Patient Online Negative Reviews As A Threat

[InvestingDoc]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

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[Sushirolls]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

I hear you. And I feel much of the same. Thankfully, I'm psychiatry, and thus far haven't had people threaten as audaciously as you've experienced of tit for tat with bad reviews. I have had bad reviews for not giving stimulants or telling people they need to stop cannabis or get a sleep medicine consult. Recent Q&A I got in email from my liability carrier basically says for us, don't even reply, even though they acknowledge they are / were your patient we can't do anything. The flipside I get as Psychiatrist is people who are satisfied and express gratitude for saving their life, or follow you from prior jobs in the past - won't leave reviews because people don't want to attach their name to psych. So we have basically no reviews, but the tiny we get are typically scathing.

I do agree with sentiments of just saying bag it, medicine isn't worth it. Being reduced to customer service, societal erosion in lack of personal responsibility, etc. Why be a physician? Is it even worth it? Right now I could maybe tell my kids to do medicine and psych, to simply take over my some day established practice, but if they think of doing anything else in medicine, nah, nope, not worth it. Society just don't care and they want cheap quick poor quality medicine.

 

[rokshana]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

Dismiss them then…can’t have a good therapeutic relationship with such demands…they can go find a new doctor

 

[bronx43]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

I hear ya, bro. Society is basically decaying at a breakneck speed in front of our eyes. I'm in academics, so reviews have little impact on me. But I recently had a guy nearly attack me in clinic because I wouldn't give him a diagnosis of a rheumatic disease.

I'm basically just living frugally, stacking the portfolio, then GTFO as soon as I can.

 

[90sportsfan]

We actually had a small group discussion about this during M1. It's one of the many things about medicine that has changed over the last 30 years and why medicine has lost a lot of prestige. Patients can tarnish your reputation online so that when patients or even family friends, kids, colleagues, or potential dates Google your name, they can find personal, embarrassing, hurtful, and damaging comments about you. Even if it's not true, it's there forever. Online reviews are a big reason why medicine is not the respected profession that it once was.

You've got to have thick skin. I've googled several well-respected physicians, and see nasty comments all the time, like, "Dr. X should not be a doctor and is the most incompetent person bla bla bla." You can usually tell when it's an angry patient ranting because the majority of comments will tell the true story. But I'm sure it still hurts the doctors to read it (hard not to take it personally). From what I see, volume correlates with negative review. For example, Derm sees so many patients, and they seem to have a lot of reviews with many negative (and it seems like the negative ones have a theme of the Doctor spending very little time with the patient and not taking time to fully answer questions). The patients don't realize that the docs' schedules are packed to the brim and if they get behind they will garner another set of negative reviews because they are late. Kind of a lose-lose situation.

 

[VA Hopeful Dr]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

You can always go real petty (I did this once a number of years ago after a patient's wife claimed I missed his cancer (he didn't have cancer)). Make up a fake Google account and go blast their business with bad reviews.

That aside, I've had more than a few patients tell me that they can tell the negative reviews are someone throwing a tantrum because no one is ever as bad as those reviews make them sound.

I actually got a real bad one today (directed at the office not me specifically for some reason). It sounds like the ravings of an utter lunatic, and as we've already fired the guy I'm not that worried about it.

 

[Postictal Raiden]

The other day I typed my name in Google just to see what comes up and sure enough there’s a Yelp review of me. I am still a resident. The lowlife, who I never met, was complaining about how the office staff were rude to him when he tried to reschedule. I contacted Yelp and they refused to remove the comment. Oh well. I couldn’t care less but this experience was a true eye opener regarding the entitled, litigious society we live in.

 

[chessknt]

Why does it matter? Are you struggling to fill your schedule and get patients and worried the online reviews are going to drive away business you desperately need? Let them leave negative reviews and send that **** to collections, report it credit agencies, and tell them to go get ****ed and find another doctor.

 

[InvestingDoc]

We are still growing our practice with one of the doctors, I'm getting ready to hire another doctor and in the works to open a third location. Unfortunately, reviews matter when growing a business.

 

[chessknt]

We are still growing our practice with one of the doctors, I'm getting ready to hire another doctor and in the works to open a third location. Unfortunately, reviews matter when growing a business.

