Insurance companies use medical coding to detail a medical procedure.
For example: an Orthopaedic surgeon will understand what a Multiple arthroscopic operation on the knee (including meniscectomy, chondroplasty, drilling or microfracture) is.
That is a lot to put on an invoice!
The CCSD code W8500 will identify the procedure.
Put this code on the invoice instead.
Codes can be found on the CCSD website:
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the major healthcare insurers.
The Group’s purpose is to maintain a common standard of procedure codes.
A CCSD code is imperative IF a surgical episode is required.
The patient should quote the code to his or her insurance company when pre-authorisation is being requested.
However, be warned.
The example above of W8500 does not come with a suggested fee.
The rate for each code is up to the individual insurance company. You need to contact them to discover what fee they will pay for each.
When an invoice is sent to the insurance company, the code should appear on the invoice. It will reconcile to that expected.
If you do NOT use CCSD codes payment will be delayed if made at all!
Without a CCSD code, you will not be able to invoice electronically anyway!
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For the simple reason, cash does not flow.
Cash has to be managed.
Around this time of year, I take calls from consultant surgeons who in view of their impending tax payments require an increase in cash collections.
It’s happened every year since MHM was formed. The normal instruction is to increase the cash flow. Immediately. Simple enough. I can do that.
Existing clients don’t call because invoices have already been generated for them and they’ve already been paid for their work.
Their cash has already been maximized.
The real problem faced by potential clients though was highlighted this morning when a consultant surgeon referred to needing an outstanding cash flow “purge” within his practice.
This highlights to me a more fundamental underlying issue. Let me explain.
A consultant surgeon – just the same as any business – should know how much he is invoicing both in terms of patient numbers and the value of those patients.
If he is invoicing correctly and ensuring he gets paid he can also, therefore, calculate his revenue receipts.
he wasn’t a consultant surgeon but sold another service or product, he should be able to perform the same calculation.
So he knows how much he is or should be invoicing. Providing he proactively manages his practice.
If you think about it, most consultant surgeons already know their overheads too. They know how much their room rental is. They know how much the staff cost.
And they know how much their professional indemnity costs (too much before you ask).
Of course, there are other expenses but fundamentally they already know their expenditure.
They know their total costs.
Therefore they know or should know how much they are spending too.
Enter stage left Mr. Micawber:
He knew a thing or two about how to run a private medical practice did Charles Dickens.
For one thing, he knew cash doesn’t just flow into it.
It has to be managed.
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Top up (or GAP) invoices = asking the patient to agree to pay the difference between a consultant’s fee and the fee an insurance company is prepared to pay.
The discussion concerning them seems to take place more in whispers than anything else.
And sometimes they are even deemed to be almost a taboo subject because they don’t exist.
But they do.
So, and for the record:
I have no problem issuing them on behalf of my clients.
Why and when?
Consider the case of a real consultant surgeon whose patient is quite happy to pay, for example, £852 for a surgical episode.
But the patient is insured with XYZ Insurance.
XYZ will only pay a “customary and reasonable fee” of £639.
The fee was £852 but due to “market conditions” XYZ has reduced it by 25%.
Thus the consultant may now as part of his recognition protocol only charge £639.
Most consultants actually perform the same procedure throughout the month.
Empirical evidence using MHM clients confirms they all perform, in their own specialism obviously, the same code(s) on average 5 times a month.
If that code happens to be the one reduced by £213 each time, the reduction in revenue is over £1,000 each month.
In the original scenario though, the patient has chosen to see that particular consultant.
His/her decision has zero to do with fees.
That is the consultant the patient has chosen.
If the patient is advised the fee for their procedure is £852 but their insurance company will only pay £639 towards it and then if they – the patient – is asked beforehand to pay the difference and agrees, where is the problem?
Ah no, say the insurance company, you can’t do that for that is above our stated fee schedule so you are risking your recognition with us if you do.
This article is not about if they are right to potentially withdraw recognition if fees are not adhered to.
Neither is it about whether XYZ Insurance is right to reduce the fee.
The first thing consultants will all do is be deeply unhappy about the reduction.
The second thing they will do is attempt to mitigate the loss somehow or another.
