Podcast

Ep 18: Building a Private Practice By The Numbers with Sandra Weitz of The Practice Building MD

About Sandra Weitz, MD:

Dr. Weitz is a fellowship-trained, board-certified pain management specialist who started her own practice and grew it to 11 providers. She started her own multi-specialty ambulatory surgery center, anesthesia company, and built a 25,000 square foot medical office building.

Dr. Weitz also owned an anesthesia company, imaging center, physical therapy center, and several other vertically integrated medical businesses. She ultimately sold several of her businesses to private equity and publicly traded companies.

Dr. Weitz now teaches physicians how to start, run and grow a successful medical practice and leverage it into multiple revenue streams.

Click On Your Preferred Podcast Platform Below to Listen or Watch the Interview on YouTube.

Learn more about The Practice Building MD and how it can help you grow your private practice.

You can also connect with Dr. Weitz personally by adding her on LinkedIn.

Transcript

Hey podcast listeners. This is Omar M. Khateeb, your host to Journey to Private Practice with another wonderful guest, somebody that I was fortunate enough to come across her content online. More specifically around the numbers and finances of medicine and running a private practice. And once I heard her story, I knew I had to have her on.

And that’s Dr. Sandra Weiss, Dr. Weiss, thank you so much for joining us. How are you doing today? I’m great. Thank you so much for having me. Absolutely now both, you know, we have a really exciting topic for the day and I, I can’t wait to get into it, but for those listeners who are just getting, um, you know, starting to learn about you, can you, in a nutshell kind of tell, tell them the story that you told me, because I think it is the most awesome story of a physician, not happy with the system and saying, you know what, I’m going to do it the way I want to do it.

And, and just having a phenomenal, uh, I guess you can call it a, maybe a happy ending, happy beginning. So, but yeah. Tell us, tell us how this all started. Starting back at San Francisco. Okay. So I did a surgery internship and the seizure residency and AP management fellowship all at UCF and basically decided, all right, I love academics.

I’m going to stay on faculty and join the pain service and be an assistant professor in the department events. Did that for five years? Um, I was incredibly fortunate in that. Uh, number one, I became the head of the pain service the first day after my fellowship, um, in large part because the guy who was the head decided to quit, um, and that should have been actually an omen that I recognized at the time, but I didn’t.

And I was also very fortunate in that they appointed me to the finance committee for the department of anesthesia. Um, Actually enabled me to then learn how to read a financial statement, how to figure out how much money my service was making, how much money the department was making. And so when we ultimately were taking a pay cut every year, I went to my chairman and said in missing something here we I’m a cash cow.

My service is a cash cow. We are bringing in all of this money. Why is it that we need to take a pay? Cut? Well, anybody who knows anything about the university of California will tell you that number one, you’re paid based on what the state says. It doesn’t actually matter, uh, how much work you’re doing.

Uh, you know, this was the height of the Silicon valley. Boom. The cost of living in California was outrageous. Actually, it’s still outrageous, but my husband and I said, you know what, there’s gotta be a better solution to this. We’ve got three little kids. Um, you know, I commute a huge distance. The cost of living is out of control and I have no upside potential.

We need to leave long story short. We moved to Baton Rouge, Louisiana. Um, talk about moving to the other end of the world. And I joined a group who said that they wanted a pain specialist. The only problem was that what the job was advertised and what the people told me when I interviewed had absolutely nothing to do with what they actually want.

Which would be a familiar story to a lot of people. And I was with them for about 18 months when I decided that I was going to go out and start my own practice. I talked to the, uh, hospital nearby who actually wanted a multidisciplinary pain program. And they were like, okay, well, if you’re going to start your own private practice, maybe you can be our medical director and help flesh out this program.

And I said, oh, that sounds great. Worked with them for about a year, still running my own practice, but developing the program for them and went to them and said, Hey guys, I have no more hours in the day. My wait list is six months. I’ve already brought in a mid-level. I need to hire more doctors. And their response was where the thousand bed hospital.

And we don’t actually have to form a joint venture with you because if you don’t do it, we’ll just get somebody else. They said. Okay, except you don’t actually have anybody else and you don’t actually have a way to run a multidisciplinary program that feeds your imaging center, your PT, your procedure area, and all these things.

If you don’t have a pain doctor and they’re like, oh, but you’re replaceable. Is it okay? That’s great. And left. And then I’ll fast forward to flight, a lot, built a building. The building was 25,000 square feet. And then ultimately put a multi-specialty ambulatory surgery center that I owned into it upstairs became a clinic with 23 exam rooms.

Grew the practice to 11 providers. And then added an anesthesia company, a physical therapy center and imaging center, massage chiropractic care, uh, psych services, including psychiatrists, psychologists, social workers, um, acupuncture, weight loss, really in the name of producing a complete integrated multidisciplinary multimodality pain.

