How to increase profitability of a Psychiatric Practice?

[prominence]

Any ideas on how to generate additional revenue for a psychiatric (outpatient only) private practice?

I know expanding to become an IOP as well as prescribing Suboxone are options. Any other thoughts?

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[st2205]

Hire a scribe.

 

[whopper]

From personal experience, get a good base of reliable and consistent patients that have been stabilized. Most of those patients just want refills once they are doing well. A patient just wanting a refill, even if assigned 20 minutes often times will just walk out after 5-10, even after you've crossed the Ts and dotted the Is to make sure they are getting appropriate psychotherapy.

This takes some time and if you start a brand new practice, most of the patients will not be at this point. Even if they are, you have to interview them to figure out what's going on and that takes time too.

As for Suboxone, you might not want to do this. Suboxone patients are high maintenance with several of them calling at inconvenient hours, screaming, and demanding a refill of Suboxone without a visit or swearing that the dog ate the script.

Add more therapists/doctors to the practice. This will translate to lower overhead due to shared costs.

 

[vistaril]

Any ideas on how to generate additional revenue for a psychiatric (outpatient only) private practice?

I know expanding to become an IOP as well as prescribing Suboxone are options. Any other thoughts?

there are lots of ways to maximize revenue....the question is how far you are willing to go(ethically) to do so.

Everyone draws the line at a different place.

for example whopper mentions above getting a bunch of med mgt pts stable and then just refilling their meds. I know some people who would say- "well if they are stable and you are just refilling their meds, why not release them back to their pcp and you can be seen again on an add needed basis"? Some would say that is an inefficient use of health resources and therefore unethical. I WOULD NOT be one of them, but that's one way to look at it.

Another question getting to the ethical/how far are you willing to go angle........how many patients do you book for a med check? I know some pp outpt psychiatrists that regularly book 5 or sometimes 6 f/u's in an hour.....is that ethical? Again, everyone has a different line.

Is doing suboxone ethical if you're spending less than 60-90 seconds with some stable f/us? Again....where is that line?

 

[Frazier]

Looking at your colleagues and the overall field, do you (anyone) feel that psychiatrists are more (or perhaps less) business-oriented than other professions in healthcare?

Besides the obvious barriers such as startup capital/stress/risk/etc. Why don't more psychiatrists establish larger business enterprises -- such as having several therapists, psychologists, receptionists, and billing specialist work for them under the umbrella of a corporate entity?

Are most simply not interested in maintaining a complex administrative role...or?

 

[birchswing]

Botox.

 

[vistaril]

Botox.

why in the world would a patient go to a psychiatrist for botox?

some family medicine people already do botox, and they generally have to do it at a discounted rate relative to derm and plastics. This makes sense.....as if you are a patient and could pay the same thing for botox from a derm or pcp, wouldnt you go to the derm?

Likewise, if a psych did botox, they would probably have to do botox at a discounted rate vs that of pcps, which means a discounted of a discounted rate compared to the initial providers.....

 

[vistaril]

Looking at your colleagues and the overall field, do you (anyone) feel that psychiatrists are more (or perhaps less) business-oriented than other professions in healthcare?

Besides the obvious barriers such as startup capital/stress/risk/etc. Why don't more psychiatrists establish larger business enterprises -- such as having several therapists, psychologists, receptionists, and billing specialist work for them under the umbrella of a corporate entity?

Are most simply not interested in maintaining a complex administrative role...or?

it's the nature of psychiatry.......psychiatry is a field where the main skill is *the psychiatrust* seeing the patient and making a clinical judgment and then plan based on that......

many psychiatrists do have therapists on staff. some therapists work for themselves. Most psychologists work for themselves.

So to answer your question- it's just the nature of what psychiatry is. It isn't some field like pain medicine where you can set up this large umbrella of care and have your hand in all those little pieces.....the core of it is you actually seeing the patient.

 

[digitlnoize]

Botox.

why in the world would a patient go to a psychiatrist for botox?

some family medicine people already do botox, and they generally have to do it at a discounted rate relative to derm and plastics. This makes sense.....as if you are a patient and could pay the same thing for botox from a derm or pcp, wouldnt you go to the derm?

