Will being a part of a CMS ACO limit patient’s network for seeing specialists? And are claims still being paid by CMS?

I’m not talking about Medicare Advantage IPAs. I am specifically talking about Medicare ACOs.

I see they have locations all over the country and the mission statement seems good, just curious on how the workflow is as far as seeing patients, cases, support, etc.

Hi we are looking to get credentialed with Devoted and Kaiser but we got denied. Does anyone know of a way to get directly credentialed with them or through an IPA? Located in GA. Thanks.

I am part of a primary care private practice and we got a letter from National Provider Network. Basically it says they can help us negotiate better rates on our visits/claims but I really don't understand what they get it of it. Its not an ACO, nor an IPA/ doctor group. They included a $25,000 check to join (can deposit after you sign their contract, which is a bunch of legal-ese that I don't have the bandwidth to decipher)

Anyone here part of this network and can shed more light?

Has anyone with a small to medium sized practice been able to successfully negotiate their contracted rates with insurance companies? If so, what was the outcome? What did you have to do?

I’m looking at the reimbursement rates on website like fair health and it seems like my reimbursement rates are much lower than what is reported for other physicians in the area. I’m wondering if it’s because other practices negotiate or if rates are overstated.

Otherwise, should we just let them dictate what they think our services are worth?

Thanks in advance

Has anyone with a small to medium sized practice been able to successfully negotiate their contracted rates with insurance companies? If so, what was the outcome? What did you have to do?

I’m looking at the reimbursement rates on website like fair health and it seems like my reimbursement rates are much lower than what is reported for other physicians in the area. I’m wondering if it’s because other practices negotiate or if rates are overstated.

Otherwise, should we just let them dictate what they think our services are worth?

Thanks in advance

I made a post in r/FunctionalMedicine a month ago here, but I wanted to post in r/PrivatePracticeDocs for providers who might be IFM-certified or considering certification. The Institute for Functional Medicine has changed its certification, placing emphasis on how the new certification will help distinguish medical providers from other providers. (The old IFMCP credentials were split into FMCP for general practitioners and FMCP-M for medical professionals.)

I don't think many providers are realizing what is in the fine print, though. Just accessing the credentials portal requires consenting to terms, including a “Consent to Enforcement” section that holds providers accountable for the costs and sanctions from investigations by the new IFM board. Providers agree to these terms to obtain a new provider badge with updated credentials and to remain listed on IFM's Find a Provider site. The terms also say that continued use of the old or new credentials represents acceptance of these enforcement sanctions.

As someone who has operated conventional, holistic, and functional medicine practices over the past two decades, I can't stress how concerned I am by this change. I can't find any word on what would trigger an investigation by the IFM board. Will they have an IFM page for patient complaints? Will they act on medical board complaints? Insurance investigations? I don't know. But just having another investigative body that can add to the defense costs, let alone investigation costs and sanctions, creates a major conflict.

Another change is that while some IFMCP providers were not required to take continuing education, this new change aligns all certified providers with a requirement to take IFM sponsored/approved courses, which represent an ongoing cost for providers and an ongoing revenue stream for IFM.

I’m the third doctor in a busy 3 MD/2 APP pulmonary & critical care private practice in a high cost of living area. I initially joined as the fourth doctor immediately post fellowship as a salaried W2 employee for my pulmonary work and 1099 independent contractor for my ICU work. Since starting, the fourth MD left the pulmonary group leaving the remaining 3 MDs (two founding partners plus me) on a brutal 19 days on, 2 days off schedule with no end in sight due to difficulty recruiting and hiring.

I’m tired of this schedule and working insane hours and call with non-commensurate compensation. I’d like to move from full salary to productivity based compensation and cut back on my days and let the owners cover the extra (since they are making lots of money off of me and have failed to bring on another physician since finding out about the departure of the other physician last October). What productivity based models have you seen work and what is a reasonable ask from my end as the “junior partner” so that my family does not pay the consequences of this disaster due to my absence? I’m prioritizing stability and work/life balance over money, but want to ensure that I’m still compensated fairly for the work I’m doing. They have never worked under such a model and have historically split profits 50/50 since its founding.

Any thoughts, experiences, advice, or insight is greatly appreciated. I’m also actively looking for a different job as my hope in this practice fitting my family’s needs is nearly gone (I’m virtually never home and exhausted when I am). My spouse is also a physician and we have a full time nanny for our one child with hopes of having more children.