Long-term ended up selling the building tour REIT sold the ambulatory surgery center to a publicly traded company, sold some of the others to private equity. And here we are today. That’s amazing. So you really have no reason to be working, but yet you, you are taking it upon yourself to start this new venture.

And that’s essentially how we found you, which is you are doing the great, am I, in my opinion, a public service of helping. Doctors actually understand their finances and more importantly, scale their businesses so they can be successful and stay independent. How did that come about? And I’m going to put the link to your website in the show notes.

So I know you have some great content there coming up. Why is my question? Well, there’s one real just gut level answer. And that is, I am petrified that there will be no physicians left to take care of me and everybody. When we need a doctor, I think that physicians feel, you know, disenfranchised because they don’t understand the business of medicine.

And so I basically realized that I have spent, you know, 20, some odd years really doing the business and medicine and medicine is a business. I mean, you can argue with me all day long about the fact that it isn’t, it absolutely is. It’s a customer service. Business. And if you don’t address that, okay, then you basically can’t be successful in medicine and you get frustrated.

If you’re an employed physician and you feel the system is taking advantage of you because you don’t actually understand. How the system works, how to take care of the business aspect of it, not the patient aspect, right. We all go to medical school and learn how to take care of patients, but we don’t understand the finances behind it.

We don’t understand how revenue is generated. We don’t know how to get referrals. We don’t know how to manage our overhead. All of these things that go into how much money do I actually make for the amount of work that I am doing. I think that by teaching physicians that information. It, it, it will empower them.

And as a result, their job satisfaction and their desire to remain in medicine is going to go away. Yeah, and I, I wholeheartedly agree. And, and aside from I think, and this is, this is the kind of medicine I grew up with and, you know, seeing my father, having his own surgical practice, but, you know, the data shows that, you know, these a lot of medicine practice within an office, the quality of care is better.

The costs are definitely a lot lower, you know? And so I think. It’s I think there needs me more people like you, uh, doing this and, and, and this should be something that’s instituted and training because the business of medicine really has to be put back in the physician’s hands, if, if, if we’re going to make healthcare better.

So I think that the mission that you’re on is, is very noble and, and, and, and, um, I’m very happy to have you on our platform. Hopefully, you know, give more audience exposure to, especially those physicians who are in prior practice. You know, they could be getting so much more and gaining so much more independence if they just knew a few specific things.

So let’s kind of start there, you know, you know, let’s take your S your typical physician who owns a private practice, maybe a staff of five or six and office manager, couple, you know, you know, medical staff and PT. What’s the most common thing that you see happening. Cause I know on Facebook you have a very nice, large private Facebook group of physicians that you advise.

What’s the most common thing that keeps on coming up where if it was solved, that would kind of take care of a lot of other problems that faces. So I think. This is true even before the person has five or six employees. Okay. They, they w let’s even start from the, the solo provider who has no mid-levels who may have one or two.

It is it. And it’s the same issue, whether you’re that solo provider who just started your practice last week. And the big practice where, you know, you’re 10, 15, 20 docs, right. It’s the same issue. And that is that you absolutely need to understand where every single penny is coming. Yeah. And how to make sure that you are getting paid the most amount of money that you can for the actual work that you are doing.

Because a lot of times, you know, and I hear this repeatedly from physicians, you know, there are some physicians who are, you know, in private practice and they’re like, oh my God, I’m barely making ends meet. There are some who are like, I’m doing okay. But you know, there’s a lot of work in this. I, I really could be doing better for, for less hassle.

And then there are some who are knocking it out of the ballpark. What’s the difference between these people? And the difference is really looking at your data, understanding your data and understanding where does that money come from? So what do I mean by that? If you are in network, Okay. Do you have the best contracts that you can?

Do you know what your contracts even say? Half of the doc signed, I talked to, they have a contract. They don’t know where to look for the fee schedule. They never get a copy of their fee schedule. They don’t know that the fee schedule. Yeah. Let’s say for example, per proprietary. So instead of somebody saying, oh, it’s, you know, 90% of Medicare and you can go to the Medicare fee schedule and look it up, it’ll say that it is based on the 2017 Humana RB RVs fee schedule.

That’s based on Medicare. Okay. But it’s, Humana’s proprietary fee schedule. So unless you’ve asked for it, you don’t actually know how much you’re getting paid for each code. Okay. People don’t understand what their payer mix is. Right. So for example, I may get paid, and I’m just giving you numbers,

150% more by this insurance company as compared to some other insurance company. Well, if you knew that wouldn’t you go out of your way to get more of the patients that are paying you at 150% level as compared to the other? Of course. But you need to know your payer mix, right? If you don’t have your contracts and the fee schedule loaded into your practice management software, it may be that Blue Cross is supposed to pay you $90 for a visit.

