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

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

#261

Post by ejb999 » Fri, Mar 08, 2024, 10:31 PM UTC

resoluteteeth wrote: post #190

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?

one of the problems is, how can a doctor in good conscience continue to renew your prescriptions, if they don't see you and re-evaluate the need?

Maybe they put you on 5MG on amlodipine for your moderately-high blood pressure 18 months ago, but since then you have put on an extra 75lbs and now you have critically high blood pressure - lots of liability if they just keep re-prescribing a low-dose that doesn't match your current conditions.

Everyone wants the easy path to getting the pills they think they need - then there is a bad outcome and some greedy lawyer and client come along and want $10Million in damages for the poor care they got.

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

#262

Post by NegativeK » Fri, Mar 08, 2024, 10:34 PM UTC

qudat wrote: post #195

thaddeusmt wrote: post #166

My spouse is a physician, and "patient messages" (aka "non-face-to-face" encounters) usually aren't reimbursed by insurance. Having a friendly online conversation with a patient doesn't generate the "RVUs" they need (contractually!), so time spent messaging is time taken out of their personal day on top of their regular workload. Responding to messages can also just be very difficult and time consuming. Maybe you ask…

My wife works at an academic hospital and bills for messages sent through the portal. If it hasn't arrived yet, it will. Patient care specialists (nurses, physicians, etc.) are spending a ton of time everyday responding to patient "text" messages.

A friend is a vet and frequently rolls their eyes when I mention that I'm going into a doctor's office to review lab results. But in that meatspace discussion, we talked about dietary changes, upcoming medications and potential interactions, how my primary should get some records from another doctor, and I was able to ask about if an elective medical procedure was advisable, given my medical history. It was easily 20 minutes of relaxed discussion about an actual medical plan.

If it was three minutes of "these are your lab results; you should/shouldn't come in for a follow-up," I'd agree that it should be a phone call that's covered under the cost of the original appointment. But given that vet friend is constantly pressed for time and doesn't get to bill separately for those callbacks, I can't imagine why my primary doctor would want to do the same.

I don't want medical professionals responsible for my care to squeeze things in when they have time. Insurance is likely to be even more of a pain in the ass, and cramming in tasks because they're unpaid means lower quality of care.

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

#263

Post by NegativeK » Fri, Mar 08, 2024, 10:35 PM UTC

devin wrote: post #5

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've never had a problem across several doctors on getting a direct reply to my message. For me, there is an SLA. They explicitly state I'll receive a reply within 24 hours. That has been true across multiple health systems I've used. Edit: In no way am I saying "American healthcare is just fine!" only that I actually have had a really good experience using messaging to communicate with my care teams.

Are you, by chance, using concierge doctors?

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

#264

Post by rqtwteye » Fri, Mar 08, 2024, 10:38 PM UTC

alistairSH wrote: post #174

rqtwteye wrote: post #164

Earlier quoted context omitted.

The system should not be that complex and full of traps. I rarely go to a doctor and when I have to go every few years I have no idea how things work and what to avoid.

It's not. ER - life or death (if you can drive yourself, it's probably not an emergency) Urgent Care - you have the flu, and your PCP isn't available; minor emergencies (but you can still drive yourself) PCP - flu, check-ups, whatever The balance billing and OON charges are separate issues from over-use of the ER.

If the system was honest, then the ER would send people to the right place instead of charging them an arm and a leg for basically nothing.

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

#265

Post by annoyingnoob » Fri, Mar 08, 2024, 10:40 PM UTC

otterley wrote: post #241

annoyingnoob wrote: post #31

You think that is bad. Try working with an attorney, they charge you to read your email and not respond at all.

Did you ask for a refund of those billings? If they refuse, you should report them to the State Bar if they're doing that. It's unethical to charge for services not rendered.

https://www.avvo.com/legal-answers/can-a-attorney-charge-for...

https://lawstuffexplained.com/can-a-lawyer-charge-you-for-em...

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

#266

Post by e_i_pi_2 » Fri, Mar 08, 2024, 10:46 PM UTC

My partner has had issues that could be fixed with a few messages and the doctor just refused to respond and said they have to wait until the next appointment. It begins to feel like malpractice when they're refusing to fix simple issues because of billing limitations. I think the core issue here is that we're trying to make healthcare profitable when it probably shouldn't be. Stuff like healthcare, housing, and education _should_ be losing money because it's an investment in the population. If you have a hospital that's making money that seems like a bad sign

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

#267

Post by NegativeK » Fri, Mar 08, 2024, 10:46 PM UTC

danielschonfeld wrote: post #18

Every time the topic gets of healthcare comes up I always wonder how many doctors have tried themselves to interact with their own clinic (has to be their own) Trying to do simple things like: - Setting or getting an appointment. - Calling to sort out their office’s coding error that resulted in me getting an erroneous bill - Trying to get access to their portal or getting results for tests transferred in a realiable…

> I truly think that they would be mortified beyond words

My primary knows and gives me tips for navigating the administration of their own (as in, they own it) practice. I guarantee they hear quite a bit of griping and moaning from patients about phone tree and waiting room delays.

Retaining good admin staff in my area is very difficult, but doctors aren't going to close their practices because of it.

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

#268

Post by danlugo92 » Fri, Mar 08, 2024, 10:50 PM UTC

screye wrote: post #253

pseudocomposer wrote: post #247

Earlier quoted context omitted.

It seems like we just need more doctors, no? The AMA is notorious for trying to limit the number of new doctors. They do that more than much of anything to do with public health.

> trying to That's an understatement. It is blatant and deliberate.

Is it greed? Is it all doctos tacitly agreeing to this so they can get bigger paychecks?

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

#269

Post by atum47 » Fri, Mar 08, 2024, 10:52 PM UTC

I believe in the near future we gonna have LLMs answering common questions related to medical care.

Not gonna get in the merit of saying if it is ok or not, but I believe some already have the capability of answering screening questions and even exams results.

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

#270

Post by wighty » Fri, Mar 08, 2024, 10:53 PM UTC

ineedaj0b wrote: post #244

The hospitals are poorly run. Please hate your hospitals management more. Or if you are a good manager, convince some friends to run a hospital. Imagine 10 appointments a day, 30 mins each. You have to write /everything/ down the patient tells you. You often have to go over the 30mins because some patients need it. You need to follow up to order extra tests, you need to occasionally google something. You skip lunch o…

> The nurses have left and you can't legally 'bill' or code the appointment without the nurses.

What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse patient triages) in addition to anywhere from 30 minutes to 2 hours of completing my notes each night.

The payment methods for primary care do not work.