It isn't What you do; it's Where you do it

It has been pointed out that there are huge geographic variations in medical practice. Likewise what is usual and acceptable in terms of administrative practices varies tremendously, depending on where you are.

For example, in my discussion of administrative fees I mention my success in implementing fees for the completion of forms without an associated office visit, primarily because most practices in my area were already charging them. DrFlea, on the other hand, points out why they won't work for him:

I can't charge to fill out camp and school forms. My colleagues don't do it, and the Medicaid folks can't/won't pay.

There you have it. I was able to because others already did. Flea can't because no one else does. Take-home lesson would appear to be that it doesn't pay to be an early adopter.

On the other hand, someone has to be first. Here's hoping I have the resources -- in terms of patient goodwill and recognition of the excellent services I provide that aren't actually medical care -- to pull it off.