And they’re paying you $88. Well, okay. You think to yourself? Well, that’s only $2. Yeah. But if you have a thousand of those. Right? Then that’s $2,000. So you can easily see that four. And if you have a huge practice, let’s say you have 20 providers and you’re losing $2 per visit per provider, right. That turns into a lot of money.

So understanding those numbers are, are really the fundamental difference or thing that any physician in private practice could do to make sure. That if they solve that they would be so much happier and they’d be so much better off financially and it makes it, yeah. And I think it makes so much sense.

And I think, you know, I feel like there’s this there’s a lot of residue of what medicine used to be, which was there was there, there was a time, there were no billing companies, you know, patient comes in and he sees the doctor and the doctor, you know, if it gets paid it’s that it was that simple. But I think we’re, we’re far past that point.

And

I think what physicians have to understood. There are plenty of companies, whether it’s payers, billing, companies, marketing companies that are more than happy to take advantage of you and either pay you less or get you to pay them more. Because if you’re not asking about it, who the hell is going to care?

And so, you know, right. Is that, is that, is that, am I off on saying that no. You know, that’s exactly it. And part of the problem is, and, and, and whether some of this is the residual of the way that it had been, or it’s really more a function of the employed physician mentality that most physicians come out with straight out of residency or fellowship.

Is all I have to do is take care of the patient and them paid my fair share. Well, I don’t even know that they’re thinking or that they’re going to get paid their fair share. I think they’re thinking, and somebody else will deal with the business aspect. That’s why we have an office manager. That’s why we have a billing company.

That’s why we have a somebody else. All right. And they basically defer. The active management to these other people. Well, you know, if you allow somebody else to do it for you and you basically, you know, give up that control, then you have no, no recourse right now. And I want to be really clear. I’m not suggesting that you have you as the physician have to submit the bill.

Okay. I’m not suggesting that you have to do every single last task, but you can not hire an office manager and think that the office manager is going to run your practice independent of you. Okay. You cannot say I’m going to hire a billing company and assume that I never need to read the financial reports or understand the financial reports to know whether or not they’re doing a good job.

Right? You cannot say, oh, somebody wants to charge me X percent for my collections for a billing company. And just hand them over the money without ever thinking, are they really, you know, do they have a dog in the fight? How much are they working for this? How much effort do they put into it?

And, and what else is it? What else do I need to do? Right. You still have to be involved. And otherwise to your point. Yeah. You know, people will, it’s human nature, right? It’s, it’s disingenuous to think that people are always going to do the right thing. We’d love to think that, but that’s not true.

Everybody’s out for himself, especially, you know, whether it’s a billing company, whether it’s, uh, an insurance company, you know, United healthcare, has they publicly traded. Hey there. If they underpay you by 50 cents for a visit that’s 50 cents more than they have. Right. And it’s not their problem to worry about, and it’s not there and it’s not their problem to worry about you.

And you know what, it’s really your fault if you don’t chase them for the 50 cents, because at the end of the day, right, if they have a hundred thousand claims. At 50 cents claim that they are managing to get more of their profit just went up hugely. Right. But similarly that 50 cents, while you may say, oh, that’s not that big a deal.

If you look at it over a practice over a lifetime, that could be the difference between, you know, my practice is doing well. And my practice is doing extremely. Absolutely. And even small things that might seem negligible, like in the case of your, of, of like losing our 50 cents. Let’s just say that only amounts to $2,000 a year.

Well, if you had that $2,000, you can spend that on certain things. Like, for example, the marketing that you need to get that type of patient in the catchment areas, that’s going to take your practice to the next level and you find out, Hey, you know, You know, cause Nope, nobody, everyone is looking for the expert and the specialist.

Right. And so for example, that might be a way that you discovered like, Hey, this procedure pays out the most, not a lot of people do it. I’m going to be known for this one thing. I can do these other things on the side. But when a patient says, Hey, I have XYZ. Who do I go to? My name should be the first one that comes up.

Like this is the way it happens. And I think people don’t think like this because they’re not. Where’s the data and where, how do I make the decision? There’s kind of like, I’m just gonna practice medicine and I’ll just get paid. Oh, no, no, no. So for first of all, to your point, To the extent that you have a niche,

To the extent that you can hone in on that niche and differentiate yourself, it will pay you dividends.

Okay. A, you’ll get more patients. B, your ability to negotiate with the insurance companies goes up because you call them and say, Hey, I’m the only guy in town who does X, Y, and Z procedure. And they need people on their panel who do X, Y, and Z. And if you’re the only person who does that, you’re more likely to get a contract and get onto their panel.

