Costs and figures... startup Solo podiatry office
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I had to pay for an environmental survey and the data was reviewed by a medical physicist, but I was not required to take any additional steps.
BeaverBlade
Full Member
a physicist quoted me $1700 so i'm doing it myself since it's not necessary evidently. now if my plan sucks it might be i guess.
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I've obviously described above how I found a way to save money on this. I think the hilarious thing that comes to mind is that if in the future someone every tries to buy my practice will I be one of those owners who is butthurt about all the work (setting up the x-ray and the insurances and the autoclave!) they had to do to get this started verse simply riding off into the sunset knowing you can't practice forever.
BeaverBlade
Full Member
If I had to do this in the era pre-AI i would be ****ed
I start salivating when I see a new Medicaid patient on the schedule because I know it’ll be a slam dunk surgery booking since they don’t have to worry about time off from work.
Why is it a malpractice nightmare
statistically speaking, medicaid beneficiaries are more likely to sue. Also, they make more sympathetic plaintiffs for juries.
Also when you have a medicaid beneficiary who IS employed, the FMLA forms never end...I had a lady extend her FMLA 6 months after a pinky toe arthroplasty
What were your thoughts on them?
So - more commentary on Eclinical works - just for consideration.
1. Eclinical works has a fee. It appears to be some variation of $500 or $600. They have a signup plan where you pay $5 a visit until you reach 100 patients a month or whatever.
2. If you use Eclinical works - you likely use Trizetto. They have a fee structure of like $90-140-200 or something like that depending on which plan you use. They have a claim submission price of $0.45 cents until you reach a certain patient volume and switch to one of the all in prices above.
3. Eclinical works wants you to use Healow pay. Healow pay probably makes sense for your "out of office" payments. They charge 3.5% + $0.30 cents for credit card charges. So if someone prepays their copay before being seen at your office or logs into their account and pays a balance out of the office - you'll ultimately receive a credit card processing fee for said collections. Could you try and use a different service - perhaps, but you'd have to reconcile the external payments into ECW and "card-not-present" transactions are more expensive even with something like Helcim that charges you the interchange rate + a small percentage.
4. In the office - you should be using Square, or Stripe, or Helcim - or whoever to try and get a lower credit card processing fee and then posting-reconciling these payments into ECW as they are made. You can drop the price on anything that is paid for in the office likely to under 3% unless its a very small balance (smaller balances make the cent component more relevant). If you use something like Xero for your accounting software there are add-ons that immediately reconcile these payments from Square into Xero.
5. Last of all, if you are using Eclinical works and want to use Text to Pay to get people to pay their statements online (through Healow) then you have to pay some sort of per-text price for the messages and you have to sign up for their statement service. The statement minimum monthly price is $20 and it starts at $0.88 a page.
6. I've already mentioned somewhere else they try to get you to use their fax service, but I declined.
Where am I going with all this - in the end you are likely to have multiple different bills coming in from your EHR/Clearinghouse/Credit Card processor - likely no matter who you go with.
The big win of these against something like Athena is - your insurances that pay via ETF aren't going to be dinged by any of the above. Yes, you are going to have credit card processing fees, but you can try to control the process. The more money you collect from patients up front for CPTs and services and what not - within reason the less the people above can ding you.
The less you collect the more of the money is going to be reduced by statements going out, by card-not-present transactions etc.
Again - do not go into this believing that you can simply "pay your EHR and be done". There will be more fees.
1. Eclinical works has a fee. It appears to be some variation of $500 or $600. They have a signup plan where you pay $5 a visit until you reach 100 patients a month or whatever.
2. If you use Eclinical works - you likely use Trizetto. They have a fee structure of like $90-140-200 or something like that depending on which plan you use. They have a claim submission price of $0.45 cents until you reach a certain patient volume and switch to one of the all in prices above.
3. Eclinical works wants you to use Healow pay. Healow pay probably makes sense for your "out of office" payments. They charge 3.5% + $0.30 cents for credit card charges. So if someone prepays their copay before being seen at your office or logs into their account and pays a balance out of the office - you'll ultimately receive a credit card processing fee for said collections. Could you try and use a different service - perhaps, but you'd have to reconcile the external payments into ECW and "card-not-present" transactions are more expensive even with something like Helcim that charges you the interchange rate + a small percentage.
4. In the office - you should be using Square, or Stripe, or Helcim - or whoever to try and get a lower credit card processing fee and then posting-reconciling these payments into ECW as they are made. You can drop the price on anything that is paid for in the office likely to under 3% unless its a very small balance (smaller balances make the cent component more relevant). If you use something like Xero for your accounting software there are add-ons that immediately reconcile these payments from Square into Xero.
5. Last of all, if you are using Eclinical works and want to use Text to Pay to get people to pay their statements online (through Healow) then you have to pay some sort of per-text price for the messages and you have to sign up for their statement service. The statement minimum monthly price is $20 and it starts at $0.88 a page.
6. I've already mentioned somewhere else they try to get you to use their fax service, but I declined.
Where am I going with all this - in the end you are likely to have multiple different bills coming in from your EHR/Clearinghouse/Credit Card processor - likely no matter who you go with.
