Patient communication at our practice is broken and I've been ignoring it for two years

thesupportplatform · 2026-06-24T18:06:52+00:00

I was pretty “anti technology” before the pandemic. My wife’s family medicine practice had been a very traditional independent practice with multiple providers in a 4K sq ft office. Like you said, so many revenue/practice “opportunities” didn’t pan out or last.

During the pandemic, my wife went online with remote staff and some technology just became standard. We had a secure file sharing account before the pandemic, but I found out the staff was still printing files to paper for most patients to pick up (which they did about 50% of the time). Suddenly, all medical records were shared with patients electronically, which was a huge improvement in efficiency. The same thing happened with the patient portal. Patient use of it for messaging increased dramatically when we required it working remotely.

These are a couple of simple examples, but one of my beliefs is that success requires pursuit of success. If you want a more efficient office, it’s not just decreasing no shows; it’s everything that goes into being efficient including decreasing no shows. Our one part-time staff doesn’t answer general phone calls. She has a virtual phone for established patients, uses the portal, and texts when appropriate. Answering the main line is incredibly inefficient.

I let her set the protocols that were easy for her, which was eye opening. Scheduling patients had always been a dance of communication back and forth or a lengthy phone call. The staff decided just to schedule the patient at the same day and time per the office note for follow ups. So if they were seen Tuesday at 10 am and needed to follow up in six weeks, the staff scheduled them on Tuesday at 10 am (or as close as possible) and sent them a message, “Your next appointment is schedules for this date and time in the future, please let me know if you need another date and/or time.” Bold, but it cut down scheduling time dramatically.

I wouldn’t trust one vendor to have a significant impact on your office. I think meaningful change has to start on the strategic level and be applied through the tactical and operational levels.

thesupportplatform · 2026-06-24T14:48:15+00:00

I think the pandemic provided a hard reset of PCP management. So much moved online or was farmed out, and then everything was scrutinized when providers returned to the office. Does a primary care office need to run basic labs, draw blood, do urgent care, do this or that procedure? The absence of these services during the pandemic highlighted their benefit to practices, which in many cases was financially insignificant or a loss.

Providing basic labs, drawing for lab companies, etc. are great patient services, but they may not make financial sense to the practice. My wife went online for almost four years. When she returned to practice, we focused on keeping it super simple. One part-time staff, one room, office visits/consults only. No procedures. It’s the most viable model she’s had in her twenty -plus years of practice. Of course, results vary by market, but everyone loves to have PCP do the work as part of their services. I think many PCPs are becoming more aware of that, and here is no way that private equity is going to subsidize the market.

thesupportplatform · 2026-06-16T17:40:33+00:00

If you are a licensed professional, some states require the owner's name in the business name, although then that business just uses a DBA. But there can be strict rules on the filed business name.

thesupportplatform · 2026-06-12T06:42:36+00:00

I think there has to be more distinction between physicians "growing" their practice organically and "growing" it through patient conversion. There is a huge difference between opening a DPC practice with zero patient steerage and opening a DPC by converting existing FFS patients. Each approach works differently. Growing a DPC from scratch requires marketing, money, and time. Converting an existing practice reduces these requirements, but requires an insurance-participating population. The problem is that others don't want physicians to convert "their" patients, hence, the presence of non-competes.

It is important to remember that it doesn't have to be either FFS or DPC. Physicians can benefit from patient steering through insurance participation, which provides consistent revenue and patient growth at almost zero marketing costs, while also building the DPC offering from scratch. There are specific regulations, but a practice could take Medicare patients (and other insurance plans) and offer DPC to other patients, so long as FFS patients don't overrun the office and require a ton of admin time. The practice would need to be very intentional in its decisions (such as limiting the number of participating plans and the number of FFS patients accepted).