Do you know that for sure though or is it just conjecture? Like have you had a drop in new business since the bad reviews appeared? Have you tried offering incentives to all patients for a few months (like a credit or Amazon gc or something) for leaving a review?

If you truly believe that why not hire one of those reputation protection services and see if they can help?

 

[Splenda88]

I hear ya, bro. Society is basically decaying at a breakneck speed in front of our eyes. I'm in academics, so reviews have little impact on me. But I recently had a guy nearly attack me in clinic because I wouldn't give him a diagnosis of a rheumatic disease.

I'm basically just living frugally, stacking the portfolio, then GTFO as soon as I can.

I am a new attending and I told all my physician friends to have 10-yr exit plan because medicine is changing at the speed of light.

 

[90sportsfan]

Why does it matter? Are you struggling to fill your schedule and get patients and worried the online reviews are going to drive away business you desperately need? Let them leave negative reviews and send that **** to collections, report it credit agencies, and tell them to go get ****ed and find another doctor.

It's beyond just the business implications of a bad review. It is hard not to take it personally when someone is degrading you online, and that anyone Googling your name (including family and friends) will see it. It's just another of the many headaches you will have to deal with as a doctor nowadays.

 

[InvestingDoc]

Do you know that for sure though or is it just conjecture? Like have you had a drop in new business since the bad reviews appeared? Have you tried offering incentives to all patients for a few months (like a credit or Amazon gc or something) for leaving a review?

If you truly believe that why not hire one of those reputation protection services and see if they can help?

Yes, after a negative review we often see about a 10% drop in transient visitors to our website that improves usually upon the next 5 star review. Must be baked into google search algorithm.


We just got another negative review for not giving someone ivermectin and google refuses to remove it. Patient left us a voicemail stating they would remove it if we called in the med for them.


This is the world we now live in.

 

[bronx43]

Yes, after a negative review we often see about a 10% drop in transient visitors to our website that improves usually upon the next 5 star review. Must be baked into google search algorithm.


We just got another negative review for not giving someone ivermectin and google refuses to remove it. Patient left us a voicemail stating they would remove it if we called in the med for them.


This is the world we now live in.

Why not ask your satisfied customers to put positive reviews? That would drown out the negatives

 

[InvestingDoc]

Why not ask your satisfied customers to put positive reviews? That would drown out the negatives

We have started to do that and have already had quite a bit of success in getting those reviews up.

 

[rokshana]

Yes, after a negative review we often see about a 10% drop in transient visitors to our website that improves usually upon the next 5 star review. Must be baked into google search algorithm.


We just got another negative review for not giving someone ivermectin and google refuses to remove it. Patient left us a voicemail stating they would remove it if we called in the med for them.


This is the world we now live in.

And was he dismissed?

 

[InvestingDoc]

And was he dismissed?

Yes, we dismissed them.

 

[Candidate2017]

We can't totally avoid difficult patients. But it's worth it to examine things systematically and see if you can identify commonalities and processes that lead to problems. Basically, profiling (and implementing systemic controls). Not just the patient, but also your response. For example, do you engage in back and forth with your patients? Do you have clear guidelines communicated in writing? What is your billing process? How well trained is your front desk? Maybe you just need to move to another neighborhood?

There are certain patients that predictably cause trouble, as well as certain physician personalities and responses that predictably amplify the trouble.

 

[collegestud2013]

Might be better to switch to some type of shift-based medicine (Eg hospitalist, ED, critical care, urgent care) where reviews matter much less and patients get a provider based on who happens to be working that day and not by their choice. But at least in outpatient medicine you can choose to only to see the patients you want to see and not take on or stop seeing the difficult ones.

 

[rokshana]

Might be better to switch to some type of shift-based medicine (Eg hospitalist, ED, critical care, urgent care) where reviews matter much less and patients get a provider based on who happens to be working that day and not by their choice. But at least in outpatient medicine you can choose to only to see the patients you want to see and not take on or stop seeing the difficult ones.