Likewise, if a psych did botox, they would probably have to do botox at a discounted rate vs that of pcps, which means a discounted of a discounted rate compared to the initial providers.....

I know a bunch of psychiatrists that do tons of botox. Another popular option for extra psych money is breast implants, sclerotherapy for leg veins, and of course, cardiac caths. I mean all of these are such easy procedures that a monkey can do them, and it's fairly easy to get credentialed in them these days...

Psychiatrists: Still better cardiologists than your noctor.

 

[whopper]

well if they are stable and you are just refilling their meds, why not release them back to their pcp and you can be seen again on an add needed basis"? Some would say that is an inefficient use of health resources and therefore unethical.

True, and I actually have encouraged that. The problem (If you want to call it that) is most patients, if you get them better, want to stay with you. Another thing is several of these patients already went to the PCP and that doctor didn't get them better. Another is the PCP often times freaks out when they see the person on Zoloft 200 mg, not knowing that most of the time antidepressants don't do anything except at high dosages, then screw up the patient telling them they need to be on a lower dosage, and then the person's depression or anxiety relapses.

I'd guestimate that on average, I lost about 20-40% of patients that were stabilized because they then just went to their PCP after they got better and I'm completely fine with that. About another 20-40% insisted on staying with me no matter what saying something to the effect that I was the only doctor that got them better and they weren't going to screw with success.

As time went by, my list just kept going up with stabilized patients that just wanted refills even though I was giving them 4-6 months worth of it. This starting becoming easier and easier...one stabilized patient after another where all I was really doing was writing a MSE and a prescription, and the # of patients seen was getting higher and higher. I also never encouraged a patient to simply just use the meds. I always provided psychotherapy or referred them for it.

 

[billypilgrim37]

Even in medication management, much of your value to your patient is the relationship you develop with them. If they go back to their PCP, you aren't going to gain their trust. You aren't going to be there when their prodromal symptoms start before the next episode. You aren't going to be there to answer their questions about how long they need to be on their medications, which medications might be reasonable to taper or adjust and when, and which side effects may be ameliorated that maybe weren't so bothersome then, but are now. If you're not seeing them, you're not going to be able to make sure they take advantage of the psychosocial interventions available to them that PCPs inevitably don't know about.

There are certainly times when it's totally appropriate to refer back to a PCP. I do it a lot more in child than I do with adults, but that might be because the adults I see are typically much sicker than children. But there is nothing wrong with using the skills you learned in residency that don't require a prescription pad to contribute to the maintenance and continuation of your patient's mental health. Personal practice and income needs are secondary here.

 

[F0nzie]

Looking at your colleagues and the overall field, do you (anyone) feel that psychiatrists are more (or perhaps less) business-oriented than other professions in healthcare?

In my residency program nobody really wants to do private practice. Maybe it's because we're a bunch of slackers . I feel most physicians in general are not very business oriented for a variety of reasons, however, some specialties seem to have a greater slant to the business end of things. Personally, I do not think Psychiatry is one of them.

I look at running my own private practice/business like investing in stocks. Stocks are riskier than bonds, but have the potential for higher gains. I plan on opening up my own private practice on the side for diversification of income. 70% employment 30% private to start, then tip the scale to 50/50 when private starts to outperform.

 

[vistaril]

Even in medication management, much of your value to your patient is the relationship you develop with them. If they go back to their PCP, you aren't going to gain their trust. You aren't going to be there when their prodromal symptoms start before the next episode. You aren't going to be there to answer their questions about how long they need to be on their medications, which medications might be reasonable to taper or adjust and when, and which side effects may be ameliorated that maybe weren't so bothersome then, but are now. If you're not seeing them, you're not going to be able to make sure they take advantage of the psychosocial interventions available to them that PCPs inevitably don't know about.

don't disagree entirely with that concept, but the reality is that health care $ are limited and will only continue to get more limited. And every time some other provider has their hand in the pot for a "stable" pt not currently requiring that level of care, that only adds to overall costs.....