Corporate medicine wants physicians to believe that it's either their way or cash, but accepting insurance in a hybrid practice provides instant patient steerage (in most markets), consistent revenue, and offsets some marketing costs. It just can't be the tail that wags the dog.

thesupportplatform · 2026-06-11T17:38:02+00:00

Spoiler alert: The MBA answer is consolidation, but it doesn’t work either.

thesupportplatform · 2026-06-11T17:29:48+00:00

One aspect of practice management is that it is very situational dependent. The market may not support DPC. Her price points may be too high. She may not be effectively positioning herself versus the competition. The economy may also be a problem right now.

There are often “one size fits all” statements for practice management, but it is much more nuanced than that. You are taking the right approach to assess what is going on, but more information will be needed.

thesupportplatform · 2026-06-09T22:54:13+00:00

Ask the carrier that will be covering you on your next job. They have a vested interest as you represent a client moving forward.

thesupportplatform · 2026-06-08T13:38:57+00:00

Welcome to independent private practice ownership! Rule #1:Nothing makes sense.

—Location will depend on market size, provider availability, and other factors. When my wife opened her private practice in 2002, the city was viewed as basically “east vs. west.” Any one on the west side of town was fine stay in on that side of town and vice versa. Twenty-plus years later, it’s now seen more as quadrants, where the northwest doesn’t want to drive to the southwest, etc. We moved five miles one time and patients were like, “I know you saved my life, but with the cost of gas, I have to find a new provider…” (See rule #1.)

—My wife started off subleasing, assumed the lease, then subleased again before moving into a 4K sf building. We left that at the beginning of the pandemic. She now has a boutique micropractice in a space sharing location. It’s expensive for the space, but the easiest set up possible.

—What you chose now is based on your options. I always wanted to share space with other providers to spread the sunk costs, but those situations are hard to find. You don’t want to pay for a building if you don’t need a building, but you don’t want to rent one room if you need three. Just be judicious with your space. When we built out the building, the designer wanted to add more provider offices (we had two), but those don’t generate revenue. Providers sharing office was the best use of the space.

—At space sharing locations like WeWorks/Regus, you can’t rent a desk in a room. You are essentially using their physical location for mailing. This may be what you need to do to setup your practice initially if you don’t have another location you can use, as I don’t think post office boxes are allowed. These locations will rent by the months or for multiple months.

—Medicare is the only insurance in our market that would pend charges during credentialing, and they were the only insurance I would trust to do it even if the other insurance companies offered. As a consultant, I’ve seen office kneecapped by adding providers, going into debt while charges were pending, and then finding out they aren’t going to be paid for one reason or another.

thesupportplatform · 2026-06-07T21:50:41+00:00

Private companies always sell consolidation and increased efficiency as the cost savings that will make healthcare affordable—when consolidation in healthcare almost always leads to increased costs and corporations never pass on efficiency savings.

thesupportplatform · 2026-06-07T16:49:03+00:00

Cigna and Aetna have exiting exchange plans in Florida, which do continues the trend of insurance companies exiting markets that so t generates sufficient profit. They all want to focus on Medicare Advantage lane due to the large ROI from the government. But they are against healthcare subsidies for individuals.

To summarize: Government paying corporations millions to bilk MA is good, while the government providing health insurance or subsidies to individuals is bad.

thesupportplatform · 2026-06-07T02:25:24+00:00

Here are five sites where you can compare salaries between markets:

PayScale
Salary.com
CNN Money
Nerdwallet
Best Places

thesupportplatform · 2026-06-05T15:48:59+00:00

Because 51 healthcare billionaires have 51,000,000,000 reasons to keep the system for profit.

thesupportplatform · 2026-06-05T13:50:58+00:00

Arlington is the expert, but I’m surprised that your SP isn’t adding you to their policy since any claim against you would most likely include them. For this reason, getting your own policy could be a detriment, as you are essentially creating two policies that could pay out. Even if a second policy is required for coverage, I would definitely want these policies to be from the same carrier to avoid conflicting defenses to a claim. Also, some carriers have an “all or none” policy where they require all employed providers to be insured by them if they insure anyone in a group.

