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Sneaky Things That Doctors Do To Survive Financially, Part 2

Dr. Val’s note: this post is Dr. Dappen’s continuation of “Sneaky Things That Doctors Do To Survive Financially.”

***

The Funnel

By Alan Dappen, M.D.

Back to the gridiron we go. Two powerful teams square off. It’s Team Doctors vs Team Insurance. You, the patient, the object of our affection, have bought entry to this game through two payments. The first serves as your season ticket, and is the $800/month fee (coverage for a family of four) that goes to Team Insurance. You gain admittance to today’s game through your $20 dollar co-pay, which is collected by Team Doctor.

The $20 co-pay is really a ruse to distract attention away from Team Insurance and the plays the Doctors are about to pull. In reality, $20 co-pay doesn’t come close to covering the cost of an office visit (more about this on a future posting). Team Insurance is supposed to make up the difference of these costs for Team Doctors. To stay in the game, Team Doctors must hit Team Insurance just right to cough up enough money to cover their bills. On the other hand, Team Insurance hits back, denying and delaying payment of claims from Team Doctors, pocketing plenty of money to keep their fans (share holders) screaming “We’re Number One.”  The focus of this game is on money, with the patient distracted by the $20 co-pay, believing it is fair payment and the middle man (insurance) works in their best interest.

Now let’s look at “The Funnel,” the number one play Team Doctors use to recoup their money. Let’s say you have a typical medical problem and contact your primary care provider for help. You inadvertently have stepped into the playing arena. To get you the help you need, Team Doctors will run you through “The Funnel.”  This formation is the most effective play used to sustain doctors financially. Keeping The Funnel packed to the brim with patients is critical to the success of a medical office, with this success hinging on seeing at least 25 patients a day and keeping the simple problems coming back to ensure the cash follows.

Here’s how The Funnel works:

1.    Overloading: Also known as seeing patients for anything. Insurance companies will only pay primary care providers for a face-to-face visit, and not a phone call or email consultation. Ironically, 70% of typical day-to-day primary care problems can be solved by a phone or email conversation only.  Doctors need payment from insurance providers to stay in business so only conduct office visits, no matter what the problem.  Think back on some of your medical needs and how they were handled: Need a prescription refill? Need to ask a simple question? Need an antibiotic? Need to set-up or discuss a lab test? Need a follow up? Make an appointment to be seen.  Welcome to the funnel!

2.    Get the patient through as fast as possible: Keeping the flow rate constant through the funnel means limiting opportunities where patients can slow their transition through the neck of the funnel, possibly plugging it up, and thus slowing the doctors’ chance for cash.  Four major strategies keep the pay/time ratio flowing properly for Team Doctors:
a.    Ration the long visits, like a physical, by making patients wait 6-12 weeks to come in for them.
b.    Divide and conquer the 20 minute visit. Invite the patient to stick to one problem per visit and then invite her to return to the top of funnel on another day for any additional problems.
c.    Find ways to “increase value” of visits by requesting additional tests or services, like “How about we do an EKG?”
d.    Turfing the “complicated (time consuming)” issues to other practices. Ever been sent to a specialist that your doc couldn’t solve your problem 10 minutes? This is why.

3.    Get the patient to come back, as often as possible. Also know as a refilling The Funnel.  Continuous, fast-paced repeat business is the most important measure of a financially solvent office. Imagine this: Medical partners who get to know their patients and consequently care for their well-being create liabilities if that caring takes longer than 10 minutes on average per patient.

I invite readers to write in their examples of being part of the funnel. Did the funnel compromise your care or inconvenience you?  Why would the doctors run you through the funnel?

Lastly is the question: What can you do about The Funnel? Better understand the system, why the funnel exists and why it’s important that you, the patient, take control of not only your care, but how it’s paid.

Until next week, I remain yours in primary care,

Alan Dappen, M.D.


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10 Responses to “Sneaky Things That Doctors Do To Survive Financially, Part 2”

  1. DJ says:

    $800 for a family of four?! Wow. My HMO is now $1500 a month (went up 20% this year) for just my husband and I.

  2. DJ says:

    $800 for a family of four?! Wow. My HMO is now $1500 a month (went up 20% this year) for just my husband and I.

  3. Warmsocks says:

    My PCP's funnel? He's pretty good at #1, #3, and #2a, but too good a doctor to stick to 2b,c,d.

    I went in for what turned out to be rotator cuff tendinitis. Cortisone shot (both shoulders, so one was not reimbursed), and follow-up in a month. Follow-up again in another two months, repeat shots (again, only reimbursed for one), check back in a month…

    Physical exams now are only 45 minutes instead of a full hour.

