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Doctors give extra fees a shotFrom: rmodugno@aol.comTue Sep 16 11:53:50 2003
This story was sent to you by: Robert Modugno MD What do y'all think about surcharges? -------------------- Doctors give extra fees a shot -------------------- -------------------- -------------------- Some patients asked to cover rising office costs By Bruce Japsen Tribune staff reporter September 16, 2003 At a time when health insurance premiums and co-payments for medical care are rising quickly, some doctors have started asking patients to pay even more in fees and special surcharges. Physicians who say they do not recoup enough money from insurance companies to cover their costs of doing business are beginning to introduce new fees for patients, beyond the traditional out-of-pocket costs such as co-pays and deductibles. Doctors say the fees, costing some patients $300 a year or more, are needed to defray soaring administrative costs and rising malpractice premiums and to make up for flat payments from managed-care companies. Without the fees, some say, they would be forced to short-change medical care or be forced out of medicine. "The cost of doing business continues to rise," said Dr. Emily Gottlieb, an Evanston internist who is billing some of her patients between $200 and $300 annually for a "practice maintenance fee." "This fee is allowing me to continue to practice medicine. I would go broke otherwise or have to retire," said Gottlieb, who is 60 and has practiced in the Chicago area for more than two decades. "The only other way I could cover my medical costs is to see more patients in a shorter time, and that would be shabby medical care, and I won't practice medicine like that. I call my patients back on the phone, and a lot of doctors don't." Gottlieb is one of the early adopters of the fees, which are controversial and risky for physicians. The surcharges could alienate patients and, legal experts warn, such surcharges could violate contracts physicians have already signed with insurance companies. Blue Cross and Blue Shield of Illinois, the state's largest health insurance company, said it is aware of about a half-dozen doctors in the Chicago area are now charging the fees. The insurer said it would investigate Gottlieb's surcharge and others the company hears about. "We do frown on this type of practice," said Robert Kieckhefer, spokesman for Blue Cross and Blue Shield of Illinois. "The reimbursement we pay the doctors is intended to cover follow-up services like refilling prescriptions and things along those lines." Insurers say doctors' agreements with insurance companies typically include payment of predetermined or fixed fees to provide certain medical-care services and all related follow-up consultations, phone calls and office visits. But doctors say their new administrative fees are designed to cover items not covered in contracts with insurers, such as the cost of malpractice insurance or added paperwork to comply with new government regulations such as the recently implemented federal privacy rules under the Health Insurance Portability and Accountability Act. "Physicians are feeling the squeeze of administrative costs," said Dr. Cecil Wilson, a Winter Park, Fla., internist and member of the American Medical Association's board of trustees. "All of these unfunded mandates increase the workload on the physicians. You hear physicians talk about how hard it is to pay the staff and keep the office going, so physicians are looking at all options." The American Medical Association is not tracking the prevalence of the fees, but the Chicago-based doctors group said it is getting an increasing number of inquiries from physicians seeking advice about implementing such surcharges. This summer, for example, Town & Country Pediatrics in Chicago and suburban Glenview began charging $25 for after-hours calls from patients. "We need the fee to cover our costs," said Dr. Kenneth Polin, one of 11 Town & Country pediatricians. "It is something new, but 20 years ago when you said the fee was $10 people paid the $10. Today the insurance company doesn't let you charge more. Our charges are limited and discounted and, if anything, our costs have gone up." Filling out forms Elsewhere, some doctors have charged $10 to $25 to fill out forms for patients who need a doctor's approval to send a child to camp, clear a work physical or transfer someone from one nursing home to another. At the Diamond Headache Clinic in Chicago, physicians in the last year began charging patients for letter-writing services and legal documentation. Both services used to be free. "We are still happy to do it, but we just can't do it for free anymore," said Dr. Merle Diamond, the clinic's associate director. Doctor surcharges are also appearing in other parts of the country, sometimes in different