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Strategies to boost your income, enhance your bottom line. (Innovation).

IF YOU WERE TUNED to an NBC-affiliate radio station late at night in the 1990s and heard the callin question: "What are the side effects of Prozac?" the answer likely came from nationally syndicated Yale psychiatrist Harvey Ruben, MD, MPH.

For more than a decade, Ruben worked full time seeing office patients, then spent a few evenings each week calming the masses as a radio talk show host.

The annual supplemental income of $90,000 to $125,000 helped pay tuition for his three sons to attend to Harvard, Yale and Dartmouth. "I wouldn't have been able to have sent then otherwise," he says.

Ruben's TalkNet radio program established his credibility as a mental health expert, which helped to launch another profitable venture, speechmaking.

Charging up to $1,500 plus expenses, Ruben lectures to psychiatric and state medical societies around the country on a range of topics. He isn't alone in trying to parlay his medical diploma into extra cash. For many physicians today, it's a necessity.

Outside of doctor's spouses, you won't find many people sympathetic to the notion that physicians have fallen on hard times. Yet, perhaps in no other period in recent years have doctor's incomes been as squeezed.

As malpractice premiums skyrocket, employee salaries and benefits rise reimbursements tighten, managed care hassles multiply and what can be billed becomes more restricted, doctors seek to reduce expenses and find alternate legal and ethical income streams that don't degrade the profession.

Fortunately, there is no shortage of moneymaking ideas.

Some serve to enhance good practices, converting them into models of assembly line efficiency. Other ideas require big time commitments and special skills, like being able to teach, speak or write.

Ruben advises doctors interested in working in the media to attend an annual American Medical Association conference in April, "Medical Communications and Health Reporting."

Break out sessions with faculty from the Chicago-based National Association of Medical Communicators provide practical "how to" advice. Convention social occasions allow neophytes to commune with the experienced for networking opportunities.

Doctors leave the meeting ready for the next step: offering their services free as local guest hosts to acquire a list of credits as stepping stones to paying slots.

"Be brash, be bold, use any ties you can. It doesn't happen unless you're fairly aggressive," Ruben says.

Chart review/expert witness

Another lucrative part-time job requiring no special training is chart review and expert witness work for attorneys and insurers.

"The money is better hour for hour than the practice of medicine--with less stress and no expenses," says Miami cardiologist, Bruce Miller, MD, who reviews charts on weekends to determine medical malpractice or the extent of injury in accident cases.

The work is done at leisure with easy deadlines. Hourly fees are $250 to $500 for chart review and up to $10,000 per day to appear in court, depending on physician specialty, credentials, availability and case complication.

"I enjoy it because it's educational and self-improving," Miller says.

How to get started? Go to www.finelaw.com and click on, "Experts and Consultants." There, you'll find listings of expert witness firms that hire physicians. Be prepared to fax, mail or e-mail a CV. You can also eliminate the middleman and sign up directly with personal injury lawyers and insurers in your area.

Doctors must be prepared to testify in court about their findings. Physicians who have been repeatedly sued are not good candidates because their histories can be brought up at trial.

Additionally, doctors who are too experienced--perform too many chart reviews or appear too many times in court--are considered suspect by juries.

Patient seminars and forgotten codes

One little used CPT code that can earn physicians hefty returns both financially and in good will is 99078, physician education services in a group.

All that is needed is a computer billing program and a large waiting room. Ask your billing manager to run a report of patients with the same disease or condition, such as all patients with osteoporosis or all patients with diabetes.

During a lunch hour or in an evening session, patients with the same problem are invited to hear you lecture on managing their illness. It is the same talk given to patients in exam rooms but on a larger scale.

The billing manager then bills insurers. Medicare will not pay this code because it is considered preventive care. Check state Medicaid carriers and individual payers for other payment information.

"If it's not covered, that does not mean you can't charge patients for this very valuable service," says Barbara Cobuzzi, a national advisory board member of the Salt Lake City-based American Academy of Professional Coders.

Medicare will pay group diabetic counseling under CPT G0109 by certified doctors. Payment is about $15 per patient, but restrictions apply.

Doctors who wish to do lifestyle and nutrition counseling for patients at risk can use CPT 99411-99412, preventive medicine counseling, for 30-60 minutes. Medicare won't pay for this code but some insurers may.

Other ways doctors can legitimately earn extra cash is capturing untapped opportunities--billing codes for what you are already doing and not getting paid for.

Some oft-forgotten lonely codes are 99354-99357, prolonged services. Doctors who spend a lot of time with a patient usually upcode a visit to 99215 or 99205. But billing a midlevel 99213 with 99354 can actually produce more income and it's more valid, according to Cobuzzi.

