After waiting hours to see the doctor for a 2-minute visit, some patients have resorted to giving a bill to their physician.
It sounds extreme, but economist Alan Krueger writes that the cost of patient waiting, estimated to be $240 billion in 2007, is neglected when considering the cost of health care.
I’ll be the first to admit that many doctors do not appropriately value patient time, and, under normal circumstances, there is no excuse for a physician to run more than 30 minutes behind.
I concur with Mr. Krueger when he writes, “The time that patients spend seeking, receiving and paying for health care services is just as real as the dollars they spend for medical services.”
However, patient time is not valued by the physician compensation system. Doctors are incentivized to see as many patients, and do as many procedures, as possible.
If doctors were allowed to bill for time, as lawyers do, I suspect you will see a much greater value and respect for patients’ time.
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- California’s balance billing ban, are hospitals about to give patients refunds?
- You’re spending too much time with patients
- Patients waiting for hospital beds
- Female physicians and the Canadian doctor shortage
- AMA working for reform that benefits patients and physicians
{ 28 comments }
True. This is another problem with our third party payment system.
However, some of the same patients who complain when I run late often expect me deal with 4 or 5 medical issues at one 15 min. visit (plus a form or two and some unrelated refills). God forbid they come in for two visits and pay two copays.
You can’t please everyone, we all make compromises between covering multiple problems, urgent issues and staying on time.
I often envy the physicians who bill by the minute at each visit or phone call. I imagine that would help this considerably.
As physicians I do my best to manage schedule to fit my needs and those of patients. We have daily walk ins with urgent problems that need to be address.
Multiple urgent phone calls. Factors that have a direct effect on schedule.
We do work for the patients behind the scene, no direct patient encounter, without additional reimbursement (reviewing report,labs, consults, talking to consults, completing forms for patients, regular medication refills, obtaining prior auth for meds and for procedures…
I think patients need to be aware of this and appreciate of a 30 minute wait occasionally.
Some physicians run late for reasonable reasons and some physicians run late for unreasonable reasons. One key is to make sure patients know the doc is running late so they can make a decision to wait or reschedule. Providing patients with more than just magazines can help them make use of their waiting time – providing areas to use computers and cell phones, or providing someone to help them set up an online account to receive secure communication from the physician’s office are all feasible. Being upfront about a physician’s typical schedule habits is helpful. Some patients will gladly wait for a doc who routinely runs 45 minutes late and some won’t – that should be their choice. I had one personal physician whom I loved and she advised me on my first visit that most of her patients take 1/2 day off from work to see her. I agreed that it was worth it to have her care for me, so I took the time off after that and never worried again if she was running late. I took work or a book with me and enjoyed the time out away from work!
Interesting idea.
I don’t think I would expect to see a patient again if they found reason to send me a bill for their time. Nor would I necessarily feel obligated to pay them on that basis. After all I am not getting any service from them, and they really are not paying me for my time either, just a service as defined by a CPT code. What I have done is refused to bill patients when I ran behind and felt it was my office’s fault and that the delay could have been prevented. (When I am delayed by events beyond my control, like patients with real emergencies, I offer my apology and explanation, and they can accept that or not.)
The patient isn’t usually the customer, the insurance company is. So of course they get suckey “customer service”. Doctors who take no insurance and charge patients cash usually provide better customer service. 9 times out of 10, the docs who habitually run way behind “for a 2 minute visit” are the ones who are on all the insurance panels and participate in Medicaid and Medicare.
patients aren’t kept waiting just because doctors feel like keeping them waiting. there are a multitude of rearons why we are running behind. send you bill to the insurance companies, cms, other entitled patients or wherever.
see, doctors are just as capable of refusing to take responsibility for anything. welcome to our world!
in the meanwhile, no i will not be reimbursing you for your wait time. (then again i am in the ed where NOBODY came with an appointment)
Anon: 6:41 – I’ve tried doing what you indicate you do do – namely not billing patients that have waited over 1 hr to see me. My biller however told me I couldn’t do this – something about opening myself up to medicare fraud? I think the essence was that I could not charge one patient less than the other – this not being “fair”. Any advice or comments on this?
I know a glaucoma specialist who is routinely running a couple of hours behind schedule toward the end of each day. I personally witnessed an elderly patient crying in the waiting room one winter day because she was afraid to be walking home through the city after dark. It’s inexcusable. If you must work two hours late each day, stop denying it and space out the appointments appropriately.
