Financial Hard Times
February was a tough month for ECFC. Our patient visits were down and our receipts even lower. We typically see a decline in receipts the first couple of months of the new year as patients are recovering from the holidays, have new insurances and new deductibles or now have no insurance at all. Our office staff were on edge about their positions, my partners were concerned we may have to close and my mind was racing with ideas to increase revenue as well as patient visits.
There have been a few changes in the health care landscape of Eagan since I opened (here) in 2005. A CVS Minute Clinic opened a half mile up the street and a new "health system" primary care clinic opened in the downtown area (about 5 minutes away). These clinics provide stiff competition to our small NP practice. Minute CLinic was able to negotiate with MN insurance companies to waive patient copays for visits to the clinic. I am contracturally obligated to collect copays for patient visits. Insurance payments have decreased as the copay amounts have increased. To the general population, that means I get more in my pocket, when in fact, the insurance company pays less and the patient is now making up the difference. Of course, all that applies after the insurance company disallows and reductions have been applied to the billed encounter. Hence, I cannot financially afford to waive copayments - even if I was not obligated to collect them. In addition, MN requires electronic insurance billing by July 1, 2009. We need to invest in a billing system.
So, what to do what to do? Financial stability seems to be an ongoing challenge for us. My partners and I sat down and looked at the budget and talked about where we could trim even further. None of us are taking a salary so a cut in our pay wasnt an option. We looked at our supplies and found ways to decrease our expenses by switching suppliers when there were advertised specials on our regular supplies. In one instance we were able to save nearly a thousand dollars by switching our supplier for our strep tests. We talked with our staff and asked them to try to keep their hours within their appointment (32 hours, 15 hours, etc) and have told our MD she needed to stick within her 10 hour a week schedule. We have an appointment to speak with the landlord about a modest decrease in rent for the next year and we have trimmed our reception staff.
My job is to find ways to bring in more patients. I have asked my staff to go outside and start tripping people but.... We decided to put up a banner that states "your neighborhood quick clinic" and a sign that says "new patients welcome". Our location is great, on the corner of two main thoroughfares and just across from a day care and a large church so the signs will be visible. I am making the rounds of the local school health classes, womens groups and grocery store health fares. We have added a third evening clinic to compete with the local Minute Clinic and we are collecting emails to start an online news letter. One of our families is helping to get testimonials added to our website and we are planning a Spring Health Fair and BBQ open house.
It is still hard to understand how the emergency rooms can be packed with patients who do not have emergencies and our primary clinics are seeing patient visits decline each month. I have a family who called on two separate occasions for advice on a non-urgent medical problem. Each time there were appointments readily available, each time the family said they appreciated our advise and would call if they felt they needed to be seen and BOTH times they went to the local emergency department for care DURING office hours. When asked why they drove to the ED and waited to be seen vs coming to the clinic, they said they really didnt know why, they like the clinic and they just did it. In this case, the copay for the ED was far more than the copay for the office visit.
On a ligher note, we had the busiest day since we opened on Monday. You can never tell with health care. Our new financial advisor asked about our "fixed" costs and I had to laugh... fixed...rent, two leases and a loan payment. Fixed revenue? That is an even bigger laugh..... and so it goes.
Keeping you posted....
ON a side note, my thoughts about retail health: I am a primary care provider who has felt the impact of retail health in a very different way that most of my NP collegues. Retail health clinics are necessary because health care in general has seemed to move away from serving the public toward serving themselves. What I mean is, kids dont want to miss school, people cant miss work and disease doesnt go to sleep at night. There will always be a place for retail health in the "fix it now and fix it fast" world of today. I am torn between the opportunities available for NPs in the retail health sector and the restrictions they put on NP practice. It is a two edged sword.