IPAs: an evolutionary dead end; Insist on copays up front; You can't always be accessible
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"How IPAs are changing" [June 20] did a good job covering the current state of IPAs. It was humorous to read about the convoluted schemes these dinosaurs have concocted to justify their continued existence.
IPAs evolved out of physicians' fear of managed care and their yearning for a cheap way to "do something" about inadequate reimbursement. But since antitrust laws generally prevent IPAs from negotiating fees for their members, most were doomed from the outset.
Now, large health plans dictate reimbursement rates to doctors, who have been reduced to thanking them for being allowed into their networks. The only way to stop this trend is through the negotiating leverage of larger, fully integrated, group practices.
The advice to resort to your normal collection procedure to collect unpaid copays makes no sense [Practice Management Q&As: "The rules of copays," June 20]. It will likely cost you more to collect the copay than it's worth.
Make it office policy to inform your patients when they schedule their appointments that a staffer will collect their copay before they see the doctor. Then if, at the time of service, they don't have cash available, your staffer should suggest that they use a check or credit card to fulfill their obligation. If they still say they can't pay, she should offer to reschedule the appointment. In my experience, at that point, almost all patients manage to come up with their copay or ask where they can find the nearest ATM.
Proper training of the front office staff can bring your A/R in line and reduce the time spent chasing unpaid copays.
I had to chuckle when I read internist Judith A. Paley's article about hard-to-reach physicians ["When the doctor is in(accessible)," June 20]. I could have my office open 18 hours a day and still somebody would complain that I didn't return a call on time or that I took a vacation day when she was sick.
Long ago, I gave up trying to be always accessible to everyone. I've learned that the customerpatientis not always right, and that it's hard, but necessary, to sometimes say No. I try to do the best I can and give service as conscientiously as possible. Basically, I simply strive to be fair, not only to my patients sitting in the waiting room or calling on the phone, but also to myself, my family, and my office staff.
Leslie Strouse, MD
New Albany, IN
It's important to recognize that policy flows from the top, down. If your staff is overly protective of your accessibility, they may have gotten the impression from your complaints or comments that you don't want to talk to patients.
Frank J. Weinstock, MD
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Letters to the Editors. Medical Economics Sep. 19, 2003;80:9.