Dude… have you followed investing docs history?
Maybe you should look at that …

 

[NotAProgDirector]

Are you able to publically respond to negative reviews? On some hotel websites, I've seen a neg review with a response from management. Usually, it says something like "we're really sorry you had this bad experience, reach out to us, yada yada..." in your case, you could respond "We're sorry you had a bad experience. We have reviewed your case at your request. Unfortunately, the anti-worm treatment you are requesting is not indicted for your condition and has serious potential health risks. We wish you the best of health going forward." Skates close to the HIPAA line, but probably OK (assuming the post is anonymous). But probably will only make them post more, so probably not worth it.

The patient is the one with the disease.

 

[chessknt]

Are you able to publically respond to negative reviews? On some hotel websites, I've seen a neg review with a response from management. Usually, it says something like "we're really sorry you had this bad experience, reach out to us, yada yada..." in your case, you could respond "We're sorry you had a bad experience. We have reviewed your case at your request. Unfortunately, the anti-worm treatment you are requesting is not indicted for your condition and has serious potential health risks. We wish you the best of health going forward." Skates close to the HIPAA line, but probably OK (assuming the post is anonymous). But probably will only make them post more, so probably not worth it.

The patient is the one with the disease.

Yea you can’t respond to them other than something generic like please call to discuss. You might do well to respond with emojis or something childish to attract people who aren’t crazy by signaling what you think of their ******* review.

 

[VA Hopeful Dr]

Yea you can’t respond to them other than something generic like please call to discuss. You might do well to respond with emojis or something childish to attract people who aren’t crazy by signaling what you think of their ******* review.

Or just ignore them altogether.

 

[rokshana]

Or just ignore them altogether.

Or a badge of honor… you probably don’t want “that” patient anyway.

 

[InvestingDoc]

Are you able to publically respond to negative reviews? On some hotel websites, I've seen a neg review with a response from management. Usually, it says something like "we're really sorry you had this bad experience, reach out to us, yada yada..." in your case, you could respond "We're sorry you had a bad experience. We have reviewed your case at your request. Unfortunately, the anti-worm treatment you are requesting is not indicted for your condition and has serious potential health risks. We wish you the best of health going forward." Skates close to the HIPAA line, but probably OK (assuming the post is anonymous). But probably will only make them post more, so probably not worth it.

The patient is the one with the disease.

Yes we are publicly responding to negative reviews. I don't break HIPAA but I do call patients out politely on their bull****. For example our ivermectin one star review I mention that I'm sorry they are not satisfied with our practice but it is true that our practice is pro vaccine for covid prevention rather than ivermectin prophylaxis dose. I wished them health and happiness and moved on. The patient who claims that we gave them pneumonia during a GI endoscopy, I replied that we are a primary care practice and do not preform those procedures and I'm sorry to hear that she had a bad experience somewhere else. Google refuses to remove them.

The crazy ones people I think can see right though. It just sucks that it really seems to affect our google search page ranking the more negative or positive reviews we get based on website traffic data.

Might be better to switch to some type of shift-based medicine (Eg hospitalist, ED, critical care, urgent care) where reviews matter much less and patients get a provider based on who happens to be working that day and not by their choice. But at least in outpatient medicine you can choose to only to see the patients you want to see and not take on or stop seeing the difficult ones.

I can choose to see who I want but usually most of our one star visits are new patients who book for annuals and end up being totally crazy then leaving us a bad review. I've also been a hospitalist and man....that had its own issues. So many metrics that the grass is def greener. Running a practice has its issues but I'm making 2x the money I was making as a hospitalist and no weekends, no holidays. I do complain about the issues but I do love what I do and love growing my practice. There are just lots of issues when running a business/practice that I like to blog about to show the good and the bad in an effort to be as transparent as possible.

 

[BorntobeDO?]

We all have our fair share of crazy patients, unhappy patients.

However, this trend of patients threatening negative reviews in order to get their way is alarming and frustrating.

In the past 2 weeks we have had 3 patients all call in and demand something and if they don't get it they threaten to leave a bad review online.

Two people have complained about paying a copay and threatened to leave a bad review if we make them pay it. We made them pay it and sure enough they went online and trashed us on multiple review sites.


One person threatened and left a bad review after we didn't see him for 6 months and wanted us to do an early refill on his testosterone, adderall, and xanax that another doctor had been filling for him for years. We said no, he left multiple bad reviews online, called us and threatened us to the point where we had to call the cops and buy a concealed handgun.

