bers,” said AAP CEO/Executive Vice President Karen
Remley, M.D., M.B.A., M.P.H., FAAP. “The future
continues to be bright for pediatrics, as evidenced by
the high fill rate for our specialty.”
Christian D. Pulcini, M.D., M.Ed., M.P.H., chair of
the AAP Section on Pediatric Trainees, commented on
the high match rate in pediatrics: “This is a wonderful
confirmation of how robust and attractive the field
of pediatrics remains among medical trainees. I look
forward to so many wonderful individuals joining our
field and discovering the richest life experience: the
opportunity to improve the health and well-being of
children each and every day.”
Internal medicine-pediatrics (med-peds), which is
celebrating its 50th anniversary as a combined special-
ty, filled 93.4% of the 381 positions offered.
“Med-peds continues to attract allopathic seniors
at a very high rate (76%) compared to other primary
care specialties,” said Allen R. Friedland, M.D., FAAP,
former chair of the AAP Section on Medicine-Pediatrics Executive Committee and a member of the AAP
Committee on Pediatric Education.
Other primary care specialties did well in the 2017
Match, too. This year, internal medicine filled 97.8%
of positions offered, family medicine filled 95.8% and
obstetrics and gynecology filled 100%.
This year, the National Resident Matching Program
reported a record-high 35,969 U.S. and international
medical school students and graduates vying for 31,757
Although the number of Match registrants was the
most ever, the increase was due primarily to growth in
U.S. allopathic medical school seniors and student/
graduates of U.S. osteopathic medical schools.
Results of the Match are watched closely, as they can
be predictors of changes in physician workforce supply.
Dr. Guralnick is chair of the AAP Committee on Pediatric Education.
present an insurance card, receive care and walk out
the door, sometimes paying a copay that represents a
fraction of the cost to deliver that care. Even when a
call is made to the insurance carrier to verify benefits,
there is no guarantee the provider will be paid.
Co-insurance, high deductibles and health savings
accounts increasingly are shifting costs for medical
services to the patient/family. The implications for
pediatric practices are increased work for staff to get
payment from patients for services that already have
been provided and increased risk that the practice may
never get paid.
No margin, no mission
So, what should a practice do?
First, it is imperative to recognize that profitability
is a practice responsibility. Good business policies are
crucial to ensuring that your practice can serve your
patients and families for the foreseeable future. “No
margin, no mission.”
An important strategy to instill in your practice
culture is that work performed while the patient is
in the office is significantly more efficient than work
attempted after the family leaves the premises.
Having current insurance that is verified at the time
of service is the first step to streamlining payment, but
asking if “anything has changed” at the front desk is not
sufficient. Having a credit card on file (CCOF) policy
can make all the difference.
Benefits of CCOF policies
Your practice should implement a CCOF policy for
the same reason the hotel made you present your card
when you checked in: to ensure full payment is received.
Having a CCOF program helps the practice mitigate the
risk of extending interest-free credit to families. It’s an
effective way to collect patient balances and reduces the
administrative burden of patient collections.
The CCOF does not eliminate the claim submissions
process. It’s intended to be a more reliable and effective
means to collect patients’ portion of the charges. It is
important to note that most third-party payer contracts
prohibit collecting the total amount of payment at the
point of service, so the practice may collect only the
patient’s co-payment, co-insurance or deductible. A
CCOF policy can remove difficult outstanding balance
conversations from front desk check-in, and more time
can be dedicated to patient care.
How do you begin?
Step 1: Build consensus. Practice leadership needs
to buy in, and all staff, especially front desk, need to be
on board. Without 100% consensus, the implementation will not be successful.
Step 2: Provide thorough background and information. Management must express clearly the reasons
for implementing a CCOF policy to all staff. Data
showing how much money the practice had to write
off, outstanding patient balances year over year and
rising accounts receivables go a long way to get buy-in.
Allowing staff to strategize ways in which your patients
could be served better with those additional funds can
help shift the focus. Could your practice use a care
coordinator or an electronic patient recall/reminder
system? This isn’t about greed. It is about preserving
the practice’s mission to provide quality care.
Step 3: Answer difficult questions. Is the practice
willing to lose patients over the policy? How many
times will the practice allow parents to give an excuse
for not providing their card? What are the consequences for not complying with the policy? Will the policy
be optional for certain patients? If providers want to
make exceptions for specific families, are they willing
to offer their own credit card as a back-up?
Step 4: Provide training. The front desk must be
comfortable asking for the card, and providers have
to be comfortable backing up the decision. Preparing
scripts and rehearsing with specific key words/language
are helpful. Role-playing to prepare staff for parents who
resist is crucial to successful implementation. Some staff
are better able to handle conflict than others. Have a
predetermined way for a point person to take the conversation away from the front desk and resolve it.
Step 5: Communicate the policy to patients and
families. Give them six to nine months’ warning of your
policy and the effective date. Explain why the practice is
making these changes. Put information on your website,
hang signs in your office and send out communication
via your practice portal or email service.
Step 6: Remain committed to your mission and
determined to succeed. Some will complain, but the
vast majority will comply. Most people are accustomed
to autopay, recurring billing, online banking, etc. Measure your success and demonstrate your return on investment to your staff. Thank them for their commitment to your patients. Remind them of your mission
to deliver great care to your patients and families.
Dr. Kressly is a member
of the AAP Private Payer
Advocacy Advisory Committee. Betancourt is a
practice manager and a
member of the AAP Pediatric Practice Management Alliance.
Dr. Kressly Betancourt
Examples of pediatric practices’ credit card on file policies are available on the AAP Practice Transformation
Credit card continued from front page
Match continued from front page
For more information and data tables about the 2017
Resident Match, visit www.aap.org/workforce.
Medical students from Oakland University William
Beaumont School of Medicine were pleased to share
that they matched in pediatrics.