Fee For Service


A poem about the painful absurdities of practicing in a fee-for-service model. Published on Doctors’ Day 2023, in celebration of my impending freedom from this broken system. FFS, you atrocityWith wRVUsCruelly concocted by CMSEncoding suffering with ICD-10And compounding it endlesslyWith Z codes for SDOHAnd 7 characters to specifyEpisode of care How I do translateThe sequelae […]

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The High Cost of High Cost

Since my model of practice (a monthly fee without copay or other profitable procedures/products) benefits most from people paying for my service without heavy use of those services, this seemed to be prudent.  It seems that I was right about this, when comparing experiences with my colleague.  People are much less likely to pay $50 per month (or more) unless they have significant need, so a higher price essentially selects for more complex and/or demanding patients.  

This is why I can reasonably handle 640 patients today with only two nurses (one of whom is away on vacation).  Yes, I don\’t get as much money as I would for 640 patients at a higher monthly rate, but I wonder if I could actually handle that number of patients with only two nurses if I selected out for more demanding patients with that higher rate.    I doubt it.  The longer I consider this, the more I\’m convinced of its truth, and the less I am inclined to raise my rates (much to the chagrin of my accountant).

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