Wednesday, August 30, 2006
Medicine is simply a revenue-driven business
Many offices are starting to charge for administrative requests in this time of declining reimbursement. Hey, that's what you get in a fee-for-service system:Doctors - particularly primary care doctors - are increasingly billing for services that patients have long expected to get gratis: prescription refills, photocopies of medical records, phone consultations, family medical leave forms, medical disability forms, waivers of insurance premiums, waivers for handicapped plates.You can't practice good medicine if you're out of business. (via SoloDoc)
Automotive forms. And life insurance premium forms.
Travel insurance forms.
And now, e-mail responses.
The practice, almost unheard of five years ago, has disgruntled some patients and is starting to come to the attention of consumer advocates, who denounce it as one more sign of a broken-down medical system.
"It shows that healthcare is like any other enterprise: It is revenue-driven," says Arthur Levin, director of the New York City-based Center for Medical Consumers. "The system is moving further and further away from being a public good to one in which the physicians are mere shopkeepers. How many times can they ring up the register?"
Posted by Kevin |
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"It shows that healthcare is like any other enterprise: It is revenue-driven," says Arthur Levin, director of the New York City-based Center for Medical Consumers.
And show me an industry that can last beyond the week that isn't revenue driven.
Sure, we can have high ideals for bringing health care to the masses, but even the baby-boomer flower children quickly figured out that 'whithout margin, there is no mission'.
The doc has only his time to sell, and a finite amount of it available. Why should patients be surprised at paying for services that consume time.
And show me an industry that can last beyond the week that isn't revenue driven.
Sure, we can have high ideals for bringing health care to the masses, but even the baby-boomer flower children quickly figured out that 'whithout margin, there is no mission'.
The doc has only his time to sell, and a finite amount of it available. Why should patients be surprised at paying for services that consume time.
"Why should patients be surprised at paying for services that consume time."
In part because some (repeat, SOME)of those services already have several charges attached that the patient has paid for, and it becomes a question of how often a person can/should be billed for essentially one service...or into how many tiny billable pieces that one service should really be broken into.
In part because some (repeat, SOME)of those services already have several charges attached that the patient has paid for, and it becomes a question of how often a person can/should be billed for essentially one service...or into how many tiny billable pieces that one service should really be broken into.
# posted by 
: 12:16 PM
: 12:16 PM
Which of those services are you referring to? Seriously, I don't see where even one of the examples from the article was a service that was already covered in the office visit charge. "Evaluation and treatment" doesn't mean filling out eight-page FMLA forms or photocopying your three-volume chart for you.
# posted by : 6:23 PM
: 6:23 PM
We fax medical records to another doc at the request of the patient at no charge. This still takes staff time. We charge for copies (they are expensive!) to anyone. We do not charge for short forms that do not render an opinion, or for patients who are indigent needing assistance. If you want to know the truth, the most time-consuming forms are medication assistance forms, disability forms, and workman's comp related forms.
# posted by : 7:36 PM
: 7:36 PM
I get peeved at doing precert for prescriptions. I write the rx and then have to fill out papers and then I or my nurse spends 20 minutes on the phone with a pharmacy gatekeeper justifying the prescription. It costs me around $40 in staff time and has no benefit to me at all. I feel bad about the patients problem but why should I be penalized to benefit the insurance company?
# posted by : 8:25 PM
: 8:25 PM
>...with a pharmacy gatekeeper justifying the prescription <
Make sure you clarify that's the INSURANCE company gatekeeper. The pharmacy has the same problems with those lousey b@st@rds as well.
Make sure you clarify that's the INSURANCE company gatekeeper. The pharmacy has the same problems with those lousey b@st@rds as well.
"If you want to know the truth, the most time-consuming forms are medication assistance forms, disability forms, and workman's comp related forms."
In Mississippi, Workman's comp pays pretty well and the forms aren't that bad. Workman's comp varies from state to state
In Mississippi, Workman's comp pays pretty well and the forms aren't that bad. Workman's comp varies from state to state
Great for those of you in MS. In MD, workman's comp stinks and worse, is widely abused, with people coming in with complaints of problems they say arose at work that clearly were not. Some expect me to be complicit with their charade, maybe thinking that because they are corrupt that I should be also. I don't give that any encouragement, but it is annoying.
As for charging for filling out lengthy forms, I think that is fair. I don't charge for MVA forms and other brief forms, but anything that requires generating letters to persons not consulting me, or opinions about fitness for work or other activities are fair game. Those are not covered by E/M coded services yet cost my practice in time and resources, are not essential to providing E/M services.
Patients really should not expect their doctors and their doctors' office staff to be their unpaid personal secretaries and social workers.
As for charging for filling out lengthy forms, I think that is fair. I don't charge for MVA forms and other brief forms, but anything that requires generating letters to persons not consulting me, or opinions about fitness for work or other activities are fair game. Those are not covered by E/M coded services yet cost my practice in time and resources, are not essential to providing E/M services.
Patients really should not expect their doctors and their doctors' office staff to be their unpaid personal secretaries and social workers.
# posted by : 2:58 PM
: 2:58 PM
No, I don't expect my doctor to be an unpaid secretary or social worker. I'm sure he has better things to do with his time.
What I want to know is: Why aren't you blaming the government or insurance companies for some of these hassles? I think it's asinine that people have to have those stupid FMLA forms filled out if they're home sick for more than three days or whatever. It's nothing more than a lot of ridiculous paperwork. But *I don't make up the rules.* Some of the anger here is misdirected.
Do you think it would be more fair if physicians were salaried? Or would you find something wrong with that as well?
What I want to know is: Why aren't you blaming the government or insurance companies for some of these hassles? I think it's asinine that people have to have those stupid FMLA forms filled out if they're home sick for more than three days or whatever. It's nothing more than a lot of ridiculous paperwork. But *I don't make up the rules.* Some of the anger here is misdirected.
Do you think it would be more fair if physicians were salaried? Or would you find something wrong with that as well?
# posted by : 9:46 AM
: 9:46 AM
Oh yes! Please give me a salary!! Then I wouldn't have to worry about paying my staff and overhead before I get paid (sometimes I don't take home a check for month). Oh and yes, if I am salaried then I should get weekends off and also holidays off. So if you come in sick on Saturday at 2:00 in the morning, I am off! Please, I want to be a government worker!!!
# posted by : 9:04 PM
: 9:04 PM
You already are a government contractor if you accept Medicare or Medicaid. You don't get any benefits and have no power to negotiate. Private payers now largely follow Medicare, and you cannot negotiate with them either. This monopoly power would be subject to antitrust regulation in any other industry. It should be illegal.
# posted by : 9:29 PM
: 9:29 PM
I recently heard it was against the law in New Jersey for doctors to charge a fee for filling out disability forms. Does anyone know if this is true? So if it is now the doctor is REQUIRED by law to provide a free service and use of his/her time.
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# posted by : 9:20 PM
: 9:20 PM
