Like most pediatric practices, Somerset Pediatric Group, with five offices in northern New Jersey, has watched reimbursements decline while nonclinical services have escalated.
Faced with a mountain of paperwork for its patients, the practice finally succumbed to a prevailing trend in pediatrics: charging parents for services that insurance companies are unwilling to cover.
“It came about because the schools instituted so many forms,” says Holly Parlavecchio, the group’s chief administrative officer and the chairperson of the New Jersey Pediatric Society Practice Managers. “The increasing number of forms was astronomical. They weren’t coming in [only] at the time of the visit; they were continuous.”
Somerset Pediatric Group isn’t alone. More and more pediatric practices are charging for supplemental services, yet many practices resist these administrative charges because they are worried about ethical or legal considerations. If you’re already charging patients or if you’re just considering putting new financial policies into place, make sure you understand your practice’s rights and obligations.
Is it the right thing to do?
Is it OK to make money off nonclinical services? Many practices ask themselves this question; they wonder if it’s unfair. If that’s how you are thinking, you might be approaching the problem from the wrong angle.
“In pediatrics, there isn’t a whole massive list of additional things you can do or ancillary revenue sources that you can apply,” says Chip Hart, director of pediatric solutions at Physician’s Computer Company, which provides pediatric-specific practice management software.
“It’s not like adult medicine, which has really exploded with that.” Hart has worked in pediatric practice management for 20 years and is the author of the blog Confessions of a Pediatric Practice Management Consultant.
Pediatric practices are less concerned about finding new revenue sources, as is often the case when a group charges patients directly for a new service, as they are with simply being reimbursed for the extra time they’re spending on activities demanded by schools, clubs, camps, and sports teams. “What you’ve seen over the last five or 10 years is a real growth in the amount of administrative overhead pediatric practices are expected to provide with no extra reimbursement to pay for it,” Hart explains. “In the good old days, you came into the office, you paid your cash, and you left. Now you can have a patient whom you have never even see that you have to do three or four hours of paperwork and phone time for — and then you never get reimbursed.”
Nearly every pediatrician has been in the situation where a mother calls to discuss medications but then proceeds to ask questions about bedwetting and immunizations and anything else that’s on her mind. Physicians and nurses spend a lot of time answering such calls, but how often do those calls get billed? Very rarely.
In the past, pediatric practices were expected to provide those services for free and recognize it as one of the costs of doing business. But it’s gotten to be too much. It’s not a nuisance — it’s a huge, uncompensated expense.
Don’t think so? Consider: If you have an average patient population of 5,000 children, each of whom needs at least one form filled out, one phone consult during office hours, and one prescription refill, it’s easy to put a number on the amount of billable hours you are losing in a year. Now think about the number of patients who miss appointments.
Still feel like it’s unfair to put a price on your practice’s time?
Stop drowning in paperwork
Of all the areas where pediatric practices are hit hardest, paperwork ranks as the first. The sheer number of forms received is staggering. Ten years ago a practice could expect the occasional physical form, no more than a page or two long; now the list of forms you receive could be longer than the patient’s actual medical history.
Catawba Pediatric Associates in Hickory, N.C., found themselves awash in forms. “We get camp forms, daycare forms, insurance forms,” says Debbie Cashion, practice administrator since 1981 and past chair of the North Carolina Pediatric Society Practice Managers.
Catawba Pediatric finally instituted a simple policy of $10 per form. “We’re charging for forms if they don’t bring it when they come for their actual sports physical or checkup,” explains Cashion. “If they bring it in at the time of their checkup, we do fill it out and don’t charge.”
Somerset Pediatric charges even less — only $5 per form — but builds in an incentive for parents, by filling out any number of forms for free — no matter how many — if the parent brings them in on the day of the patient’s routine exam. Says Parlavecchio, “If the doctor is in the room with you, they have the chart open, they have the paperwork out, and will fill out anything you want. After that if you bring in a form it is a $5 charge. That’s for every form after or before your routine physical.”
