Sunday, December 30, 2007

Just Doing My Part



Take Action Now!


Dear Patients,

New York State is currently in a health care crisis that threatens all of our abilities as patients to get affordable healthcare. The threat comes from a tort system in New York that has run out of control. Jury awards have risen dramatically over the years and are often out of proportion to the nature of the injuries. The problem is only getting worse.

I support tort reform that retains our rights to seek reasonable compensation when injured by a negligent act, but the system must prevent excessively high awards for pain and suffering that is limited in intensity and duration.

I call on you to take action and contact your local representative in the state assembly and ask them to support liability reform. I have pre-printed, addressed, and stamped envelopes; all you need to do is sign.

Please become involved in this grass roots effort to save New York from an impending health care implosion and in doing so, help to lower health care costs for the majority.

If you have any questions, please feel free to contact me.


Richard A Schoor MD FACS

Wednesday, December 19, 2007

Taking Notes From a Plumber

I just had a great experience with. . .a plumber! Yes, that is right, a plumber. And I paid $680. How is that. Well, I took notes. Not on his plumbing technique, but on how the business was run. Terrific from first contact to last. Let me tell you about.

We have a leaky pipe in the basement of our house. Though we have a contract with a plumbing service for our boiler and AC, I forgot their name and did not feel like looking it up. Plus, this pipe would not be a "covered" service anyway. As I was about to blow off the whole thing for another day, my wife handed me my 5 month old and a flier from a plumbing company. I get tons of these things, but timing is everything, right. I looked at it and liked the message: on-time service, up-front pricing, no surprise or hidden costs, all credit cards accepted, all work guaranteed in writing for 1 year (that's hell of a global), and a coupon. On the bottom of the flier was their phone number, clearly visible. I called—7:15AM—and, voila, they answered. Sold!

Over the phone, the receptionist had a friendly voice and she offered me a number of scheduling options, that day, or any other day. She had one of those great phone voiced that makes you feel like she is on your side. I should have offered her a job. Anyway, I took an appointment for the following morning, between 8 and 10AM.

At 8:30AM, the plumber arrived. He parked his truck so to not block my car, and when he entered the house, he had his own door mat with him. Nice: makes for good style points. I showed him the problem, along with several others that have been lingering, and after an inspection he came up with a solution, a guaranteed price, and the 1 year guarantee on the work. Plus, he turned off some pipes to the outside, gratis, and wore shoe covers so he would not dirty the rug. Again, nice style points and demonstrated that he was on my side and cared about details.

The work was completed quickly, but not too quickly. He made a soft up-sell on some biological cleaner, and I declined, and here's the kicker: when it came time for payment, we completed the transaction with a mobile, cellular credit card processor. Payment to him guaranteed. No accounts receivable. Not only relatively painless to me, a technological talking point.

Lessons for the doctor.

1: Answer the phones.

2: Hire excellent phone personnel and train them well.

3: Make the patient know that we are on their side.

4: Embrace technological advancements, especially when it comes to accounts receivable.

5: Attend to the details. They really matter.

Anyway, thanks for listening and if you want their number, send me an email.

The IU.

Tuesday, December 18, 2007

What Medicare cuts could mean

It looks like Congress will not intervene and that Medicare cuts of 10.1% on average are imminent. Urology is slated for an 11% cut. What does this mean in real dollars. Let's take a look.


Practice A sees 1200 patients per month = 14,400 visits per year x 25% Medicare = 3600 Medicare visits per year x average visit value of $150 = $540,000 reimbursed per year from Medicare x 11% = [$59,400 - $540,000] = $480,000 lost income if Medicare is dropped completely.

Practice A sees 1200 patients per month = 14,400 visits per year x 10% Medicare = 1440 Medicare visits per year x average visit value of $150 = $216,000 reimbursed per year from Medicare x 11% = [$23,700 - $216,760] = $193,000 lost income if Medicare is dropped completely.


