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

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

#331

Post by [deleted] » Sat, Mar 09, 2024, 5:47 AM UTC

vladgur wrote: post #330

matsemann wrote: post #192

Earlier quoted context omitted.

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) T…

[deleted]

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

#332

Post by SkyPuncher » Sat, Mar 09, 2024, 6:12 AM 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…

My wife is a doctor. They all know the problems, but there's often either not the incentive or time to fix it. The system they work in doesn't care to fix it.

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

#333

Post by throwaway4220 » Sat, Mar 09, 2024, 6:53 AM UTC

AtlasBarfed wrote: post #319

throwaway4220 wrote: post #317

Earlier quoted context omitted.

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…

I know several doctors. The ones that GP / Family practice are in it for the "right reasons". The specialists, the two I know probably make 700k and up, are superficially in it to "help people" but it is apparent they love the money. Radiology, Cardiology, and AssDocs. US specialists make far too much money, especially considering that GPs barely make 100k sometimes, but for two extra years you get 6-7x the salary? C…

Learn statistics, or talk to more doctors. https://www.whitecoatinvestor.com/how-much-do-doctors-make/

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

#334

Post by distances » Sat, Mar 09, 2024, 9:41 AM UTC

moal wrote: post #35

Doctor-patient written communications (email, whatsapp whatever) can put doctors in legal risk whether they answer or not. Answering in a meaningful way also takes from the physician's time, much of it during their after-hours. The clinic where I practice requires making a telephone number and email available to patients. A lot of patients might use them sensibly but some patients just abuse this. If it were up to me…

> The clinic where I practice requires making a telephone number and email available to patients

I wonder if contacting your doctor directly is a US thing? Before this discussion I had never heard of such an option. I definitely don't have any way of directly contacting any medical staff, neither a nurse nor a doctor, it will have to be through an appointment.

This might finally explain why this "ask your doctor" is so often repeated online as a realistic option? You definitely won't ask your doctor about every minor thing if it's behind an appointment.

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

#335

Post by onlyrealcuzzo » Sat, Mar 09, 2024, 12:25 PM UTC

thereticent wrote: post #288

onlyrealcuzzo wrote: post #243

Earlier quoted context omitted.

> 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.

This is roughly how it works for non-equity partner lawyers as well.

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

#336

Post by dillydogg » Sat, Mar 09, 2024, 12:58 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…

In my outpatient family medicine clerkship, I saw over 25 patients a day. 20 minute appointments from 8 AM until 5 PM. It was a whirlwind of activity from beginning to end. I don't think in 4 months I saw my preceptor get a 20 minute lunch break. It's crazy. Each room you go in, subjective, objective, assessment, plan, boom, next room. Hope you got all your orders in before that next patient without getting too far behind! I don't think people get how much their doctors are doing behind the scenes.

And after each appointment they need to document everything in the chart. If you aren't charting in the room, you will be there for hours after your last patient catching up. But if you do chart in the room, your patients get mad at you because you are on the computer the whole visit.

Then you have to prechart at the end of the day on all of your patients tomorrow and get ready to do it all again.

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

#337

Post by dillydogg » Sat, Mar 09, 2024, 1:01 PM UTC

whiterknight wrote: post #276

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.

The problem is doctors are expensive so the management is economizing their time.

In my experience in the clinic, the attendings are spending an incredible amount of their time doing busywork required by management instead of actually caring for patients.

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

#338

Post by lotsofpulp » Sat, Mar 09, 2024, 1:21 PM UTC

AtlasBarfed wrote: post #319

throwaway4220 wrote: post #317

Earlier quoted context omitted.

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…

I know several doctors. The ones that GP / Family practice are in it for the "right reasons". The specialists, the two I know probably make 700k and up, are superficially in it to "help people" but it is apparent they love the money. Radiology, Cardiology, and AssDocs. US specialists make far too much money, especially considering that GPs barely make 100k sometimes, but for two extra years you get 6-7x the salary? C…

>I worked at a major insurance company. They can't for public reasons show TOO much of a profit, which is PERFECT for the MBAs running that company, because they hoover up all the excess in a bloated executive structure and embarrassingly huge bonuses.

Nonsense if you read the SEC filings and compare health insurance executive compensation to other business' executives that lead similar number of employees and revenue.

Try to make sense for why people getting paid in equity would want to lower their own compensation by hiding profit. Across the entire industry, at least 7 publicly listed businesses (UNH/Elevance/CVS/Cigna/Humana/Centene/Molina). That would be a very impressive collusion scheme, if they can pull that off maybe they deserve it.

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

#339

Post by lotsofpulp » Sat, Mar 09, 2024, 1:28 PM UTC

AtlasBarfed wrote: post #309

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.

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…

>resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly

Are you aware of the lack of standards in NP education and training? The American public has no idea how raw of a deal they are getting. This is shrinkflation in healthcare, whereas you might have expected to see a doctor before, now you have to see a PA/NP, where the barrier to entry is extremely low and the training standards are loosely enforced, if at all.

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

#340

Post by lotsofpulp » Sat, Mar 09, 2024, 1:31 PM UTC

Rury wrote: post #322

a_gnostic wrote: post #301

Earlier quoted context omitted.

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…

>When I pay my toll on the highway, I expect it to pay for maintaining the road I used, not for unrelated things

This is a great example. You expect to pay for the "maintenance of the road", but what about the ongoing opportunity cost of the road and all the externalities of the road? What about all the roads that do not have tolls on them? The toll road does not exist in a vacuum, and life is not so simple so as to be able to sequester all costs into separate line items.

In fact, one of the main uses for tolls is not for the maintenance of the toll, it is for managing congestion of the road, since the road has a carrying capacity. After a certain number of vehicles, the road becomes less and less useful, so a variable rate toll can ensure a limited number of vehicles operate on the road at peak congestion.

It is simply not feasible to tie revenue to expenses 1 to 1, and specific taxes (like tolls) legislated to do that for government expenses hamstrings leaders because it removes flexibility needed to move resources around (which obviously could be used for bad, but also good, as you demonstrated your business's example).