See my comment here about this same issue… that I’d start paying my patients for being late if I started charging by the hour.
I read the same article and I was mad. I felt it was irresponsible and a bit unfair for Mr. Krueger to blame doctors, at least partially for the rising cost in health care.
First of all, health care is not a car wash or oil change service for your car. It is a little more complicated. Secondly, doctors don’t run late on purpose. It is not as if they are sitting in the back drinking coffee and chatting.
I know there are irresponsible doctors, just like in every profession. But come on, doctors want to go home to their families too. The sooner they finish with you, the sooner they can go home to their families.
Lastly, what about the millions of dollars doctors lose because they have to wait months for payment from the government or private health insurance company? Mr. Kruger is an economist, so he knows very well the principle, time value of money.
So, I propose this… my office will run on time, but patients will have to pay for their visit – in full – before they leave my practice. Oh, and I get to set my own rates for services I provide, not the health insurance companies or Medicare.
Brandon
http://pediatricinc.wordpress.com/
I say it is fair if I get to turn aaround and bill patients for time they take beyond their alloted time.
I also would like to be able to bill the ignoran plaintiff attorney who made me sit through a 3 week court trial.
Wouldn’t go so far as to “bill” a habitually late doctor, but see no reason why the desk staff can’t try to contact those patients by phone who would otherwise be left sitting in the waiting room if they showed up on time. Common courtesy. Most people have cell phones, so it would be easy enough to contact them.
How long would you wait for a patient who was unavoidably held up in traffic or couldn’t find a parking spot in your complex? My guess is, if s/he wasn’t ready at whatever instant you are, you’d cancel the appointment and move on.
Nobody said life was fair and circumstances are equal. But just as patients should give you advance notice if they need to cancel, you should try to let them know if you’re running significantly behind.
“After waiting hours to see the doctor for a 2-minute visit, some patients have resorted to giving a bill to their physician.”
Perhaps it’s not the waiting that makes patients dissatisfied, it’s the 2-minute visit.
I don’t mind waiting (ok-not two hours) and I understand that things happen. I do mind my appointment being cut short.
And why is it that common courtesy is thrown out the window when at the doctor’s office? Just let me know so I can run some errands, make arrangements for someone to pick up the kids, etc.
“What I have done is refused to bill patients when I ran behind and felt it was my office’s fault and that the delay could have been prevented.”
I really don’t want a “free” office visit when your late. I want a caring physician that listens to my concerns and takes the time for a thoughtful diagnosis and treatment plan. I do my time being wasted by having to come back 4 or 5 times because you don’t have time to consider my health in a 2-minute appointment.
Anyone can understand the emergencies that happen but my former allergist was always an hour late because he was talking to drug reps!
9:31:
You are talking around the obvious problem: even if you got the full 15 minutes, or half-hour, your appointment was allowed, are you or your designated insurance company properly paying for that time? Because if you are not, or if enough other patients are not, the only way to keep the operation running is to see more patients on a given day. In our present system, you can’t just charge more money and collect. There is only a very small market for cash-pay care that can achieve viability. The third-party payers, government and private, really do have the medical care market locked up. The hard truth is that cash-only, whether it is fancy “concierge” style or bare-bones is not a very big market anywhere. People just won’t pay what it costs for care. Many people think their “co-pays” are excessive when, in reality, they are a pittance.
And the schedule-packing achieves its own viciousness: more patients mean more claims, more staff to create, file and follow those claims, more nursing or technical employees with bigger payroll expenses, more space requirements, and so on.
To Anonymous 9:13,
One of the few options that physicians do still have is to provide their services at no charge. It is not fraudulent to provide a service to a patient for no charge UNLESS it could be proven that you routinely waived charges to a specific group of patients for your own personal gain (referrals to your practice, etc.) This is the old “professional courtesy” debate.
Let your biller know that it is now possible to charge patients less than you charge Medicare patients, but you should be sure to substantiate hardship reasons.