Discharge codes are also "found money." When doctors give lengthy instructions to patients and their families, they can bill 99239 for discharges longer than 30 minutes. The difference between this code and 99238 for 30 minutes and under is about $25.

Medical school faculty

It is true some medical schools, like Jefferson Medical College in Philadelphia and the University of Miami School of Medicine in Miami consider a part-time faculty appointment an honorary position and typically do not compensate physicians.

Doctors donate a few hours weekly or monthly as a way of giving back, to keep current, to build up practices or in exchange for the title "clinical assistant professor" that can be attached to brochures and business cards.

That is not the case with other schools. Mercer University School of Medicine in Macon, Ga., and Saint Louis University School of Medicine in St. Louis, Mo., for example, are willing to reimburse physicians for their time.

Saint Louis has a part-time faculty staff of about 50, all of whom are paid hourly, daily or yearly. Depending on specialty, negotiated fees range from $50 to $200 per hour, up to $1,000 per day, or up to $20,000 annually for a half day a week, every week.

Physicians guide medical students, interns and residents on rounds, teach or allow their patient bases to be used for clinical research. Community doctors who see patients in university medical clinics can bill for visits and procedures in addition to teaching/preceptor fees they receive.

Interested physicians should first contact their specialty's medical school department chair, says Daniel Zabel, MPH, who directs Saint Louis's faculty practice.

"Stress what particular value you can add. A doctor who can do specialized procedures or surgeries is a better candidate," Zabel says. He advises face-to-face meetings where community physicians offer individual skills and present CVs. A lengthy credentialing process typically follows.

HMO Reduction

Physicians often think they must sign up with as many HMOs as possible to build practices and keep the front door swinging open.

Nothing could be further from reality, says Deborah Grider, an Indianapolis practice consultant. Grider recently evaluated a Midwest internist who was considering closing down because he was losing money.

"He had over 500 HMO capitation patients on his panel and was seeing 200 of them every month. They were very sick. He lost $45,000 in one year. Moreover, he was so busy seeing these HMO patients that he was turning away Medicare and third party-paying patients who would have paid him a higher fee for their care. If you get four or five carriers who are losing you money, that could bankrupt your practice," Grider says.

Executive physicals/FAA physicals

Physical exams are nothing new. But when marketed properly, they could be practice moneymakers or practice builders.

The 600-physician University of Wisconsin has been offering executive physicals for 15 years and promoting them by brochure. CEOs and other top businesspeople are sent by their companies which pay about $500 to $1,000 cash for the peace of mind of knowing the heads of their organizations have been thoroughly checked.

For that fee, executives typically spend half a day receiving a one-hour history and physical exam, resting EKG, chest x-ray and labs. Popular add-ons include exercise stress test, sigmoidoscopy or colonoscopy and audiograms, according to James Casanova, MD, CPE, FACPE, associate dean, clinical affairs, Medical College of Wisconsin Physician Practice. It's a win-win for companies that tout it as a company benefit and for physicians who do not have to file claims.

Practices can also specialize in other types of physicals, such as insurance physicals for life insurance companies, sports physicals for local schools and colleges, and Federal Aviation Administration physicals. Commercial pilots must be examined every six months but cannot go to their regular doctors unless they are certified as Aviation Medical Examiners (AME's), according to FAA rules.

Certified AME's receive an average of $80 for these exams which are sometimes paid for by the FAA. To capture this business for pilots, student pilots and air traffic controllers, doctors should send a letter on their letterhead to FAA regional offices.

For information, contact Douglas Burnett, 405-954-6214. If there is a need for FAA examiners in your county, you will receive an application, go through a credentialing process and be sent to a four and half day training course in Oklahoma City at your own expense.

Medical director

Some sidelines suit nearly every specialty, such as becoming a medical director for a hospice, nursing home, home health agency or assisted living facility.

Tim Gallegos hires medical directors for Castle Peak Hospice in the Dallas/Fort Worth area. He says even cardio-thoracic surgeons serve as hospice medical directors. However, internists, geriatricians and rheumatologists are best suited for these jobs.

"The least desirable specialty is oncology because oncologists have a hard time embracing palliative care," Gallegos says.

The pay is up to $3,000 monthly, but the demands are great.

Physicians are expected to conduct weekly staff meetings that last from two to six hours, recertify some 20 patients monthly for hospice care by physical examination, give in-service training sessions on pain management and other topics, take 24-hour call and indirectly supervise nurses, home health aides, bereavement counselors, chaplains and volunteers.

