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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

#321

Post by pests »

ultra_nick wrote: post #170
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…

Same, my wife works a 10 hour day, comes home, gets yelled at by neurotic patients for an hour, then does paperwork for another hour. We're not even making money yet due to student loans. Sucks.

I mean you are making money, just spending it all.

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

#322

Post by Rury »

a_gnostic wrote: post #301
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…

Why do they bill $700 for a bag of salt water they paid $1 for? (1) 1. https://www.advisory.com/daily-briefing/2013/08/27/the-secre...

A major part of business of former employer of mine, involved simply buying parts from another business, doing things to try and hide who the OEM was, and having salesmen resell it for a large markup without doing anything else to the parts. A major reason it did this, was because it subsidized the other side of the business which often lost money in the short term, but resulted in growing this profitable side of the business. If things were priced correctly, the money losing side would have charged more its services, and this profitable side cheaper. However, if they did just that, the demand may have not of been there to sustain or grow the business like it had.

I honestly hate this sort of stuff though. When I pay my toll on the highway, I expect it to pay for maintaining the road I used, not for unrelated things. Anyhow, may be a similar kind of thing going on here, or you know... just flat out profiteering.

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

#323

Post by triceratops »

arealaccount wrote: post #168
gotbeans wrote: post #149

Earlier quoted context omitted.

26k for an mri /w contrast last week because insurance decided it's not necessary despite the doctor asking for it. Now the doctor has to put an appeal to explain medical necessity, I'm at his mercy.

Is insurance the villain on this one of the hospital charging insurance 26k for an MRI?

$26k for a contrast MRI is outrageous. An MRI machine costs $1m at the high end. If you figure the procedure takes 2h and the machine runs 22h/day - which they tend to do - they're making over a quarter of the cost of the machine daily. It doesn't cost anywhere near that to run it; even if we're talking maintenance, salaries, and utilities.

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

#324

Post by neilv »

meragrin_ wrote: post #298
neilv wrote: post #249

> “It just feels a little intimidating when you open the portal and the first thing it says is ‘be aware, we’re going to bill,’” she says. “We have to send these messages and we shouldn’t have to think to ourselves, ‘Should I send this?’” If the provider doesn't bill, problems from the patient's perspective: 1. Some patients are reluctant to message when they should, because they don't want to impose when they know t…

> 1. Some patients are reluctant to message when they should, because they don't want to impose when they know the provider isn't set up to charge. Huh? While I won't challenge these people actually exists, I cannot imagine they are statistically significant. I have never heard of anyone being worried about being charged too little by a health provider.

I don't know. But, just above this in my comment history, someone claimed they'd never seen an English language contraction of "who are". So maybe we're all siloed. Fortunately, fortifying our organizations/circles with a diversity of perspectives can help compensate for our individual blind spots.

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

#325

Post by DANmode »

throwaway4220 wrote: post #317
AtlasBarfed wrote: post #309

Earlier quoted context omitted.

The AMA is one of the four pigs at the trough of US healthcare: 1) Insurance companies - extract profit from the usual insurance model applied to healthcare. 2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing. 3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else 4) AMA/Provi…

Bit insulting to be called a pig - also why would you want more pigs at the trough if this is a problem? Anyway NPs and PAs are providing the majority of care in hospitals. Please, let “AI” come. My EMR is basically run through telnet (no joke) because the hospital system (biggest in the US) does not want to upgrade. “Trial lawyer awards” are capped in several states including CA. I can tell you that more than 75% of…

They don't have to be in it for the money - they know it's coming, even if they're garbage.

That's what the "restricted supply" bit is about.

Even the worst, most harmful doctors I've come across are making more than everyone else I know.

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

#326

Post by DANmode »

thereticent wrote: post #285
NegativeK wrote: post #274

Earlier quoted context omitted.

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…

> Doctors (including my MD colleagues) do not get together to limit the number of doctors available.

There are limited slots each year at the accredited schools you must attend in order to acquire your role.

Nobody's accusing you of doing it - but the number of doctors is limited

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

#327

Post by givemeethekeys »

nradov wrote: post #310
givemeethekeys wrote: post #280

Earlier quoted context omitted.

The individual doctors don't have much choice when they're heavily indebted by the time they become doctors. We (the AMA?) regulate where a doctor gets their education in order to become a doctor. This gives schools a lot of power. It also gives hospitals a lot of power when those doctors work insane shifts during their rotations.

The AMA is only a private professional association. They have some political influence but no regulatory authority. Medical schools have to be accredited so that's one limiting factor. But the real bottleneck today is more lack of slots in graduate medical education (residency) programs. Every year there are some students who graduate with an MD but can't practice medicine because they don't get matched to a residenc…

Maybe they should be able to gain experience abroad towards their accreditation. Win win win. They get accredited. The country receiving them gets well-educated help. We end up with more doctors.

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

#328

Post by linehedonist »

chriskanan wrote: post #188

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…

Pretty dismissive of your wife’s patients. To your “welcome to parenthood” I might reply “welcome to being a pediatrician.”

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

#329

Post by BriggyDwiggs42 »

throwaway4220 wrote: post #317
AtlasBarfed wrote: post #309

Earlier quoted context omitted.

The AMA is one of the four pigs at the trough of US healthcare: 1) Insurance companies - extract profit from the usual insurance model applied to healthcare. 2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing. 3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else 4) AMA/Provi…

Bit insulting to be called a pig - also why would you want more pigs at the trough if this is a problem? Anyway NPs and PAs are providing the majority of care in hospitals. Please, let “AI” come. My EMR is basically run through telnet (no joke) because the hospital system (biggest in the US) does not want to upgrade. “Trial lawyer awards” are capped in several states including CA. I can tell you that more than 75% of…

Are you saying you’re a doctor? The comment didn’t direct that insult at doctors.

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

#330

Post by vladgur »

matsemann wrote: post #192
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…

I agree that charging a fee can be fine. For me it's often a win-win. I spend less time having to go there, and the doctor can spend less time than an in-person visit and even do it on some down-time. But it's still a service, so paying about same as a regular doctor visit (about ~$20 or so here in Norway) is fine. My biggest gripe here is that if the doctor answers me outside office hours, an additional "emergency /…

I recently was informed that the question to my doctor over messaging qualifies as “e-visit” and was giving 3 different CPT codes(differing by time physician would spend answering it) The CPT is how services are identified for medical billing and I called my hospitals financial assistance line to find the contractual “allowed amount” they would charge my insurance(and therefore me since I did not hit my deductible)

The cost for this e-visit message would range from $65 if it took less than 10 minutes to $438 if it took more than 25 minutes.

With absolute zero accountability on how this time was spent.

Lawyers are way more transparent than medical billers

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