Fam Pract Manag. 2009 Sep-Oct;16(5):31.

Give cash-paying patients some cash back

I have a lot of cash-paying patients, and I reward them for taking good care of themselves by charging them less when appropriate. If I can see them for a five- or 10-minute visit to manage their refills instead of a 20-minute visit to explain that they should exercise and diet to better manage their blood sugar and blood pressure levels, it saves me time, and I pass the savings on to them.

I usually discount these patients' visits by 20 percent to 25 percent. I also have a generic pharmacy in-house, so sometimes I give them three months of their medications for free, which can be worth about the same amount as the visit discount. I tell cash-paying patients about the incentive at their initial visit. They seem to appreciate it, and it is amazing how money works as a motivator.

Dress up your ceiling lights

Our office installed decorative fluorescent light diffusers over our ceiling fixtures. The screens have images of blue skies with billowy clouds, colorful butterflies and hot air balloons that help create a more relaxing atmosphere in our exam rooms. We purchased ours online at; they are available from other companies as well. Patients give us positive feedback on them almost daily, and they look so much more professional than pictures tacked to the ceiling!

Calculating average work RVUs for family physicians


Do you know how many relative value units (RVUs) a family physician might expect to generate without obstetrics, assuming the physician sees 20 patients a day in the office?


The Medical Group Management Association (MGMA) collects specialty-specific RVU data as part of its annual Physician Compensation and Production Survey. According to the 2008 survey, which reports 2007 data, family physicians generate 4,600 median work RVUs without obstetrics. (Work RVUs are numbers assigned to services that establish the differing amounts of physician work associated with them.)

The typical office visit for a family physician is represented by CPT code 99213. The work RVUs for that code in 2009 are 0.92. Based on this number, at 20 visits per day a family physician might be expected to generate 18.4 work RVUs per day, on average.

Think like an athlete when assessing injuries

When seeing an athlete for an injury, it is important to find out what stage of the season he or she is in (e.g., preseason conditioning, in season, or postseason playoffs). Acknowledging the patient's performance concerns provides comfort, makes it easier to take an accurate history and fosters confidence in and compliance with the treatment plan. For example, if I see a high school football player in the summer for a wrist injury, I identify how this will impact his off-season conditioning and weight training, and we talk about the prognosis relative to the schedule for fall contact practices. If I see a female cross-country runner for a mid-season ankle injury, I begin by recognizing where she is in her season and discussing her injury recovery and participation goals.

This approach also generates new visits by these patients' teammates, which adds to our bottom line.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2009 by the American Academy of Family Physicians.
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