Chris Francis sounds a little frustrated.

“Most people are not really prepared to meet their coinsurance or deductible amount,” he says, but “when we give people the option of rescheduling their procedure,” rather than proceeding without payment, many will find a way to pay. “A lot of people are trying to test the system.”

Waco Surgical Group, where Francis is the administrator, has considered charging interest on overdue accounts or even taking patients to small claims court to collect large, overdue accounts — and to release a little steam. In the end, though, it hasn’t yet adopted these more punitive measures, opting instead to work with patients one on one to find solutions. The group feels like it needs to balance service against more aggressive collection tactics.

“In a smaller market like Waco, we are the largest surgical practice. We want to be available to everyone we can possibly be available to,” says Francis.

The Texas practice isn’t the only one struggling with the impact of consumer-directed plans. As overdue patient accounts stack up, more physicians feel like they’re playing the patsy. And there’s a temptation to retaliate with interest fees, court dates, or other hardball tactics. Why shouldn’t patients pay up?

Whether patients pay, says consultant Judy Capko, “doesn’t have much to do with their own expendable income; it’s an attitude.”

How frustrating.

But hold up.

Before you respond emotionally, tighten up your collection processes. If there are fewer outstanding accounts, there’s less aggravation.

If you do decide to get tough, be sure you understand the best options.

Start with sound collections

“Doctors are the worst business people when it comes to getting their money. They’ll send out the same bill five times,” complains Gregory Mertz, a consultant with The Horizon Group in Virginia Beach.

Patients don’t pay because they figure that no one really expects them to.

Mertz worked with a large family practice in Memphis that would send out statement after statement to patients and never collect.

He had the practice set a firm policy, communicated clearly to patients in advance, to send out two statements then pass all patient accounts to collections. “Word got out,” says Mertz, and the practice started getting paid. “If you follow your policy, if you stick to the fact that if you don’t pay me I’m going to send you to collections, that is as effective as using late charges or interest and you don’t run as big a risk of upsetting patients.”