How feasible is to start your own PP?

[Drhappyface]

Neuro resident who needs some advice.

1)The trend these days seems to be employed positions with a large hospital entity but does this also hold true for neurology?

2) Considering that there aren't many billable procedures in neurology, how do PP stay afloat with their overhead and how profitable is PP compared to a employed position?

3) What are some ways in which you can expand your practice? How much more value can a infusion center and botox add? What are some other ways to bring value to your practice?

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[NewYorkDoctors]

Not a neurologist but I am in private practice and I had PP colleagues who do general neurology and have a thriving practice .

The key is opening a practice in a convenient place near many internists . Convenience is key for getting these referrals. Patient volume is the key driver of revenue . You’ll want to be able to attract all the “crap consults” like nonspecific dizziness that fits nothing the neuro exam , “numbness” that fits nothing in the neuro exam , “weakness” that is really fatigue , and other point less referrals . But hey they pay the same a day complex consult. the small independent practices have EMG , MSK ultrasound and those trigger point injections , that peripheral nervous system sudomotor testing (not that I’m aware of any EBM use for that but hey it has a cpt code that pays) , and administering injections of those calcitonin receptor blocker meds for migraines and do the Botox injections as well. Despite using botox for like blpeharospams or something , some neurologist take cosmetic courses and advertise Botox for cosmetics. Hey nothing is stopping you from doing it if you get the training independently outside of residency or training . You can also always contract a mobile radiology center to do ultrasound in your office . Probably the relevant ones are carotid TCD and echo . You don’t get paid for those (radiology does) but you get a nominal fee from them for using your office space and in turn you can drive more follow up visits .

The larger independent practices do their own infusions for biologics for MS and bought their own MRI machine and hired their own neuroradiologists and that’s their money printing machine . The benefit of expanding to a larger practice (more partners ) is that you’ll be able to do hospital consults (which is meant to build follow up in the office ) without sacrificing office time and get more revenue to hire nurses for the infusions and eventually the ability to buy the MRI and hire the radiology staff .

Hope this helps . Bottom line these private practice neurologists do make bank but have to build up slowly at first and have to see many neurology referrals which should be psych referrals for somatic disorder .

 

[Telamir]

^^^
I think this post significantly drained me of serotonin.

 

[sharkbaitwhohaha]

^^^
I think this post significantly drained me of serotonin.

Can’t make overhead billing Medicare moderate-high MDM. The “business” side of neurology makes up for the cuts to office visit billing and EMG reimbursements.

 

[deathmerchant]

Neuro resident who needs some advice.

1)The trend these days seems to be employed positions with a large hospital entity but does this also hold true for neurology?

2) Considering that there aren't many billable procedures in neurology, how do PP stay afloat with their overhead and how profitable is PP compared to a employed position?

3) What are some ways in which you can expand your practice? How much more value can a infusion center and botox add? What are some other ways to bring value to your practice?

You can do it, I know few people who have successful practices. its definitely harder these days. You have to be able to do procedures and see high volumes to run a successful independent practice. And also be comfortable with business management. Best procedures to learn in residency- EMG, Sleep studies, EEG, and Botox, trigger injections. Practice owned Infusion center/Imaging/Outpatient Rehab can boost you a lot.

If you can find 1 or 2 partners and/or possibly a couple midlevels, that would work much better. Its also important to develop a good relation with some Primary practices, although there is a major need of outpatient neuro in almost all areas. The other option is joining a multi-specialty, physician owned group and split the overhead.

 

[Telamir]

Can’t make overhead billing Medicare moderate-high MDM. The “business” side of neurology makes up for the cuts to office visit billing and EMG reimbursements.

Oh I'm sure. It's just definitely not my thing and it made me cringe a little.

 

[NewYorkDoctors]

Another general PP tip is you need to join an independent practice association . This is a Group of private practice physicians who are represented by a group who can help you negotiate the best insurance rates . It’s a form of collective bargaining . Also referral amongst each other is tacitly understood . Otherwise if you try to apply to insurances completely solo , that’s a good way to get your insurance application ignored .

 

[DrSatan]

Why (my) PP hard?

 

[elanmorin]

Why (my) PP hard?

Have you tried injecting it with PE (private equity)? Anecdotal evidence, but I've seen that deflate many PPs of varying sizes.

 

[Drhappyface]

Are there certain parts of the country try where PP is more likely than others? I'm assuming major cities are saturated.

 

[neurolddoc]

Private practice still remains a viable business model in my opinion. However, I think it would be more difficult to hang out a shingle than to join an established practice. We are a single specialty practice of small to moderate size. We are big enough that we can have multiple testing modalities supported. We have EEG, ambulatory EEG, neurovascular laboratory, vestibular laboratory and multiple nerve techs to support the doctors doing EMGs.

We work very hard with most doctors seeing more than 20 patients a day. We do very well financially.

It also takes considerable energy and attention to running the business aspects of a practice.

As some have pointed out, a single group has little negotiating power with insurance companies and in my area, insurance reimbursements are some of the worst in the country. We are however fortunate to be in a state that has expanded Medicaid coverage and Medicaid pays as well as Medicare.

 

[Zendo]

Not a neurologist but I am in private practice and I had PP colleagues who do general neurology and have a thriving practice .

The key is opening a practice in a convenient place near many internists . Convenience is key for getting these referrals. Patient volume is the key driver of revenue . You’ll want to be able to attract all the “crap consults” like nonspecific dizziness that fits nothing the neuro exam , “numbness” that fits nothing in the neuro exam , “weakness” that is really fatigue , and other point less referrals . But hey they pay the same a day complex consult. the small independent practices have EMG , MSK ultrasound and those trigger point injections , that peripheral nervous system sudomotor testing (not that I’m aware of any EBM use for that but hey it has a cpt code that pays) , and administering injections of those calcitonin receptor blocker meds for migraines and do the Botox injections as well. Despite using botox for like blpeharospams or something , some neurologist take cosmetic courses and advertise Botox for cosmetics. Hey nothing is stopping you from doing it if you get the training independently outside of residency or training . You can also always contract a mobile radiology center to do ultrasound in your office . Probably the relevant ones are carotid TCD and echo . You don’t get paid for those (radiology does) but you get a nominal fee from them for using your office space and in turn you can drive more follow up visits .

The larger independent practices do their own infusions for biologics for MS and bought their own MRI machine and hired their own neuroradiologists and that’s their money printing machine . The benefit of expanding to a larger practice (more partners ) is that you’ll be able to do hospital consults (which is meant to build follow up in the office ) without sacrificing office time and get more revenue to hire nurses for the infusions and eventually the ability to buy the MRI and hire the radiology staff .

Hope this helps . Bottom line these private practice neurologists do make bank but have to build up slowly at first and have to see many neurology referrals which should be psych referrals for somatic disorder .

How much did these neurologists make? In other words, what is the ceiling for a robust private practice like this and is it worth all of the effort compared to being employed in a system?

 

[Sushirolls]

Psych here.
Read this thread I started for most everything you'd need to get things up and running.

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

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I'm actually surprised more neurologists aren't opening their own practices. Rural place I'm at now and even in Metros they are back out months. You can really set your own terms. Don't take medicaid or any low paying commercial insurance if you don't want. Add on whatever procedures you want over time. Do traditional practice with volume, and multiple support staff, or go lean and see less patients and do most everything yourself.

Don't join the collective / independent practice associations. They will ream you with required EMRs that will charge way too much.
Stay away from private equity, too.