Is starting your own PP financially worth it?

[BobBarker]

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Lots of Medicare and Medicaid. That is normal in our field.

No, my personal collections are much higher.

Yes, I have another Dr that works for me/with me. We trade patients back and forth as we are compensation blind.

 

[Ducttape]

How do they pay a pension and not a 403b. Do you work in the last century?

i have been working for this system for 15 years...

and technically, i had an employee number in this system dating back to 1991.

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bob, why do all of your dates start with July 1?

for example, does "July1-Feb28 $488,167" mean that you made 488k from july 1 to feb 28, and that you made $900k from march 1 to june 30?

 

[BobBarker]

Yes. I’m showing how it takes time for the insurance to roll in and the practice to get more full.

 

[Drhappyface]

Yes, a Medicare RFA patient adds up to $2500 and maybe $3200 if they might benefit from a LSO.

Sorry
How are you getting at $2500 for an RFA? Reimbursements from 2024 show reimbursement of $430.50. What other fees or codes do you add? Or is the reimbursement for just one level? ( eg x6 for bilateral l3-4, l4-5, l5-s1 would equal around 2500?)

 

[BobBarker]

1. Consult
2. LSO - I don’t actually give these patients an LSO but it is allowed
3. Bil two level mbb
4. F/U
5. Bil two level mbb
6. F/U
7. Bil two level RFA
8. F/u


That is probably over $2500

Then 6-12m later you might get another round
9. F/U
10. 2nd bil two level RFA
11. F/U



Ok, now time for their neck.

 

[Drhappyface]

Gotcha
Thats the total patient. I was thinking on it was one visit

What percentage of a typical practice are medicare vs medicaid vs commercial? I would assume being mostly Medicare or medicaid would make it difficult for a practice to stay afloat.

Do you perform advance procedures also in a ASC? Maybe not your own but contracted to one?

 

[BobBarker]

I don’t think it makes much of a difference here. If my practice was all traditional Medicaid it would probably be exactly the same revenue. It pays a little better than Medicare. Not enough to worry about.

Yes, I do implants/lateral SI/mild, etc at an ASC or HOPD. I have a small ownership in an ASC which is fine since it is a fairly large 6 room center. That is fully optional and you technically lose money for time doing anything at a facility vs staying in your office if you are in private practice and don’t have ownership.


Example:

Pump implant pays a pro fee of like $500 Medicare. You are better off hanging out in your office doing anything else or taking time off to enjoy the outdoors - unless, you are an owner and the facility is profitable. It might not be. Or you are actively trying to build up your surgical practice for the chance to be offered ownership.

The facility I bought in was already profitable. So me joining, is accretive. After my implant costs, I’m not really increasing overhead otherwise and then I really turn up the profitability. Commercial DOES pay much, much better on the facility side. Some of the case profit is outlandish. But that gets diluted out to the other docs.


Hospital employed you can do big cases or not. However, you want to get your units.

 

[hhp]

For insurance contracting, everyone here uses the same consultant. Billing, you would outsource that. My billing company CEO helped set up my practice. So that might be a good contact for you when you are ready. Equipment to me is fun/easy. I think I have a long detailed post about the equipment in my post history from 2022 or 2023.

I started billing on my own July 1 2022. I was only in clinic 1 day a week for the first 3 months. In October, I began having a NP there every day. I still worked at the hospital.
We collected around $300k in those 6 months. Which despite being low paid the costs, and you have a 6 week minimum delay in A/R. So total money collected from the work done over those 6 months is more than that.

Can you share which consultant is commonly used for insurance contracting?

 

[BobBarker]

The dominant one in Oklahoma is Berkeley and Associates. All of my peers use them.

 

[Yo GabbaPentin]

I have a job opening presently if anyone is interested. Multi specialty group. Lots of autonomy assuming you aren’t interested in doing illegal or dangerous things. Physician owned. Working 4 days a week. 7 figure income with zero buy in and we can grow as much as you want. The catch is that you have to work with me. DM me if interested

 

[Pain Applicant1]

I work less than 35 hours/week including running biz.

For other pp peeps- anyone use anything other than quickbooks for your bookkeeping? I keep it in house and have 6 entities. Subscription is $1000/yr

waveapps

 

[nvrsumr]

In the same vein anyone have someone cheaper and better than paychex?

 

[jsammi245]

Depends on where you want to hang up your shingle and what kind of pain practice. I feel like most people who are thinking about their own practice are in areas where there are already a fair number of pain physicians and the ideal job doesn’t exist. So from a practical standpoint, the question is how are you going to build up your patient volume. If you are an opioid-free practice, that’s great- but harder to woo referrals away from the doctors who already have established relationships and an army of midlevels writing refills. You can try to develop a relationship with personal injury/ambulance chasing law firms for supplemental cash as they will not expect you to write for pain pills. Those contracts can be competitive as well.

