At his old practice, he estimated his overhead at $350,000, and he believes that most of it went toward meeting the needs of health insurers. He needed experts to read his charts and plug the right insurance codes into his bills. He needed staff to secure prior permissions for prescriptions and procedures. He had one employee who worked 40 hours a week just arranging patient transfers to specialists.
He also calculated that he needed to see 25 patients a day just to cover his overhead. In order to make his salary, he often saw 35 or 40. And he never could spend as much time as he'd like with them. According to his wife, Gena, practice employees had developed a ruse to keep Stein from talking to patients for too long. When a patient visit ran over, someone would knock on the door and tell him that another doctor was on the phone.
"You can't take care of 25 or 30 patients a day," Stein said. "That's not possible. What you're doing is running a cattle drive."
His new practice, he said, has an annual overhead of $50,000, and that number includes the flat screen television and leather couches in the waiting room, the Starbucks coffee brewing behind the reception desk, the electronic record software and the high-tech diagnostic equipment that Stein bought when he opened his doors...
...The key to his financial model, he said, is that he doesn't sign contracts with insurance companies, which means he's not bound by their reimbursement rates and not subject to their rules. He can decide what tests to perform or drugs to prescribe without having to make phone calls or fill out forms. He also doesn't have to worry about laws governing health insurance or Medicare fraud. Since he doesn't bill the companies, he doesn't have to follow their rules.