From Physicians Practice Inc. Q. I am starting up my own family practice. What panel size should I expect to have in a mature practice? The Medical Group Management Association (MGMA) reports that family practice physicians not doing obstetrics see a median of 4,594 ambulatory patients per year. Does that sound right to you? A. To clarify, the MGMA reports 4,594 ambulatory encounters a year, not patients.
Even if you have a relatively small patient panel, if those patients are sick or you see them a lot, you can still generate many visits and many payments. What pays is seeing patients, not having them pick you as their primary care physician on their insurance forms. That's why a panel of 2,000 elderly patients represents a much different workload than 2,000 patients in their 20s and 30s. In short, panel size matters less than encounters and charges. That said, a normal panel size in family practice is about 2,500. A patient on your panel is generally one you have seen in the past two years. Q. Is there an industry standard for the frequency of mailing patient statements? We send each patient a monthly statement, but are thinking it would improve workflow and cash flow to mail 25 percent of the statements each week rather than have one mass mailing. A. Ideally, you'd send statements on a rolling weekly basis. That is, for every patient you see Monday through Friday this week, mail statements by next Monday.
Shorter batches improve collections -- a patient who just saw you is much more likely to pay than if a month has passed. It might also help to reduce the number of statements you send. Most practices send far too many. I recommend sending at most three, with increasingly serious language (see the collections letters in the Tools area of our site at www.PhysiciansPractice.com). A patient who has not responded after the third statement is not going to respond to the fourth, fifth, or sixth. After the third, tell patients you are sending them to collections -- then do it. Q. Some of my employees stay on the clock even though they are not working. How do I put a stop to that? A. The first step is to establish a written policy that says that all staff are required to clock in and out, and also that everyone has to request overtime or extra hours -- they can't just stick around. Having this in writing and announcing it at a staff meeting will help all by itself. Also, ask why people are not clocking out. Is there a more convenient place to put a time clock so that people remember to use it? There are also biometric devices now (see www.countmeinllc.com) that prevent fraud and are simple to use. You need to understand why the problem exists to best solve it. Certainly, if you see people hanging out who are still clocked in, address it then and there; tell them to clock out. Q. We are somewhat confused by the subject of copays. Eighty-five percent of our practice is generated in the hospital -- either through consults or the emergency department -- and we rarely see patients in the office until their follow-up. Are we ever allowed to collect a copay on a patient's follow-up visit? A. You are correct that most patients you see -- those that came to you from the hospital -- do not owe you a copay when they come to your office for follow-up care.
Follow-up visits generally don't include copays. Of course, you'll want to collect from anyone else -- your other 15 percent of patients. Q. Can we have patients prepay their deductible or copay to give the patients an incentive to show up or at least cancel an appointment rather than no-show? A. I have never heard of practices requiring a prepay. You can certainly ask your payers if they would allow this; this is entirely up to them and their contract with you.
Some practices do charge no-show patients a fee, of course -- usually around $15 to $25. If you go this route, make sure you let patients know in advance (or it doesn't serve its purpose), and don't spend more time collecting it than it is worth.
Reminder calls also work wonders. Copyright (c) 2005 Physicians Practice Inc. www.PhysiciansPractice.com All rights reserved. Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.
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