And the second point is the more relevant one.
Many times I hear from insurance companies the market is contracting and cost has to be taken out to make the private medical insurance offering more attractive.
But why is the cost reduction, or so it appears, being continually directed at the consultants?
Yes, I am aware that certain fees have gone up but overall fees have come down.
I’m equally opposed to those consultants who insist on ignoring insurance companies’ fee structures for every single procedure and/or episode.
I’m also very focused on taking costs out of any business so I can see where the insurance companies are coming from.
But not at the expense of continually reducing a consultant’s fee and thereby reducing his profit continually AND the patient’s right to a choice.
Top Up or Gap invoices are a reaction to consultants continually seeing their fees being eroded.
I haven’t said I completely agree with them for they should be unnecessary.
What I am saying is that I understand why I’m being asked to produce them and when.
Consider an actual quote to me recently from a very well established consultant surgeon.
An orthopod who has been in private practice for over 10 years:
That, perhaps, sums up precisely why some MHM clients are asking me to produce Top Up or GAP invoices.
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There are only 24 hours in a day.
All of my guys are incredibly busy.
I’m amazed at the volume of work they get through in a single day.
They are either on-call, doing a ward round or in theatre. Then they have to see their private patients.
That explains why most of them call me either very early in the morning or in the evening.
It doesn’t bother me.
It’s my job to fit in with them and make their life easier.
Recently, however, I was asked to review the private practice of a consultant who was having serious difficulties generating any cash into his practice.
And following my question to his long-suffering medical secretary, it didn’t take long to establish why.
The question was: what is the biggest problem you have this week. The reply said it all:
“I never get a response to the queries or receive the information I need after I’ve asked Mr. Surgeon. He always seems too busy to deal with the things I need”
Yet most of the information the med-secretary needed was fundamental to generating cash into the practice.
For example: two clinic lists from last week were still unprocessed (result: no invoices sent out) or remittances from an insurance company (no idea who had or hadn’t paid) or the post Mr. Surgeon picked up and put in his bag one day last week (it had cheques from patients in it)
So I spoke with Mr. Surgeon and asked him what he thought about it.
His response was a classic:
“I just don’t have time to deal with all that. My private patients are paying to see me so they must come first”
The stark reality is he is right enough to be dangerously wrong.
He is right as regards putting the patients first but he needs to ensure his administrative support is first rate too.
The reason Mr. Surgeon is having difficulty generating the cash due is in him not dealing with such issues as the missing clinic lists or not passing over remittance advice.
Mr. Surgeon needed to make very sure, the support facilities of the practice were dealt with.
The word “support” suggests these things can be demoted to a “Too busy to deal with that and they are not that important so I’ll deal with it later” category.
Eventually, they catch up with you.
In the case of Mr. Surgeon, they were the reason he was struggling to generate cash into his practice.
Compare and contrast that with another real-life MHM client: Mr. B Surgeon.
He is very different from Mr. A Surgeon save curiously they see a similar number of patients each week and are in theatre on the same day too (but in different parts of the UK)
Mr. B Surgeon will send his clinic list the day he sees his patients.
His theatre lists arrive the same day too.
All of which means his invoices are out the proverbially electronic door within 24 / 36 hours.
In the unlikely event, there are queries, a response comes back to me either that same day or at the latest the next. His cash flow is many, many times greater than Mr. A Surgeon.
In case you are wondering why I don’t have such issues with MHM clients its because every single week my clients take their post or clinic lists etc scan them to me and promptly proceed to forget about them thereafter.
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Every single consultant I’ve ever met is dedicated to patient care and the best possible outcome for his or her patient.
But sadly that has little to do with the outcome of the practice as a business.
They may think it does.
But it doesn’t.
Patients reviews are ALWAYS good and they reflect the clinical outcome.
Potential patients do actually read them and take the decision to see a consultant based, in some part, on good patient reviews.
But other than that, there are numerous other items impacting the business outcome.
Planning has a HUGE impact on the outcome.
Specifically, if you don’t have a plan you won’t be able to know if you have achieved the desired outcome anyway.
But what needs to go into the plan?
