The Bigger Picture: New Approach for a Bad Economy

You’ve probably already seen the signs. A few months back, Benjamin Brewer wrote a much-quoted piece for The Wall Street Journal about how “tough times” were prompting patients to skip care: “A 59-year-old woman decided not to have a mammogram this year. At her age, she should be screened for colon cancer, too, but she is holding off until she becomes eligible for Medicare at 65. … She is pinching pennies by scrimping on preventive care,” he wrote.

That’s risky behavior for patients, but what about you? Legal, moral, and economic hazards abound. What if a patient doesn’t fill her prescription, gets sicker, and blames you? As the economy worsens, more patients will eschew visits and instead call in or e-mail for scripts and treatment plans. Are you confident about when to require patients to show up in the office as a condition of treatment?

Here are a few suggestions to protect yourself and your patients.

• Talk money. Don’t be afraid explain to a patient why your prescription or recommended procedure is important. Ask patients to let you know if they don’t follow through for financial or other reasons. A 2008 study by the Center for Studying Health System Change revealed that only 48 percent of physicians feel ready to discuss medical budgeting with patients. But if your patient is already sitting there in your exam room planning to cut those pills you just prescribed in half to save money, you had better know now, so you can suggest alternatives. You may need to convince patients that paying for treatment is worth going short elsewhere. This is marketing that benefits you and your patients. Brace yourself for the conversation.

• Tighten up recall and reminder processes. You can’t realistically expect all patients to show up for regular follow-ups, now more than ever. Set policies to document when you’ve asked patients to come in for a recheck, annual exam or other service. Use the myriad of automated reminder systems to encourage patients to make appointments for those services and to show up for them. You want to stress the importance of the visit.

Likewise, when you ask patients to make an appointment for a mammogram, colonoscopy, or other diagnostic or specialty service, follow up to see if they made and kept the appointment. You can’t force them, but you can document that you encouraged their compliance.

Take a look at how you communicate results of lab work, too. You might not see this patient again for quite some time, so are you confident that your patients hear about every abnormal finding? Don’t depend on flipping through the chart just before a patient visit to alert you to whatever news the patient needs to hear. Set plans to communicate outside patient visits.

• Set restrictions on virtual care. Expect more calls or e-mails from existing patients, and be prepared with a standard policy that covers the reasons folks will need to make an appointment to see you.

David Troxel, medical director for The Doctors Company, a malpractice carrier, helped write national guidelines for managing “e-risk” - the malpractice risk associated with virtual treatment. He advises, certainly, limiting phone or Web-based advice to patients you’ve already seen in your office. New symptoms for diagnosed problems or referrals might be easily handled virtually, but entirely new problems or serious complications need to be seen. “Physicians are trained to get a good deal of information by reading the nuances of body language,” Troxel points out. Pain, for example, is hard to judge without a physical exam. If you wish you could see a patient, then by all means advise them to come in, cost aside. You have a moral obligation to provide your best care.

It would be nice, sure, if patients’ personal finances didn’t affect your care and your business. But it’s not an ideal world and the times call for practical measures.

What are you doing to face the tough times? Share your stories in the Physician Forum.

Pamela Moore, PhD, CPC, is director, content & strategy for Physicians Practice. Moore has been writing for physicians on practice management issues for 10 years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pam.moore@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.