On the flip side, if you run your own practice and prescribe pain medication, you’ve created two ways to effectively never enjoy vacation time again. Someone always needs/wants a refill, expects you to be available immediately, has a prior authorization headache, etc. You live and die by how good your staff is, and it is very hard to find good staff who will stick with you for the peanuts you offer with no benefits compared to the hospital system or bigger groups. You can’t just be a doctor and do the doctor stuff, you have to be HR and admin. If you’re not business-minded that part can suck.

It's part of the reason I don't think I can open my own practice. When you live in a competitive market you will get all the patients other pain doctors do not want to see. You will start our really slow. I don't even think in my area it will be possible to open a non-opioid practice. There are literally pain doctors within a few miles of each other. PI is another story and can be a headache too. I have seen my colleague run his practice and it is a lot of work. From ordering supplies, hiring MAs, managing staff who do not like each other etc. sometimes it's better to just do your work get paid and go home. Also, I agree once you start prescribing pain medications you will never be able to take long vacations everyone will need their refills etc.

 

[BoardingDoc]

Also, I agree once you start prescribing pain medications you will never be able to take long vacations everyone will need their refills etc.

Yep. Going from fellowship where I did a ton of COT to my new job where I do ZERO is a complete game changer. Completely different lifestyle. The juice from the recurring 99214 med refill visits just isn't worth the squeeze for me.

 

[Drhappyface]

Sorry to start this thread again but I'm really questioning PP now. Currently working with a PP owner. Really awesome, truthful and hardworking guy but his view on pain medicine is really pessimistic. He thinks that PP will eventually go away due to slowly decreasing reimbursement or procedures. Eventually we will get to the point where we are just employees in HOPD setting where our earning potential is limited. Really brought got me thinking how bad things will be in a few years when I want open up my own.

 

[drusso]

Sorry to start this thread again but I'm really questioning PP now. Currently working with a PP owner. Really awesome, truthful and hardworking guy but his view on pain medicine is really pessimistic. He thinks that PP will eventually go away due to slowly decreasing reimbursement or procedures. Eventually we will get to the point where we are just employees in HOPD setting where our earning potential is limited. Really brought got me thinking how bad things will be in a few years when I want open up my own.

Is your practice leveraging AI? It's changing the game from clinical documentation, pre-auth, credentialing, and revenue cycle management. We're steadily reducing staff FTE by using AI and remote workers. You can more or less run an entire practice off your iPhone now.

 

[gazzer]

Is your practice leveraging AI? It's changing the game from clinical documentation, pre-auth, credentialing, and revenue cycle management. We're steadily reducing staff FTE by using AI and remote workers. You can more or less run an entire practice off your iPhone now.

Can you please give us some specific examples. I know the clinical documentation part has been solved. How are you using AI for prior auth, credentialing and revenue cycle management?

 

[drusso]

Can you please give us some specific examples. I know the clinical documentation part has been solved. How are you using AI for prior auth, credentialing and revenue cycle management?

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[callmeanesthesia]

It's just exploding. You have to evaluate the right option for your needs, but within five years, most of the unnecessary paper shuffling in healthcare will be handled by robots. Buy yours today!

The AI-first Healthcare Revenue Cycle Management Platform

ENTER is an AI-first Revenue Cycle Management (RCM) solution to help healthcare providers reduce claim denials and eliminate administrative burdens.

www.enter.health

AI-Powered Revenue Cycle Automation | Thoughtful

Automate Your Revenue Cycle with Thoughtful AI. Eliminate manual tasks and boost efficiency, accuracy, and compliance. Start saving time and money with healthcare's most powerful AI Agents.

www.thoughtful.ai

Automated provider credentialing and enrollment | Medallion

Provider credentialing and enrollment reimagined. Accelerate time-to-revenue, stay compliant, and scale provider operations, without adding headcount, through automated credentialing and enrollment.

medallion.co

Are you still on Aprima? Have you had success with integrations? I’m still using Insight Health which you had recommended but haven’t pursued integration. I beta tested Aprima’s built in AI scribe and it was worthless. I think it’s better now but still doesn’t do a great job of putting in the right order codes, so what’s even the point of paying $300 a month for it?

We just started using Copilot 365 to process referrals (just started as in yesterday, so I’m not sure how it will work out yet). I wrote a series of prompts to extract demographics, payor and auth info, and summarize the clinical info including imaging reports. The referral coordinators drop the PDF in and paste in the prompt. They’re also going to experiment with creating AI agents to optimize the processing. Best of all, it’s free since it’s included with our enterprise Office 365 license. I’d be happy to share my prompts if anyone wants to try.

I’m very interested to hear what other solutions everyone else had success with and how you’ve deployed them. Billing? Prior auths? Marketing? Clinical workflow?