It is hard enough to convivence people to do outpatient medicine...and honestly this has me frustrated that now we are seeing a trend of threaten a bad review to get exactly what you want. Previously...bad reviews were in two categories. We could have done a better job and patients called us out on it or Patients had unrealistic expectations like why cant this doctor do my EGD...umm we are not a Gi practice.


My wife asked me if I would want my kids taking over my practice one day and immediately it was a hell no from me. I'm tired of hearing from my biller on a daily basis nowthat someone doesn't want to pay their copay and is threatening a bad review if we make them pay it.

I hate to think that I'm getting a bit jaded but this whole the customer is always right and can threaten negative online publicity to get what they want has to eventually have some repercussions.

Alright, my rant is over....back to seeing patients

You aren’t collecting copays prior to visit? I thought that was common. Maybe I am misunderstanding. I would think that kind of thing would weed out these people real fast.

 

[emergentmd]

Medicine has become quite ridiculous where patients have a tremendous amount of control. Truthfully, if a pt is really petty, they could create 1000 gmail account and put in a bad review every other day.

Google won't do anything about it. Its almost impossible to trace.

Its the world we live in and Google reviews generate alot of traffic to any business. Just another thing to worry about on top of difficult patients, unreliable employees, unreasonable hospitals, scheming carriers, and controlling government.

Good luck to the next generation trying to open up your own practice. Its just becoming extremely difficult.

 

[bronx43]

Medicine has become quite ridiculous where patients have a tremendous amount of control. Truthfully, if a pt is really petty, they could create 1000 gmail account and put in a bad review every other day.

Google won't do anything about it. Its almost impossible to trace.

Its the world we live in and Google reviews generate alot of traffic to any business. Just another thing to worry about on top of difficult patients, unreliable employees, unreasonable hospitals, scheming carriers, and controlling government.

Good luck to the next generation trying to open up your own practice. Its just becoming extremely difficult.

Opening up one's own practice is dead already, with the exception of a few rare cases (like InvestingDoc). The best case scenario for young docs going forward is joining existing physician-owned practices, and avoiding large corporate systems where you're just a faceless minion of the profit-seeking leviathan.

 

[VA Hopeful Dr]

Opening up one's own practice is dead already, with the exception of a few rare cases (like InvestingDoc). The best case scenario for young docs going forward is joining existing physician-owned practices, and avoiding large corporate systems where you're just a faceless minion of the profit-seeking leviathan.

Nah, lots of new DPCs opening all the time that do well

 

[bronx43]

Nah, lots of new DPCs opening all the time that do well

Sure, there are a few in my area too. But my point is what percent of new grads do that versus join a health system or established group? It’s probably little more than a rounding error.

there are simply too many headaches compared to the alternative

 

[InvestingDoc]

You aren’t collecting copays prior to visit? I thought that was common. Maybe I am misunderstanding. I would think that kind of thing would weed out these people real fast.

If the patient books for an annual physical, we have a form that we have a patient sign saying what is and is not a physical. The nurses also reiterate this to the patient prior to the visit. We even gave an example such as the annual physical as to talk about vaccines, blood pressure, cancer prevention. But lets say for example you wanted to talk about new back pain, that is not an annual physical.

So, despite us having patients sign a form and a nurse going over what a physical is and is not....we still get tons of people trying to push it for a "free visit."

So, if a patient despite the warning and the signed form prior to all annual physical and an email prior to the visit explaining what an annual physical is...some patients abuse it and we sure as hell charge for it. We bill it as a visit plus or minus a physical if we have time to do the physical.


Otherwise, yes we do collect copays ahead of time. We have tried to stop these patients by saying...hey this is outside of annual physical territory...they either say "whatever thats fine" or they stop and tell me that they just want the free visit. The ones who say "whatever thats fine" I would guess that 10% of them still call in a bitch about having to pay a copay.

We are considering terminating these problem patients form the clinic because I just don't know how we can give any more warnings about what an annual visit is and is not.

If anyone else has a better system...all ears.

