YEAR FOUR, Q1-Q4, YEAR END SUMMARY:
SUBJECTIVE:
Q1:
Officially off all Medicaid. Can now accept cash pay.
Seeing more politically motivated relocations. People coming here to join their fellow *color state* tribe members, and other patients leaving here to join their tribe in *color state*.
The acquisition of ChangeHealthcare by UHC appears to be getting blocked in the courts. This is good news.
[*months later update, nope, it got approved]
Such a low volume this quarter, and mixed with it being deductible season, so much less money coming in. Stark contrast from a record high of December.
Assistant took initiative and pushed to change up scheduling process to give patients an appointment at first, but it is conditional, with requirement they have all paperwork done 1-2 days ahead of the consult appointment. Previously we’d wait to allow any scheduling until all paperwork done. Keeping track of this work flow change. Could be positive. Could be neutral. But seeing as how I have schedule gaps, hard to make an argument of this as a negative change.
Q2:
Little bit of a bounce back of numbers of patients and consults, but still heavy in ‘deductible season’. Looking again at moving to middle of nowhere with the BOSS and this area of interest, has a much more favorable payer mix then the other area I scoped out in past. The insurance reimbursements are lower than current local, but overall, the positively skewed payer mix should be equal. Anticipate best plan would be to truly close office location here, and open new location in that locale, stop accepting new patients from here, and only accept new patient from that locale. Keep the existing patients active with telemedicine. Get new contracts or register new office location with all current insurance companies.
Q3:
Actually moved. The limbo before the move and having assistant explain to some patients, especially those seeking stimulants, drastically cut down on new consults. Normal attrition and lack of new consults slowing drying up the practice. Things are not looking good. Finally decided to keep current patients, but with a future lack of office here, DEA rules – I need to hand off my stimulant and suboxone patients. So far 97%, my estimate, of non controlled substance patients are sticking with me and opting to do telemedicine. Was going to sublease from psychology group, more expensive than what I wanted for this area, but it checked all the boxes and the office is professional. They were suffering front desk staff shortages, and their office is in disarray. Had a superficial glimpse into their work flow. Made me appreciate my positives I’ve built up even more. Their disarray, and their landlord disarray, and the slowness of lawyer all compounded into the delays of getting an actual lease in hand. Craigslist, or driving around, is how you find lease options here. National search firms or brokerages or leasing firms aren’t used. Refreshing, but a different spin for lease locating. Craigslist had a new option, I pounced. Single large room, in suite sink, and a common area bathroom. No waiting room. Cheap, $750/month. I’ll make it work – including the UDS testing. Moving was a pain for personal residence, and moving business office was a pain, too. Just like personal, you don’t realize how much stuff you have accumulated until you have to move. This quarter and next are going to hurt financially really bad. Paying full lease price, as sleep doc isn’t subleasing anymore, and overlapping with this new lease… I’m just hoping to break even this quarter and next. THE BOSS has given me 2 years to make this practice hum, or I have to get back in the WRVUs mine with Big Box Shop. I had a solid contract in hand for local employment.
I just couldn’t do it. Not until current lease ends, will I see the lower overhead benefits in 2023. But that should amount to annual gross change of +33.6K (or just +12K if you factored in the sublease previously from Sleep Doc).
Psychologically I’m half dreading all these tasks before me (see the list at post #460 above). But the other half is a boost, a new infusion of excitement and hope with this new location. Such a small town, new landlord already heard about me weeks ago coming to town and was excitedly saying ‘you are the Psychiatrist! I wondered when you’d reach out to me. We so need you here’ I’ve had some experiences in small and smaller towns in the past, but this locale very much so the rules of “watch what you say” and “everyone knows everyone” apply.
I’ve spent too much time thinking about how/when my taxes switch over to the new state. I’m going to stop thinking about this and let the accountant tell me.
I’ve been a few weeks into concentrating my clinical time into 3 days per week, and I’m kicking myself for having not done it sooner. Goals are 3 days clinical, 1 day catch up or new consult overflow, 1 day truly off. Fingers crossed I stick to it.
I especially appreciate my assistant. She was openly updated with all the updates and downs, and was starting to put in play contingency plans for new employment if I’d gone employed. Thankfully, she is still willing to stick with me and intends to ride this practice out until she or I retire. She too has disdain of returning back to Big Box shops. We are psychologically preparing that it is now the eye of the storm, and Q4 will be a whirlwind of activity. Time will tell.