And you’re more likely to negotiate a favorable rate. Um, but to your point, the, the information, your decision making has to be unemotional. It has to be data-driven. Okay. The understanding for. Understanding which procedure generates more revenue. So not saying that you do things that are not medically necessary, but if I have a choice between doing procedure a or procedure B, and there’s a difference in the reimbursement with one insurance company over the other, I want to understand that, right?

I want to understand, I’ll give you an example that you and I have discussed before. There’s this thing called the site of service differential. Okay. Some Medicare has a site of service differential. The difference between the facility fee and the facility price that a physician has paid for service in the non facility price.

But a lot of the commercial insurances don’t necessarily offer you a contract with the site of service differential. So if you do a procedure in your office, You have to cover the overhead for that. You have to cover this, the kit, the drugs, the staffing for it. Right. And that’s why you, for Medicare, you get paid more.

If. You do that same procedure for an insurance company where there’s no site of service differential, you’re going to get paid the same amount as if you had done it as an ambulatory at an ambulatory surgery center or a hospital. And the reason that’s relevant is that. So if I, in that case, if you, If you don’t have a site of service differential, just to be super clear and you get paid $200, okay.

I get paid $200 in my office, or I get $200 if I do it at the ASC. Well, I don’t actually get $200 if I do it in my office because it’s 200 minus the overhead it just cost me. As compared to if I did it in the ASC where I get $200 and I really get all of that $200. But without understanding the data, without drilling down and knowing your numbers and really code by code, payer by payer, understanding what your reimbursement is.

You’re leaving money on the table. and this is easy money for time and number one in piles up. But you know, my, my issue with this is you’re doing the work. It’s not like you’re not doing the work. Why would you not get paid the maximum amount you could get paid for the work that you are doing? And I think, you know, and, and let me know, cause you you’ve speak with hundreds of physicians on this topic.

Do you feel like one, because what you just described is very logical. It’s almost, I would say it’s even common sense. Do you feel like a lot of physicians don’t do this because they, you know, forget the data. It’s just that they’re not curious enough to ask the questions and say, well, what is the difference between these things?

And then actually seeing and say, this actually doesn’t make sense. Why am I doing this in the office? I should just do this at the AC or, or vice versa, or why don’t I go shut the contract for, for that, uh, for that fee? Is that, is that the reason why? I mean, why do you think the reason, why do you think this happens so often?

I think that it is more lack of education and lack of awareness. Then it is lack of interest. Um, I tell you a little story, just totally unrelated to the business and medicine that I think really kind of tells the whole thing. So when I was a surgery intern at San Francisco general, I had to do a rotation at the, on the ENT service.

So this is a county hospital and my chief resident was not interested in going to clinic. He had other things that he’d rather do. He’d rather go to the ER. And so he sent me the intern to clinic. Okay. Problem was it’s a county hospital. There was no attending that came to clinic every day. So probably the first three, four days I’m in clinic by myself.

And I saw so many patients with earwax. Okay. Everybody. I had that those couple of days had earwax finally, an attending shows up and says to me, you must have seen a huge amount of pathology. These clinics are just teaming with pathology and I’m like, that’s so much, all I’ve seen is your wax. And the guy looked at me like I had three heads and he said, come, let’s go see some patients.

I saw TV of the console. I saw different types of cancers. I saw all sorts of stuff in about two hours with this attending physician. Hey, why am I telling you this? Because it has to be in your differential diagnosis. It has to, you have to know that it’s a possibility to even recognize it. And so I think the problem with.

Understanding the numbers is that people don’t have any experience with it. They don’t, they don’t realize, you know, as I said, they’ve abdicated their role in terms of the active management to that office manager, to that billing company, to the practice management, uh, software, right. They get some report and they think that the report just kind of does itself without them actively participating.

Okay. What does this mean? If somebody doesn’t tell you that you’re supposed to collect 90% of your AR in the first 90 days, and that if you have this huge bucket of money out in greater than 180 days, that’s a problem, right? You get the report every month you go, I have money that’s going to be coming in.

You have no idea that if you get out past 90 days, your chance of collecting that money goes to almost zero, right? Most people don’t know that the state insurance commissioners have laws that say when you’re supposed to get paid, that you should be paid within 30 days. If you see that you have money still out at 60 days, Most people are not thinking to themselves.

Gee, why is there money out at 60 days? Am I being denied? Or how often do I get denials? Or maybe I’m getting denials for the same thing, because you know what, not every billing company, not every practice management software, even when you have your own in-house billers, unless you’re communicating right.

You don’t necessarily know that it’s the same code. That’s being denied every single time. And maybe that code is being denied because you’re just not putting one simple sentence into your note for medical necessity. I mean, sometimes it’s, it’s an easy fix. I mean, I hear all the time. Oh my God. I’m so bogged down with denials.