 

[InvestingDoc]

Opening up one's own practice is dead already, with the exception of a few rare cases (like InvestingDoc). The best case scenario for young docs going forward is joining existing physician-owned practices, and avoiding large corporate systems where you're just a faceless minion of the profit-seeking leviathan.

It is going to take a very very special person to open their own non procedure based practice. A most likely stubborn person who is willing to grind it like they are a resident again to make this business successful.

The two biggest factors stopping people from starting up their own practice in my opinion.
1. Student Debt or recurring family financial obligations
2. Prolonged credentialing process

However it is becoming super cheap and easy to start your own practice if you wanted to.

EMR is cloud based and can be found for less than $300 a month with a month to month subscription. No need for upfront one time costs to get everything implemented.

Almost everything is electronic. No need to even order Rx pads anymore. Everything can be done electronically pretty much. No need for paying extra for controlled substances Rx pads. This also cuts back on printing requirements since everything is digital.

Automation and the race to free baby.
-I used to have to pay for email reminders being sent to patients or text messages about $200 a month. Now, boom its free with my EMR.
-No longer need to pay after hours telephone answering service which is often hundreds of dollars a month. My voice over data phone can be set up to forward those voicemails to an email inbox that the doc who is on call covers.
-Mass emails. I can download a list of patients, upload those emails into mailchimp and email out a campaign. No need for marketing firm.
-advertising. Hello metrics. I can see exactly what words, what zip codes, what time of day....everything you would want to know and more about how patients are finding me. My cost to acquire a new patient is still hovering in the $3 range. Considering the lifetime value of our patients is in the thousands....this is amazingly cheap and no guessing how well that billboard or radio ad is really doing.
-free marketing. Social media can suck but post on instagram or facebook and I can clearly see when a post hits because traffic goes way up....and its free.
-voice dictation and dot phrases have decreased my time needed to document per visit to around 2-3 minutes. Then on to the new patient. NO longer spending just as long typing with my patients.


For some reason I feel like going solo or starting your own practice now is a lot like the quote from a tale of two cities.


It was the best of times....and it was the worst of times...

 

[fooli_doc]

If the patient books for an annual physical, we have a form that we have a patient sign saying what is and is not a physical. The nurses also reiterate this to the patient prior to the visit. We even gave an example such as the annual physical as to talk about vaccines, blood pressure, cancer prevention. But lets say for example you wanted to talk about new back pain, that is not an annual physical.

So, despite us having patients sign a form and a nurse going over what a physical is and is not....we still get tons of people trying to push it for a "free visit."

So, if a patient despite the warning and the signed form prior to all annual physical and an email prior to the visit explaining what an annual physical is...some patients abuse it and we sure as hell charge for it. We bill it as a visit plus or minus a physical if we have time to do the physical.


Otherwise, yes we do collect copays ahead of time. We have tried to stop these patients by saying...hey this is outside of annual physical territory...they either say "whatever thats fine" or they stop and tell me that they just want the free visit. The ones who say "whatever thats fine" I would guess that 10% of them still call in a bitch about having to pay a copay.

We are considering terminating these problem patients form the clinic because I just don't know how we can give any more warnings about what an annual visit is and is not.

If anyone else has a better system...all ears.

My perspective is a little different since I'm employed, but the whole annual physical v e&m visit is a huge issue with our healthcare system in general. Virtually no one is going to come to the doctor without a problem and honestly I have a hard time blaming them. I try to convert as many visits into physicals as I reasonably can for a few of reasons. First, if the patient is paying an insurance premium I want the insurance provider to actually have to pay for something. Second, part of my pay structure is based of % collections, and my collection rate is going to be much better if I'm billing more fully covered physicals. I just make the main part of my documentation for a physical but still address problems. I usually won't double bill to avoid collection rate issues adding up and for long term patient satisfaction. This is especially successful in younger (or just non-medicare) patients that may just have one or two issues but maybe "haven't been to the doctor in years" and want a "full blood panel." Now if they come in with major e&m type issues then I'm not going to even bother doing this. I find that patient's appreciate this and more willing to come back for e&m follow up. I guess I'm playing the long game with hoping billing less now helps in the future. We will see if it pays off. Not sure if that helps from a private practice perspective, but I've been able to avoid any scathing reviews related to that type of issue.