I was going to try and write a comical comparison to halux's experience - describing how quickly "we just want you to be happy" became spending 2 months asking for a $100 bottle of Cantharone or how "Dragon is too expensive", but it just reinforces the fact that I need to leave with a side of why haven't you left yet. Eh, can't stop myself. I think this has been a pretty good discussion of the ups and downs. I had a friend who is hospital employed tell me they hired some PP people who may have been owners and they said they were making more hospital employed than in their prior businesses. That said - as someone who is part of a dysfunctional practice - its totally possible to work really hard and make no money. Like see 30ish patients 4 days a week, 3-5 surgeries a week and barely break $400K in collections (and have high overhead too).
-Instead of offering profitable DME - spend your time cutting felt foot pads for people and encourage them to come back regularly to have their orthotics adjusted for free.
-Not diabetic? Bill a level 2 E&M for nails and calluses to a MA plan that pays 65% of Medicare - so like $20. A beautiful double whammy. Technically fraud and you made no money.
-Cut out a plantar wart and if it comes back - have 3-4 free visits and then refer to dermatology.
-Routinely debride wounds and then bill it as a level 3 instead of a wound code... perhaps for the best because none of the notes would ever pass an audit since they have no measurements...
-Never review your contracts, have no idea what anything pays. Accept a bunch of well-below-Medicare rates. Cry that everything pays poorly. Other docs in town try to get you to join IPO to negotiate better rates on health insurance for employees, pay rates, etc, but you say no.
-Have an office manager who never actually goes through the books - turns out thousands of dollars of "paid" money was sitting in limbo waiting to be put into the bank account if only someone would have clicked a button.
-Have difficulty with prior authorizations or some sort of issue with Tricare - announce you'll just see Tricare people for free rather than doing whatever paperwork
-Also unlimited post-op dressing change visits. Lots of them.
-Full sterile prep for matrixectomies with sheets and prep and sterile gloves.
-Gather no information ahead of time from patients about their insurance so people regularly show up for visits with insurance/Medicaid you don't accept and get turned away at the door. Hell awkward. Gather no information on if patient will have referral ahead of time.
-Try to make plans to do inpatient care, but you aren't going to add Medicaid/any new insurance plans ...who do you think ends up in a hospital needing podiatry care?
-Since you didn't gather any insurance information you also can't get deductible information ahead of time.
-Since you have no idea what anything pays - if people call asking for a quote on an office surgery just quote them the entire fee schedule price and then say ...well your insurance may reduce it somewhat.
-Quote cash pay patients full price and not have any set system in place for a price reduction - then haggle with them the day of, if they show up.
-Routinely let cash pay patients back into the office without noticing they don't have insurance so the doctor gets to have the money conversation.
-Don't like making customs because you hand cast so set the price really high to scare people off.
-Keep old EHR on expensive server you pay expensive IT company to maintain
Anyway. Looking forward to my own thing even if I never match the hospital game. I probably would be a bad hospital employee anyway since I don't need an MRI to treat 99% of MSK issues. I do order a lot of PT and vascular testing.
Things I'm planning.
-Hard focus on overhead. Evaluate inefficiencies, big and small. Cheap rent. avoid paying thousands of dollars a year for a basic, zero frills website, overpriced local companies for cleaning and 401ks and day to day crap like - 50 page faxes for a toenail referral printing on the machine. Should have been turned into an email by the machine....
-No paper charts - no huge bins of old crap. Everything gets scanned. Yeah, I get it. Its work. I don't want to pay for a storage facility to hold old charts.
-Actually negotiate/explore health insurance instead of just saying "all I care about is a PPO" and picking the first plan that comes along.
-I will optimize my fee schedule to stop scaring off cash pay patients. I will know the price of everything that happens in the office. Fee schedule for cash pay on website.
-Get their insurance information ahead of time. I've literally heard people crying when they found out they waited 3 weeks to get in and we don't accept Medicaid.
-No desperate conversations telling people they need surgery for benign podiatry conditions that will resolve.
-Make my own video marketing materials for things like ingrown nails, plantar warts, and bunions and winner - not having to care that someone else would be butthurt about it.
-Marketing - both real, online, in person, but also the GD appearance of the office. Sterile. Clean well lit. Not depressing. Fresh paint. No f^&*ing nails littering the hallway. No grubby, old, little bottles of lotions and potions sitting on counters.
-Get a partner in 2 years and don't screw them so they stay.
-DME. But like the sort of DME people might need like an affordable CAM boot or a nice orthotic - not some BS brace that DeHeer's people are trying to push in place of a CAM boot... I'm not selling anything I can't tell a patient the price of.