Okay. This is, I’m going to call BS because there’s no reason in the world that you should have so many denials because. Basically if there’s a root cause and if you’re getting so many denials, then it’s your responsibility to go in and figure out why is this getting tonight? Is there an issue with how it’s being submitted?

Is it an issue with documentation? Maybe this particular insurance company has decided that that code is not medically necessary. Okay. Or they’re not covering it anymore, but if you know that something is not going to get paid. Why in the world are you doing it? I’ll give you an example. They had a new provider straight out of fellowship who came to me and said, I want to do we do this all the time.

If the guy came from Brigham and women’s, and it was a radio-frequency procedure that essentially stunned the nerve instead of killed the nerve, I’ll spare you the specifics. And I went back to him and I said, the code is for a neuro ablative procedure. In other words, you have to kill the nerve. Okay.

Starting the nerve doesn’t count. Okay. You can’t fill this coat. So if you want to do the procedure that you want to do, then you’re essentially going to be doing it for free. But I can’t allow you to do that because ultimately if you spend time doing it, you’re not doing something else that you could be getting paid for.

Number one, and number two, it’s costing. Staff is costing, you know, equipment it’s costing disposables. So if you want to do this procedure, be my guest, but it’s going to cost you a thousand dollars every time you do it. And I’m going to deduct that from your salary. Well, yeah, it shouldn’t take you long to figure out that the guy said, oh no, nevermind.

W when I couldn’t do that procedure here, But how did, how did that come about? Well, because I knew the code, I knew it wasn’t approved. I knew it was going to be denied. And so instead of doing it and losing money, you just choose not to do that. Nobody is in the business, in any business. Okay. Doesn’t matter whether it’s the business of medicine or whether it is.

Apple computer, right? Nobody is in business to lose money. Nobody is paying you to use their service. Hey, if you go to a restaurant and they’re losing money, that restaurant’s not going to be there in three months. So why in the world as a physician, would you do stuff that you can’t don’t get paid for?

And we’re actually losing money for the benefits? Yeah. And I think, I think, again, I’m, I’m, I’m making an assumption here, but I think that there’s this again, this old residue where it’s like, oh, I’m a physician. Like there’s no such thing as physicians being unemployed. Yeah. There is, there’s plenty, you know, at least once who don’t have their own practice anymore because they don’t, they are not in control.

Okay. I mean, the only reason of physician should ever be unemployed is when they’re in a position where they are not in control and your ability to be in control, basically boils down to do, you know, your own numbers, even if you’re an employee doc, right? You need to be able to assess how much revenue do you generate for this entity.

And I want to come back and say something about. Overhead, because this is true in private practice. It’s certainly true if you’re an employed physician. Um, it, and that is everybody is focused on how much is the overhead. And the reason that I’m not making enough money is because of the overhead. Okay.

And to the point where I had one doc who worked for me, who was like, oh, we need to like, how many pencils are we using? And I, I looked at him and I said, for real, for real, okay. If you see one extra patient right in, oh, we get paid for that patient. It’s $95. You know how many pencils we have to not use to get to that same point.

Right? It costs money. To run a business period. End of the story. So no matter how much you talk about overhead, there is no way you’re going to get that number to be right. Okay. And so yes, you have to control it. Nobody is saying that you, unless your office is on rodeo drive in L in Los Angeles, you do not have to have the most decked out, uh, furniture.

You don’t have to have, you know, champagne being handed out by, uh, you know, waiters in your office and I’m being facetious. But my point to you is, as I say, let me which doctor that is because I really, really like to go see them. But my point is, is that even after you ratchet down and control your overhead, there is still going to be some amount of overhead. The only way to increase your profit — if you understand that profit is revenue minus expense — the only way to tangibly increase your profit is to increase your revenue. Okay. And when you talk about employed docs that are, or are you talking about docs that are out, out of work, right? It’s because there was not enough revenue generation to cover and exceed that overhead and yes, in large systems where you’re an employee doc, you have no control over the overhead, but you also more importantly, don’t control how good a job.

That entity is doing in collecting every single penny that they’re entitled to. And there’s no transparency, right? And that is why, even if you’re an employee, doc, you have to ask for your monthly reports, you need to learn how to read those monthly reports. You need to really be able to understand. I saw how many patients and how much did I collect.

And then the one thing I wouldn’t touch on Omar, and I’ll, I’ll be quiet and we can move to your next question. Is. The difference between charges and collections. Okay. And I just want to touch on that because there’s so many people who are focused on charges, charges, charges, charges are really funny money, great charges have nothing to do with what you’re going to collect, because you can set your charges to be whatever you want.

And so when you talk to me about, you know, the residual of the old mentality, There was a time in deed where you could charge whatever you wanted. And then the insurance companies would pay based on the sink called usual and customary. So if you charge some huge amount, you could get some fraction of a huge amount.

