Practice Management

Medical Economics, August 26, 1996 | Go to article overview

Practice Management


Managed care's magic number

Q: How many capitated patients do I need assigned to me to assure a profit? Can the minimum number come from a combination of plans, or do I need to get a certain floor level from each? A: Primary-care physicians need 300 to 500 patients per plan to stay afloat under capitation, assuming the payments cover primary-care services only. These numbers don't assure profit; they simply spread risk. The plan's patient mix of age, sex, and health status, as well as its capitation rate and what that covers, will determine profitability.

How to parlay a compliment into free advertising

Q: A patient sent a note thanking me for my prompt and undivided attention and praising my staffers for their kindness and courtesy. I'd like to post it on the bulletin board in my waiting room. Short of the patient's withholding permission to do so, is there a reason not to do this? A: No. A posted letter is free advertising and great public relations. If the patient balks at your request, ask whether removing her name from the letter would make the idea palatable. If she still says No, allow only your staffers to read it. They'll appreciate the pat on the back.

Don't leave the letter on your bulletin board for more than a month; patients will think you've received no praise in the interim. Include other marketing information, too.

If you build it, how many will come?

Q: What factors should I look at when trying to predict how many patients I can expect the first year my practice is open? How quickly should a practice grow after that?

A: Consider the size of your community, patient demographics such as age and income, the number of physicians in your specialty already practicing in the area, and patient volume in existing practices. You can get demographics from the chamber of commerce. The state or county medical society or a local hospital should be able to provide you with the other information.

In a viable practice, patient census should double in your second year and grow 10 percent in each of the third and fourth vears. Achieving an ideal referral rate

Q: Is there a "normal" rate of referrals to specialists in gatekeeper health plans? I'd like my referrals to be in line with whatever the norm is. A: Rates vary by region, availability of specialists, which specialties an HMO designates as primary-care providers, and community practice standards. One consultant estimates that the average patient under 65 will see her primary-care physician twice a year, and a specialist twice a year. This estimate typifies women enrolled in HMOs who need to get a referral to see an OBG.

Ask the managed-care plans you contract with what they consider normal. You can be fairly sure you fall within the norm if you follow practice protocols developed by the various specialty societies and managed-care plans. Whether MSAs will be costly to doctors

Q: I know a lot of doctors are enthusiastic about medical savings accounts, which were explained in your Oct. 9, 1995, issue. But if patients tried to save money by shopping for the lowest fees, wouldn't doctors lose out in the long run? …

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