 

[drusso]

Are you still on Aprima? Have you had success with integrations? I’m still using Insight Health which you had recommended but haven’t pursued integration. I beta tested Aprima’s built in AI scribe and it was worthless. I think it’s better now but still doesn’t do a great job of putting in the right order codes, so what’s even the point of paying $300 a month for it?

We just started using Copilot 365 to process referrals (just started as in yesterday, so I’m not sure how it will work out yet). I wrote a series of prompts to extract demographics, payor and auth info, and summarize the clinical info including imaging reports. The referral coordinators drop the PDF in and paste in the prompt. They’re also going to experiment with creating AI agents to optimize the processing. Best of all, it’s free since it’s included with our enterprise Office 365 license. I’d be happy to share my prompts if anyone wants to try.

I’m very interested to hear what other solutions everyone else had success with and how you’ve deployed them. Billing? Prior auths? Marketing? Clinical workflow?

Yes, we are still on Aprima. Our integration goes live at the end of the month. It's been a slog.

Also, incorporating various AI tools into back-office and call center activities.

 

[callmeanesthesia]

Yes, we are still on Aprima. Our integration goes live at the end of the month. It's been a slog.

Also, incorporating various AI tools into back-office and call center activities.

I looked into some of those links you posted for the AI RCM. Are you using one of those, and if so is it good and cost-effective? Of course they don’t give hard numbers but ChatGPT found a reference to one of them charging 6% of collections. We currently pay only 4.5% with top 10th %ile performance. Days in AR less than 30 days and cash to net revenue right around 100%.

 

[DrJekyllNj]

It’s a tough climate right now. Location is key.

 

[Agast]

It’s a tough climate right now. Location is key.

So did you successfully sell your practice?

 

[DrJekyllNj]

So did you successfully sell your practice?

I’m not following what you mean

 

[bubaghanush]

I’m not following what you mean

Let me tell you a story.

There once was a user named Doctodd. He posted his practice here to sell. One day he got banned for being naughty. Then his 'friend' JoeFlores joined SDN the next day. He also advertised his 'friend's' practice. Nothing wrong with that. But alas, he was also banned for being naughty.

Now we have another friend who joined two weeks after but waited four months to make a flurry of posts to get into the private forum. Will they be naughty or nice?!

 

[Agast]

Let me tell you a story.

There once was a user named Doctodd. He posted his practice here to sell. One day he got banned for being naughty. Then his 'friend' JoeFlores joined SDN the next day. He also advertised his 'friend's' practice. Nothing wrong with that. But alas, he was also banned for being naughty.

Now we have another friend who joined two weeks after but waited four months to make a flurry of posts to get into the private forum. Will they be naughty or nice?!

You mean… do we get Dr Jekyll or Mr Hyde

 

[jsaul]

I didn't realize some people really need to keep posting and trolling on the SDN pain forum to give them I guess "entertainment" in their life

 

[Drhappyface]

How much collections should a solo physician practice bring in once its established eg 2-3 years? Have any of you guys added on other sevices eg stem cell? Prp? Allowing NP/PA to do botox for both cosmetic and migraines, weight loss etc etc.?

 

[BoardingDoc]

How much collections should a solo physician practice bring in once its established eg 2-3 years? Have any of you guys added on other sevices eg stem cell? Prp? Allowing NP/PA to do botox for both cosmetic and migraines, weight loss etc etc.?

That number is wildly variable depending on how busy you are, and can further vary based on how much you're pushing these ancillary services that you mentioned.

Also, this question belongs in the private forum.

 

[drusso]

That number is wildly variable depending on how busy you are, and can further vary based on how much you're pushing these ancillary services that you mentioned.

Also, this question belongs in the private forum.

Why?

 

[BoardingDoc]

Why?

Discussing detailed financials is much more likely to get a comprehensive response in the private forum.

 

[drusso]

Discussing detailed financials is much more likely to get a comprehensive response in the private forum.

You guys are funny...

 

[OM1027]

Are you still on Aprima? Have you had success with integrations? I’m still using Insight Health which you had recommended but haven’t pursued integration. I beta tested Aprima’s built in AI scribe and it was worthless. I think it’s better now but still doesn’t do a great job of putting in the right order codes, so what’s even the point of paying $300 a month for it?

We just started using Copilot 365 to process referrals (just started as in yesterday, so I’m not sure how it will work out yet). I wrote a series of prompts to extract demographics, payor and auth info, and summarize the clinical info including imaging reports. The referral coordinators drop the PDF in and paste in the prompt. They’re also going to experiment with creating AI agents to optimize the processing. Best of all, it’s free since it’s included with our enterprise Office 365 license. I’d be happy to share my prompts if anyone wants to try.

I’m very interested to hear what other solutions everyone else had success with and how you’ve deployed them. Billing? Prior auths? Marketing? Clinical workflow?

I'd like to try these prompts if you are willing to share them