I too got really angry when I read this. But even more angry when I read all the doctor-hating responses to the blog. I try my *best* to be on time and see everyone when they want to be seen. And I try my best to be thorough. And I try my best to let the patient talk and not interrupt despite the fact that they are rambling on and on about something that is entirely not pertinent to their problem for that visit. Because maybe it will give me some insight into who they are. And I try my best to do the physical exam of yore (see the most recent NYT Health blog). And guess what, I can’t do it all. I just can’t. I’m clearly a failure in all of these patient’s eyes. I am just a greedy god-complex of a doctor who thinks that all people should bow to me.
Nevermind that I had to wait 4 weeks to get my car back after someone ran into my car while it was parked in the driveway. There were a lot of accidents and they were backed up. And my claim was stalled because it was a hit and run. Guess what, I didn’t blog about what jerks the automobile repair business is. I just waited. Such is life. And you know what…you’re not going to believe this…I have even been a patient myself before and have had to wait. I waited 10 hours in the ER when I broke my ankle. I waited over a week for surgery to be scheduled. Then I took one whole day to do my pre-op visits. All day. But my ankle is fixed and I think that everyone did the best they could for me. People need to get over their entitlement. I wait and wait and wait all the time. I wait for patients to get off of their cell phones. I wait for them to finish eating. I wait for them to pay their bill. I wait for them to spit out what medications they are on. I wait for them to stop telling me about their cousin’s brother’s friend who successfully treated his gonorrhea with Hoodia.
If people want to know why doctors seem so dispondent, that is why. What we do is NEVER good enough for everyone. Never. And it is only going to get worse. I had these visions of making a difference. Of holding hands with my patients while they endured some horrible disease. But not anymore. A loud minority of patients have beat it out of me. Thank you for enabling that, NYT.
- A doctor who needed to rant
“even if you got the full 15 minutes, or half-hour, your appointment was allowed, are you or your designated insurance company properly paying for that time?”
My insurance company issues checks the Monday after I see a provider. I used to go to bat for my doctors against the insurance companies and made sure my doctors got paid. I don’t anymore. So I pay for 15 minutes and only get two and that’s ok because the next guy is going to stiff you?
In fact, I rely on Google for determining possible diagnoses treatment options because I don’t have enough time with my doctor appointments to be useful. I wonder if I slipped my doctor cash under the table would he care more?
The American public better get used to more waiting under ObamaCare.
I don’t mind waiting up to an hour if I can be somewhat assured of having some quality face time with the doctor. I don’t mind having to wait a month to see a specialist if I feel the visit is going to be worthwhile.
Unfortunately, too often what I get is a doctor who’s running half an hour behind, who’s harried and stressed out and who rushes me through my appointment in less than 10 minutes and doesn’t have the time to discuss or explain anything. I try to hold up my end of the bargain by being concise and providing the most useful information I can, so I don’t waste his time, but I always walk out of there wondering if any of it sank in or if I’m going to end up with some horrific problem that got missed because the doc was too busy and distracted to pay attention.
Don’t talk to me about the money. My health plan has small numbers in my particular market so we are paying through the nose. On $1,000 in gross charges last year, I paid $825 out of pocket, insurance covered another $125 or so and the rest was written off to discount. By my calculations, that’s around 95 cents on the dollar – yet I don’t get any more face time with the doctor than someone on Medicaid or Medicare. And out here in Sticksville, there just aren’t enough doctors to go around, so *everyone* has to wait, regardless of who you are or how well your insurance pays.
I just keep my mouth shut and try to be pleasant, because I can see the doctor is doing the best he can with the resources he has. But I don’t like it. The last time I was at the doctor, I felt rushed and unwelcome, like I was just some impediment to be raced over on his way to the next patient – even though I was probably the best-paying patient he saw all day. When I had a question about his treatment plan, he cut me off.
Presumably he doesn’t like the situation any better than I do. But how do you even begin trying to fix a system that is so broken? I have to say I pity you guys. I can deal with it by simply not going to the doctor unless I really, really have to, but you’re forced to deal with it day in and day out. No wonder so many of you are getting bitter.
Comment chain interesting for 2 reasons.
1. Doctors really see their actions as a little moral melodrama. (But we work so hard, and are so dedicated how can we be considered BAD for being late all the time.) But, they are bad from an economic perspective. Everyone’s time is money and doctor’s inability to stay on schedule in theft, at least from a utilitarian perspective.
