The Business of Health Care

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For primary care providers, staying in business means making enough money to cover your overhead, pay your staff, and hopefully turn a profit. But money matters in health care can be particularly sensitive. Some clinicians share their experiences with how to get patients to pay for the care they receive.


Finance is a touchy subject, but in health care the discussion of money may be particularly sensitive. Yet as primary care clinics struggle to stay open, many practices are implementing policies that they hope will generate revenue (even if that just means collecting the fees they are owed in the first place).

More practices are starting to request a credit card number from patients in order to “hold” an appointment; if a patient becomes a no-show, the office reserves the right to charge a fee to the card. (Some even ask for a down payment upfront.) Having this information on file, along with a signed consent from the patient, also makes payment collection easier.

While such policies are standard in the hotel industry and common among restaurants, in a health care setting they engender mixed feelings. Health care, after all, is a human commodity—but at the end of the day, it is also a business.

“The truth is, you cannot provide services without making money,” says Barbara C. Phillips, MN, NP, who in addition to her clinical practice provides business consulting services to NPs. “If you have a business—and all clinics are businesses—you have to generate enough revenue, enough profit, to cover your overhead, so that you can pay your staff, so you can grow your business and provide more services.”

Along with helping to improve patients’ health, getting paid for the services they provide is the goal of every clinician. For one thing, it helps their own bottom line (even if not all primary care providers drive Jaguars, as some patients seem to think) and for another, it allows them to stay in business, where they can provide more services to more people in need.

But—particularly in tough economic times—getting paid is not always easy. Some patients really are in financial straits, yet desperately need health care, whereas even those who are insured may balk at the idea that they owe money out of pocket after a bill has been adjudicated.

How clinicians handle money matters depends on the type of practice they have and their comfort level with implementing different policies. For example, at Deerpath Primary Care, a mid-sized private practice located on Chicago’s North Shore, collections are handled by Athena Health. Patients provide a credit card number at the time of their visit and are asked to sign a consent form giving Deerpath permission to charge the balance of the bill to that card after the claim has been adjudicated.

“As it turns out, a lot of people like this, because they don’t have to do anything,” says Lisa Dandrea Lenell, MPAS, PA-C, who is Director of Operations as well as a clinician at Deerpath. “They don’t have to get a bill in the mail; we just send them a receipt.”

Patients can choose from a number of ways to be notified about pending bills—phone, email, texts, or messages through a secure Web portal. Through the portal, patients can also make or cancel appointments and set up a reminder service to notify them of upcoming appointments. They are also informed that 24 hours’ notice of cancellation is required or a $50 no-show fee will be assessed.

“We don’t often add it on,” Lenell admits. “But if you’ve done this a couple of times, and we know that you were told about the $50 fee, then we’ll add it.”

By contrast, Joy Elwell, DNP, FNP-BC, FAANP, owns her private practice in Scarsdale, New York, and does not have credit card policies in place. Her electronic medical record system sends automatic reminders to patients via email—one a week before the appointment and another the day before—and her staff follows up by phone the day before the appointment as well.

“If patients still forget—if they forget once, well, everybody forgets now and again,” Elwell says. Her staff calls to check on the patient and reschedules the appointment. “If they do it twice—if they break two appointments in a row—then we tell them that they cannot have an appointment. They can come in and be seen, but they will have to wait for an opening and we will fit them in when we can.”

Elwell’s reason for not taking “reservations” with a credit card or assessing no-show fees is simple: On occasions when she has been asked for her information, she hasn’t liked the way it made her feel. She knows other practices that have such policies and has been surprised to learn that patients return to those practices despite the request for credit card information.


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