Don't let consumer-driven health plans run over your practice

MGMA Connexion, Apr 2006 by Delaveris, Steven L

Fee schedules must respond to health savings accounts

The American health care system has become increasingly chaotic, and attempts to organize the bedlam seem to be thwarted at every turn. The paperwork involved in going to the doctor for a simple check-up, or worse, for a specific illness, can be harder to overcome than the malady itself. Consent forms, claim forms, privacy forms ... it's no wonder that patients suffer from chronic confusion, while the medical community scrambles to simplify the process and regain control over the physician-patient relationship. More time diagnosing and less time processing would benefit everyone.

As a primary care physician with more than 25 years in the exam room, it's my prognosis that the health care system in this country is in critical condition, and we, as medical professionals at the heart of the organism, have the resources to remedy the patient. Some physicians are catching on and taking steps to regain control of the doctor/patient relationship by making fee schedules readily available to their patients and, subsequently, establishing the trust that should be inherent to such a partnership. It's true that the practice of medicine is a business, but in what other industry does the consumer contract for service without having at least an inkling of the cost?

Even doctors don't know what to charge

Physicians don't publish their fees because they're confused about what they can, or should, charge. Consider that standardized codes (current procedural terminology) vary by only miniscule increments (24 pages devoted to the initial visit alone), and it's easy to see why physicians have been "HMO'd" into fee bewilderment.

Health savings accounts (HSAs), once heralded as the cure-all for the payment system, may be falling from grace, at least as far as physicians are concerned. While HSAs relieve the patient of co-payments, they come with high deductibles and a ton of administrative baggage. Providers still have to wait for insurance companies to adjudicate the claim, then try to collect the allowed amount from the patient. It's a hassle, and it hinders us from completing the business transaction - service has been rendered and payment is due. That may sound harsh, but there's no mission without money, and no money without mission.

An innovative approach to HSA payment

My practice has taken an innovative approach to help solve the problem of self-pay at the time of service. We use a product from a Columbus, Ohio-based national business service provider (BSP) that specializes in the medical industry. It essentially rewards patients with cost savings when they pay during check-out. By establishing and publishing our own fee schedule, we use the software to give the patient a break.

The BSP product calculates the HSA-allowed amount prior to sending the claim to the insurer, so we can tell the patient how much is owed before he or she leaves the office. If the patient pays then and there, we give a 30 percent discount off the HSA's allowed amount. Hence, we execute our own fee schedule, not held ransom by third-party payers. We've taken back control of our business and our livelihood, which in turn lets us spend time where it should be spent: caring for patients.

According to the Medical Group Management Association, the typical internal medicine practice writes off 60 percent of its gross charges to contractual allowances.1 Our software removes the penalty for patients not protected by third-party contracts that set the maximum charge (yet preclude physicians from billing for the balance) and gives the self-pay patient the same protection opportunity as insured patients. Everyone wins (with the exception of the insurer). The software promotes operational freedom and allows billing personnel to keep the cash flowing.

The bottom line is that we have to watch the bottom line. Innovation and forward thinking are instruments that we physicians must add to our little black bags if we want to keep ahead of the insurance industry and on top of the latest in diagnostic techniques and research.

note

1 Medical Group Management Association Physician Compensation and Production Survey: 2005 Report Based on 2004 Data.

By Steven L. Delaveris, DO, FAAFP

about the author

Steven L. Delaveris, DO, FAAFP, MGMA member, and principal and CEO, doshealth, Columbus, Ohio, delaveris@doshealth.com