Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting two articles on cutting costs at a pediatric micro practice and price transparency for medical procedures, written by Gabriel Perna, Terrence Redmond McAllister, MD, and Leann DiDomenico McAllister. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.
CUTTING COSTS TO STAY AFLOAT
The current healthcare market is testing our personal ethics. Our income is down significantly, and when we evaluate the reasons and what can be done about it, we don't like our options …
Our financial outlook for 2016, so far, looks much better than 2015. To make up for the loss of revenue, we chose to cut costs and won't be replacing a nurse practitioner who left us last year. This change significantly reduces our expenses and has a relatively small impact on patient care For example: longer wait times for returned phone calls and no more Saturday appointments. Of course, with our fixed expenses growing constantly (EHR costs and our own healthcare premiums in particular), who knows for how long we can offset lower revenue by just cutting costs. So tell us, besides turning our backs on low-income families or charging concierge prices, what else can we do? What have you done? Have you sold your soul for decent income or are you sacrificing your financial stability for your ethics?
… Just based on what you have indicated you will come up better by eschewing Medicaid, and going "nonpar." In the event of Medicare for all, the affluenza patients you cite will end up paying you less and will result in you working for them in a capitated environment where the frequency of these visits will increase with no significant payment to you for those services.
Since you seem to have a busy practice, you can take the risk of being bold and kind to your patients at the same time. Declare your practice a no insurance zone / physician-only practice. Have three or four evening hours from 5 p.m. to 10 p.m. to accommodate parents who work. Charge more (about 30 percent to 50 percent more) for evening services. Post your visit fees based on what you know is a reasonable amount. Exclude immunization from the basic fee. Figure a visit fee including immunization for the 1-year-old to 5-year-old age group that get the most-expensive vaccines. Reduce practice overhead and staffing levels to reflect the decreased volume.