TPBG- Third Party Bypass Grafts- The time has come!!!!
It is time to take Washington out of the equation.
Here is an analogy: Lets just perform a CABG on our present healthcare system, but change the name to TPBG, Third Party Bypass Graft. Leave the diseased portions in place, and just bypass them. The diseased portion will soon cease to function.
Make a route around the diseased portion that is wide open for better patient care and less regulations. Our patients will start moving to the wide open patent system very quickly when they see the medical care is better, easier, and in most cases less expensive.
The past twenty years, we have been trying to treat our present system medically, and all that has happened is that it has gotten sicker. Those that wish to continue to try to treat the problems with letters to Washington, or negotiating contracts with third parties will just be swept up into the diseased portion or evil atherosclerotic plaque. We do not have a pill that will reverse this plaque and defeat the third parties other than to decide to make them irrelevant.
We are overdue for a TPBG. I for one have bypassed the system and am very happy, and will be even happier next year as my practice continues to grow. Ever since my TPBG, I have more time for my patients and my family, and no longer have the morbidity associated with all the third party nonsense. And the beauty of it is, I did not need a knife or a hospital stay for my TPBG. All I needed was a pen and a stamp. I wrote a letter to terminate my third party contracts, put postage on the letter, and sent it away. No morbidity, no referrals, no billing staff, less office staff, and more time to spend with the patients to give better care.
Its like I always hoped I would practice my profession!
Wednesday, July 16, 2008
Monday, July 7, 2008
1ST 6 month transition to cash practice
January-June 2008 transition to Cash Only + Medicare Solo physician, suburban practice, large HMO penetration. Conversion to cash practice, Medicare, Selfpay 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. April-June had Medicare secondary insurance money only, otherwise all revenues were direct from patients.
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Comparisons given below are percentages comparing Jan-June 2008 to January-June 2007.
Patient Volume decreased by 41%.
New patients seen decreased by 55%
$ per patient seen Increased by 69%
Revenues remained the same. The revenues dipped in the second quarter. This is due to the majority of my established patients joining my Wellness programs in the first quarter.
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More Analysis:
$ per patient visit for 1st quarter 2007 was $64.43
$ per patient visit for 1st quarter 2008 was $108.00.
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 in patient visits is as follows:
Selfpay 48%
Wellness 23%
Medicare 20%
Old Insurance-Ancillary 7% and dropping
Retainer 2%
The breakdown in % revenues per patient visits is as follows:
Wellness 33%
Selfpay 33%
Old Insurance-Ancillary 21% and dropping
Medicare 11%
Retainer 2%
$ per patient visit is as follows:
Wellness $165.00
Retainer $158.00
Selfpay $87.00
Medicare $61.00
- ------------------------------------------------------------------------------------------------
Further analysis:
Wellness Plan: A good percentage of revenues came in from Wellness Plan fees, which is upfront money. This skewed the numbers higher at the beginning of the year. The numbers, averaging $165 per patient visit, are now coming into the range that I expected and are still almost double the average of selfpay patients. 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. I am also looking into a monthly payment plan for the Wellness program, which would run between $25-30 a month, instead of a lump sum upfront. This would help with patient budgeting and allow marketing to small businesses. A physician who has already made this system work can be found by clicking here.
Selfpay: averaging $87 per visit. That is $23 more per visit than I received last year, or a relative increase of 35%. 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 $61 per visit: This is low as it includes office visits for venipuncture, B12 injections etc. 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. With Medicare payments from the government expected to drop, continued participation in Medicare is not guaranteed.
Retainer: averaging $158 per visit. This is 45% better than selfpay, but only a small percentage of my practice. As with the Wellness Plan I may allow a monthly or quarterly payment plan. It is really nice to see a retainer patient and know that I can be a doctor and not worry about what everything costs in relation to their treatment.
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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 receive. They can get appointments same day. We have time to help them coordinate their care with specialists. All things that were difficult or impossible in the old-insurance driven model.
------------------------------------------------------------------------------------------------
Other Good Effects:
Expenses have gone down.
My medical billing expenses have been slashed by at least 50%.
I have eliminated one medical assistant during my day hours, and went from two to one medical assistants during evening hours. My payroll expenses have been slashed by about 30%.
My supply costs have also decreased by 20%.
I have spent more on marketing the new practice style, but overall my expenses are down about 12% compared to 2007.
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. Hopefully the addition of a monthly or quarterly payment option along with the results of marketing my practice will continue the successful transition.
-------------------------------------------------------------------------------------------------
Comparisons given below are percentages comparing Jan-June 2008 to January-June 2007.
Patient Volume decreased by 41%.
New patients seen decreased by 55%
$ per patient seen Increased by 69%
Revenues remained the same. The revenues dipped in the second quarter. This is due to the majority of my established patients joining my Wellness programs in the first quarter.
------------------------------------------------------------------------------------------------
More Analysis:
$ per patient visit for 1st quarter 2007 was $64.43
$ per patient visit for 1st quarter 2008 was $108.00.
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 in patient visits is as follows:
Selfpay 48%
Wellness 23%
Medicare 20%
Old Insurance-Ancillary 7% and dropping
Retainer 2%
The breakdown in % revenues per patient visits is as follows:
Wellness 33%
Selfpay 33%
Old Insurance-Ancillary 21% and dropping
Medicare 11%
Retainer 2%
$ per patient visit is as follows:
Wellness $165.00
Retainer $158.00
Selfpay $87.00
Medicare $61.00
- ------------------------------------------------------------------------------------------------
Further analysis:
Wellness Plan: A good percentage of revenues came in from Wellness Plan fees, which is upfront money. This skewed the numbers higher at the beginning of the year. The numbers, averaging $165 per patient visit, are now coming into the range that I expected and are still almost double the average of selfpay patients. 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. I am also looking into a monthly payment plan for the Wellness program, which would run between $25-30 a month, instead of a lump sum upfront. This would help with patient budgeting and allow marketing to small businesses. A physician who has already made this system work can be found by clicking here.
Selfpay: averaging $87 per visit. That is $23 more per visit than I received last year, or a relative increase of 35%. 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 $61 per visit: This is low as it includes office visits for venipuncture, B12 injections etc. 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. With Medicare payments from the government expected to drop, continued participation in Medicare is not guaranteed.
Retainer: averaging $158 per visit. This is 45% better than selfpay, but only a small percentage of my practice. As with the Wellness Plan I may allow a monthly or quarterly payment plan. It is really nice to see a retainer patient and know that I can be a doctor and not worry about what everything costs in relation to their treatment.
-----------------------------------------------------------------------------------------------
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 receive. They can get appointments same day. We have time to help them coordinate their care with specialists. All things that were difficult or impossible in the old-insurance driven model.
------------------------------------------------------------------------------------------------
Other Good Effects:
Expenses have gone down.
My medical billing expenses have been slashed by at least 50%.
I have eliminated one medical assistant during my day hours, and went from two to one medical assistants during evening hours. My payroll expenses have been slashed by about 30%.
My supply costs have also decreased by 20%.
I have spent more on marketing the new practice style, but overall my expenses are down about 12% compared to 2007.
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. Hopefully the addition of a monthly or quarterly payment option along with the results of marketing my practice will continue the successful transition.
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