| Converting to Cash Only Practice? |
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Originally Posted by J Tate, MD  After 20 years of accepting all forms of health insurance, about 2 years ago I got out of all insurance networks and quit Medicare and Medicaid. I was scared to death to do it, but I was slowing going broke trying to collect from insurance institutions. Something had to change. My patients now pay full-fee at time of visit: no billings, no receivables. We give patients a HCFA form they can mail to their insurance company for any out-of-network reimbursement. Medicare patients sign my "opt-out" contract, pay my full fee and don't file a claim. I do no "treatment plan" paperwork; call no insurance companies to report progress or to get approval for a couple of more patient visits. I'm making as much money as ever, seeing about 65% as many patients as I use to. I have the time to truly work to help the patient in every way I can during our visit--not just focus on the chief complaint and try to get out of the room without being bogged down in other issues. Now addressing those "other issues" fully and completely is part of the superior clinical care that keeps patients willing to pay out-of-pocket to see me. With the need to offer more and better service in order to retain patients, I've been motivated to expand my clinical skills to include treating headaches, obesity, and even mild hypertension in addition to mainstream psychiatric disorders. I've been motivated to improve "customer" service: quicker appointments with less time in the waiting room; easy access to me via e-mail or telephone; more and more educational materials for patients, written by me; a very pleasant staff and office environment; proactive follow-up with patients after their appointment. I'm the first physician in my area to take this track, but I'm not the first in the US. The self-pay "boutique clinic" movement began a few years ago and it's growing. I know there's been disagreement about the ethics of this movement, but I say that each of us is morally entitled to an emotionally non-toxic work environment in which we can practice our craft in the best way we know. We're also entitled to be fairly compensated. Of course, each of us is free to work pro bono (or reduced-fee) hours as we see fit. My current style of practice allows me to do my very best with each patient at each appointment. It gives the patient the very best experience and outcome. It allows me to look forward to going to the office. It motivates me to study to tirelessly get better in every aspect of my practice. To take this step, you've got to be able to "differentiate" yourself in the public's mind as worth the extra cost. You've got to learn basic business skills in clinic operation, customer service, and marketing. Business is not a four letter word; it's a set of skills that you can use for good or ill. I think physicians as a group are too pessimistic about the public's willingness to pay out-of-pocket for medical services. How often do you hear complaints from the public about long waiting times to get an appointment, long waits at the office to see the doctor, too-brief visits with the doctor, superficial prescriptions that don't really address the problem? Having to go from doctor to doctor to get effective treatment for a single problem? A lot. People don't buy the cheapest car. They don't buy the cheapest clothes. They don't buy the cheapest house. Brand-name OTCs sell well even sitting right next to the generic with the same ingredients clearly printed on the package. People spend to get what they perceive to be the best "value to price" ratio. It's up to the physician to establish in the public's mind--and certainly in patients' minds--his or her increased value; the public will then gladly pay an increased price. My advice to young physicians: plan to be among the top physicians in clinical excellence; make the effort to learn how to run a successful small business in a capitalistic and globalized society. Take the chance to set yourself free from the shackles of health insurance hassles and constraints. I only wish I'd done it years ago. Oh, yes, we cancelled all insurance company contracts. It was the insurance companies that had the hardest time. One even said that the contract could never be cancelled! I had to find my old contract and quote the termination paragraph to the insurance company. But overall, it wasn't hard. By the way, as part of the move to opt-out from all insurance, I began offering a 100% patient satisfaction money-back guarantee. I got the idea from a book on how to market professional services. The guarantee was scary to offer at first. But just like the book said, it has worked out well. It is a strong point of differentiation in my marketing. It keeps all of us at the clinic very focused on "customer" satisfaction; it keeps complaints coming to me rather than to my state medical board. I've only had one patient abuse it; I refunded her about $600 even though it was clearly unwarranted. That's been a small price to pay for the benefits of offering that guarantee. |
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