Sounds crazy but the aim of the plan should be to achieve the outcome, yet you can’t reach the outcome until:
a) you define what the outcome should be
b) you define the plan to achieve the outcome.
Just talking about it won’t be enough. It never is.
Unfortunately, far too many consultants start a private practice without deciding what their desired outcome is. Instead, they make reference to “making more money” or “seeing more patients”
But the smarter ones start by saying I want to make, for example, £5,000 a month (outcome) so I need to see at least 20 patients during that month.
It matters little if it’s £5,000 or £25,000.
What matters is they have a defined outcome with a plan to get there.
Then they start giving immediate thought and planning on how to see 20 patients a month.
None of which has anything to with clinical outcome!
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I was chatting with a friend recently regarding his view that remote consultations were the way forward.
Covid-19 will seriously change the face of private practice in her view. More specifically, it will demonstrate remote consultations are the way forward to grow a practice.
In my friend’s view, more consultants are now willing to provide video consultations that ever before.
And further, in her view, all the consultants she had spoken to and asked were enthusiastic about the electronic consultation offering.
When asked if they would offer more and more electronic consultations most said they would.
They see it as a way to grow a private practice.
I’m not disputing the view Covid-19 will change many things including the face of private practice.
But I don’t see it, in a post-Covid-19 world – as a catalyst for remote consultations.
For one thing, we are in the midst of an unprecedented situation.
By all means, consider the reality of where we will be afterward but it is far too earlier to make sweeping predictions.
Further still, it is unrealistic to make the forecast that electronic consultations will become widespread based on six weeks of evidence.
But what is a wory is of whom was the question asked.
Only the private consultant.
The patient wasn’t or hasn’t been asked.
I’m not suggesting for a single second patients will or will not be willing to have their consultation electronically.
I’m saying is that it is wrong to say electronic consultations are the way to grow a private practice. You must first establish if the patients would be prepared to accept electronic consultations rather than face to face consultation.
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I never anticipated this. There again nobody did.
In all my years of running a private medical practice, at no time did I consider a UK wide lockdown.
The only “emergency” situation I planned for was for a client to be unable to practice due to breaking his leg!
I called it my “Bust leg” scenario.
In essence, it assumed the consultant couldn’t physically journey to a hospital.
In such a situation, the only thing you could do was conduct electronic consultations. That may be by telephone or Skype etc.
New patient numbers would fall off a cliff but at least follow-up consultations would be conducted.
I actually had to arrange this once. The consultant fell over and broke his ankle. So we arranged for telephone and Skype consultations.
It worked and worked well.
It never occurred to me though that a UK wide shutdown would not only prevent a patient from attending a hospital but they were too scared to leave their own homes.
So the very first thing I did when the shutdown came into force was speak to every single private medical insurance company.
The reasons are obvious.
I wanted to make sure all MHM clients were able to hold and get paid for electronic consultations.
I’m pleased to say most already were and with the support of insurance companies, all the remaining ones were immediately allowed to follow suit.
It’s easier to say what was NOT next.
Absolutely not a debate on how long the shutdown would last.
There was and still is no point because only the Government can decide how long.
The second item was to alter the view a private practice was closed. Only one of my clients actually closed. She did so for the most unfortunate of reasons. She was diagnosed positive for this xxx bug.
The most important requirement was to make sure patients – existing or potential – knew or could easily establish, the practice was NOT closed.
MHM isn’t closed either!
It may have moved from Hilton Hall to temporary offices.
But it’s still here.
I just love the concept of temporary offices though because, in reality, it’s now operating from my “home office”
Otherwise known as the spare bedroom.
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All MHM clients are very dedicated individuals.
Having spent approximately 15 years of training and finally becoming medical professionals, they go on to work incredibly long hours.
They do so because they actually love what they do.
All at some point all have taken the decision to start a private practice.
It’s unlikely they would be my clients otherwise if you think about it.
They start a private practice because they wish to make more money doing what they love anyway.
To have any other objective is either (a) silly or (b) engaging in self-delusion.
There is no shame in admitting you start a private practice to make money.
As I’ve blogged many times previously a private practice must be run as a business – a business with more than a social conscience but nonetheless still a business.