I think as the health care crunch becomes even more pronounced over the next decade plus, this will become even more an issue. IOW, once someone gets referred to psych(and I dont mean the chronic SMI population), there is going to be pressure to treat them.....meaning treat them and get them back. This idea that psychs(and many other people as well) can get an outpt, treat them successfully, and then latch onto the stableness of that outpt for years and years is something that I think insurers are really going to attack in the near future.....

 

[whopper]

Even in medication management, much of your value to your patient is the relationship you develop with them.

True. It's not just about us giving the right meds but feeling comfortable with the provider. Since I've left private practice, I've had several patients demand to continue seeing me at my new outpatient practice with the university, several driving over an hour to see me because it's much further from the private practice.

I had one patient threaten to sue the former practice where I worked at because he insisted seeing me and only me, citing that he saw 8 previous doctors and no one got him better until I saw him even though I'm no longer there. The guy was on Prozac 20 mg for depression that never got better. I told him that antidepressants usually don't work at lower dosages, titrated it up to 80 mg Q daily over the course of one month and he got better.

Now we all know that what I did wasn't hard. It's actually piss poor easy and should be common knowledge to all psychiatrists but for whatever reason the other doctors (several of them psychiatrists) never did it. Now the guy absolutely does not trust anyone else but me. He accused my former practice of abandoning him even though we followed patient termination guidelines to the letter of the law and I provided him with 6 months worth of refills instead of the legally required one month. They referred him to my new office in the university but it doesn't take his insurance and he doesn't have the money to pay out of pocket.

Stabilized patients, in addition are profitable for another reason. If they are happy with your service they spread good word of mouth, and they won't be calling you at 2AM. Everytime you get a new patient, there's a chance this patient could be some Axis II Cluster B nightmare calling you all the time without good reason, and most insurance companies will not allow you to bill for over the phone therapy. Good word of mouth will allow you to increase your number of out-of-pocket payers willing to pay good money for higher quality treatment.

One way we diverted several calls away from me while I did private practice was we had a therapist do the 24 hour calls and only called me if it were something where I had to be involved such as a serious adverse med reaction. That therapist diverted most of the BS calls away from me that turned out to be 95% of them. I ended up getting a call only about once every several weeks. The therapist ended up getting calls almost on the order of daily.

 

[Leo Aquarius]

One way we diverted several calls away from me while I did private practice was we had a therapist do the 24 hour calls and only called me if it were something where I had to be involved such as a serious adverse med reaction. That therapist diverted most of the BS calls away from me that turned out to be 95% of them. I ended up getting a call only about once every several weeks. The therapist ended up getting calls almost on the order of daily.

Where do you find such a therapist? Job posting on Monster or something?

 

[whopper]

The private practice was headed by a psychologist and a licensed counselor. The counselor handled the calls, and he was smart about doing it. He diverted the bogus calls away from me, only called me if I really should've talked to the person immediately, and if I should talk to the patient but it could've waited, he took notes and texted it to me the next day so I wouldn't have to worry about it outside of business hours.

This works if the person handling the calls for you has a good clinical sense. You cannot have a receptionist do this for you.

 

[TexasPhysician]

Convince a bunch of wealthy people that TMS is cool.

 

[F0nzie]

Clone yourself

 

[Chrismander]

semi-hijack: has anyone here started using E&M to increase revenue? What are the pitfalls, challenges, benefits that you've found?

 

[nitemagi]

Reduce overhead -- (digitize) - EMR, efax, google voice, computer credit card billing
- Minimize paperwork (better to take a lower fee than be waiting months for insurance reimbursements).
- Get referral sources (true for private practice in general). Network a lot, put your name out there.

 

[whopper]

Looking at your colleagues and the overall field, do you (anyone) feel that psychiatrists are more (or perhaps less) business-oriented than other professions in healthcare?

