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More doctors are charging fees to respond to patient messages
231–240 of 372 posts
Re: More doctors are charging fees to respond to patient messages
#232I met with a new accountant yesterday. He told me that if I email him and ask if I can expense a lunch and it's a 1 minute answer, he's not gonna charge me. But if it's gonna take him a good amount of time to respond, then he will. And I think that this is completely fair. I'd expect the same from a doctor. If I am asking a very occasional and non-urgent question with a quick answer (e.g., can I take my medicine and…
> occasional
Well, it would be occasional for you to ask questions to your doctor, but your doctor wouldn't be just occasionally answering questions from their patients
> Non-urgent questions
Imagine everyone sending non-urgent questions... Isn't it even more irritating to be receiving non-urgent questions than urgent ones if you're a doctor? I guess the doctor could reply with a FAQ.
Honestly, this is where I think personal LLMs should come to the rescue. Just ask a doctor-sanctioned/fine-tuned LLM for trivial questions.
Re: More doctors are charging fees to respond to patient messages
#233Earlier quoted context omitted.
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.
Agreed. I have been on the same generic blood pressure medication for ~15 years now. I was recently on a vacation in Mexico and surprised to see that you can just buy it off the shelf there. That being said my healthcare plan includes a free yearly checkup with my doctor so it's kind of nice to have a yearly baseline of bloodwork/labs and be able to see it my patient portal.
Many (most) antihypertensives need periodic monitoring for electrolytes or kidney function. In Mexico, they are not going to get sued if you go into renal failure as compared to the US. Partly done for you and partly because of the sorry tort system in the US
Re: More doctors are charging fees to respond to patient messages
#234I worked for a mature healthcare company and much of our marketing centered around healthcare provider surveys of doctors and nurses. The results were unsettling. Extremely high rates of burnout, typically due to administrative overhead. Horrifying medical error rates. Doctors should be compensated for the amount of time to send an email. Every other industry is capable of restructuring support to satisfy demand. It'…
> what would it take for the healthcare industry to restructure itself to actually function?
I can't quote it precisely, but here's a gist from The Glass Bead Game:
> Intelligence can find its own way, the teacher's job is to address stupidity.
Overlooking the crudeness here, I think it's a good idea, and translates to medicine. Most of us are not qualified to define good care, but we know bad care when we see it.
One example of bad care is when you don't discover how expensive a treatment will be until 3 months after it has occurred.
Another might be cases where medical professionals are expected to work insane long shifts with insufficient sleep time in between.
Whatever the examples are, let's make a list of them. Build consensus around the worst offenders, and then start revoking counts-as-medical-insurance tax status from the insurers who fund the bad behavior. If you want pre-tax-medical-insurance dollars, you must:
- be able to turn a "what if" treatment scenario into a dollar amount in less than 10 minutes
- not have organizations be in-network which create unsustainable working conditions for medical personnel
- [other example of bad care goes here]
...and we add to that list over time. Markets don't do design, they do evolution. We have to kill off the ones we don't like if we want more of the ones we like.
Re: More doctors are charging fees to respond to patient messages
#235Earlier quoted context omitted.
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.
Absolutely. I used the number of administrative personal * administrative salaries because it's a quick mental visualization.
I just reviewed United Healthcare's 2022 10k.
In 2022, they had $324B in revenue, and paid $210B in medical expenses. Of the $114B remaining, $85.5B was various operating costs, $28.5B (25%) was corporate profit / operating income (before interest & taxes).
Even if all 40,000 employees of UnitedHealth Group were making 200k (they're not), that'd only account for $8B of their $85.5B in non-medical costs.
https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...
Re: More doctors are charging fees to respond to patient messages
#236If you're in the US, and can afford it, I think direct primary care is the way to go.
Re: More doctors are charging fees to respond to patient messages
#237Earlier quoted context omitted.
Respectfully save me the Ayn Rand. Some of us live in the real world and not the political utopias of our minds.
I'm going to jump in here and offer up an Ayn Rand because you brought her name up. Ask anyone who has a dog, preferably a big dog, what it costs for a vet visit. Better yet, talk to someone who has had a sick dog. Something terminal, or possibly terminal. Costs are wayyy lower. Same x-ray, same imaging, many similar medicines. I've talked with vets, human doctors, and doctors who own dogs. They all come to the same…
Because if I kill your dog I don't get charged with murder.
Re: More doctors are charging fees to respond to patient messages
#238Earlier quoted context omitted.
I have a partner who's a nurse practitioner in primary care and I just want to emphasize how hellish it is for people on the inside as well. The economic model of running a healthcare business is entirely based on their ability to bill for provider time. Healthcare providers have very high costs to match their very high fees and also pay a bunch of people to 'help' providers see more patients. A big part of this mix…
Somehow, US healthcare is ~ 2-3x expensive as equivalents in other wealthy countries, which get better outcomes. Who is collecting this extra money? It's not the medical professionals, you say (and I believe).
It's partially medical professionals! My partner is better paid than she would be in, say, Canada. US medical worker pay absolutely contributes to our costs - I just meant to point out it's not the only factor and that those jobs, though well paid, can be taxing for the people in them on a day-by-day basis.
Re: More doctors are charging fees to respond to patient messages
#239I guess I'm really lucky, my doctor sends me emails and responds to emails, as does his nurses. During Covid my doctor gave me his cell phone number to text him if things got worse. If your doctor charges money for emails, find another doctor or pay the fee. There's plenty of doctors.
Re: More doctors are charging fees to respond to patient messages
#240People talk a lot about prescription drugs, but the real driver of costs are the hospitals, both public and private. Drugs account for 10-15% of total healthcare spending; it’s the hospital reimbursement & compensation framework along with private insurance that is driving the bulk of costs. It’s evolved into a patchwork, opaque, dysfunctional system where the end consumer has little view into the inner workings and…
> Drugs account for 10-15% of total healthcare spending
And still, drugs are too expensive in the USA, especially old drugs like insulin and albuterol (asthma inhalant) that seem to find new ways of being re-patented (e.g., through new delivery devices that are just novel enough to be granted a patent, but provide no significant improvement to the patient).
If drugs, pricey as they are in the USA, are only 10-15% of healthcare spending, that should frighten you as to how cost-inefficient our health care system is.