Re: Cash discount?

[Guest guest]

I definitely don't want to go the boutique route because I feel I would be

limiting my practice to only the rich (if I did all-out boutique with very

small number and high annual fee). I really want to be able to treat

anyone who wants to see me. This includes the hard working, blue-collar

worker...

Someone who isn't so poor that they don't qualify for medicaid, but

doesn't make enough to afford health insurance. I'm actually having

patients ask me if I will offer a retainer fee model so they can continue

to see me when I open. Currently, these patients see me through my

residency program on a sliding scale.

I explain that it would probably be cheaper to see me on a fee-for-service

basis, but a lot of patients like the monthly payment option and added

security of knowing they'll get to see me...not some random resident that

constantly changes every 2-3 years. These are usually patients that see

me on a regular basis due to chronic disease(s).

Just some thoughts. Right now, I'm thinking just fee-for-service to keep

things simple, but $30-$50 a month is attractive to some patients and I

was wondering if there were problems in offering mixed fee schedules.

How much of a discount is typical to offer cash-paying patients? I'm not

looking to give my services out for free (no living under a bridge in a

box for me, LL!), but I would like to give my cash-paying patients a

break.

Thanks for the opinions!

- Graham

[Guest guest]

,

Are your patients asking about a retainer fee that is paid IN ADDITION

TO your normal and customary fees, or about a prepaid monthly fee in

lieu of a per visit fee? If they don't have enough money for health

insurance, I doubt that they would want to pay anything extra. I think

a monthly prepaid fee is an interesting concept (a throwback really to

the original idea of prepaid health insurance) but I wouldn't have the

resources or interest in keeping track of who has or hasn't paid their

monthly fee.

My fees for cash-paying patients are modeled on Gordon's (but higher

than his fees): $50 for each 15 minute interval of service, with a 20%

discount for prompt payment. This effectively lowers it to $40/15

minutes. I wanted to be affordable to my patients without insurance, as

well as eliminate the hassle of sending a bill. Everybody who has come

in without insurance has paid in full at the time of service so far.

Unfortunately, my business plan was based on an average fee of

$78/visit, so I have a ways to go in order to be successful. And

fortunately my wife is an employed physician so I am not an infrabridge

box-dwelling physician either....yet.

Seto

South Pasadena, CA

On Saturday, April 3, 2004, at 05:47 AM, Graham, M.D. wrote:

>

> I definitely don't want to go the boutique route because I feel I

> would be

> limiting my practice to only the rich (if I did all-out boutique with

> very

> small number and high annual fee).  I really want to be able to treat

> anyone who wants to see me.  This includes the hard working,

> blue-collar

> worker...

>

> Someone who isn't so poor that they don't qualify for medicaid, but

> doesn't make enough to afford health insurance.  I'm actually having

> patients ask me if I will offer a retainer fee model so they can

> continue

> to see me when I open.  Currently, these patients see me through my

> residency program on a sliding scale.

>

> I explain that it would probably be cheaper to see me on a

> fee-for-service

> basis, but a lot of patients like the monthly payment option and added

> security of knowing they'll get to see me...not some random resident

> that

> constantly changes every 2-3 years.  These are usually patients that

> see

> me on a regular basis due to chronic disease(s).

>

> Just some thoughts.  Right now, I'm thinking just fee-for-service to

> keep

> things simple, but $30-$50 a month is attractive to some patients and I

> was wondering if there were problems in offering mixed fee schedules.

>

> How much of a discount is typical to offer cash-paying patients?  I'm

> not

> looking to give my services out for free (no living under a bridge in a

> box for me, LL!), but I would like to give my cash-paying patients a

> break.

>

> Thanks for the opinions!

> - Graham

>

>

>

>

>

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>

>

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>

>

[Guest guest]

,

My thoughts were definitely in lieu of insurance. I haven't the foggiest

idea of how I would keep track of who is on what plan. My accountant

liked the idea of different options such as

group 1) insurances that I take with " business as usual " ;

group 2) out-of-network patients that I give the HCFA 1500 form and

discount the reimbursement difference and

group 3) the no-insurance patients that pay a flat monthly fee for

x-amount of visits and lab work included. I guess

group 4) would be those willing to pay my fee schedule out-of-pocket (with

a 20% cash-in-full discount)

My question is, does this violate the " I must charge everyone the same

fee " rule? I know medicare patients (which I will definitely provide for

as they pay the best here) could only be billed through medicare, but if

someone doesn't have insurance, can I bill them differently? I doubt it.

These are just ideas, but I'll likely start off very simple with just a

few plans.

