Max’s Back Pocket Vol. XVI

Summer kicked in a few days early here in New England. The heat made week five of biking to the hospital a little more challenging, but I still made it all five days. It will be another hot day today so we will have our morning coffee and find a river or lake to swim in this afternoon. Here is a waterfall we found last weekend.

Thompson Falls in NH – can’t swim here though.

Week one of my state’s softer “safer at home advisory” seemed to go pretty well. Although our town has been busy, people appear to be playing by the rules. Of course, we won’t really have material data on if COVID-19 is spreading for a few more weeks. Mrs. Max OOP and I are lucky enough to be in one of the states where cases are on the decline.

With that, welcome to the 16th edition of Max’s Back Pocket.

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Medimentary could probably have a standing spot in the weekly Max’s Back Pocket reel. The mind behind that blog is very quietly sharing some pretty impressive content and ideas about healthcare. Maybe even a bit deeper than some of the stuff we produce here at Max Out of Pocket. This is the kind of blog I tend to gravitate to. Perhaps it is time for Max to set up a “blog roll” and link back to it.

Last week, they touched on The Paradox of Thrift While Choosing Financial Independence. Ah, personal finance and healthcare, my type of blog.

Hopefully, he or she is not getting sick of my long and obnoxious comments. Here are some of my notes on the article.

Here at Max Out of Pocket, we covered one of my favorite employer benefits; paid time off.

Yesterday was payday, which usually triggers some activity in my personal finance world. Some of it happens automatically, such as adding 9.85 hours to my PTO bank. That took my total to a healthy 260 hours.

Sitting on over 6 weeks of vacation is a pretty good place to be.


I have stumbled across some write-ups by Rebecca Pifer at the Healthcare Dive over the last few months. I like her style and it’s to the point. A few articles outlining the operational and financial impact COVID-19 has had on small practices caught my attention. The titles highlight the dire state of things, particularly for independent practitioners.

In the first link, Rebecca reviews a study from FAIR Health outlining bleak revenue numbers for professional services across the country. These numbers are daunting, and further demonstrate just how fragile the fee-for-service model is. And they don’t just apply to professional services; hospital systems are seeing similar shortfalls.

Consolidation Into Health Systems

Shrinking revenue figures like this lead right into the next article, written back in March. The provider consolidation into health systems we have seen over the last decade has been stark. Surprisingly, in 2018, over half of physicians (54%) still worked in independent practices. That percentage was higher than I would have thought. Unfortunately, that number will continue to shrink as these revenue numbers chip away at independent practices’ already razor-thin margins.

I have spent most of my career working for large health systems, a consolidation “machine”. Large hospital systems do a lot of great work for their communities and can take some of the financial pressure off physicians and allow them to focus on patient care. But I am also a huge fan of nimble small businesses and their ability to adjust quickly. Independent clinics can provide a level of customer service large systems struggle with. I think over-consolidation will be a problem in the long run.

The article also mentions that lower telehealth reimbursement rates will impact these clinicians. One thing I would add is the administrative burden of setting up the billing, will also be a problem for small practices. I highlighted some billing concepts with Telehealth Billing: Exposed!

I am lucky enough to work for a financially solid health system with a strong balance sheet. We were able to absorb the crashing revenue number we saw in March, April, and May. Unfortunately, that just hasn’t been the norm across the country. Every day, I am seeing more and more hospital systems furlough or layoff employees.


Mrs. Max OOP and I had a two-month obsession with RVs in 2018. Specifically, the Winnebago. We figured we would live in it full time and travel around the country with our two cats. That dream was short-lived, but I still get envious every time I see someone else doing it. Maybe someday we will get there.

Take the folks over at Money Fitness Journey, for example. They gave us a free tour of the inside of their RV. One thing I like about this tour is it is real. The RV actually looks like someone lives in it, not an Instagram post. Oh, and they have two nice-looking dogs. Thanks for sharing this and thank you for your military service, David.

Speaking of PTO and travel, Max will take next Friday off and embark on my first trip to Cape Cod for the weekend with Mrs. Max OOP. We will follow the rules and maintain social distance as required. It will be nice to get out of town and I will reduce my PTO bank by 8 hours.

That’s a wrap. Enjoy the first day of summer!

Is your state opening back up? Are you comfortable going to see your provider?


2 Responses

  1. Medimentary says:


    Thanks for the shout out again. As always, I appreciate your thoughtful comments. You publish a lot of posts and I’m impressed. Maybe I need to learn how to be more efficient and proficient!

    • Max OOP says:

      Thank you, Dr. Medimentary. I am slowly learning quality over quantity is key in this crazy blogging world, and you have that down.

      Enjoy your weekend.


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