Patients can ask for discounts if the doctor is running late

Should doctors face consequences if they run late?

From the New York Times’ health blog, Well, comes a story where a medical group promises, “same-day appointments and longer, more personalized visits that start on time.”

Sounds good, right?

But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, service will most definitely improve.

For one, doctors will be under less pressure to make financial ends meet, thus stopping the pressure to double book appointment slots.

Failing that, it’s said that patients can ask their doctors who run late for a discount. It can’t hurt, but can run afoul of the insurance companies:

If you have private insurance, whether your doctor would be allowed to waive a co-pay or other patient costs depends on the insurance policy. Often the insurer would have to give permission, according to a spokesman for America’s Health Insurance Plans, an association representing insurers.

Then, the doctors have to agree to give you the discount. The ones I spoke with said a discount, if any, would depend on a number of variables including the practice’s philosophy toward discounts, the region and the particular treatment.

One thing I’ve learned from reading the various patient experiences on this blog: respect the time of your patients. Under normal circumstances, there is no reason why they should wait more than 15 minutes in the waiting room. If that is happening repeatedly, it’s a sign that you’re overloading your schedule.

In some cases, however, there’s little incentive for doctors to change:

If you’re mid-treatment for cancer or another life-threatening disease, it’s hard to start over with a new physician. And if there are only a few specialists for a particular disorder (or only one in your area), doctors can treat you as shabbily as they’d like. You can suck it up and deal with it or you can drive hours out of your way. But you need the doctors more than the doctors need you in this instance.

And if that doctor is repeatedly late and turning patients’ appointments into an all-day affair, that’s an unfortunate shame that has little recourse for correction.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.TheWriteTreatment.com Barbara Hales

    The problem with this philosophy is that physicians worried about being “docked” pay will rush through a patient encounter to get to the next one. The amount of personal attention has already been shortened and made to suffer due to financial considerations-seeing more patients in less time to keep up with expenses. This idea will impersonalize and short-change the patient further.

  • Dr.CRNA

    I would like to share a story about a more likely scenario. My wife and I had just moved to a new town and my wife was about 3 months pregnant. Several people recommended one particular OB/GYN so an appointment was made and medical records were transferred. My wife arrived 30 minutes early, per the physicians office request, to fill ou the necessary paper work. I remind you that she was 3 months pregnant and had our 18 month old son in tow. After completing the new patient paperwork the waiting began. She sat in that physicians waiting room for just over 2 hours, nauseated, starving (because of the requested NPO status for blood work) and trying to pacify an 18 month old. She approached the recepionist a few times to inquire about her an expected wait time and was met each time with an increasingly annoyed attitude. Finally her patience came to an end and at the 2 hour and 20 minute mark she approached the waiting room window and explained that she needed to feed our son and asked the receptionist if they would call her when the Doctor was ready to see her. The receptionist promptly stated that they didn’t do that and offered to reschedule her appointment, but offered no reason or apology for the Dr.’s delay. Blame it on pregnancy hormones, blame it on frustration from dealing with a toddler for a couple of hours in a waiting room or most likely a combination of all the above, but at this point my lovely wife lost it. She unleashed a combination of hormones, rage, and tears on that snotty little receptionist that resulted in the immediate appearance of atleast one nurse and a security guard and the eventual and miraculous appearance of the Doctor she had come to see. She was promptly escorted to an exam room. Surprisingly when the Doctor arrived in the room to see her, she was not apologetic or even sympathetic. If anything she seemed annoyed. The Doctor then proceeded to lecture my wife on patient/doctor relationships and how she should behave towards her office staff. It was all more than my wife could bare. My wife told this highly recommended physician how poorly her office staff had treated her and went on to discuss how poorly her office must be run if she had patients waiting for over 2 hours to be seen. It was evident that this Doctor/patient combination was not going be a good fit so my wife told the Doctor that she would be seeking care elsewhere. My wife then proceeded to pack up our son and find her way out. Mind you, this was the first visit. No exam was done, the doctor never even took her history. When I made it home from work, my poor frustrated wife was still in tears.
    To add insult to injury, about a week later my wife opened the mail to find a full bill from the OB/GYN and a letter officially firing her as a patient.
    I work in health care and specifically I work with surgeons on a daily basis, so there is little in the way of audacious behavior that surprises me, but I found this level of disrespect to be shocking. I couldn’t believe that a physician would treat a new patient this manner. I couldn’t believe the complete disregard that had been shown for my wife’s time or comfort. Needless to say, we found a different Doc, one that wasn’t quite as “highly recommended” or busy and maybe because of that he had a little more time in his schedule and was a little more accomodating of our needs.

