Just Say Yes! (to Private Practice)

By David Kopacz, MD
“My first word of advice is this, say yes. In fact, say yes as often as you can. Saying yes brings new things. Saying yes is how things grow. Saying yes leads to new experiences, and new experiences will lead to knowledge and wisdom. Yes is for young people, and an attitude of yes is how you will be able to go forward in these uncertain times,” (President of the University of Connecticut, Michael Hogan’s 2009 commencement address, quoted in “How a New Jobless Era will Transform America, by Don Peck, The Atlantic Monthly, March 2010, p. 48).

Doctors are a pretty conservative bunch. We get to where we are by saying no to many things that are a lot more immediately enjoyable than studying biochemistry. It can and has been said that doctors are a risk-averse group. Why then would any physician in their right mind say “yes” to private practice when there are no financial guarantees, no colleagues, maybe even no employees, no 401(k), no one paying your malpractice insurance, maybe you have some patients, but maybe you don’t even have that!

Why on earth would you say yes to private practice?
Well, for me, it felt like a necessity, and I suppose many adventures start out that way. Read more

Changing the PrivatePractice.MD Mission

The focus of the discussion on PrivatePractice.MD is changing from this point forward. When I first thought about starting a website for doctors in private practice, I planned to develop a team of medical practice experts to teach all of the doctor members useful facts and impart general business knowledge that most doctors don’t get taught in their long education.

Medical practice experts will still be part of this goal, and many of the upcoming podcasts will feature these experts. But I realize that there are many fine brick and mortar and internet resources for medical practice management information available to physicians. Read more

Podcasts Coming Soon!

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PrivatePractice.MD will soon be producing podcasts featuring interviews with interesting physicians managing successful and often innovative medical practices. If you would like to be interviewed or want to recommend a physician or practice to be spotlighted, please send your suggestions to feedback@privatepractice.md.

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Paying An Annual Fee to Keep Your Doctor

I recently was informed by one of my clients that he is being “courted” by a company that helps doctors trim their practices to 400-600 patients. These patients will be invited to stay with the practice by paying an annual fee to have better and more access to their doctor by having less wait time for an appointment, longer appointments, and the doctor’s cell phone number or other personal information to use for communication.

I am not sure how I feel about this new niche being carved out on the business side medicine. I am told that it is not the same as a doctor creating a boutique practice, one in which insurance is not accepted. The company courting my client is currently reviewing various aspects of the practice not the least of which are the demographic, insurance and age factors. Through use of marketing tools as well as I guess some quantitative and qualitative analysis, the company will decide which patients should be invited to stay with the practice for an annual fee (I have heard these fees to be between $1500 and $2000 payable over four installments).

As a billing service, I will not lose this client because insurance will still be billed. The annual fee is a private contract between doctor and patient. I will make less money probably because my earnings are based on the doctor’s receipts and he will see less patients every week This is NOT why I am unsure how I feel about this relatively new idea.

My concern is for the 1400-1600 patients in his practice who will not be asked to “rejoin” the practice. Where will they go to find another primary care physician who isn’t already overloaded? Where will the patients who have no insurance go (as I don’t think they have an additional $1500 to pay for an annual fee?) Where will patients who have a Medicaid plan go as fewer and fewer doctors are participating in those plans?

So you can see why I am conflicted. For the 400-600 patients who will have more access to the doctor, this could be a way to decrease what sometimes is a stressful experience. And for the doctor who can and will spend more time with each patient there will also be a decrease in stress on all aspects of the practice. But my conflict continues.

Patients Without Healthcare Insurance

As I complete my fifteenth year as a solo medical billing service,I find this year the most difficult one for patients suddenly without insurance. Over the years I have seen cycles where patients are forced onto Medicaid plans for a period of time but then move back to managed care due to re-employment or they become eligible for Medicare. While I always have some balance bills for patients who “refuse” to pay their portion under the terms of their insurance, this year is different.

There are now stacks of balance bills for patients who are unable to pay. Many of these patients have been seeing the same doctor for years (primary care or a specialist for a chronic condition). Some patients doctor hop to spread the debt around.

Some patients come in with expired insurance and if eligibility is not checked, the patient gets a free ride at least for a while. Some patients might give a check that will be returned for insufficient funds while others may think twice about using a credit card should your office accept that form of payment. Some people will simply ignore the bill because they are overwhelmed with all the other bills, so what is one more?

Now is the time to set policies for patients who have no insurance. Certainly checking eligibility makes sense even in better times. A partial payment can be advised while making the appointment and if you take credit cards, ask the patient if you can expect him/her to use it. Set up a payment plan at the end of the visit and keep one employee or your billing service informed of the arrangement. Make notes in the computer as to what was discussed. Consider a courtesy on a case by case basis especially if you can obtain payment in full at the visit. This saves time, creates loyalty, and a good feeling among the staff who collected the money.

You know your patients best and when they hopefully obtain insurance again, do you want them going to another doctor who might have been more flexible during this rough patch? Is a collection agency really the answer that may take a portion that is larger than the courtesy you may give? Most people want to pay their bills; be clear on what you are billing them for and communicate your policy with your patients

Electronic Health Records: First Do No Harm

In medicine, we have all heard the creed “first, do no harm”, from the ancient Greek physician Hippocrates. This is an excellent principle for physicians to guide them in their practice of medicine. It is also, however, an excellent creed to guide physicians in their quest for the right electronic health record (EHR) system.

Most of the practices that we advise and that are using some form of EHR are struggling to make their adoption successful. The struggles range from the minor troubles such as workflow disruptions and input irritations that drive staff nuts, to the “what have we done to ourselves” sentiment. There is a common theme among these practices, and that is that every one of them made major missteps key areas of the project before the first piece of software was ever installed. They were not adequately prepared, and as one physician recently shared with me, his practice has been “harmed” by their EHR efforts. Read more

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