Re: Non-covered benefits fees

[Guest guest]

Hi sharlene,

Good question. I have the same curiosity. Since I just started, I see most comercial insurance and medicare patients. I find myself spending long time with patients and chart late of the day. And I see way less patients than I used to when I was employed.

Obviously, I need a solution for the long run.

Best,

Wen

 

I have a question for the group. Have any of you instituted a modest non-covered benefits fee that resulted in financial (or other) disaster for your practice? Say, in the $200-300 per year range? I would still be billing insurance, as well. Here's my background...I have an ultra-low overhead, solo, family medicine practice that has been open nearly 3 years. I work from my home in rural, upstate NY, full-time, with my non-medical husband as my only (and unpaid) staff. We do our own billing and are very good at getting everything the insurance companies owe us. We participate with only decent payers, including Medicare (no UHC or Medicaid). Very few of our patients are well-off, and many are struggling, since unemployment is fairly high here. I give a discount for PIFATOS for cash-paying patients, which brings their payments down to a few dollars above Medicare's rates. I accept less from a few people who are in dire need. Some of our insured patients can't/won't pay their portion after the insurance companies pay, so we have some bad debt. We have about 540 patients and could have a lot more, but I keep putting on the brakes to new patients because I can't do all the work required to take care of them, especially when they are new. I am chatty and have a perfectionistic streak, so my visits are long and it takes me wayyyy too long to do my notes. I give super service, almost always seeing patients the day they call, and frequently in the evening or on the weekend when it seems they really need it and I am not otherwise occupied. I accept e-mail from patients, although most of mine don't use it, and they have my cell-phone number for urgent calls. I do home visits for a few who are truly home-bound. I enjoy taking care of complex patients, so I am not always sending them off to a specialist (30-45 minutes away) for every little thing. I frequently pick up and successfully manage things that the few other primary care providers in my area miss. My husband says that I give " concierge care at bargain-basement prices! " As a result, I am basically always working, but still not making enough money to cover my needs, since I went to med school late, still have med school loans, and am just finishing putting 2 children through college. I am 55 and, at the rate I am going, I honestly don't think I would be in any position to retire until I was at least 75, and 80 would be a lot safer! (For me, not the patients!!) I REALLY don't want to try to see more patients, because I feel overwhelmed already, so I am thinking about a fee to get paid some extra for this fabulous service I give. I don't think there is enough money around here to support the $1500+ annual fees of most concierge practices. Even with a much smaller fee, I realize that I will lose a lot of patients who can't or won't pay it, and I am doing the math to see at what point I will fall below what I am making now. With a $250 annual fee, I predict that I could make about the same as I am making now, with about 1/2 as many patients, and my life would be significantly better. If I kept even more patients, I could make more, which I really need. I am thinking of giving my current patients 3 months to decide whether they want to pay the fee and remain in the practice. So, do you think I will " crash and burn? " ---Sharlene

[Guest guest]

whether your population would support such a change is hard to gauge - certainly those not paying their copays currently (or complaining about them) are likely to leave.  I feel my practice is very similar to what you described but Im in the center of a relatively large city where there are many concierge practices charging 2500-4500 per year.  I find my NCBF is essentially to me practicing the way I want (needing 40+ minutes per visit and dealing with the extensive amount of out of office diaglog which for me is mostly email).  I have found a good balance with around 400 patients and a 300/year fee (with some people paying less on an as needed basis).  There is no way I could have the practice without it as I can only see around 850-950 patients per year in my setup.

Make sure you are coming to camp as this is a topic definitely that will be discussed

 

Hi sharlene,

Good question. I have the same curiosity. Since I just started, I see most comercial insurance and medicare patients. I find myself spending long time with patients and chart late of the day. And I see way less patients than I used to when I was employed.

Obviously, I need a solution for the long run.

