More doctors are charging fees to respond to patient messages • Hacker News Board

Re: More doctors are charging fees to respond to patient messages

#51

Post by moralestapia » Fri, Mar 08, 2024, 5:33 PM UTC

cratermoon wrote: post #24

DaveExeter wrote: post #21

Earlier quoted context omitted.

[flagged]

Ah yes, of course, https://bitworking.org/news/2008/01/the-free-market-fairy/

He's right, though.

I moved to Canada recently and caught a flu that I didn't take care of and, in turn, developed into pneumonia. It took me FIVE days to be able sit down with a doctor and get an antibiotic prescribed even thought it was more than evident I needed immediate care. I could have died if I waited another day. But was it free? ... ehrm ... yeah.

In Mexico, doctors are as free market as it can get, downsides and upsides of that considered; with cash in hand you can get any kind of attention you need in the exact moment you need it. And it's not even that expensive, after converting MXN USD. I could've dropped by with any of the 1,000s doctors that are available, many of which don't even require appointments. I would've got the attention I needed and the antibiotic prescription in 2-3 hours. That would had cost me ~60 USD.

Re: More doctors are charging fees to respond to patient messages

#52

Post by freeAgent » Fri, Mar 08, 2024, 5:33 PM UTC

JustBreath wrote: post #39

medmunds wrote: post #12

Every time my lawyer replies to my email, it costs me $35. At least. That's just for one or two line responses. Anything that requires research or (gasp) looping in a partner gets a lot more expensive, very quickly. This doctor sounds like a good deal.

This is a pretty privileged perspective. There's also quite a difference between the ethics of healthcare and legal services. Most of the time if you need a legal answer from a lawyer who charges like that, it's because you know you'll net more money from having the answer than it will cost to get a reply. With healthcare, you're not trying to make money you're just trying to live.

There's a lot to unpack here, but in the US healthcare is delivered in a fee-for-service model very much like any other service you use. Unless and until we change that model, why do you expect doctors to give up income they could receive from seeing patients in-person in order to read and respond to your emails for free?

Re: More doctors are charging fees to respond to patient messages

#53

Post by mindslight » Fri, Mar 08, 2024, 5:33 PM UTC

DaveExeter wrote: post #21

danielschonfeld wrote: post #10

Earlier quoted context omitted.

American healthcare is the epitome of capitalism run amok. It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.

[flagged]

I'm in agreement that healthcare is sorely lacking many individualist incentives, including market ones [0], but can we not pigeonhole anything we don't like as "socialism" ? It just makes for a terrible time talking past one another.

[0] hint: receiving bills for charges you never assented to is not a foundation of a working market, and should obviously be illegal.

Re: More doctors are charging fees to respond to patient messages

#54

Post by nightski » Fri, Mar 08, 2024, 5:34 PM UTC

recursive wrote: post #34

DaveExeter wrote: post #21

Earlier quoted context omitted.

[flagged]

How much time would you spend shopping around while you're bleeding out from a head wound? What would you use for negotiation leverage?

Typically one would not do that. You'd shop around ahead of time, sign up for a plan and then if/when the emergency came it would already be taken care of.

Re: More doctors are charging fees to respond to patient messages

#55

Post by freeAgent » Fri, Mar 08, 2024, 5:34 PM UTC

rpearl wrote: post #25

medmunds wrote: post #12

Every time my lawyer replies to my email, it costs me $35. At least. That's just for one or two line responses. Anything that requires research or (gasp) looping in a partner gets a lot more expensive, very quickly. This doctor sounds like a good deal.

Typically, when you are talking to a lawyer, you have signed a contract, paid a retainer, and have an explicit hourly rate negotiated for interactions with that specific firm.

Yeah, and typically when you do the same with a doctor the fee you pay has been negotiated with your insurance provider. This is no worse than anything else billing-related in healthcare.

Re: More doctors are charging fees to respond to patient messages

#56

Post by recursive » Fri, Mar 08, 2024, 5:35 PM UTC

nightski wrote: post #54

recursive wrote: post #34

Earlier quoted context omitted.

