Recently, I gave a presentation to a large primary care group in central Ohio. I asked the physicians how many of them were already experiencing an increase in patients not showing for appointments and how many were experiencing problems collecting copayments and/or outstanding balances. In the group of approximately 300 physicians, about 50% of them raised their hands. Even though physician salaries have increased by 4% over 2007 levels, our industry is not recession proof. In todays era of high deductible health plans and higher patient responsibility for health care costs, physicians are likely to see: patients canceling or delaying services, being noncompliant with needed preventive services, stretching their medication dollars, and generally cutting back on spending money for healthcare.
Emily Berry, in an article for American Medical News, reports approximately 3/4 of surveyed insurance company executives stated they expect physicians to have cash flow problems because of economic recession. In addition, one executive commented that the situation for primary care providers was especially problematic, because their financial situations were fragile before the recent crisis. In a second article for the same publication, Pamela Lewis Dolan cites the opinion of several financial consultants in relation to how the “credit crunch” might affect physician practices. Overall, the consensus is, physicians are not immune to problems with both their personal and practice finances. As uncollectible debt builds on practice books, this debt can weigh heavily on a financial institution that is deciding whether to lend capital. On the personal financial side, when residents are confronted for the first time with an attending physicians salary, many pitfalls present themselves.
Many new physicians are lured into large mortgages that may not be sustainable over time given the current recession and probability of lower practice collections. This fact, coupled with the current housing crisis, could limit the physicians ability to seek a new practice location in the future.
Coping with the decline
What are some of the ways physicians can cope with declining patient schedules, reduced patient compliance, lower collections, and the potential problems that can result? We need to work smarter, not harder. Health care IT and patient intelligence data can provide physician practices with several solutions that can accurately benchmark collections and highlight key indicators, while assessing the scheduling and contacting patients for needed appointments. These technologies can also identify populations of patients for needed care and help drive patient compliance through outreach. Moreover, a patients health status is maintained or improved while filling a physicians schedule. Also, even in a recession, payers are willing to give incentive bonuses to physicians who can demonstrate high quality care. One example of this is the Physician Quality Reporting Initiative (PQRI) program by CMS which is the model for other payers to follow.
Even in a down economy, physicians have the ability to maintain their schedules, improve the quality of patient care, and weather the storm. We need to think innovatively as we look to new ways to maintain our practice schedules and remain focused on caring for patients.
Recently, I gave a presentation to a large primary care group in central Ohio. I asked the physicians how many of them were already experiencing an increase in patients not showing for appointments and how many were experiencing problems collecting copayments and/or outstanding balances. In the group of approximately 300 physicians, about 50% of them raised their hands. Even though physician salaries have increased by 4% over 2007 levels, our industry is not recession proof. In todays era of high deductible health plans and higher patient responsibility for health care costs, physicians are likely to see: patients canceling or delaying services, being noncompliant with needed preventive services, stretching their medication dollars, and generally cutting back on spending money for healthcare. 
