How to recruit new patients at an outpatient group practice?

[hdeng]

Hi everyone - I recently graduated from residency and will be starting as a 1099 at an outpatient group private practice. My schedule just went live so patients will be able to start scheduling with me. I'm a bit worried since my salary is 100% production-based (it's a 75/25 split) about how to quickly fill my schedule so that I'm at least making a livable wage, especially with student loan repayment starting in a few months. In residency, we obviously didn't have to worry about recruiting patients so this is new territory. I made a Psychology Today profile to generate leads and will reach out to some residency contacts, but other than that, what are the best ways to help patients find me?

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[ObsequiousAplomb]

Ideally, the new group would have had enough of a surplus of patients and referrals prior to hiring you that a good bulk of the patient recruitment is already underway. They should have an existing network of referring providers to utilize. Starting there and looking for other sources would be a good start. Psychology Today makes sense as well. Was this not something discussed when you were interviewing?

 

[calvnandhobbs68]

So yeah, this is always tough the first month or two when you're ramping up a new practice. I mean, this is basically just starting a private practice just paying someone a cut of your income to handle admin stuff (which is exactly what I did by the way last year). First few months of a new practice are always lean. The way I mitigated this was by having them eat some of the initial cost by paying me an hourly rate for the first couple months which I then "paid back" later on in the year with my collections (since insurance billing tends to lag another 30-60 days after you see the patient and submit the bill) but sounds like it's too late for you to do taht.

Agree that since you're joining up with a group, part of what you're paying them for with that 25% split is to use their recognition and referrals in the area to build a patient population more quickly. Talk to the practice about this. Having an active psychologytoday profile can help but I don't get most of my referrals from there. Mostly from PCPs and therapists.

Are you taking insurance or not? Insurance companies can also actually be a source of referrals as people will often call/contact their insurance to see who is available in the area and takes their plan. Making sure your profile with insurance companies with online searching is accurate can be helpful. PCPs will also fall over themselves to refer to a psychiatrist who has openings and takes insurance.

 

[forchinet121]

Was it discussed how much you will make on average from a 99214, 99213, 90833? What will you get to keep from each of those codes on average?

 

[WisNeuro]

Does your practice take insurance? If so, just let a few clinics know that you have immediate availability and you'll be full in no time.

 

[hdeng]

Ideally, the new group would have had enough of a surplus of patients and referrals prior to hiring you that a good bulk of the patient recruitment is already underway. They should have an existing network of referring providers to utilize. Starting there and looking for other sources would be a good start. Psychology Today makes sense as well. Was this not something discussed when you were interviewing?

We did talk about this when I was interviewing and it sounds like they do have reliable sources of referrals (mostly therapists). I'm going to meet with the practice manager next week to ask about details. So far, I have 3 new patients scheduled with me - I assume they found me via the practice's website.

 

[hdeng]

So yeah, this is always tough the first month or two when you're ramping up a new practice. I mean, this is basically just starting a private practice just paying someone a cut of your income to handle admin stuff (which is exactly what I did by the way last year). First few months of a new practice are always lean. The way I mitigated this was by having them eat some of the initial cost by paying me an hourly rate for the first couple months which I then "paid back" later on in the year with my collections (since insurance billing tends to lag another 30-60 days after you see the patient and submit the bill) but sounds like it's too late for you to do taht.

Agree that since you're joining up with a group, part of what you're paying them for with that 25% split is to use their recognition and referrals in the area to build a patient population more quickly. Talk to the practice about this. Having an active psychologytoday profile can help but I don't get most of my referrals from there. Mostly from PCPs and therapists.

Are you taking insurance or not? Insurance companies can also actually be a source of referrals as people will often call/contact their insurance to see who is available in the area and takes their plan. Making sure your profile with insurance companies with online searching is accurate can be helpful. PCPs will also fall over themselves to refer to a psychiatrist who has openings and takes insurance.

The practice owner did offer me an advance that I can pay back with collections within my first 6 months there. I don't need the advance at this point but it is there as a cushion if the first few months are leaner than I expect.

