Ah, yes, the only fans model.
More doctors are charging fees to respond to patient messages
311–320 of 372 posts
Re: More doctors are charging fees to respond to patient messages
#312Earlier quoted context omitted.
> The nurses have left and you can't legally 'bill' or code the appointment without the nurses. What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse pati…
I think it's pretty stupid that basic appointments are billed on complexity and not time. Well, and lots of other things too. Getting a radiologist to do a definitive diagnosis using imaging doesn't actually make the ER doctors job harder (rather, it de-risks the interaction for them). It's also ridiculous that I have to promise to pay any bills that my insurance won't cover. If some care can't be justified as medica…
The No Surprises Act included some protections against balance billing. It's still a problem but somewhat less than before.
https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...
Re: More doctors are charging fees to respond to patient messages
#313Earlier 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 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 reasonably put the entire burden on physicians; it's too much for one profession to handle.
Re: More doctors are charging fees to respond to patient messages
#314Earlier quoted context omitted.
Totally context dependent. Call me new-fashioned, but I don't want to spend a few hours of a workday several times per year to see a doctor for less than 5 minutes for prescription refill for a drug that I have been taking for years. Why in the world would either of us need to see each-other in person when he can ask me the same 3 questions he always does over the phone?
It sounds like you shouldn’t need to meet with him at all.
One of the side effects is increased risk of suicidal thoughts, so I think it’s not unreasonable to have a medical professional ask every once in a while. OTOH, the pharmacist dispensing it could handle that
Re: More doctors are charging fees to respond to patient messages
#315Earlier quoted context omitted.
I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and wa…
My elderly disabled mom on a fixed income is being billed for an ambulance ride from a hospital to a long-term care facility because Medicare deemed it "unnecessary" even though the shuttle couldn't take her.
I'm sorry. Hospital staff are notoriously bad for incorrectly filling out the paperwork that Medicare requires to justify ambulance transport, such that we (paramedics and EMTs) are constantly explaining it to them.
Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.)
Too many of them literally fill out patient demographics and a signature and say "here you go".
We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).
Re: More doctors are charging fees to respond to patient messages
#316I 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…
As another commenter said, EMR have allowed Drs to dictate messages for some time now, filling in important details for them. I worked on a very popular one some 12 years ago. No, I wouldn't care if it takes them 30 seconds vs 10 min. as long as it is my Dr driving it.
Re: More doctors are charging fees to respond to patient messages
#317Earlier 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…
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 my medical school class was not in it for the money, for what it’s worth.
Re: More doctors are charging fees to respond to patient messages
#318Earlier quoted context omitted.
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Only 10% of the increase in medical cost in the US is attributable to doctor salaries. The remainder is administrative overhead, Rx costs, insurance administration, etc. There are now 10 administrators for every 1 doctor. Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x. If each administrator is making 100k+ - 150k+, that's significant cost. Some of the…
US administration costs account for 14% of "excess costs" (above OECD average).
https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
I worked in healthcare and this McKinsey report (exhibit 2 on page 81) is probably the best analysis I've seen that tries to isolate where the extra money is going.
The biggest driver of higher US healthcare costs is outpatient care. And it's not just that each healthcare event is more expensive (though it is), it's that Americans get a lot more outpatient care than other OECD countries.
Re: More doctors are charging fees to respond to patient messages
#319Earlier 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…
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? Come on.
I worked at a drug/device company. It started out in a garage and was originally a "morally run company". But it had long devolved into an MBA enshittified acquisition-deal company.
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.
Never worked for a law firm. I generally assume them to be the smallest pig, the runt, which is useful for the other pigs to bully and blame for everything.
Re: More doctors are charging fees to respond to patient messages
#320Earlier 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.
Do you think if there are more doctors, they are going to be more willing to provide free services? I don't - doctors want to get paid for their services - insurance companies (in general) don't pay for doctors to respond to emails - having more doctors doesn't solve this problem. Not saying we don't need more doctors, but seems unrelated to to the problem being discussed.
If there are more doctors they won't need to choose between working unpaid overtime or charging an overtime rate. Patient workloads could be adjusted that doctors could respond to messages during their regular work hours.