 October 2002 • Volume 8 • Number 10 |
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How are you coping in today's trying economic climate? This recent e-mail query to several AAFP members sparked some serious venting that included these comments:
Sound familiar? Perhaps you or your colleagues have had the same troubling thoughts. Read on to see how some FPs have tweaked their practices to keep their books in the black and their spirits high.
Encourage cash at time of service
Michael Jaczko, D.O., of Carlton, Ore., opened a solo practice in this rural community in 1998. "My first year into practice, I was getting crushed by insurance plans," he said. Then three years ago, Jaczko embraced a plan called SimpleCare. Patients who pay cash at the time of service save about half, said Jaczko. An estimated 20 percent of Jaczko's 2,500 patients pay a yearly fee of $25 per person or $35 per family (to SimpleCare) to become a part of an association of patients and providers. (Go to http://www.simplecare.com to read more about SimpleCare.)
By combining SimpleCare with a catastrophic health insurance policy that has a high deductible, patients are finding health care more affordable, said Jaczko. "Many of my patients with insurance opt for SimpleCare for office visits, procedures and tests." Jaczko also charges for office visits in 15-minute increments, so patients can have as much of his time as they want.
"The community has embraced it -- I have patients opting for this payment plan every day," Jaczko said. He has better cash flow and fewer insurance hassles, including less need to find a code to justify every service he provides. "Under the SimpleCare plan, I don't use any codes -- I just write down 'depression' or whatever the patient comes in with," he said. Jaczko is so impressed with this model of care that he wants to push it on a state and national scale.
Add "medispa"
Eric Dohner, M.D., of Walton, N.Y., supplements his solo practice with a cash-only cosmetic practice and "medispa." His 1,900-square-foot satellite location has been open 15 months, said Dohner, and "revenues have exceeded expenses from the second month."
Dohner offers treatments including massage therapy, laser therapy, microdermabrasion, sclerotherapy and spa treatments.
He spends every Tuesday afternoon and every other Friday afternoon at his secondary practice. "This decision was half economic and half professional satisfaction," said Dohner. "The patients love the practice, and we are growing every month; I've had a lot of support and referrals from the medical community."
Revisit house calls
Thinking about adding house calls?Try these tips from George Taler, M.D., (see story above) for making house calls profitable.
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Another way to win community support and help reduce office overhead costs is to add house calls to your practice menu.
Constance Row, executive director of the American Academy of Home Care Physicians, said her organization has 718 members in 40 states -- and she predicts the numbers will increase.
"I can say the number of inquiries has certainly risen," said Row, who used to field about one call a month and now gets several each week. "Physicians see it as a way of coping with overhead and meeting a public need." Row often hears from physicians about the frustrations of managed care. "Doctors see this as the kind of doctor they wanted to be in the beginning," said Row.
But can adding house calls to a practice also make it profitable? Absolutely, said FP George Taler, M.D., of Washington, D.C., whose three-physician practice currently serves about 270 homebound patients. "But you have to provide an organized structure to make it efficient and financially viable." (See information box.)
When you see complex patients in a venue with less overhead, you can spend more time with the patient and reduce disruption and reimbursement losses in the office, said Taler.
"Our practice is in the black now," he said, "but we were supported by our hospital for the first two and a half years before we became self-sufficient."
The key to making the enterprise profitable is learning to maximize income through sources of revenue that are open only to homebound patients. For instance, said Taler, about one-third of these patients receive skilled nursing services through a home health agency; there are billing codes that, before geographic adjustments, pay $60 to $70 for certifying and recertifying these referrals.
Many of those same patients need care plan oversight, said Taler. Each calendar month, document at least 30 minutes of time spent organizing the patient's care with other health professionals, and that time is reimbursable for up to $130 a month, depending on your Medicare locale, he said.
Update your procedural skills as well, said Taler. "Keep in mind that Medicare is all about procedures." He gives injectables for cancer patients and provides wound care, debridements, and gastrostomy and tracheostomy tube changes for his homebound patients. "Your patients are grateful, these are not difficult techniques and they reimburse well," said Taler.
Homebound patients also have a very high rate of hospitalization, so if you want to maintain hospital privileges, "this is a source of potential patients," Taler said.
Most gratifying to Taler is the knowledge that there's great need for physicians providing home care. "We can have a tremendous impact on the ability of people to live a good life by going to their homes," he said.
Editor's note: To learn about another practice concept that includes house calls and reduces practice overhead -- the "circle of care" concept -- see the September FP Report at http://www.aafp.org/fpr/20020900/5.html and the September/October Family Practice Management at http://www.aafp.org/fpm/20020900/29ajob.html.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.