Tuesday, October 26, 2004

Buried in paper, medical groups turn to annual fees

Next trend? Doctor service charges

By Tim Bonfield
Enquirer staff writer

Starting next month, a family medicine group in Madeira and another in Springdale will join a small but growing trend of doctors who charge patients annual administrative service fees.

Dana Johnson, a receptionist with Springdale Family Medicine, talks to a patient over the telephone, while Norma Melton, also a receptionist, takes care of paperwork in the background.
(Enquirer photo/MEGGAN BOOKER)
Doctors say the fees help offset the costs of numerous professional services that they don't get paid for, such as calling in medication refills, consulting over the telephone and filling out medical forms for the Family Medical Leave Act, school physicals and applications for handicapped parking permits.

For patients of Madeira Family Practice, fees of $40 for individuals, $50 for couples or $60 for families take effect Nov. 15. For patients of Springdale Family Medicine, fees of $45 for individuals and $65 for families take effect Nov. 1.

"These are professional services that we're liable for," said Dr. Douglas Hancher, a member of the Springdale group. "It used to be that a doctor could simply raise rates for office visits to cover these kinds of things. But we can't do that anymore. I could charge $150 for an office visit, but I'll still get paid $38 from the insurance company or whatever their standard rate happens to be."

Patients of these practices might be irritated by the new fees, but few are so irritated that they plan to switch doctors.

Earlier this month, Madeira Family Practice sent out letters to about 5,000 families informing them of the new fees. With three weeks before the Nov. 15 deadline, the practice has received more than 100 checks from patients.

That compares to four or five irate phone calls.

"We didn't really want to do this, but our costs have just escalated out of control," says Dr. Doug Moore, a member of the Madeira practice. "We've tried to limit costs as much as we can. Our doctors have already taken pay cuts. But we can't increase our rates."

Amy Stevens, a patient at the Madeira practice, said she hasn't paid the fee because she doesn't need many administrative services from her doctor. But she also sees the fees as a sign of the times.

"I think this is coming for everybody," she said.

Some Greater Cincinnati doctors already charge similar fees.

Dr. Albert Weisbrot, who recently moved his practice to Mason after many years in Montgomery, started charging individuals $45 a year and families $80 a year in January. "I think we might have lost three or four patients because of it. We lost more by moving our office," Weisbrot said.

Montgomery Family Medicine doesn't charge an annual fee. But since March 2002, it has charged a-la-carte fees for after-hours phone calls, prescription refills without appointments, form completion and other services.

"It doesn't cover all the costs, but it has helped our doctors feel less put upon when they have a stack of paperwork at the end of the day that they won't be reimbursed for," practice manager Lola Parrish said.

Nationally, many doctors have at least considered charging administrative fees; but only a few have done so.

In Rhode Island, Dr. Allen Dennison charges $2 a minute for telephone advice and collects as much as $25 for filling out forms. He started charging the fees almost 14 years ago.

"It's not a large amount of money for me," Dennison said. "But it sends a message to patients that my time is worth something."

Probably less than 1 percent of practices actually have implemented administrative fee programs, estimates Fran LaVallette, president of Healthcare Facilitators, a practice management consultant based near Orlando, Fla.

"It's a relatively new issue. There's typically a lot of bad PR for the first doctor in a community who does something like this," LaVallette said. "But if it's a success, I think you'll see a lot more of it in Cincinnati."

The American Medical Association takes a cautious view of administrative fees.

In general, the fees do not violate ethical codes.

But the association recommends that doctors avoid charging such fees to lower-income people and make sure their fees comply with state laws and insurance contracts, and that they give patients plenty of notice.

"The fee ought to be reasonable and reflect the fair cost of whatever the service is," said Dr. Edward Hill, president-elect of the American Medical Association.

Several local doctors said the fees do not apply to all patients. For example, laws prevent them from charging such fees to people covered by Medicare or Medicaid.

Technically, the annual fees in Madeira and Springdale are voluntary. Those who don't pay the annual fee would instead pay from a list of charges for services.

The bottom line: Doctors wouldn't resort to such tactics if they were getting fair reimbursement for their services, Hill said.

"I think this is a symptom or a sign of a profession that is undergoing some stresses," Hill said.

Share your thoughts

If your doctor started charging an administrative service fee, would you pay it? Or would you look for a new doctor? Send your comments to Tim Bonfield, Cincinnati Enquirer, 312 Elm St., Cincinnati OH 45202; or fax at (513) 768-8340.

E-mail tbonfield@enquirer.com

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