10 Ways to Waste Money in Primary Care

Continuing on the primary care waste theme  (no, primary care is NOT a waste!),  I would like to give you my 10 top ways that primary care physicians waste money. 


1) Open the office at 9:00, close at 5:00 and have 90 minute lunch. 

This practice started back in the day, when primary care docs saw patients in the hospital before the practice opened and went back to the hospital at lunch.  For many physicians, hospitalists have taken over hospital work.  Please, do not call me and tell me how primary care is dying when you work 4 days a week and only see patients for 6.5 hours!  Yes, I know you still take phone calls at night, BUT last I checked we are still not getting paid for these.  You must see patients to generate revenue!

2) Not coding properly.  C’mon, learn the difference between a 99213 and 99214.  For a simple “quick and dirty” I summarize from Physicians Practice, October 2008:

99213: Expanded problem focused history.  Level of detail: ONE stable chronic illness OR ONE self limiting or minor problem.  Level of decision making: low: e.g. otc meds, PT, med management with minimal risk.  (Antibiotics.)  Note that it is ONE stable chronic illness or ONE self limiting problem with low level decision making!!!

99214: Detailed history.  Level of detail 2-3 STABLE chronic illnessesor 3+ self limiting problems.  Level of decision making: moderate such as medical management with moderate risk  (e.g. warfarin.)  Last time I checked your average internal medicine patient likely had AT LEAST 2 chronic illnesses.  (Think diabetes, heart disease, hypertension.)  


3) Bounce checks.  Yup, we rocket scientist physicians commit this cardinal sin of financial management.  Get a decent bookkeeper!

4) Run up employee over time.  See my previous post rant on wasting time with your employees standing around while you do everything.  If you are running up overtime, you have to figure out where everyone’s time is going.  If you are really that understaffed, you can consider hiring a temp to see if that improves the squeeze, but better yet, see what/where  inefficiencies are occurring.

5) Don’t pay off the practice’s credit cards in full.  One of the practice ExtraMD works for financed the start up of the practice on credit cards, but I think there are better ways to start up!  (I shudder to think of the interest paid on that endeavor!)

6) Don’t have a consistent billings and collections policy.  Hope that insurance companies will pay you what you’re owed and that patients will happily fork over their copays.  (Please notify me immediately should the insurance companies pay you promptly with out asking, and I will buy you dinner!)

7) Give you practice manager cart blanche to run the practice.  Don’t check out the financial statements s/he gives you and sign checks blindly.  TWO OUT OF THREE PHYSICIANS WILL BE EMBEZZLED DURING THEIR CAREERS!  (In my travels, I have had several physicians tell me their embezzlement stories.  Sad, but likely preventable.)  You must have internal controls.

8) Thinking you know enough to run your practice with out help.  (Hmmm, we physicians have this reputation for arrogance.  Does this fit the profile?)  Yes, you really do need a good bookkeeper, accountant and attorney  (I’m not referring to a malpractice lawyer here, but a business attorney.)

9) Wasting time.  See below.  You are probably sick me talking about this.

10) Ignoring this post because you don’t care about financial management of your practice.  GET INFORMED! GET EDUCATED! GET YOUR HEAD OUT OF THE SAND!  Pretending that finances don’t matter is a good way to have to close the practice doors and go to work for an HMO.  (To all those that DO work for an HMO, I’m assuming you quit reading long ago.)

Cheers! Be smart, be good and have fun.  KEEP THE DOORS OPEN!