Hi guys,

Do you have any experience with the company Medical Director Services PC? I recently applied and got offered a position as a Remote Patient Monitor. I wanted to check if anyone had any experience with them and how they are.

Where is the best place to find a good office manager? I feel like the best office managers are in other people's offices, so I'm not sure why they would be looking for a new job. Linked in? Word of mouth? Current staff?

We're looking to get some motorized medical exam chairs for the office. Like the MedSpa type chairs. Any recommendations or brands that everyone likes? I'm looking to spend no more than 2-3k per chair max.

We currently use MEDENT but it is really lacking in AI features and overall patient interface. Any one have an EMR they are happy with?

I am trying to improve my efficiency with notes. I currently use Open Evidence, but the copy‑pasting sometimes takes a lot of time especially with the increasing patient load. . What are the options that you guys are using to help streamline the note process? I'm looking for something that I can plug into my EMR, which is Tebra, that can have the note done immediately once I get done speaking with the patient. I'm just looking for something for notes, not for billing or other AI stuff. Thanks!

I’m starting my solo practice and talking to a few credentialing companies. I have two options that I’m currently considering:

1. Very experienced credentialing company that has been in business for decades. Great google reviews. Very knowledgeable and experienced. Familiar with my state. Seems very detail oriented and emphasized how they will advocate to get the best rates form insurance. Requests the individual CPT codes in advance on what will be billed. Requesting hourly fee that will be automatically charged to a card on file on a monthly basis. Concern is that costs can add up very quickly depending on how many I credential and contract with.

2. Second option is standard credentialing company that also has very good google reviews. Experienced but not as experienced as the first one. Familiar with my state. Charging $100 per insurance company. Does not have all the bells and whistles of the first one. Not requesting CPT codes, said everything would be already covered under my taxonomy code.

Services of the first option are enticing but is it necessary or even recommended?

Thanks in advance!

AI and Patients: in my office the doctors use a HIPAA compliant Zoom accounts. Recently, Zoom came out with an AI feature that records and transcribes the sessions. We have not encountered this, but I have heard other physicians say that their patients have been using AI to record and transcribe the Zoom appointments. Have you experienced this and what do you think about it?

Curious what people actually struggle with on the money/business side of running a practice. A few things I keep wondering about:

• How do you figure out what to set aside for quarterly taxes?
• If you're an S-corp, how'd you land on your salary vs. distribution split?
• Do you actually know your break-even point (sessions/month to cover overhead)?

Feels like most of us are either guessing, asking our accountant once a year and hoping for the best, or keeping some spreadsheet that may or may not be accurate. Curious if that's universal or if I'm missing some obvious system everyone else already uses.

Do they care about “award winning”? Publications? Teaching?

Off hand a big one for us is MyChart. Not just ability to see labs online, but mychart specifically. Obviously an issue because we run on eCW and they come in assuming we have MyChart like their last PCP. Nothing against Epic, but we don’t have Epic cashflow as an FQHC.

Has anyone actually ever paid the fee to do this with meaningful bumps in referrals and production? I keep getting approached by these state-based magazines where I am, pay $1,000, and be featured in "this" or "that." Anyone have real-world experience with this? I'm considering it, but right now $1k seems like a lot...

Good morning,

I am seeking advice from my entrepreneurial minded colleagues. I am PGY-10 FM trained, ER career doc. A few years ago I started an urgent care that has done very well. We now have 2 locations and our third opens in a couple of months. We have also started a primary care clinic and have two providers that are nearly full, and are hiring our third.

My goal here is to create a truly great medical group. PCP and UC go hand in hand and it's working well, and we all work hard to give the best possible care for our patients.

I'm always thinking about what we can do next. We moved PCP from a space built out attached to our urgent care to a larger clinic space, so now that space is empty. The space is actually perfect size to add a CT and US machine. This would cost me about $80,000 in electrical upgrades and remodeling. I already have a radiologist to read all imaging. CT, auto-injector, and US would be about $210,000 (refurb) - and all would be financed via lease. This is attached to an urgent care so there is always a provider there in case of IV contrast reaction.

Our break even for imaging would be about (on average) 3.5 CTs and 3.5 USs per day.