The problem now is that what you’re paid is based on the contractual. So it’s based on the Medicare fees. If you’re in network, it’s based on the, um, Medicare fee schedule it’s based on the insurance contracts that you have. So you may charge $500, but you may have a contractual adjustment of $350 because the contract says they’re only paying you 150 for the service that you just charged them 500 for.

And so that’s why, you know, when you talk about controlling the variables that the revenue, the overhead and unders, and really drilling down and understanding. The data. Okay. You actually have to deal with real numbers. And the real number is the collection number, not the charge number. And I think that’s such an important thing to, to, to understand like that, like, I feel that there’s definitely ways to get a deeper and more granule granular, but there there’s some foundational things that you just mentioned just in this, in this past 20 minutes that I think just if they, if they understand those things and start making decisions from that, it’s going to make a difference like night and day, you know?

Yeah. I mean, I think the issue here. Is there are ways that you can leverage your practice. Okay. One of the things that, you know, peop people always are like, oh, I don’t want to work harder. I don’t want to work hard. You don’t need to work harder. You need to work smarter. You need to collect every single penny that you’re entitled to.

Then you need to figure out, okay, how do I grow this? How do I get more referrals? How to your point, you know, do I use that extra money that I got to market to get myself more patients? Or maybe I use the extra money that I’m now collecting, because I’m doing a better job actually doing this. Absolutely either hire a mid-level or to hire another physician.

Let’s say you want to hire a new associate. You need to be able to project. How many patients do they need to see? How much are they going to make from those patients? So you can figure out what salary to offer them. Well, where are you going to come up with that salary? Right? You have to take a risk. Okay.

Well, if you can make more money. Because you’re doing a better job in the collection part. Right? You have funds available to front that doctor. But the other thing is, unless you’ve honed the machine to look at your data, collect the money that’s due you. When you bring on somebody else, you can have the same set of issues with that new doc.

Okay. So in order to scale your practice, the first step. Right because people have some people have this growth, growth, growth, I’m going to bring on doctors and I’m going to bring on satellite offices. If you’re doing a not so great job of maximizing what you’re getting out of the base, out of the core,

there’s no reason to think that as you’re expanding, it’s going to improve. It will only get worse because there’s more of it. Okay. So if you know, at the, at the end of this episode, if you don’t take home, any other message, the message is you have to start at that at that core, at your base practice, and really understand your numbers and maximize those numbers.

Before you start to think about what other projects you can take on, because you’re, you’re not going to help yourself. I wholeheartedly agree, Dr. Weitz. I’m so sorry. Someone keeps knocking on your TV. One second. Sure. I don’t know who that, I think it’s a yard man. He saw me through this window now he’s trying to get my, so please.

I apologize. I’ll be right back.

All right, we’ll cook that out. Sorry about that. Not worried. Okay, perfect. Okay. So I’m gonna, uh, Slowly wrap things up. Okay. So, okay. So yeah, Dr. Weitz completely agree with you and you know, I want to be mindful of your time. And again, I know we’re going to have you back. I’m going to leave it in the show notes.

Your website is the practice building md.com, correct? Correct. So, you know, as a takeaway, because I try and, you know, always give. Actionable next steps, you know, and I think sometimes for physicians, if it’s something that doesn’t make sense and is not that obvious, they want to do things that do make sense, like this whole idea around like, okay, This is start growing.

Let’s do this. Let’s do that. When the foundational pieces of what it takes to actually have a successful business, whether it’s a private practice or startup or anything else is not being tended to. And again, growth is only going to make those things worse because you’re just gonna, you’re just going be, you know, losing more and more money as you’re trying to make more money.

And I think that’s, that might be a source of burnout. So for, for that physician, who’s listening and in a private practice that they. What should they do? What’s the one thing they should do this week. What’s the one thing they should do this month. And what’s the one thing they should try and aim to do this quarter.

If, if, if there, if there are such things. Yeah. So I think from my perspective, if you don’t already have it, the thing you should do this week is make sure that you have a fee schedule for every single contract that you have. Yeah. Whether it’s a, this week, this month thing that, that is loaded into your practice management software or that your billing company has it so that when you get paid X, there is a way to look at whether that matches up with what that contractual amount actually is, because I’ll come back to the example, I guess.

If I’m supposed to get $85 and I get 84 50, you know, for every one of those claims in a month, I’ve now made an extra 50 cents. Right? So that’s an easy way to start to increase your revenue. That’s number one, number two, the, you know, know your payer mix re get the report, look at your payer mix and make determinations based on that.

