[HN Gopher] More doctors are charging fees to respond to patient...
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More doctors are charging fees to respond to patient messages
Author : gnicholas
Score : 120 points
Date : 2024-03-08 16:44 UTC (6 hours ago)
(HTM) web link (www.wsj.com)
(TXT) w3m dump (www.wsj.com)
| gnicholas wrote:
| Getting a doctor to respond through our digital messaging
| platform is practically impossible. Unless you're extremely
| persistent and specifically ask for the doctor's input (and send
| 3-4 messages back and forth with the nurse, whose responses are
| less relevant than a google search), it's impossible.
|
| I wonder if charging for these messages will make doctors more
| likely to respond. I wouldn't mind a modest copay for these. But
| if I pay $30 for an appointment, a quick message should be under
| $15. There would also have to be some sort of SLA, or the ability
| for a patient to specify that a question/email has expired and no
| longer requires an answer.
|
| I've had situations where I waited for a doctor's callback so
| long that I ended up calling a friend who was a physician
| assistant, watching a youtube video about how to fix the problem,
| and taking care of it myself. The only way that process could be
| any worse is if I got a reply after I had fixed it -- and a bill
| for the message.
| devin wrote:
| I've never had a problem across several doctors on getting a
| direct reply to my message. For me, there is an SLA. They
| explicitly state I'll receive a reply within 24 hours. That has
| been true across multiple health systems I've used.
|
| Edit: In no way am I saying "American healthcare is just fine!"
| only that I actually have had a really good experience using
| messaging to communicate with my care teams.
| NegativeK wrote:
| Are you, by chance, using concierge doctors?
| devin wrote:
| Negative.
| NegativeK wrote:
| Wild. I've never seen anything remotely close to an SLA
| with the healthcare professionals I've seen.
| smallmancontrov wrote:
| > I wonder if charging for these messages will make doctors
| more likely to respond. I wouldn't mind a modest copay for
| these.
|
| How long until administration figures out that they can juice
| revenue by shitting up the emails to increase back-and-forth
| traffic?
| FireBeyond wrote:
| Hah, in MyChart, my provider has started having an MA answer
| your emails, and then "I'll forward this to the provider".
| Waiting to see if I get billed for the MA's "effort".
| ejb999 wrote:
| why are you putting effort in quotes? Do you not think
| there is any 'effort' involved?
|
| Why do you think someone else's 'effort' should be free?
| FireBeyond wrote:
| This is an absolutist take.
|
| No-one's saying it takes zero literal effort. Just
| "Should I be billed by the practice $25-30 for an MA to
| get my email and say "I have forwarded your question to
| the provider"?", and then a subsequent $100+ for the
| provider's response to my question.
|
| Why should that not be part of the intrinsic baseline
| officework and not a billable service?
|
| Especially when it's a 100% artificial roadblock inserted
| by the practice? After all, the communication portal in
| MyChart is "Message My Provider", not "Message An MA To
| Message My Provider".
| pants2 wrote:
| While waiting 6 weeks for an appointment with a specialist and
| suffering in pain, my mom diagnosed herself, created a
| treatment plan, ordered prescription pills from some Chinese
| site, and started treating her condition herself. She cancelled
| her appointment because she was feeling much better.
| wannacboatmovie wrote:
| This is terrible advice.
| burnished wrote:
| It isn't advice
| NoMoreNicksLeft wrote:
| > I wonder if charging for these messages will make doctors
| more likely to respond.
|
| Why would it do that? If they get money for messages sent
| (rather than messages sent by doctors) then some flunky can
| send a message and you can still be billed. Given how this
| sounds like a profit center, and doctors are cost centers
| (imagine if they needed to send more messages... now they have
| to pay more doctors!), I figure physicians will be kept far
| away from any such system.
|
| If we plot out perverse incentives as a space, I believe that
| our fate will be to trek through every possible point in that
| landscape such that we eventually see every single one. This
| means you will eventually get universal healthcare, most likely
| as the very last of those perverse incentives.
| gnicholas wrote:
| Interesting point. That could make for some awkward
| conversations if the patient thinks messages were coming from
| their doctor but then the director had no memory of the
| messages. It would also seem fraudulent to have messages
| signed by the doctor when it wasn't actually sent by that
| doctor.
