your day doesn’t generate revenue.
  6. Look at how you use your space.  Could you rent a spare exam room to a occupational or physical therapist?
  7. 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!
  8. 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.
  9. 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.
  10. Shop at big ware houses, like Costco.  Get toilet paper, and office supplies at a discount.
  11.  Make sure you charge for vaccination admission and the vaccine itself.
  12.  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?)
  13. Don’t buy new–buy used equipment when possible.  (Checked Ebay lately?)
  14. 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!
  15. Consider ancillary services.  See previous post on ancillary services.  See what you can stomach.
  16. Consider group appointments.
  17. 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.