Q4:
This caught me by surprise but I had 2nd round of patients drop off form the original office. For some reason being so far away was an issue, despite all or most all of their appointments have been telemedicine anyways. So this dip and just starting to get word out about my practice was more plateau overall - despite the growth from local. Delays with some insurance companies switching over my practice address and on their directories were a big headache and delayed or stopped some patient getting in. Some wanted to see in person and not telemedicine based out of the original office, so they waited until insurance was squared away. In this state, the Blues are split up it, isn’t one regence/blue to rule them all, but two sperate ones. I got my first payment back from one and had distress, a bout of demoralization. Perhaps I had to take that employed job? My reconnaissance on numbers apparently was inaccurate. A bulk of patient panel were in the lump of Blue/regence/cross insurance, and I was going from $200-220/ per 99214 down to Medicare $110ish.
That's a solid $100 per encounter, or $200/hr loss! With moving I can't simply do a 180 and be cash only. I can't go back to employed. By default I have to play the volume game. I feel myself needing to review every post by
@randomdoc1 However, I still was waiting the entity of this blue/regence/cross whatever dyad, to get me paneled. Perhaps their rates will be what I thought, and I can submit claims to that one? I'm going to put my head in the sand and ignore things for now. Let things simmer, get more data, make decisions in Q1. Still paying lease for both locations really, really hurts. I took home after overhead, and not even paid taxes yet only $5800 for Q4. How deep is the hope well?
[*spoiler, fast forward to Q1 2023, 90% of the blues will go the other entity, I was sending to wrong one, and the other one pays what I originally researched... all is well.]
Assistant notes much more pleasant population to work with here, kinder, more courteous.
OBJECTIVE:
Total Patients: | 110 | *70 old location | *40 new location |
| | | |
Follow Ups: | 590 | 11.3 (weekly mean) | |
Consults: | 81 | 1.6 (weekly mean) | |
Weekly Clinical Hours: | 7.2 (annual mean) | | |
Weekly Clinical Hours: | 8.0(annual mean) | *updated formula | |
| | | |
Overhead Percentage: | 59.3% | | |
| | | |
GROSS PROFIT | $146,216.45 | 100.00 % |
Accountant | 305.00 | 0.21 % |
Advertising & Marketing | 1,588.25 | 1.09 % |
Board Certification Fees | 350.00 | 0.24 % |
Charitable Contributions | 390.00 | 0.27 % |
Credit Card Processing Fees | 1,470.11 | 1.01 % |
Insurance | 3,580.00 | 2.45 % |
Medical Billing Services | 909.56 | 0.62 % |
Medical Society Membership Dues | 560.00 | 0.38 % |
Office Supplies & Software | 3,852.49 | 2.63 % |
Other Business Expenses | 830.83 | 0.57 % |
Payroll - Taxes | 5,645.67 | 3.86 % |
Payroll - Wage Expenses | 15,134.21 | 10.35 % |
Rent & Lease | 47,702.89 | 32.62 % |
State Tax | 1,768.51 | 1.21 % |
State Medical License | 1,242.50 | 0.85 % |
Taxes & Licenses | 291.95 | 0.20 % |
Urine Testing Supplies | 610.31 | 0.42 % |
Utilities | 1,388.38 | 0.95 % |
Total Expenses | $87,620.66 | 59.93 % |
NET OPERATING INCOME | $58,595.79 | 40.07 % |
ASSESSMENT:
- Professional Dissatisfaction
- Slow practice growth rate
- Optimization Deficiency
- Infrastructure Deficits
- Retirement Exposure
PLAN:
- In Remission, continue this private practice. Still holding ground on the Never Again policy toward Big Box shops. Test waters with job interview, still couldn't do it.
- Okay with current pace, anything more I get behind on notes. The rate of growth I see with new location and assistant excitedly confirms, is good business decision and the right one. THE BOSS says I have 2 years to get this place humming or I go back to the wRVU mines.
- I had some increased billing of 90833 ups/downs. Can't drop medicare. Not in good place, in fact actively taking again in new location.
- Made positive change of down sized office to a basic suite, but until old office lease drops off I won't see these fruits.
- Very low risk of conversion to retirement at this time. LOL. Retirement? Markets have crashed and we have Lets Go Brandon dynamics in full force, and I didn't have enough income to be able to put any money away. Assistant was okay with no SEP-IRA deposit, thankfully, too.
[**Double spoiler, at almost end of Q1 for 2023, Things are looking so much brighter, rate of growth, patient population, lower overhead, updated policies, improved some work flow, things are looking up, and THE BOSS won't need to intercede.]