Is it fair to charge fees for paperwork?
That old phrase is taking on new meaning for health care providers as some practices institute patient fees to help cover the costs of administrative management and paperwork requirements.
Prior to 2009, only a smattering of medical offices charged administrative fees but with the passage the next year of the Affordable Care Act – and as technology costs jumped following the Centers for Medicare and Medicaid Services push for the adoption of electronic health records – the concept of charging fees caught on.
At the heart of the issue is time spent on patient care. The physician’s or dentist's time takes up the lion’s share of the cost of a patient’s visit, but time is spent by staff as well: making reminder calls, calling to straighten out insurance coverage issues, answering patient questions, coordinating referrals to specialists, emailing records histories, completing health and dental forms for school-age children, to name just a few. It all takes time.
According to the Medical Group Management Association, the cost of operating a medical practice has increased by 50 percent over the last decade, while reimbursement for physician services has lagged behind. MGMA has found physicians, both doctor-owned and large group practices, charge an average $20 for completing certain forms, such as disability evaluations or other forms unrelated to an office visit.
According to MGMA senior fellow Laura Palmer, the prevalence of fees depends on what the market will bear. “If (competing practices) in the community are charging to complete forms, a practice is more likely to charge. In most rural communities and less affluent areas, I rarely see fees charged. Practices in states that are very public and specific about medical records copying charges are more likely to have specific fees associated with completing other forms (insurance, disability, return to work, school physicals and sports eligibility, etc).”
So what is the answer? Would charging an annual or “a la carte” paperwork fee help or hurt?
Certainly the fee would help the bottom line. But at what price? Would your patients balk – and walk – at a “record-keeping fee”?
At California cardiology practice where a fee was imposed, doctors and staff said after they explained the reasons to their patients, many were “ok” with fee. For others, those already struggling with increasing health care costs and unable to absorb the cost shift, the additional fee sent them elsewhere for care.
Some feel insulted, even betrayed, by a doctor whose priority is on profits before patient care, seeing it as a simple nickel-and-dime money grab.
For now, physicians have been at the forefront of this change, but it may not be long before dentistry feels the same financial pressure.
There’s a fine line between real-world costs and patient relations. Have you drawn such a line in your office? Tell us about it.
The views expressed in this column are those of the writer and not necessarily the opinions of the Chicago Dental Society. CDS presents Front Desk, a column addressing problems dentists and staff members experience in the office. Front Desk is prepared by Stephanie Sisk, a freelance journalist. Suggestions? Email suggestions for topics to be covered to the Chicago Dental Society.
© 2015, Chicago Dental Society
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