1st quarter 2008 transition to cash practice

January-March 2008 transition to Cash Only + Medicare Solo physician, suburban practice, large HMO penetration. Conversion to cash practice, Medicare, and Wellness-Retainer model at affordable market based prices. January and February’s numbers contained some old insurance money and is included in percentages given. Also 2 insurers remained thru part of January due to their contractual terms that I chose not to fight as it only set me back a few weeks. But February and March had little if any old insurance money and was very low compared to January.
------------------------------------------------------------------------------------------------- Comparisons given below are percentages comparing Jan-March 2008 to January-March 2007.

Patient Volume decreased by 40%

New patients seen decreased by 50%

$ per patient seen DOUBLED

Revenues increased by 18%
------------------------------------------------------------------------------------------------ More Analysis:

$ per patient visit for 1st quarter 2007 was $63.40

$ per patient visit for 1st quarter 2008 was $128.00

My practice has multiple payment options for patients. These range from selfpay, to Medicare, to Wellness and retainer options. More info on how these options differ can be found by clicking here.

The breakdown is patient visits is as follows:

Selfpay 40%

Wellness 20%

Medicare 20%

Old Insurance-Ancillary 18% and dropping

Retainer 2%

The breakdown in % revenues per patient visits is as follows:

Wellness 35%

Selfpay 29%

OldInsurance-Ancillary 25% and dropping

Medicare 8% and slightly rising as we wait for money to come in and deductibles to be paid.

Retainer 3%

$ per patient visit is as follows:

Wellness $289

Retainer $244

Selfpay $95

Medicare $40 - but waiting on billing-collections-deductibles

Other-ancillary $38 - these are quick 5 minutes visits overseeing a Naturopathic doc.
------------------------------------------------------------------------------------------------ Further analysis: A good percentage of revenues came in from Wellness Plan fees, which is upfront money. This may skew the numbers at the beginning of the year. My job is to market my office to new Wellness patients throughout the year. If I do not get these new Wellness patients, the revenues will slow.

Selfpay averaging $95 per visit. That is $32 more per visit than I received last year, or a relative increase of 33%. Also I have more time open in my schedule to fit in these patients, as I am not seeing the $10 copays or capitated patients.

Medicare averaging $40 per visit. This is skewed as I am waiting for payments to come in. But why should I have to wait? And why should I have to pay a billing specialist to get the money that I earned? Even if this number goes up to $65 per visit , it is still much lower than the selfpay, and a pittance compared to Wellness and Retainer.
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I have had a good number of patients leave my practice due to the dropping of insurance. Some have been nice about it and understanding, and some have been downright rude and insulting. So be it, i do not take it personally. Each patient may make their own decision. I am still available to anyone who wants my services, they just have to be willing to pay me directly for my services, which are priced at an extremely reasonable rate.
The feedback I have received from the patients who have remained has been terrific. While they wish they could pay me less, they have all been happy with the type of non-hurried care they recieve. They can get appointments same day. We have time to help them coordinate their care with specialists. All things that were difficult in the old-insurance driven model.
------------------------------------------------------------------------------------------------ Other Good Effects: Expenses have gone down. My medical billing expenses have been slashed by at least 75%. I have eliminated one medical assistant during my day hours, and went from two to one medical assistants during evening hours. I anticipate my payroll expenses to be slashed by about 25-30%. For other good effects for my patients please see my blog post of 2-20-2008.
------------------------------------------------------------------------------------------------ My goal is to get to about 1000 patients in my practice, instead of the average of 2500 in my community. If I can get 50% and up in the wellness and retainer plans, my revenues will be higher, and patient care will be much improved.

I call that a Win-Win!!!!