The big win of these against something like Athena is - your insurances that pay via ETF aren't going to be dinged by any of the above. Yes, you are going to have credit card processing fees, but you can try to control the process. The more money you collect from patients up front for CPTs and services and what not - within reason the less the people above can ding you.
The less you collect the more of the money is going to be reduced by statements going out, by card-not-present transactions etc.
Again - do not go into this believing that you can simply "pay your EHR and be done". There will be more fees.
100%.. AI note fees, AI billing fees (got that email today), statement sending fees, payment processing fees, collections fees, etc etc.
(I actually just do pay the base EMR fee... and statements the biller sends... but I pay a medical biller svc 5% too)
[I use Helcim for POS, Nextiva for digital faxing]
The key, imo, is to avoid new tech as long as possible... I have the oldest model card reader they allow, happy to take cash and checks, etc. Heck, I do marketing with cookies... have never paid for online ads.
You are the first person I've met who knew what Helcim was.
I'm using AT&T for my fax. The line is $30 a month which seems fine, but the taxes on it are ridiculous. Its bundled with my internet so maybe the sum total of it generates taxes or maybe the second you have a phone line in Texas you just get annihilated.
The credit card fee game really is something else. A patient paid like $800 for an open fracture the other day. My receptionist could not get the card to run through on the reader so she had to key it. 3.3% x $800 adds up. Little did I know that ethilon 4-0 nylon suture is $12 a string. I'm going to switch that to Amazon business and get them for like $4-5 in the future, but damn - overhead will nickel and dime you.
Just set-up my Select Health Epayments Center account. Trying to use this to intercept and prevent Zelis virtual credit cards. It appears to be technically owned by Zelis, but its a free EFT portal.
where you getting your podiatry chairs from?
My final winner: Practice EHR--extremely easy to use, great mobile app features, and one of the most cost effective. Lets see, its a relatively smaller company and not a lot of people in podiatry know about it. But I played around in it for hours and got multiple provider feedbacks which were overwhemingly positive. it almost reminds me of EPIC..also AI features re insane and only going to get better (I will probably upgrade with AI features once i get big enough 🤞
A close second: Emedicalpractice- very customizable, very cost effective, easy to use but not as easy as practice EHR. I would have chosen this one if it wasnt for Practice EHR.
ModMed: Garbage EMR. I used it in my previous job and one of the main reasons for me quitting was the shift to ModMed EMR. Plus its super expensive too, I would rank this one last!
NextGen: decently priced in the 300s, lots of pods use them and love it, it serves our purposes but to me the whole platform seems very old looking and outdated. moderately easy to use
Tebra: moderately easy to use, priced in the 300s, great for marketing purposes. I would say this would be my third option
Intergy: another garbage emr which is also super expensive, only thing its good for is billing. I would say Intergy sucks even more than ModMed
Dr. Chrono: priced in the 300s, very popular amongst pods, main thing that put me off was multiple ppl cant be logged into a patients chart at the same time. really slows down workflow in my opinion
Eclinicalworks: too many clicks, have used it for years and think its just OK to ****ty. definitely not worth $500-600/month.
Athena: Pretty expensive but actually worth it. If I had money to burn this is the EMR I would use!
Sevocity: basic emr, ok to use, priced in the 300s, dont hate but but also dont love it
Practice fusion: this is the cheapest EMR for very good reason. total trash
Populate EMR: ok to use, priced moderately, not too impressed with it
AdvancedMD: this is a good EMR, pretty easy to use, priced moderately in the 400s
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My main concern with EMR's is similar to what Feli was alluding to... they keep adding a la carte **** to get you more and more invested and dependent on their ecosystem. The more modules you add on, plus AI dictation, plus billing, the more it runs up the bill and the more eggs you have in their basket and then you're stuck and at their mercy when they jack up prices every month.
BeaverBlade
Full Member
it's best to just get the basic emr and never depend on them for anything else i feel lol
Well I love how opinionated you are and I'm blown away that you took the time to try that many EHRs. I just listened to adamsmasher and he obviously lead me to astray to one of your worst EHRs 😉. There was a part of me that was going to respond - "in the end, they are all probably the same", but then I saw that Modmed is like $800-1200 a month which is just unreal. So maybe there are EHRs that really truly are worse.
I'm still finding new things to customize in ECW to make my life better. Like the fricking program comes with a body part list for where your shot/steroid went. There I was searching the list for "foot" like a sucker drowning in all the other places they have as injection site. Turns out you can delete all the other body parts out of the list so that Left Foot / Right Foot / Bilateral Feet are the only things that show. Awesome, but stupid that I had to do that.
On the other hand - not sure I trust your judgement since you think Athena is awesome, though I concede it is intuitive.
I don't remember supporting eCW with much enthusiasm. More like it was in use when I joined the group and I didn't feel like retraining myself, my partner, and my employees on something new so I never considered switching. It's just mediocre enough to meet my needs. You cut down on the clicking if you learn to navigate your way through a note using this bar:
That's not the order the sections are in on the progress note, because eCW knows you're too smart for that so they challenge you by mixing the tabs up. I appreciate that level of respect for the user.