We do take insurance - only BCBS and BCBS PPO (and self pay). I am in the process of getting credentialed with them now. Once I'm in network with them, what do I need to do to set up a profile with them (or is it automatic)? Since most of your referrals are from therapists and PCPs, how did you establish a working relationship with them? I don't know a lot of therapists or PCPs in the area outside of my residency program and I doubt there's much insurance overlap between the residency patients and what we accept at the PP.

 

[hdeng]

Was it discussed how much you will make on average from a 99214, 99213, 90833? What will you get to keep from each of those codes on average?

The practice owner said that once I'm full, I'll make on average $300/hour (75% of $400). I'm guessing this is a mix of new evals, 99214, 99213, and 90833? To be honest, I'm not the most savvy when it comes to billing codes. If you have good resources for someone to get up to speed on billing codes, that'd be much appreciated!

 

[Stagg737]

Since most of your referrals are from therapists and PCPs, how did you establish a working relationship with them? I don't know a lot of therapists or PCPs in the area outside of my residency program and I doubt there's much insurance overlap between the residency patients and what we accept at the PP.

Google local PCP clinics and therapists. Contact them and ask if they have time for a 15-20 minute phone call, or better yet ask if they've got some time during lunch to meet at their office to introduce yourself and discuss what services you offer. Even if you're only able to talk to 3 or 4 clinicians it can potentially be a huge referral source, especially if you can meet with some larger clinics. Or, since the practice's cut is 25% of what you bring in, have them make those calls for you.

The practice owner said that once I'm full, I'll make on average $300/hour (75% of $400). I'm guessing this is a mix of new evals, 99214, 99213, and 90833? To be honest, I'm not the most savvy when it comes to billing codes. If you have good resources for someone to get up to speed on billing codes, that'd be much appreciated!

Lots of threads on here about billing, but you should almost never be billing 99213 unless you have a very low-acuity and high-functioning population. If your patient has 2 chronic stable problems or 1 new/exacerbated problem + you prescribe meds you automatically hit a 99214, which is a 0.62 wRVU difference per encounter. Where I'm at that's roughly a $35 difference per encounter. If you do 30-minute f/ups, you should be able to add 90833 on to a fair number of them if you're doing basic therapy with patients. If you do 15-20 minute f/ups that means you won't be able to (ethically or really legally) use that add-on.

 

[randomdoc1]

On your psychology today profile you can target two additional zip codes. Change them around every few days. Network with good therapists with similar philosophies. It will attract a better patient population. And stay on top of your insurance and patient aging reports. Make sure everyone pays up. That is where you can hemorrhage tons of money. I’d focus equally on that if not more than recruiting patients. Most patients do not pay their bills. I collect at the visit.

If you can, I recommend being in network with more insurances or the practice will take longer to build and/or you have fewer patients to choose from. I like patients who are a good fit. Or else you can end up investing a ton of unpaid time in challenging cases. Medicare can pay well and generally reimbursed at 100% where’s commercial plans can have deductibles, most do these days…and…did I mention that most patients don’t pay bills? Many of your locally based insurances would love more psychiatrists and pay competitively.

 

[randomdoc1]

The practice owner said that once I'm full, I'll make on average $300/hour (75% of $400). I'm guessing this is a mix of new evals, 99214, 99213, and 90833? To be honest, I'm not the most savvy when it comes to billing codes. If you have good resources for someone to get up to speed on billing codes, that'd be much appreciated!

This is assuming also a 100% collection rate. I’d recommend keeping track of your collections aka aging reports. Our office has an over 99% collection rate. Unfortunately this is only possible with providers collecting during visits. I’ve tried every billing method known to man and even collecting at the front. Patients are surprisingly evasive about paying. But when the provider is talking and it is during a visit, they are more agreeable. Many patients surprisingly question you too saying they don’t have a deductible, especially if they are new to you, so I’m always prepared with a pdf of their insurance policy. Most patients when they say they will call and pay later never do. So when building the panel, there will be a lot of weeding out of this. Some patients do let their balance accrue and in those situations I’m forced to suspend appointments and call the patient to discuss the clinical situation. Refer to low cost clinic if needed. Yes, many providers are shocked by this news, but the proof will be in your numbers reports. Definitely check them.

Along that note, there is definitely a clinical correlation with finances. Those who are more on top of it tend to have stronger defenses, better work ethic, lot less complexity.

