A DC recently sent me the following question:
I need to raise my fees, but it's been so long since I raised them that I'm not sure what's the best/easiest way to do it. Should I put up a notice? Do I raise everyone's fees all at once? Cash and insurance at the same time? I could use some guidance on the topic.
My answers: No. Yes. Yes. End of column. I could quit there, but I'd better add just a little more.
It is a fact of life that prices gradually, and sometimes not so gradually, go up. Window-shop for a car, furniture, appliances, etc., and you'll see most items are inching steadily upward. Do we agonize so much over raising our fees because we're afraid that patients won't like us or will be mad if we expect a reasonable fee? Will we find out that they were coming to us because we were the cheapest around? Why don't you think you're entitled to a reasonable fee?
I have a real problem when I see doctors who've spent 4-7 years in college and are working hard, but are barely able to pay their bills because they're afraid to charge a reasonable fee to all patients. Some doctors allow financially sound patients talk them into reducing, waiving and otherwise "eating" fees, all because these doctors aren't sure their services are worth the money.
I'm assuming that you've considered "usual, reasonable and customary" for your area and done the research on your cost per visit. I'm not talking about what you make per visit, but how much it costs to take care of a patient. Be sure that any changes you make accommodate costs and inflation since your last change, and whatever profit you need.
Now, about the sign. What is it with signs? "If I put up a sign, everyone will just do what I want, and I won't have any discussion or negative comments from the patients!" Right. What will happen if you put up a sign is that patients will have time and opportunity to sit in your waiting room and discuss the pros and cons! They'll have time to figure out how to best hit you up for an exception and/or whine and make grim predictions. They'll have time to go home and gripe to family and friends who will indeed sympathize and suggest that "someone must be cheaper."
After the change goes into effect, the patient who has just seen the doctor will simply be told by the staff that there has been a fee increase and what the charge is for the visit. No additional comments, apologies or justifications should be made. Proceed to end the visit as usual. If the patient pays cash and does not have the extra, accept the usual fee with the statement that they make up the difference on the next visit. Patients seem to have far less trouble with fee increases than we do!? Hmm?
This technique would be used for everyone. I would have a sample new charges/visit written up to show insurance patients so that they know what you'll be charging their company. I don't think there's any point in trying to underplay (hide!) the increase in charges to insurance. They do get the EOBs.
Be sure that you explain how it affects what they pay, since that is the patient's main concern. There will be variations in the amount of co-pays, so it would serve you well to get the math all done before the change. You should have this all figured out before you talk with patients. This is definitely not a situation you figure out as you go along.
You asked about whether everyone should be raised at the same time. Why not? If it's got to happen, let's get it over with and get on to the things that are more fun. If you have a large practice or a low stress tolerance you could take each type of insurance one at a time, but I wouldn't use that as an excuse to delay the inevitable. So pull up your socks and get going. I'm sure your fee increase is long overdue.
Dear Readers:
I am always interested in hearing your thoughts and questions. I want my column to reflect your real life! You can talk to me or write me at the address below.
For those of you who would like to contact me by e-mail, I will need your real name, city, state, age, time in practice and normal weekly patient load. Also include your hours, number of staff and other pertinent facts that you think I'll need to answer your question. I don't answer nonspecific questions like, "How can I improve my practice?" I may ask you to call me if your question is long or complex.
Kiki Herfert
15852 Jefferson Avenue
Grosse Pointe Park, Michigan 48230-1445
Tel/Fax: (313) 822-9199
kikiherfer-aol.com
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