Doctor's Office Economics '" Solo Practice in 2010

There seems to be a disconnect in today's world as to what people want to pay for certain things and what they actually cost. As a physician running my own practice, I see this problem all the time. I pay all the bills, and have staff that has to try to collect the money from our patients and insurance companies. I think most people don't really know where the money they pay at the doctor's office really goes.

Costs

Patients often pay only a small amount or "co-pay" at the time they come to the office. This is usually less than $20.00. It is amazing to me how many times people will "forget" to bring their money. It costs a significant amount of money to send a bill or collect money after someone leaves the office. Many people do not pay at all. Some offices add a "rebill" fee onto the bill if they have to send one to help defray the cost of billing. If we have to send an account to collections, we lose at least one third of the money collected.

Medical supplies have become more and more expensive over the years. Most of the time, we do not charge extra for the supplies that are used during your visits. But the supplies for that suturing that was done in the office have increased far faster than the charge for it. In the hospital, they are allowed to charge for each item they use. We are not allowed to do the same thing in the office. The reason you see less and less doctors doing vaccines in their offices is because they are actually losing money on the vaccines if they submit them to your insurance company. Fortunately there are federal and state programs to cover vaccines, but you often have to go to your local health department and sit and wait to get your shots.

Fees

People seem to think that they can call and get answers or advice for free. Can you call your lawyer and get any advice without getting billed by the minute for your phone call? Your doctor has at least as much education and experience, and is paying the same number of staff members etc., but we have been told that anything we do over the phone is "not reimbursable". So you will be told to come to the office or go to the emergency room. Besides, we can get sued by that same lawyer for any advice we give over the phone!

People don't understand why we charge a "no show fee". In my practice, we do not "double book". Out of respect for our patient's time, and because I spend a good bit of time with each patient, I book a single patient for each time "slot". When one patient does not come in, I do not have another patent to "fill" that time. So there is no money coming in to pay for staff, rent, etc for that period of time. If you didn't have the courtesy to call us so we could at least try to find someone else to fill your time, that time is wasted from our standpoint. Some practices make people wait and book extra to fill their time slots, others take walk in patients only. So, if you want a doctor that sets aside time just for you, you will pay for it if you don't come.

To look at some other fees you may expect to pay for as the time for certain interactions with the insurance companies, pharmacies, etc becomes longer, check out this article: http://www.associatedcontent.com/article/5637318/new_doctors_offices_fees.html?cat=5

Insurance

If I bill your insurance, I have to submit the bill over the internet. I pay a monthly fee for the internet. I pay a monthly fee to the "clearinghouse" that checks the bills and then sends them to the insurance companies. I also pay a fee for each individual claim. If I don't submit over the internet, I have to buy special forms (printed in red) to type the information on and submit in special envelopes, plus pay postage for each claim. Either way, it's costly to submit insurance claims. The doctor's offices have been absorbing this cost for years.

Insurance companies may "lose" claims or deny them. Then my staff has to spend time on the phone trying to find out what the problem is. This costs me money for staff time and phone. I may have to resubmit the bill, which means I have to wait another four to eight weeks for my money. Meanwhile, the expenses on my end continue. We have stopped participating with many insurance companies for office visits because of the poor payment policies and incredible delay that insurance companies routinely place on any payment.

In the last year, Medicare has stopped payments several times while the government has decided whether or not to cut our payments. At this point the "adjustment" to Medicare is over 20% of what they are currently paying. This will go into effect December 1, 2010 unless Congress stops it again. Medicare already pays less than other insurances. Many doctors do not accept new patients, and more and more are dropping the program altogether.

Business Expenses

If I accept credit cards, I have to buy a machine or pay a monthly rental. I have a monthly fee to the credit card people plus a percentage fee of each transaction. This option often gets my money from people who "forgot" their checkbooks, though.

Business telephone rates are several times that of residential rates. This is especially true if your doctor has more than one phone line. Most offices do, so that they can have a fax, internet, and several lines for incoming and outgoing calls. Phone bills alone can run thousands of dollars for a busy practice.

The bills I pay every month include rent, electricity and any other utilities, internet, the company that transmits our bills over the internet, insurance for my staff, salaries for the staff, taxes on staff salaries, unemployment, workman's compensation, advertising, equipment and supplies, maintenance on any equipment that belongs to me, postage, paper, ink, printing, extra taxes because I have a medical practice, and the list goes on and on. There are fees to belong to professional organizations. I have to admit that I have limited those to the few that are very important to me. When I'm done with office stuff, I start paying the bills at home.

So What?

What is the doctor supposed to do? I still have three teenagers who want to eat. They want to do stuff at school. I have a house to maintain. Thank goodness I am an "old fart" who bought my house a long time ago and has it paid off. Younger doctors have house payments and loans from medical school. Many doctors leave medical school with over $200,000 in debt. I drive an old car, worry about how I'm going to buy all the same things you worry about - shoes for the size 14 feet, pants for the kids who's legs keep growing, school supplies, etc.

What I take home shrinks every time something else goes up or an insurance company decides to pay less. So I have to decide when to say "when". So does every other doctor. If you find out your doctor doesn't take your insurance anymore, think about everything you have read in this article. Remember that we are people with lives and expenses, too. Most of us are just trying to keep things going and give you the kind of care we think you deserve.

I work hard at keeping my expenses down. Please help me and my fellow doctors by bringing in your copayments. Help us deal with your insurance companies. They respond better to you than to us. Be active in your health care so we can keep your costs down as much as possible. Try to remember everything you need while you are at the office to minimize calls later.

We know that the economy is difficult and patients are having a tough time. But doctors are people, too, and we are having just as much trouble as you are.