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.

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