That's not the order the sections are in on the progress note, because eCW knows you're too smart for that so they challenge you by mixing the tabs up. I appreciate that level of respect for the user.
Basic Package: $229/month. Probably the 2nd or 3rd most cost effective EMR thats out there.
In a perfect world, what would a single Dr private practice look like? What services would be offered, and which would be referred out? What “specialty” services “cash pay” should be offered? How much physical space is needed? At what point would a practice need to add a second Dr? Third Dr?
$250 cash pay ingrown nails, 10 a day, then go home. 20 days a month. That’s all.
If I can’t win the PowerBall, I’d settle for that instead,
You guys have to learn how to just pay down debt REGULARLY, invest in indexes REGULARLY. Keep your personal budget low.
(trades on single stocks or covered call etc options is bonus, but far from necessary to win the game)
You will make far more from not paying interest and gaining invest income than you ever will seeing more patients. Compounding gains % is amazing. It is boring yet effective AF to pay student loans hard and buy a share of VOO per week or a few per month or whatever (and buy max $7.5k backdoor Roth each January obviously).
If you do it right, you soon will be more worried about your EMR company exit/cancel policy (not kidding, read reviews and Google this on whatever one you choose.... many are malicious when you try to switch/retire) than you are about ever-rising monthly EMR fees. You will get to basically this point where your retirement account(s) go up/down more in a day than your biz makes in a day or even a week. 🙂
...I would make your cash pay fee sched (and your OTC prices) very reasonable... easy whole numbers.
Remember that these pts are paying today (hopefully cash, no POS or Zelis or etc fee), no billing hassles, no later rejections/reductions, etc.
The self-pay ppl are also likely between jobs, students, etc and not exactly flush with cash... but they can still be goodwill, may have insurance soon or fam/friends to send.
You can't charge cash pay pts less than you charge insurance (so roughly just set EMR to 2x MCR usually, or whatever your biller wants).
You CAN offer a "pre-pay" / "same day pay" discount (they'd pay the full price if paying later... which you basically don't allow for self-pay).
[these are just some I found on the internet... if they aren't readable format, I can try to take out all formatting, lmk]
(trades on single stocks or covered call etc options is bonus, but far from necessary to win the game)
You will make far more from not paying interest and gaining invest income than you ever will seeing more patients. Compounding gains % is amazing. It is boring yet effective AF to pay student loans hard and buy a share of VOO per week or a few per month or whatever (and buy max $7.5k backdoor Roth each January obviously).
If you do it right, you soon will be more worried about your EMR company exit/cancel policy (not kidding, read reviews and Google this on whatever one you choose.... many are malicious when you try to switch/retire) than you are about ever-rising monthly EMR fees. You will get to basically this point where your retirement account(s) go up/down more in a day than your biz makes in a day or even a week. 🙂
...I would make your cash pay fee sched (and your OTC prices) very reasonable... easy whole numbers.
Remember that these pts are paying today (hopefully cash, no POS or Zelis or etc fee), no billing hassles, no later rejections/reductions, etc.
The self-pay ppl are also likely between jobs, students, etc and not exactly flush with cash... but they can still be goodwill, may have insurance soon or fam/friends to send.
You can't charge cash pay pts less than you charge insurance (so roughly just set EMR to 2x MCR usually, or whatever your biller wants).
You CAN offer a "pre-pay" / "same day pay" discount (they'd pay the full price if paying later... which you basically don't allow for self-pay).
[these are just some I found on the internet... if they aren't readable format, I can try to take out all formatting, lmk]
| CPT Code | Name | PRE-Payment Price (Charge) |
| 99203 / 99204 | NEW patient 35min / 50min | $100 ($200) |
| 99213 / 99214 | ESTABlished follow-up patient 25min / 35min | $50 ($100) |
| 76882 / 76942 | Ultrasound | $75 ($150) |
| 20550 / 20551 / 20600 / 20600 / 20612/ 64455 | Injection or aspirate with or w/o steroid | $75 ($150) |
| 11721 | Debride toenails | $50 ($100) |
| 11055 / 10056 | Callus debride | $50 ($100) |
| 11730 / 11750 | Ingrown toenail avulsion / matrixectomy | $150 ($300) |
| 17110 / 17111 | Wart or porokeratosis lesion destruction | $100 ($200) |
| 97597 / 11042 | Wound debridement | $100 ($200) |
| 10060 /10061 / 10120 / 10140 / 10160 | Abscess / foreign body / hematoma | $100 ($200) |
| 29405 | Cast | $100 ($200) |
| 29540 | Strapping | $25 ($50) |
| 29581 / 29580 | Wrap multi-layer / Unna Boot | $50 ($100) |
| L4361 | Boot pneumatic | $100 ($300) |
| L1902 | Ankle brace | $50 ($150) |
| L4397 | Night stretch splint | $50 ($150) |
| L3260 | Surgical shoe | $10 (cash svc) |
$1 items | $10 items |
DigiStrip (2 small) | Achilles silicone sleeve ankle single |
Emery board | Certain Dri foot deodorant roll on |