 

[AD04]

The new group should be giving you a salary for the first year if they want you full time. If pay is only based on production, you should get a job and do this on the side starting 1 day per week and grow from there. This way, you have less financial pressure and more leeway to experiment with different marketing ideas. This is especially true when there are other psychiatrists / providers in the practice and you don't have control regarding patient flow or marketing.

Salary or reduced hours allows you to safely assess if the practice manager / owner is honest. Or if they would even give you the equipment and resources to succeed. (The practice I was previously at give me a crappy laptop that was probably 10 years old that took 10 minutes to boot up even though the owner said he'll get me a new laptop since I couldn't use the desktop. The laptop was so bad I had to bring my own.) Make sure they provide breakdown of how your production and split are calculated.

I learned all these the hard way.

 

[calvnandhobbs68]

The practice owner did offer me an advance that I can pay back with collections within my first 6 months there. I don't need the advance at this point but it is there as a cushion if the first few months are leaner than I expect.

We do take insurance - only BCBS and BCBS PPO (and self pay). I am in the process of getting credentialed with them now. Once I'm in network with them, what do I need to do to set up a profile with them (or is it automatic)? Since most of your referrals are from therapists and PCPs, how did you establish a working relationship with them? I don't know a lot of therapists or PCPs in the area outside of my residency program and I doubt there's much insurance overlap between the residency patients and what we accept at the PP.

Should be pretty automatic for the insurance company profile but just search yourself once you're in network and see if the info is accurate.

I just walked over to a few PCP offices, gave them a couple flyers with a brief blurb about me and my interests, contact info for the office, what insurance companies I was in network with, said hey just started a practice in the area, will probably be pretty open for the next couple months but will likely fill up soon so wanted to let you know in case you have patients you're trying to get in with psychiatry. That way they could put the paper in their workstation or office for quick reference. Once they refer a few people to you and patients have a good experience, they'll start sending a bunch of patients your way. PCPs are generally a bit better for referrals since they have panels of thousands of people (unlike therapists who might have 30-60 patients at a time). I also get a lot of internal referrals since I'm attached to a therapy group though and there's a ton of therapists in this group.

Make sure they provide breakdown of how your production and split are calculated.

100%, make sure they're giving you a monthly or biweekly breakdown patient by patient of collections, outstanding balances and your split of this to make sure they aren't screwing you. If they can't provide this easily, they aren't efficient at collections and don't know their own finances or are actually trying to screw you.

 

[randomdoc1]

100%, make sure they're giving you a monthly or biweekly breakdown patient by patient of collections, outstanding balances and your split of this to make sure they aren't screwing you. If they can't provide this easily, they aren't efficient at collections and don't know their own finances or are actually trying to screw you.

There is an interesting caveat to this. Most billing departments are not as well versed as we are at tactfully setting boundaries. Considering the patient population we deal with, it's not surprising there are incidences of avoidance, denial, deception, and acting out. This is no different in billing. Some examples I ran into where an average or even above average billing department is not sure what to do and they may feel awkward/avoid enforcing the collection:
-Patient says they will call back later to pay/check insurance/get their HSA/whatever excuse. Then they don't.
-Patient gives the stonewalled look and says things like: I don't have a deductible/I never had to pay at ___ clinic/that must be out of network/whatever excuse. Patient evades paying.
-Patient says they paid or are getting to it-->they let the balance accrue to infinity. Cases of severe borderline personality will lie (they are used to departments being so separated), at my office we call them out and the facial expression is priceless.
-Patient evades all calls, emails text messages but keeps somehow popping up on your schedule

There's nothing wrong or "bad" about collecting as the provider during the visit. As a matter of fact, if I did not do this, I'd have a much smaller patient panel and even those long term patients are not consistent with paying on their own. They are more likely to trust us as providers and wanting to work with us since we provide care. Collecting on my own was how I exceeded 400k profit my first year in solo practice. That was pretty much the secret. That and efficient claim tracking software.

