EDITOR’S NOTE: As the director of content for insidePatientFinance.com, I read and follow a host of vital conversations in the healthcare industry. One of those important discussions involves the balance between delivering quality care while at the same time managing a business. The “core competency” of doctors (as a profession) is to make people well, to treat illness, and to improve quality of life. And doctors have their hands full just doing that. So your core competency and training—even as you’re running a business—is not all of the business-related minutiae. Or at least it can’t be your first priority. But you still need all those business elements to function efficiently in order to continue to provide the best care for patients.

The piece below originally appeared in the June edition of The DECA Relay, a monthly newsletter for healthcare finance professionals. You can access an archive of past Relay newsletters from DECA Financial Services’ Blog or by clicking here. I think Dr. Mulvey, a practicing emergency physician, approaches that balance in an intelligent and genuine way.

Michael R. Klozotsky, Chief Content Officer
insidePatientFinance.com – @insidePF


By Dr. Andy Mulvey, MD FACEP

The growing consensus among emergency physicians is that we are sailing the Healthcare ship into the perfect storm. Rising ranks of government patients and reduced commercial payers are resulting in declining patient revenues. Physician shortages in our specialty create growth and recruiting challenges while driving up compensation rates. Finally, the ranks of the uninsured continue to grow as we see steady, high unemployment. As a result, many emergency physician practices are facing an uninsured patient population that has risen to one quarter or even a third of their total billable visits. I have seen this expanding problem first-hand as part of a small, independent emergency physician group. We were experiencing tremendous downward pressure on group revenues while having to pay more just to recruit and retain enough providers to keep our contracts.

In this era of healthcare, patient collections can no longer be looked at as a side item to augment group profits. Rather, collections are now a critical component of accounts receivable recovery and hold the key to the long-term health of so many emergency physician practices. Unfortunately, this is not an area of expertise for most groups and the billing companies we partner with fail to address the bad debt. To them, bad debt is costly, inefficient, and not worth their effort going after. They want to grab the low fruit with electronic billing for government and commercial payers and then outsource the remaining accounts receivable to collection agencies that charge a large fee and often underperform.

This paradigm creates unique challenges for emergency physicians as we try to have to balance the need for strong collection services while still treating our patients with respect. Can we find a way to improve revenue from patient copays, deductibles, and the uninsured while recognizing our duty to treat and our professional responsibility as physicians? How can we retain some control of the collection process when these patient accounts are outsourced and we lack an understanding of the entire operation?

I believe the key component to a successful collections model for emergency physician groups is to become more engaged in the billing and collection process. We can’t just turn over patient charts and wait a few months for our ninety-five dollars to arrive. How many physicians/groups don’t even know how our patient collections are handled and who is doing it? Like anything else in life, if we get more involved we can obtain more control and hopefully better results.

This is exactly what we did in my group and the payoff was significant. We discussed the process with our billing company and interviewed several collection company vendors. After gaining a clear understanding and approval for the collections process, we selected a company that we felt provided the best fit for the culture of our group. Over the next year, we realized a several percent increase in patient collection revenue, a large payment from old bad debt just sitting on our books, and more influence in how the patients themselves were handled on our behalf.

Nobody expects emergency physicians to become experts at billing and collections. However, as we face growing economic pressures, the difference between success and failure will be in how engaged we become in the financial operations of our business.

  • Call your billing company,
  • ask some questions about their mechanism for handling bad debt,
  • most importantly: select your own collections vendor.

We balance so many responsibilities as practicing emergency physicians, yet we cannot ignore the twenty or thirty percent of our practice revenue which goes to collections. Managing this piece well will allow you to feel better not only as a physician, but as a business owner.


Dr. Andy Mulvey is an actively practicing emergency physician who recognizes the importance of the science, art, and business of medicine.

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