Money. Fees. Collections. Just hearing these words might make you feel a little uncomfortable. These aspects of running a practice seem to have a way of touching your self-esteem, self-worth, risk tolerance, confrontational abilities and communication skills.
The way in which you determine patient fees, achieve patient acceptance, deal with third parties and handle collections can become a barometer of countless other aspects of your practice. Income, referrals, patient satisfaction, profitability and compliance can all be affected by your practice’s financial policy.
Chances are you’ve heard many different approaches to developing an effective financial policy to help increase your collections. The ideas that follow are from a different perspective – the patient’s.
Shooting the Messenger
Poor collections and uncollected balances are a symptom. As with health complaints, treating a symptom rarely produces lasting benefits. Treating the symptom with letters, collection services, attorneys and small-claims court is often counterproductive. You may win the battle, but lose the war. Collections problems are often caused by a lack of a clearly explained financial policy or poor administration.
The fact is, if you’re involved with a lot of third parties, you’ll need to manage your patients’ pocketbook in addition to their health complaints. Many patients don’t discover the limitations of their policies until they show up in your office. You may find yourself educating patients about how the “business” of healthcare works these days.
Identify the shortcomings of your patients’ insurance coverage before they even begin care. If you don’t, patients are likely to “shoot the messenger” – you – rather than placing the responsibility with the insurance carrier. Offices with excellent collections have found they must offer patient education and financial education.
Put It in Writing
Practices with high collections (in the 90% range and higher) generally enjoy high levels of patient satisfaction, which translates into more referrals and a more stable practice. Clarifying your financial policy is essential.
Many offices with collection problems try to remain flexible, ready for anything and everything. However, trying to be all things to all patients is a recipe for frustration. Your financial policy helps determine what patients belong in your practice. Without a written policy that is properly administered, you can become a target for irresponsible patients and the “let’s make a deal” mentality that bites you in the back weeks or months later, after the patient is feeling better and owes you hundreds of dollars.
Helping Patients Understand
The majority of financial policies are structured in a way that makes sense for the doctor. They either list the fees based on the services that are offered (exams, adjustments, X-rays, etc.), which are often meaningless to new patients; or they try to make the case for wellness care at a time when a patient isn’t even sure chiropractic will work for his or her presenting complaint.
Most patients don’t understand the purpose of adjustments, therapy or an orthopedic examination. Since many patients bring their medical-doctor experiences with them, they need some orientation.
Chiropractic care is delivered over a series of office visits, so why not arrange your policy so it reflects how patients encounter your office? Be sure to answer the following patient questions in your written financial policy: “What procedures (and why) will be performed on the first visit and what are the fees associated with them?” “What happens on the second visit and how much does it cost?” “What happens on a regular visit?” “Why does it take multiple visits? And how much do they cost?” The same goes for progress examination visits. Use your financial policy to map out your office procedures and explain their purpose and benefits.
Third-Party Motives
Part of your financial policy orientation should be a review of the motives of all the parties. Clarify the motives of your patients for having consulted your office. Clarify your motives for accepting them as patients. Explain the motives of their HMOs/PPOs. What you’ll often notice, is that you’re stuck trying to serve two masters – your patients and their HMOs/PPOs.
Consider the same scenario from the patient’s point of view. Given a choice, should your patients serve or follow the recommendations of their “financial master,” or should they take the recommendations of their wellness-oriented “health-care master” (you)? Who is likely to have the greater influence over your patient?
You’re Not a Bank
Many times the financial aspect of the doctor/patient relationship gets out of hand because patients run up their outstanding balances over weeks and months without being asked for payment. While partly administrative and procedural, the culprit is often a lack of a clearly set “credit limit.”
Like the expiration date printed on many packaged foods, outstanding patient balances are perishable. The larger they get and the longer they remain uncollected, the chances of actually seeing the money diminishes with every passing day.
Set a credit limit and put it in writing in your financial policy. That’s the easy part. The difficult part is having the discipline to enforce the limit if patients aren’t taking steps to take care of their debt.
Patient Accountability
Being a stickler about having patients pay their balances may make you worry: “But they won’t like me! They might drop out of care! They won’t follow through on my recommendations! They won’t get the optimum results chiropractic can deliver!”
Possibly. Yet if you don’t make patients responsible and accountable for their health, several even more disturbing things can happen. First, their respect for you may diminish. (If you don’t respect yourself enough to demand payment for your services, you must not be worth it.) Second, they could refer their similarly irresponsible friends to your office. (Birds of a feather flock together.) And third, you may be tempted to send nasty letters, turn them over to collections or take them to small-claims court. These actions can sully the relationship considerably more than simply asking a fair price for your services and expecting payment.
Individual Consideration Contract
Poll a group of staff members out of earshot of their doctors and many will say they are frustrated by the “deals” their doctors make with patients. While staff members are expected to administer these special payment cases, the arrangements are rarely written down.
You have every right to make special arrangements with patients who are experiencing financial hardships. Just put it in writing.
Presenting Your Written Policy
Ten to 20 years ago, when everyone had insurance with $100 deductibles, it made sense to have a staff member cover the presentation of your financial policy with your patients. Times have changed.
Give patients a copy of your financial policy to review after they have completed your admitting paperwork. Then, during your consultation, walk through the main points of the policy and reach an agreement with the patient.
If you think getting your hands “dirty” by discussing money with a patient diminishes your clinical reputation, think again. Maybe you have the luxury of compartmentalizing and separating your fees from their care, but patients don’t. Do you separate the taste of the lobster dinner from its cost when eating out? Of course not. Neither do patients.
If the thought of presenting your fees to patients is a frightening prospect, you may have some money issues of your own to resolve. Are you overcharging? Are you worth it? Would you pay for the care you’re asking patients to pay for? Resolving these issues could dramatically enhance your practice. It could improve collections. And it could improve patient satisfaction, ultimately increasing referrals.