When the discussion gets awkward I just say things like "I do have a pdf of your insurance policy here and your in network rate does show that you have a deductible. Unfortunately we're both bound by your insurance terms and by law I am to collect at the insurance determined rate [or it literally constitutes insurance fraud]. However, you can feel free to talk to your HR department about if they offer other plans and/or HSA funds as part of your benefit." Yes, patients will start to push boundaries and ask for you to go at a lower price. Some patients still don't trust it even after the claim is processed and I end up having to show them the EOB. Sometimes I tell them we can call the dang insurance company on threeway because the denial is so strong. But if this ends up being a recurrent pattern, I get ready to transfer the patient out because it takes up too much time.

This too becomes a learning opportunity because it is a real life setting where people have to deal with financial realities, problem solving, versus asking us as providers to in a way, financially enable them. Now, if they truly do not have the means, there are other community resources and that is what they are there for.

I personally send all bills via text, email and land mail. At least twice a month. 80% of the recipients never, ever, respond. But they keep booking appointments. So we collect when we see them next. New patients are initially more evasive, but they learn fast. They either pay or they disappear. Otherwise it's easy for non-paying patients to stay on the panel forever and you're essentially giving free care.

It is also wise to note, this is not specific to private practice either. If one works in a hospital system or community health center, yes, there is some funding. But much of the income is still reliant on what is collected from insurance and patients. My colleagues work in hospital systems and they see tons of patients and make less than a well run PP. I think a part of this equation is that patients don't pay their bills there either and/or inefficiency with the insurance claims system. But the provider should not be the one absorbing the cost. Although many systems find it easier to just make us do more visits. The tight follow up is the key.

 

[Candidate2017]

I made a Psychology Today profile to generate leads and will reach out to some residency contacts, but other than that, what are the best ways to help patients find me?

The owner is taking 25% of your billings, so they should be helping you get patients. Otherwise, may as well have your own practice.

Patients are surprisingly evasive about paying. But when the provider is talking and it is during a visit, they are more agreeable. Many patients surprisingly question you too saying they don’t have a deductible, especially if they are new to you, so I’m always prepared with a pdf of their insurance policy. Most patients when they say they will call and pay later never do. So when building the panel, there will be a lot of weeding out of this. Some patients do let their balance accrue

Along that note, there is definitely a clinical correlation with finances. Those who are more on top of it tend to have stronger defenses, better work ethic, lot less complexity.

There's definitely a strong correlation between a dysfunctional personal life and one's willingness to causally lie, cheat, and steal from someone providing them valuable time and service in the context of a professional relationship.

 

[smalltownpsych]

There is an interesting caveat to this. Most billing departments are not as well versed as we are at tactfully setting boundaries. Considering the patient population we deal with, it's not surprising there are incidences of avoidance, denial, deception, and acting out. This is no different in billing. Some examples I ran into where an average or even above average billing department is not sure what to do and they may feel awkward/avoid enforcing the collection:
-Patient says they will call back later to pay/check insurance/get their HSA/whatever excuse. Then they don't.
-Patient gives the stonewalled look and says things like: I don't have a deductible/I never had to pay at ___ clinic/that must be out of network/whatever excuse. Patient evades paying.
-Patient says they paid or are getting to it-->they let the balance accrue to infinity. Cases of severe borderline personality will lie (they are used to departments being so separated), at my office we call them out and the facial expression is priceless.
-Patient evades all calls, emails text messages but keeps somehow popping up on your schedule

There's nothing wrong or "bad" about collecting as the provider during the visit. As a matter of fact, if I did not do this, I'd have a much smaller patient panel and even those long term patients are not consistent with paying on their own. They are more likely to trust us as providers and wanting to work with us since we provide care. Collecting on my own was how I exceeded 400k profit my first year in solo practice. That was pretty much the secret. That and efficient claim tracking software.

When the discussion gets awkward I just say things like "I do have a pdf of your insurance policy here and your in network rate does show that you have a deductible. Unfortunately we're both bound by your insurance terms and by law I am to collect at the insurance determined rate [or it literally constitutes insurance fraud]. However, you can feel free to talk to your HR department about if they offer other plans and/or HSA funds as part of your benefit." Yes, patients will start to push boundaries and ask for you to go at a lower price. Some patients still don't trust it even after the claim is processed and I end up having to show them the EOB. Sometimes I tell them we can call the dang insurance company on threeway because the denial is so strong. But if this ends up being a recurrent pattern, I get ready to transfer the patient out because it takes up too much time.

