jmj11 Posted January 11, 2013 Share Posted January 11, 2013 Here is a question that I would like your opinion on. I've spoken to several people and have gotten different opinions. I have simply structured our fee schedule about 200% of Medicare allowable. This is somewhat industry standards. However, since we deal with the most complex patients, those who have failed other tertiary centers, the appointments are very long and detailed. So, billing for time and for content, we can charge > $600 for a new visit (lasting over 90 minutes) and over $300 for a follow up (lasting 45 minutes). Occasionally, about once a week, we are getting patients who are livid with the bills (not bills that they actual pay themselves or anyone pays for that matter) because they get the impression, as one patient said, "you are money hungry pigs." Now the painful part of this, is that we are NOT rolling in the dough but have to struggle to pay our bills and keep the lights on. For one, the insurance companies pay us contractual payments, which are 1/3 to 1/2 of what we charge. But some pay on a percentage of what we charge so by charging these high, but industry standards, we do get some more payments. So here is the question. I think it interferes with our provider-patient relationship if they think I'm in this to get rich. So it is a relative issue. So I address this up front? My thought is to give them a short handout about the economics of medical practice and to show that I personally don't pocket $500/hour or would it be better to just ignore the issue and let the chips fall were her fall? I'm interested in your opinion. Link to comment Share on other sites More sharing options...
ATCLATEMTB Posted January 11, 2013 Share Posted January 11, 2013 I think it would be wise to give to everyone. You can simply state you have created this informational brochure regarding the cost of the care they benefit from. Explaining the sub-specialty nature of your work, the time expense, focus on patient care and needs, as well as the constant pressures of insurance companies right off the bat so they understand. The patients might not truly understand the forces at work, not to mention how rare it is to have a provider spend greater then an hour with a patient. (outside the OR of course) You would hate to find success for a patient, only to have them get the first bill or two and leave the practice due to "absurd" cost. You have to express the financial risk you have taken and cont to take as an investment and commitment to THEIR health. I'm curious, since you are an owner / provider how many times you have been asked for reduced fees as well as how you have handled it? Link to comment Share on other sites More sharing options...
jmj11 Posted January 11, 2013 Author Share Posted January 11, 2013 I'm rarely asked for reduced fares (twice in two years) but I do offer 40% discount for cash only. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 14, 2013 Moderator Share Posted January 14, 2013 tough question wow a patient that actually reads the EOB - that in itself is surprising.... Seriously though - health care in this country is EXPENSIVE and the patient really has no clue what it costs..... to get people complaining is par for the course - people complain how much the oil costs, how much the car repair costs, how much their taxes are, how much the pay for a dinner out...... pretty much anything. In this case I would NOT defend it as it makes you look guilty of overcharging. It is a reasonable fee and this is a free country where you get to choose how you spend your money. The one caviate is to never turn anyone away based soley on ability to pay - then you can defend that you are indeed not money hungry. However NEVER talk about your pay or expenses with a patient - you will never win (unless you are talking to a CEO who thinks you should be paid more) We do okay, even at the low end, and great at the high end so complaining about it only makes us look like sore loosers (or money hungry people) In short it is the reality of the situation, if they don't like it they don't have to access your services and it costs A LOT of $$$ to keep a practice open and running. But NEVER debate or talk money (other then the monies due to you) with a patient as it screws up the patient relationship - this is where you office manager needs to be the face of the clinic. Link to comment Share on other sites More sharing options...
KMD16 Posted January 14, 2013 Share Posted January 14, 2013 Ventana, you're spot on! Link to comment Share on other sites More sharing options...
jmj11 Posted January 16, 2013 Author Share Posted January 16, 2013 I've simply added brief language to our one page financial statement, which all patients read. Right after it states the goals of our practice, "patients having an increased quality of life and wellness," I added one sentence that simply states "So to continue providing excellent care to our patient, our financial goal must be to remain solvent in an environment of extremely high costs of doing business and ever decreasing reimbursement." It is a catch 22 because if it is an unspoken topic, it also screws up the patient-provider relationship for some patients. I would like to see a study of patient (or even provider) perceptions of medical business. When I charge almost $500/hour, some patients do the quick math in their head and think I make about $950,000/year. So, in those patients' views, we are in it to get rich and not about helping them. If I wanted to get rich I would certainly be doing something else. I wish there was a way, and debating it patients is not the way, of making the public aware that we in medical practice waste 50% of our time, energy and money just dealing with insurance companies and we have so many costs that normal businesses never face, malpractice being only one. I have a long-term strategy and dream of getting away from insurance companies altogether. Link to comment Share on other sites More sharing options...
rcdavis Posted January 17, 2013 Share Posted January 17, 2013 You owe no explanation. Your value, to them, is your expertise. You are trying to take care of what no one else can take care of.. In patient others have given up on... You might ask them: what is it worth to you to have someone willing to accept you as a patient when everyone else has given up? As the owner, you can prorate your charges as you see fit, but the prime directive of your business should be survival. If you do not survive, you can help no one. Don't arrange your practice by satisfying the out layers. You owe no explanation, and have no duty beyond what you already do: providing comprehensive, compassionate, and expert headache care to the best of your ability. The folks who complain are welcome to move on... Suddenly they presume your "sucess" should be limited based on false assumptions... Oops, becoming political. Stay the course mike. Stay the course. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 17, 2013 Moderator Share Posted January 17, 2013 You owe no explanation. Your value, to them, is your expertise. You are trying to take care of what no one else can take care of.. In patient others have given up on... You might ask them: what is it worth to you to have someone willing to accept you as a patient when everyone else has given up? As the owner, you can prorate your charges as you see fit, but the prime directive of your business should be survival. If you do not survive, you can help no one. Don't arrange your practice by satisfying the out layers. You owe no explanation, and have no duty beyond what you already do: providing comprehensive, compassionate, and expert headache care to the best of your ability. The folks who complain are welcome to move on... Suddenly they presume your "sucess" should be limited based on false assumptions... Oops, becoming political. Stay the course mike. Stay the course. I will second that! Link to comment Share on other sites More sharing options...
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