The lesson of Officer Krupke
The subject of this blog is how to (1) run a financially successful practice, (2) earn as much money as the anesthesiologist sitting behind the curtain thinking about his dinner plans, (3) not miss your kids’ soccer games and school plays, and (4) work 40 hours a week. All at the same time. I can write about it because I’ve done it. My experience is that (3) and (4) are way more important than (1) and (2). However, in the spirit of cognitive dissonance, my focus is on financial success. The reason is that the Match results are in, and once again family practice residencies attracted fewer American medical students than the year before. The extinction continues. The reason is net income. So I return to the subject of money, the love of which is the root of all evil. While I continue to wait for the angel of charity to slash the unwarranted incomes of less challenging specialties, let’s address collection policies. Every time I go to a medical convention, a management consultant has a couple of sessions in a noisy, curtained venue that will tell you in 45 minutes what I’m going to tell you in six words: You’ve got to dump the deadbeats. Some of you have been brainwashed by social workers (on government payrolls, with defined-benefit retirement plans) into believing that deadbeats should be objects of mercy, not justice. They believe, with the delinquents confronting Officer Krupke (see Stephen Sondheim, West Side Story):
“Dear kindly social worker,
They say go earn a buck.
Like be a soda jerker,
Which means like be a schumck.
It's not I'm anti-social,
I'm only anti-work.
Gloryosky! That's why I'm a jerk!”
The world is full of jerks. The key to a successful practice is to distinguish between the jerks you can work with, and the jerks you can’t. That’s where your collection policy comes in.
Personally, I hate confrontation. I have only tossed a couple of patients out of my practice face-to-face. One of them was a pretty good friend who kept verbally abusing my staff. I’ve never done it for non-payment of debt. But lots have been booted out by a process that I consider both just and merciful.
The key is that I make it clear that no one will ever be dumped for inability to pay. If they ask for their debt to be forgiven, it will probably be forgiven. If they want to pay $5 per month, that will be fine. Here’s the key paragraph from the letter patients get before they are turned over to collections:
“I’ve tried to be human about debts. Anybody who tries to make arrangements to pay, and then follows through without our badgering, will make us happy. I don’t care if your monthly payment will never retire the debt. Just don’t make us keep sending you bills. That’s all we ask.”
And then there's this from our dismissed-from-practice letter:
“Our office policies do not prevent us from forgiving debts. It is only when patients neglect to discuss arrangements with us, or fail to abide by agreements, that we terminate service for financial reasons. It simply wastes too much time to chase patients with past due bills. Our office policies do not allow for dismissal based on the patient’s type of insurance or medical needs.”
Bills must be sent monthly, with “past due” amounts clearly labeled. At some point (you decide) comes the collection letter, then the heave-ho. But it has to be the same for everybody; no “respecting of persons,” in the Biblical sense, is allowed.
The alternative? Wasted time, which is wasted money; confused staff, leading to demoralization; all the tough calls ending up on your desk, making you late for the soccer game; or, worse, one more paper stacked in the inbox.
And ultimately, you'll end up with a practice skewed toward the type of patients who are least satisfying to treat, and whom you encouraged in their dysfunctionality.
Posted at 10:46AM Mar 25, 2009 by Doug Iliff | Comments[10]