Yet, sadly, many consultant surgeons make the mistake of believing their practice will grow and make them rich if they continue doing what they love to do.
Sadly that is not true for doing what you love seldom leads to long-term financial success.
And that means you must measure the performance of your practice.
This is the point at which the private consultant surgeon realizes he/she must understand financial analysis i.e. the numbers.
It’s not all that complicated. Supplying data to your accountant every year isn’t the same as understanding the numbers behind your practice though.
Let me give you a real example.
I was contacted recently by an established medical professional. He claimed to be working all the hours God sends but said he was always broke.
It didn’t take long to work out why.
The first good indicator was a complete lack of financial analysis other than a tax report a little over one-year-old. No debtors ledger was available.
He didn’t have any real idea how much he was owed.
Indeed it transpired both patients and insurance companies were only invoiced monthly.
So I took the last six months’ worth of clinic lists and checked how many had or had not been invoiced.
Quite a lot had not.
I did the same with surgical episodes with the same result. This was followed by an investigation into how much had not been paid even if invoiced.
But it was also a case of adding up the total revenue generated for each month, calculating the total costs (room rental, monthly indemnity insurance premiums, secretarial costs, etc). Then one was subtracted from the other.
Even if any type of provision was made for tax liability was ignored the results were not encouraging.
The really bad news is that the consultant looked very blank when I asked which percentage of patients were referred to him from which source.
It was clear this particular consultant had no real idea of how his practice or business was performing.
And that was and still is a very dangerous place for any business to be.
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Most consultants when they first start a private practice, consider how best they can set their fees.
In the case of self-funders, there is nothing to stop you charging any consultation fee you like.
Save of course if there are other consultants in your area then their fees will influence that which you charge.
Effectively it is up to the patient whether they chose to accept that fee or not.
In reality, in the case of an insured patient, it is not the consultant who sets fees.
It is the patient’s insurance company.
Consideration of fees for an insured patient should be viewed from two distinct areas:
1: Consultation fees
2: Surgical Fees
Consultation fees (for both initial and follow up) will be agreed at the point of recognition by the respective insurance companies of the medical professional e.g. consultant surgeon, anesthetist, etc.
The insurance company with whom your patient is insured will always set surgical fees.
You may feel the fee is too low and therefore try to charge more.
Almost certainly your invoice WILL be rejected.
Keep sending invoices in for fees greater than that allowed by a particular insurance company and you run the risk of being de-recognised.
It’s not a good idea to be in such a position.
Whether it is right or wrong for insurance companies to hold such power over the setting of surgical fees is for another article.
I have very firm views on it but at this point, the stark reality is that the insurance companies do hold most of the cards.
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I had a discussion with one of my clients a few weeks back.
She was very firmly of the opinion patients should able to contact her secretary or her practice at any time of the day.
Respectfully, I disagree.
Patients may indeed be demanding on occasion but the idea of 24/7 is a step too far.
For example, MHM opens it’s phone lines from 7 am Monday to Friday. It closes it’s phone lines at 8 pm Monday to Thursday and 1 pm on a Friday.
However, during those hours the telephone is answered. And answered quickly. None of this “press button one for payments, press button two for appointments, press button 3, etc!
MHM never has done that and it never will.
Instead, the phone is answered.
Interestingly on more than one occasion, I’ve had a caller say to me “Oh a human being has answered the phone!”
Outside of those hours, there is an answering machine with a message stating when we are open and if a message is left we’ll get back to you within the hour.
There is also an answering machine if all the phone lines are in use. Calls are returned within the hour.
Not one single patient has ever complained about that.
Patients are human beings.
They are also human beings concerned with their health.
That’s fairly obvious but worth repeating.
It’s worth repeating because they deserve to be spoken to and not forced to just process their health inquiry electronically.
None of that means I’m against online bookings. Nor am I against using an answering machine. Far from it.
But only outside “normal” working hours.
Once patients are aware of when they can contact a practice and if they are confident, they will be looked after they will be happy.
That is precisely what I said to my client.
Sometime later she called me and agreed.
There is no requirement for 24/7 access.
