Tuesday, March 09, 2004

More patients!

After a slow start, business has been picking up. Since my first patient 1 week ago, I've seen 5 others since, ranging in age from 8 to 92. My first visit was at 8PM, another was on a Sunday afternoon, and 3 saw me today. I was surprised to get 3 calls requesting appointments on my home phone today from people we know. I'm going to have to start monitoring the home phone number, too, it seems. The common denominator to all these is accessibility. I was able to accomodate people who wanted to be seen after hours, on weekends, that same day. Most of the patients I saw already had a doctor, but found seeing me more convenient, even though I told them I wasn't able to accept insurance yet.

When I thought about it, I realized that this is the way it will be most of the time. People calling that same day for an appointment. I should get used to it, never knowing what to expect from the day. Each patient has expressed how much they appreciate what I'm doing, how "nice" it is to be able to call up and see a doctor in town, that same day. I've given everybody a copy of a newspaper article about Drs. Gordon Moore and Linda Lee describing their solo practice models. I feel like I want to promote this concept of a hassle-free doctor as much as I want to promote my own practice.

I've yet to feel totally comfortable with my office protocol, though. I have office forms borrowed from other physicians, but I don't need all the information these forms ask for. I'll have to sit down and fine tune them to suit my own needs. I have learned the hard way that I have to make sure I ask patients to fill out the forms BEFORE I start talking about their problems. I guess that's what receptionists normally do.

I still feel awkward when they ask me how much they should pay. My "rate" has been $50 per 15 minutes with a 20 percent discount for prompt pay. So it's been working out to $40 for most people, not because everyone takes 15 minutes or less, but because I feel guilty about asking for more than that. I don't think I've spent less than 20 minutes with anyone, and most get more than 30 minutes of my time. At this point, it doesn't much matter since I don't have any other patients waiting. But my practice model was planned with an average reimbursement of $75 per 30 minute visit in order for me to reach my target. Hopefully this will change once I can accept insurance.

Speaking of which, it has taken me longer than I planned to apply. Mainly because I had difficulty figuring out how to get a copy of the fee schedules for each insurer. I didn't want to sign any contracts without knowing in advance what I was going to get paid. Pacificare's application packet already included a list of the 25 most common CPT codes and what Pacificare will pay for them. For Aetna, I had to fax a list of my most common CPT codes and they faxed their reimbursement rates back. So far, it seems like everybody pays LESS than what Medicare pays. Aetna's rates range from 78-106% for the E&M codes, while Pacificare ranges from 63-91%. I imagine Blue Cross and Blue Shield will be similar. At least, I hope they aren't much worse.

But quite a few patients are waiting for me to accept insurance before they will come see me. I don't blame them. I guess I'm surprised to have patients willing to pay me for my services at all.

I wonder if anyone will call tomorrow?