Physicians Practice - March 2008 - (Page 67)

THE GREAT PRACTICE MAKEOVER WHEN BAD THINGS HAPPEN TO GOOD PRACTICES HER DREAM PRACTICE BECAME A NIGHTMARE. NOW WHAT? BY SHIRLEY GRACE Finding your niche — everyone’s dream. Reena Yonkosky found hers providing complex wound care. “All I want to do is heal wounds,” says the certiﬁed wound specialist. “I’m good at it; I’ve saved many people’s feet that others had given up on.” With a nonphysician business partner she met at St. Joseph’s Hospital of Atlanta (he was there partner had set up — purportedly to handle communications with payers — was in fact in the partner’s own name, not that of the LLC. More investigation revealed that her partner had drained the checking account with unauthorized salary withdrawals, and that he had forged the physician’s name on credit card applications and high-interest loans for medical equipment for the BEST INTENTIONS “I know I’m not a businessperson, but I’ve always been solvent. I really don’t want to close. I want to succeed.” practice. Yonkosky immediately ﬁred him, but the damage was done. North Georgia Institute for Wound Care was drowning in nearly half a million dollars of debt. Criminal implications aside, Yonkosky had to ﬁnd a way to stave off defaulting on the loans and other expenses. She took out a personal loan against her beloved farm, and she tried to renegotiate with those she calls “loan shark” creditors for better terms on her medical equipment loans, with little success. Two years later, the practice’s monthly operating expenses exceed its accounts receivable. The one administrative staff person — who handles the phone, patient processing, billing, and more — is inundated with rejected claims she doesn’t have time to chase. Reimbursements have shriv- Reena Yonkosky, MD to sell debriders), two investors, and a $40,000 personal equity line of credit for startup expenses, Yonkosky formed an LLC in May 2005 and opened North Georgia Institute for Wound Care in Cumming. The practice grew nicely: The ﬁrst year she treated about 1,500 patients; the following year, twice that. Yonkosky loved going to work every day, even the “getting there” part. She’d swapped a harried daily commute into Atlanta for a minutes-long car ride from the 12-acre farm she owned. Getting scammed in pursuit of your dream — everyone’s fear. Just six months after opening, that nightmare became a reality for Yonkosky, when Medicare called to ask why all of their remittances to the practice were marked “Return to Sender.” Yonkosky investigated. She found that the post ofﬁce box her WWW.PHYSICIANSPRACTICE.COM eled on the vine. “Medicare cut reimbursement for ambulatory surgery centers by 67 percent,” notes Yonkosky. “It used to be $448; now, it’s $132.” Other reimbursements are down, too. “We’re getting maybe 50 percent back. We’re not getting reimbursed for wound care supplies,” Yonkosky says. “[It’s] getting to be ridiculous.” Add in burgeoning attorney fees incurred by the mess of her failed partnership and the associated debt. “I’m never able to really make a dent in the principal,” she laments. Even worse, Yonkosky is precluded from securing low-cost ﬁnancing help from places like the Small Business Administration because the estranged and uncooperative ex-partner still owns a minute portion of the LLC. Legal arbitration, as recommended by her attorney, may resolve this snag, but at the time of this writing the issue hung in limbo. “I’ve never been in debt. I paid off my residency in ﬁve years. At my age, to have this debt, it’s just like a big weight,” says the 60-year-old, her voice thickening with despair. “I know I’m not a businessperson, but I’ve always been solvent. I really don’t want to close. I want to succeed.” Can she? Perhaps. But Yonkosky’s dire situation may call for some extreme action to save the practice she loves. TIGHTEN THE PRACTICE BELT Any practice should routinely examine its expenses for waste. For North Georgia Institute this is critical, as every penny matters. Ofﬁce supplies, medical supplies, postage, and such MARCH 2008 | PHYSICIANS PRACTICE | 67 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - March 2008

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

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