Preparing yourselves for the transition away from third parties

Preparing yourselves for the transition away from third parties:

I have been asked by other members of the physician community to write about my practice transition and the different feelings, thoughts and reactions I have had as well as those of my peers, patients and community.

A few necessary items to make the transition are listed below in no particular order:

Courage- I have learned that the path to success is not to always follow the crowd. Watch for patterns and trends and determine what you feel is sustainable and what areas are not.

Thick Skin- There will be many parties that will try to throw mud at you. Face it. A majority of the public does not like change!

Marketing Plan- Be prepared to lose a good portion of your practice. But a good marketing plan outlining the positive and valued aspects of your practice will help you to retain your existing patients while growing your practice with new.

Good communication skills- Goes hand in hand with good marketing. If you or your staff can not communicate the purposes of your transition, it will not succeed.

Savings or a spouse that works- Be prepared for a possible decrease in your revenues. It should increase as patients who desire your new style of practice join you, but how long it will take is not possible to predict.

Ability to stay within a budget- You had better have a firm grasp on your practices finances. Knowing where every dollar goes and being able to determine how much overhead you can cut to keep the practice going and to keep your income flowing is an absolute necessity.

Proactive and visionary- If you wait until everyone else is doing it, you will be left behind.

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Patient’s reactions:

Yelling and Screaming- There have actually been patients who have called up my office yelling and screaming that I no longer work with insurers. They do not understand the concept of a doctor-patient relationship without third party intrusion. I find that these are the patient’s who trust doctors the least.

Abandonment- Some patient’s feel abandoned. Again, you or your staff need to explain to all your practice that they are all still welcome, only that they will be responsible for payments as opposed to insurance.

Entitled- These are the patient’s who feel that they bought a product (insurance plan) that entitles them to free or low priced care.
"I already pay too much for insurance": Some patient’s, no matter how much they like you, feel that healthcare costs too much already by complaining about their insurance premium. It is a difficult concept for patient’s to understand but health insurance and healthcare are two different entities.

Excited and understanding: I like these patients. They understand the issues facing physicians, and they also value our services.

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Doctor’s in the community:

Inquisitive: I have had responses from other docs such as, "You are doing what?, I wish I had the courage to do that!, and "You’ll end up going back to insurers"

Watching from afar: These same docs are also watching from afar. Many pharmaceutical reps have taken questions from other docs in the community asking how my transition is going.

Eager to steal your patients: Soma, albeit a minority of doctors, actually badmouth me and my new practice style to patients who have transferred out. This is the part I do not understand and is one of the main reasons our profession has been taken over by the big business interests.

Trying to find the courage to be the next to transition: There is one other doctor in my community who has given up insurance and switched to a Concierge practice. In speaking with him, so far he is very happy, and he feels that he has his patients respect.

Respect: Whether other physicians approve or disapprove of my transition, I have earned their respect for making a bold move.
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My feelings through the transition:

Excitement: It is exciting to start over again. Now I have not totally started over as about 40-50% of my patients have remained in my practice. But it feels good for the ego when you find out that people do value your services and that you are not just another name in the insurance directory.

Pissed off at Insurance lies to patients: I get calls from patients who tell me that the insurance company will not cover testing if it is ordered by a non-participating doctor. Unless the patient is in a managed care setting, this is wrong and disingenuous on the part of the insurance industry. A good article on the above abuses can be found by following this link to an article entitled "The Health Insurance Mafia."

Fear: On the days when I see 6 patients instead of the 25 I would usually average, it can get depressing or fearful. But then the next day comes and I have 20 patients and the fear fades.

Boredom: What do I do with all the free time I have at the office when I am not seeing patients. Well so far, I have had all my paper charts scanned into electronic format, and all the paper and filing cabinets stored in a basement. I am cleaning out some exam rooms and decluttering the other office rooms. I am preparing to give some rooms a new look, new paint and more open airy feel. I have time to journal my thoughts on this transition by use of this blog, and also posting to SERMO, a physicians online community.

Like a doctor again: Imagine you are a primary doctor and you want to send a patient for some tests. You hand them a prescription and send them to your medical assistant who helps the patient schedule the test. No referrals needed. No time consuming bureaucratic waste, a happy patient who feels the office is truly helping them get through the maze of the healthcare system.
More time to spend with family and friends: The best part of the process so far. While I am a physician, I am first a husband, father, friend and neighbor.

Enjoyment of the challenge: Whenever I get bored, I look for a new challenge. I have found it. While my office is low in patient volume, it will increase within a few years, and I will look back on the boredom and wish I had some of it again.

More info on my office can be found on my website at http://www.drhorvitz.com/