December 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.
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Comparisons given below are percentages comparing Jan-Dec 2007 to January-Dec 2008.
Patient Volume decreased by 43%.
New patients seen decreased by 49%
$ per patient seen Increased by 18%
Revenues decreased by 30%.
Expenses decreased by 20%.
In 2008, my practice had multiple payment options for patients.
These range from Selfpay, to Medicare, to Wellness and Retainer options.
The breakdown in patient visits is as follows:
Selfpay 50%
Wellness/Retainer 25%
Medicare/Insurers 25%
The breakdown in % revenues per patient class is as follows:
Selfpay 50%
Welness/Retainer 32.5%
Medicare/Insurers 17.5%
$ per patient visit is as follows:
Selfpay $83
Wellness/Retainer $104
Medicare $61
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Analysis:
Wellness Plan:
Averaged out to $104 per patient visit, 41% higher then Medicare, and 20% higher than selfpay. A good percentage of revenues came in from Wellness Plan fees, which is upfront money. In 2008 most plans were $200-300 upfront with $25 copays per visit. As many patients joined early in the year, the numbers were higher in the first quarter. To level out the revenues for 2009, I have started a monthly payment plan through Bank-ACH. This would help with patient budgeting and allow marketing to small businesses, and individuals with FSA's, HSA's and high deductible insurance plans. I am combining the Wellness and Retainer options for 2009. Info on this option can be found on my website. My job for 09 is to market my office to new Wellness patients throughout the year, whereas in 08 I only marketed within my practice. The new Wellness Plans will have no copay, but a higher upfront cost. This will save time at check-in and check-out by between 5-10 minutes per patient. Multiply that by 15 patients and that is 1-2 hours a day of time saved from paperwork, and instead used for patient care.Selfpay: averaging $83 per visit, lower than Wellness Plans, but 26% higher than Medicare. It is $19 more per visit than I received last year, or a relative increase of 23%. I have more time open in my schedule to fit in these patients, as I am not seeing the $10 copays or capitated patients. I hired a new part-time medical assistant who also works at an HMO dominated office. She is amazed that my patient's expect to pay for my services. At the HMO-dominated office, the patient's often get nasty and refuse to pay their copays. I have found that HMO patient's value their doctor's office by the cost of the copay. The lower the copay, the less value they place on their care, and the more entitled they become. 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 $75 per visit, it is still much lower than the selfpay, and a pittance compared to Wellness Plans. With Medicare payments from the government expected to drop, continued participation in Medicare is not guaranteed.
--------------------------------------------------------------------------------------------Other Good Effects:
Expenses have gone way down.
Overall expenses are down 20%.
My medical billing expenses have been slashed 66%.
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 33%.My supply costs have also decreased by 33%.
--------------------------------------------------------------------------------------------
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, 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.
My goal is to get to about 1000 active patients in my practice, instead of the average of 2500 in my community. If I can get 50% and up in the wellness 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.
Saturday, January 10, 2009
Wednesday, July 16, 2008
TPBG- Third Party Bypass Grafts- The time has come!!!!
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!
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!
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.
-------------------------------------------------------------------------------------------------
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.
-------------------------------------------------------------------------------------------------
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.
Thursday, June 12, 2008
Medisave: A Blend of Government funded healthcare in a privately controlled fund
Medisave: A Blend of Government funded healthcare in a privately controlled fund
Much of today’s debate about healthcare reform revolves around two distinctly differing viewpoints. On one side we have the call for a government takeover of the present system, with new insurance mandates, continued insurance management and regulation, and higher taxes. On the other side we have the call for an end to government regulation, an opening up of the free market, and the end of the insurance industry's undue authority and oppressive control over healthcare processes, without any new taxes.
Is there a way to bring the two sides together?
Let’s look at some numbers:
Estimated population of the United States is 300 million.
Estimated direct government contribution to healthcare spending in 840 billion dollars.
That is about $2,800 a year per person.
Is there a way to spend that money more efficiently?
Here is my proposal:
Individually owned Medisave accounts for all United States citizens from birth.
With no added taxes from the government, the $2,800 can be used to purchase a catastrophic high deductible insurance policy that would also cover the first $500-1,000 per year of preventive coverage for well exams, Pap smears, childhood vaccines, etc.
These Medisave accounts would be individually owned and controlled and could be managed by banks or other brokerage service centers. To cover the costs of the deductible, patients and employers could voluntarily contribute to the accounts. For the unemployed, there could be more charity care and other tax deductible accounts set up. Means testing would also be on the table for those truly in need. Any money remaining in the Medisave accounts at the end of the year would roll over for the following year.
Hopefully money would be saved in these accounts to fully cover any future year deductible. Family members can use a portion of their excess Medisave dollars for other family members or for charity to others in need.
The Medisave accounts would be paid for by the same taxes present today. However these monies would need to be separated from the government’s general fund to avoid having any of the funds spent on other programs. With the accounts controlled by individuals, it would bring an end to government lobbyists and special interests.
Tort reform would also need to be enacted to lower the costs of defensive medicine. A fair system is beyond the scope of this article.
Lets look at the positives of this plan:
1) Lowers employer costs greatly. Employees could get more in salary as a result. Also insurance is fully portable, and not dependent on employment, only upon citizenship. Non-citizens can buy into the plan at much lower costs than today’s insurance premiums.
2) Ends Medicare and Medicaid and all the government regulations and price controls and replaces them with individually controlled and owned policies.
3) No price controls. The free market would set the costs. Competition would open up and be fierce to increase innovation and decrease costs. Look at all the mini-clinics opening up as lower cost alternatives as an example of true free market competition.
4) Citizens can opt out of the plan, but what would be the advantage?