Felt met pads (pair of 2) | Compression stockings (15-20 or 20-30mm) |
Felt pads (U-pad, arch pad, donut pad x4) | Foot powder (miconazole) |
Gel toe pad sleeve (2) | Foot skin cream moisturizer (Eucerin) |
Gel toe cap single (2) | Foot spray powder (miconazole Lotrimin) |
Gel toe spacer (1) | Heel gel cups pair |
Golf ball | Heel protector foam boot single |
Tube Foam (approx. 6”) | Lidocaine cream |
Memory foam insoles pair | |
$3 items | Surgical Post Op shoe Velcro single |
ACE wrap 3” or 4” | |
Antifungal clotrimazole or tolnaftate cream | $20 items |
Antibiotic ointment | Diclofenac (Voltaren) gel 50gram |
Band aids & alcohol -or- Bandage Wound pack | |
Capsaicin cream | $30 items |
Crest foam toe pad R/L single | Contracture soft boot single |
Crest gel toe pad R/L single | EvenUp shoe level |
Epsom salt | PureStride insole Adult pair or Kids pair RED |
Foot powder (dry talc Arm & Hammer) | Salicylic acid 30% cream jar |
Foot spray powder (corn starch) | |
Hydrocortisone crm | $50 items |
Moleskin (3 sheets per pack) | PowerStep ProTech insole pair BLUE |
Pumice stone | PowerStep Dress 3/4 BROWN or SlenderFit PINK |
Shoe horn (long or travel) | |
TheraBand | $75 items |
PowerStep Morton Extension GRAY | |
$5 items | $150 items ($50 with pre-pay deposit) |
Bunion pad sleeve single | Swede-O Ankle Lok brace |
Arch pad sleeve single | Night stretch splint |
Ankle sleeve elastic single | |
Elastic shoelaces pair | $300 items ($100 with pre-pay deposit) |
Golf club cover (Rory McIlroy St. Bernard) | Air boot CAM walker |
Heel lift foam | |
Ice Pack Gel | $350 items ($100 deposit, $250 balance at p/u) |
Metatarsal pad sleeve single | Custom orthotics pair = $350 |
Custom orthotics REFURB pair = $150 |
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100%. No debt, VOO or equivalent and chill is never the wrong answer.
Definitely look at your retirement plan’s options as well. The default probably isn’t going to be the best performing index, and they may not have you on even the VOO option. If you’re relatively young and risk tolerant, it’s not unreasonable to parse out a portion for growth/tech funds (VUG/VGT).
Don’t be like one of our docs who commits financial malpractice by only using a money market account. Or another one who has never maxed their 401k + match even though it’s doable and available.
Those cash pay numbers are low to me.
1. Yes - there should be a method to your madness on cash pay. For example - Medicare pays $32 for x-rays. The doctor doesn't actually take the x-rays (most places) and x-rays are digital and don't actually cost anything. Ideally the machine is just humming all day. If your cash x-ray price is $300 - cool if people will pay it, but my suspicion is you are chasing business away when the receptionist says the price over the phone. Why mark up a service that the doctor doesn't truly perform. Put the value on the things you personally do.
2. Self pay patients are the only people who you can truly pass the cost of our services to. I sometimes wonder - what did the world look like before the .gov marketplace. Did expanding the number of people with low quality marketplace insurance deplete the number of self pay patients who simply paid cash for their care. I assume yes, but I don't know it.
3. Medicare has functioned like an anchor dragging all of our prices down towards it. Where I am - all of the low paying insurances - UHC, Aetna, etc are lower than Medicare. These are not reimbursement levels we can survive on. The other day a insurance that I historically had great rates with wrote to me asking for 130% over Medicare. They used to pay 165%. I haven't heard their counteroffer yet, but that sort of revenue drop for me can't be controlled with belt tightening. Someone has to make up the difference. I have so far managed to negotiate the same contracts I had at my last office, but this one scares me. It will be a painful cut if I can't salvage the contract.
4. Medicare used to pay $200 for 11750. BCBS used to pay $350. We are now grateful and accepting of reimbursement that our boomer forefathers likely would have viewed as poor. I don't think $250 is unreasonable for a matrixectomy, but I do also want us to have services that are valuable and we need more good codes. This is part of why I think dentistry is superior to podiatry. A filling is like $900 right? What's our filling procedure going to be?
5. Why do people with insurance often get the worst deal. When we give a generous self-pay deal we are essentially making the patients who already paid an insurance premium pay more. Just food for thought. Yes, direct cash on the barrel with no take backs, referrals, has value.
6. My experience with self-pay is that some of these patients come in locked and loaded to only pay whatever the lowest fee is that you are willing to charge. My original office had a very low 99203 rate which is what the receptionist gave out on the phone. Closer to $100 than to $200. So patients came ready to decline x-rays, decline injections, etc. And then they wanted to talk about 100 different problems which were to all fall under the low paying visit. We should be satisfied with our self-pay rates and visits. We shouldn't think "another low paying cash pay visit". Say no to "loss leaders".