Best,

Wen

 

I have a question for the group. Have any of you instituted a modest non-covered benefits fee that resulted in financial (or other) disaster for your practice? Say, in the $200-300 per year range? I would still be billing insurance, as well. Here's my background...I have an ultra-low overhead, solo, family medicine practice that has been open nearly 3 years. I work from my home in rural, upstate NY, full-time, with my non-medical husband as my only (and unpaid) staff. We do our own billing and are very good at getting everything the insurance companies owe us. We participate with only decent payers, including Medicare (no UHC or Medicaid). Very few of our patients are well-off, and many are struggling, since unemployment is fairly high here. I give a discount for PIFATOS for cash-paying patients, which brings their payments down to a few dollars above Medicare's rates. I accept less from a few people who are in dire need. Some of our insured patients can't/won't pay their portion after the insurance companies pay, so we have some bad debt. We have about 540 patients and could have a lot more, but I keep putting on the brakes to new patients because I can't do all the work required to take care of them, especially when they are new. I am chatty and have a perfectionistic streak, so my visits are long and it takes me wayyyy too long to do my notes. I give super service, almost always seeing patients the day they call, and frequently in the evening or on the weekend when it seems they really need it and I am not otherwise occupied. I accept e-mail from patients, although most of mine don't use it, and they have my cell-phone number for urgent calls. I do home visits for a few who are truly home-bound. I enjoy taking care of complex patients, so I am not always sending them off to a specialist (30-45 minutes away) for every little thing. I frequently pick up and successfully manage things that the few other primary care providers in my area miss. My husband says that I give " concierge care at bargain-basement prices! " As a result, I am basically always working, but still not making enough money to cover my needs, since I went to med school late, still have med school loans, and am just finishing putting 2 children through college. I am 55 and, at the rate I am going, I honestly don't think I would be in any position to retire until I was at least 75, and 80 would be a lot safer! (For me, not the patients!!) I REALLY don't want to try to see more patients, because I feel overwhelmed already, so I am thinking about a fee to get paid some extra for this fabulous service I give. I don't think there is enough money around here to support the $1500+ annual fees of most concierge practices. Even with a much smaller fee, I realize that I will lose a lot of patients who can't or won't pay it, and I am doing the math to see at what point I will fall below what I am making now. With a $250 annual fee, I predict that I could make about the same as I am making now, with about 1/2 as many patients, and my life would be significantly better. If I kept even more patients, I could make more, which I really need. I am thinking of giving my current patients 3 months to decide whether they want to pay the fee and remain in the practice. So, do you think I will " crash and burn? " ---Sharlene

[Guest guest]

HI Sharlene Sorry to hear about  overwhelmed.I work in a similar area  We don;t see bad economy here it i had always been bad.My sense is you are  doing a great job if your husband does not work outside the home and with 540 patietn s you  put kids through  college     an d   pay loans.   Wow!

I f you really think you can get 250-300 patients  to pay that fee  great ly it seems extremely unlikely-- these fees and " people will appreciate you if you ask " are unrealistic in most areas --plus as health reform  comes  things will change in many ways...

 If you do not ,an  you don't want,  to change your work flow to see1-2more a day then your best simplest bet is to  reduce the number of patietns you see- to reduce your stress and to  make it possible to--> get a job Someplace  do an urgent care shift or  one of these online work at home chart reviw  jobs etc etc  or have the husband get a job ,1-2 days a week. That is the  simplest  easiest way to boost your income rathe r than sweating this out --even if the non covered fee thing could work- and do let us know if you swing it others would be interested-- the  time it is  going ot take  you to set it up ,explain it ,lose  patients over it, market it, etc etc etc does not seem to make sense

 I vote for some attrition in the practice to reduce it  then  get a job  UNfortunaltey this is what alot of folks do  Email me off list if you need to BestJean

 

