Marsha Summers started Quantum Medical Solutions to help doctors in private practice separate billing from patient care. After 25 years of business she continues to work primarily with small practices, handling billing, CMS credentialing, HIPAA compliance, human resource and a host of other services.
“I see myself as a physician advocate,” says Summers. “I try to find ways to help them survive in private practice.” Rather than stand back and watch the changing business of healthcare bankrupt physicians, she helps them discover their options, build a referral base, and shorten the reimbursement cycle by avoiding critical coding errors, etc.
I spoke with Summers about the importance of preserving private practices and quality doctor patient relationships, and how physicians can learn to thrive in a “hybrid practice.”
What are the biggest challenges facing private practice physicians today?
Fewer doctors are going into private practice these days; it’s a dying breed. Doctors are dispirited. 84 percent say they wouldn’t recommend medicine to their kids. More and more doctors will become employees of large medical centers and foundations.
Doctors making big money is a myth; their expenses are very high: malpractice premiums, EMR implementations and medical education costs, with $150,000 loans coming out of medical school and residency. The physicians I know have all cut costs as much as they can. I’ve lost 25% of my clients because they felt they could no longer survive in private practice.
Many geographical areas where physicians practice don’t have the wealthier clients with private insurance and money for concierge services. These physicians have lots of Medicare patients and a shifting referral base. Plus doctors are spending 20% more time on bureaucratic paper work. They are seeing fewer patients and taking on more administrative duties.
How has the insurance industry evolved since you started Quantum Medical Solutions?
Every year premium costs are higher, benefits go down, and reimbursements to doctors go down. Reimbursements have dropped about 15 percent in the past 4 to 5 years alone.
I recently met with a thoracic surgeon. When he cracks open a patient’s chest, and puts the circulatory processes on a pump to perform an artery bypass, then brings that patient back to life again and assumes a period of 90 days without any further billing, guess what Medicare pays? About $1,000. Two months ago I had an oil leak in my car. I was quoted $1600 to repair that. How can that possibly make sense?
And with the newer insurance exchanges under Obamacare, the private insurers will take at least a 30% cut in reimbursements and more. It is death by insurance companies for private physicians.
Today, insurance companies contract with independent practice associations (IPAs), which function as middlemen between doctors and insurance companies. The IPA sells health plans to employers and advertises their network of specialists. This is managed care. The IPA gets their money from insurance carriers and they decide what to pay to reimburse physicians.
What can physicians do to survive in private practice?
First, understand that we live in a world of duality and in every problem there’s an opportunity. There must be a complete rethinking about private practice. The old model won’t last. They need to think about hiring physician assistants and nurse practitioners, seeing fewer patients, or dealing with fewer insurance companies.
Some doctors are reimbursed as little as $30 for an office visit. They’ll have to have a hybrid practice and take more cash paying patients, or increase patient volume. A hybrid model would be where they take PPO patients but drop certain insurance plans.
They might be paid on a cash basis, or they would bill only certain insurance companies that make decent reimbursements.
The majority of physicians don’t put money at the top of their satisfaction list. They list patient interaction, patient relationships and helping give patients a better quality of life as the most satisfying element of being a physician. To retain that satisfaction, the hybrid practice will have to become further defined and refined. Those who stay in private practice will have to be more entrepreneurial than ever before.