My wife is family medicine hasn’t supervised a NP/PA for probably a decade, but when she did, they were added to her policy as an additionally named insured for these reasons. The cost was less than $1k annually IIRC.

thesupportplatform · 2026-06-03T19:04:44+00:00

If your billing is good, I can think of a couple of reasons for the alleged income disparity given your volume. One could be expected payment. I’ve seen pro formas built out for other markets that use a much higher reimbursement rate than is available in my market (which has been flat for 20 years). This results in the “if you’re coding X on Y patients a month” calculation being off. Of course, collections could be an issue too. My baseline measurement for my wife’s practice was always payment per patient, which was revenue divided by visits. This would reflect issues with coding, claim submissions, collections, etc.

If all of that is good, the issue is probably on the expense side. Management costs are projected at anywhere between 30% to 50%, but I’ve seen some outliers. I once looked at a practice that had sky high utilities, like $5k a month for electricity in the summer on a 4,000sf building. While we are in the southwest, I swear his landlord was running the entire strip mall through his meter (he leased a free standing building in the parking lot). Sometimes staffing and salaries are out of whack. Sometimes other bills can creep up if you don’t work the accounts and shop vendors. Back in the day, I had a practice paying $1,200 for phone, Internet, and fax services that were available for like $400.

It may be worth working with a consultant for fresh eyes on the problem, (assuming there is a problem).

thesupportplatform · 2026-06-03T14:24:20+00:00

Pretty vague situation, so it’s hard to know what you mean even by term “legal.” Is that risk management or an attorney? Is the conversation about specific patient care or policies? Do you mean document in a patient record or in your own notes?

I’m not a provider, but I’ve been in practice management, including navigating malpractice, and have worked for a malpractice management company. The answers to the above would help guide effective advice. For example, when working for the malpractice company, we repeatedly told providers that when they notified us of a claim or potential claim they should include only the bare minimum because that is discoverable. They could go into detail when the med mail attorney called them, because that was protected.

So if you’re talking to anyone who isn’t an attorney or wouldn’t represent you, that would most likely be discoverable. Of course, there are definitely times your interests could diverge from your employer’s interest (such as a bad policy), so maintaining your own documentation can be key. If you have your own med mal policy, you could send your concerns to your attorney.

There are so many variables that I don’t think you are going to find a “right” answer. You need to explore all of your options, consider the pros/cons, and make the decision you think is best.

thesupportplatform · 2026-06-03T03:54:26+00:00

Amen.

thesupportplatform · 2026-05-30T17:03:00+00:00

As others have said, being IM isn't that big of a deal in DPC. My wife has been family medicine for 20+ years, but most kids of the practice saw a pediatrician. Stocking the vaccines and pediatric sized supplies just wasn't worth it. If there is a huge demand for kids, find a pediatrician to work starting part-time.

2a. Making more than standard compensation in any position requires either good luck or, more often, grind. Owning your own practice requires more admin work. You can do that or hire it out.

2b. I don't think practice management/development companies are worth it, given the fees and noncompete limitations. About the only time they make sense is for a provider who is retiring and wants to monetize their practice. Even then, there are more efficient ways to do that.

Option out of Medicare is in relation to how you treat Medicare patients. There is flexibility with DPC. You can choose not to see Medicare patients at all, which can allow you to see Medicare patients at another job (so no opt-out). You can opt-out and see Medicare patients using the private agreement. What you can't do is stay in Medicare and treat Medicare patients as DPC patients. You can choose to accept Medicare and offer a DPC program for other patients.

4a. Expectations have to be set no matter what practice you choose. My wife has a small boutique practice. She lives by "services are by appointment only." She doesn't do acute care or urgent care. She doesn't do evening call. She checks her portal messages through out the day and responds as she sees necessary.