7. I have personally not gotten any mercy anywhere being self-pay ie. dentist, veterinarian etc. My experience with these other doctors is that they like to hit you with many "lower" cost services. For example - they'll charge an "exam" for looking in my kids mouth but also charge a cleaning for spending one second rubbing a probe on a tooth and then charge individually for every single x-ray. The other day I got a $430 bill for a 6 month check-up from a pediatric dentist. The vet will charge you an exam, and the procedure, and the antibiotic, and the anesthetic. Every single thing is broken out and charge There's something perhaps to be said for them charging for what they actually do, but the big take home to me is just how punched in the face we are by all the 25 modifier rules. If dentists cut nails they'd charge an E&M everytime.
I write all this and yet - for the most part my suspicion is people would still find my self-pay rates pretty reasonable. I don't necessarily disagree with anyone above and if I lived in a self-pay world the simple truth is that a lot of my codes would likely be priced lower to take into account the simplicity of payment and what not. I think self-pay can be complicated which is funny because it shouldn't be. We should just ask for what we need. The price is the price. True capitalism should be transparent.
1. Yes - there should be a method to your madness on cash pay. For example - Medicare pays $32 for x-rays. The doctor doesn't actually take the x-rays (most places) and x-rays are digital and don't actually cost anything. Ideally the machine is just humming all day. If your cash x-ray price is $300 - cool if people will pay it, but my suspicion is you are chasing business away when the receptionist says the price over the phone. Why mark up a service that the doctor doesn't truly perform. Put the value on the things you personally do.
2. Self pay patients are the only people who you can truly pass the cost of our services to. I sometimes wonder - what did the world look like before the .gov marketplace. Did expanding the number of people with low quality marketplace insurance deplete the number of self pay patients who simply paid cash for their care. I assume yes, but I don't know it.
3. Medicare has functioned like an anchor dragging all of our prices down towards it. Where I am - all of the low paying insurances - UHC, Aetna, etc are lower than Medicare. These are not reimbursement levels we can survive on. The other day a insurance that I historically had great rates with wrote to me asking for 130% over Medicare. They used to pay 165%. I haven't heard their counteroffer yet, but that sort of revenue drop for me can't be controlled with belt tightening. Someone has to make up the difference. I have so far managed to negotiate the same contracts I had at my last office, but this one scares me. It will be a painful cut if I can't salvage the contract.
4. Medicare used to pay $200 for 11750. BCBS used to pay $350. We are now grateful and accepting of reimbursement that our boomer forefathers likely would have viewed as poor. I don't think $250 is unreasonable for a matrixectomy, but I do also want us to have services that are valuable and we need more good codes. This is part of why I think dentistry is superior to podiatry. A filling is like $900 right? What's our filling procedure going to be?
5. Why do people with insurance often get the worst deal. When we give a generous self-pay deal we are essentially making the patients who already paid an insurance premium pay more. Just food for thought. Yes, direct cash on the barrel with no take backs, referrals, has value.
6. My experience with self-pay is that some of these patients come in locked and loaded to only pay whatever the lowest fee is that you are willing to charge. My original office had a very low 99203 rate which is what the receptionist gave out on the phone. Closer to $100 than to $200. So patients came ready to decline x-rays, decline injections, etc. And then they wanted to talk about 100 different problems which were to all fall under the low paying visit. We should be satisfied with our self-pay rates and visits. We shouldn't think "another low paying cash pay visit". Say no to "loss leaders".
7. I have personally not gotten any mercy anywhere being self-pay ie. dentist, veterinarian etc. My experience with these other doctors is that they like to hit you with many "lower" cost services. For example - they'll charge an "exam" for looking in my kids mouth but also charge a cleaning for spending one second rubbing a probe on a tooth and then charge individually for every single x-ray. The other day I got a $430 bill for a 6 month check-up from a pediatric dentist. The vet will charge you an exam, and the procedure, and the antibiotic, and the anesthetic. Every single thing is broken out and charge There's something perhaps to be said for them charging for what they actually do, but the big take home to me is just how punched in the face we are by all the 25 modifier rules. If dentists cut nails they'd charge an E&M everytime.
I write all this and yet - for the most part my suspicion is people would still find my self-pay rates pretty reasonable. I don't necessarily disagree with anyone above and if I lived in a self-pay world the simple truth is that a lot of my codes would likely be priced lower to take into account the simplicity of payment and what not. I think self-pay can be complicated which is funny because it shouldn't be. We should just ask for what we need. The price is the price. True capitalism should be transparent.
What I've advocated for self-pay is that you pick a number that the patient needs to ante up before they get past the front desk. For me, it's $275. If they pay, they get whatever they need from me on that visit. XR, injection, matrixectomy, stretching advice, all the above. If they don't pay, plenty of other podiatrists in the sea. This has been controversial with my partners because what if it's a really simple visit, are you still going to charge $275. My answer to that question is that by setting my price at $275, I communicate to patients the value of the care that they will be receiving, and if we cannot see eye-to-eye on that value then patients will self-select to not come to my office.
The alternative framework for self-pay patients is playing "let's make a deal" in the exam room for every treatment option, and there may be many treatment options. That's not a good use for any of our time.
The alternative framework for self-pay patients is playing "let's make a deal" in the exam room for every treatment option, and there may be many treatment options. That's not a good use for any of our time.
