To the patients of Yafferuden:In spite of
working from 7-7, five days per week, with only 10 days off-- last year Dr Ruden and Dr Yaffe took home less income than we paid our first year physicians.
Insurance, rent, IT, and staffing costs increase every
year. Re-imbursement rates from managed care remained the same for 7 years. Under these circumstances, it should come as no surprise, that eventually we must cut staff, withhold raises, and even cut services.
We have given much thought as to whether it might be possible to remain in managed care insurance plans.
Many of our fellow pediatricians, gyn's, internists, and specialists have dropped out of managed care
insurance plans (Oxford, Aetna, Blue Cross, United Healthcare, Cigna, etc.) and are now just seeing fee for service patients. Dr. Ruden and I know that we could drop out of managed care, and even if we lost 2/3 of
our patients, we could do very well in private practice with about 10,000 remaining patients. But we have a loyal and dedicated group of patients who would be left behind, and a large number of our loyal staff
that would no longer be needed. This is not what we had in mind when we started building this wonderful practice.
We started as a private practice. We have continued to function as a high-end private
practice, offering many services that are above and beyond the way things are done in the usual managed care insurance environment.
We are the only office in the entire area that is open 7:30AM to 7:30PM, five days
per week, and on Saturday mornings. We must employ 40 administrative personnel to maintain double shifts (7-3, and 12-8). A single 9-5 shift would eliminate about 15 employees, saving us about
$500,000. A medical problem starting at 4PM would have to be dealt with in the ER. As in other practices, the before work and after work appointments would not exist. It has been suggested by the insurance
companies that we establish our hours as 9-5, and charge significant out of pocket surcharges for visits before and after hours. We do not want to do this.
In the last 3 years, we have invested over $700,000 in
information technology. We have developed our own software that will allow patients to access their healthcare information online. Through patient data-entry, our software will enable the most detail-packed
health record ever devised. We have continued to develop our website, which has been widely recognized and written about for its many innovations. We have produced and added a nutritional supplement website.
We widely use email communications with our patients. We have state-of-the-art call center phone technology that enables us to monitor patient onhold time, and to monitor secretarial efficiency and
etiquette. We have fulltime IT personnel on staff. Needless to say these services are not managed care industry standard. By cutting our advanced IT services, we could save over another $260,000
annually. This is not the direction we would like to take. Should we charge surcharges for uncovered IT usages? This is not what we want to do.
Is there any way we can continue to operate a
patient services oriented office, with all the scheduling, IT, and other amenities, practice high-quality medicine, give raises to our staff, and attract high quality caring office personnel?
After many long hours of
discussions with our managed care insurers, it has been established that instead of cutting services, nickel-and-diming our patients, or dropping out of managed care, we can legally follow AMA and industry guidelines
and establish a modest annual administrative fee that covers the cost of these additional 'uncovered services'. This fee would go toward staff costs, long-overdue staff raises, and increasingly advanced patient
benefiting IT services.
We have discussed this administration fee proposal with 230 of our patients and have had 230 consecutive positive responses. We want to be very, very fair in charging this
fee. We will waive the administrative fee in all cases of financial hardship. We will keep the fee reasonable. We hope to decrease or eliminate the fee as circumstance change. We will refund the
fee if our 'uncovered services' are found disappointing. We will expect ongoing feedback, both good and bad. (We will offer, though discourage, a fee-for-service approach for uncovered and extra services.)
If this administration fee works as well as we and the managed care companies hope it will, Yafferuden will be able to remain in managed care insurance plans, offering uncovered services, including extended hours,
and many internet based services.
Our goal is to stay in managed care insurance plans, with satisfied patients and staff. Details of the plan, including costs, will follow.
For the first
time, we feel as if we are working with the managed care companies, rather than against them.
Sincerely,
Drs. Yaffe and Ruden
