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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

#341

Post by alistairSH »

kelnos wrote: post #208
alistairSH wrote: post #174

Earlier quoted context omitted.

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.

Your simplistic description shows that you don't even know what you're talking about! The ER is for far more than life or death. A broken bone -- no matter how minor -- is a perfectly reasonable reason to visit the ER. Urgent care may work just as well, but there are many reasons why urgent care might not be a great option for people in their circumstances.

Sure. I never said otherwise. There’s obviously some judgement, and some areas won’t have an option. Bit to claim it’s too confusing to figure out (as the prior post suggested) is completely hyperbolic as well.

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

#342

Post by __MatrixMan__ »

nradov wrote: post #313
__MatrixMan__ wrote: post #296

Earlier quoted context omitted.

On the flip side: It's so frustrating to go in search of guidance re: lifestyle changes and they don't wanna hear it, instead all that do is recommend drugs. Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.

I think you have that backwards. Gatekeeping (certain) drugs requires expert clinical knowledge to achieve the right results without harming the patient. This is one of the primary focus areas for physician training. If patients need lifestyle advice then going to a highly paid physician is a waste. Those patients should start with a (cheaper) therapist, personal trainer, dietician, or social worker. We can't reasona…

If you go to those people and tell them you have pain and you need to know which muscles to strengthen and which muscles to stretch, whether to rest or work out or get an x-ray, etc. they tell you to go to a physical therapist. But you need a referral for a physical therapist, so you have to go to a primary care physician first. All they do is throw drugs at you so you basically have to lie about taking the drugs because no I don't need painkillers I need answers, and then you can finally get your referral and go to the physical therapist who can help.

I've had this experience once and my wife has had it thrice (different doctors, different injuries).

By asking primary care physicians to gatekeep drugs, we're introducing a bias where when you walk in the door they assume you're after drugs. I don't have a solution for how best to gatekeep drugs, I just wish I could find a doctor who was unencumbered by that task so they could focus on healthcare instead.

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

#343

Post by thereticent »

DANmode wrote: post #326
thereticent wrote: post #285

Earlier quoted context omitted.

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

Not everyone is accusing the doctors involved, but when I wrote the comment, there were numerous armchair expert opinions squarely blaming the doctors, including at least one who said that doctors limit the number of training slots available to keep their prices high. Thankfully, those perspectives have been addressed or at least outpaced by better thought out criticisms since then.

Ultimately, the number of training slots in the current system is limited by MHA and MBA administrators who see training and instruction as subservient to profits, not the doctors who make up the departments and training faculty. Or, more broadly, they are limited by the healthcare operations not being legislated in a saner way. I was just clarifying.

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

#344

Post by tonymet »

__MatrixMan__ wrote: post #296
ejb999 wrote: post #258

Earlier quoted context omitted.

sadly, a lot of patients consider that good care - around me, doctors stopped weighing patients, and don't ever discuss lifestyle changes or dietary changes (patients by and large don't want to hear it) - they just give the patients the pills they want to offset the poor lifestyle choices.

On the flip side: It's so frustrating to go in search of guidance re: lifestyle changes and they don't wanna hear it, instead all that do is recommend drugs. Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.

i totally agree. the drugs are a huge health problem, but also psychological. Having to care for the elderly I've noticed the drugs serve another more concerning purpose. They create a psychological dependency from the patient onto the doctor / healthcare provider. The patients treat the doctors like magicians because of their control over meds.

Breaking drugs out to pharmacies, Mexican style, would go a long way to interrupt this dependency.

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

#345

Post by tonymet »

nradov wrote: post #313
__MatrixMan__ wrote: post #296

Earlier quoted context omitted.

On the flip side: It's so frustrating to go in search of guidance re: lifestyle changes and they don't wanna hear it, instead all that do is recommend drugs. Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.

I think you have that backwards. Gatekeeping (certain) drugs requires expert clinical knowledge to achieve the right results without harming the patient. This is one of the primary focus areas for physician training. If patients need lifestyle advice then going to a highly paid physician is a waste. Those patients should start with a (cheaper) therapist, personal trainer, dietician, or social worker. We can't reasona…

if this were true, why do the pharmacy rules vary considerably among different countries. In the US the rules are very strict. In Europe moderate and in Mexico very lenient.

Every time you try to change a medical policy the threat is "you'll kill grandma". the fact is that grandma's care is awful and we need radical changes.

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

#346

Post by AtlasBarfed »

throwaway4220 wrote: post #333
AtlasBarfed wrote: post #319

Earlier quoted context omitted.

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/

Uh, your article basically confirms what I was saying: specialists get paid crazy amounts, so the motivation of doctors when they hit the real world is to specialize.

But gp is where you do preventative care to avoid the specialists.

