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Patient payment plans, collections on rise as economy remains sluggish

EDITOR'S NOTE: Times remain tough — and dermatologists and patients continue to face sometimes difficult financial decisions. In this issue, we look at what some practitioners are doing to keep their businesses strong.

National report — As the sluggish economy continues to pinch both patients and practices, dermatologists are working harder to collect what's owed them — and to spend smarter on business expenses.

Collections are on the rise, many practitioners say, and so are the numbers of patients requesting extended payment options. Meanwhile, declining revenues are forcing many doctors to cut back on personnel, marketing and overhead costs.

Dr. Cleveland
Mark G. Cleveland, M.D., of Burlington, Iowa, says that over the past two years, the number of patients whose accounts are referred to a collection agency has risen 40 to 50 percent. The number of patients with whom he works out payment plans also has expanded about 50 percent.

"With the economic issues, we have a lot more people struggling," he says.

Some doctors say patients are being caught off guard by changes in their medical coverage.

Dr. Downie
Jeanine Downie, M.D., says that since 2009, she's noticed about three patients a month wind up in collections because they are unaware that their deductibles have risen.

"They think everything is covered and either ignore or throw away the bills" sent by her Montclair, N.J., private practice, she says.

Paying up front

One way to avoid such problems, says Joel Schlessinger, M.D., an Omaha, Neb., dermatologist, is to collect payment for medical visits up front.

Dr. Schlessinger
Dr. Schlessinger says the number of his patients referred to collections has decreased two-thirds since January, when his practice instituted that policy.

"We've always had that approach for anything cosmetic," he says. On the medical side, "With the significant changes that have occurred in deductibles and particularly health savings accounts, in which deductibles can be as high as $5,000, we felt it was imperative that we have a thoroughly transparent process for patients at check-in."

To that end, Dr. Schlessinger says unless a patient's current insurance information is on file, nurses now check medical insurance and deductible levels before placing patients in an exam room. In fact, he says that whenever possible, nurses inform patients of their deductibles and out-of-pocket costs before their visits.

"Generally, people are very happy about this because they know what they're going to pay for the visit in advance — rather than being surprised if a bill comes a month later," he says.

Benjamin Treen, M.D., a Dothan, Ala., private practitioner, says that about a year ago, his practice started asking patients for credit card numbers before treatment, to cover any fees that insurance didn't.

But his office didn't require it, he says, and "maybe 15 percent" of patients provided the numbers. In July, Dr. Treen traded his Greenville, S.C., solo practice of 23 years to work in an Alabama office of Gulf Coast Dermatology, based in Panama City, Fla.

The economy alone didn't drive him from solo practice, Dr. Treen says. Rather, he says he was tired of management headaches — such as personnel matters, regulatory issues and day-to-day decisions — and the slow economy confirmed that he'd made the right choice.

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