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Administration/What should be done if we get a flat fee, but the procedure lasts excessively long?

QUESTION:

At our center we have flat fees for Plastic surgery cases but it seems as though the surgeons often run over on time or do more than they say they are.  We are looking at placing time limits on each plastic procedure and any time over will be billed to the patient.  Do any of you have such a fee schedule and would you share it--I am not sure how to set it up?  This is becoming a very big issue with our anesthesiologists. 

-- From Diana McDaniel, R.N., M.S.N., Evansville, IN

REPLY:

The issue of private pay and a fee schedule can be tricky as there are many variables.  The success of the fee structure lies in reducing the variables. Each practitioner may have a different pay schedule as their "surgical time" is variable.

We have a "start up" fee for the first hour and then have a fee with each following hour. You must know the average length of time for each procedure your surgeon performs.  The flat rate fee can be derived using this average time.  Notify the surgeon and the patient that all time over the "usual" will be balance billed to the patient. Conversely you must be ready to refund a patient who is shorter than the "usual" time. Have the option to reevaluate this "usual time" on an ongoing quarterly basis. We also have a "minimum time" or "minimum fee" that is structured so that people will stack cases and/or understand that anesthesia time has value when it is reserved for them.

To address the actual fee, one must know the competition and adjust or set their fee accordingly.

I hope this fits the bill.

-- From Meena Desai, M.D ., Villanova , PA

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