For example, understanding who’s paying you what percent of Medicare, Medicare is a great base in terms of a, um, oh, I’m blanking on the word guys, a, you know, in terms of a benchmark, right? So if somebody’s paying you 105% of Medicare, 85% of Medicare, whatever. If you look at your payer mix and you have 10 payers and one’s paying you 110% and one’s paying you 60%.

Right. And the 60% makes up 90% of what you’re seeing. Then you will quickly come to see what you need to try and do either renegotiate that contract or try and see fewer of those patients and try and market to more of the patients with better paying insurance. That’s something easy that can happen during the, during this quarter.

The third thing. And I’m like, I can give you a list of them, but I’m going to leave it at three is look at your denial rate, your denial rate. Shouldn’t be more than about two or 3% at most. Right. And if it is, then you want to get a list of every single one of the denials and drill down to understand why are you getting those denials?

And what of those factors can be easily reversed? I think that makes a lot, a lot of sense. And, you know, um, to kind of, you know, wrap things up. Yeah. One thing I like about again before you and I had spoken you other things that would, I want to attend your webinars and looked at your content is very much not just about knowing your knowing your numbers, but actually using data and being more data-driven.

I think that, and this is a shame, you know, search shameless plug here. One of the reasons why Dr. OCI teller like founded Genten, which was there, there’s a lack of transparency behind. A lot of billing and reimbursements. And if you don’t have access to the data, like if you, if you don’t have data to manage, like there’s nothing really to manage or improve on.

And so this concept of reimbursement intelligences is I think, a powerful. And when you think of reimbursement intelligence, like what does that look like in the setting of a private practice and what does that mean?

So, you know, I think. Just to be one, I think reimbursement intelligence is a fancy term for what I’ve just described to you. It is really just this ability to look at those reports and make informed decisions. Based on that instead of, you know, the, the spaghetti against the wall approach of I’m going to do something, it really is looking at your reimbursement and, and making an informed decision.

Do I do more of this? Do I keep taking this payer? Do I renegotiate my contract? Do I do this procedure? That’s basically what I think of when I think about reimbursement intelligence, as I said, I completely agree. Assigning a name to something, um, that is essentially there. Anyway. I know. I, yeah, I completely agree.

And I think part of this is that, you know, you know, if you’re, if you’re a practice and you have the right software and service, it’s providing that transparency. Then great, but more often than not a lot of physicians, I feel cause there’s this transition into this new age of using, you know, technology driven, you know, tools and data, but they have to have it like, you know, like when my father had, which was, you had a biller, you did your procedures and they build out.

Unless you asked for the reports and data. Nobody has a reason to say, Hey, Dr. But I want to just let you know here’s how, how we’re doing this this month. Oh, by the way, if you look at a little bit closer rationally, not doing that great, but you know, whatever we’re co we’re collecting our, our fee from it.

So I think, you know, a lot of, a lot of what you just said is rooted in the theme of start asking questions and be curious. And if you don’t know the answer to a question, you have to go and find it out. So if you don’t know your contracts, if you don’t know your. You need to go ask the past somebody to give you that and find out, is that, is that correct?

Um, I think that’s very correct, but I’m going to take it one step further. Um, please do, because, you know, I had my own EMR practice management software. Since 2011. Okay. And I can tell you that even back in 2000, and that was really, and even before then we had back in the day from 1999, that’ll tell you how old I am.

Um, a practice management software called medical manager. Okay. Anybody who’s a dinosaur will know that. Yeah. I have always been able to run my own reports if you own the practice. Okay. Learn how to run your own reports. Yes. You can talk to me about transparency and yes. You know, your biller, a billing company, your biller in-house should be giving you those reports.

You should be having a monthly meeting with those people to go over the reports. Right. But. There is no reason that you cannot run the reports yourself. Not only cannot you have to. Right. I can tell, I could tell you when I was practicing exactly where our charges were every day of the month, and whether we weren’t on track to be in the same place as we had been.

I could tell you that we had a collections problem when with Humana, right? It w w a week into a month, one year, because they had a computer glitch. Right. But I saw that we were not getting paid and I’m like, okay. Our Humana numbers are way off of where they should be. Why what’s the issue? Oh, let me call them and find out, said the biller.

Okay. So this idea of somebody I’ll take it one step further than this transparency thing. I’m going to tell you that you need to be able to run those reports. Now, what I think that technology has helped with is the ease of being able to figure out which report and how trans, how easily you can navigate through this information has improved dramatically.

Right. In the old days, you’d pull up a pull down menu and there’d be like 45 would seem to be 45,000 different reports giving you that you could massage in all sorts of ways, because basically the data is in there in something called a relational database. Okay. So depending on which fields you want to pull the information from, you can get the information in, in all sorts of different ports.

The problem is you have to know what report you want and what information you’re looking for. I think the thing that technology has done certainly in its current form is make that more user-friendly. So it’s easier for the physician to actually understand the information, digest the information, and then act upon that information.

