The Business of Medicine - A Moral Dilemma?
Recently, there have been an increased number of articles that I have been reading on different blogs related to the business of medicine. It is well understood that during the course of training in medical school there is little if any training in the business of medicine and how to survive as a solo owner in your own practice. There has always been a form of moral dilemma with regards to taking care of patients and at the same time needing to run your business in a professional manner.
We as providers have a difficult time with taking care of patients and staying out of the financial aspect of the practice. In many cases we feel that we would like to under charge or no charge a visit for a specific case or a patient because either we feel that the time and effort for what we performed in the sense of an office visit was in our minds simple and it doesn’t make sense to us to charge $100 or $200 to the patient for our “10 min or 30 min” office visit.
There is specific guidance and guidelines that I continue to discuss throughout the blog regarding how to appropriately document and put down on paper or through your electronic medical record what you did during the visit and if needed the time you spent with the patient. None of this is new, as a matter of fact the guidelines are both labeled the 1995 and1997 guidelines.
The Art of Medicine
In my opinion, we have come to a crossroads in the state of medicine currently with regards to how we need to take care of the patient and provide quality patient care and at the same time keep the patient as the primary focus in our practice with balancing the art of the business of medicine simultaneously. It doesn’t matter if you own your own practice, or if you’re in a group practice, or you are part of a very large corporation that has hundreds if not thousands of physicians and primary care providers in that practice, the bottom line is if the practice is not successful and is not able to provide an income for the providers and pay the overhead, then everyone in that practice will be out of a job.
The point of all of this goes back to one primary question:
What is the basic business training that you have that is going to help you become successful in managing and balancing both quality patient care and at the same time a good business sense, which provides a sound business model for you to survive in today’s medical field?
We have been faced over the past few years with the reduction in our fees over time such that on the cover of a recent medical journal the next phase, coming in January 2013 puts us at the possibility of having a 32% reduction in our fees across the board. In my basic understanding of business, I have discussed with other business owners in other industries the concept regarding being faced with a 32% reduction in their overall fees if they would be able to survive. The consensus in every case is a resounding, NO.
Balance Your Day Every Day
It is key in this day and age to balance the business of medicine and the art of medicine with the focus still being quality patient care.
I believe that the curriculum in medical school today needs to include business training, business plans, and how to appropriately run a medical practice today. This is different than the standard business and business plan that’s taught in any business course in my opinion, because what we face is different than any other industry. We face providing a service to a patient whereby we then file an insurance claim and then wait for the insurance company to then pay us for the services we rendered an average of two to four weeks “prior” and then wait sometimes up to 90 days later when we are finally paid for that service.
We also face the possibility that the patient was not insured at the time of their visit. Even though we did everything possible to check what insurance they have, what benefits they have and whether the insurance was currently active. The patient has almost no responsibility at this point in being involved in making sure that their insurance is not only active, their payments are up to date, and that their benefits are going to be available for their visit. In the end if the insurance denies their claim for any particular reason, (even if they authorized that service at the time of visit) it is our responsibility to go back to the patient and asked them to pay for their services whereby in some cases it becomes a problem collecting for that service.
Did You Say You Checked The Benefits
In addition, it has become the primary care responsibility in most cases, for us to obtain authorization for a particular test that we need to do in order to provide quality patient care. It is the primary care’s responsibility to pay for an employee to be able to make that call which can take up to 30 minutes to an hour to obtain authorization for a specific medically necessary test. Moreover, if the proper terms and the proper information is not put into the authorization system, it is then channeled up to a peer to peer review to discuss the need for the particular test.
This usually does not go directly from a physician to physician peer to peer review, no it goes to another person who may be a nurse or other “medically” trained person whereby the discussion goes on one more time to see whether or not the test requested by the provider is “medically necessary” in the carrier’s opinion and will be finally authorized.
At what point did it become the primary care responsibility to not only obtain authorization for a particular test but to incur the costs involved in hiring an employee to be able to make that phone call to obtain that authorization.
As you can see, even in the short discussion and description of the basic day-to-day workings in a medical practice the art now, which is the business of medicine, where the focus is maintaining quality patient care balanced by authorizations in order to perform that quality patient care and the cost incurred with being able to provide the service, which enables the provider to perform that quality patient care.
How Do You Get The Information Correct
In my opinion, it is impossible for the basic non-medically trained and non-medically involved person to truly understand the workings of a medical practice today, regardless of whether it’s a solo practitioner or the large multi-thousand provider practice. As a matter of fact, the larger you become, the more compliance issues you probably face and the more people you need to hire to provide oversight to make sure that those compliances are being met.
Today we are faced with endless changes in the medical industry that are coming at us on an almost day-to-day basis. In the end, the point is, make sure that not only are you trained in the Science and Art of Medicine, but you take the time to learn what it takes to be knowledgeable in the Business of Medicine.
photo credit: Tomas Fano
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