2. Medicine is a limited good. It is rationed, either by the market or by a (insurance or government) bureaucracy. Wait times are the clearest evidence of that rationing. Do you want to pay for a prompt physician–or do you want some bureaucrat deciding that an average 20.4 minute wait is OK. Ah . . . Obamaland.
It’s quite simple. We run behind because we are given 1-hour problems to solve in 15 minutes. This, of course, is impossible to do.
“There is only a very small market for cash-pay care that can achieve viability. The third-party payers, government and private, really do have the medical care market locked up. “
The first statement is not true. The second may be true only if Obama and Stark outlaw or cripple cash practices.
Compared to most medical expenses, outpatient visits, especially in primary care, can be a bargain when you strip off the overhead involved in dealing with government and insurers. Most patients pay more each year for cable.
It’s true that many are currently unwilling to pay directly for physician visits because they feel entitled to this or they feel they already paid for this via taxes. As ‘normal’ clinics and physician offices service begin to resemble 1970s Soviet department stores more and more, this will likely change.
9:36:
You say the quoted statement is not true and yet contradict yourself in your last paragraph.
If patients will not pay cash for services, what besides an expression of their “demand” is that. My statement is true, most won’t pay cash if they can at all avoid it. Many will drive long distances and spend more time and money than they realize avoiding having to pay cash. Many more will wait long periods for appointments elsewhere. It isn’t logical but it is true.
For Pete’s sake, if the patient has a habitually late doctor, then go elsewhere. Sheesh. Some people need to grow up.
The contradiction is mostly due to my muddled writing.
You’re right in that the current market for cash is small. I’ve seen the same things you have; many patients simply feel that our services should be free of any out of pocket costs to them.
However, private practices are going bankrupt rapidly and the big clinics now have less need (and are less able) to subsidize service at their clinics from profitable procedures and tests. Among the effects of this will be even longer waits, more rushed appointments, more midlevels handling more complex cases, and crappier service from overworked physicians and clinic staff in general.
Some subset of patients will become fed up enough to support a larger viable market for cash outpatient practices in each area, especially if those practices keep the price reasonable.
These are some of the same reasons many insured patients currently use the ER for nonemergencies, it’s faster and they feel it’s worth the higher copay.
Wouldn’t go so far as to “bill” a habitually late doctor, but see no reason why the desk staff can’t try to contact those patients by phone who would otherwise be left sitting in the waiting room if they showed up on time. Common courtesy.
My thoughts exactly. I find it amazing how in all of the replies by doctors as to the valid reasons why they are late and rants about insurance, I don’t see a single reply as to why they can’t notify patients if they are more than half an hour late.
I don’t think any reasonable person would understand how difficult it is to run on time when there are walk-ins with emergencies or a doctor’s spending more time with a patient. But why is it difficult for someone in a doctor’s office to pick up a phone and say “doctor is running 2 hours late. Would you like to reschedule or come in later?”. A lot of people are going to a doctor’s office from work. Being able to spend extra time at work may mean being able to meet a deadline (and keep one’s job), not to have to ask one’s manager for time off or, for people who are paid by the hour, to earn some money. Then there are also people who are genuinely not feeling well. These people may feel more comfortable waiting at home than in the office where they may even run risk of infecting other patients. How difficult it is to call someone’s at his cell or office?
I am not talking about 15 minutes or half an hour late – I understand that these delays are difficult to predict before the patient gets to the office. But if you are running an hour late and think you are likely this delay to increase, why can’t someone in your office call? How difficult is it?
It’s not just the doctors. I was once made to wait for well over an hour for a pelvic ultrasound. Would’ve waited longer had a woman who was ahead of me not taking pity on me and letting me go ahead. You know, right, it’s when you have to drink a lot of water but can’t go to the bathroom. So this extra hour meant being literally in pain. This could’ve been easily avoided had the lab called and said “we are running an hour late, don’t drink the water just yet”. But nobody there gives a damn.
I think this problem IS complex. I’ve been on BOTH ends of the problem. We need a health care system where the patient IS the customer, where the office staff ARE thinking along those lines, not just about billing,and where we can ALL show respect for one anothers time. I’ve been kept late by a patient, only to have the front desk of my personal physician refuse to let me see my doctor because I am over ten minutes late. This same doctor often runs late, and I believe through NO fault of his own.
These issues are complex and must be dealt with by the entire team so that respectful, cost-effective strategies are implemented….
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