In my opinion, in general more so. The reason being that psychiatrists have more flexible hours including being able to actually spend time into the business. Surgeons, as a comparison, are often times are sleep deprived so managing the office with someone shovelling the snow, buying the coffee, etc are things they don't want on their mind. My opinion is based on my experience and it's judging the profession as a whole. I've seen people in every field fit every description.

 

[Frazier]

In my opinion, in general more so. The reason being that psychiatrists have more flexible hours including being able to actually spend time into the business. Surgeons, as a comparison, are often times are sleep deprived so managing the office with someone shovelling the snow, buying the coffee, etc are things they don't want on their mind. My opinion is based on my experience and it's judging the profession as a whole. I've seen people in every field fit every description.

Thanks for the response, guys.

I know in certain other specialties, stark law plays a role in how referrals are made. That said, would the hypothetical business I described earlier in the thread (i.e., a psychiatrist hires therapists/psychologists/etc as employees in said corp) break these referral-focused laws?

Would this type of entity be forced to refuse medicare and medicaid in order to "stay legal" (since stark law seems to only govern self-referral for medicare and medicaid patients)? ...or since therapists/psychologists aren't physicians is the whole concern moot?

 

[whopper]

Unless there's specific state laws I don't now about I don't see it breaking anything. I've already seen practices with several specialists.

 

[Frazier]

Unless there's specific state laws I don't now about I don't see it breaking anything. I've already seen practices with several specialists.

That's what I was thinking too... Thanks for the insight!

 

[vistaril]

Thanks for the response, guys.

I know in certain other specialties, stark law plays a role in how referrals are made. That said, would the hypothetical business I described earlier in the thread (i.e., a psychiatrist hires therapists/psychologists/etc as employees in said corp) break these referral-focused laws?

Would this type of entity be forced to refuse medicare and medicaid in order to "stay legal" (since stark law seems to only govern self-referral for medicare and medicaid patients)? ...or since therapists/psychologists aren't physicians is the whole concern moot?

no it's fine and it's fairly common.

Most psychologists do not want to "work for you" though. they arent midlevels after all.

Also, the psychiatrist really needs to ask themselves if they want to have lcsws/lpcs on salaried staff, or just share office with them to reduce overhead? Many lcsws/lpcs would prefer to be salaried staff and get benefits, someone to pay the back end of their fica, health insurance, a steady paycheck regardless of no shows, not worried about billing/collections/etc.......these people are expensive. Remember if there salary is 25 dollars an hr for example, your total cost to employ them will be a lot more than that....after benefits and employment taxes are considered. When you consider everything(and how much they are actually being reimbursed total for individual therapy), it often makes more sense to just work with them in the same building and not have them as salaried staff.....

 

[whopper]

If I ever do private practice again I sure as heck plan on using several nonpsychiatrists as team members. I'd want a psychotherapist there to handle the 24 hour calls to deflect the BS calls away from me, a psychologist for neuropsych testing, especially TOVA testing for ADHD, and the more the better so long as they're competent to reduce office overhead.

 

[Frazier]

no it's fine and it's fairly common.

Most psychologists do not want to "work for you" though. they arent midlevels after all.

Also, the psychiatrist really needs to ask themselves if they want to have lcsws/lpcs on salaried staff, or just share office with them to reduce overhead? Many lcsws/lpcs would prefer to be salaried staff and get benefits, someone to pay the back end of their fica, health insurance, a steady paycheck regardless of no shows, not worried about billing/collections/etc.......these people are expensive. Remember if there salary is 25 dollars an hr for example, your total cost to employ them will be a lot more than that....after benefits and employment taxes are considered. When you consider everything(and how much they are actually being reimbursed total for individual therapy), it often makes more sense to just work with them in the same building and not have them as salaried staff.....

If I ever do private practice again I sure as heck plan on using several nonpsychiatrists as team members. I'd want a psychotherapist there to handle the 24 hour calls to deflect the BS calls away from me, a psychologist for neuropsych testing, especially TOVA testing for ADHD, and the more the better so long as they're competent to reduce office overhead.

Thank you both for the detailed responses. 🙂

 

[BS81]

no it's fine and it's fairly common.

