WSJ – turning to other industries to cut physician waiting times:

Portland, Ore., physician Chuck Kilo, whose GreenField Health Systems helps restructure medical practices, and is assisting with the program, says that too many doctors’ appointments take up valuable office time with follow-up that could be accomplished with phone calls and email.

Sounds good in theory – one barrier is that phone calls and emails are not reimbursed. Another is that liability pressures force physicians to do everything face-to-face.

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  • Anonymous

    What kind of reimbursement or remuneration scheme do lawyers have? Do their fees depend on how many times they signed their name on a dotted line or how many times they made eye contact with their client during an appointment? What complicated codes do they use?

    Or do lawyers pretty much get paid in proportion to the amount of time they spend on a case, including phone time and document-chasing time? Why should it be any different for physicians?

  • Anonymous

    Its different for lawyers because they operate in a free market and doctors dont

  • Anonymous

    Lawyers, just like doctors, can opt in or out of the insurance system. Some, like doctors, like the steady, guarantee pay.

    Some don’t.

  • Anonymous

    Technically true but hardly comparable. Doctors on salary have more of a steady income than doctors taking insurance payments. So do the concierge doctors who eschew insurance altogether, for that matter. And seriously, what percentage of attorneys actually earn 100% of their income through insurance compared to those who demand retainers up front and bill down to the minute? Its a minority, not the norm. Finally, legal insurance and health insurance reimburse in entirely different ways. For one, legal insurances still cover the billable hours spent on research, document preparation, phone calls, etc., while health insurance pays a small flat fee per encounter.

    A very weak response.

  • Anonymous

    legal insurances still cover the billable hours spent on research, document preparation, phone calls, etc., while health insurance pays a small flat fee per encounter.

    Interesting. Why shouldn’t health insurance also pay for a physician reading up on the latest and the greatest about his patient’s illness so that he can deliver more up-to-date care? Wouldn’t this count as research?

    I suspect these differences reflect how minor the legal insurance market is compared to health insurance.

  • Anonymous

    Excellent question. I can spend ten minutes doing a follow-up with a patient, get paid for a Level II visit at maybe $35-$60, then spend up to an hour in total time on any or all of the following: haggling with the insurance company to obtain prior-authorization on the CT I ordered, haggling with a different insurance representative over the phone to get a medication approved, talking on the phone in consultation with another specialist I may send them to, answering their call later that night through an answering service page because they forgot to ask me a question during their visit, talking to their family members about their medical condition, filling out disability or sick bank leave forms for the patient (these can be a real pain), phoning in a prescription refill they forgot to get during their visit, etc., etc., etc.

    None of this is billable or reimbursable, but it takes up a hell of a lot more time than the actual visit itself. Everyone expects these services to be free because insurance has made it that way. If I were a lawyer (or any other like professional, I’m really not picking on the lawyers on this one) I would be able to actually get paid for my time (novel idea), but since I’m a doctor and make more money than most, I’m not supposed to complain about it.

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