  • family doc

    Sure, I’ll give a discount for running behind as soon as I can add a schedule disruption surcharge for “oh by the way…” complaints of chest pain, rectal bleeding or mental status changes after I’ve already spent their 15 minutes on nonurgent problems.

    Schedule overloading? That’s a provider trying to minimize losses in the high volume, low pay model most of us are trying to leave. If patients don’t like it, then they should plan to pay a modest membership fee so the practice doesn’t have to cram patients on the schedule to make ends meet.

  • Dr Synonymous

    I appreciate my family physician enough to be willing to wait for him. Shouldn’t everyone have a doctor that’s worth the wait?

    • Cospo

      Absolutely. And I count my blessings that I have one of that sort. Even though I really don’t like to wait and wait and wait, I appreciate my docs. Only one makes me wait what seems an eternity, but I plan for the long wait now. The other 2 are wonderful too, but I don’t have to wait so long because their offices seem more efficient – mainly, I think because they seem not to overbook. It’s a shame how health care now is restricted to small time slots where you just about have to talk rapid fire to get in all your concerns before the bell dings. The idea of paying an annual membership fee is a good one, I think, if you can afford it and it permits your doc the time to build a patient-doctor relationship as it used to be in the past. Now, things are mostly hurried, seemingly cursory, and don’t always give the doc a better overview of you, your situation and your issues.
      I don’t know, as someone else touched upon, how certain insurers would view the membership fee. Would it even be feasible? Although I think it’s a great concept – perhaps to have both insurance AND an annual office fee. Of course, if you must see several different specialists within a given year – how expensive could that get to be for a patient? It’s a quandary.

  • Vox Rusticus

    There are unfortunately crossed purposes and conflicting messages at work. Doctors want patients to know that they are interested in their problems and are willing to spend the time they require to help them. At the same time, third-party payers sharply restrict payment so that time is significantly limited by poor payment, and addressing multiple problems, or even one problem in detail is more than can be done in the time allotted for an office visit.

    I can understand patient frustration with this, but at the same time, those patients who expect their doctor to accept whatever their carrier allots for their service are at least indirectly contributing to their predicament. The only way to make this kind of arrangement work is to have more frequent but short visits. Demanding more time than is afforded inevitably leads to delays. It is not always possible to build unscheduled buffer slots in a schedule to absorb delays; in essence, this is unreimbursed time for which the collections on scheduled and attended appointments must cover.

    The cash-pay practice is a real alternative. At least one is not left wondering at the cost; that is stated up front, and the patient can decide whether the service is worth the price or not. Of course insurers hate this model; it takes them and their shady behavior out of the transaction and prevents them from hiding how deeply they have discounted (or rather, underpaid) the doctor’s services while selling the subscriber on the “value” of their policies.

  • http://nostrums.blogspot.com Doc D

    In thirty years of practice I can’t remember a single time I was late for reasons that were under my control, or that of my staff.

    What I found works better, is to go out into the waiting room, and tell people exactly what was going on and why (usually a call to the ER).

    What people hate is being “dissed”. When they understand why, most reasonable people realize that the emergency could have been them.

    • Cospo

      WOW! This is the BEST idea ever. Personally, I’d prefer a doc who was as considerate as that to come out to the waiting room and say something like that to his patiently (or IMpatiently) waiting patients. I’ve been in situations with a certain doctor of mine – whom, by the way, I need more than he needs me, I think – where I’ve actually waited a minimum of 2 – 3 hours to be seen. But he’s done me so much good that I can’t imagine leaving him. The same sentiment reigns amongst all the patients with whom I’ve waited. We really hate the wait, but so much appreciate the time he spends with each of us that we simply plan on long waits and bring a snack!!

  • http://www.twitter.com/alicearobertson Alice

    Being a member of some supposedly exclusive doctors club where you can get same-day treatment with a select group may be worth considering (but how do you know if you like the doctors without paying? Is this a type of Sam’s Club Patient’s membership? Do they offer pro-rated plans, or a 30 day free membership? A franchise where a member has rights to complain? Or a doctor-run type of outfit?). Paying $199 is something I would consider just to prevent having to sit at the ER with my mom for hours-upon-hours when there is nothing wrong with her (sometimes it’s dehydration), several times a year (sometimes they admit her and after a few days discharge with a clean bill of health). It’s extremely hard to get a same-day appointment, so she waltzes into the ER where it’s all paid for.