Besides the time commitment, other issues are Drug Enforcement Agency license exposure and malpractice coverage. Doctors must be willing to aggressively treat pain by prescribing Schedule II pain medications.

Check with professional liability carriers to find out if coverage exists outside physician offices. "Try to get named as an additional insured under the entity's professional liability policy," advises Kurt Driscoll, vice president, FPIC Insurance Group, a Jacksonville, Fla., malpractice insurance carrier.

Physicians who have been sanctioned or excluded by Medicare for any reason--including nonpayment of school loans--may not be hired for these jobs because their services, or services they order, can't be reimbursed in many cases, according to Baltimore health care attorney Howard Sollins.

Speechmaker

Kansas City hospitalist and geriatrician, Leonard Hock, DO, practices full time but earns $20,000 in additional annual income by giving speeches to church and physician groups, retirees, health care workers and health management executives.

He charges up to $2,500 per talk plus expenses. Moving aging patients to dependent living situations from independence to dependence, was the topic of one recent speech he gave to adult children.

Hock says the market for convention speechmakers is large and wide open. "Speakers bureaus are always looking for speakers," he says. But physicians need "podium presence" and can't rely on visual aids.

To get in shape for speechmaking, doctors who are not born adept at speaking should join their local chapter of the National Speakers Association (call for nearest chapter, 480/968-2552) or Toastmasters International (949/8588255) to learn the skills to become professional speakers.

"Nervous doctors who turn on PowerPoint, press a button on the laser pointer and make their audiences dizzy for 45 minutes won't get invited back," Hock says.

Hock attended these meetings as well as took college courses and tapped private consultants. "Take courses from experts," he advises. "You need more than confidence."

Give a few free speeches for practice by putting up a sign in your office that notes you are willing to give talks to community groups, he advises. Some beginning types of speech topics could be: "When to call the doctor." Once your skills are in place, go to an Internet search engine and type in "speakers bureaus" for listings of agencies. Send your CV, noting your speaking experience.

"They don't care how many articles you've written. They want to know how was your audience evaluation," Hock says.

Doctors may also want to speak at evening dinner meetings of physicians invited by pharmaceutical companies. Speakers earn $500 to 1,000 for these talks that are usually an hour in length. Contact pharmaceutical company product managers and offer your services.

Moderator

One quick and easy way to pocket extra cash is to work as a focus group moderator.

These groups can be in person but are often one-hour telephone conference calls that pay $150 for the moderator and lesser fees for participating doctors. Moderators present questions from a prescribed "cheat sheet" supplied by a pharmaceutical firm to a panel of physicians.

The tapes of these conversations are transcribed and shipped to pharmaceutical company marketers to help sell products.

A typical discussion is "Treatment of Diabetes," says George Silverman, president, Market Navigation, Orangeburg, N.Y., a pharmaceutical marketer that hires physician moderators,

"It is not necessary to have great content knowledge," he says, "what we look for are people-friendly skills."

On any single night, Silverman says there are probably hundreds of teleconferences taking place across the country. To become a moderator, contact some of the many market research companies with Web sites by searching for, "market research and medical and focus group."

Dot corn docs

Mydoc.com, the brainchild of Roche Diagnostics, a division of F. Hoffman-La Roche Ltd., the giant Swiss pharmaceutical, diagnostics and vitamin firm, is an Internet physician practice that allows doctors to diagnose and treat patients they have not seen for a limited number of common ailments, such as sinusitis and urinary tract infections.

The company sets itself apart from online prescription mills by refusing to prescribe lifestyle drugs, narcotics and anti-depressants. Patients respond to some eight screens of history questions and then receive a diagnosis and prescription, if needed, for $39.95.

They can also opt for an online discussion with the doctor for an extra fee. A board-certified primary care doctor reviews every inquiry.

"Initially I was skeptical," says Roger Spahr, an Indiana board-certified family practitioner. "I did due diligence, found it to have value and merit without harm and decided to be a pioneer."

Spahr says about half of all log-in guests do not receive a prescription, but are referred to specialists or therapists. He takes calls as he works because the computer beeps like an alarm clock when someone logs on, so he can be doing other things at the same time.

Physicians with a good "bedside" manner and computer familiarity log on to the Mydoc.com Web site from their homes or offices on Roche-supplied computers when they are scheduled to work. Hours are flexible but firm.

Physicians must be willing to work 40 hours monthly to receive company-owned hardware and high speed Internet access. Payment ranges $45 to $75 per hour. Credentialing is the same as for a hospital, Spahr says. Check with malpractice carriers to verify coverage for online consultations.

