Talk is cheap

How many docs hate giving away free advice?

Shouldn't there be a system that rewards us for this sidewalk chatter or elevator conference?

The issue is our present payment system. We make our living evaluating patients in our offices or hospital and then send a bill, not to our patient, but usually to a third party go between. We can wait for months to be paid for our services, and during the wait our frustrations mount. There must be a better way as it seems we are working for free!

So what do we do??

About 2 years ago I came to a crossroads in my practice. I was getting busier, and not being able to spend as much time with each patient as I liked. Even though I was busier, my revenues were stagnant, and my expenses were rising. Not a great situation for the future. I belonged to a multi-specialty IPA that was quickly disintegrating, as specialists withdrew to form single specialty organizations. Many family docs in the IPA got together to see if we too, could convert to a single specialty of our own. The thinking was that if we got enough members, we would have the clout to battle the insurers for better contracts.

At the same time I was approached by a practice management company that offered to convert my office to a concierge retainer style practice. I went through the process of sending out surveys and was very close to joining this company. However the lack of being 100% in control of my own destiny made me decline the offer.

I decided to remain independent, because as I like to say, "I don't play well with others." But remaining independent was a guarantee for continued decreasing revenues , or I would have to see a greater volume of patient's. To me, that would be selling out my values for income. Many of the primary docs in the IPA joined another IPA that already had clout with the insurers. At this time, they are doing well financially, however with the possible changes in our healthcare system, I do not know if that model will be sustainable.

So I chose to terminate from third party contracts other than traditional medicare. I focused in the first year on retaining as many patient's as possible within a reduced self-pay fee and also the introduction of wellness and retainer plan options. I survived the first year. Percentage numbers have been previously reported on this blog. Now it is year two, and my focus is on retaining my first year patient's while starting to market to new. I have merged the wellness plan with the retainer option, so now I offer medicare, selfpay and retainer- with a monthly payment option. The retainer with monthly payment option has been popular so far, as there is no copay per visit. This has attracted many patient's with HSA's, FSA's and also the uninsured.

So what does this have to do with free advice. As more of my patient's transition into my retainer option, there is no such thing as free advice. As 2 minutes on the phone may negate a 20-30 minute office visit, and as I am being paid to be available, not per office visit, sidewalk chats are welcome.

It is nice to be able to help my patient's without worrying about getting paid, and without any third party in my mind. I am free to be a physician again!!

DoctorSH