Reimbursing time

Bingo:

Technologically advanced and costly treatments save lives, but their allocation needs to be made sensibly and not to the detriment of old-fashioned talking and listening between doctor and patient.
Patients want and deserve this time-intensive care, and although it can often be ultimately cost-saving, it will not be the norm until the financial incentives reverse themselves.

(via Shrink Rap)

Comments

Anonymous
It doesn’t make sense either to pay for the physician to talk to the patient about the price of wheat, politics, how the local football team is doing, etc. Which is what will happen if you “reimburse time spent”.
Anonymous
Every other consultant on earth charges top dollar for time spent.
My lawyer brags at his palm pilot/cellphone combo. Each and every cell call is hot synched to the office computer and billed at $350 an hour, pro-rated of course. Thus an 11 minute call generates a bill for $64.16 to a client’s bill!
Physicians are financial masochists/suckers of the first order not to do bill for time spent on patient face time.
Mike
Anon 2:12. OK, so I won’t talk to the patient about anything, how about that. I’m not sure how I’ll figure out whats wrong with them. If its an emotional problem then they are certainly screwed in your system.
Why would I talk to a patient about the price of wheat???
Anonymous
So Mike you would advocate making the system more inefficient by paying for time. Every person talking healthcare nowadays wants more people to have better access to care. How do you achieve that by encouraging physicians to do less. I can see it now a typical office visit if everything was based on time.
You have a new patient come in concerned that they might have Hypertension and you will state.
“Tell me about your childhood. Was it a happy one?”
After you discuss this and other things and do a 2 hour long H&P you send him or her on his way.
If you are paid by the hour you will talk about whatever you feel like wheat, corn, sorghum. Who cares? That is my point, you don’t care, because you are paid by the hour. Their is no incentive for efficiency with that.
Anonymous
Mike and Anon 2:12 – those are the topics that rural folk want to talk about in their medical visits; if you do not ‘chew the fat’ with them, you’d be branded as uptight and rude!
In the VA, you have to listen to repeated war stories – real or imagined – that seem to become real with re-telling, with interjections of how ‘he/my dad doesn’t really like to talk about his war experiences…’
Before its over, 2/3 of the visit had been wasted on these useless, trying-hard-to- be-nice listening-to-crap exercise…loosen up folks!
Anonymous
Anon 10:33 – YES, doctors need to be re-imbursed for listening to these crap…do u think majority of doctors would like to talk about crop prices? I could not care less…but we have a mandate to ‘listen’ to crap 99% of the time!
Anonymous
What about the farmer or commodities trader whose blood pressure is up precisely because of the price of wheat and how he worries about it excessivly?
The problem now is that the doctor, unless he gives his time away, is not paid for discovering and addressing that source of the problem directly (by couseling regarding the management of obsessive worry). Therefore he is likely to keep jacking up the BP meds (and then have no idea why they are excessive when the price of wheat changes) without even knowing the real problem.
The problem of doctors wasting the patients time with idle chitchat is specious. That is certainly no more and probably less of an issue than his doing so with any other consultant. Sure, I have talked with my CPA about things other than my taxes and books, and he charged me for the time, but I had to let him get to know me in order to advise me, and I needed to become comfortable with him to know how to value his advice. It is all part of the process or a quality professional-client relationship. In any case, the client who is responsible for the fee is there to monitor the process.
If you are concerned about the lack of a watchdog when a third party rather than the patient is financially responsible, the problem is not time charging but an idiotic system in which “insurance” pays for basic routine physician’s serviices rather than just catastrophic and large expenses. The solution to that is to stop that silliness.
Third parties could more easily stop the severe cases of abusive charging with time based charges by sharing data. It is a simple matter to have an investigator note when a guy enters and leaves his office, and then check the hours billed for office care that day.
The people who don’t want this are the ones making tons of money herding people through like cattle pretending to provide medical care.
Anonymous
Guys, when you start charging for your time, people won’t chit chat because they’ll know they’re on the clock. As someone who does charge by the hour, trust me, that’s exactly what will happen.
Of course, all this is moot because none of you will actually refuse the current payment model, which gives you a pretty fine standard of living. Until you do refuse it, there’s no incentive for those paying to change. It’s on you, the physician. No one else.
Mike
Anon 12:33, you make no sense. First of all, if an insurance company saw you seeing 2 or 3 patients a day for 2 or three hours apiece, think they would check it out. Secondly, if doctors make more money seeing more patients, but still get paid for time spent something reasonable, but less than seeing theirnext patient, then the incentive will still be to ee more patients, notr waste time with one patient.
LAstly, I did not go into medicine to spend time bulls%&$ing with patients about wheat prices and I would have no intention of doing that even if talking was paid for. But, I might just get an extra moment to ask the travel history, which might clue me into a diagnosis. Much of medicine IS talking to get the answer, and although I don’t like “How Doctors Think”, the message there is just that!
Anonymous
Mike, The insurance company might check into it, but if they were paying you by time spent isn’t that the point. They are paying you to leave no stone unturned by reimbursing for time. Wouldn’t you be doing 8 page long histories on every patient. They do have a system as you suggest and its reflected by the level of your billing.
Anon 12:18 you are wrong because patients will still chit chat as long as people continue to be disconnected from what they actually pay for. They see it as being on someone else’s dime.
Mike
Anon 2:51, thats the problem. It ISNT reflected in what you get paid. First of all, they downcode automatically, everyone knows that. Second, complexity doesnt equal time spent! If someone starts crying because a loved one died, the complexity is not wuddenly shooting up. If a diabetic needs counselling, many plans dont pay for that. They still have the same old “diabetes”. If there is paperwork or talks with family members, there is no code for that!
So you are wrong. It is NOT facotred into the level of billing. Its “supposed” to be. But I thin kyou and I are intelligent enough to drop the facade, and talk about a better way. And a better way would be to reward a physician for time spent, as much as for a lance boiled.
Anonymous
“lance boiled”
Love it.
Mike
OK, meant “lanced boil”
so sue me. (Ummm, on second thought…)
Anonymous
So Mike, if you talk about how someone’s boil makes them feel should you get paid more?
Mike
Again, for those who are not doctors, no physician is going to ask about how a boil makes them “feel”, unless it relates to pain, or suspected cellulitis or some spread of infection.
I wish the dopes who are convicned doctors like bulls&%*ing with patients to make a buck would get a clue. After all, we ARENT lawyers.
Anonymous
I take that as a no. What if they are crying because it hurts really really bad? Or they need counselling on how to avoid getting a boil on their ass. I do agree gast does not equal good, but slow sure as heck doesn’t either and rewarding docs to be slow seems like a lousy way to make the system more efficient. Paying for time is no way to open up access for more people it will drive it the other way.
Anonymous
correction typo- fast

Reimbursing time

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