SPOILER!…No one wants to practice clinical medicine

[sloh]

Attached are the posts. You can actually look up his post history on Reddit as well

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[VA Hopeful Dr]

Do you consider yourself an outlier, or can most FM docs achieve this if they choose to? Is it doable in a mid-sized or large city?

With the right practice set up, you definitely can. If you're employed, you have to find an employer who actually values primary care.

 

[VA Hopeful Dr]

There’s an FM on Reddit who practices in Ohio. Employed but paid based off productivity/RVU’s. He’s convinced his higher ups to allow him to convert pretty much all inbox messages to televisits or office visits. Max problems he deals with per visit is what the code will reimburse for. All other problems are scheduled for another visit. Dude knows his worth and is unwilling to work for free. Grosses ~800k working ~35 hrs/week. No call, no weekends, no nights. The money is there in FM if one is motivated and a smart doc.

He's at one extreme end of the spectrum on this. A level 4 visit only requires 2 problems. If you refuse to address more than that, you're going to end up with pissed off patients. Most of my chronic disease visits are diabetes, hypertension, and hyperlipidemia minimum. Making that 2 visits would be a very hard sell.

I tend to agree with most messages needing visits. We've just gotten our telemedicine set up going so we'll see how that goes.

 

[lobelsteve]

8950 visits per year (all level 4 follow-ups).
225 working days per year if 5 days per week and vacation.
Just under 40 per day.
With the hours this guy claims to work, he is seeing way more than 10 per hour.

 

[sloh]

8950 visits per year (all level 4 follow-ups).
225 working days per year if 5 days per week and vacation.
Just under 40 per day.
With the hours this guy claims to work, he is seeing way more than 10 per hour.

Tbf a lot of FM docs field inbox messages and phone calls without charging for that time. We are the only profession that does this. Lawyers charge for their time. If he can convert these messages and phone calls to encounters that can be billed for essentially doubling his clinic volume, more power to him.

 

[Agast]

Smart about billing sounds dangerously close to upcoding. You could definitely try to chew your way through as many patients as possible but then there's the liability of missing things that might be medically important.

 

[hyperalgesia]

They encourage cash payers so the money doesn’t sit on their AR for weeks to months like it does when billing insurance, and they don’t utilize overhead (i.e, billing services) to collect and post the reimbursements. I would love for patients to pay cash for all my bread and butter injections. I doubt their entire business model would be based on self-pay as a $450 MRI may be ‘cheap’ to you, but not to a lot of folks out there. I agree with you that medicine has never been a free market in this country.

How much do you think that MRI would cost if you're a poor person with poor insurance, with it's deductible and copay and other hoops to jump through?

 

[RoloTomassi]

An imaging center will go belly up if it relied purely on the concierge model. A 1.5T MRI coil costs a lot of money to set up and operate, even more costly in a CON state. There is one ‘concierge’ radiologist who has three sub-1 Tesla centers in my area, but
most of his revenue is from personal injury. This is not a sustainable model in most states.

Probably location dependent. Local MRI place with 1.5T, cash only, no PI, doing really well, expanded to multiple locations in a few years. Good price, fast scheduling and reports. Business model works well with boom of high deductible plans.

 

[Pain Applicant1]

Attached are the posts. You can actually look up his post history on Reddit as wellView attachment 378611
View attachment 378612
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View attachment 378614

I couldn't read that much of the post but one thing I can definitely say is that you definitely cannot learn billing in one hour. I'm speaking from experience.

 

[nvrsumr]

We have $350 cash lumbar MRIs locally

 

[MitchLevi]

I've had multiple conversations with someone we would all consider top 3-4 KOL in the country. Nice guy. Extremely insightful. Pay him enough money and he will tell everyone your stimulator works the best.

He would see 40-50 pts per half day. From that volume, he's capturing huge numbers of procedures.

I can't imagine what he's billing and collecting. Surely there's risk in being part of the extreme 0.1% right?

 

[cowboydoc]

I couldn't read that much of the post but one thing I can definitely say is that you definitely cannot learn billing in one hour. I'm speaking from experience.

I think he's just referring to office E&M coding, on which an hour lecture could do most docs a ton of good.

 

[RoloTomassi]

He would see 40-50 pts per half day.

Personally or him+midlevels?

 

[lobelsteve]

I've had multiple conversations with someone we would all consider top 3-4 KOL in the country. Nice guy. Extremely insightful. Pay him enough money and he will tell everyone your stimulator works the best.

He would see 40-50 pts per half day. From that volume, he's capturing huge numbers of procedures.

I can't imagine what he's billing and collecting. Surely there's risk in being part of the extreme 0.1% right?

Sounds like Pope.

 

[MitchLevi]

Personally or him+midlevels?

He sees everyone, but midlevels are part of it and he has scribes.

Sounds like Pope.

Haha.

 

[gaseous_clay]

How much do you think that MRI would cost if you're a poor person with poor insurance, with it's deductible and copay and other hoops to jump through?

If I was a poor person, I would most likely be on Medicaid, which would cover most if not all the costs of the MRI depending on the state. If I didn’t qualify for government government insurance and had poor insurance, it would depend on my copay and whether this MRI was being done to diagnose a non-emergent condition. If so, I would wait until my deductible was met prior to undergoing the study. That’s what most poor folks do, and I bet they don’t pay $450. Rich folks will just pay to get the MRI done regardless of the cost.

 

[gaseous_clay]

Probably location dependent. Local MRI place with 1.5T, cash only, no PI, doing really well, expanded to multiple locations in a few years. Good price, fast scheduling and reports. Business model works well with boom of high deductible plans.

I’m sure this is very state dependent and demographic dependent.

 

[gaseous_clay]

8950 visits per year (all level 4 follow-ups).
225 working days per year if 5 days per week and vacation.
Just under 40 per day.
With the hours this guy claims to work, he is seeing way more than 10 per hour.

This scenario sounds ripe for an audit.

 

[gaseous_clay]

I've had multiple conversations with someone we would all consider top 3-4 KOL in the country. Nice guy. Extremely insightful. Pay him enough money and he will tell everyone your stimulator works the best.

He would see 40-50 pts per half day. From that volume, he's capturing huge numbers of procedures.

I can't imagine what he's billing and collecting. Surely there's risk in being part of the extreme 0.1% right?

Sounds like Paul Lynch

 

[MitchLevi]

Sounds like Paul Lynch

A few posts up. Haha.

 

[lobelsteve]

I rolled my eyes at him when he said he averaged 65 per day in clinic and he became condescending and talked about efficiency.

 

[lobelsteve]

 

[gaseous_clay]

Couldn’t sleep Steve?

 

[lobelsteve]

Couldn’t sleep Steve?

Bed early. Up early.

 

[wendalltwolf]

View attachment 378640

He’s either working on an early Batmobile prototype, or wondering if it’s better to just quit and take care of the kids while his wife works.

 

[lobelsteve]

He’s either working on an early Batmobile prototype, or wondering if it’s better to just quit and take care of the kids while his wife works.

Movie is Gung Ho. They had to build a couple hundred cars in a certain deadline so they cut a ton of corners. Funny movie.

 

[oreosandsake]

I've had multiple conversations with someone we would all consider top 3-4 KOL in the country. Nice guy. Extremely insightful. Pay him enough money and he will tell everyone your stimulator works the best.

He would see 40-50 pts per half day. From that volume, he's capturing huge numbers of procedures.

I can't imagine what he's billing and collecting. Surely there's risk in being part of the extreme 0.1% right?

40-50 per half day.

sounds like great quality care.