Similarly, if your young healthy dog needs yearly vaccinations, they always hit you with the exam fee. They glance at the paws, glance at the teeth, try to sell a $600 cleaning, squeeze the belly, listen to the stethoscope for 10 seconds and then BAM: exam fee + vaccines. $250. That’s with declining blood work because you know your dog is healthy. Probably another $100 with BW. And good luck finding a place that will do vaccinations without the exam fee.
BeaverBlade
Full Member
I just learned Medicare 73630 will pay me $30. I’m having doubts about this machine… unless I make it go brrrrr really unfortunate.
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1. You can bill bilateral x-rays - so the visit technically can be worth $60 if the patient wants to talk about both bunions.
2. It allows you to offer the service on-site.
3. It allows you to definitively answer questions about osseous pathology.
4. It prevents the need to send the patient elsewhere.
5. It allows you to track the progression and follow-up of things.
6. No one else orders the correct x-rays. Patients routinely bring NWB films.
7. Some insurance companies will pay more ... though most won't. Medicare has anchored this down.
8. But self pay people will have to pay what you ask... within reason
9. If you really think about the value of the visit - a 99203 is ...$100-110 on a lot of plans. Adding a $30 x-ray increases the value of the visit by about 30%. Adding a second x-ray if justified increases the visit value by 60%. $160 to talk to someone for 10 minutes and show someone their x-rays isn't a bad reimbursement.
10. We've had a bunch of threads and arguments in the past on here about when you should commit and what you should do ie. should a new podiatrist start off with an x-ray.. I've gotten quite a few patients from other podiatrists because the patient didn't trust the judgement of the other doctor because they didn't perform an x-ray. Everyone is going to rationalize and have their own reason for why they do or don't x-ray, but for me it generates part of the experience. You are here to get definitive treatment and answers. Imagery is part of that. Whether they tell you or not - some patients expect it.
11. In the grand scheme of things, if you are successful - the cost of this will be trivial.
BeaverBlade
Full Member
Great post. Thanks for talking me off the ledge. FWIW I’m purchasing a new machine so it’s quite expensive. From my math I may break even around the 18 mo mark with it and get it paid off. That’s my goal at least.
ModMed is absolutely human garbage
BeaverBlade
Full Member
Now now
Please click all the toenails that are fungal on this picture of a human foot.
Not sure where you are purchasing, but there are savings to be had purchasing the XCEL unit used.
I really do think the value of the service exceeds the direct reimbursement of the x-ray which obviously in isolation isn't impressive. Think of it like the veterinarians though. Each little charge building on the next until Boba Foot doesn't believe in pet ownership anymore.
BeaverBlade
Full Member
Yeah I’m getting a new 20/20 unit so it’s more expensive. I couldn’t get any trustworthy used quotes and feel better with a five year warranty.
I’m should I could’ve done it better.
There’s a ton of sketchy medical websites where people get scammed though.
Humana Payor Portal - Availity
So - this is a throwback. A few years ago - something like that, time blends - a guy posted on here complaining that he was getting douched by Humana. They were charging $5 as a per check fee. In general I don't see Humana, but one snuck in.
I open the EOB and I'm first confused. My 99203 Medicare fee schedule is $114 - they state the allowance is $120. The EOB also says I'm in network - I'm not / haven't been for years. And then I realize the check with it is smaller than I would have expected. Sure enough - they've added the $5 fee in small print on the back.
What I ultimately found though was that $5 check charge was there because they wanted to pay us via EFT. Said screw it and signed up for the EFT through the Humana Payor Portal on Availity. Long story short - I thought that guy was getting screwed, but it looks like there was just some more behind the scenes work to be done setting up his account. And to me this is the perpetual work you have to do in PP to prevent companies from skimming off of you.
So - this is a throwback. A few years ago - something like that, time blends - a guy posted on here complaining that he was getting douched by Humana. They were charging $5 as a per check fee. In general I don't see Humana, but one snuck in.
I open the EOB and I'm first confused. My 99203 Medicare fee schedule is $114 - they state the allowance is $120. The EOB also says I'm in network - I'm not / haven't been for years. And then I realize the check with it is smaller than I would have expected. Sure enough - they've added the $5 fee in small print on the back.
What I ultimately found though was that $5 check charge was there because they wanted to pay us via EFT. Said screw it and signed up for the EFT through the Humana Payor Portal on Availity. Long story short - I thought that guy was getting screwed, but it looks like there was just some more behind the scenes work to be done setting up his account. And to me this is the perpetual work you have to do in PP to prevent companies from skimming off of you.
BeaverBlade
Full Member
What do you guys look for specifically when hiring staff?
How do you conduct an interview? How do you filter out people?
How do you conduct an interview? How do you filter out people?
My 2 current staff came from my last office so I haven't had to do any hiring yet.
At my last office, we'd put out a want ad wherever - I don't recall, but like Indeed or things like it. We kept changing sites. I don't know where you live, but we'd rapidly get swamped. It appears part of being unemployed is applying to every job under the sun - even if you aren't qualified. So if you put up an ad for 2 weeks and you don't pay attention you'll end up with hundreds of apps from people with McDonald's for experience. I recommend only having the ad up 3 days because you are likely to get 50-100 applications.
