Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, January 31, 2007

More on the Administrative Fee

Just to provide some more details about my new fee and my plans for implementing it:

Here are the "rules" as posted at the front desk and in the waiting room:
  • $20 per person per year, payable at the first office visit of the year
That is, if you only come in once a year for a pap, you don't have to pay it until you come. I suppose I'll continue to comp you the phone call with the results, although if it's abnormal and it takes me 20 minutes to try and explain it to you, that's all uncompensated. If you never call for prescritions or advice on what to do for a cold or how early a pregnancy test can be expected to turn positive, then sure, I can see how asking for more money makes me look greedy. I plan to start out pretty lenient on this, gradually getting more hard-nosed about phone advice over the next year or two.
  • Can be waived for financial hardship.
Duh. I also don't plan to charge it to Medicaid patients, although technically I don't have any. I still "officially" accept Medicaid, but I don't accept any Medicaid managed care, and all Medicaid patients in my state must be enrolled in a Medicaid managed care plan. It was an end run that bothered me morally at first, but had to happen.
  • For new patients, payable at the second visit.
You're paying for excellent service. It only makes sense for me to show you how great the service is before asking you pay for it.

As for patient feedback, so far it parallels the comments. I had considered from the outset that those who complained enough to transfer out were folks I wouldn't miss anyway. Many patients have no problem with it. Several have said the fee is too small. I say there's nothing keeping it from going to $25 in a year or two, then maybe to $30, and so on. I have about 2000 active charts, and I was thinking that at the most, I can hope to get it from half of those patients. More conservatively, about 500. That's an extra $10,000, which covers about half my malpractice insurance. It's very much in the "every little bit helps" department.

Right now we're still working out the details of implementation: how to keep track of who's paid and who hasn't, and of those, who hasn't because they haven't been in yet and who has specifically refused to pay it. I know it would be a snap on an EMR, but I'm still paper-based, and will probably continue to be for the forseeable future.*

Thanks for all the support as I head off into this new phase of practice. Either it will be the last meteor destroying the atmosphere, shoving me off into the tar pit, or it will be the dawn of a new day; in which case I'll have to rename the blog, "Musings of a Phoenix."

*For a quick refresher on my issue with EMRs, here's a snippet from one of my P4P posts:
A man in the back spoke of the new EMR he had just purchased for $30,000. Once all the numbers were crunched, though, it turned out he was only going to see about $3,000 in P4P bonuses. The response, delivered somewhat more softly than the stentorian tones of the main presentation, was that his return was more likely to be in the areas of quality and lifestyle. I imagined presenting a proposal to an insurance company -- actually to any kind of business -- and saying, "Now, you'll only make back about 10% of your initial investment, but you're likely to see improvement the areas of quality and lifestyle."


At Wed Jan 31, 03:40:00 PM, Anonymous Anonymous said...

I suppose I wouldn't have any objection to paying an "administrative fee," but the service had damn well better be good. Because I know I would resent being gigged for an extra $20 a year that the competition doesn't charge, and then having to call and prod to get test results, not have phone calls returned on a timely basis, constantly get fobbed off a nurse when I really need to speak to the physician, etc.

I would also be a little irritated at being charged $20 when I maybe only call the doc once a year to get a prescription renewed. Why should I pay the same fee as someone who makes multiple office visits and requires a lot of paperwork and phone calls and hand-holding? You might want to look at some sort of sliding scale that increases in proportion to the number of encounters with the patient. Or just tack on a flat $5-10 for every single patient encounter so the fee more adequately reflects actual patient use.

My impression is that you don't offend in any respect of patient service. So your patients will probably feel it is money well spent. They may decide to vote with their feet, though, if it doesn't "buy" them adequate service... especially if the physician clinic down the street offers the same level of care and doesn't charge the extra fee.

Good luck with this - I hope you keep us posted on how it goes.

At Wed Jan 31, 03:46:00 PM, Blogger Judy said...

I would gladly pay my internist $20/year administrative fee. If you provide the same level of service that she does, you deserve it too.

Oh, and as for keeping track, maybe some kind of stickers on the front of the chart, since you're paper-based. You'll be collecting the fee when the patient is in the office, so the chart should already be out and you'll have the chart out if you're returning phone calls, etc.

At Wed Jan 31, 07:15:00 PM, Anonymous Anonymous said...

To the first poster: you'd be irked at paying $20/yr for him to renew your prescriptions over the phone? I can't imagine your incandescent fury over the vast majority of physicians who would make you come in for an exam and charge you a $20 copay while wasting your time as well.

At Thu Feb 01, 11:35:00 AM, Blogger Bookhorde said...

I got the letter.
I was nervous opening the envelope -- oh, Dog, has something horrible happened? Are you moving your practice? It was a relief to read it. I don't mind paying extra. Being able to see the doc when my kid's sick and not having to wait more than a few minutes in the holding tank -- priceless.

At Wed Feb 21, 09:16:00 AM, Anonymous Anonymous said...

I am the practice manager for a 2 physician Internal Medicine office in Northern Illinois. We just implemented an "administrative fee" at the $120 level. This will pay for all non-insurance covered services like refills, prior authorizations, parking placards, etc, but will also allow us to purchase and implement an EMR/PM, bring our lab back in-house, and pay our staff at a reasonable level of compensation.

In the week since the letters have went out, only 3 patients have elected to leave. This in a practice base of over 5600.

Good business? I believe so. But you can be damn sure the level of care the providers offer and the staff show is going to set the standard for other offices to emulate.


At Thu Feb 22, 11:49:00 AM, Blogger Radioactive Tori said...

I think anonymous that commented above me might be talking about the practice I go to. The similarities are amazing.

I do feel these two particular doctors are worth it, but how do you address the concern I have that if every doctor I go to starts doing this, I will no longer be able to afford to see them all. I had cancer just recently and between myself and my son (who has stomach issues) I am currently working really hard to pay off our medical bills from surgeries we have both already had, save up for future surgeries we might need and also trying to pay our copays and prescription fees for the numerous medicines we are both on. I feel like I am drowning, but yet my husband makes enough money (I am a stay at home mom who had to start watching some children during the day because of medical bills) that I would feel silly asking the doctor's office to wave the fee for me because there are certainly people more needy than me. I do feel doctors deserve the extra (which isn't really extra at all) money, but it is getting really hard for me to imagine paying it all.


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