But there is a BIG requirement for patients to be able to access her practice efficiently during “normal” working hours.
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A CCSD code is used by insurance companies to identify a medical procedure.
An Orthopaedic surgeon, for example, understands what a Multiple arthroscopic operation on the knee is.
But it’s a lot to put on an invoice every time you produce one!
Put the CCSD code W8500 on the invoice instead. It will identify that specific procedure.
So where do you find a code?
A CCSD code is found on the CCSD website: www.ccsd.org.uk
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the five major healthcare insurers – Aviva, AXA-PPP, BUPA, Vitality and Simply Health.
The group’s main purpose is to maintain a common standard of procedure codes. The codes reflect current medical practice and are published as the CCSD Schedule.
The various insurance companies will, therefore, recognize such codes.
Whilst the example W8500 above will be recognized, it does not come with a suggested fee.
The fee payable for each code is up to the individual insurance company concerned.
To find the correct fee for the code, the insurance company concerned should be contacted.
When an invoice is then sent to the insurance company for payment, the code should appear on the invoice. Both the code and the fee will match that expected by the insurance company.
If alternatively, you do NOT use CCSD codes payment will be substantially delayed if made at all!
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The normal item when I get asked to review a consultant’s invoicing process is the potential for weakness in the area of records on his/her part.
Sometimes, I’m presented with a carrier bag full of invoices, remittances, and receipts.
My favourite though remains the cardboard box stuffed full of pieces of paper.
That was the filing system.
Close examination of the pieces of paper in the cardboard box suggested they were invoices.
Many in fact did not have an invoice number on them.
Indeed the majority did not actually have the word INVOICE printed on them either.
That can be a problem when I come to reconcile payments against such payments IF they’ve been paid at all.
That is important because it’s difficult to contact an insurance company and discuss invoices for one individual patient if the invoice does not show a specific invoice number.
In fact, the only way you can tell them apart is if the values are different and they are on different dates.
It’s always best to have a unique reference number on an invoice i.e. an invoice number and a date.
And don’t forget to print the word INVOICE on it.
At least that way, you stand a chance of knowing which ones have or have not been paid.
Then the hard part starts as you begin to look at what is or is not on the invoice and get a feel for what was likely to be paid anyway and what was likely to be rejected due to total lack of detail.
Normally this is followed by a request to see clinic lists and the process of obtaining the right data off the clinic list for submission to the insurance company.
There is also an additional cost to not keeping accurate records.
When it comes to tax time, it’s going to take a lot longer – and thereby cost much more – for your accountant to do the necessary computations.
At worse you could end up paying too much tax.
All because records aren’t kept correctly.
Please keep accurate records if only because it means you stand a much higher chance of being paid!
Please email me if you want details of the bare minimum records you should be keeping for invoicing purposes.
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This issue came up recently with a consultant surgeon.
What is the difference between benefits and fees and how are fees accounted for against a benefits package?
Consider the total benefits payable under a patient’s policy. For example, the benefits payable is £100.
It could be more. The fees mentioned below could be higher too.
Against such a benefits package, fees are deducted thus:
£20 is paid out. The total benefits figure reduces to £80.
Subsequently, the patient requires surgery. £50.
This is also paid.
The accumulator reduces to £30.
Finally the hospital tenders their account: £20. The gasman submits his: £10. The benefits accumulator, therefore, reduces to ZERO.
The benefits package is equal to the fees.
If the initial is £21, the surgery £51, the hospital £21, and the gasman £16 then the total fees = £109. Against a total benefits package of £100.
Thus, if fees exceed the total benefits a shortfall will be created.
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I spent some time yesterday looking at the invoicing of a consultant surgeon.
I noticed that the invoices for initial consultations going out to one particular insurance company were being charged at exactly the same fee as for follow-up consultations i.e. £125 each.
Instead, they should be £175 for initial and £125 for a follow-up.
So… £50 multiplied by the number of errors spotted so far over the first month I’ve checked (9) = £450!
The bad news is that this has been happening for, so far as I can tell at the moment, for at least the last four months.
Potentially, £1,800 worth!
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A couple of examples recently where consultants who have tried to base their fees on the best rate available.
Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400.
