When opening their offices, many Nurse Practitioners look for ways to meet the needs of the uninsured and under-insured patient. This can often be a challenge because of several rules and regulations are in place regarding fee schedules particularly with Medicare. For instance it’s my understanding that you cannot bill a patient less than your Medicare allowable.
In the most recent issue of Family Practice Management, Brian R. Forrest, M.D. discusses the business model where he only sees patients for a flat fee. He does not take Medicare nor does he use sign any other insurance contracts. And according to his article, he is able to cover his overhead on four visits per day, hence the title of his article Breaking Even on 4 Visits per Day.
One of the most appealing things about this type of the model, is that you do not have to deal with billing insurance companies. A great deal our time is spent talking with insurance companies about coding, why they rejected a claim, and what we can do to get this claim paid. Between that, all the prior authorizations that we have to obtain for prescriptions or referrals, you almost need to hire one full-time person. It’s a very frustrating and an efficient way to provide health care.
Another Nurse Practitioner in our town recently opened her practice. She is only the second NP to own her own practice in our area (I, being the first). Her model initially was to be cash only in to see people on a walk-in basis. With the number of uninsured people in our community she felt it would be a great service. In addition she is fluent in Spanish and had hoped to reach that community as well. However what she found was that people still didn’t want to pay, even though her fee schedule is far less than an individual would have to pay elsewhere.
While I am not giving up on the model that Dr. Forrest proposes, I will still need to do much research to see how I could make it work in my community.
Read the article, think about it, and look at your own community. This is something that could work for you in your community? Could you do this by joining forces with another nurse practitioner and sharing resources?