A Common Sense Approach to Running a Non-Insurance Based Medical Practice

I have been operating an internal medicine practice in Northern Virginia for twenty-two years, but have not participated with insurance companies for the last fifteen. Why did I opt out of insurances? You already know the reasons…third party payers telling you what your services are worth and constantly devaluating those services producing frustration, anger and difficulty in supporting the lifestyle you and your family deserve.

I saw this coming fifteen years ago. Every year the commercial insurance companies would send you their rates for the next year and those rates would be constantly declining. To make the same amount of money, you had to keep seeing more and more patients, necessitating less time with each patient. Your administrative staff was being overwhelmed with fighting claims that were not paid, issuing consults to specialists and otherwise spinning their wheels at YOUR expense.

Fifteen years ago, I reached my breaking point. I was subjected to weeks of nonpayment by an insurance company. What was my offense, you ask? Well, the insurance company had sent a survey to the patients and some of them had not completed it. The company decided that it would stop payment to the physicians for any patients that had not filled out the survey. I decided to write the insurance companies and cancel all of my contracts with them. Risky? Of course! Would all my patients leave for co-pay accepting doctors? Was there going to be mass exodus from the practice? Would I have to fold shop and become a Kaiser doctor? I am proud to say that fifteen years later, my medical practice is thriving.

I’m seeing lots of patients, getting paid a good wage to see them and I am happy coming to work. If you are considering ditching your insurance company participation, here are some practical tips that may be of help:

1. Customer Service: Similar to any other business, your patients are also customers and you need to treat them like VIPs. Do you think when a patient calls they want to get some phone menu that tells them to push “1” for appointments, “2” for med refills, etc? NO! They want a live person answering the phone to say “How can we help you?” If they are ill, do they want to be told there are no appointments available until tomorrow? Do they want to feel they have to fight to get an appointment? NO! They want to know if they are sick they can always count on you to see them the same day.

2. Have Availability: The old model of opening your doors at 9 a.m., closing for an extended 1.5 hour lunch, then ending the day at 4:30 p.m. is not compatible for running a non-insurance based practice. Your patients have to work and they cannot afford to miss time at work. They are concerned about their jobs and the more they disappear from their jobs, the more they will worry about being replaced. Although it's a pain to have Saturday morning, early morning and evening hours, having this type of availability to your patients will make them very happy…and willing to pay you upfront $$$ for their visits. Their ten dollar co-pay physician will not be flexible with their scheduling.

3. Stay in Contact With Your Patients: You have spent years building your practice. Gather e-mail addresses and send out a monthly newsletter to your patients informing them of new services your office offers, biographies of your staff, etc. Make your patients feel they are part of a “family”. Their loyalty will be enhanced markedly by keeping them informed and reaching out to them monthly.

4. Bring In Ancillary Services: These are your patients. Why are you allowing them to go elsewhere and spend money on weight loss, cosmetic procedures and other services that you can provide to them? You can utilize your existing overhead, staff, facility, etc. to develop a separate ancillary stream of revenue and at the same time help your patients be healthier and happier.

There are many other common sense approaches to helping your practice become a place where patients will have no problem taking out their wallets and paying full price for your services. Do NOT allow insurance companies to dictate what you are worth. We as a profession have allowed the insurance companies to devalue and demean what we truly bring to our patients. You save lives and you should not allow some (fill in the blank) insurance company executive to pay us less than an unskilled worker. Consider taking the bold step of ridding your practice of insurance participation, but before you do this, ensure that you are following some common sense approaches to making your practice a more conducive place for this to take place.