He decrees he will charge PMI Company 1 the PMI Company 2 rate.
Right up to the point PMI company 1 receives the invoice for the higher amount.
They will decline to pay that fee.
Most likely they will shortfall it.
But, replies the Consultant, no problem.
The patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t.
Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable.
Carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling.
Continue doing it over a number of months and for sure eyebrows will be raised.
Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain the same by “inappropriate billing” is not the smartest way to go about it.
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Every time I give a presentation to consultants wishing to start a private practice it’s pretty much guaranteed, I’ll get asked about having a website.
In particular, I’ll be asked – do I need one?
Short answer: YES!!
Ah! – Comes the response from a fellow presenter with a very well established practice – I don’t have one.
I don’t need one.
That may be so because he is well established.
But for someone just starting out being on the private hospital’s website, just being on the PMI website or on a directory of consultants is not enough.
Neither is, although still a big source of referrals, having patients referred only by a GP.
Patients are very switched on.
They will trawl the Internet looking for whom they consider being a suitable surgeon with whom to book a consultation.
They may still ask their GP for an opinion. And then be concerned if the GP recommends another surgeon because the surgeon is a friend of the GP.
What does the GP do if he doesn’t know a suitable surgeon?
Yep – he goes to the Internet too.
The bad news is that it is not just a case of building a website.
I call it the “build it and they will come” principle.
Websites need to be maintained and refreshed – at least every six months.
Then there is the question of social media.
MHM doesn’t build websites nor do we manage social media for its clients.
It’s far too complicated.
We just pass on the requirement to one of our partner organisations.
Based on the analysis of MHM clients with a website and those without, it is pretty clear those with a website see more patients.
You sure you can’t be bothered with all this Internet stuff??
How many of you still rely on GP referrals only?
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At a medical conference recently a friend of mine was discussing the future of the private practice industry and what lay ahead.
My colleague shared the view that the “younger” newly appointed consultant is more adaptable to the direction of change in the private practice.
Thus they were a major driver in how the industry moves forward.
I say they are entrepreneurs.
Let me explain why.
Certainly newly appointed consultants cannot look forward to a hefty NHS pension at the end of their career.
The younger consultants are also facing a squeeze in fees from private medical insurance companies.
Not to mention they journeyed through a number of years to reach the position they are in now.
Yet they find themselves in an increasingly competitive market.
The market is more competitive than those who came before them.
The younger consultants are, so the evidence suggests, much more open to a business-orientated approach than before.
They have to.
In other words, the newly qualified consultant still has a mortgage to pay, mouths to feed, etc so is much more receptive to being an entrepreneur.
Say what you may but the fact remains the private medical healthcare environment is changing.
Just as the NHS healthcare environment is changing.
At the forefront of such changes will be the newly qualified consultant surgeon.
To adapt or take advantage of such opportunities as may arise, the new qualified are using technology as never before.
For example, they are much more amenable to the use of internet-based technology for marketing and PR.
They have to be entrepreneurial.
To prosper, let alone survive, they must invest in technology.
What is interesting is that they are more willing to do so than ever before.
To succeed with a private practice requires a significant amount of seriously hard work.
This is not to suggest the application of medical skills is not important.
But what is equally important are entrepreneurial skills.
Marketing, financial expertise, and business managerial skills for example.
These should not be assumed to be easy.
They now have to be acquired.
Consider that a consultant – newly qualified or otherwise – works within the NHS.
The NHS provides a support infrastructure including premises, secretarial support and, crucially, a constant supply of new patients.
In the private sector, none of these items will be supplied.
The consultant has to go out and actively find them for himself.
And that is why the consultant surgeon should be viewed as an entrepreneur.
Does anyone have a different view? I’d be delighted to hear from you.
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One of the most common remarks I hear from my guys is the number of patients they see in the NHS.
They literally have patients queuing up to see them.
Such a comment is normally followed by the opposite when discussing a private practice.
This, for me, confirms the absolute difference between the public and private sectors.
In the NHS, a consultant surgeon does not have to do much in order for patients to be delivered to them.
In the private sector, the opposite applies.
In the private sector a consultant surgeon, because fundamentally a private practice is a business, MUST attract a patient.
