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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

#281

Post by bombcar »

codemac wrote: post #178
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…

If my actual doctor responded to my messages within some SLA (2 days?) then I'm more than happy to pay much more. Now a days what happens is I send a message with photos or many details, and some poor nurse who is assigned message triage is going through many and responds with generic pointless text for my issue. Then I get charged $15.

I read your post.

You owe me $3.99

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

#282

Post by wighty »

qudat wrote: post #196
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. Physicians won't see a dime of that money unless it's through RVUs and even then it's marginal at best. The real money is in procedures.

There are some codes that can be used for asynchronous portal messages, but to be honest the AMA is still pretty broken as far as how much time we need to spend for things... the codes are 99421 (5-10 minutes over 7 days), 99422 (11-20 minutes), 99423 (21+). It is not clear to me how well these codes are actually paid for by private insurance. In a wRVU system a PCP may get paid like $5-13 for the first code, $15-30 for the 2nd, $24-44 for the 3rd. This is a lot less than a visit... and you must spend the minimum 5 minutes on the portal message or you are billing it fraudulently. I can cover an in person level 4 visit (99214) in 5 minutes in some cases, which pays something like $100.

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

#283

Post by wighty »

FireBeyond wrote: post #256
ejb999 wrote: post #254

Earlier quoted context omitted.

why are you putting effort in quotes? Do you not think there is any 'effort' involved? Why do you think someone else's 'effort' should be free?

This is an absolutist take. No-one's saying it takes zero literal effort. Just "Should I be billed by the practice $25-30 for an MA to get my email and say "I have forwarded your question to the provider"?", and then a subsequent $100+ for the provider's response to my question. Why should that not be part of the intrinsic baseline officework and not a billable service? Especially when it's a 100% artificial roadbloc…

> After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".

That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an MA/nurse first.

As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.

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

#285

Post by thereticent »

NegativeK wrote: post #274
devin wrote: post #271

Earlier quoted context omitted.

Negative.

Wild. I've never seen anything remotely close to an SLA with the healthcare professionals I've seen.

I don't know what is happening elsewhere I suppose. I'm a PhD clinician at a US public academic medical center and respond to patients within 24 hours even if it's to say "let me check on that...it may take a week to get the answer/letter/etc." I'm pretty sure that's the expectation for all our MD/DOs and other clinicians. We don't bill for it, and it doesn't contribute to our targets, but it just seems like it falls under a salaried expectation to me. It's for the patient.

That said--hospital management, driven by the insurance world, tries to wring as much uncompensated labor out of the medical workforce as possible. Doctors (including my MD colleagues) do not get together to limit the number of doctors available. That's baseless conspiratorial thinking that doesn't withstand a moment's scrutiny when you understand the incentives at work in American healthcare.

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

#286

Post by thereticent »

tonymet wrote: post #273
mherkender wrote: post #159

Earlier quoted context omitted.

Maybe it wouldn't fix everything but I'd like to see a great increase on the cap of the number of medical residencies supported by the government. The AMA and doctors in general shouldn't be artificially limiting the number of doctors. I'd like to see the other usual suspects addressed too but it seems like the doctor shortage is a big part of the problem.

i agree this is a big problem. but as long as you have 10+ admins for every doctor , costs will be through the roof.

This is one of the major issues underlying the perversity of US healthcare. That and high-level executive churn incentivizing "innovative" initiatives and policy changes just so the executive makes their mark and leaves for the next rung elsewhere.

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

#287

Post by Macha »

gnicholas wrote: post #120
HumblyTossed wrote: post #7

I don't mind paying for my Dr's time. If my insurance starts doctor blocking by making me chat with an AI first AND charging me for that? No, that's not going to be acceptable.

Yeah that wouldn't be a good outcome. How would you feel if the doctor were messaging you through a platform that had extensive predictive text features, possibly trained on that particular doctor's past messages, and allowed her to send a message in 30 seconds that would have taken 10 minutes to type out? If you used that system for years and paid for it happily, would you be upset to learn that the doctor was spend…

The difference here really is that the doctor is reviewing what is being sent in some practice. Sure, there's some possibility that the doctor is over influenced by the suggestion and goes "it seems right", but that's true even if they effectively google it as GPs often do today. Whereas a LLM trained on the internet at large seems about as useful as WebMD, which sometimes feels like it would tell you bleeding after an accident chopping food is a sign of cancer.

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

#288

Post by thereticent »

onlyrealcuzzo wrote: post #243
ericd wrote: post #64

A 15 minute email from my lawyer costs about $150, I don’t see why we should be outraged about $25? It’s much harder and more expensive to become a doctor.

> A 15 minute email from my lawyer costs about $150 Unless your lawyer is an equity partner, he's not getting much of that $150. In the US, the median doctor makes almost 75% more than the median lawyer...

I can assure you that in a hospital system, the doctor is not getting much of the $25 either. For my situation, we don't charge for messages, but for other services we need to hit a target (messages don't count) based on our salary, and productivity bonuses above that target are about 5-10% of the billed amount.

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

#289

Post by 1vuio0pswjnm7 »

Alternative; works where archive.is is blocked:

https://www.msn.com/en-us/money/insurance/the-medical-bill-y...

Text-only, no Javascript:

    tnftp -o'|grep -Eo "\"body\":\".+\"readTimeMin\""' \
    https://assets.msn.com/content/view/v2/Detail/en-in/BB1jwATu
    |(echo "";sed 's/\"body\":\"//;s/\\//g;
      s/\",\"readTimeMin\"//') > 1.htm
    firefox ./1.htm
    links 1.htm

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

#290

Post by ericd »

adolph wrote: post #177
ericd wrote: post #64

A 15 minute email from my lawyer costs about $150, I don’t see why we should be outraged about $25? It’s much harder and more expensive to become a doctor.

Lawyers did pricing better than doctors. Medicine hid costs through a payment plan lumped in with hazard insurance. Now that the game of hide the money has played out, people see real costs and they act shocked.

Yeah, I guess many people started to think of the copay as the true cost, since that’s what they paid most of the time?
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