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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

#351

Post by AtlasBarfed »

lotsofpulp wrote: post #339
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…

>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 extrem…

You're not wrong.

In a perfect world, healthcare services would be well-matched to the level of care needed. Standards would be laid out and followed, and effectively priced care delivered.

And then, please don't laugh, if lower cost healthcare was delivered, then premiums would go down. No, no, don't laugh. Okay, you're right, there's no incentive for a local monopoly health insurer that owns the hospitals to pass the money to the consumer. YOU DON'T HAVE A REAL CHOICE. So if you are in buttshit Indiana, you basically get to use Anthem. And they have no incentive to deliver cost savings to the insured.

So of the four pigs, they are all opposed to each other to some degree:

Doctors: hate insurers (who want to lower their salaries/fees/billing) and trial lawyers (who cost them in malpractice insurance).

Drug/Device: hate insurers (who want then to pay less than bloated retail price) and trial lawyers (who sue them in massive class action lawsuits)

Insurers: hate everyone (because they own the money that comes into the system, they attempt to let it go to anyone else, be it drug company, doctor, lawyer, or claim)

Lawyers: hate insurers

BUT, the one shadow incentive they all have is to increase spending on healthcare. So even though the pigs oppose each other on details, they all want people and the government to pay more money for healthcare.

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

#352

Post by chadash »

unsupp0rted wrote: post #222
chadash wrote: post #6

I met with a new accountant yesterday. He told me that if I email him and ask if I can expense a lunch and it's a 1 minute answer, he's not gonna charge me. But if it's gonna take him a good amount of time to respond, then he will. And I think that this is completely fair. I'd expect the same from a doctor. If I am asking a very occasional and non-urgent question with a quick answer (e.g., can I take my medicine and…

You've painted a picture in which doctors charge for time. This is (or should be) incongruous with what a doctor is for. Doctors charge for identifying and telling you things non-doctors can't, with a high degree of non-harm-doing. They've already put in the 10,000 hours to know which bolt to turn.

Doctors very much charge for time. By definition, their work doesn't scale. But because of their immense training, they get to charge _a lot_ for that time.

The same is true in law. Just because you have 10,000 hours of training doesn't mean you aren't billing by the hour.

This is why there are many many doctor and attorney millionaires and very few doctor/attorney billionaires.

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

#353

Post by MR4D »

olddustytrail wrote: post #237
MR4D wrote: post #42

Earlier quoted context omitted.

I'm going to jump in here and offer up an Ayn Rand because you brought her name up. Ask anyone who has a dog, preferably a big dog, what it costs for a vet visit. Better yet, talk to someone who has had a sick dog. Something terminal, or possibly terminal. Costs are wayyy lower. Same x-ray, same imaging, many similar medicines. I've talked with vets, human doctors, and doctors who own dogs. They all come to the same…

Because if I kill your dog I don't get charged with murder.

Not at all the same thing.

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

#354

Post by whiterknight »

dillydogg wrote: post #337
whiterknight wrote: post #276

Earlier quoted context omitted.

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.

Interesting. If you had to weight it towards legal compliance or productivity surveillance which would you say?

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

#355

Post by AbstractH24 »

As someone with a device implanted in my brain that records my brainwaves and shares them with my doctor, but not me (Neuropace) I have mixed feelings.

On the one hand, it’s frustrating to me that I can’t see my own data without first reaching out to my doctor.

On the other, it terrifies me that he’ll respond to any question I send him within minutes, because his workload is clearly unsustainable and I’m deeply concerned about burnout.

Would a charging me make me message him less? No, but my guilt and concern greatly restricts this and I can’t imagine that’s true of everyone.

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

#356

Post by nradov »

__MatrixMan__ wrote: post #342
nradov wrote: post #313

Earlier quoted context omitted.

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 bec…

You don't need a referral to visit a physical therapist. You can just make an appointment and go.

Certain health insurance plans may require a referral in order be reimbursed but that's not universal.

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

#357

Post by dillydogg »

whiterknight wrote: post #354
dillydogg wrote: post #337

Earlier quoted context omitted.

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.

Interesting. If you had to weight it towards legal compliance or productivity surveillance which would you say?

Maybe letting them see patients? I feel like this is a false dichotomy. I guess legal compliance of I had to choose, so it wouldn't lead to insane numbers of patients per hour

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

#358

Post by lotsofpulp »

AtlasBarfed wrote: post #350
lotsofpulp wrote: post #348

Earlier quoted context omitted.

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…

> 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.

This is false. Stock buybacks can only happen from net income, which is why health insurers don’t do them…since they have very little net income (aka profit).

> executives funnel money to a bloated management structure

You will have to provide proof that at least 7 publicly listed companies’ executives are colluding in such a manner AND their shareholders are willingly going along with employees enriching themselves at the shareholders’ expense. Lots of bold claims with no evidence, and some outright wrong ones.

>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.

Also, there are 100 senators, and so legislation passing/not passing can never be blamed on just one. Leiberman took the public relations hit, but there were 40 other nay votes to blame also.

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

#359

Post by throwaway4220 »

AtlasBarfed wrote: post #346
throwaway4220 wrote: post #333

Earlier quoted context omitted.

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.

"6-7x" over "100k" you were claiming earlier is not right. mean specialist versus PCP is ~50k on average, with huge regional variability.

Your second point is right, so what are you gonna do? Make a medical system where preventative care and quality of care are valued? Then you'll get called a "communist" who wants "death camps" and get your birthplace questioned. So here we are.

In the 70s and 80s, I'm told general practitioners made more money then specialists, something I agree with. But even now, lots of people want to do general practice. The smartest person in my med school class went into pediatrics because she loved it. Money is not the biggest motivator for speciality choice, but it is one. Isn't this the case in literally every other field? Maybe SWEs who are full stack get paid more or something?

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