My wife was a believer in asking people to fill out a pre-job type survey about what they wanted etc through Google Forms. No one ever did it.
Probably - the thing to do is just immediately interview people. If someone shows up with a resume - interview them on the spot. If someone calls and asks to interview - probably interview them because that's in some way a higher level of interest.
Obviously the ideal person already has healthcare experience BUT the higher the person's experience the easier it is for them to just quit on a Friday because they have a new job on a Monday and the more people they know the more likely they have a friend or a sister at someone else's office.
Your employees are going to talk about pay so the lowest paid employee will always be looking for a new job. Something to think about if you have an enormous differential across people doing the same job.
My 2 current staff are great, but I wasn't blown away by either of them at their interviews. My partner hired one and my last office manager hired the other. So there's something to be said for first impressions not meaning anything because they are good employees.
I would say - if people suck at interviews. Just move on. Awhile back we interviewed 8 people in a row. None were great, one got hired, and they lasted 2 weeks.
Definitely have a trial period ie. 3 months where they can be let go. Know that you can schedule 10 interviews and only 3 will show up.
At my last office, we'd put out a want ad wherever - I don't recall, but like Indeed or things like it. We kept changing sites. I don't know where you live, but we'd rapidly get swamped. It appears part of being unemployed is applying to every job under the sun - even if you aren't qualified. So if you put up an ad for 2 weeks and you don't pay attention you'll end up with hundreds of apps from people with McDonald's for experience. I recommend only having the ad up 3 days because you are likely to get 50-100 applications.
My wife was a believer in asking people to fill out a pre-job type survey about what they wanted etc through Google Forms. No one ever did it.
Probably - the thing to do is just immediately interview people. If someone shows up with a resume - interview them on the spot. If someone calls and asks to interview - probably interview them because that's in some way a higher level of interest.
Obviously the ideal person already has healthcare experience BUT the higher the person's experience the easier it is for them to just quit on a Friday because they have a new job on a Monday and the more people they know the more likely they have a friend or a sister at someone else's office.
Your employees are going to talk about pay so the lowest paid employee will always be looking for a new job. Something to think about if you have an enormous differential across people doing the same job.
My 2 current staff are great, but I wasn't blown away by either of them at their interviews. My partner hired one and my last office manager hired the other. So there's something to be said for first impressions not meaning anything because they are good employees.
I would say - if people suck at interviews. Just move on. Awhile back we interviewed 8 people in a row. None were great, one got hired, and they lasted 2 weeks.
Definitely have a trial period ie. 3 months where they can be let go. Know that you can schedule 10 interviews and only 3 will show up.
18 months to break even on an X-ray machine that costs the price of a car sounds really, really good. If that is the case, that's well worth the investment.
BeaverBlade
Full Member
Is this sarcasm?
We upgraded our XR system several years ago, 16k as I recall. At the time we were a 3 doctor group and we recouped the cost of the system in under a year with my XR alone. Probably closer to 6 or 8 months between the 3 of us.
Obnoxious things: the plaque battery loses its charge and needs replacing every 2-3 years and that's a 2k recurring expense. Compare that to the price of a cell phone battery and I don't know where that number comes from.
Also the people who sold us the system charge us $89/month for cloud backup storage of XR. Legally, you need to have some kind of backup for your PHI including all radiographs. While it's convenient to be able to access XR anywhere, even on my phone, this is basically the price of a gym membership for a service that is pure profit for them.
classic podiatry, debating if xray is worth the financial investment because we dont understand our own job or how a business works. Hold on, let me go ask a obgyn if the 20k fancy ultrasound is a good return on investment. Who really needs to see the baby anyways lol
Excellent comment if costs money podiatrist tries go cheap
I was actually reading about building a secure NAS for x-ray storage last night because perpetual endless monthly fees irritate the hell out of me. It's doable if you have tech knowledge and self-hosted NAS is 3–5x cheaper over 5 years than subscription cloud PACS.
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BeaverBlade
Full Member
Why do you talk like this? This is the best troll on here
Good question. This stuff is not easy. It is absolutely critical to success, though. I was fortunate to have very good guidance.
A lot of people suck at it; they just make it up as they go along and basically read the resume to the interviewee (who parrots it back).
Others do even worse and dump hiring (or dicipline, training, etc) on a wholly unqualified "office manager" with likely minimal exp and no training on HR.
Imo, you need a rock solid company policy document (with job descriptions in it)... mine is 4pgs and goes 1. Hiring 2. Employee Code of Conduct 3. Job Duties 4. Compensation 5. Leave 6. Disciplinary Policy. This will save you a ton of hassle later (but it's a living document... evolves a bit as biz goes on).
After that's done well, then much is on autopilot... for hiring, you have a blueprint and simply target what skills the jobs need. Compensation's and employee evals are spelled out in general terms. It is well worth the time and $$ to consult a HR pro on this stuff for ideas and help and to review of the company policy (attorney also, but usually just to proof the policy... attorney gets expensive).
- Compensation:
>Benfits are personal choice but generally dumb at lower paid jobs imo.. the main thing 99% employees at this level want is $24/hr when other area places pay $18/hr. Do bonuses (defined in policy and sometimes more random... holiday, etc). Define when employee evals will be (raise likely, but not implicitly stated in policy... in event employee is not good, or biz $$ is strained).
