You can turn your practice around

That's how beaten down Landers felt as a physician. Her paycheck just didn't reflect the 60-hour weeks she put into patient care. In 2002, for example, she earned just $85,000, far below the $150,000 netted by a typical internist that year, according to the Medical Economics Continuing Survey.

Family and friends call her Taffy, but Landers proved to be one tough cookie in the face of her financial doldrums. Instead of moving to Canada or the classroom, she slowly began overhauling her practice. Her perseverance has paid off. Last year, she earned $125,000, a great leap forward from her 2002 compensation (though still well under the norm for internists). And she's expecting to grow her practice more in 2007.

Take a hard look at billing and collections

One of Lander's first acts of financial self-preservation was cutting loose three insurers-Aetna, Cigna, and UnitedHealthcare-whose miserly fee schedules were depressing revenue.

"It was a scary prospect at the time, but my practice didn't suffer," says Landers. "I'm still seeing as many patients per day as I did before I fired these insurers. Some of those plans' patients did leave my practice, but plenty of others stuck with me. They had to pay me out of pocket, but they were able to get some reimbursement from their insurer. I used to discount their fee if they paid me cash at the time of service. Then I discovered that their insurance reimbursement usually exceeded their discounted fee. So I ended the discount."

Landers' biggest move on the revenue side, though, was dropping her outside billing agency in 2004 and taking that job in-house. The company that she had relied on to collect her money was lackadaisical at best. Instead of getting claims out the door within 24 hours of the service, it sometimes sat on them for a month. The company also was slow to work denied or underpaid claims. If an explanation of benefits came back stating that the patient wasn't covered under a particular health plan, the company would dun-and irk-the patient instead of finding out if he had a new health plan. When checks from health plans and Medicare didn't arrive when they should, Landers' urgent calls to the billing agency were met with nonchalance.

To set up her own operation, Landers purchased billing and scheduling software called PracticePoint Manager from McKesson along with the necessary hardware, all for about $25,000. More importantly, she turned to a billing and collection consultant named Leanne Chaney-Baldwin to train her staff. Chaney-Baldwin taught them not only how to use the new system, but also how to master the entire revenue cycle, from patient scheduling to payment posting.

In sharp contrast to the outside billing company, Chaney-Baldwin has mother-henned Landers' practice, monitoring office morale as much as accounts receivable. "If people aren't happy, I want to know why," she says.