New Patient Fees Make Up for Lower Revenue

By Silverman, Jennifer | Clinical Psychiatry News, January 2004 | Go to article overview

New Patient Fees Make Up for Lower Revenue


Silverman, Jennifer, Clinical Psychiatry News


Copying medical paperwork just got more expensive--for the patient. Barraged by rising medical liability premiums and diminishing Medicare payments, a small but growing number of office-based physicians are charging patients for administrative services that they once offered for free, outside of the office visit.

Dr. Joseph Clift, an internist in Oakland, Calif., has charged for prolonged telephone conversations that involved either major medical decisions or therapeutic changes.

"As far as I know, no one is charging for telephone calls routinely," Dr. Clift said in an interview. He also charges patients on a per-case basis for copying records or documents.

Dr. Joseph Leming doesn't see anything wrong with charging patients for these services. "Whenever a physician extends liability or incurs expenses, there should be a charge that offsets that expense," said Dr. Leming, managing partner of Prime Care Family Practice, Colonial Heights, Va.

Twenty years ago, physicians were reimbursed adequately enough through their evaluation/management services to offer patients additional services between office visits. Several factors--including the effect of managed care, rising practice costs, and the need to provide consumers with quality services--have essentially eliminated that margin, Dr. Leming said.

The cost of running a medical practice has gone up about 60% over the past decade, according to estimates by the American College of Physicians.

Entire clinics have instituted uniform charges for unfunded services. "One of the greatest aggravations" for a physician is being asked by patients to rewrite all their medications when their employer changes their insurance or pharmacy benefit management company or when their deductible is raised, said Dr. Terry Mills of the Wichita Clinic, a Kansas-based multi-specialty group of 165 physicians.

The work involved in that task "far exceeds the postvisit work [reimbursed] by the CPT," Dr. Mills said. The clinic now charges patients a $5 service fee for prescription rewrites, along with other types of paperwork.

Dr. Leming's office for the past few years has used a subcontractor to fulfill requests for copies of medical records. Patients pay a $10 base fee, 50 cents per page, and shipping and handling charges.

Patients pay $17 to $30 for their record, depending on length. In transferring this job to the subcontractor, the office was able to save $24,000 a year by eliminating a full-time employee.

Dr. Leming's practice also charges patients a base fee for completing Family Medical Leave Act forms requested by their employers, or other forms that the office considers to be "unrelated to health care." Many patients are disappointed with this new system, "but they realize it's the cost of doing health care. …

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