Mydoc.com is licensed only in Indiana and Illinois at this writing and can only support board-certified physicians licensed in those states. However, the company expects to be operating in 12 states by the end of 2002 and nationwide at the end of 2003. To apply, contact Dean Wochner, MD, 317/208-2654.

ACPE Resources

Learn new and creative ways to boost revenue, increase the bottom line and improve your ability to serve your patients and community. Join Dr. Robert Kauer of Case Western University's Weatherhead School of Management in a Virtual Summer Meeting on the Web on July 30-31.

Or purchase the recorded, on-line version if you can't attend the live lecture. Issues to be discussed include:

* Developing strategies to boost your income

* Learning to think like an entrepreneur

* Exploring alternative sources of revenue

* Focusing on productivity and efficiency

* Optimizing cash management and AR collections

* Creating value for your organization in competitive marketplaces

For more information on this opportunity, visit the ACPE Web site at http://www.acpe.org/education/weblectures/index.htm or call the College at 800/562-8088.

RELATED ARTICLE: 10 More Ways to Make More Money

1. PUBLIC RELATIONS

Get over your suspicion that PR cheapens the profession and hire a spin doctor to get your name favorably in the media for the good acts you do. Personal aggrandizement is not unethical if it directs needy patients to your door who otherwise might not have found you. Physicians typically pay monthly retainers of about $1,500 to $6,000. Find an agency that specializes in medical public relations.

2. STREAMLINE PRACTICE

Call in an efficiency expert to find out where you are bleeding red ink; sometimes just changing the physical layout of the office and coordinating information flow will add immediately to the bottom line. Costs can be $20,000 and up, according to one consultant, but do it once and you may never need to do it again. It could save big bucks over time. Go to an Internet search engine and type in the words "medical consultant" and "physician" and your state.

3. COMPLEMENTARY MEDICINE

Add complementary treatments, such as massage therapy or acupuncture by having a masseuse or acupuncturist come in one day a week, charging these specialists rent for the use of your office.

4. PRODUCT SALES

Sell vitamins, cholesterol lowering supplements, hair and skin care products, and more. To become a distributor or salesperson, call companies like NuSkin, 800/487-1000 and Rexall Sundown Inc., (Top Rx) 800/542-8677.

5. ADD NURSE PRACTITIONER OR PHYSICIAN'S ASSISTANT

For information, contact the American Academy of Nurse Practitioners, 512/442-4262, www.aanp.org or the American Academy of Physician Assistants, 703/836-2272, www.aapa.org.

6. OFFICE LAB

Doctors who were not scared off by CLIA--Clinical Laboratory Improvement Amendments of 1992--earn 40 percent or more on lab tests after initial investment in lab equipment. For cost analysis, call ACP-ASIM for Office Lab Check Up, a $99 to $175 software program that helps determine feasibility, 800/523-1546.

7. NICHE PROMOTION

Find the one thing your practice does well and promote it. Or, find something odd and hype it. Santa Ana, Calif., mother-daughter ob-gyns, Drs. Nasrin Farbaksh and Kathy Anderson, advertise themselves through their unique partnership, a play on words, calling their practice the Mothers & Daughters Center.

8. HOTEL HOLISECALLS

Doctors earn $100 to $225 per housecall to a hotel to treat guests. Transportation and malpractice coverage required. Submit applications to national companies, Housecalls USA/HotelDocs, 800/468-3537, and TRAVELMED Inc., 800/878-3627, as well as local firms that can be found on the Internet

9. LOCUM TENENS

Use vacation or down time to work as a locum tenens physician. Assignments can be as short as few days or as long as 18 months. Locums agencies pay travel, lodging and car expenses. Among the larger firms are CompHealth Inc, 800/453-3030, Medical Doctors Assoc., 800/780-3500, J & C Nationwide Inc., 800/272-2707. Also, become a cruise ship or camp doctor.

10. TAKE WEEKEND CALL FOR OTHER DOCTORS

Bill patient insurers.

Maureen Glabman is a Miami-based health care reporter and recipient of the 2000 Reuters Fellowship in Medical Journalism at Columbia University's Graduate School of Journalism.
COPYRIGHT 2002 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

 
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Title Annotation:supplemental income for physicians
Author:Glabman, Maureen
Publication:Physician Executive
Geographic Code:1USA
Date:Jul 1, 2002
Words:3351
Previous Article:Bonuses questioned. (Short Takes: News at Deadline).
Next Article:Competing by design: healing environments attract patients, reduce costs and help recruit staff. (Innovation).
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