I graduate June 30th and hope to open my doors August 1st (not looking

good); I REALLY don't want to lose all the patients I currently have

(300-500+ with more on the way). I've been very fortunate (and honored)

to receive the recommendation of a well-liked/respected internist in the

community. He is one of my faculty members who is taking a job as

director of hospice. He is basically GIVING me his practice and

reassigning his patients to me (600+ and 100-200 of my own (with decent

insurance)). My residency does not have a No-compete clause, so they're

ok with me taking all these paying patients away from them.

My schedule is booked solid through graduation with these patients...I

don't want to let them down. They are VERY excited with what I hope to

offer them via the for Less model.

I still have so many questions that I'm not sure which ones to ask or how

to prioritize...I'm tempted to get a practice management consultant

involved, but I've been holding off trying to do as much as I can. I may

take a salary gurantee from a local hospital. The loan is completely

forgiven as long as I stay in St. sburg (which I plan anyway) for 3

years. I of course will have to have my attorney go over the contract

when it's ready.

So...I'm very tempted to tell my patients to come see me even if I'm not

on their plan and just charge the copay (I know, I know...here comes the

infrabridge, box-dweller). The reason I want to do this is to not LOSE

any patients while I get on the various plans. If after a year (with

salary guranteed) I haven't gotten on a particular plan (or don't WANT

to), then I let those patients know that I can only see them as an

out-of-network provider and possibly give them the HCFA to submit for

themselves--by then, patients may not mind doing that if they like the

care they're recieving.

Thanks, for the reply...anybody with thoughts on the above plan?

Thanks,

- Graham

3rd year Family Medicine Resident

St. sburg, FL

Seto said:

> ,

> Are your patients asking about a retainer fee that is paid IN ADDITION

> TO your normal and customary fees, or about a prepaid monthly fee in

> lieu of a per visit fee? If they don't have enough money for health

> insurance, I doubt that they would want to pay anything extra. I think

> a monthly prepaid fee is an interesting concept (a throwback really to

> the original idea of prepaid health insurance) but I wouldn't have the

> resources or interest in keeping track of who has or hasn't paid their

> monthly fee.

>

> My fees for cash-paying patients are modeled on Gordon's (but higher

> than his fees): $50 for each 15 minute interval of service, with a 20%

> discount for prompt payment. This effectively lowers it to $40/15

> minutes. I wanted to be affordable to my patients without insurance, as

> well as eliminate the hassle of sending a bill. Everybody who has come

> in without insurance has paid in full at the time of service so far.

> Unfortunately, my business plan was based on an average fee of

> $78/visit, so I have a ways to go in order to be successful. And

> fortunately my wife is an employed physician so I am not an infrabridge

> box-dwelling physician either....yet.

>

> Seto

> South Pasadena, CA

[Guest guest]

I am currently doing the hospital guarantee start-up assistance deal. I too

just graduated residency. I thought that you could not even accept any co-pays

until you are credentialed with the plans? I have just been treating them for

free until I am credentialed (hospital provides income guarantee so I still get

paid).

[Guest guest]

,

I'm not 100% sure of what I will do (or what is allowed...still learning),

however, I know of some doctors that just collected co-pays until they got

on the various plans...

My point of view, if you charge a co-pay and see the patients regardless

if you are on their plan (something I will urge them to do in a letter

before I graduate), then they won't know the difference (business as usual

so-to-speak). I tell them that I can always bill the insurance companies

retropectively (which isn't always true, but easier than explaining the

hospital gurantee). This way they are set straight from the beginning.

If I can't back bill, then I just right off the difference. I'm still

surviving and avoiding practicing from a box under the trestle. This is

where the hospital gurantee helps out immensely.

I plan on having a set fee schedule and if I am not trying to get on a

certain plan (especially certain medicaid HMOs), then I will tell the

patient this up front and bill them the full amount (minus a cash-in-full

discount). Same would apply to non-insured patients.

If I legitamately TRY to back-bill the insurance plans that I eventually

get on of the patients that I collected copays from, then I'm not

technically billing patients on a different fee schedule than those that

don't have insurance or who have medicare or some other plan that I AM

on.(I hope to at least be on medicare and BC/BS by the time I open).

This way I don't let patients get comfortable seeing me for free and yet I

don't lose any of them by alienating them with forms to fill out and send

in to their insurance company for reimbursement. At least I collect

SOMEthing. Also, with recent changes in insurance plans, many patients'

copays are as high as $35 now (of course doctors aren't being reimbursed

more, the insurance companies just get to pocket more money >:

Anyone have any thoughts on this plan?

Thanks,

>

> I am currently doing the hospital guarantee start-up assistance deal. I

> too just graduated residency. I thought that you could not even accept

> any co-pays until you are credentialed with the plans? I have just been

> treating them for free until I am credentialed (hospital provides income

> guarantee so I still get paid).

>

>

>

>

>

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