But again, don’t assume that the billing company or your biller is going to be the one to do that, learn to do it yourself. I wholeheartedly agree. That’s why it’s just kind of wrap up and again, thank you very much for spending some time with us. I have a strong feeling. You’re going to be in high demand to come back as a repeat guest.

So this last part of the show, we’d like to do something that’s called the rapid fire question. So I’m gonna ask you three rapid fire questions. Youth, you can take as long as you want, or as short as you want on them. The sooner you answer the sooner I’ll move to the back to the next question. Okay. Yeah.

All right. So medicine, um, is, is founded in a culture of continuing education and learning. You never stop learning. Right. And part of that culture is also mentorship. So along the way, a both in academia and business, you probably have. You know, mentors, whether they’re mentors who were directly in contact with your people that you watch from a foreign leader from what was the most memorable, but yet painful thing a mentor had had told you.

And how did that change you as a physician and as a business person? Oh, that’s very easy. So, you know, I was the head of the pain services I told you. And, you know, I got appointed as the head of the pain service at the age of 29. Right. Fresh, fresh out of being a fellow. And there were personality issues among the other attending scheduling issues.

They were, they were always seem to be issues. Some of which was probably because I was young and naive. And I went to my chairman, a guy named Ron Miller, who was stodgy to say the least and said, Dr. Miller, I have X, Y, and Z problem. I don’t even remember what the problem was. And he looked at me and this was probably like the 15th time I’d been in his office in a month with yet some other problem.

And he looked at me and he said, okay, this has to stop. I am not interested in hearing about your problems, do not bring me problems, bring me only solutions. And I have to tell you that that probably is the thing that made me, you know, what I am today, because number one at the time, you know, imagine that I was young, naive, and, uh, quite emotional.

I left the office in tears. I’m trying. I have a problem and I need a solution and you’re telling me, don’t bring me solutions. If I had one, I would have solved the problem myself. But in reality, right, it was the greatest favor because there really are no problems. There are only solutions. And if you start from a position of, oh my God, this is a problem.

It clouds your ability to see the solution. If you start from the, I can do this, I can figure out how to get out of this hole. You’re going to be much more successful, completely agree. And I, and I think that that’s great advice really, for anyone. I think the words we use are very important and the moment that we say I have a problem, or I’m having a problem with this, whether, whether you believe in God, Your mind will find a way to make sure that you continue having that problem.

And it’s going to continue to be hard. I completely wholeheartedly agree. I think that’s fantastic advice. Okay. Next one. This one’s an easier one. So lately, um, especially at the time of COVID, you know, we, we, uh, consumed a lot of media and books and everything. What’s a book or a podcast that you’ve gone through recently that you’ve really enjoyed, recommended a lot to others.

Normally. Um, I am a Booker. That’s a book. Okay. Um, I, I love world war two history.

Got it. I I’m much more of a factual than a fictional reader. Me too. I don’t know why I’m trying to get more into fiction, but I like nonfiction. I’m going to add that because I, I, I too, like, I like history, so I don’t have that in my bookshelf. So I’m buying better right after this. All right. Last question for you.

This one’s an interesting one. So my favorite question asks, okay. I want you to pretend that, uh, that I come to you and say, Hey, Dr. Weitz, next year, we’re taking out. An advertisement. That’s going to go on every single billboard, which will go in front of every private practice across America and every private practice physician as they go into, into, into work that morning, they’re going to see this billboard.

What do you put on that billboard and why?

You can practice medicine the way that you want and control your own destiny as to why, because I wholeheartedly believe that. And the only way to practice medicine that you want is by taking control of your own destiny and actively managing it.

Couldn’t think of a better, better way to wrap the wrap up the show. And I think that the theme around taking control, not, not, not feeling like a victim, but feeling that you are the one who’s going to make that change. You just have to take action and think differently. Look for the solutions. I think that that’s a great way.

Great way to end Dr. Weitz. Thank you so much for coming on. You know, again, I’ll leave it in the show. Show notes, your website, the practice building md.com. And also for those who want to connect with you online, you know, what, where can they find you and follow you? So they can find me on Facebook either on my Facebook page, they can certainly ask to join the private practice, the private medical practice academy, Facebook group.

Um, you can also find me on industry. And if you, uh, want to email me, my email’s actually at the bottom of the show notes for my podcast, with the same name, the private medical practice academy. Fantastic. I’ll leave links to all that in the show notes. I highly recommend people to go check it out. Cause it’s, it’s a, it’s a wealth of resources and more importantly for free.

So you can’t argue with that. So, Dr. Weitz, thank you so much for joining the show. This is an all market team with another episode of journey, private practice. We’ll see you all next time. Thank you. Thank you for having me. My pleasure.

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