We will be working towards creating more blogs in the future. Please stay tuned..
August 12, 2023
Please see a letter below that I wrote in response when one of our patients messaged in asking some important questions like, how do other practices work without charging fees like the new Quarterly Administrative Fee?
I hear everyone’s concerns about this and I have honestly struggled with implementing this policy for a long time, but finally got to the point where I don’t really have a choice. The typical primary care / specialty medical practice is owned by a hospital corporation which makes money on imaging, labs, surgeries and in patient stays. This allows for the out-patient clinics to lose a little money but still be functional as part of an organization. Because of the corporate backing that keeps those offices functional, they unfortunately are also required by the corporation to follow certain rules. In most cases these rules involve seeing on average 20-30 patients in an 8 hr day. When this occurs, the typical visit is 10-15 minutes long and leaves very little time for communication with the patient. I was just speaking with a colleague about Dartmouth and how they book 8 minutes / patient. By doing this volume, their bill out and income is much higher than ours, which allows them to maintain their staff.
This kind of “quick care” is not the kind of care we want to provide at Compass. I want to know my patients, be involved in their lives and be able to educate and be trusted by them when I make recommendations. This means my providers see on average 8-10 patients / day vs 20-30 and we don’t get paid for a lot of the time we spend with people. Insurance pays for visits up to 54 minutes – and that counts the time we spend writing our notes (which takes 10-15 minutes after seeing patients for 45-60). We can bill out for additional time beyond the 54 (code 99417) but most insurances consider this code one that should go to your deductible- therefore requiring you to pay the allowed fee (about $50) out of pocket. We have tried billing this for people and sometimes I still do – but I can’t tell you how many patients got angry at us because their insurance does not cover this or applies it to deductible resulting in them paying extra for visits. This makes it very hard for us to give patients what they want/need without extra costs…The system is broken!
Other practices often don’t order the number of labs / tests that we do which saves the providers the time of interpreting results and not providing care outside of visits for which we do not get paid for. That doesn’t help patients with managing hormone and nutrient levels, so not only do we order the tests, we review them all and provide recommendations / education for patients regarding their results. This to me is good care, but still makes us no money -and I really don’t think it is fair to make each patient come in for a 30minute appointment to receive basic information about their labs. Of course, when it is indicated for significant abnormals or by patient request, we do offer lab reviews with education and treatment holistic options – often information not provided at other practices.
At other offices, many medications are often sent out for a year at a time with little follow-up and monitoring. At Compass we prescribe thyroid meds for 3-6 months depending on patient stability (to help optimize doses based on body fluctuations) and mood and anti-hypertensives are sent at 6 month intervals so we at least have to check-in with patients every 6 months to make sure they are doing alright on their current regimen prior to sending new prescriptions. Of course, this sort of stuff is part of good care and takes up our time, but we do not get paid for checking in more often to make sure everyone is doing well. Many practices actually make patients come in to the office for their “10 minute visit” to get a simple med refill. That results in them receiving your co-pay and an insurance payment (making money) while we do this via phone and portal at the patient’s convenience (without pay). Same applies to triage and portal messages. We have clinical staff that triage messages with patients, review them with providers between visits and then get back to patients with recommendations – often providing care / answers without making patients come in – again costing us money not making it.
We are busy and are helping a lot of patients so we try to make things work so not to over-book the day by making patients come in for every little thing. That being said, we do realize there are times where patients have to come in to receive urgent day of care – or require in-person assessment. We have recently adjusted the provider schedules so that there are a couple hours every day that there is a provider available to see these kinds of visits. These visits are booked during the provider’s administrative time to work on the notes we have to write (to provide insurance with reasoning for why we should be paid) and we interrupt that with urgent visits when needed. We have been doing this for a few months now and it seems to be working well for squeezing in sick visits. With regards to booking routine visits – you are right that it can take a month or two to get in with me…but we work as a team and Brittany and Rebecca have appointments next week. I am 6-8 weeks out for
45-60 minute visits…that is partially because there are only 8-10 slots in a day (again to spend time with patients).
I will tell you that in most clinics this is an issue because there are not enough providers to go around. Many providers are leaving primary care (hard work and low-pay) and the rest of us are trying to compensate and pick up the slack (which is why finding someone new is so difficult). You will likely experience waits and short visits no-matter where you go as that is the standard medical climate these days. I am trying to find a way to navigate this problem and make it manageable for Compass and our patients. Here, we also try to offer many services and keep patients in-house vs sending out to specialty clinics (many of which have a 6 mo wait IF they are even taking new patients). This means our clinicians have to be well educated on many advanced topics which requires a lot of education / training and time. The hormone pellets and cosmetic treatments we keep at a competitive rate (still the only NH BioTE clinic). We minimally mark up the supplements we sell and our medical weight loss program is set at about $250 out of pocket vs the average $1000 monthly. We try to offer these services at a reasonable cost so that more people can afford them and benefit from them. This again contributes to a lower profit margin for us, and just goes towards the fact that we put our patients first vs prioritizing making money.
The new fees will allow for us to maintain more staff, expand hours and actually pay our staff an appropriate wage for the work they do. I personally have not taken a salary in the 5 years we have been open and I still work a side job on Wednesdays to support myself. Something has to change and I don’t want it to be what we do for our patients. When I originally sent out the 1st letter it was going to be that all patients were $100 / qtr but after having multiple letters like yours and concerns about family costs – we changed things so that 14-24yo are only $50/qtr making it less of a burden for families. I hope that helps people and that they are able to see I am trying to be reasonable and want to maintain our current population (especially those who care about their wellness). I just won’t be able to stay open and provide the type of care that we do if we don’t change something. This type of situation occurs all over the US and is becoming more typical - we are just a little slow in ME/NH. I think the type of care and services like what we provide here, to find another clinic is going to be just as expensive if not more-so. I did a lot of research into what others offer and set the $50-100 quarterly vs 100-300/month as a way to balance our costs and not be too expensive for the average patient. I know it is different and comes as a shock – but I truly believe this is going to be a common thing for most privately-run clinics in the next 5 years – that or we will all close.
I hope this letter helps you understand the back-side of the medical world and can explain a little more about why we do what we do and where the new quarterly administrative fee is coming from. Thank You for your understanding and appreciation.
Laura Honored as a Woman of Distinction
In April 2018 Laura Hudson FNP-C, APRN, MSN was notified that she had been nominated and accepted for admission into the Trademark Women of Distinction Honors 2018 Edition. This came as a fun surprise as Laura was delighted for the acknowledgement!
Thanks to everyone who lets me be me and do what I do -Laura
Nurse Jen Graduates with a 4.0 from her FNP program at Walden University!
Some of you may remember that Jen was an NP Intern in 2017 with Laura while she was working at MFG & PCW. Jen has now successfully finished her Family Nurse Practitioner program and did so with fantastic grades and understanding of what it means to become an NP.
CONGRATS Jen we are so proud of you!
July 9 2018
And....We are open in the new space! We have expanded into multiple new rooms within the Journey to Wellness. Check in is at suite 9 and we have 2 other rooms for exams and appointments. We are still using the billing software through MFG & PCW through the end of 2018. The new phone and fax numbers are active and we are here to help!
FNP-C Jennifer Skoczylas!
Congrats to Jen for passing her AANP Board Certification!
The Compass Family is all so proud of you!
October 22, 2018
Happy Birthday Laura!
November 22, 2018
Happy Thanksgiving Everyone!
This year the Compass Family Health Team are particularly thankful for all of our amazing patients. You give us purpose and make us smile every day! Wishing you the best long weekend! See you when we re-open on Monday morning!