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A cash-only endocrinology practice streamlines reimbursement issues
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LAS VEGAS — At the American Association of Clinical Endocrinologists 2014 Scientific & Clinical Congress, Donald A. Bergman, MD, MACE, former AACE president, outlined the benefits of a cash-only endocrinology practice.
Bergman, who manages his own practice in New York, said that a cash-only practice can make care easier for some patients. Cash-only practices can help circumvent the chart review and downcoding that traditional relationships with insurance providers can precipitate.
“What will make your cash-only practice work for patients and for you is concierge-style services (without a concierge fee) at market-value prices,” Bergman said in a meeting session.
Donald A. Bergman
As part of the alternative billing practice, Bergman said his patients receive an "encounter form" at the end of their visit, which includes procedure and diagnosis codes. The patients then pay with cash, check or credit card.
Patients can submit their own visit information to insurance programs, for which purpose the office generates an official receipt. Because Medicare requires physicians themselves to submit encounter documentation, Bergman's practice does submit documentation to Medicare.
Bergman added that physicians can opt out of Medicare, as long as patients are notified ahead of time, and the proper affidavit is filed with the appropriate local carrier.
When it comes to expensive lab services and some drug companies, Bergman says that he negotiates with service providers for a lower fee, noting that his close relationships with drug and testing service providers enable this.
To begin the transition to a cash-only practice, Bergman said that physicians can first notify insurance carries and network patients; notify network physicians who provide referrals; counsel staff as to the scope of the transition; and develop an identity as a specialist whose service is worth out-of-network service.
To make a cash-only practice “worthwhile,” Bergman encouraged physicians to have a friendly and welcoming staff, and to take care to inform patients of any appointment delays; physicians can stay on track during the day by scheduling time for phone calls and patients who require extra time to talk. Bergman emphasized that it is important to make patients feel that they have adequate access to the physician’s care, whether by phone, email or personal visits.
Bergman noted that cash-only care is significantly harder when hospital care intersects office care, since hospital copays and a deductible are separate, which requires the patient and insurance to be billed separately.
“This shouldn’t be a concern … If you’re a good endocrinologist, your patients won’t end up in the hospital,” Bergman said.
For more information: Bergman DA. W42. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Bergman reports no relevant financial disclosures.
Perspective
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Katherine A. Roberts, MD, FACE
I’m in Williamsburg, Va., which is the No. 5 place to retire. It’s also very wealthy retirees. I opted out of Medicare because I had so many patients that all I could do was really spin my door. And I can’t do that.
In order to treat these hard endocrine patients — like people who have had diabetes for 50 years — you have to spend 45 minutes with them. Medicare paid me $127 for 45 minutes. I couldn’t afford that. I opted out of Medicare to fund my kids’ college education.
I made a lot of enemies, but my patients love me. They call me when they have a problem. I take care of them. Many of them say, “This is Dr. Kate. I’m alive because of her.”
My patients are my family. I want to spend time with them and need to be able to spend time with them,
And the thing is, it’s not that expensive for the patient. A lot of people ran away when they saw I was dropping Medicare because they never stopped to ask how much it was going to cost. They thought it was going to be really expensive.
I have a couple patients who are retired maids, so I give them their medications. They pay the cash I request and I open my sample closest. It’s a give and take, but they’re happier, healthier and living longer and that’s what I want.
The thing about cash-only or direct pay, as Brian Forrest said, is it costs a carton of cigarettes a month for your health care. Think about that.
In addition, people are moving more to the medical savings accounts. We’re finding more and more that people really want value for their dollar because they’re paying for this now, which is fabulous to me. Because if you’re paying the same for me as you have to pay for the physician who spends 3.7 minutes with you, you’re going to come to me.
We need to get rid of the regulations. We need to go back to the value.
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