Sunday, May 29, 2016

Money Talks: Survival of the Small Pediatric Clinic

Recently, my front desk staff asked if they could “guest” write on MommyDoc.  So with some edits from me here are their collective words.

We often hear “I love our doctor so much, I would not go anywhere else, but that front office is so rude asking for money when we walk through the door.”  Whether it is in regard to a co-payment, deductible, or other outstanding balance, there seems to be a miscommunication as to why the front feels so strongly about collecting money owed before appointments. 

We care as much about the people we see on a monthly or yearly basis as the doctors we work for.  Revenue collection IS our job and without this, you would not receive the personalized, in-depth care you enjoy in a small, private practice environment.  The days of physicians driving fancy sports cars and living in mansions are long gone.  Reimbursement from insurance companies has continued a steady decline.  Physicians are now unable to support private practices without joining larger groups.

Imagine for a moment we are at a Starbucks and the physicians are your daily coffee; you approach the counter and order your favorite drink, Dr. Niran is a whole milk Peppermint Mocha and Dr. Saad is a sweet Vanilla Latte.  Would you order your drink and then pay a few months down the line “if and when you have enough to cover the bill?” Better yet as you pick up your warm drink, would you say “I am not sure if there is money in my account, but trust me, you will get paid sometime?”   Insurance companies pay claims 30-90 days after the service, assuming we had the correct insurance information from our patients at the time.  Would Starbucks still actually be in business if they allowed this kind of payment delay?  Of course not, this is no different than paying a co-pay each time you see your doctor.

A man called our office this week and asked what WE charge for co-pays.  What the what? Copays and deductibles are what YOUR insurance requires you to pay according to your contract.  They consider it “your investment” in your health care.  We were asked the other day whether the copay really makes a difference in our bottom line.  You bet it does!  It makes up a significant portion of total income for our business and keeps us afloat. 

Copays pit your physician against your pocketbook.  Insurance companies want to chargeyou $30 when you see your primary care doctor, $75 if you are seen at an urgent care facility, and as much as $150 when you go to the ER.  If an insurer “allows” $100 per visit to the doctor, they actually pay only $65 and stick you with the other $35.  So on average, your co-pay makes up 25-30% of primary care physicians revenue.  If any business went without 25% of their revenue, they would go bankrupt. 

So many insurance plans are available that consumers must be savvy shoppers to make sure they understand exactly what their plan is offering.  People are surprised when they pay little in monthly premiums, thinking it is a great deal, to realize later their insurance will not pick up the tab until the beneficiary (you) pay a substantial “out of pocket” amount, known as the deductible or patient portion. 

If you are a family with a couple of small children who will be coming to our office at least several times per year for well child exams, immunizations, illnesses, or injuries then a plan with a high cost for each visit might not be the right plan for you.  You might be better off with insurance and a higher monthly premium or smaller deductible when your child is ill. 

Over the past 5 years, a number of physicians in Kitsap County have gone out of business for financial reasons, retired much earlier than expected, have declared bankruptcy and closed, or have been forced to join larger corporations.  This means physicians will have less time to spend with you and must increase the volume of patients seen each day to make ends meet.

We definitely understand patients not wanting to be hassled about payments, especially when your child is ill, but we NEED to stay in business.  This means we must collect payments big and small.  Personally, we feel extremely uncomfortable asking people for money when they come in, knowing a parent will protest or refuse to make a payment and demand to be seen. 

The bigger picture is:  unless our physicians get paid, they cannot afford to continue as our physicians.  If we let people come in without collecting revenue owed, the likelihood of collecting money owed drops significantly.  There are costs to mail out bills and if we begin losing more than we take in, the staff and others employed by this practice will be out of jobs.  If our physicians are not able to make a living, we will close.  You lose the doctor your children love so much and we lose our patients.  Thank you for reading our plea.  We hope you can understand.  We at the front desk, look forward to seeing you soon. #‎BusinessOfMedicine

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