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More doctors are charging fees to respond to patient messages

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

#181

Post by BobaFloutist »

dghlsakjg wrote: post #152
BobaFloutist wrote: post #106

Earlier quoted context omitted.

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…

You have no idea what this person was being seen for. It is fairly common for someone to be advised to seek emergency treatment out of precaution to ensure that a minor symptom is not indicative of a severe problem. For example dizziness can be a completely nothing-burger inner ear problem treated with a bunch of motions from youtube, or it can be a stroke. The ER exists to make that distinction. Part of all those lo…

>You have no idea what this person was being seen for.

I feel fairly comfortable assuming that they were being seen for a minor-to-moderate burn.

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

#182

Post by alistairSH »

bdzr wrote: post #161
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.

It's really not, it's a frankenstein of a system with capitalist and socialist traits. If it were capitalism run amok, a consumer would be able to figure out the price of something as though it were a cup of coffee. Pricing is completely opaque and provides nearly zero demand for providers to compete.

It's not socialist (Medicaid/Medicare notwithstanding). But, it's definitely not "ECON-101 free-market capitalism" either. Lots of regulatory capture from both medical and insurance providers. Plus a bunch of self-inflicted dysfunction because we keep electing ding-dongs into Congress.

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

#183

Post by QuantumGood »

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…

One Medical charges $9/month (through Amazon), all video visits are free (if you click the proper link), and I've had multiple prescriptions renewed that way. Three times waited less than a minute, longest wait was 15 minutes, and the app will call you back if you wish so you don't have to keep the app open.

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

#184

Post by balderdash »

$39 a each message seems expensive - but I don't think $39 per thread/conversation is unreasonable with the actual doctor (would not pay not that for staff).

I’m making up numbers but if a private practice physician earns $250k/year for 2000 hours that’s $125/hr + taxes and benefits + rent/overhead + nursing and staff, you figure that cost is probably closer to $300/hr then you you assume they have to do ~30min of prep/admin for every patient hour that’s closer to $450/hr that’s ~$37.5 per 5 min of patient time (and none of that is factoring in reimbursement rates), people can disagree as to how those costs should be borne but let’s not kid ourselves as to what the cost of doctors time is…

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

#185

Post by dghlsakjg »

BobaFloutist wrote: post #181
dghlsakjg wrote: post #152

Earlier quoted context omitted.

You have no idea what this person was being seen for. It is fairly common for someone to be advised to seek emergency treatment out of precaution to ensure that a minor symptom is not indicative of a severe problem. For example dizziness can be a completely nothing-burger inner ear problem treated with a bunch of motions from youtube, or it can be a stroke. The ER exists to make that distinction. Part of all those lo…

>You have no idea what this person was being seen for. I feel fairly comfortable assuming that they were being seen for a minor-to-moderate burn.

That was the treatment received, but perhaps they were referred to the ER by EMS for smoke inhalation.

I don't know either, but the broader point is that people are referred to the ED by medical professionals for seemingly minor issues all the time, and that the incentives are all lined up to treat stupid shit in the ER rather than have someone tell them to go somewhere that makes more sense.

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

#186

Post by gizmo686 »

Someone1234 wrote: post #142
edm0nd wrote: post #102

Earlier quoted context omitted.

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...

Medical providers are constantly telling patients not to self-diagnose/self-treat/play google-doctor, but as soon as there is a billing problem, everyone uses that to victim blame. Kind of messed up if you ask me. Personally I am not qualified to determine what a treatable and non-treatable burn looks like. Where I went to school they don't teach that.

The ER is not the only place you can go for medical treatment.

My order of operations for medical treatment are:

1) Virtual consultation. Free through my insurance. If you need to pay full price, this about as expensive as option 2. Also worth skipping if you can tell that an in person visit will be needed anyway.

2) A clinic. I use CVS's minute clinic. Looking at their price list [0], a minor burn treatment will run you about $100-$150, which is about what I would expect for talking to a professional.

3) Urgent Care

4) Emergency Room

[0] https://www.cvs.com/minuteclinic/services/price-lists

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

#187

Post by tzs »

bilater wrote: post #72
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…

The whole prescription business is such a grift. Doctors deliberately give you max 2 years of a prescription that you know you will need for longer (such as allergy meds, eye prescriptions) and then you have to waste your time and spend money just to renew it.

When I need a prescription refilled I request a refill from the pharmacy. If the prescription has expired the pharmacy calls or faxes my doctor's office and they send a new prescription to the pharmacy. There is no charge for this.

I've only ever had doctors that worked that way so didn't even know that there were some that did not.

I now wonder which is more common, and if there is some way to tell beforehand when choosing a new doctor which kind they are?

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

#188

Post by chriskanan »

This could potentially increase the number of useful questions being asked. My spouse is a physician. Recently she had to answer a phone call from a patient in the middle of the night where they were asking a question from a party about something non-urgent for their child. In another case, she got called by a parent at 2am because their kid was having trouble sleeping but nothing else was wrong with them (welcome to parenthood). If people had to pay, maybe they would _think_ before asking questions.

I've been in meetings with healthcare providers about incorporating LLMs into text-based patient-physician messaging to improve triage and routing. It is just overwhelming for many providers. A large percentage are getting burnt out, and much of their time is uncompensated.

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

#189

Post by Eric_WVGG »

bdunks wrote: post #172
betaby wrote: post #151

Earlier quoted context omitted.

[flagged]

Only 10% of the increase in medical cost in the US is attributable to doctor salaries. The remainder is administrative overhead, Rx costs, insurance administration, etc. There are now 10 administrators for every 1 doctor. Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x. If each administrator is making 100k+ - 150k+, that's significant cost. Some of the…

That kind of lazy thinking drives me up the wall. There's a huge swatch of America that thinks elementary school teachers are bringing home FAT BUCKS because college tuition costs are high.

It's the corporations, stupid.

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

#190

Post by resoluteteeth »

I have mixed feelings about this.

On the one hand I don't want doctors to charge for an email consultation every time I need a prescription refilled.

On the other hand, maybe insurance companies should encourage doctors to do this by paying them (and not charge a copay) because it will reduce the need for office visits which will probably be cheaper for them overall?

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