One of Graham’s suggestions to fix primary care:
Pay primary care doctors for their paperwork”“and I think it would pay primary care doctors better, allow them to provide better care for their patients, and encourage more medical students, residents, and other already-trained doctors to go into the field.
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{ 6 comments }
So the slower and less efficient you are the more you get paid? How does that make any sense. Are you going to pay me if it takes an hour to write my name?
Slower is not always less efficient. Fee for service means that if you slap a diagnosis on after a faked 3 minute exam rather than take time to do it properly. you get the same fee and make more money for your time. But in the end the right diagnosis is likely to be more “efficient” as the patient therefore has a better chance of recovering.
In my administrative capacity I have reviewed thousands of charts and have seen a great deal of waste made by haste–and more than a few people seriously injured.
If that name is being written after an hour because it took my doctor that long to review the chart, talk to the nurses, talk to my family, get my history, examine me, listen to me talk about how scared I am and offer some emotional support, and help me work with him to choose and plan how to implement treatment–then I will gladly pay for that hour whatever level CPT code it is and without regard to what the RVS Nazi’s think it is worth. It my ass that is sick, not theirs.
Some kinds of efficiency I don’t want from the guy in whose hands my life lies.
If you are writing it on my orders and it takes you that long to give thoughtful consideration to what you are signing, you are damned right I will be glad to pay you for an hour to do it rather than for 2 minutes for the distracted, mindless slapdash work that I see all too often!
Anon 4:41 – misses the point entirely. We don’t need to talk about the extremes.
Some formula based arounding paying for time in primary care will result in better, organized, more comprehensive care.
Hey, in my practice, I have the luxury of considerable forethought and reflection. But how many can say that in the current system.
No matter how you put it, it’s still paying for inefficiency. The guy that gets right to the point and sees 30 people gets paid the same as a guy seeing 10 that talks to every patient about the local football team and the price of wheat.
Well, if the patient wants a doctor who talks about football and is willing to pay by the hour, whose business is it anyway?
And I have seen too much important stuff missed by the “get right to the point” crowd. To get right to the point, they have to decide what the point is that they are getting to before they have enough information to know what “point” they are missing.
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