News flash!  The healthcare model in America is a mess!

Providers are increasingly dissatisfied with their profession.  There are a multitude of studies and articles available online, but in one particular wsj.com article from August of 2014, I found this quote from a physician:

“I feel like a pawn in a moneymaking game…”  

Ouch.  But what else is contributing?

  1. Reimbursement amounts have decreased
  2. Reimbursement time has increased
  3. Reimbursement challenges have increased
  4. High deductible plans are the RULE, not the exception
  5. Patients view unrestricted access to healthcare as a right
  6. Patients are increasingly non-compliant

Patients are possibly even more dissatisfied.  The same article cites the fact that unhappy doctors make for unhappy patients, but there are additional factors at work here:

  1. Insurance premiums are up dramatically and set to go another 25% higher in 2017
  2. Narrow networks have locked patients out of their preferred physicians office
  3. Wait times have increased across the board
  4. Quality of care has decreased
  5. Primary Care is a gatekeeper, not a facilitator
  6. Plans are too confusing

I could write an entire doctoral thesis on what ails healthcare, and I’m sure some have.  Government involvement is higher than ever, patient entitlement is higher than ever, physician disenchantment is higher than ever.  NOBODY is happy.  Not patients, not doctors, not hospitals, not insurance companies (Dropping out of Obamacare left and right).

Nobody will take the blame.

As a physician in private practice, what can you do?  Your cash flow has been affected.  The first quarter of the year may actually be a COST to your practice.  Margins are getting thinner.

I have two recommendations:

  1.  Treat your patients really well.  This should go without saying, but when your dissatisfaction is represented by every patient that walks through your door, when the embodiment of your problems is represented by the next flu vaccine on your schedule, it’s easy to forget.  This is particularly true when you realize that patients are equally frustrated with you, and equally unhappy with what you represent.  Treat them well.  Treat them like your neighbors, like parents, like people.  They have choices, and they can choose to go elsewhere.
  2. Collect your due.  This is hard to do with happy patients, let alone unhappy patients, but it’s absolutely necessary!  Communicate with your patients, explain why, explain how it works, and explain what is expected of them, but collect payment.

As an employer, you are aware of the most common plans available.  Many of the new plans, and in particular the Bronze and Silver Obamacare Exchange plans, make use of high deductibles, up to $6000, with a maximum out of pocket for a family of $13,000.  That’s $13,000 that you, as a provider, will probably never be able to recover.

money

 

If you have a large patient base that opted for either the Bronze or Silver plan, you already know the demographic.  You already know they are the least likely to make copayments, most likely to have outstanding amounts due, and are also among the most demanding in your patient population.

Do you want to continue to see them for free for half of the year?

Collect co-pays.  Collect deductibles.  Refuse to see patients that will not pay for care.  Go to battle with your carriers.

Is it reasonable for you to be expected to see patients that will not pay for care?  If you cannot pay staff because you cannot collect payment, how long is this model sustainable?  One more year?  Five?  How much have you already given up?  Have you cut your own salary yet?

Patients have a lot to bear right now, it’s true.  Escalating costs, escalating complexity, and escalating tempers.  Asking them to pay for a $300 visit with a specialist is not going to go well.  There will be some that get really belligerent, and your front desk staff are going to hate it.

What should you do?

Communicate.  Make the policy public, and then enforce it.  We are on the cusp of open enrollment for 2017, where patient premiums are going to go up.  You might already have a sign in your office that says “payment for service is due at the time of visit”, but do you enforce it?  It’s a big fat confrontation, right there, the first thing a patient sees when they walk in, before they even get to speak with your staff.

How can we approach it differently, but still be perfectly clear what is expected?  How can you have really happy, loyal patients?  Treat them well.  Make them want to come back.  If you collect money, actually get paid for the patients that you see, could you afford to lose the ones that don’t pay anyway?  If you didn’t have to spend extra time arguing with your worst patients that don’t pay you, do you have time to cater to your best ones that do?

Patients.  Listen up.  Healthcare is NOT A RIGHT.  “Health” doesn’t magically happen just because you have a doctor, or an insurance plan, or took the stairs.

It’s time to take responsibility for your health.  It is unreasonable to expect someone to do it for you.  Not the President, not your spouse, not your parents, not your kids.  You must do it.

I’ll save this rant for next time…

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