|
| I think it's much more likely that doctors will end up
| sending AI-autocompleted messages that take very little time
| to complete but seem like took much longer.
| NoMoreNicksLeft wrote:
| I have not used a medical messaging system, but if it's
| anything like the messages my bank or my insurance company
| sends on their own systems then these will look much more
| like text messages and less like emails. No place to
| "sign". No need to risk it looking like fraud. As for
| awkward conversations, I'd be shocked if many people don't
| experience circumstances where their doctors act as if they
| don't remember previous in-person conversations. They're
| seeing 25 patients a day for 3 minutes at a time after all.
|
| The standard will evolve to something like clinic staff
| sending the messages which will be overseen/supervised by a
| medical doctor (who won't be involved in composing the
| messages or spend any time looking at them before or after
| they are sent). We'll see trials where the doctor who was
| supposed to be keeping an eye on the messages wasn't, and
| some flunky kills a patient by suggesting that drinking
| used engine oil will cure the sniffles. Keep in mind that
| the messages can be sent from anywhere too, technically no
| need to keep that onshore. May eventually get legislation
| that would guarantee that, but only after a wild west
| period that lasts a few years.
| qudat wrote:
| > I wonder if charging for these messages will make doctors
| more likely to respond.
|
| Physicians won't see a dime of that money unless it's through
| RVUs and even then it's marginal at best. The real money is in
| procedures.
| helsinkiandrew wrote:
| https://archive.is/KtTeA
| CharlesW wrote:
| Here's American health care:
|
| * I needed refills for two prescriptions that I've been taking
| for years. This time, for opaque reasons, I needed to talk to a
| doctor first.
|
| * Fine, but I couldn't accommodate an in-person check-in. I chose
| a "video visit" that, due to logistics, I had to do while away
| from home. Because they were a half-hour late, I was effectively
| forced to do this from the couch of a Costco floor display so I
| could still pick up my kid on time.
|
| * The appointment was 8m, at an out-of-pocket cost of $160+. I
| was not warned that I'd be forced to pay $20/minute for the
| privilege of being blessed with refills.
|
| Land of the fee, baby.
| danielschonfeld wrote:
| American healthcare is the epitome of capitalism run amok.
|
| It's terrible and the only thing worse than the exorbitant fees
| is the complete and utter lack of consideration to the
| patient's time.
| aeturnum wrote:
| I have a partner who's a nurse practitioner in primary care
| and I just want to emphasize how hellish it is for people on
| the inside as well. The economic model of running a
| healthcare business is entirely based on their ability to
| bill for provider time. Healthcare providers have very high
| costs to match their very high fees and also pay a bunch of
| people to 'help' providers see more patients. A big part of
| this mix is also that it is not enough to provide healthcare
| - you are actually paid for providing documentation that you
| carried out the specific care that you "should have done"
| given the case notes. Ensuring you properly annotate the
| files of patients (for the benefit of generating the right
| charge codes! Nothing to do with patient care) is another
| burden that's required to sustainably provide care. As a
| result the costs "per provider" are much higher than the
| provider themselves - you also need medical assistants who do
| every piece of work the provider isn't legally required to
| do, billing staff to properly bill that work, admin staff to
| manage their schedule in detail, etc.
|
| The lack of regard for patient schedules is a direct result
| of how insanely packed the schedules of providers are.
| Fifteen minutes per patient is luxurious and my partner
| spends a lot of time after work entering notes for patients
| she saw that day (she "works" 32 hours / 4 days a week, which
| is really closer to 40-45 all told). My understanding is that
| the clinic does not have a high profit margin (serving
| medical / medicare patients + high overall costs), so every
| patient counts, and the admin staff will add people w/o
| permission. It's common for her to find patients scheduled
| over her breaks or for her to be scheduled after she should
| have left the building. Burnout has always been bad but it's
| reaching epidemic levels now in the wake of covid, which
| further restricts the supply of healthcare and makes people
| wait longer to be seen.
| mindslight wrote:
| I think people tend to get stuck on the ridiculous
| charges/billing and don't often get to the point where they
| appreciate just how bad the provided healthcare is, and how
| much it utterly destroys patient agency by replacing it
| with bureaucracy. The provider/"insurer" dynamic is really
| the deep set home of the rot. As a table stakes reform,
| health "insurance" companies need to be prevented from
| managing healthcare and relegated to purely financial
| payers, but doing so would put so many low-level
| bureaucrats out of work it's politically untenable.