    My doctor no longer does prescription refills over the phone. Patients are expected to know how many refills they have and get new written prescriptions at their appointments. I have no problem with the doctor being paid for the time it takes to pull a chart, check medication, ensure that it's still appropriate for me to take, but that is against the rules. So if I have to go in and pay $20 in order for insurance to be billed $80 for a twenty minute appointment, that's okay with me. Because I like my doctor. He is good, and he truly cares for people. It doesn't begin to make up for the two times my doctor spent half an hour with me, and the one time he spent a full hour, but only got paid for twenty minutes. I will gladly pop in for a couple minutes to get my refill, and hope that if it happens for enough years, somehow he will be repaid for all the unreimbursed time he spent with me.

    My doctor does not have clocks in any of the exam rooms. Most appointments stay within the scheduled timeframe. He says that sometimes people need more time, and he doesn't want them to feel rushed.

  4. Warmsocks says:

    My PCP's funnel? He's pretty good at #1, #3, and #2a, but too good a doctor to stick to 2b,c,d.

    I went in for what turned out to be rotator cuff tendinitis. Cortisone shot (both shoulders, so one was not reimbursed), and follow-up in a month. Follow-up again in another two months, repeat shots (again, only reimbursed for one), check back in a month…

    Physical exams now are only 45 minutes instead of a full hour.

    My doctor no longer does prescription refills over the phone. Patients are expected to know how many refills they have and get new written prescriptions at their appointments. I have no problem with the doctor being paid for the time it takes to pull a chart, check medication, ensure that it's still appropriate for me to take, but that is against the rules. So if I have to go in and pay $20 in order for insurance to be billed $80 for a twenty minute appointment, that's okay with me. Because I like my doctor. He is good, and he truly cares for people. It doesn't begin to make up for the two times my doctor spent half an hour with me, and the one time he spent a full hour, but only got paid for twenty minutes. I will gladly pop in for a couple minutes to get my refill, and hope that if it happens for enough years, somehow he will be repaid for all the unreimbursed time he spent with me.

    My doctor does not have clocks in any of the exam rooms. Most appointments stay within the scheduled timeframe. He says that sometimes people need more time, and he doesn't want them to feel rushed.

  5. whnp says:

    I can see your points mostly but I am at a loss at to how 2c improves anybody's bottom line, unless it is law-suit protection. We are not reimbursed at any level nor receive money for any test we send the patients out for, including blood tests and imaging. I'm not sure what you're talking about there unless you're implying that it makes the patient feel his face-to-face time is more worth the time because you did extra “stuff”.

  6. whnp says:

    I am at a loss as to how 2c can improve anybody's bottom line, unless it is as lawsuit protection. We are not reimbursed at any level nor receive any money for tests outside the office, including blood work and imaging. Maybe you're implying that patients will think face-to-face time is “worth it” if we just arbitrarily add unnecessary testing?

    The flip side of all this is the patients who refuse to come in (because of costs and travel time) and want to conduct all health care for free over the phone, cutting into my time with patients in the office and wanting endless refills on meds that may or may not still be helpful. I, for one, am very reluctant to diagnose a “discharge” or a “pain” over the phone, even if the patient is convinced it is just like the last “discharge” or “pain”. I doubt I would change my practice even if I were reimbursed for phone calls.

  7. whnp says:

    I can see your points mostly but I am at a loss at to how 2c improves anybody's bottom line, unless it is law-suit protection. We are not reimbursed at any level nor receive money for any test we send the patients out for, including blood tests and imaging. I'm not sure what you're talking about there unless you're implying that it makes the patient feel his face-to-face time is more worth the time because you did extra “stuff”.

  8. whnp says:

    I am at a loss as to how 2c can improve anybody's bottom line, unless it is as lawsuit protection. We are not reimbursed at any level nor receive any money for tests outside the office, including blood work and imaging. Maybe you're implying that patients will think face-to-face time is “worth it” if we just arbitrarily add unnecessary testing?

    The flip side of all this is the patients who refuse to come in (because of costs and travel time) and want to conduct all health care for free over the phone, cutting into my time with patients in the office and wanting endless refills on meds that may or may not still be helpful. I, for one, am very reluctant to diagnose a “discharge” or a “pain” over the phone, even if the patient is convinced it is just like the last “discharge” or “pain”. I doubt I would change my practice even if I were reimbursed for phone calls.

Trackbacks/Pingbacks

  1. Better Health » Beyond the Five-Digit Codes: The Art of Putting Patients First
  2. Better Health » Sneaky Things Doctors Do To Survive: Financial Reality Part 3
  3. Better Health » The Unturned Stone of Healthcare Reform: Primary Care Practices That Compete on Price & Quality

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