Practice B sees 400 patients per month = 4800 visits per year x 25% Medicare = 1200 Medicare visits per year x average visit value of $150 = $180,000 reimbursed from Medicare x 11% = [$19,800 - $180,000] = $160,200 lost income if Medicare is dropped completely.

Practice B sees 400 patients per month = 4800 visits per year x 10% Medicare = 480 Medicare visits per year x average visit value of $150 = $72,000 reimbursed from Medicare x 11% = [$7,920 - $72,000] = $64,080 lost income if Medicare is dropped completely.


Practice C sees 200 patients per month = 2400 visits per year x 10% = 240 Medicare visits per year x average visit value of $150 = $36,000 x 11% = [$3,960 – $36,000] = $32,040 lost income if Medicare is dropped completely.


So as you can see, the numbers are large indeed whether a group or solo urologist keeps or drops Medicare. However, based on my calculations, a urologist or urology group would still do better remaining par with Medicare. Out and out dropping of Medicare would be tantamount to suicide for the business.

Though it is tough for me as a urologist to admit, Medicare has me by the balls.

Good luck to everyone else.


Monday, December 17, 2007

Speak of the devil.

The new HIPAA rules for practices such as mine.

Can't wait to read through them.

Results of my survey

I just sent a survey to an admittedly un-scientific sample of my patients, yet the results were interesting. The survey, sent to 24 patients selected at random, asked respondants 9 questions relating to the practice, the patient's experience here, and asked for suggestions for improvement. Here is a preliminary result that I'd like to share with you, as I find it interesting.

  • 16 out of 24 respondants stated that email was their preferred method to communicate with the doctor or staff, and this was not age dependent.
  • 24 out of 24 respondants stated that they had NO concerns regarding email security.
  • 24 out of 24 would refer me to a friend or famlily member.

Interesting. I am not sure what it means, but I believe that:
  • HIPAA is perhaps a bit overblown.
  • People want to communicate by email.
  • I'm pretty awesome.

I plan to send more surveys to try to get some real scientific data with hope of publishing it here on my blog.

Until then,
The IU.

Tuesday, December 11, 2007

The Paradigm Shaft

Several years ago a wise man said something to me that really impacted my life. He was a Pharma drug rep, but prior to that, he was an accountant for a financial service company. One day, during his old career, he had an epiphany of sorts when he was conversing with an investment banker. The accountant lamented to the banker, "How come you make so many times what I make?" The banker responded, off handedly, "Because I make money and you cost money."

"Because I make money and you cost money." Wow!

Several weeks later, this accountant left his company and went into sales so he could "make money."

He told me that story over dinner one night and I had epiphany of my own. There are 2 types of people in the world: those who make money and those who cost money. People that make money will always be worth more than those who cost money. Most of us fall into the cost money category. Think about it. The dichotomy really has truth to it. Movie stars, investment bankers, top professional athletes, even top doctors and lawyers, all validate their incomes because they produce wealth for others as well. They make money. Nurses, medical assistance, accountants, teachers, police officers, fire-fighters, in fact most of the rest of us, are in more of a support role and don't really bring in the bacon. Not to say that our jobs are not important. They are. It is just that we cost money, rather than make it.

Doctors used to be in the "make money" category. Throughout the 1960's, 70's, and 80's, doctors not only made money, we were seen as having the ability to generate wealth for others. The perception was that we made money. Beginning in the 1990's--though it's roots actually started under Nixon & Reagan--physicians came to be seen as cost centers rather than revenue centers. This shift in perception, a paradigm shift really, put us in the very precarious position we sit today. In fact, to the extent that there has been the downfall of doctors, this paradigm shift led directly to it.

People that make money are always worth more than people who cost money. It is really that simple.

Again, I don't have a solution for the problem. I only have the observation. I suppose that if you are a physician, you may benefit from re-tooling your practice so that you can be seen as a revenue generator, rather than a cost center.

Remember, 2 types of people exist in the world: those that cost money and those that make money. Try to be the latter.

Good luck.

The IU.