Most psychologists do not want to "work for you" though. they arent midlevels after all.

Also, the psychiatrist really needs to ask themselves if they want to have lcsws/lpcs on salaried staff, or just share office with them to reduce overhead? Many lcsws/lpcs would prefer to be salaried staff and get benefits, someone to pay the back end of their fica, health insurance, a steady paycheck regardless of no shows, not worried about billing/collections/etc.......these people are expensive. Remember if there salary is 25 dollars an hr for example, your total cost to employ them will be a lot more than that....after benefits and employment taxes are considered. When you consider everything(and how much they are actually being reimbursed total for individual therapy), it often makes more sense to just work with them in the same building and not have them as salaried staff.....

Interesting points... maybe owning the building and renting out the office space +/- front office support staff would be a better money/headache ratio.

 

[michaelrack]

Interesting points... maybe owning the building and renting out the office space +/- front office support staff would be a better money/headache ratio.

if you have the $ to buy a building

 

[Frazier]

Purely keeping in the spirit of this thread, I was curious how some of you feel about the integration of telepsychiatry...

There was a thread in 2008 discussing its potential in the future (http://forums.studentdoctor.net/archive/index.php/t-584439.html), and with advancing technology & internet speeds... well, who knows.

In another thread, Whopper said this: "Which is another way to maximize profits-allow a few select patients you've come to know over time and trust for home-office visits, then charge yourself rent for the office, and claim it as a tax deduction."

So, it got me thinking -- if a psychiatrist had a patient population open to the opportunity of telepsychiatry, COULD that psychiatrist offer sessions from their home office, thereby reaping the benefits of:

• maintaining home/family privacy,
• increased convenience (i.e. saves patient traveling, not having to take off time from their job, etc.),
• the added tax deduction of a home "tele-session room"

?

I admit that I know very little about this option in regards to reimbursements. Is this type of offering covered by med insurance... or would it be essentially restricted to cash clients?

With very little overhead involved (and ignoring any legal technicalities -- since I'm currently ignorant on the matter), I imagine that it would be very convenient to have a few hours worth of sessions booked throughout the week (whether early morning, late at night or on the weekend) to supplement the traditional brick-and-mortar businesses...

Thoughts?

 

[billypilgrim37]

[*]increased convenience (i.e. saves patient traveling, not having to take off time from their job, etc.)

Most telepsych doesn't work like this. Generally (if done right) the patient is still at an office with a well-trained nurse or therapist on site. It's not just skyping from your home to theirs. Far too many liability issues as it is without not having a trained professional in the same or next room. My program does a decent amount of telepsych and one of the jobs I've been offered at an other institution would have a telepsych component, and all of them would be me in my work office and them at a remote office. Doing private telepsych sounds like a good way to make a disaster happen.

 

[notdeadyet]

Agree with Billy. If you look at established telepsych practices (either the private companies, or the big kid on the block, the VA), they all operate like billypilgrim describes. You need to have a staff member on the patient end in case of decompensation, suicidality, etc.

Telepsych has a lot of promise, particularly for delivering care to the underserved, but the Skype-your-patient thing smacks of bad juju.

 

[vistaril]

Interesting points... maybe owning the building and renting out the office space +/- front office support staff would be a better money/headache ratio.

well yeah....but nice office buildings in desirable locations are obviously very expensive. If one had the money to buy such a building, there really isn't anything from stopping them from doing it with not just the building they practice in but the buildings other physicians do so as well.......really, whether or not one owns the building is a separate question that is 100% real estate.

 

[Frazier]

Most telepsych doesn't work like this. Generally (if done right) the patient is still at an office with a well-trained nurse or therapist on site. It's not just skyping from your home to theirs. Far too many liability issues as it is without not having a trained professional in the same or next room. My program does a decent amount of telepsych and one of the jobs I've been offered at an other institution would have a telepsych component, and all of them would be me in my work office and them at a remote office. Doing private telepsych sounds like a good way to make a disaster happen.

