Collecting Sighs

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Sigh.

My billing manager came to me again today with the infamous blue folder. In it was a list of patients who were significantly delinquent in their payments to our practice. The names on the list weren’t the kind of people you would expect; they were really nice folks – the kind of people I am glad to have in my practice.

My manager saw me looking at them sadly and rushed to justify herself. “These folks have been contacted numerous times, with offers to stretch out the payments to keep them small. They just don’t return our calls” she explained. “This woman said she would bring by $10 last Friday, but never showed up.”

It wasn’t just individual names I was looking at, it was families. I pictured the children; one little girl always asks for me when she was not feeling well. I thought about how I’d get the bigger kids to laugh. I thought about the parents, who were really nice people and were good parents.

Sigh.

“We just can’t let them keep coming in and building up more of a bill,” my manager added. “These families both have outstanding balances of over $300 and they haven’t even made an attempt to work things out with us. I know it’s hard for you, but we have to draw the line somewhere.”

Sigh.

I signed my name in the box next to their name. They will be sent to collections and given a letter of discharge from the practice.

I hate it. They are really nice folks, and I understand how bills can be overwhelming at times. We really do whatever we can to accommodate this, sometimes having them pay $10 per month for a year and calling it even (even if their bill is well over the $120 this represents). We have never been predatorial. I don’t want this to be about money, but if they don’t even work with us….

Sigh.

I don’t think I could tolerate not being my own boss. I don’t take authority too well. But I absolutely hate this side of private practice. I hate it when money stands between me and a little girl that wants me everytime she is sick.

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DrV

Hated this too. When I was in private practice I had the very same feelings. I think that half the patients really wanted to pay but couldn't. The other half just didn't feel that paying me was a priority. And it was very hard to sort out who was who. Tough reality of medicine. Good post
Dr. Pat

I am a pediatrician in one of the only privately owned pedi practices in our state. Yes, it is sad but people do have to take financial responsibility and we bend over backwards to make affordable payment plans for our families. Unfortunately some people won't work with us and at the end of the day, I have to pay my employees and the partners. As pediatricians we're already at the low end of the MD pay scale so and we OWN our practice, no handouts from the hospital. So we have to collect those co-pays,etc. I've also been inpractice for 23 years and have learned that we doctors can also turn into enablers due to our innate desire to help others.

I do disagree with the pedi practice manager about not letting her docs know who she's putting out of the practice. Sometimes there are extenuating circumstances that only the docs know that would lead us to keep patients even if they're not paying. We deal with the issue by having all the physician partners go over the accounts of certain patients to decide whether they need to go to another practice. That helps the PCP make a decision sometimes when it's difficult. The doctors have to know who can't pay and we ultimately have to make the decision. Life isn't always easy but we're all grownups.
Ken O

I have never, ever, paid a bill that I've not received! ;) Ok, I have paid big bills by installments or credit cards, or even a formalised credit agreement, but I don't pay bills if I don't get billed!
Frank Drackman

You're askin for the whole Bill all at once??? Did you pay Cash for your Car and House??? Umm OK, I did, but that doesn't matter...
Charge em 1% interest a week, payble in Cash or they get a visit from
Sal the Collector who lets his blackjack do the talkin...
Once word gets out you're a pushover even the Insurance companies won't pay ya...Oh yeah, that already happens...
Rob

The reason we do the review is because sometimes we know more about the situation than our managers - we know grandma just died, mom has cancer, and lots of other things that the manager might not know. They just found that docs didn't like patients being discharged without their knowledge.
Ken O

I've read too much American fiction where the protagonist was the child of "that deadbeat Doctor" (read PHP who didn't charge people enough to make a living themself) not to see this as a necessity.

Brandon, I think you have a point in saying that the physician shouldn't, even if they're a partner in a PHP practice, be personally involved in collecting delinquent accounts.
Brandon

I manage a pediatric practice; thus know very well this situation. In fact, I deal with this very same issue frequently.

My approach is simple. I don’t let my doctors get involved with this ugly part of the business; especially pediatricians. Pediatricians became physicians for different reasons than other physicians. They are special human beings in a way firefighters, nurses and even teachers are special people. Consequently, when it comes to people in pain whether physical, emotional or financial, it’s intrinsic for pediatricians to reach out and try to help; especially if children are involved in some way.

In order to avoid having my doctors make these tough decisions, we follow a comprehensive financial and collection policy (we too make every effort to work with patients), which parents are well aware of. So after we've followed our protocol and the patient still hasn't made an effort to pay, then the decision has already been made. But the doctors are not involved at any point in this process. They can't. They are pediatricians.

I let my doctors know that if they discuss business matters (billing, statements, collections, copayments, patient balances, deductibles, etc.) with patients, then they have to let me discuss clinical issues with patients.

And nobody wants that.

Keep up the great work Dr. Rob. I enjoy your blog and have printed several of your post to give to my docs in an effort to let them know, they are not alone.

@PediatricInc
Charlene

Unfortunately this is what you need to do. Your office can only offer so much assistance. If that assistance is ignored, then your only option is to do what you did.

Yes, health care is a business. You need the reimbursement to keep your doors open so you can treat all the other patients, pay your staff, and feed your family. Health care is not free. The paradigm shift happened about twenty years ago when HMO's became prevalent and people now feel that they do not need to be financially responsible for their health care.

Your Billing Manager is correct.
Connor Young

It happens at every office, and can't be avoided, as you said. At ours, the doctors look at the list, and make a personal, friendly call to those that most desperately need to be cared for, or have the most desperate financial situations. More often than not, the patient, hearing from the doctors themselves (although our billing staff is wonderful) can make the difference, and payment plans are fulfilled.

Of course, time constraints make this impossible for many practices, and, of course, the responsibility falls first and foremost to the patient.
bill

Pick one. Tell me how much. If I can afford it, I'll pay it.
Qkwan

That is so sad. As someone halfway done with PA school, I am not looking forward to such things. You're right though. If people aren't willing to work with you... What can you do?