Ways to Pump Up Your Bottom Line (Despite Healthcare Reform)

Leigh Page


October 25, 2012

In This Article

9. Provide More Preventive Services

The ACA is expected to boost demand for a host of preventive services by removing copays for them. Copays have been taken off of vaccines; annual check-ups for Medicare patients; blood pressure and cholesterol screenings for private-pay patients; and colonoscopy, mammography, and osteoporosis screenings. The changes also apply to smoking cessation, weight loss counseling, and diabetes care.

One caveat: The changes do not apply to "grandfathered" health plans. Under the ACA, these are insurers that have not changed their offerings since the new copay requirements went into effect. But these plans are expected to eventually change their offerings, at which time they would lose their "grandfathered" status and start having to waive out-of-pocket charges like everyone else. In 2009, the Department of Health and Human Services estimated that 54 million Americans were eligible for more preventive services owing to the ACA.

Massachusetts also removed deductibles from preventive services when it introduced its version of healthcare reform 6 years ago. Since then, demand for those services has shot up, says Joseph J. Viadero, MD, an internist in Turners Falls, Massachusetts. "Today people are more willing to seek preventive services in my office," he says. "They are also more likely to go to my office than to the emergency department."

To reap the benefits of the ACA's preventive services provision, Laurie Morgan says that practices need to be proactive. They need to inform patients when they are due for annual physical examinations and vaccines. You can call these patients or mail a letter, but she says a less expensive option is emailing them or texting them on their cell phones. In this case, you'll first need to collect patients' email addresses and cell phone numbers.

One key preventive service that is subject to the waiver of out-of-pocket charges is screening colonoscopy. According to The Medical Bill Survival Guide: What You Need to Know Before You Pay a Dime, the physician fee for a colonoscopy ranges from $220 to $440, and the hospital charge is $576 to $2000.[2] But if a polyp is found, the procedure cannot be considered a screening, which means the out-of-pocket charges cannot be waived, and a patient in a high-deductible plan could end up paying the entire bill. Unfortunately, patients will not be able to know this until after the procedure is completed.

Colonoscopies are usually provided by gastroenterologists, but in some cases family physicians perform them, including Dr. Kresnicka in Iowa. He says he decided to provide colonoscopies because there were not enough gastroenterologists in his rural area and his patients were not getting the screening they needed. He had been providing flexible sigmoidoscopies, as many family physicians do, but they are "just half the test," he says. "The gold standard now is colonoscopy."

Challenges When Extending Your Services

When Dr. Kresnicka tried to get privileges to do the procedure in his hospital, he says he met with stiff opposition from gastroenterologists on staff, who argued that family physicians are not qualified to do the procedure. Colonoscopy is the second most contested hospital privilege for family physicians, according to the AAFP. But the AAFP, citing comparative statistics on outcomes, says that family physicians are capable of doing the procedure as long as they get proper training.

Dr. Kresnicka eventually obtained the right to do colonoscopies, but it was not easy. He had to go to a hospital in another town to obtain privileges, and before he could start working independently, he had to perform 100 procedures that were precepted by another physician -- twice the number that the AAFP recommends. A general surgeon agreed to precept him and he met the requirement, but he limits his colonoscopy work to his own patients. For more information, he advises contacting the American Association for Primary Care Endoscopy.