Re: oops

[Guest guest]

Put it in perspective. For me, that $5 can represent close

to 10% of a fee that has already been discounted 40%. We are the ones

being nickeled and dimed, not the patient. And if they can’t accept

that, ask them to find a doctor that they don’t feel does that.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Sangeetha

Murthy

Sent: Tuesday, September 02, 2008 7:53 PM

To:

Subject: Re: oops

This is getting better and better.

Its all about resetting expectations on the part of the patient. I

currently work with a practice that gives away a lot ...all in the

name of marketing/ customer development etc etc.It works for some of

the expense sharing partners who see a lot of patients a day- so what

they give away is a miniscule portion while costing the less

productive( nice word that)partners a lot

So patients think nothing of asking that they not be " nickel and

dimeD " . I heartily disagree and thats why we are parting ways. I can

see that the first few months will be a little difficult- but

appreciate all the tips you have given me.

On another note- I am looking at 4patientcare and appointment quest as

webschedulers. Does anybody have experience with 4 patientcare.com. I

will also be using Amazing charts

Thanks

[Guest guest]

Put it in perspective. For me, that $5 can represent close

to 10% of a fee that has already been discounted 40%. We are the ones

being nickeled and dimed, not the patient. And if they can’t accept

that, ask them to find a doctor that they don’t feel does that.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Sangeetha

Murthy

Sent: Tuesday, September 02, 2008 7:53 PM

To:

Subject: Re: oops

This is getting better and better.

Its all about resetting expectations on the part of the patient. I

currently work with a practice that gives away a lot ...all in the

name of marketing/ customer development etc etc.It works for some of

the expense sharing partners who see a lot of patients a day- so what

they give away is a miniscule portion while costing the less

productive( nice word that)partners a lot

So patients think nothing of asking that they not be " nickel and

dimeD " . I heartily disagree and thats why we are parting ways. I can

see that the first few months will be a little difficult- but

appreciate all the tips you have given me.

On another note- I am looking at 4patientcare and appointment quest as

webschedulers. Does anybody have experience with 4 patientcare.com. I

will also be using Amazing charts

Thanks

[Guest guest]

I have 2 words about patients like this. Collection. Agency.

Re: oops

I do what Annie does. It really does get easier with time. Just this week though, I got a call from someone who owes more than $200. ( 3 visits without insurance, without telling me about the first 2, last one was an "l'll gladly pay you Tuesday for a pap smear today") She was really sick with a terrible headache she was sure was meningitis. I said "you need to go to the ER", she said, "I don't have insurance", I said "you have a big balance here too and I can't take care of meningitis." She didn't come in, went to er, her Mom called me and gave me grief too on the voicemail, she said "I can give you $50, if that's what it takes". This patient is 28 yrs old. They are not destitute. I didn't call her back. I had sent the patient the listing for all the free care you can get here in Columbus.

Then later this week the Mom came in and told me how it was a good thing she went in because she had a ct scan done that showed she had swollen muscles all in her neck and head. (WoW, that does sound painful) and the ER doctor just didn't even know what would happen if she hadn't gotten some flexeril and oxycodone. She might have gotten, and I quote, " a severe stick neff". (I think the diagnosis was probably stiFF neCK)

Anyway, guess what, still no payment. My assistant and I both tell people that some sort of effort needs to be made. Some people send just $5 a month and I'll keep seeing them. When it gets hard is when you have entire families who will be pissed off. I don't mind losing a patient here and there (especially when you are seeing them for free).

Kris

It's only a deal if it's where you want to go. Find your travel deal here.

[Guest guest]

LOL That's exactly what I tell 'em. This just happened last week. The MA comes and asks me to talk to the patient about why they needed to pay the copay on the followup.

Re: [Practiceimprovemen t1] oops

head count #2 . yes. of course butI do have a biller and I like that I can share talking with patietns with bill problems with her She is very sweet and often fixes things and the team work with her is very nice It takes some gettin g used to to ask for money Sometimespatietns just don;t understand truly The card says right on it 15.00 office vsit and tehy might not know. Alway s good to defer to Them "yep that;s what They say right here" I say I mean I do not make theri isiruance rulesTo my mediciad patietns I say things a bit differnlty They have a 3.oo copay but while I desperalty want it they do not have any money these folks One guy was going to walk to see me yesterady 10 miles but he got his dad's care as long as he picked dad

up at the mill at 4 am.For th em I say " Can you do your 3.00 copay?"They say can I pay next time, about 3/4 of the itme Sometimes i have given THEM money like for gas.One I bought some one;s meds for them - they paid me back later It is always good for you, a family doc ,to have like, a wife with a good job in town ( alsaka homestaeders phrase) if you want money But you will get used to asking and you will find your own way to do itwelcome

Sangeetha,

Welcome to the listserve. I don't think you can have it both ways:

1. No third party interfering between you and the patient AND

2. No direct payment from the patient to you.

Yeah, it makes me uncomfortable asking for money, but I do it because it reinforces the concept that YOU are providing the service and the patient is paying YOU. You can put an employee between you and the patient just to collect the "filthy lucre" but that's still a third party and you are already questioning the reliability of such a person. Is it worth the extra cost just so you don't have to touch the money?

