But you lose even more on a patient who doesn't pay a pre-deductible copayment or one where the insurance company denies payment.
Also, I have never understood why some practices can afford to see significant numbers of Medicaid/Medicare patients and others can't. Differences in overhead, time spent with patients, type of practitioner who actually sees the patient, minimum earnings expectation... what is the explanation?
Basically you’re right. It really depends on what types of procedures you do, how many patients you see and how efficient you are. In some cases, you simply cannot offer certain treatment to patients because the reimbursement per hour is too low. That’s the problem with government fiat pricing; in some cases, the fee is too low,and other times it’s too high. But like a broken clock, it’s right twice a day.
But as reimbursement for providers trends downward, the tipping point at which a service cannot be provided will become commonplace to a point where it is impossible to make a profit. A patient cannot be a cost center unless providers are paid a fixed amount (capitation) and the incentive is to deny care. This is where 0-care seems to be headed. Administrators and dubious doctors will become experts in providing just enough care to avoid a patient lawsuit. And if doctors are eventually employed by the state or Feds, there will be no lawsuits.
As far as co-pays and deductibles are concerned, more and more, they will have to be paid in full at the point of service, because as you have correctly noted, the cost to collect this money eats into the margin.
The market system would go a long way in determining fair pricing and physicians would have an incentive to provide treatments with the greatest value as determined by the patient.
Maybe if you take a lot of them you can account for the ones that aren't going to show up using the law of large numbers. If you just take 1 a day you can't risk that they won't show up by scheduling someone else for the same time. But if you take 6 a day you can schedule 8, knowing that generally 25% won't show up.
Medicaid patients once made up more than 40 percent of Florence Pediatric Dentistry’s client list, but the practice no longer accepts Medicaid because those patients frequently missed appointments and because the Medicaid agency reimbursed the office poorly for its services, Elvington said.
http://www.postandcourier.com/article/20130616/PC16/130619545