start up issues

[stim4u]

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Hello Board:

A couple questions for you. When first starting up, and having a few employees, what is the best method of making extimated tax payments? Would one perform these duties themselves (ie. software?), or is it better to have an accountant and/or bookkeeper take care of these issues?

What type of disability insurance or group insurance are private groups using for employees (ie. WC)?

What problems have people run into implimenting their EMR, and is having paper backup worthwhile?

Finally, what are the formal requirements for HIPPA training (ie. just reviewing cd's on a saturday, or completing paper work) ?

I am sure more questions will come up, but I appreciate any input.

stim4u

 

[Jared Leger]

Hiring a part-time book-keeper is probably the least expensive and best use of time.

We have had about a six month ramp up period using our EMR, works great for office-based procedures.

You can purchase HIPPA videos, then have you staff sign off they have been inserviced. Make sure you have a policy on HIPPA in your office. Sales reps need to sign a document stating they have read the HIPPA policy as well as all employees.

Are you doing office based procedures?

JL

 

[stim4u]

Jared:

Thanks for the info. Yes, I am looking to perform office based procedures with a remanufactured C-arm, low overhead, and a dream...

I am also looking to purchase an EMR system compatible with a billing company with which I am negotiating with. I want to be as seamless as possible, w/ a fax server, compatible practice management software, etc. Any advise would be appreciate. Also, any negotiating strategies w/ the Big Blue/Aetna/Cigna would be helpful.

Cordially,
Stim4u 😉

 

[stim4u]

Another thing came to mind:

I am looking at a remanufactured OEC 9000 vs. 9400, roughly a 10k difference. Apparently, both have parts available through these bigger manufacturers, USB digital capture, and all new parts. Anybody, have any experience with either of these devises, and is USB capture possible with the OEC 9000. I am not too happy with the Ziem we currently use at our academic center, as it has errors everyweek.

stim4u

 

[Aether2000]

I have had an OEC 9400 for 2 years now (cost $28K) and overall it is not a bad device. There are severe difficulties with lateral views in which there is any open space in the field of view....requires manual contrast/brightness adjustments and collimation. But overall I am very happy with our choice...the images look as good as a Ziehm Vista to me. Unfortunately, GE/OEC stopped manufacturing parts for the 9400 Dec 2005, but used parts will be available for years through remanufacturers.

 

[Doctodd]

Also check the Philips BVG300 (i think)....i used 2 different OEC 9400's also, and hated them for the reason algos pointed out. You cant oblique it enough for left side spine procedures because their is a bump stop on the machine's arm. You have to have the patient roll to the right to look at anything on the left. I dont know the prices for a BVG300, but if they are close, i would choose the Philips based on using it. I have no idea on maintenance costs.

T

 

[Doctodd]

What EMR? I asked this and would really like help in deciding.

T

 

[Aether2000]

1. What size of practice (number of providers MD, NP, PA, etc)?
2. Are you primarily performing procedures or will you instead be seeing a large number of follow up patients and patients for narcotic management?
3. What skills do you have for inputting data...fast typing? using transcriptionist? using templating?
4. You will need to select from an office based system, an ASP (the patient data resides elsewhere and is instantly accessed by internet), or hybrid system
5. What bells and whistles do you need? (Prescription writing, lab results transfer, storage of MRI/xray/CT images accessable to the chart, compatibility with other EMR systems in local hospitals, patient call back for appointments, patient inputting some data, etc?)
6. If the system is complex, you will need an IT person to be frequently available for updates, crashes, etc. If the system is simple, you will usually need an IT person less, but you rarely can get along without them. They are part of a number of hidden charges for an EMR.
7. How much money do you want to spend? EMRs currently range from free to $75,000 cost for a small practice...
8. Do you need front end office integration? (scheduling, interoffice messaging, etc) Do you need back office integration (integrated or linked billing systems, report generation, etc)

 

[stim4u]

DRTodd:

After reviewing AlgosDoc's EMR assessment, I am planning on using QD clinical (stat systems). It should meet most of my needs and is reasonably priced. I have demo'd several online EMR versions as well. After observing the QD clinical system in an physicians office this week, I let you know my impressions.

stim4u 😉

 

[Doctodd]

DRTodd:

After reviewing AlgosDoc's EMR assessment, I am planning on using QD clinical (stat systems). It should meet most of my needs and is reasonably priced. I have demo'd several online EMR versions as well. After observing the QD clinical system in an physicians office this week, I let you know my impressions.

stim4u 😉

Thanks....we are demoing some EMR's also. Can you send me a link to QD? Will google it now anyway.

T

edit....found it.

 

[Jared Leger]

Amkai charts is a sweet EMR system. It has great features for Ambulatory Surgery Centers.

It also has a customized application for pain management clinics. I have not used it, just seen a demo.

I would advise against Medi-talk EMR software.

JL

 

[C Fiber]

What are the prices for these systems?

 

[Jared Leger]

Depends on what you want your EMR to do.

Scheduling? Billing? Reporting? Materials Managment? Surgery Center? In-office procedures?

A very broad range would be 50-150K depending on what package you invest in.

The problem is these systems are depreciating from the moment you own them. Upgrades make it not depreciate so fast. Think about this when shopping around.

Jared

 

[Aether2000]

Many of the more expensive systems cost far more than they are worth. I prefer starting small and working up...
You can go as low as free and yet a pretty darned good system (http://www.liferecord.com/) or an easy to use system that looks like a doctors chart with built in scheduling (www.amazingcharts.com) for $1,000. QD Clinical is about $12,000. There are some that are much much more expensive but I would not recommend these because the world of EMR is rapidly changing and evolving to a set of standard databases and operational interlinked systems. None of the current EMRs will exist unchanged for the long haul and therefore I would not plunk down $100k for a program that will be archaic in 2 years.

 

[PainDr]

Anyone have a preference regarding RF generators?

 

[Jared Leger]

I just bought 2 Stryker's and have been very satisfied.

I just heard that Baylis Medical/Kimberly Clark has an RF machine that will burn 3 levels at once. This could be a huge timer saver.

JL

 

[Aether2000]

Neurotherm has the first machine to do 3 burns...we have one in our ASC and it works well. Baylis is not far behind and Stryker has some amazing technology coming out in the near future. I lhave 2 Fischer/Liebinger/Stryker machines in my office and they also do a fine job, are small and portable.
Owl has the smallest machine of all, but operates on an unusual frequency of 100kHz. It is a colorful and inexpensive machine. Radionics/Tyco/Valleylab: well, requiem aeternam. Cosman is the new kid on the block...a reanimation of the old Cosman that was purchased by Radionics. It is the least expensive on the market.

 

[neuropathic]

How is the Philips BV300 compare to OEC 9800 in terms of image quality, reliability? Is the BV300 bulkier than the 9800?

In terms of the RF generator, I really like Stryker, but I am also wondering whether I should use the Baylis machine because of the ability to do transdiscal procedure in the future. Any thoughts?

 

[stim4u]

Speaking of Intradiscal electrothermal therapy. Has anyone used the radionics IDET probe (cost $1200, reusable?). I assume you can use a similar intraducer catheter as with the smith and nephew device? I only have experience w/ S&N.

stim4u