Preparing for Reform’s New Patients

February 1, 2010

In the wake of a “reformed” healthcare system, here’s how to take steps now to get your practice ready for an influx of newly insured Americans.


One element of healthcare reform has remained constant throughout the months of congressional debate: Soon more Americans will have health insurance.

Even as the details - and some controversial elements - remained up in the air, each version of the legislation has sought to expand health coverage to at least 31 million more Americans.

That’s likely to have a huge impact on physicians. You can bet it will, sooner or later, mean an increase in your patient volume.

Although the debate in Washington has plodded on for many months, now is not the time for a wait-and-see approach. Instead, seize the opportunity to take a hard look at your practice operations. Taking steps to prepare your practice now will position you to take advantage of the changes.

“There’s no time like the present,” says Susanne Madden, president of consulting firm The Verden Group. “Even if you’re not doing it because health reform is eminent, do it because you could probably stand to improve some things around your practice that can only save you money and help you provide better quality of care for your patients.”

Here are a few areas to consider now to be ready for an influx of new patients:

Get ready for new - previously uninsured - patients

Newly insured patients may be unfamiliar with how the system works. They make appointments, but might not know about their copay and deductible requirements, leaving it up to you and your staff to fill them in, says Dave Gans, FACMPE, vice president of practice management resources at the Medical Group Management Association.

“I would recommend a practice assess its policies for collecting copayments and billing for deductibles,” Gans says. Those policies should then be published in plain language for new patients, and patients should be counseled on payment when they come into the practice, he says.

An uninformed patient can mean “increasing the administrative time the receptionists or business office staff have to spend with patients on the intake process,” he says.

Evaluate your payer mix

The increased patient volume also could mean a shift in your payer mix, says Madden. If one insurer winds up dominating the individual insurance market, a payer that once represented 10 percent of your revenue may swell to 30 percent, she notes.

That’s not a big deal, of course, if you are comfortable with that payer. Madden suggests practices first look closely at their payers and determine which payers reimburse well and keep costs low. Be more selective, she says, and consider a short list of payers you may drop in the future.

If you are participating with, say, two dozen insurance companies, it may be time to pare it down. Look at costs and rates, as well as volume.

“If you have a whole bunch of plans you participate with that are only two or three or four percent of your business, think about cutting them out all together,” Madden says. “Every time you add a plan there is an exponential cost factor that goes along with that.”

Rethink your scheduling

How would you accommodate a 10 percent increase in patient volume without hiring additional staff? Maybe you need to extend your hours, at least temporarily, or consider other scheduling strategies, says Madden. One option for practices with several physicians is what she calls a “rolling sick block.” One doc spends a period of time seeing only sick patients (which can be scheduled more frequently), while the others see well patients. “The idea here is you can load up those hours in a designated session to get in as many patients as possible,” she says.

Consider additional staff

It takes time to recruit and hire staff, Gans says, so practices should be assessing whether their current number of physicians is sufficient to meet a growth in demand.

“You need to look at what specialties you want and how you are going to recruit new doctors,” he says.

Adding nonphysician providers is also an option. Hiring a nurse practitioner will cost practices less than adding another full-time physician and can help extend the physicians’ time by handling some of the patient counseling and education.

“There can be a collaborative partnership in using a nurse practitioner to help you minimize the time you spend in the room with a patient, but ensure the patient receives all the well care and good treatment they can,” Madden says.

Whatever you do, don’t panic. Although the legislation contains several provisions sure to affect physicians, most elements are phased in over time. Plus, the increased demand can be good for physicians and patients alike, notes Andrew Gurman, an American Medical Association board member and orthopedic hand surgeon in Altoona, Pa.

“To some extent this is a nice problem to have,” he says. “We know people who don’t have insurance live sicker and die younger. We hope to be able to see people earlier in the disease process when there are more therapeutic options available.”

Sara Michael is an associate editor at Physicians Practice. She can be reached at sara.michael@cmpmedica.com.

This article originally appeared in the February 2010 issue of Physicians Practice.