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."