Agree with Billy. If you look at established telepsych practices (either the private companies, or the big kid on the block, the VA), they all operate like billypilgrim describes. You need to have a staff member on the patient end in case of decompensation, suicidality, etc.

Telepsych has a lot of promise, particularly for delivering care to the underserved, but the Skype-your-patient thing smacks of bad juju.

Excellent, thanks for the info!

Going back to what Billy said above, perhaps the convenience factor for the patient (i.e. "no commute necessary") is off the table... and I learned something new -- that it is best practice to have a staff member nearby the patient during the telepsych.

So, with that said, would a psychiatrist be able to conduct occasional telepsych from their home office IF the patient was in an established professional setting on their end?

 

[strangeglove]

Most telepsych doesn't work like this. Generally (if done right) the patient is still at an office with a well-trained nurse or therapist on site. It's not just skyping from your home to theirs. Far too many liability issues as it is without not having a trained professional in the same or next room. My program does a decent amount of telepsych and one of the jobs I've been offered at an other institution would have a telepsych component, and all of them would be me in my work office and them at a remote office. Doing private telepsych sounds like a good way to make a disaster happen.

As long as the appropriate staff is at the patient site, there's no reason why you can't deliver telepsychiatry from your home. This would seem feasible if you worked part-time for a clinic in some underserved area, rather than a private practice. That said, I will occasionally do Skype sessions with some of my more stable private patients when I am or they are out of town.

Using telepsychiatry to justify a home office deduction is a very interesting idea. I wonder what the minimum time requirement to take advantage if this would be.

 

[billypilgrim37]

As long as the appropriate staff is at the patient site, there's no reason why you can't deliver telepsychiatry from your home.

I'm no computer whiz, but I've been told by IT and Hipaa folks (not that you can believe anything either of these folks say) that there are some definite issues with security, and I doubt most people have an adequately secured network in their home. I would be surprised if any organization large enough to have a lawyer would be okay with this.

Private practice is clearly a different matter, and good people with good judgment in private practice break rules all the time and nothing bad probably ever happens. Skyping, using unsecured email, using google voice, these all violate hipaa.

At the same time, they're also tools used to improve clinical care and keeps costs down at very little real threat to patients, and that should really matter more than a paranoid one-size-fit-all mess of legislation.

 

[SomeDoc]

I'm no computer whiz, but I've been told by IT and Hipaa folks (not that you can believe anything either of these folks say) that there are some definite issues with security, and I doubt most people have an adequately secured network in their home. I would be surprised if any organization large enough to have a lawyer would be okay with this.

Its possible to have a secure hipaa-compliant network at home (with a possible proxy server at the main institution/university). This is seen and done in radiology; the difference with psychiatry would be larger bandwith utilization since we would be dealing with realtime/dynamic audio and video data versus discreet imaging-data stacks, but given the current trends in telecommunications this is becoming more of a non-issue.

 

[strangeglove]

There is nothing inherently illegal, negligent or unethical about violating HIPAA, as long as you aren't billing insurance or otherwise transmitting information electronically. That's one reason among many not to take part in any insurance networks.

 

[whopper]

Private practice is clearly a different matter, and good people with good judgment in private practice break rules all the time and nothing bad probably ever happens. Skyping, using unsecured email, using google voice, these all violate hipaa.

When I first did private practice, the office staff regularly accepted e-mails, even told patients I could e-mail them back. I told them this was in violation of HIPAA and they did not know this. I was the first psychiatrist working at this practice and the other providers typically had people with GAFs over 60.

I did not like doing e-mail because 1) some patients tried to substitute it as a cheap way out of actually doing an office visit 2) some people write tremendously long emails that can take hours to read 3) I can't read the person's face as to what's going on 4) If you allow a patient to email you, some will literally do so to the degree where you're spending more than an hour a day on it--all of it nonbillable and arguably not meeting the standard of care since you're not doing a face to face interview.