This too becomes a learning opportunity because it is a real life setting where people have to deal with financial realities, problem solving, versus asking us as providers to in a way, financially enable them. Now, if they truly do not have the means, there are other community resources and that is what they are there for.

I personally send all bills via text, email and land mail. At least twice a month. 80% of the recipients never, ever, respond. But they keep booking appointments. So we collect when we see them next. New patients are initially more evasive, but they learn fast. They either pay or they disappear. Otherwise it's easy for non-paying patients to stay on the panel forever and you're essentially giving free care.

It is also wise to note, this is not specific to private practice either. If one works in a hospital system or community health center, yes, there is some funding. But much of the income is still reliant on what is collected from insurance and patients. My colleagues work in hospital systems and they see tons of patients and make less than a well run PP. I think a part of this equation is that patients don't pay their bills there either and/or inefficiency with the insurance claims system. But the provider should not be the one absorbing the cost. Although many systems find it easier to just make us do more visits. The tight follow up is the key.

Love this discussion about the importance of money and collecting and how it is part of the treatment. That was how o was trained and I am amazed at how few clinicians of all stripes in our field don’t get that. Just as I don’t avoid asking the client the difficult questions about sex or suicide or drug use, etc; I also don’t avoid the questions about finances. I also agree that by being part of it as the provider, it increases the collection. I make all my patients pay at their sessions and we don’t take insurance so at least I don’t have to explain that part. In six months, I have had one guy try to walk out and then he said it was supposed to be a free consult. I decided he wasn’t worth the effort so I wrote that one off. That is the only non-pay. Have had a couple of declined cards and we just straightened it out at next session.

The other area where I insert myself is in scheduling follow-ups,for new patients or even certain patients that might have a change in schedule and tend to procrastinate or avoid. Of course, if it’s a flaky patient or one that I’m not eager to keep on my panel, then I just say they can call us to book their next session when they have their schedule figured out. 😏

 

[randomdoc1]

Love this discussion about the importance of money and collecting and how it is part of the treatment. That was how o was trained and I am amazed at how few clinicians of all stripes in our field don’t get that. Just as I don’t avoid asking the client the difficult questions about sex or suicide or drug use, etc; I also don’t avoid the questions about finances. I also agree that by being part of it as the provider, it increases the collection. I make all my patients pay at their sessions and we don’t take insurance so at least I don’t have to explain that part. In six months, I have had one guy try to walk out and then he said it was supposed to be a free consult. I decided he wasn’t worth the effort so I wrote that one off. That is the only non-pay. Have had a couple of declined cards and we just straightened it out at next session.

The other area where I insert myself is in scheduling follow-ups,for new patients or even certain patients that might have a change in schedule and tend to procrastinate or avoid. Of course, if it’s a flaky patient or one that I’m not eager to keep on my panel, then I just say they can call us to book their next session when they have their schedule figured out. 😏

I've heard the "free consult" BS too. We're not car salesmen. And over here, prior to that first visit, we tell patients exactly what is owed starting from visit #1, via a documentable electronic track. When a patient acts in such a manner, it puts them already on bad terms with me as the owner. I've seen patients give us expired insurance policies and try to get in saying it is active. One called multiple times trying to trick a different person into scheduling her (after we gave her free clinic resources)--my front would have been tricked (she actually convinced 3 different people on 3 occasions) had I not caught it. I blocked her number on the Voip. I've beat this finance talk into the ground. But, the vast majority of providers are completely in the dark about this happening behind the scenes. People treating us this way makes my blood boil. We entered this field to help people and there are far more people than meets the eye that behave this way. As I said many times, patients with this profile also tend to have more severity, acuity, chaos, pathology which = time consuming. If someone has pathology but they make effort in their care and are respectful of boundaries, that is a different story, but someone who continues their behavior while literally in your office does not sound ready for change. There are many people who are ready to change and we get compensated for our worth. We're a scarce resource and need to be where it is of most use. It's also econ 101--chaotic models = unsustainable.

