Entrepreneurship opportunities within outpt subspecialties

[bochaw]

For those of you who are a rheumatologist or endocrinologist, do you see PP (in or outpatient) being viable in the future for rheum/endo and are there opportunities for entrepreneurship as a rheum/endo physician? I’m looking mainly at services that relate to medicine in some way, not things like real estate or stocks.

Thank you and any help is much appreciated!

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[dozitgetchahi]

Rheumatologist here. I do 100% outpatient.

- Yes, outpatient PP rheumatology is quite solid right now, especially if you can get an infusion operation going successfully.

- What do you mean by “entrepreneurship”? Are you talking about having your own outpatient infusion clinic as a rheumatologist, starting a large rheumatology group that expands into a monster that buys up all the other PP rheumatology groups in the state, or what…?

 

[bochaw]

for example, i have been seeing a lot of patients that need to wait for >3 months to get appointment with rheum OR endo. So, i guess then it should be feasible to hire tons of NP and open a private practice? even without infusion.?

 

[dozitgetchahi]

for example, i have been seeing a lot of patients that need to wait for >3 months to get appointment with rheum OR endo. So, i guess then it should be feasible to hire tons of NP and open a private practice? even without infusion.?

Please don’t do that…don’t contribute to the currently abysmal quality of care in some parts of the country in these specialties by running an NP rheum/endo farm. I see a lot of rheum patients from these types of NP heavy practices and half the time they are so mismanaged…the midlevels generally have no idea what they’re doing and the docs co-signing the notes are obviously asleep at the wheel.

Please don’t contribute to the disintegration of American medicine by using incompetent midlevels to line your pockets as an “entrepreneur”.

 

[rokshana]

Most people who go into endocrine do so because they have true interest in the subject… money is of course of an importance…you want to get properly compensated for the work, but most of us are interested in giving good care to pts…if we were interested in making the big bucks, we would have gone into a specialty that was gear that way.
Mid levels have a role… it is however not as the driver of endocrine care… that is the role of a board certified, fellowship trained endocrine physician.

 

[NewYorkDoctors]

If you hire a mid level , do so only to help you write the notes and do the computer work . You should still do the cursory examination and reassurance hand holding with the patient like the attending to resident / fellow dynamic . Not only will you not miss anything to get you sued (or harm the patient ), you will foster better patient satisfaction of having a “team” approach .

Some 99213 mills have PAs (not NPs who can operate independently) solo the patient without seeing the attending to increase revenue . That’s a easy target.

I don’t have mid levels yet but I am considering it since my volume is picking up significantly . Many patients cannot get appointments quick enough since I spend the requisite time talking to patients . The best way to ensure adherence is to talk it out . There are cpt codes for extended time of visit that can be used if you and your mid level double team it . Palliative care discussions can be held (relevant for my IPF patients for instance ) and 99497 can be used to essentially double the 99213 volume . The mid level can help me get the nuts and bolts out of the way so I can focus on the big topics

My additional revenue stream comes from my pft lab , some injectables (asthma biological primarily ) , and point of care ultrasound (the same icu techniques can be used in outpatient and successfully billed - I usually use it to follow some things up rather than to rely on that versus radiology for the initial diagnosis )


As for the initial question I have picked up additional revenue working with a third party company doing remote telemonitoring of vital signs . A company will supply the RPM devices to patients and I write reports and use the cpt codes 99453 99454 99457 99458 accordingly. I have about 100 patients right now on theirs and I have optimized their BP management remotely - you can call them and use 99441-99443 -) and all these codes are projected to bring on 200K revenue this year in addition to the office work I do .

But I am unsure of what entrepreneurial opportunities there are besides buying more commercial real estate and opening up additional sites .

Perhaps one can get inspiration from those “MD degree without residency “ YouTube videos