How much time would you spend shopping around while you're bleeding out from a head wound? What would you use for negotiation leverage?

Typically one would not do that. You'd shop around ahead of time, sign up for a plan and then if/when the emergency came it would already be taken care of.

That's what we have now. I hope you're conscious enough to tell the ambulance driver which hospital to drive to.

Re: More doctors are charging fees to respond to patient messages

#57

Post by FireBeyond » Fri, Mar 08, 2024, 5:35 PM UTC

smallmancontrov wrote: post #16

gnicholas wrote: post #2

Getting a doctor to respond through our digital messaging platform is practically impossible. Unless you're extremely persistent and specifically ask for the doctor's input (and send 3-4 messages back and forth with the nurse, whose responses are less relevant than a google search), it's impossible. I wonder if charging for these messages will make doctors more likely to respond. I wouldn't mind a modest copay for th…

> I wonder if charging for these messages will make doctors more likely to respond. I wouldn't mind a modest copay for these. How long until administration figures out that they can juice revenue by shitting up the emails to increase back-and-forth traffic?

Hah, in MyChart, my provider has started having an MA answer your emails, and then "I'll forward this to the provider". Waiting to see if I get billed for the MA's "effort".

Re: More doctors are charging fees to respond to patient messages

#58

Post by bodiekane » Fri, Mar 08, 2024, 5:35 PM UTC

smallmancontrov wrote: post #27

DaveExeter wrote: post #21

Earlier quoted context omitted.

[flagged]

So why is our healthcare twice as expensive as the countries who actually do have socialized health care? When is that competition going to kick in and bring down costs? https://www.healthsystemtracker.org/chart-collection/health-...

Because Obamacare legislation ended up as a terrible version of socialism/pork-barrel spending/crony-capitalism in order to get the required support to pass.

The democrats wanted to get subsidized healthcare for low income people and people with existing health issues that would guarantee they would be uneconomical to insure. The healthcare providers, insurance companies and pharma companies wanted to remain viable, profitable businesses.

The compromise was to essentially guarantee profits to healthcare companies by crafting legislation that overcharges young people, healthy people, male people, middle class and affluent people to subsidize costs for other groups, while giving a consistent profit margin regardless of costs to insurance companies.

There is nothing about American healthcare that resembles functioning markets or capitalism. It's a very heavily regulated industry where the government exerts extreme control, while choosing to legislate in a way that maintains a consistent flow of money to influential lobbying groups and political donors.

Re: More doctors are charging fees to respond to patient messages

#59

Post by Ekaros » Fri, Mar 08, 2024, 5:36 PM UTC

DaveExeter wrote: post #21

danielschonfeld wrote: post #10

Earlier quoted context omitted.

American healthcare is the epitome of capitalism run amok. It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.

[flagged]

It is perfect example of crony-capitalism... Under socialism basic care would come from one pot. And state would tell what everything can costs.

Re: More doctors are charging fees to respond to patient messages

#60

Post by freeAgent » Fri, Mar 08, 2024, 5:38 PM UTC

avgDev wrote: post #49

freeAgent wrote: post #40

Earlier quoted context omitted.

Trust me, they are all aware of this. The problem is that, for the majority of doctors now, they do not own or control their clinics. They are either: 1)employees of the health system or 2)partners or employees of a provider's group that essentially contracts with the system to provide doctors. The doctors themselves have no real control over how their clinics operate outside of contractual negotiations.

The doctors are just cogs in a machine. The problem is that if your compensation is $200k-$1000k why would really want to tackle the issue. Specialists make so much money they can hire a personal assistants to handle all the annoying things. I know several pharmacists, one is highly intelligent and she is the only one who wants to get out of the field because healthcare in the US is toxic and profit driven.

Yeah, most of the time when patients send emails, they get responses from a nurse. At least at my wife's clinic, they do not always charge for emails. They only choose to charge when an email is asking something non-obvious or for the doctor to take some action that requires additional work/time outside of just reading and responding to an email.