forms, according to the AMA. Dr. Allen Dennison charges patients of his Barrington, R.I., practice $2 a minute for phone calls and $2 a minute for filling out their paperwork. "If a patient needs an assisted-living form filled out it could be four pages, and the company wants a recapitulation of your entire health history," said Dennison, an internist. "Believe me, when you are 85 years old, the history goes back a long way, and the companies ask all of these questions." "Some like it and some don't," Dennison said of his patients. "I have no latitude on my fees anymore. I can no longer build [administrative costs] into my fees anymore because they are totally structured by either Medicare or managed care. Doctors should not give away time, because that is all we have left to sell." Some physicians are also considering charging a dollar or two per minute for giving out medical advice over the phone or charge patients for paging them after hours, the AMA said. Often, the implementation of such administrative fees has come in states the AMA deems to be in a malpractice crisis such as Illinois. The 19 "crisis states," where patient care has been threatened by an exodus of physicians or by doctors limiting certain services, include Florida, New York, Texas and Pennsylvania, the AMA said. In Illinois, doctors' base insurance rates are, on average, rising 35 percent this year, although it has not been uncommon to see physician rates more than double, hitting $200,000-plus for certain high-risk specialties such as obstetrics or neurosurgery. Gottlieb's rate doubled this year, to $36,000 from $18,000 last year. Still, the AMA warns doctors to pay attention to their insurance contracts to avoid possible legal issues, and to take into consideration whether a patient can afford any added fees. "The physician does have an obligation to consider the patient's ability to pay when setting the fee," Wilson said. Gottlieb said she didn't send the letter to government-insured patients such as those covered by Medicare. And she is not going to require patients who cannot afford it to pay her. In fact, she admits that the fee probably wouldn't work if it weren't for the location of her practice in north suburban Evanston and the largely affluent suburban North Shore demographic that her practice serves. Affluent areas AMA officials, too, say many of the surcharges seem to be introduced in more affluent areas to avoid limiting access of patients to medical care. Gottlieb's office manager said she is aware of at least a half-dozen other physicians in the north suburbs who are charging administrative fees. "I couldn't possibly get away with this in a blue-collar area," Gottlieb said. Gottlieb is basing fees on patient age, charging $200 for patients between ages 30 and 60 and $300 for patients older than 60 because they tend to need more attention and thus require more administrative work. "It has been layered and layered and layered," Gottlieb said. "If you want the patient to have some sort of MRI you have to jump through a few hoops and spend 20 minutes on the phone to get a patient an MRI. I can't charge anybody for that, but if I talk to my lawyer for 10 minutes on the phone I get charged with that." By late last week, Gottlieb had heard from more than 20 of the patients to whom she sent letters. Only three were upset enough about the fees to say they would change doctors, said Gottlieb. Although she is still sending out letters to 800 of her more than 2,000 patients, Gottlieb's office staffers say the early feedback from patients has been positive. One of Gottlieb's patients, Jay Lytle, a 65-year-old managing director of First Bank & Trust in Evanston, credits Gottlieb with saving his life earlier this year. "I would rather have her spend a little extra time with me and give me a little extra time, so it's worth the extra $300 a year," he said. During Lytle's routine annual physical in February, Gottlieb took an extra 25 minutes to review his history of cardiograms. "She read a minuscule change on my EKG on a Monday and then looked back at my records over several years," Lytle said. By Tuesday he had a stress test, and a Wednesday angiogram revealed a 98 percent blockage in one of the main arteries leading to his heart. "I had open heart surgery on a Thursday," he said. "I had been contemplating taking a ski trip. Had I done that, I wouldn't be here today. I don't think every doctor with the time pressures they have would have found that." Copyright (c) 2003, Chicago Tribune -------------------- Improved archives! -------------------- -------------------- Searching Chicagotribune.com archives back to 1985 is cheaper and easier than ever. New prices for multiple articles can bring your cost down to as low as 30 cents an article: http://www.chicagotribune.com/archives
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