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Monday, January 05, 2004Lewis didn't take home a paycheck in June, July, September or October. He worked 10- to 12-hour days, six days a week, and estimates that he averaged around $30 an hour this year for his efforts. (Lewis declined to specify his income, but using the figures he provided for this story, it would appear he made about $100,000 during his best years.) ...At 44, Lewis has been able to save little money for retirement. He still pays $320 a month to cover medical school loans. His wife's job provides health insurance for them both. ..."I think we're running a really tight ship right now," says Katherine Lewis, who managed to trim about $4,200 in monthly costs by reducing the phone bill, bringing in another doctor to share the office space and laying off the office manager. "Even if you're an excellent businessman, it isn't going to cut it," she says. "There's always something, and the medical system doesn't give you enough cushion." In 2000, the office flooded, causing more than $20,000 in damage. In 2001, an office theft cost the practice $14,000 before it was discovered. Both incidents left the practice cash-poor for several weeks until insurance payments came in. Then, earlier this year the practice moved into a new space, which cost more than $40,000 to outfit. This year, Lewis's malpractice insurance increased from $12,000 to $18,000. Lewis has never been sued, and has no complaints on file with medical boards in Maryland or the District. ...."During the first year, I was just really, really frustrated, because I'd install a pacemaker and have no hope of getting that to my bottom line," he said. On Aug. 7, Lewis handles a case that seems unlikely to get bogged down in the reimbursement process: an hour of patient consultation that he values at $195, even though Medicare's set rate for the service is $127.68. Lewis collects the patient's co-payment of $25.54 on the day of the visit, and, if all goes without a hitch, he will collect $102.14 about six weeks later. Meanwhile, in the adjoining room, Lewis's secretary grapples with a worst-case scenario: She's trying to figure out how $3,460 worth of services billed a week ago has become a $345 item in the practice's computer system. She can't log into the online bill-monitoring system the practice pays $150 a month to use. The billing agent who collects 8 percent of every bill paid by insurance companies is unresponsive, so she spends up to five hours a day auditing the bills. Lewis looks over her shoulder and shrugs helplessly. Collecting 45 percent of billed charges is the best anyone can hope for, he says, because collecting more than that requires too much effort. ...In a typical month, Lewis said, the practice took in $18,000 to $25,000 in gross revenue. From that figure he had to pay rent, phone bills, loan payments, malpractice insurance, the lawyer, the accountant, the billing agent, the secretary, the copier lease, office supplies, staff health insurance and computer support. This left him with about half the gross to pay himself. Some months, there was nothing to take home after the bills were paid. "We looked very hard at the trends, and they are only going down," Lewis said. That was the last straw. "We all value taking home a paycheck as a sign of respect." Dr. Lewis closed his practice and took a job with the FDA testing pacemakers. Poor guy. I feel his pain. posted by Sydney on 1/05/2004 12:13:00 AM 0 comments 0 Comments: |
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