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.

Friday, February 09, 2007

Update: Administrative Fee

It's been just a few weeks since the fateful letters went out informing my patients of my new administrative fee, and things have been hopping:
  • Bad addresses: not unexpectedly, each day we get a couple of the letters back.
  • "Please transfer my records": two families so far.
  • Phone calls: some.
  • Checks: plenty.
The phone calls are easily handled. People are reassured that they don't have to send the money before scheduling an appointment. We've also been emphasizing that it's optional. I plan to gradually become more hard-assed about not providing phone services and refills to non-payers over the next 6-12 months. It would be too abrupt to go from our present, extremely laid-back style to the opposite extreme of pay-now-or-pay-as-you-go without at least an informal transition period.

If I had it to do over, I would have included the "Rules" sheet that's posted in my office along with the letter in the mailing. That's where it's spelled out that you don't have to pay until you come in and that it can be waived for financial hardship. I think that's why folks have been sending in the checks, which of course has been very heartening. Even more so have been the little notes some people include. Things like:
  1. "Thank you for all you do."
  2. "Well worth it."
  3. "Just having the phone answered by a person is worth the $20.00"
Bottom line for this interim report is "so far, so good."


At Fri Feb 09, 11:55:00 AM, Anonymous Anonymous said...

I'm not a doctor and can't envision all the crap you guys have to go through in your daily business that invariably have little to do with doctoring. But yours is a service industry - you provide a service to your patients. Right, wrong or indifferent, here's how I see this pay to play.

I've paid you the required office fee so that you can diagnose whatever is ailing me - as it should be. But if you tell me that I need a blood test and then refuse to call me with those results because I didn't pay for the extra fee, then yes, I have a problem with this scenario.

This is a la carte medicine where I have to pay for the steak, salad and baked potato separately. I see my blood test results as an extension of my initial visit to you. Of course, if I need further treatment, I have no problem paying for it.

Frankly, I'd be affronted to have my doctor tell me that he'll no longer call me with lab results. You strike me as a terrific doctor, and I can see why your patients are willing to pay the extra fee. I can also see how calling patients eat into your day. But isn't this part and parcel the nature of your business? As wonderful and talented as you seem to be, I see this as extortion. I'm not looking to get flamed, and I certainly mean no insult. My intent was to offer a patient's view of this policy.

At Fri Feb 09, 12:04:00 PM, Anonymous Anonymous said...

I advise you to stay away from Ruth's Chris restaurant. I do so because, the most excellent food is strictly ala carte-steak,salad, potato, any other side-dish are each charged for seperately.

At Fri Feb 09, 12:52:00 PM, Anonymous Anonymous said...

Yep, I know - hence my comparison. I agree that the food is excellent, as is #1Dinosaur's medical expertise. While I have the option of deciding how desperately I want the potato or salad, it's a no-brainer that I need the results of my blood test - something I feel I already paid for with my initial office visit.

At Fri Feb 09, 04:18:00 PM, Blogger MedStudentGod (MSG) said...

Well done and good to hear. Hope that this is a sign of the relative ease with which you will be able to continue to implement cost-effective methods. After all, you run a doctor's office and a business. Have to pay the bills in order to take care of patients :)

At Fri Feb 09, 04:29:00 PM, Blogger #1 Dinosaur said...

Anon: What I hear you saying is that you feel that calling you back with results should be "bundled" into the office visit charge. Fair enough in principle; except that the insurance coding guidelines are explicit that only "face-to-face" time is what counts. When labs are all normal, I agree the whole thing is no big deal. But when your cholesterol is elevated and you have mild diabetes and that phone call becomes a discussion of lipid lowering medication and counseling about diet and exercise, that becomes de facto "work" that I am performing unpaid.

The other thing to realize is that other docs are routinely making their patients come back in for results -- even completely normal ones -- specifically to generate that office visit, which is the unit of work for which they get paid. To me, that sounds more like extortion than my once-a-year $20 Administrative Fee.

Don't mean to flame you, but I hope that helps restore at least a modicum of your good opinion of me.

At Fri Feb 09, 05:13:00 PM, Anonymous Anonymous said...

Ah, Dino, my opinion of you never waivered. I think you're a terrific person, and your patients are lucky to have you.

I hear what you're saying about the callback being far more than a simple, "You're going to live" conversation, and admit that I hadn't considered that scenario. See, that's why you're the doc and I'm the idiot patient. In cases where you need to go into detail with your patient, that really is the equivilent of another appt., so I see the method to your madness.

Personally speaking, I think I'd actually prefer another appt. with my doc to discuss further treatment protocols. I'm a face to face type of person and think better when they're sitting in front of me. But I, admittedly, would resent being charged to have him tell me that my tests came back normal, especially since I only see the guy once a year. I suppose my problem with the overall charge is that you don't differentiate between the simple five second, "You're fine" conversation and the "have you considered a kidney and brain transplant?" conversation.

Lastly, the only flame I fear is the "you're not fit to wear your own skin" offering.

At Fri Feb 09, 06:10:00 PM, Blogger Sid Schwab said...

To cover all the work done of necessity and not reimbursed, twenty bucks/year seems paltry indeed.

At Fri Feb 09, 06:51:00 PM, Blogger Bo... said...

The fee would be worth it to me because I get so many bonus things from my doctor, i.e. all those times they fit me into the schedule as a walk-in when I didn't have an appointment, all the free samples of meds my doc gives me, and all the good gossip I hear in the halls, heh!...

At Fri Feb 09, 07:40:00 PM, Anonymous Anonymous said...

Even before the $20 fee began, wouldn't a patient who's had an abnormal test and who now needs treatment, wouldn't that scenario mean he/she would have to come in to the office to discuss options, rather than you discussing these things on an unreimbursed phone call?

I can understand having the $20 fee for calling in refills, since that takes some time. But I've got mixed feelings about having to pay to hear back by phone that your tests were normal. There's nothing to discuss in this scenario.

At my family doctors practice (4 doctors), they have a phone option where you can leave a message to be contacted about test results. If anything is abnormal, you have to come in to discuss this with a doctor. There is also an option to request a refill. Right now, the only thing these doctors charge for is for filling out forms. Plus, the office will not fax in prescriptions to mail order pharmacies.

If my doctors office had a $20 fee, I'd pay it. Not because I get such great care there, but because their office is so well run. They do return phone calls, they don't lose paperwork, they give me copies of anything in my chart, etc. Well worth $20.

At Sat Feb 10, 01:50:00 AM, Blogger Cathy said...

I spend all my time ruuning back and forth to my Doctros to get this result and that result. Almost always it is something that could be discussed in about a 1 minute phone call.

I would gladly give each one of them 20.00 per yr. if it could stop all this running to their office for my results all the time.

At Mon Feb 12, 04:14:00 AM, Blogger alwaysthegoodgirl said...

I'd pay it to you. You seem reasonable as do your rules.
I doubt you'd do what my OB/GYN's office staff managed. I got test results in the mail on Friday.
The tests were done on...*drum roll*...
September 25, 2006. It was just a CBC!!


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