5) If individuals want to buy a Medigap policy for their deductibles, they may buy one on the open market.
6) Insurance companies would stay in business but would have to change they way they operate. They would no longer be in the business of healthcare, but back solely in the business of insurance.
This proposal would cover every United States Citizen and be funded by the government in the form of Medisave withholding deductions from paychecks. This would replace the Medicare withholding. The percentage needed can be calculated by a group of budget economists. It would be budget neutral as no new funds would be needed.
Medicare and Medicaid would end along with the regulations. Patients would have open access to any doctor or health care provider they choose in the free market. Payment would be direct from their Medisave accounts at the time of service or as agreed upon between patient and the doctor or provider. There would be no third party involved to increase costs or intrude upon the doctor-patient relationship. And most importantly, those with medical expertise and genuine interest in our patients' health will once again have absolute control.
Much of today’s debate about healthcare reform revolves around two distinctly differing viewpoints. On one side we have the call for a government takeover of the present system, with new insurance mandates, continued insurance management and regulation, and higher taxes. On the other side we have the call for an end to government regulation, an opening up of the free market, and the end of the insurance industry's undue authority and oppressive control over healthcare processes, without any new taxes.
Is there a way to bring the two sides together?
Let’s look at some numbers:
Estimated population of the United States is 300 million.
Estimated direct government contribution to healthcare spending in 840 billion dollars.
That is about $2,800 a year per person.
Is there a way to spend that money more efficiently?
Here is my proposal:
Individually owned Medisave accounts for all United States citizens from birth.
With no added taxes from the government, the $2,800 can be used to purchase a catastrophic high deductible insurance policy that would also cover the first $500-1,000 per year of preventive coverage for well exams, Pap smears, childhood vaccines, etc.
These Medisave accounts would be individually owned and controlled and could be managed by banks or other brokerage service centers. To cover the costs of the deductible, patients and employers could voluntarily contribute to the accounts. For the unemployed, there could be more charity care and other tax deductible accounts set up. Means testing would also be on the table for those truly in need. Any money remaining in the Medisave accounts at the end of the year would roll over for the following year.
Hopefully money would be saved in these accounts to fully cover any future year deductible. Family members can use a portion of their excess Medisave dollars for other family members or for charity to others in need.
The Medisave accounts would be paid for by the same taxes present today. However these monies would need to be separated from the government’s general fund to avoid having any of the funds spent on other programs. With the accounts controlled by individuals, it would bring an end to government lobbyists and special interests.
Tort reform would also need to be enacted to lower the costs of defensive medicine. A fair system is beyond the scope of this article.
Lets look at the positives of this plan:
1) Lowers employer costs greatly. Employees could get more in salary as a result. Also insurance is fully portable, and not dependent on employment, only upon citizenship. Non-citizens can buy into the plan at much lower costs than today’s insurance premiums.
2) Ends Medicare and Medicaid and all the government regulations and price controls and replaces them with individually controlled and owned policies.
3) No price controls. The free market would set the costs. Competition would open up and be fierce to increase innovation and decrease costs. Look at all the mini-clinics opening up as lower cost alternatives as an example of true free market competition.
4) Citizens can opt out of the plan, but what would be the advantage?
5) If individuals want to buy a Medigap policy for their deductibles, they may buy one on the open market.
6) Insurance companies would stay in business but would have to change they way they operate. They would no longer be in the business of healthcare, but back solely in the business of insurance.
This proposal would cover every United States Citizen and be funded by the government in the form of Medisave withholding deductions from paychecks. This would replace the Medicare withholding. The percentage needed can be calculated by a group of budget economists. It would be budget neutral as no new funds would be needed.
Medicare and Medicaid would end along with the regulations. Patients would have open access to any doctor or health care provider they choose in the free market. Payment would be direct from their Medisave accounts at the time of service or as agreed upon between patient and the doctor or provider. There would be no third party involved to increase costs or intrude upon the doctor-patient relationship. And most importantly, those with medical expertise and genuine interest in our patients' health will once again have absolute control.
Tuesday, June 3, 2008
An Open Letter from America's Physicians
Dr Steven Horvitz- Reading between the lines: Healthcare Information you can trust!
In the first half of 2008, I have been involved in a grass roots campaign with other doctor's across the nation whose goal is to reform the healthcare system and to restore the doctor-patient relationship to make healthcare once again affordable for all. Written below is a letter that I helped to create along with six other doctors. We are presently acquiring physician signatures so that we can present our thoughts on the problems that face our healthcare system and how we can best solve them.
We presently have over 3,200 physician signatures with more each and every day.
I ask for your opinions on healthcare today and on the letter as it is written. The physician community truly wants to partner with the American public to create and better system.
----------------------------------------------------------------------------------------------------------------
An Open Letter from America's Physicians
Dear Fellow Americans,
For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient well-being is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.
Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:
Dear Fellow Americans,
For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient well-being is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.
Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:
- You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks, and restrictive regulations limit your choice of doctors and your access to care.
- You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes.
- The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.
- The insurance industry's undue authority and oppressive control over healthcare processes
- Excessive and misguided government regulation
- The practice of defensive medicine in response to a harmful and costly legal environment
We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients' health have absolute control. This letter is merely a summary of the most important problems in our current system. We believe that by partnering with the public we can start to demand real change and formulate practical solutions.
We invite you, our patients, friends, neighbors, and employers to unite with us at this important time in the history of healthcare in the United States. Together, we can guarantee our nation a healthier tomorrow.
Please talk to your doctor about this letter and visit http://www.sermo.com/doctor... for more information.
Respectfully,
The Undersigned U.S. Physicians
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