    I guess one wonders how $199 will help the patient get better care? If there are caring doctors there wouldn’t they be practicing on their own and trying to take patients that day without the membership fee? But then again……..sometimes capitalistic ventures and competition is helpful………but not when huge hospitals are buying up all the competition.

  • http://www.twitter.com/alicearobertson Alice

    Okay, I will ask the obvious (and probably most ignorant question of this thread)……..how could such a concientious doctor run two hours late consistantly? I understand emergency situations, and the unforeseen problems….but packing snacks because a doctor is usually running hours behind? How lacking in management skills is it when their patients are constantly waiting? But why change if you are so good they are having a fan fest in the waiting room? Surely…as an act of good faith these doctors could have their staff call your phone and tell you to show up an hour later because they are running behind once again? That would show the doctor cares about your time and schedule.?

  • soaringcanary

    This issue, and all comments, are no surprise to see after I have sat with my steadily-growing-more-impatient 97 year old father [tapping finger/anxiety/rising BP] for close to 90 minutes to see his podiatrist [MD] who still sees Medicare patients. Needless to say, other experiences shared here have been far worse than ours, but for comparison, after we sat for the first appointment in a literally ‘packed’ waiting room of [only] white/gray haired people and then saw the doctor for 8 minutes, I was [still] willing to write-off that waiting as a one-time event. But when it happened on the second and third appointment that’s when I knew this was about that doc’s scheduling pattern. And on the third visit when I heard the receptionist take a call from a patient for that day and eventually make the suggestion, “Well, as the last patient of the day at 3:30PM…why don’t you wait an hour or so before coming in?” then I knew this was not only a pattern but so was it historical enough that [at least] one patient ‘knew to call in’ before leaving home! Think about it; how many of us have the time or would be willing to wait on-site for 1 or 2 [or more] hours for a ‘scheduled’ haircut, the auto repair, a restaurant meal or even the Veterinarian for an ailing pet. This is not only highly disrespectful to the patient, but so is it a huge waste of time and a severe loss of good will between two people who do want something from one other. In my opinion, this brokenness in the doctor’s office needs some serious PR tweaking which might include the earlier mentioned [as a proactive] ‘call to the patient’…or even the return to house calls for the bread & butter [necessary yet more routine] appointments, i.e. pregnant women, the elderly or non-emergency. In our case, I hold the hospital who oversees such in-house clinic accountable for not hiring a second [or third] circuit rider MD to provide the hygiene/circulatory-necessary podiatry services in our rural coastal community which is inherently more populated by the elderly retired. One thing I will add about the 8 minute appointment is that once the MD took hold of dad’s swollen feet [with an obvious glint of sweat on his brow] there were too many ‘crowded for profit’ reasons for why he dug a bit too rough and deep with that tool to cause both unnecessary pain and bleeding for his aged patient. So, after the “three strikes” we fired this doctor and do have a replacement [an hour away] who has delivered on every professional promise at 100% as is relative to aspects mentioned. The take-home message on this topic is that most patients [Medicare or otherwise] don’t want a fee discount, but as your fellow human beings, they do want equal services [and thoughtful respect] for equal pay.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Would patients agree to pay a surcharge if they are late?

    • http://www.twitter.com/alicearobertson Alice

      Michael Kirsch, M.D. July 9, 2010 at 11:29 am
      Would patients agree to pay a surcharge if they are late?
      [end quote]

      That would seem fair. At the Clinic you are refused to see a doctor if you are more than five to ten minutes late, and if you are late something like three times in a year you are told to move on. I am unclear if all the departments have that rule or not, but I was told this week if I fail to cancel an appointment they will bill me $75 for a no show. It wasn’t personal, just the way that certain department is now running things. I think expecting responsibility from a patient is fair.

  • Caroline Andrews

    My primary doctor and my asthma doctor both run late quite often. They both also spend as much time as I need when I’m with them. My primary care doc is in a large group, and most of the doctors are out the door at about 5, while I’ve seen him still there at 6 (when he took me late in the day so I wouldn’t have to go the weekend with a possible urinary tract infection). I’ve never felt rushed by either doctor, and they always take the time to ask if there’s anything else I want to discuss. I appreciate this level of care and caring, and I never complain about a wait. I just take a book.

  • Caroline Andrews

    I should add that the large group in which my doctor practices dictates that the doctors see a certain number of patients an hour. I always felt rushed out the door with a previous doctor in that group. I’ll accept a wait any day for a doctor who takes extra time with me if I need it.