Bring home the bacon

Episode 11: Bring Home the Bacon: It’s Okay to Get Paid Well

For medical practices to increase income, there are several steps to take. My top three favorite ways to increase income in a group are:

1. Improve your coding to get paid for what you’ve done
2. Add a medical scribe to supercharge your visits
3. Renegotiate insurance contracts and update credentialing

You’ll note that none of these require you to work harder. This is about working smarter and getting paid for everything you do.

We will have separate episodes on all three of those, because I believe they are all critically important parts of running a medical practice today.

Before we do that, I want to talk with you about earning money and valuing your time. Almost every physician I’ve met went into medicine because he or she was called to help their fellow human beings to be healthier and happier and to relieve pain and suffering. This is a noble profession, and you all have my utmost gratitude for the difference you make in this world.

All of those wonderful traits may leave you feeling a little disconnected from the notion of collecting money for what you do, or even a bit squeamish about things that seem too “business-ey”. It might even occur for you as mercenary. I’ve heard all of these words from physicians as we’ve had conversations about money over the years.

Money can be an emotionally charged topic for anyone, and when we mix it with something like healthcare that many believe is a human right, it becomes even more charged. That can be the topic for a lengthy philosophical debate, probably best had over some good wine. Philosophy aside, we have business realities, and the fact remains that today’s healthcare system in the US is a largely capitalistic one whether we like it or not.

My goal with this podcast is to raise awareness around business issues, including the need to collect money for services, so that medical practices can thrive, and you can continue bringing your high-quality care to as many patients as possible. They should all benefit from your excellent care. And, given our healthcare system’s structure, they all need to pay for it.

In my heart of hearts, I want all physicians to know their value, and to feel comfortable being paid for what you do. You’ve devoted so much of your life’s energy to your training and your practice of medicine, and our society values you. I want you to value you too! This is especially challenging for female physicians, given our cultural norms, so this message is especially for you.

You’ve worked hard. You have incredible talent, skill and ability. You have huge value. Own it.

Know your worth. If that’s challenging for you, benchmark yourself against other physicians, or even attorneys. I do this in my consulting practice. I observe that my corporate counsel, who happens to have the same number of years of experience as I do, bills his clients at nearly $500 per hour. He’s pretty smart, and so am I. Should I bill any less? I’d love to see you asking yourself those questions too if you have any hesitation about this.

I encourage you to normalize talking about money in the practice. Talk about your policies on how to collect it, and what your expectations are of staff. Talk about how and when you’ll make exceptions, and what your system is for patients who cannot pay. Make a choice about how much Medicaid or charity care you want to provide, and set up a system to do that. We’ll talk more about payer mix in an upcoming episode, but for now, if you’re giving away care by working for little or no reimbursement, I want you to know when and how much.

As one of society’s highly compensated professionals, be aware of earning differences among the people in your office, and don’t be callous. Understand that your staff are paid at clerical rates, mostly just a few dollars an hour above minimum wage, and they most likely live check to check. Understand their stressors around money, and while you cannot fix all of them, you can be sensitive to them. Also understand that when you want to give them some incentive compensation, it’s always appreciated, AND it will be effective at moving the needle on performance. More on that in a future episode.

I do encourage you to lean in, understand the business, understand the money part. Don’t delegate too much of this out of discomfort, or a lack of interest. We’ve heard in past episodes about the impact of embezzlers, and I don’t want any of you to have that experience because you shied away and trusted the wrong person.

At the end of the day, money is energy. It is an exchange of value for service. The challenge for all of us in health care is that with the introduction of Medicare and other third-party payers back in the 1960’s, we’ve become distanced from our customers, and they’ve become distanced from the actual cost of their health care. Sadly, many patients have begun to assume that the “value” of their office visit is simply the $25 copay they’re paying, as opposed to the $200 – 500 of actual value. And, our system has trained them that if they have to pay a deductible or co-insurance, that it won’t be due for a few months following the visit. That’s another topic we’ll review in an upcoming episode, as the market is shifting.

If you make more than you need, don’t shy away from that, and don’t minimize your contribution to your patients’ wellbeing by accepting less than you’re worth. Fund your retirement and any college savings accounts, then donate some to an organization in your community that is in alignment with your values. Do this with your partners as a business, or yourself as an individual or a family. I’ve seen some groups who have a directed giving committee so that each month the whole team decides where the donations will go. Have fun with this too. Making money that you can mindfully return to the community feels great.

Regardless of what you do with money you’ve earned, please value yourself and your years of hard work to get where you are today. It is easy to worry about patients, and how they’ll even afford their visit, and please rest assured that is not something to fix by down-coding or writing off balances, which I’ve seen many physicians do over the years. We recommend that your clinic have a sliding scale for patients who earn below the Federal Poverty Level, and in that way, you can recognize earning differentials and adjust pricing in a way that is respectful to you and the patient.

Join me for our next episode, where we’ll dig deeper into how to improve your revenue by renegotiating your insurance contracts.