Physicians increase revenue with better appointment analysis

by Nikolaos I. Kakavoulis, MD

Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.

Why is this happening?

Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed to run their practices. At the same time, practice costs are increasing and reimbursement rates are declining.

Physicians didn’t go to medical school to be in business – but with 87% of physicians in practices of 5 physicians or less, they are often times splitting their time with patients to essentially run a business. Wearing that hat means that physicians need to start clearly identifying and addressing key revenue drains on their practice to ensure that they continue to remain competitive and profitable. And depending on the market, there may be hundreds of physicians competing for the same pool of patients. Education and research on the latest tools and practices that will help to make their practice stand out, is imperative.

One of the primary revenue drains, vacant appointment times, is shockingly simple to diagnose. However, for newly graduated residents looking to build their practices, driving awareness and booking appointments can be a challenge. What’s even more surprising according to the Medical Group Management Association is that even physicians with busy practices and long wait lists lose 12% of their available appointment times daily, due to patients that don’t show up, or cancel at the last minute.

Scheduling delays are another challenge facing physician practices. A 2008 Athena Health white paper found that 40% of appointments scheduled more than 20 days prior get canceled or are no-shows. That rate drops to 7% for day-of appointments. Given that Americans wait an average of 20 days between making an appointment and seeing a doctor according to a 2009 Merritt Hawkins survey, it is no wonder that even physicians with busy practices face this last minute, daily drain on their income.

Thankfully with the Internet and the recent emergence of Health 2.0, physicians now have access to online tools that make tackling these problems both easy and cost effective. Several online applications exist today that remind patients of their upcoming appointments, streamline appointment scheduling, and help increase doctors’ visibility among new patients browsing the web.

To help remain competitive and profitable, here are some ideas physicians might want to consider:

· Implementing automated reminder calls, emails or text messages ahead of scheduled appointments
· Highlighting their available appointment times and last minute cancellations online to patients
· Growing their patient base through direct marketing and referrals

Nikolaos I. Kakavoulis is a member of the founding team at HealthLeap.

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  • anonymous

    i call bs on the 87% of physicians being in practices of 5 physicians or less.

  • SmartDoc

    ” Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change. Why is this happening? ”

    Uh, because Medicare and other pegged reimbursement has declined 15% between 1995 and 2003 after adjusting for inflation?

  • Yious

    I still wish my doctors would become MORE online contacting wise.

    Neither doctor that I visit AND like will respond back by emails or set up appointments online or anything.

    I know the liability is high and doctors want to see people in person, but simple questions could save patients visits and the doctor could still charge for an email response if they want

  • Chelsea

    Isn’t nearly everyone’s income declining???? Especially after adjusting for inflation.

  • anonymous

    assuming insurers allowed physicians to bill for emails, how much would you be willing to pay?
    it is hard to price in liability which changes every year.

    $20? $40?

    and in answer to chelsea, no not nearly everyone’s income is declining. at least not the people i employ or according to the business owners i encounter.

  • imdoc

    Yious, what you say makes total sense. Unfortunately in practice, such does not happen. To communicate medical problems and advice via e-mail has privacy concerns (regulation), and legal concerns (litigation), as well as payment concerns. Since public payers and insurance do not recognize legitimacy of phone or e-mail advice as a service for which a doctor can bill, most doctors have limited success in getting paid. Interesting that here is a case in which the consumer wants a service and is willing to pay, and the service provider wants to provide it, but third parties obstruct the provision. Real reform would entail ridding ourselves of such absurd aberrant economic policies. Then we would see a race to provide service in the most cost-effective and convenient manner. We are witnessing the effect of endless cycles of the triple-threat: Regulation, Taxation, and Litigation.

  • TrenchDoc

    No not everyone’s income is declining. Not atheletic coaches not professional atheletes not actors or actresses not politicians. Not any profession that REALLY matters in our society.

  • Greg

    Clinical psychologists and psychiatrists in private (psychotherapy) practices have a solution that has worked for the past 70+ years: charge patients for missed appointments.

    If you show up for the appointment, you pay the fee. If you don’t show up, you pay the fee (albeit sometimes a reduced rate). Kinda makes you want to show up for appointments. Or, if you don’t want the service, don’t make the appointment in the first place, and let the therapist fill that spot with someone else. Simple, yet effective.

  • Mike Cuesta

    Nice post Kevin.

    A great take-away from this is that the physicians practice needs to become more connected with their patients.

  • TrenchDoc

    I agree – more connected and being paid more for being connected. Most reimbursement is based on face to face time and the complexity of the presenting problem. I have been in practice 32 years with 2 different primary care groups and we have always provided 24-7 call coverage for our patients at NO EXTRA CHARGE. Multiple 12 hours of call by every 4th day of call times 32 years of practice by whatever hourly wage you want to pay me. Where else do you get tech support for free for the lifetime of the product?

  • TrenchDoc

    Another thought is to just pay docs the same rates lawyers get for their email response to their clients. Either way It is more than what we get now.

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