I have a question for the group. Have any of you instituted a modest non-covered benefits fee that resulted in financial (or other) disaster for your practice? Say, in the $200-300 per year range? I would still be billing insurance, as well. Here's my background...I have an ultra-low overhead, solo, family medicine practice that has been open nearly 3 years. I work from my home in rural, upstate NY, full-time, with my non-medical husband as my only (and unpaid) staff. We do our own billing and are very good at getting everything the insurance companies owe us. We participate with only decent payers, including Medicare (no UHC or Medicaid). Very few of our patients are well-off, and many are struggling, since unemployment is fairly high here. I give a discount for PIFATOS for cash-paying patients, which brings their payments down to a few dollars above Medicare's rates. I accept less from a few people who are in dire need. Some of our insured patients can't/won't pay their portion after the insurance companies pay, so we have some bad debt. We have about 540 patients and could have a lot more, but I keep putting on the brakes to new patients because I can't do all the work required to take care of them, especially when they are new. I am chatty and have a perfectionistic streak, so my visits are long and it takes me wayyyy too long to do my notes. I give super service, almost always seeing patients the day they call, and frequently in the evening or on the weekend when it seems they really need it and I am not otherwise occupied. I accept e-mail from patients, although most of mine don't use it, and they have my cell-phone number for urgent calls. I do home visits for a few who are truly home-bound. I enjoy taking care of complex patients, so I am not always sending them off to a specialist (30-45 minutes away) for every little thing. I frequently pick up and successfully manage things that the few other primary care providers in my area miss. My husband says that I give " concierge care at bargain-basement prices! " As a result, I am basically always working, but still not making enough money to cover my needs, since I went to med school late, still have med school loans, and am just finishing putting 2 children through college. I am 55 and, at the rate I am going, I honestly don't think I would be in any position to retire until I was at least 75, and 80 would be a lot safer! (For me, not the patients!!) I REALLY don't want to try to see more patients, because I feel overwhelmed already, so I am thinking about a fee to get paid some extra for this fabulous service I give. I don't think there is enough money around here to support the $1500+ annual fees of most concierge practices. Even with a much smaller fee, I realize that I will lose a lot of patients who can't or won't pay it, and I am doing the math to see at what point I will fall below what I am making now. With a $250 annual fee, I predict that I could make about the same as I am making now, with about 1/2 as many patients, and my life would be significantly better. If I kept even more patients, I could make more, which I really need. I am thinking of giving my current patients 3 months to decide whether they want to pay the fee and remain in the practice. So, do you think I will " crash and burn? " ---Sharlene

--      MD          ph    fax

[Guest guest]

If the answer to primary care income or time problems is to get a

second job, we deserve to be shunned by the medical students.

The fee plus insurance model seems to leave you vulnerable to

contract changes by the payers or differing interpretations of the

CMS regulations, leaving you at risk for losing a portion of your

patient panel or a messy dispute with the CMS IG.  However, we have

one local IMP type doc here who's been very successful with this

model.

The direct care models (

Forrest's Access Health, Access Healthcare,  Medlion, HealthAccessRI, Epiphany,  ) seem more

stable but the time and expense of setting up all the contracts and

another LLC may be difficult for a solo doc.

HI Sharlene Sorry to hear about overwhelmed.

I work in a similar area We don;t see bad economy here it i had always been

bad.

My sense is you are doing a *great* job if your husband does not work

outside the home and with 540 patietn s you put kids through college

an d pay loans. Wow!

I f you really think you can get 250-300 patients to pay that fee great

ly it seems extremely unlikely-- these fees and "people will appreciate

you if you ask" are unrealistic in most areas --plus as health reform

comes things will change in many ways...

If you do not ,an you don't want, to change your work flow to see1-2more a

day then your best simplest bet is to reduce the number of patietns you

see- to reduce your stress and to make it possible to--> get a job

Someplace do an urgent care shift or one of these online work at home

chart reviw jobs etc etc or have the husband get a job ,1-2 days a week.

That is the simplest easiest way to boost your income rathe r than

sweating this out --even if the non covered fee thing could work- and do let

us know if you swing it others would be interested-- the time it is going

ot take you to set it up ,explain it ,lose patients over it, market it,

etc etc etc does not seem to make sense

I vote for some attrition in the practice to reduce it then get a job

UNfortunaltey this is what alot of folks do Email me off list if you need

to

Best

Jean