 

[digitlnoize]

Did a google search:

http://www.pbhpoway.com/faq.cfm

http://voyagerllc.blogspot.com/2009/06/skype-and-hipaa-myth-buster.html

http://www.onlinetherapyinstitutebl...onferencing-secure-encrypted-hipaa-compliant/

There's a bunch more if you google: telepsychistry hipaa

 

[PikminOC]

Even in medication management, much of your value to your patient is the relationship you develop with them. If they go back to their PCP, you aren't going to gain their trust. You aren't going to be there when their prodromal symptoms start before the next episode. You aren't going to be there to answer their questions about how long they need to be on their medications, which medications might be reasonable to taper or adjust and when, and which side effects may be ameliorated that maybe weren't so bothersome then, but are now. If you're not seeing them, you're not going to be able to make sure they take advantage of the psychosocial interventions available to them that PCPs inevitably don't know about.

There are certainly times when it's totally appropriate to refer back to a PCP. I do it a lot more in child than I do with adults, but that might be because the adults I see are typically much sicker than children. But there is nothing wrong with using the skills you learned in residency that don't require a prescription pad to contribute to the maintenance and continuation of your patient's mental health. Personal practice and income needs are secondary here.

 

[whopper]

I've had a bunch of patients where they thought they were getting better advice on their physical health from me vs. their PCP.

E.g. I had an older guy with hyperlipidemia, HTN, smoked, and his PCP was doing nothing in terms of warning him of a future stroke or MI. I kept telling the guy he needed to watch his diet, stop smoking, and consider a statin and BP med if his numbers didn't straighten out with lifestyle changes.

I don't mind at all if a patient gets stabilized with me and has their PCP take over the case, but if they do stay with me, that's a sign to me that I'm doing my job right and if I profit more because I'm doing a good job, that's should be seen as a good thing. A system that works is when people profit for doing a good job.

And mind all of you that I'm not doing PP now, but I sure as heck will not fault a doctor who has extremely loyal patients because he's doing a good job and they think highly of him.

 

[C O M 2014]

I know someone with several clinics in neighboring cities run mostly by nps who told my friend he clears a few mil a year. He could be full of crap, but it doesn't seem at all unbelievable.

 

[PikminOC]

Hire a scribe.

This is exactly right. For minimum wage, I could get a scribe. Unsure how this would work with HIPPA though. Just a consent needed perhaps?

I would rather spend more time with patients than write out these notes. If someone could write out the facts I would edit together the whole thing.

 

[st2205]

This is exactly right. For minimum wage, I could get a scribe. Unsure how this would work with HIPPA though. Just a consent needed perhaps?

I would rather spend more time with patients than write out these notes. If someone could write out the facts I would edit together the whole thing.

They did this on my GI rotation. They were considered MAs (would probably have to hire a good MA that would be somewhat fluent in the lingo without having to ask questions about everything). It was unbelievable yet incredibly simple. He would go in and do nothing but talk with and focus on the patient. On exam he'd call out any different findings. Then he'd leave and that'd be the end of the encounter. Completely. This not only eliminated the headache of paperwork, but increased his ability to see more patients by a significant amount (i.e. scribe pays for themselves and then some) and added a lot of stress free downtime between patients. Very glad I did that rotation.

 

[F0nzie]

As an undergraduate, I scribed for Emergency Medicine for $5.50 an hour seeing 30-50 patients in a 9 hour shift. I can see this system being cost-effective for a high volume practice that uses check box template style notes. If you have any downtime whatsoever in your practice ie. no shows which are all too common in Psychiatry, you're losing money by hiring a scribe. Unless you value those intermittent breaks to chat with your scribe or watch YouTube instead of spending that time to catch up on your notes.

 

[michaelrack]

This is exactly right. For minimum wage, I could get a scribe. Unsure how this would work with HIPPA though. Just a consent needed perhaps?
.

I don't think there would be any problem with Hippa for a doc to use an employee to take/write notes.

 

[digitlnoize]

I don't think there would be any problem with Hippa for a doc to use an employee to take/write notes.

You just have to document that they have been HIPPA trained. Which is easy.

 

[PikminOC]

I am trying to find a good progress note template with checkboxes for my RN to fill out as I evaluate the patient. Anyone know of any good ones?