Money is not a bad thing. Really. You are not treating patients out of the goodness of your heart (at least I don't think you are) and your patients should know this. No margin = no mission. I think this is one reason why doctors allowed ourselves to get into this whole 3rd party insurance mess. We didn't want to get involved with the money. Well, see how well that has turned out?

Let's do a head count. How many physicians here ever actually ask for or collect money from your patients? I do.

Seto

South Pasadena , CA

I think the first message took off..Anyhow, hello everyone I am new here. I will be moving my practice toa low overhead model (I cannot call it IMP yet- I will not give cellphone acess). I will have a staffer , less space, less telecomexpenditure than my current expense sharing setup. My question is -the part of accepting payments really gets in the way of the patientphysician relationship. In the absence of a staffer what do you guysdo> Bill pay, preprinted invoices, autocheckin kiosks?I expect to take my time to find the right person ( ya right!), willhave to account for absences and sickness and want to set up a smoothworkflow for copay collection that doesnt involve the patient seeingme as collecting the

money.Thanks SM

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

Its a good technique. I try it when I can. Like "I have a 1pm opening on Tues, or a 3:30 on Thurs. Which would you like.

" They usually pick one. But now I am having a ball saying "If you have internet access, it might be easier to just go to our website and schedule your appt. You can see our whole sched. onscreen and match it with your calender. Yes, really! Thanks, we think its cool too. Just go to doctorcoghill.com." I had a ball with that yesterday.

Re: Re: oops

Sangeetha- agree with But I also am not clear on whose expectations need to be set or why?MAy I suggest we remove all these emotions??( docs complain about insurances patients complain about insruacnes) and use the simple technique AS MICHELE SAYS -with saying less . It is like asking a 2 yr old something They will say no if given the opportunity So ,no oportunity Say "you have a 5.00 co pay How did you want to pay that?"You do not have to justify it or wish health care were different or anything elseI have been in the Chicago convention center and seen EAds talk to patietns and she is l ike the most nicest person on the face of the earth but she doesn;t wrangle over emotional stuff . Sh e gives postive simple choices "you can two things

YOu can goto the web site and do an e vist or.. " i forgot what the other choice was...':)Keep it simple Does that help?Or tell us why you h ave 5.00 trouble and not 150.00 trouble.

Sangeetha,

You wrote "Its the $5 copays that I have a problem with. That requires a little resetting of expectations." I don't know if you mean a resetting of your patient's expectations or yours. My experience has been that most patients know that they have a copay and those that don't know are more than willing to pay it. Forgive me if I am interpreting this incorrectly but it sounds like you don't have a problem with asking patients to pay AFTER they leave your office, but that you might have a problem asking them to pay while they are STILL IN your office.

One of the tenets of the GTD (Getting Things Done) system is to do things in context and if it can be done in 2 minutes or less, then you should just do it and get it off your plate. You're much more likely to get patients to pay their copays at the time of service than if you send them a bill even a few days later. (I always wait until after the visit is done but when I go see my doctor at Kaiser they always charge me up front.)

Being able to take credit cards give patients more options to pay you (and less of an excuse not to pay you). Setting up a PayPal account gives patients yet another option but seems more appropriate for payment of their balances, rather than the copay which most insurance plan contracts state that you MUST charge patients at the time of service. You should put it in writing in your Payment Policy Statement. Here is a sample:

Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment at each visit.

Some of us do keep credit card numbers on file, so that is another way to make sure you get paid. Personally, I do ask patients to voluntarily keep a credit card on file but I don't use it for copays because the credit card companies take a small percentage of every charge that you make. I will keep more money if the patient pays me by cash or check.

Here are links to 2 articles from Family Practice Management that discuss the issue of copays and practice payment policies:

http://www.aafp. org/fpm/20020500 /19deal.html

http://www.aafp. org/fpm/20040400 /17whye.html

Finally, I haven't heard many people on the listserve talk about sending patients to collections. At what point do you decide to do that? Do you have a high percentage of patients that require being sent to collections, and what kind of return do you get from the collection agency?

Seto

South Pasadena, CA

Hello,Thank you for all your responses.I have ABSOLUTELY no problem asking for payment for the full visitcharge , delinquent bills etc. In fact, fairly routinely dischargepatients and send them to collections if they have balances/ nomitigating circumstances even in my current set up.Its the $5 copays that I have a problem with. That requires a littleresetting of expectations. And I appreciate 's input.That hasceratinly stiffened my spine!I am really looking for a GTD kind ofsolution that requires little human interaction, and so no quibbles onanybody's part. 1.PAYpal ebills?, 2.keeping card on file(esp for hmo patients who have signed up to see you and you alone on aconsistent basis. yeah , I have a a few hmo patients which I seem tohave figured out how to manage, not yet onerous, with online referralsetc

etc), 3.not collecting at time of service and having external billers bill?-since they get percentage of collections anyway.(I do not do my own billing-tended to want to chase every penny - whenI last did that -for 2 yrs)Any thoughts and any ecperiences with that.Thanks again everybodySangeetha-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax