[Jackyln Chan]

You mentioned that you realized you needed more NPs. What were the “signs” that made you think you needed them?

[katski]

This is a great question @drjackiefairwaychildrens-com . Which speaker do you want to send it to?

[Jackyln Chan]

Dr. Elisabeth DiPietro

[katski]

Ok, let’s tag @edipietro to see if she can answer.

[katski]

From @edipietro :

We track 3rd day out for well visits for all clinicians and use that metric to determine if we need to add clinicians if we have the clinical space or if we need to limit/close the practice to new patients.

[Jackyln Chan]

@edipietro Can you clarify what you mean by “3rd day out” for well visit? Are you saying that when someone calls in, you are needing to schedule someone 3 days from the day that they are wanting or 3 days from today for a well visit?

Do you limit the # of well visits vs. sick visits that you have per provider or there is no limit?

[Elisabeth DiPietro]

Hi-

We track days to the 3rd open well visit appointment (and those trends) to provide information about availability of our clinicians. The scheduling templates we look at closely to make sure that we have the necessary number of sick/same day based on the time of year and then the rest of the appointments are well visits/newborns/chronic disease management. We also try to keep the ratio of well visits to sick visits relatively even across clinicians. Last year we fully embraced online scheduling of well visits and sick visits (slots open 24 hours ahead of time for those) and that has taken the pressure off of the front desk staff.

[Jackyln Chan]

Can @huttonjs please elaborate more on how she got the certification as an autism diagnosis center? Which program or course did you go through that took 20 hours to become certified? There is essentially no Pediatrician in my area that speaks Chinese that can do the diagnosis officially so I am really interested in looking into this option. Can she outline the steps?

[Jamie Hutton]

I got certified to do STAT autism evaluations by my VA state AAP chapter. They have been doing a pilot program in our state by trying to get more general pediatricians certified so it is not taking years to get the kids into the developmental pediatricians. For over the age of 4, I got certified in the CARS evaluation by Western Psychological Services, which you can find online.

[Jackyln Chan]

@huttonjs does my AAP chapter need to approve of me doing STAT evaluations as well. Is there a specific reason you certified with your chapter? Did you do the STAT-MD training on site at Vanderbilt or online?

[Jamie Hutton]

I certified through my AAP chapter because they were doing it for free.

[katski]

For @edipietro I have a couple of questions or requests:

1. What payroll company does she use (I use Paychex and they are quite mediocre).

2. Can she post her employee manual and her guidelines for hiring and starting salaries I am not so much interested in the numbers but how she arrives at a starting salary based on experience and education. Does hse hard code annual raises into her handbook? In my Practice I tend to give some raises but tend to annual bonuses and do not necessarily give a standard raise every year.

3. WHo is her 401K provider. I use paychex for this. I am just wondering.

Thanks,

Karla Swatski

[Elisabeth DiPietro]

1. There are many different payroll companies and we have use Paychex and ADP. I believe Paylocity is also a popular one. A lot of it will depend on the relationships you and your practice leadership develop with your payroll company, as well as cost.

2. I can’t post salaries but it is important to have a standard approach. Locally you may be able to find hourly wages ranges. You can also develop a strategy regarding salary range by using education, number of years of prior experience, years in your practice, and inflation adjustment just to name a few.

3. We use our payroll company for the 401K now (it has varied but 401K administration has gotten increasingly more complex).

[Jackyln Chan]

I use paylocity actually and it is very reasonable in terms of cost per month ~$150 for me. It was honestly a rather difficult setup in the beginning but it is much better because I did get it integrated with my 401K which I use T. Rowe and Paylocity integrates with them. It has made things easier.

[Brian Birch]

@drwaipa I want to learn more about the virtual assistants. What vendor/intermediary do you use? I have worried about difficulty in delegating tasks to someone off site and then having to spend a lot of time to ensure things are getting done (and done correctly), it seems that may not be something I need to worry about! What sort of tasks do you have them do for you? I have worried about not having enough back end work to delegate–so some ideas would be helpful! Thanks and great talk!

[Jasmine Waipa]

Hi @birch-md ! Thank you for your questions! I have 3 offshore virtual assistants, and they’ve been amazing! We use the company My Mountain Mover. They sign a BAA and have annual HIPAA training. They’re all vetted and experienced in healthcare. They allow to interview 3-4 at a time and choose the one that feels like a good fit for you. They do EVERYTHING. They are currently doing the following for us:
– Sending visit reminders
– Scheduling appointments
– Writing and sending excuse notes

– Completing school physical forms
– Reaching out for collections/outstanding balances
– Panel management for the one insurer that makes capitated payments
– Patient registrations and closeouts
– Referral management
– When my front desk was sick and team was light, we had them pick up phone calls too

Teaching was very easy through Google Meet, they just watched me or my team do it “over my shoulder” virtually and developed their own SOPs. The great thing is one I had one solid VA, I could trust her to train the new ones when we needed more, and she’s been a great leader.

It’s really helped lighten the load on my on-the-ground team to focus more on patient care and less on admin. Can’t rave about them as an addition to our workforce enough. It’s made all the difference. Let me know if you have any other questions!

[Andrea Hagani]

For Dr. Hutton, I would like to learn more about the autism evaluations. How do you schedule them? I heard you say that you typically bill them as three 99215 visits. Can you walk me through how that works? Do you consider it a loss leader but a valued service? How does the compensation work for the clinicians doing them? I find this a very intriguing idea. Thanks!

[Jamie Hutton]

We schedule them as 1 hour appointments. I set aside a day once a month and do 4-5 evaluations all in the same day. Then 1 month later we schedule follow up appointments for 1 hour and I discuss the results with the families. It is not a huge money maker but a huge need in the community and brings in many new patients.