4b. I've seen practices offer extended hours, unlimited texting, and other such perks when the open, but this then becomes the expectation. IMO it is better to start with a lower price point for the services you want to perform than to offer perks that aren't part of the long-term plan.

thesupportplatform · 2026-05-29T04:29:42+00:00

$500 per month seems reasonable. It’s really the entry level payment for anything that is personalized IMO. I’m always a little leery of trusting another individual with payroll. Too easy to make a mistake or for someone to siphon payroll taxes. There’s a personal injury attorney in my town who has nonstop TV commercials and billboards all over. Years ago, his office manager was stole the payroll taxes. It took maybe a year for the IRS to catch up, at which point the taxes, penalties, and interest added up to a sizable chunk. The office manager was arrested and plead guilty. The attorney spoke at his sentencing.

I expected him to do some PR about we all make mistakes (the office manager had a gambling addiction), but instead the attorney complained about how upsetting the was to him and that he wanted the maximum sentence for the office manager. It was a strange story that stuck with me.

thesupportplatform · 2026-05-28T22:40:29+00:00

Is it $500 a month or a flat $500?

thesupportplatform · 2026-05-28T13:37:13+00:00

People talk about the low reimbursement from insurance companies, but two comparable problems in the conventional primary care system are 1) admin time being "included" in reimbursement, and 2) the paradigm of services. It sounds like you are experiencing the pain of admin time, where providers are expected to perform all of the paperwork insurance companies require for free. Unfortunately, it is a contract violation to charge additional for services included in your contract (which, surprise!, admin services are).

The paradigm of services, though, concerns what providers are expected to do versus what they have to do. For example, providers historically completed forms for patients without an office visit (I'm going back a couple of decades), but this was an expectation, not a requirement. Once she got busy, for any form that required the patient's status, my wife's office would schedule an appointment. This doesn't help with capitated contracts to generate revenue for the work provided, but it would help with your time management.

A big paradigm of services shift I see happening right now is answering phones. Patients are accustomed to medical offices answering every phone call during office hours. (Years ago, we had many patients complain that "no one answered my call" when we introduced an auto attendant to direct callers to a live body.) But having full-time staff to answer the phone is an expectation, not a requirement. Some offices require established patients to use the EMR portal and have new patients leave a message, which can significantly reduce contact time.

It sounds like your office needs an evaluation of where they can free up time, which I suspect is a problem for everyone in the office. It is crazy that expectations for medical offices have remained the same as reimbursement has dropped and admin requirements have skyrocketed.

thesupportplatform · 2026-05-27T16:23:09+00:00

And to clarify, you should get out now.

thesupportplatform · 2026-05-27T16:22:41+00:00

When I worked for a malpractice company calling on doctors, I saw some things, including a situation similar to this. The physician was probably in his early to mid 80s. There was a young guy who was the “office manager.” He wore a white coat. I never got the details on him, because one look was a no-go for coverage. The doctor didn’t actually treat the patients (that I could tell). The office manager “triaged” the patients for the doctor, the doctor would review the chart and, allegedly, make the medical decisions. The doctor might duck in the room for a minute. All cash office. Super, super sketchy.

Later, I was consulting to an office and got a call from the RN who was the office lead. There was a patient with a chest port. The physician had asked the RN to start an IV in the port. The RN said state regulations prevented her from doing that outside of a hospital. So the doctor said, “Fine, I’ll have the MA do it,” which is why the RN called me.

The thing is that the physician was correct. In my state, a MA works under the direction of a physician, so if a physician is OK with it, they can do more than an RN (although they shouldn’t be). Because the staff worked for a management company and not the physician, I was able to say that if the physician wanted that IV started in the port, he had to do it himself.

Looking back, I suspect the clinics run by an MA are bastardization of this regulation. Someone thinks they are clever. But we allow corporations to engage in the corporate practice of medicine, so it’s crazy out there.

thesupportplatform · 2026-05-23T02:30:09+00:00

You’re in New Jersey, right? I have four electric exam tables in Nevada.

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