I also am totally with you on scheduling your own follow ups. Without doing that, the calendar would be much emptier. If you think about it logistically, the more steps there are in a process, the harder it is for something to be achieved. When you're in the session with the patient, schedule the follow up, boom, done and patients are actually more likely to own up to that visit. It's an enforced level of engagement with the patient.

Go to the front to schedule there may be a line, receptionist is less familiar with pt preferences, there's room for error, maybe receptionist went to bathroom so patient thinks they will call later and 3 months pass, sometimes patient and receptionist have transference and countertransference, etc, etc. Way more things that can create barriers.

 

[smalltownpsych]

I've heard the "free consult" BS too. We're not car salesmen. And over here, prior to that first visit, we tell patients exactly what is owed starting from visit #1, via a documentable electronic track. When a patient acts in such a manner, it puts them already on bad terms with me as the owner. I've seen patients give us expired insurance policies and try to get in saying it is active. One called multiple times trying to trick a different person into scheduling her (after we gave her free clinic resources)--my front would have been tricked (she actually convinced 3 different people on 3 occasions) had I not caught it. I blocked her number on the Voip. I've beat this finance talk into the ground. But, the vast majority of providers are completely in the dark about this happening behind the scenes. People treating us this way makes my blood boil. We entered this field to help people and there are far more people than meets the eye that behave this way. As I said many times, patients with this profile also tend to have more severity, acuity, chaos, pathology which = time consuming. If someone has pathology but they make effort in their care and are respectful of boundaries, that is a different story, but someone who continues their behavior while literally in your office does not sound ready for change. There are many people who are ready to change and we get compensated for our worth. We're a scarce resource and need to be where it is of most use. It's also econ 101--chaotic models = unsustainable.

I also am totally with you on scheduling your own follow ups. Without doing that, the calendar would be much emptier. If you think about it logistically, the more steps there are in a process, the harder it is for something to be achieved. When you're in the session with the patient, schedule the follow up, boom, done and patients are actually more likely to own up to that visit. It's an enforced level of engagement with the patient.

Go to the front to schedule there may be a line, receptionist is less familiar with pt preferences, there's room for error, maybe receptionist went to bathroom so patient thinks they will call later and 3 months pass, sometimes patient and receptionist have transference and countertransference, etc, etc. Way more things that can create barriers.

I had to deal with a lot more of that when I worked at a hospital outpatient clinic where we took insurance. I also am spared many of the people with substance abuse. That is unless someone makes a “psych eval” a hoop for them to jump through. A little aside, I hate that term.

I also am realizing that the maxim of don’t work harder than your patient holds for billing and scheduling as well. If they are committed to the process and are making efforts then I will work with them, be flexible, make extra efforts. When they are entitled and passive and a “victim”. I’m not going to feed into that.

 

[randomdoc1]

I also am realizing that the maxim of don’t work harder than your patient holds for billing and scheduling as well. If they are committed to the process and are making efforts then I will work with them, be flexible, make extra efforts. When they are entitled and passive and a “victim”. I’m not going to feed into that.

Every interaction is clinically relevant!

I know this is getting off topic, but also important to have reception staff who are good with boundaries. I've had a couple personality disordered ones who fed into maladaptive dynamics as "patient advocate." The psychodynamics does not stop in our office. One started playing pseudo-therapist which I warned her about. Especially with one case that comes to mind. I said it's ok to be helpful but not too accommodating or this patient will only escalate their calls. 1 call every two weeks went to weekly, went to every few days, to multiple times a day and this receptionist burned out. Needless to say, she did not last long at the psych clinic because she was too busy trying to save everyone or get a provider to "save" someone. She was also very good at finding severe borderline with comorbid etoh use disorder cases recruited into the office and these cases she held so dear, she was devoting most of her time too. Psych clinics are interesting for sure.

 

[Celexa]

Every interaction is clinically relevant!

God, I wish more people understood this.

You're completely right that everything matters, including the smallest detail of financial management and collections. To devalue that part of the work is to devalue ourselves.

 

[Jules A]

I'm surprised so many are advocating spending their valuable time doing collections and scheduling tasks that even a marginable admin staff should be capable of accomplishing.

 

[randomdoc1]

I'm surprised so many are advocating spending their valuable time doing collections and scheduling tasks that even a marginable admin staff should be capable of accomplishing.

