Taking the Plunge
I did it. I said I was going to do it, and I finally did it.
I sent out a letter to all my active patients: beginning February 1st I am instituting a new office policy: a $20 per person per year Administrative Fee.
Not for medical care. For things like calling patients back with lab results (instead of bringing them back for return visits, like all the other docs do), mailing, faxing and calling in prescriptions, prior authorizations and referrals to the tune of dozens a day (all unreimbursed, and all -- if not part of a face-to-face encounter -- having nothing to do with medical care), for having the phones answered by a person instead of a menu machine* ("Suicide Hotline: press 1 if you have a gun, press 2 if you've overdosed, etc") and for my availability for telephone advice 24/7.
By now the letters have arrived and the phone calls will begin:
- Do I have to pay if I don't see you in 2007? (No; you don't have to pay unless/until you come into the office.) (But I won't refill scripts if I haven't seen you in a year.)
- What happens if I don't pay? (I won't call you back with labs; you'll have to come in for every prescription refill; filling out forms without an office visit will cost you $10; etc.)
- Send me my records.
The problem is that although I clearly provide better service than other practices in my area, none of them have gone to this "prospective payment model" yet. They all charge for things like forms and mailings and records (which I don't) but they haven't yet gone that extra step. It's like a miniature version of "Concierge Medicine," where you pay $1000-2000 a year for the privilege of being a doctor's patient. I have been providing Concierge service at insurance prices. So now I shall begin to charge the nominal sum of $20 per person per year (maximum $100 per family; can be waived for extreme financial hardship) and away we go.
I am not generally on the front end of the innovation curve. I pride myself on being a "late adopter" of drugs and therapies, waiting until the biggest kinks have been worked out by other doctors. More times than not, my patients have benefitted from this approach, and I don't intend to change in that respect. But being the first on the block to try something like this new Administrative Fee is more than a little scary. I shall keep you posted on my progress.
*My father's favorite: "Incontinence Clinic: Can you hold?"