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

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

#101

Post by BenFranklin100 » Fri, Mar 08, 2024, 6:35 PM UTC

FireBeyond wrote: post #29

codegeek wrote: post #20

Earlier quoted context omitted.

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and wa…

One of our employees decided to go to a random hospital ER room for a small cut on his finger. It only required a bandage, no stitches. The ER charged us $3,300. We are still fighting them.

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

#102

Post by edm0nd » Fri, Mar 08, 2024, 6:35 PM UTC

codegeek wrote: post #20

CharlesW wrote: post #4

Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor displ…

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

Counter point, why did you even bother going to the ER if that is all that was required?

That solution doesn't really scream "emergency" and seems like a waste of their time and resources...

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

#103

Post by segasaturn » Fri, Mar 08, 2024, 6:36 PM UTC

moralestapia wrote: post #51

cratermoon wrote: post #24

Earlier quoted context omitted.

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, downsi…

"Canadian healthcare wait times" are mostly a myth invented by the American healthcare lobby [1]. Canadian cities are dotted with walk-in clinics you can go to and see a doctor same day. Or worst case scenario you would go to a hospital ER. Neither of these options will cost you any money and you will get same-day treatment and care. If you made an appointment with a GP then yeah you would wait, since those visits are typically for non-medical emergencies. :)

[1]: https://www.washingtonpost.com/outlook/2020/08/06/health-ins...

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

#104

Post by NoMoreNicksLeft » Fri, Mar 08, 2024, 6:37 PM UTC

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.

Why would it do that? If they get money for messages sent (rather than messages sent by doctors) then some flunky can send a message and you can still be billed. Given how this sounds like a profit center, and doctors are cost centers (imagine if they needed to send more messages... now they have to pay more doctors!), I figure physicians will be kept far away from any such system.

If we plot out perverse incentives as a space, I believe that our fate will be to trek through every possible point in that landscape such that we eventually see every single one. This means you will eventually get universal healthcare, most likely as the very last of those perverse incentives.

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

#105

Post by plastic-enjoyer » Fri, Mar 08, 2024, 6:37 PM UTC

moralestapia wrote: post #51

cratermoon wrote: post #24

Earlier quoted context omitted.

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, downsi…

Germany has socialized healthcare and you can just go to your doctor without an appointment in acute cases like yours. Saying that ~60 USD is not that expensive comes from a privileged position where 60 USD doesn't hurt you.

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

#106

Post by BobaFloutist » Fri, Mar 08, 2024, 6:38 PM UTC

codegeek wrote: post #20

CharlesW wrote: post #4

Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor displ…

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

I mean I'm not sure that you shouldn't be charged ER prices for taking an over-the-counter-treatable injury to the ER. You probably shouldn't be charged 4000 for going to the ER, but just because you didn't actually need to go to the ER doesn't mean you didn't consume ER resources (the 24/7 staffing, the intake logistics, the trauma expertise, etc).

Probably the biggest surprise there is that a doctor saw you at all instead of you being filtered out by a triage nurse and sent to urgent care.

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

#107

Post by kergonath » Fri, Mar 08, 2024, 6:39 PM UTC

oefrha wrote: post #19

> Dr. Lauren Oshman, a family physician and associate professor at the University of Michigan Medical School, says she initially experienced some patient resistance and anger about the prospect of being billed for emails. > Now, she says, patients are typically pleased that they are able to get a direct response from her through a portal message. > “They’re thrilled when they get me directly,” she says. Geez, this co…

> Geez, this could make corporate PR people blush.

Yeah, it’s embarrassing. I am not “thrilled” to talk to a doctor directly. I pay for it, and when I do it’s because I have a reason to, which kind of limits the thrilling aspect. I expect it, and I need it, sure. But it’s not being able to talk to my doctor that elicits an emotional response, and it tends to be anger.

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

#108

Post by j-j-j-j » Fri, Mar 08, 2024, 6:40 PM UTC

danielschonfeld wrote: post #10

CharlesW wrote: post #4

Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor displ…

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.

None of that stuff would be possible without government. It's a statism run amok.

It's the same story every time. Something works relatively OK (US health care before 20 century big-gov), huge changes to incentive structure and overheads are introduced by statists ignoring higher order effects, everything goes downhill, statists blame capitalism.

Let me legally not have insurance, pay anyone in cash for my health care (no licensens and government enforced monopolies), and buy any medicine I'd like and opt out of this madness completely and let's compare with real capitalism.

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

#109

Post by ReallyAnonymous » Fri, Mar 08, 2024, 6:40 PM UTC

anon-sre-srm wrote: post #89

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.

That's the problem. The doctors should form employee owned co-ops and be sure profiteering administrators and suits aren't the ones running things.

actually, the problem is that Congress continues to LOWER physician reimbursement, but RAISE hospital reimbursement. When I became a surgeon in 2002, medicare paid $600 for me to take out a gallbladder. I had to pay my overhead (50%) so my take-home was $300. Today, in 2024, after price reductions, medicare pays $600.

That is why I have to be employed. I guarantee that after 22 years, office expenditures (rent, salaries, supplies, health insurance) would eat up the remaining $300. So taking care of Medicare patients would be charity. Medicare is 60% of my practice. Private insurance is 25%. Medicaid is 10% and unfunded is 5%.

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

#110

Post by caditinpiscinam » Fri, Mar 08, 2024, 6:43 PM UTC

moralestapia wrote: post #51

cratermoon wrote: post #24

Earlier quoted context omitted.

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, downsi…

> MEXICO CITY (AP) — Mexico’s president said Friday the country’s minimum wage will rise by 20% in 2024, to the equivalent of about $14.25 per day.

> About one-third of Mexico’s registered workers report earning the minimum wage, which will amount to about $1.75 per hour starting Jan. 1.

$60 is 4 days wages for 1/3 of workers in Mexico. It's the equivalent of $820 for someone making 75k per year in the US. So it's the same as any other free-market healthcare system: easy access for the wealthy at the exclusion of the poor.

https://apnews.com/article/mexico-minimum-wage-increase-peso...