Fierce Healthcare and USA Today both recently published items on the increasing number of physicians who are charging additional fees for services not covered by insurance.  Examples include a “no show” fee for missed appointments or a fee to complete health forms for camps, schools, or employment.  USA Today quotes Medical Group Management Association (MGMA) president, William Jessee, as he advises against these extra fees in that they may anger patients or are in conflict with current insurance contracts.

If you are a provider, frustrated by your diminishing income and think your only choice is to add fees, consider a few things first – consider this from your patient’s perspective which is what I believe is the healthcare marketing perspective.

Physicians who charge additional or a la carte fees are still in the minority.  While some of your colleagues may be joining in the fray, think about your market and your patients and how best to communicate with them, before you take the fee plunge.

As with any new service or endeavor, you want to examine your market and have a solid understanding of what your patients will tolerate.  If you have a practice filled with patients struggling to make ends meet, the addition of a fee can easily push them in the direction of another provider.  You might be overwhelmed with the size and activity of your patient panel as it is and having some choose to go elsewhere may not harm your practice.  Either way, you need to take a good hard look at your situation.  Don’t leave out your competition either.  Are there others in your market who charge fees?  The more familiar your patients are with this concept, the more likely they are to accept it.

An appropriate communication effort is necessary.  While you may know that primary care physicians are becoming more and more scarce, your patient may not.  They may not understand that outside of your practice, things can be very different and they won’t know this until they leave.  If you decide to charge fees, help them understand your motivation.

Some physicians begin the fee charging process on a voluntary basis and while this eases your patients into the concept, it still may anger some so you need to be prepared.  Help your patients understand that many of the activities outside the office visit are simply not covered and therefore you do not receive a fee for them.  As 30 million  more Americans gain access to medical care with the nation’s new health reform law, primary care providers are likely to be pressed and wait times will increase significantly.  Even if you don’t intend to charge fees now, helping your patients understand the pressure on primary care providers will serve you and them well.

Helping your patients understand that the only way available to you to increase your income to cover higher costs of care and personnel is to increase your volume or to try a la carte pricing.  Patients might need to graphically understand that if you increase your volume, you have less time with each patient and in all likelihood, the care you provide will suffer.  Charging a fee is a better option.

Here are some suggested action steps to consider before charging a fee:

• Review your market.  Talk to your patients to get a feeling of their thoughts.
• Know what your competition is doing.
• Create a communication plan.
• Be prepared for the fall-out from your position.

Good luck!