Yes, they should. But many employees don’t. I’ve been through ~20 something employees now (5 still with us, this is over 3-4 years). The population a reception or billing staff position attracts, tend to be very incompetent. Especially with the absent initiative people make to pay. I see our current employees calling patients and talking to them at the desk, the ones we have try very hard and it is patient resistance they are fighting with and not sure what to do about. We have 12 providers here. They have all tried having the front collect and do scheduling and felt their paychecks take big hits. Some came from other offices and said our office did a way better job than the last one but they still missed a lot of money. Providers are free to take that route, but when they see how much more efficient their time gets and money they make per hour, no one goes back. If someone has a system where the front does all the billing, collection and scheduling that results in a very nicely condensed schedule (with high attendance rate) with over 99% collection rate that is not over 30% benzos and/or stims and patients engage in evidence based treatment and actually work in therapy, please PM me. I would love to know how it is set up seriously. Our newest psychiatrist is 0.6 FTE, her first year outta residency she made 320k with benefits. Streamlining the process makes a huge difference.

That and, having collections outside the session multiplies the work because of all the back and forth communication and people argue over the cost because they lose track of how many visits they had. Employees have so many jobs to choose from, it’s hard to find good help. And the more employees you have, the more overhead we subsidize. Everyone here knows I’m comfortable with spending more on overhead as long as it returns on the investment. But employees is where you can easily hemorrhage if they are not productive and we live in an entitled culture. Considering each session could be a $150 collection or way more, easy to nip it in the bud at the visit. Scheduling and collecting takes 60 sec out of a session for me.

But I am with you. I’m not sure what’s happened to work culture. Sometimes I want to scream that there’s a reason work is called work. So do the damn work.

But big gains came out of this. It’s taught me to make the work flow less employee reliant. Saving tons of money actually and keeping me away from the occasional employee drama BS
-text reminders and cancel by text with time stamps
-patient portals for fielding messages directly to providers
-we’re working on setting up self check in and option to pay on own (e.g. deductible or copay at time of visit at check in once the established patients know the drill)
-user friendly online new patient intake history gathering with AI technology
-sophisticated billing software to send claims to all payers with a single click and thorough tracking--we've easily eliminated need for 1 (likely more) full time billing employee with software alone and it does a better job anyways
-etc.

 

[medium rare]

Yes, they should. But many employees don’t. I’ve been through ~20 something employees now (5 still with us, this is over 3-4 years)…

Agreed. Right now, I share my office manager with just one other provider. I’m fortunate that she is highly competent and enjoys her job. We pay her well, too, in an effort to keep her. It’s by far my biggest expense but well worth it and a necessity in my practice.

It would be different if there were multiple providers in our office and I could see the scenario you describe developing easily. At present, scheduling and collecting work very well through our office manager but I don’t hesitate to schedule a patient directly if she’s out or busy doing something else. I’d estimate that 95-97% of my patients pay with a credit card and the majority have agreed to keep their cards on file so collecting fees daily is mostly non-problematic.

I have a daysheet of each appointment for the day and I indicate on it the CPT code, the charge, and when I want that patient rescheduled. My office manager returns it to me the following day indicating the date & time the patient is rescheduled and their payment (amount and method). I review it and initial when I’ve approved and we keep that on file in addition to tracking that data with my scheduling and billing program. If a patient hasn’t paid for whatever reason or their card declined/expired, my office manager follows up immediately. She’s been very effective in collecting anything outstanding this way. If it’s a patient who has a history of “forgetting” or asking to postpone payment, she informs the patient that I will not submit their Rx or will not reschedule them until they have paid in full. This has mostly eliminated any accounts that go into delayed payment beyond 30 days.

For those patients who have a history of being difficult or delinquent in payment over 30 days, I deal with them directly. I agree fully that every patient interaction is clinical and often with the more delinquent patients, there are clinical factors involved in their pattern of non or late payment or scheduling issues. In my practice, I would say it is about 5-10% of the time that I need to do this, but it does happen. Having a system to stay on top of this and communicate expectations has been extremely beneficial for me. Things still slip between the cracks at times but, overall, it’s worked quite well.