How Doctors Get Paid
One doctor reports:
I can freeze a couple of warts in less than a minute and send a bill to a patient’s commercial insurance for much more money than for a fifteen minute visit to change their blood pressure medication.
I can see a Medicaid or Medicare patient for five minutes or forty-five, and up until now, because I work for a Federally Qualified Health Center, the payment we actually receive is the same.
I can chat briefly with a patient who comes in for a dressing change done by my nurse, quickly make sure the wound and the dressing look okay and charge for an office visit. But I cannot bill anything for spending a half hour on the phone with a distraught patient who just developed terrible side effects from his new medication and whose X-ray results suggest he needs more testing…
Most people are aware these days that procedures are reimbursed at a higher rate than “cognitive work”, but many patients are shocked to hear that doctors essentially cannot bill for any work that isn’t done face to face with a patient. This fact, not technophobia, is probably the biggest reason why doctors and patients aren’t emailing, for example.
My dermatologist does not accept any insurance and he accepts only cash and checks as payment. He talks to me and other patients on the phone all the time. He even issues prescriptions after talking with me on the phone. The only problem is that his waiting room is always packed solid with patients during visiting hours. He is so popular and well regarded that it is hard to get an appointment except well in advance.
He can do this because he can spend time with patient care, making patients happy, without wasting time on idiotic paperwork and bureaucracy. I think most docs would be happy not so much making more money, just getting time to do what they should be doing, taking care of people.
If everyone pays cash for doctors visits, what to the poor do? Just save their money until they can go?
The answer to your question depends on the level and nature of the poverty. Are you referring to a homeless person? A person who is cash poor because they have four kids and a lot of bills? Someone who just lost a job? If you give me a specific example, I will make a suggestion.
Reason why private doctors are much more efficient and useful. If you are paying the doctor, he/she doesn’t have to worry about dealing with the government to make their money, which frees them time to build a relationship with patients that allows them to treat patients through the phone.
Basically the only problem is he is wildly successful and busy by accepting cash or checks only. Its a nice problem to have in this day and age, especially in medicine.
Whenever you need urgency and need to see the doctor, don’t call ahead, show up and tell them you are willing to pay cash. Most will accommodate their schedule to see you, proof that free market works.
Nice little trick I’ll have to try next time I need urgent care
One of the biggest problems is the government intervention; it limits the way doctors practice medicine. Requiring documentation and proof of everything they do, in order to disburse money, makes it impossible for the industry to innovate and to find ways to make care more efficient. But the bureaucracy is going to destroy the system.
I wonder if quality of care or doctors visits would change if they had a different method of being compensated.
Also, what is a better alternative? Does he suggest a compensation method similar to lawyers or clergy? Is it doable?
If we compensated similar to lawyers, the system would go broke. If similar to clergy, the docs would go broke. The best is “direct pay”, then the doc is working for the patient, not the insurance compny or the government.
Actually, if we did compensate physicians in a manner similar to that of lawyers, patients would be paying directly for services — including time spent — and they would have an incentive to economize their money…and thus, the physician’s time.
Those patients who pay the least for their care at point-of-service, eg, Medicare with low co-pays or, worst of all, Medicaid with no co-pays, don’t give a hoot about how much time they consume: after all, they have plenty of time (Medicare usually retired, Medicaid usually unemployed) and they’re not paying, so why should they care? (And I can assure you that for the most part they have no empathy for their fellow patients who are waiting because of them.)
I would believe they would be more inclined to build a relationship with the patient, if they don’t have to deal with the government.
The conclusion of the blog is excellent. The author states:
“If a tree falls in the forest, does it still make a noise?
If a doctor isn’t face to face with a patient, is he still a doctor? Is he still doctoring?
I say yes, but, then, how should we get paid? D
The author is making the point that they are making change and improving the life of many, even when they are not in the office. But, their effort is real and they are making an actual change in lifestyles.
“but many patients are shocked to hear that doctors essentially cannot bill for any work that isn’t done face to face with a patient.”
Some easy diagnoses can be done by internet (facetime for instance).
Obamacare plans can have deductibles of $5,000 for an individual. Yet, only 3% or 4% of individuals will hit those deductibles within the year.
It is not surprising that some of these patients will simply pay cash to doctors rather than waste time running their claims through health insurance.
John,
If a patient has a high deductible plan and pays cash and does not submit a claim against the deductible they are simply flushing money down the toilet.
The same holds true for high deductible plans before Obamacare was created.
Thank you. I never give anyone advice. However, if one is 96% or 97% likely to not hit his deductible, and can get a better fee by offering cash, why not do it?
If one gets unlucky and one does hit the deductible in a given year, one still has all his receipts. So, one can mail them into the insurer and explain that the deductible has been met.
At this point, of course, one has entered into an administrative bureaucratic nightmare. It is a risk. However, I have heard from people who have taken this risk and it has worked out for them. Unfortunately, I cannot disclose their identities. (And I don’t endorse the behavior.)