He must engage in pro-active marketing.
He must ensure it is known his practice is there.
First of all, however, he must comprehensively understand WHY a patient is choosing to go private.
It is not merely the case of a patient wanting to be seen private because he or she has private medical insurance.
It is understanding WHY the patient has private medical insurance. I, for one, dispute it is because private care is better than NHS care.
More likely it is because the private patient wishes to be seen quicker.
Even so, a consultant surgeon MUST engage in marketing.
If the patient can be seen at the private practice quicker than at an NHS location but the patient is unaware the private practice exists then all bets are off.
Therefore a marketing plan of some description is an integral part of a private consultant surgeon’s business plan.
And therein lies the reference to the first and absolute cultural difference between an NHS practice and a private practice.
In an NHS practice, patients will be delivered to the consultant surgeon without him even asking.
In private practice, patients will not just be delivered. They have to be attracted to the practice or more accurately to the business.
Note the use of the word BUSINESS for a private practice is a business.
This is not the time to discuss which marketing strategies will and do work best for a private consultant surgeon.
This blog is more concerned with highlighting that due to the differences between the NHS and the private sector, a private consultant surgeon has no choice but to have a marketing strategy.
Just as a consultant must have a robust infrastructure to support the business (secretarial support, invoicing, banking, etc), it is equally as important to have a marketing strategy.
Look at it this way, if any business does not have a regular number of customers or clients (in the case of a medical practice PATIENTS) then inevitably the business will not succeed.
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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them.
Before asking the question of why and how does a patient chooses you as a consultant an early question is asked.
Why have the patients taken out private medical insurance originally?
There are three major reasons.
Empirical research indicates most private healthcare originates via a patient’s employer. And the main reason for holding private cover is to avoid NHS waiting lists.
This is the primary reason patients have private medical insurance cover.
The second reason for having private healthcare insurance is that it offers the benefit of when and where.
Therefore, the patient can choose.
Aligned to this is the ability to recover post-surgery in a private suite and that may be more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you, it is useful to consider why the patient has medical insurance anyway.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
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We are in the people business.
That means you can’t run a private practice by email. Nor should you for we are dealing with people.
Reluctantly, that lead to one of the MHM clients having to dismiss his secretary in October 2019.
I’m one of the worst for trying to do things as efficiently as possible.
If I can’t see the point of doing something efficiently, I won’t do it.
But that does not mean I won’t answer the phone and speak both to patients and/or clients for they deserve some respect.
Ultimately, they pay my fees so they definitely deserve my respect.
It may not be the most efficient way of spending my time but nonetheless, if I don’t, I don’t make money. Simple really.
Yet the secretary referred to earlier didn’t understand that.
She was firmly of the opinion EVERYTHING could be done by email.
From answering a patient query to booking a patient consultation, everything had to be done (literally) by email.
When I called, the phone wasn’t answered. There was a message advising me to email her instead.
Potential or existing patients heard the same.
When she did reply – by email obviously – (normally the next day and that bugged me), her answer was often ambiguous. Thus another email was sent.
Another 24 hours and I received a second email that may or may not have resolved my issue.
Quite frankly if I had been a patient looking to book a consultation with her surgeon, I would not have been impressed that nobody could be bothered to even speak to me.
When I finally got to speak to her and complained she never answered the phone her response was magical.
She hadn’t got time to answer the phone because she had all these emails coming in.
So I risked certain death and pointed out, she was getting all these emails BECAUSE she wasn’t answering the phone.
Between January 2019 and September 2019, this particular MHM client’s practice hadn’t grown; indeed it had got smaller.
So much smaller that the client could no longer afford to employ a secretary and, instead, asked his wife to take over.
His wife started to answer the phone AND answer emails.
The number of emails reduced dramatically.
Patient numbers for October, November and December 2019 increased.
Thus far in 2020, patient numbers are going up again.
p.s. what inspired me to write this particular blog was a phone call I took from a patient this afternoon. I answered the phone and the very first thing the patient said was?
“Oh. You are a human being! I thought I’d get connected to a machine and have to press numerous buttons”
Think about that for a second, please?
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