Monday, December 10, 2007

Why I Hate No-Shows

For most of us in the service industry, no-shows are a part of life. For most of us in the service industry, no shows are an exasperating and costly part of life. People that no-show don't think it is a big deal. Here's why they are wrong.

1: Lost revenue: I see patients sparingly on Saturdays, ie I reserve the day for people that really have a difficult time making it to my office any other day. This Saturday, I had office hours from 8-11, staffed by 2 people x ~$28 per year = $84, not including my time. I had 4 no-shows, each worth ~$50 x 4 = $200 lost revenue for that day. I saw 4 other patients, 2 new and 2 follow-ups = $350. Total income for this day was $350- $84- $200 = $66. Now it may be worth my time to come in to the office for $550 - $84 = $466, but not for $66.

2: Increased liability: Unlike people that no-show to a restaurant, established patients that no-show to a doctor's office can cause future problems for themselves and for the doctor. Even though they--adults all, mind you--no-showed, it is our—the physician's—responsibility to make a reasonable attempt to contact them. To do this, we have to pull their charts, review them, make phone calls to the patients, and send them certified letters. What does all this cost? It costs a lot if you factor in the following: chart review = 10 minutes per chart X 4 charts = 40 minutes x my time + staff time to call x 4 + certified postage $5.39 x 4. Plus, a no-show patient that is lost to follow-up yet resurfaces several years later with a tumor that "you missed" can bankrupt you. No, no-show's ain't cheap.

3: Increase in uncompensated work: All of the above work by the doctor is uncompensated.

4: Inconsiderate: I call to cancel reservations at restaurants and for haircuts. It's just the right thing to do.


The IU.

Thursday, December 06, 2007

Damn December

December! Everyone loves it, right. The holidays, parties, joy, peace and love on earth.


The holiday season can be a difficult time for many people. The depressed or lonely are the obvious people that come to mind. But I'm talking about the small business owners. Whether you are in retail, food service, or health care, the holiday season brings many challenges to your business. In retail, for example, experts project poor sales for this year, and owners, managers, and employees of retail chains and mom & pop stores alike may suffer the consequences.

Medicine, contrary to what I was told as a pre-med student, is far from recession proof. In medicine, we suffer right along with everyone else, minus the insurance execs.

I am not going to get into the economics of whether or not we are in a recession. We are, however, in a period of difficult economic times for many people. This economic downturn, in addition to consumer pressures that the holidays bring, mean less money spent on health care. i.e., we, the doctors, suffer.

Let's take the example of a typical patient of mine, a 35 year old man who wants a vasectomy. He works for someone else, most likely a big, faceless corporation or government agency, and his employer pays for his health insurance. His family income is $150,000 per year, which does not go very far in the New York metro area. Like everyone else, his co-pays or deductibles have risen dramatically in recent years. Far from being 5 dollars, now they are in the $35 to $50 range. His children, like my own, have had one cold after the next, after the next, and he has paid several hundred dollars in co-pays for his kids' pediatrician visits. His oldest daughter wants a new dance leotard and a Webkins doll for Christmas and his younger girl wants a Fiona doll and a Bella Dancerella video. Perhaps he and his wife agreed to not spend money on each other, but knowing that this really means "get me something," he buys his wife some inexpensive jewelry and plans to take her out for sushi. On top of all that, the pre-school/day care tuition for his toddler is due by Jan 1, or else, and that ain't cheap.

So how does this affect me? Well, he and his wife have decided that 2 children are enough and that he should have a vasectomy. Most likely, his insurance will cover it. But he still has co-pays. And I don't waive those. I simply cannot do that. Since he has all these other bills to pay, does not relish the idea of paying the 2 or more co-pays required for the vasectomy. In addition, he can't afford to take any time what-so-ever off from work, even though vasectomy patients recover quickly. He thus decides hold off for now on his vasectomy.

Multiply this times 20 vasectomies per month, times God know's how many other elective things that I do in urology, and you can see why December can be a difficult month for a urologist or any other doctor.

But Happy Holidays.

The IU.