During the day, Scott Plantz, MD, FAAEM, is medical director of an urgent family care practice in St. Petersburg, Florida. At night, he moonlights as an emergency room doctor at a neighboring hospital.

Plantz isn't working overtime to buy a sports car. Rather he's making up for the plunging profits of his five-person practice, whose patient volume has fallen off 20 percent in the last year.

Many of his urgent care patients have lost their jobs and medical insurance or cannot afford the high out-of-pocket costs of their insurance plans. So Plantz and other physicians are looking for ways to make more money in an economy that is pushing some private practices—including Plantz's—closer to the brink than ever before. "I think that what we're seeing is a system that's teetering on the edge," Plantz says.

FOCUS SWITCHING TO FINANCE

Out of necessity, physicians are becoming more engaged in the finances of healthcare, something they haven't always been comfortable doing. "It used to be that money was the last thing that physicians spoke to patients about," Jarvis says. "Now it's the first."

According to Jarvis, more physicians are using electronic payment transfers, credit card processing and real-time claim adjudication, which allows providers to bill for services at the time a patient is treated.

Practice administrator Rebecca Dunaway is trying to keep a steady cash flow at Joint Implant Surgeons, a 32-employee practice in New Albany, Ohio. As the economy took a toll on the practice's clients, physicians reconfigured their accounts receivable (A/R) operation to capture more revenue and inform patients of payment and insurance processes.

Last October, Joint Implant Surgeons created the position of physician finance advocate to help patients through Medicare claims, insurance requirements and other issues. They explain deductibles and copayments, while ensuring that clients understand their financial responsibilities. The practice also provides customers information about public financial assistance programs and helps patients and family members determine if they qualify.

All 32 employees of the practice are coached to answer rudimentary questions on billing, Dunaway says. In the end, such an approach makes the patient more loyal. "We've gotten great feedback from the patients," she says, "primarily because they have established a relationship with someone here."

More private medical practices are billing patients while they are on site rather than compiling A/R reports, generating invoices and mailing them out to customers at the end of the month, according to Doral Davis-Jacobsen, CMPE, manager of the physician services consulting unit at Dixon Hughes PLLC in Ashville, North Carolina. This allows a provider to bill for services at the time a patient is treated. A fully adjudicated response is returned from the insurer, detailing the total charge submitted, as well as the patient's fiscal responsibility.