Managing a Medical Practice in Today's Tough Economy

For those of us in private practice, managing a medical practice can be a full-time job. Not only are we providing care to our patients on a daily basis, but we are also required to constantly monitor the financial pulse of our practice. In doing so, we must routinely review the accounts receivable, do our best to manage spending on supplies, and regularly provide annual pay increases and bonuses to our employees. Not to mention the added price of providing benefits such as retirement or pension plans, healthcare insurance, and paid time off.

The above financial reviews can be very trying on physicians in private practice. Every day we are faced with reviewing third-party insurance contracts, monitoring copayments and regularly sending out bills for collections to our patients. Our costs of keeping our doors open increases as each new year passes.

In our current economic climate, it is very difficult to not only provide the needed care for our patients but also to make sure that our patients are being compliant with their treatment plans. With the current price of gasoline topping $4 across the nation, many of our patients are placing their own healthcare needs on hold just so they can have enough money left over at the end of the month to pay their regular bills. In my practice, I am regularly seeing patients defer important health screenings such as mammograms, pap smears, colonoscopy, and regular laboratory testing.

In such difficult economic times, how can the private practice maintain its financial security? As patients come in to the office for routine visits, a review of their plans show that insurance companies are assuming less of the responsibility for healthcare and patients are the ones footing more of the bill. Coopayments are increasing, deductibles are increasing, and at the same time, reimbursements from insurance companies have remained flat, if not decreasing slightly.

Just the other day, I received a refill request from one of my patients for a blood pressure medication. A review of the patient's chart indicated that they had not presented to the office in over six months for an office visit. This particular patient was taking a combination ACE inhibitor plus diuretic medication that requires not only monitoring of their blood pressure, but routine laboratory testing to follow renal function and electrolyte levels. As a family physician practicing in my hometown, I have known many of my patients since I was a child. How are physicians to encourage their patients to be compliant with follow up visits and at the same time provide compassionate care. Many of us in a similar situation would understand the financial burdens our patients are suffering from, but at the same time how do we provide the care that they need to insure that their medications are not adversely affecting them? Not only can patient compliance suffer, but the liability that physicians assume from such practices increases as well.

Another patient taking a statin medication for cholesterol lowering submitted a repeated request for a medication refill. Again, a review of their chart indicated that they had not presented to the office for regular monitoring of their liver function as I had ordered. For this patient that had been absent for almost a year without laboratory monitoring, I instructed my nurse to inform them that further refills could not be dispensed until they presented for an office visit along with a lab draw.

As many physicians, most of us have the security of being able to tolerate such economic woes more comfortably than our patients that are earning lower incomes. However, it is very important not to positively reinforce such behaviors from our patients that could place their health in jeopardy. There is no perfect solution to the problem. I am only hopeful that as this year passes, our politicians and policymakers can provide legislation that will allow for an improvement in our current economic situation. In the comments field below, I would be eager to hear about the experiences of my colleagues in similar situations to see how they are handling similar problems.

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