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

#347

Post by AtlasBarfed »

lotsofpulp wrote: post #338
AtlasBarfed wrote: post #319

Earlier quoted context omitted.

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 revenu…

Uhc for example keeps profit low, they grow the equity value by increasing revenues. They also tried the famous stick option backdating.

Insurance company profurs are in the 5-15% range. Drug/device can be in the 50-100% range depending on what patent monopoly they are riding.

But the health insurance companies operate regional monopolies or duopolies, which they achieve with vertical integration with hospital networks.

Health insurance knows they are riding a delicate balancing act. The entire first world besides the us has social health care. They all have better outcomes and vastly reduced costs. They are pure corruption.

So they can't show the drug device profit margins. They have to look like the hood guys who push down costs from the evil drug companies and those know it all doctors/ama.

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

#348

Post by lotsofpulp »

AtlasBarfed wrote: post #347
lotsofpulp wrote: post #338

Earlier quoted context omitted.

>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 revenu…

Uhc for example keeps profit low, they grow the equity value by increasing revenues. They also tried the famous stick option backdating. Insurance company profurs are in the 5-15% range. Drug/device can be in the 50-100% range depending on what patent monopoly they are riding. But the health insurance companies operate regional monopolies or duopolies, which they achieve with vertical integration with hospital networ…

These claims are all over the place, and false. Insurance profit margins are 2% to 4%, with the exception of UNH which is ~6%. Medicine company profit margins are 20% to 30%. All publicly available information.

Most importantly, though, is you would need to show what incentive an executive of a publicly listed business would have to show less profit rather than more profit (net income). Investors pay higher prices for shares of more highly profitable businesses, and executives get paid in shares.

So claiming that a publicly listed business chooses to somehow hide less net income (ignoring the claim of fraud), first you would have to provide the incentive for why executives would want to earn less.

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

#349

Post by screye »

danlugo92 wrote: post #268
screye wrote: post #253

Earlier quoted context omitted.

> 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?

If you scour my archives, I once made a heavily down voted post about how 'doctors were evil'.

It was obviously meant to be provocative and tongue in cheek. But all medical boards are exclusively run by doctors, so you have to assign blame to the profession for doctor NIMBYism.

Imo, it's another case of : "you can't get someone to understand something, if their wealth depends on them not understanding it."

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

#350

Post by AtlasBarfed »

lotsofpulp wrote: post #348
AtlasBarfed wrote: post #347

Earlier quoted context omitted.

Uhc for example keeps profit low, they grow the equity value by increasing revenues. They also tried the famous stick option backdating. Insurance company profurs are in the 5-15% range. Drug/device can be in the 50-100% range depending on what patent monopoly they are riding. But the health insurance companies operate regional monopolies or duopolies, which they achieve with vertical integration with hospital networ…

These claims are all over the place, and false. Insurance profit margins are 2% to 4%, with the exception of UNH which is ~6%. Medicine company profit margins are 20% to 30%. All publicly available information. Most importantly, though, is you would need to show what incentive an executive of a publicly listed business would have to show less profit rather than more profit (net income). Investors pay higher prices fo…

I just explained this, maybe you didn't live through the Obamacare legislation or didn't bother reading my whole response. I admit I didn't research specific profit margin figures, but your numbers ... simply strengthen my contention.

UHC and other health insurers are swimming in money. Yet the reported profits are very low ... why?

Obamacare was ground zero for public healthcare. If it wasn't for utter slimeball Joe Lieberman doing the dirty work blocking medicare for all for the insurance companies, they would have been tossed out completely.

Again, the US is the ONLY first world economy that doesn't have social health insurance. The economics of our health care system are not sustainable, and large changes will eventually come. The health care cartel cannot show the profit margins of drug/device companies. Insurance companies are the ones that deny coverage, so they are front and center with people hating the current healthcare system.

So the healthcare companies DON'T show profit, instead they expand revenue as much as possible, and the executives funnel money to a bloated management structure. You don't need high profits to drive stock growth, you just need to get ... bigger, and that's what they do. You can do other things to boost stock price without showing profits ... use ... wait for it ... excess revenue to do stock buybacks. You can "reinvest" into expanding the vertical integration of your monopoly. You can buyout more hospital networks, effectively expanding the number of people that HAVE to use your insurance.

Let me give another example. Why are MBAs flocking to nonprofit universities? There's no stock options. There's no cashing out in mergers and acquisitions. Why?

Money floods into the universities as the endowments explode, every year the tuition increases well above inflation. Yes there is a facilities race, but why do MBAs love it? Well, it is a cushy job, universities are nice places to work. But, since there's no shareholders, no owner to show profits to, they can skim off the vast revenue increase from exploding endowments and tuition increases and... pay themselves more money.

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