3 Common Frustrations in Private Practice — and How to Solve Them

When Zocdoc surveyed 760 physicians, office managers and practice administrators for a 2017 benchmark report on the state of private practice, one thing became abundantly clear: While most respondents found software useful in facilitating patient scheduling and billing — physicians spent an average of $16,503 annually on these systems — embracing software wasn’t a cure-all for every challenging aspect of running a practice. Many respondents still faced pain points with regard to revenue. About 88 percent of respondents saw patient load as a problem; 90 percent felt the effects of patients missing appointments; 86 percent struggled with the process of recouping payment from insurance companies. 

These three issues are all obstacles to a financially viable practice. Even with software, practitioners still need to understand how data and software work best together and how to communicate effectively with patients. Here’s a breakdown of these concerns, plus guidance for coping with them.

Patient load

A provider needs a large enough patient pool to run a profitable practice. But too many patients can lead to burnout and affect quality of care, even as insurance reimbursements sometimes demand that physicians pack in as many patients as possible. Is there such a thing as an ideal patient load on a daily and revolving basis?

“Patient size is a factor of economics,” said Josh Umbehr, MD, a primary care physician in Wichita, Kansas. “It’s the goal salary, plus overhead, plus 30 percent wiggle room divided by 12 months in a year that equals the monthly goal. The monthly goal divided by roughly 20 working days in a month equals the daily amount necessary.”

For Umbehr’s Atlas, MD, concierge service, that formula translates to about 600 patients in its system. But math only tells part of the story. Your specialty might also affect your target number. “It is dependent on your ability to manage the patients in a timely way,” Umbehr said. “If you are a geriatric practice, 400 patients may be too busy if you are traveling from nursing home to nursing home. If you are a pediatrician and you can see two patients per hour, then you could likely have a very flexible schedule and be profitable around a thousand patients, especially in a direct care or membership model.”

While there may be online calculators that can give you a ballpark estimate, staff size, billing and your practice’s focus all play a role. Make sure to account for these variables.

Missed appointments

Let’s face it — patients don’t always consider providers’ schedules. Healthcare is a giant, monolithic machine raking in billions of dollars. One skipped follow-up is no big deal, right?

Doctors know better. Missed appointments, particularly with late or no notice, are cumulative, and that lost income can have a considerable impact on revenue. But with the proper strategy, you can keep it to a minimum.

“In our practice, the greatest thing we can do to reduce missed appointments or canceled appointments — or just the headache of multiple patient communications to reschedule the same appointment — is to keep our schedule as flexible as possible, so we can accommodate the patient on the same day that they want the appointment,” Umbehr said. “When people feel sick today, they will make sure they get to their appointment today. The further out you schedule, the more likely it is that something else will happen and the less motivated the patient might be.”

You also want to remove any obstacles that might interfere with patients keeping their appointments. Is it their first time being seen? Make sure they have clear directions to the office. No car? Offer details on the most convenient bus routes that will be running close to their appointment time. Planning to send reminders? Personalize them. A study published in the American Journal of Medicine found that patients are more likely to keep appointments when they receive personal rather than automated calls beforehand. 

Don’t forget to keep to your own schedule as best as you can. Doctors running late can be a bad influence on their patients. “I think patients are less likely to show up on time if they don’t think the doctor is running on time,” Umbehr said. “They feel it gives them an opportunity to have a buffer and run 5 or 10 minutes late, because the doctor might also be running late, which would actually sort of make them on time.”

Try to use positive reinforcement instead — thank them for being on time or honoring their appointments.

Billing obstacles

At a certain point, office frustrations turn from patient volume and reliability to the Byzantine world of insurance providers. Constant back-and-forth wastes money — all in an effort to receive money.

“The most common issue I see is physicians and practices feeling like they have a lack of leverage in getting paid in a timely fashion for services,” said Michael VanBuren, a healthcare attorney and partner at the Ohio-based firm Calfee, Halter and Griswold. “The other thing I see, which is not new but keeps getting worse, is a lack of understanding on the part of insurance companies of the clinical work that goes into taking care of patients.”

For more efficient medical billing, VanBuren recommends taking preventive measures. Supporting documentation should be organized and submitted before a carrier begins the process of soliciting it. During the negotiation process for fees, physicians should make sure to quantify the value of their care, showing they’ve gone above and beyond what a 20-minute appointment might indicate.

“The tendency has been to wait to pay for face-to-face encounters, when really a physician’s value is so much greater,” VanBuren said, citing coordinated care management as an example of an effort that can take hours but result in an insurance rebuff. “The sooner you can articulate that value, the better.”

Physicians undoubtedly have other concerns and problems beyond these three items. But by managing patient load, reducing missed appointments and simplifying billing, even the smallest private practice can big make changes.

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