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Nickel and Dime Leakage Thatís Costing You Big
An unnecessary service charge, a bloated maintenance contract these small leaks can drain your practice.
By Sara Michael


Colonial Family Practice was doling out about $400 a year to their practice management  system vendor for antivirus protection. Problem was the Sumter, S.C.-based practice wasn‚€™t even using the service, instead using an antivirus system  purchased through a local IT company for all their computers.

Then there was the $500 annual maintenance contract for insurance card scanners which the  practice hasnít used since 2005.

No one at the practice was using the code correct function in the system, but that didnít stop them from being  charged $1,200 a year for it.

Some of [the charges] are small, but they  add up, said Krishna Bhat, a contractor working with Colonial Family Practice  to find savings in their billing, operations, and purchasing processes. He has  helped the practice comb through the bills from the practice management system  vendor, and has turned up about $37,000 in unnecessary annual fees for redundant  and unused services fees they hadnít even noticed they were paying.
  think when it comes to things like practice management systems Ē itís  mindboggling the small items that are there. Itís physically impossible for an average person to catch it.

A trickle here and there and these small charges can really add up to major leakage for your practice. Of course, youíve been warned about the big-ticket areas from which cash can really flood out of your practice: Thereís the need to code properly, rather than always opting for the safer, lower-paying 99213 for fear of being audited. And donít forget to collect copays from patients before they leave your office, which greatly  increases the chances you will ever see that cash. You know you should try  negotiating with payers and automating some of the manual claims processes.

But money still could be slowly seeping out of your practice through some overlooked cracks. Taking a fine-toothed comb to some of your bills is one less-obvious place to start.

Vendor charges may be bundled, or even if  they are itemized, often the balance changes month to month based on volume, says practice management expert Elizabeth Woodcock. The services offered by  practice management systems and EHR vendors are often so complex that most times, practices might not notice they are being overcharged. The same goes for telecommunications services. When was the last time you really scrutinized the phone bill?

But look closely. A few cents here and there for unused  services and capabilities can create mounting losses without the practice even realizing it, Woodcock says. Unfortunately, the complexity can sometimes hide the problem.

Here are a few more nickel and dime leaks that may be  costing your practice big bucks:

  • Janitorial contracts. Make sure youíre paying a competitive rate for the office cleaning, says consultant Lucien Roberts. One practice, he  says, was paying $3.13 per square foot for janitorial services, while the  neighbor was paying $1.45. For a small office, thatís more than a $2,000  difference. And if itís a satellite office thatís not used everyday, does it really need to be cleaned five days a week? Why not cut that down to two?

  • Maintenance agreements. Are you paying big bucks to keep  fixing an old copy or fax machine? Maybe itís time to consider whether the  maintenance costs are worth it, says consultant Judy Capko. Consider coughing up a few extra bucks on a more efficient machine, such as a two-sided copier or even a small card scanner for insurance cards, which will save time and money in the long run, she says.

  • Staff overtime. Woodcock estimates about a third of overtime is abused: take for example the employee who comes in 15 minutes early each day to pad her paycheck. Not much, you think? For a $20/hour employee those  extra few minutes can add up to nearly $2,000 a year. Instead, staff should have  overtime approved by a supervisor. You really want to have a policy in place, Woodcock says. If the job isnít getting done in the 40-hour week, it might be an efficiency problem, and time to take a closer look at the practiceís work flow,  Capko adds.

  • Credit card processing. Take a close look at your rates and do a little shopping around, rather than just relying on the vendor youíve had for years, Roberts advises. One practice opted for an online processing system,  which saved the cost of buying or leasing the equipment, plus the cost of the  dedicated phone line, he says. This could save $30 a month.

Thirty bucks here and there might not sound like much. But as Colonial Family Practice  found out, the smaller, overlooked charges can really add up. Plugging the  sources of some of the less visible leaks can go a long way to keeping your hard-earned cash from washing down the drain.

Sara Michael is an  associate editor for Physicians Practice. She can be reached at sara.michael@cmpmedica.com.

This article originally appeared in the November 2009 issue of
Physicians Practice.

Reproduced with the permission of Physicans Practice. Copyright (c) 2009 Physicians Practice Inc. www.physicianspractice.com All rights reserved. Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

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