>Consider salary for FTEs (makes it MUCH easier imo, signals "real" job... but need to write job descrips that way - "exempt"). Hourly staff is much more common in podiatry and other med offices, but they just milk the clock anyways (and then complain they "need more hours" around holidays, etc).
- Look for on resume:
>Job promotions/longevity is a good thing (manager, autonomy, etc).
>Lives CLOSE (more likely to be on time or stay at the job awhile).
>Good looks/grooming (won't know this until interview obviously), but be real: it's a health/wellness/sales industry and sloppy employees just aren't conductive to that. Nobody is saying you'll have all smokeshow staff, but you don't want obese chainsmokers with dirty clothes either (and you can carefully craft that stuff into company policy).
- References:
>Do this BEFORE scheduling the interview - or at least before interview occurs... why waste time doing interview if references are not good or fake/unreachable?
>If they don't list references (but the resume looks good), you can ask them for references.
- Interview format (for me anyways):
- Intro, thanks for coming, etc. Have other key staff (docs, manager) or even all staff there if it's a small office (you should have 1.0day or at least 0.5d per week where you don't have pt appts).
- Behavioral interview questions by lead interviewer (prob owner doc, but key staff can ask one if desired and predetermined) is the main part of it. This type of interview is standard (pick 3 or 4 Qs each ~5mins related to that are qualities/topics important to you... question lists on web). Have their resume to refer to, but largely ignore discussing their edu/jobs unless they bring it up in an answer... you should've read this already. You are much more reading the person... are they likeable, confident, charismatic, etc?
- Give THEM plenty of time to ask questions... 5min or more, shows respect. (many fail on this... then wonder why ppl quit fast: they accept but didn't understand $$/job). If they have little or nothing, ask them about the biz hours, biz mission, compensation, etc to make sure they grasp it.
- Give them a quick tour of the office/building (allows low pressure, less eye contact... for them to chat more and creates mini-activity together). This can be owner or other predetermined staff member.
- "If hired, when would you be able to start" and "Thanks! We'll be in touch." (and then do that with either a call to say "thanks but we decided that it's not a fit" - or "we enjoyed meeting with you, and we'd like to email you an offer letter"... by the end of the same interview day - same week maximum! It's amateur hour to interview one or two then make them wait while you try to set up more (not the way to go with small biz. Some need to do notice at their current job, but many of these people are out of a job right now and need one asap. You should've already called their references back when you scheduled the interview, so make the yes/no decision with your team right after they leave interview. You have an offer letter formatted that you just change a few things like name, $$, start date. Ask them in the email to accept and confirm start date or decline within a week (you were fast and they need to be too).
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I typically ask them some offbeat questions that hey are not expecting. Tell me about what you like to do when you are not at work. What kind of pet do you have? (it starts conversation and good pet owners show responsibility). Tell me about a real challenge that you have had in the past 30 days and what you did to overcome it. If you had the absolute decision, what type of music would you listen to? If there were no restrictions at all, where do you dream of traveling? Could you possibly be the "go to" person if we decided to get more involved in social media? When was the last time you talked to your mom? (I have found that both men and women with good relationships with thier moms are pretty decent people).
Now I know that these have little to do with the job per se, but, it does give you a better insight and it elicits more conversation outside of the normal questions. Now I am not saying that you should not ask about skill bases, but I do believe that an interview should be much more than that.
Now I know that these have little to do with the job per se, but, it does give you a better insight and it elicits more conversation outside of the normal questions. Now I am not saying that you should not ask about skill bases, but I do believe that an interview should be much more than that.
Be very careful with this stuff.
It's unlikely to actually cause an issue, but asking of cultural stuff, family, etc could be construed as discrimination. Absolutely stay away from asking married or living situations, religion, have kids, birth place, their age, tattoos, disabilities, etc. Asking about parents could open up theoretical discrimination (for or against) of adopted, etc. That stuff is only ok if THEY bring it up, and even then, tread careful. This is yet another reason for team interview and not 1 on 1 if possible.... make a 1% chance of issues basically a zero chance (have witnesses and also avoid any potentially discrimination topics).
The much safer play is just to keep it almost 100% about the job, their accomplishments and challenges at past jobs, their skills, etc. It is not a lunch with a potential new friend.
Consult an employment attorney or high level HR pro... they have seen complaints and suits for things seemingly trivial small talk or corporate rules/regs. Everything from hair color to missing work due to no child care to obscure religious days off (just give all a few "personal holiday"days), etc could be viewed - and accused - as discrimination.
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The joke here is the guy isn't even a podiatrist. Maybe he's referring to interviews he's done in other lines of work, but I think a reader would infer from his post that he's one of us - and he's not. He claimed he was researching for his daughter years ago. Maybe he's helping her run an office.
The real lesson for people getting into this line of work is that being an MA often has no real qualifications. Many of the people we hire are crush a mouse dumb. They routinely have personal and life drama problems that approach the level of insanity of our patients. The other day my MA wanted me to read her child custody documents because she was sure her ex was supposed to have given her kid back already.