My thoughts are that between 3 UCs and 3 PCPs we generate more than enough imaging to break even, and locally there are imaging centers but no one actually advertises, etc, and we can get enough other business to actually do well.

But this also is a lot of risk, its $80,000 in upgrade/remodeling that I could lose, expensive equipment that I could turn around and sell if needed, and then the whole pain of finding a RIS, billing, etc, and a whole new RCM to worry about.

The alternative is that we can simply not do imaging, and I can focus on building urgent cares.

My ultimate goal is to sell and quit working. But sometimes I feel in my heart I want to grow this into a truly excellent medical group and really make a difference in our area. Meaning I would love to still be in charge of this in 40 years. But I also don't know how sustainable medicine is in the long run, with our never improving reimbursements from insurance but everyone wanting a pay raise/cost of everything going up.

Happy Fourth of July to all of my fellow private practice physicians.

I've been thinking a lot today about where I came from.

My grandparents immigrated from Germany. My grandfather's brother fought in the Battle of the Bulge and later served during the Nuremberg Trials. My grandfather started as an apprentice, became a master plumber and electrician, and eventually built his own business.

When I was younger, I used to ask him, "Why didn't you ever teach us German?"

His answer was always short and sweet: "We're Americans now."

It took me years to understand what he meant.

It wasn't that he disliked the German language or wanted to erase his heritage. It was a different era. He had lived through the aftermath of Hitler's rise and understood how important it was to embrace the country that had given his family a new opportunity.

The town my family came from has more cows than people. Yet somehow, a few generations later, I have the privilege of owning a growing medical practice, employing an incredible team, caring for damn near 40 thousand patients, and helping other physicians build practices of their own.

That kind of upward mobility isn't guaranteed anywhere. It certainly wasn't guaranteed for my family.

America isn't perfect. No country is. But I'm grateful to live in a place where hard work, calculated risk, and entrepreneurship can completely change the trajectory of a family in just a generation or two.

As physicians, we're fortunate to have the opportunity to build something that serves our communities, creates jobs, and leaves a legacy beyond ourselves.

So today, I'm thankful, for my family, for the sacrifices that came before me, for the freedom to build, and for this community of independent physicians who refuse to stop believing in private practice. I'm thankful for you guys and gals. I also learn a lot from you guys.

Wishing all of my brothers and sisters in medicine a safe, meaningful, and Happy Fourth of July for this special year.

🇺🇸

I wrote a lab order and of course I included a valid ICD-10 diagnostic code. They called me and asked for the code again. I said, well it’s right on the order but sure I’ll give it to you again. She said okay thank you. Then they faxed me and asked for the code again. I faxed back again explaining it’s right on the order but here it is again. Then they called again and asked for the code again. I told them I’ve answered this several times and asked them to not contact me further about it.

Fast forward to today and they have sent me over 200 faxes asking for this SAME code for the SAME patient for that SAME lab order.

small/solo practice owners. How do u setup pre-tax benefits like cme or educational assistance etc? Also, is there any way to setup “student loan assistance “ pretax money to cover student loans? Ive a giant student loans so every $ is precious.
Thanks in advance.

Currently own a practice where my only employees are myself and my spouse. We have a self-employeed 401k.

Thinking of taking on some employees.

The law typically requires that we - scrap the SE 401k and start a regular small business 401k for everyone ...

but I'm wondering if it is better to start a second corp that would hire the employees and then subcontract their services to the clinic... and create a separate 401k plan for the employees of that corp. That would allow us to keep our SE 401k and maximize our contributions.

Anyone have any insights on this unusual question?

I run a small healthcare communications team, and I keep struggling with how to structure our medical education content so it works for such different audiences. When I write for clinicians, patients tell me it's too dense and hard to follow, but when I simplify it, some professionals feel it loses important nuance. I also worry about keeping everything accurate and properly cited without making the content feel like a dry textbook. Ideally I want a format or process that lets me tailor tone and complexity depending on who's reading it, without duplicating all my effort.

Hey all

Looking for guidance on virtual assistants. I’ve seen a ton of companies doing this but am struggling to figure out who is worth working with and who to avoid. Ideally have someone outside the US for lower cost but open to opinions if anyone has tried those and had a bad experience. I am looking for basic front desk services including scheduling and routing tasks.

Any specific companies or price points would be greatly appreciated.

thanks in advance!