|
| For a recent event, I got a whole nurse calling me from the
| _" insurance" company_, out of the blue, seemingly just to
| chat about the medical situation and how things are going.
| I haven't figured out what her KPIs are, but I doubt she
| remains so friendly when you bump up against them! And she
| obviously represents a severe misallocation of labor - the
| industry would be better off if someone with her education
| (and likely experience) was actually providing healthcare.
| autoexec wrote:
| > - the industry would be better off if someone with her
| education (and likely experience) was actually providing
| healthcare.
|
| Worse the odds are good she was hired to help the
| insurance company prevent people from getting healthcare.
| wolverine876 wrote:
| Somehow, US healthcare is ~ 2-3x expensive as equivalents
| in other wealthy countries, which get better outcomes. Who
| is collecting this extra money? It's not the medical
| professionals, you say (and I believe).
| aeturnum wrote:
| It's partially medical professionals! My partner is
| better paid than she would be in, say, Canada. US medical
| worker pay absolutely contributes to our costs - I just
| meant to point out it's not the only factor and that
| those jobs, though well paid, can be taxing for the
| people in them on a day-by-day basis.
| anon-sre-srm wrote:
| No, the worst part is dying of a painful terminal illness
| while being sued into bankruptcy in your dying days having to
| fight to keep minimal possessions because the hospitals and
| doctors want money.
| j-j-j-j wrote:
| None of that stuff would be possible without government. It's
| a statism run amok.
|
| It's the same story every time. Something works relatively OK
| (US health care before 20 century big-gov), huge changes to
| incentive structure and overheads are introduced by statists
| ignoring higher order effects, everything goes downhill,
| statists blame capitalism.
|
| Let me legally not have insurance, pay anyone in cash for my
| health care (no licensens and government enforced
| monopolies), and buy any medicine I'd like and opt out of
| this madness completely and let's compare with real
| capitalism.
| wwweston wrote:
| It's always been legal not to have insurance (though there
| was a brief period where externalizing costs that way was
| taxed). You can pay cash for health care as you like now
| with any provider who cares to negotiate with you on a cash
| basis. There's even a variety of non-MD providers whose
| licensure ranges from more accessible through informal to
| non-existent should you object to credentials as
| distorting.
|
| If you try doing health care this way for long enough, you
| might even discover which incentives are poorly aligned
| _without_ collective policy of some kind, but who knows,
| maybe not.
| plagiarist wrote:
| We can surely fix this mess via same invisible hand that
| sent people down the horses aisle in the farm goods
| warehouses to use deworming medicine as a preventative
| antiviral.
| bdzr wrote:
| It's really not, it's a frankenstein of a system with
| capitalist and socialist traits. If it were capitalism run
| amok, a consumer would be able to figure out the price of
| something as though it were a cup of coffee. Pricing is
| completely opaque and provides nearly zero demand for
| providers to compete.
| alistairSH wrote:
| It's not socialist (Medicaid/Medicare notwithstanding).
| But, it's definitely not "ECON-101 free-market capitalism"
| either. Lots of regulatory capture from both medical and
| insurance providers. Plus a bunch of self-inflicted
| dysfunction because we keep electing ding-dongs into
| Congress.
| gnicholas wrote:
| My doctor's office pushes really hard for me to set up a
| physical if I haven't been in recently and need prescription
| refills. This includes for allergy and asthma medication, which
| I have used as-needed since I was a child. This started
| happening around a decade ago; before that, it was never a
| problem to have the pharmacy call the doctor's office for the
| refills, and that was that.
| sp3000 wrote:
| The American sick care system is based around and
| incentivized to keep you a customer for life. I recommend
| people find preventative health and longevity specializing
| medical providers - they prioritize actual health and
| wellness.
| patwolf wrote:
| I had a prescription that I used to get updated at my annual
| physical. I would schedule my next physical when I'd leave
| the office, but then they started telling me that they
| couldn't schedule anything more than 6 months out. I waited,
| and when I tried to finally schedule the physical they
| couldn't see me for 9 months. So now I order the medicine
| from India.
| TheNorthman wrote:
| A danish perspective: Primary care doctors are paid (by the
| state) based of a fixed list. A 15 min video consultation pays
| 162.99 DKK (~24 USD)
|
| [1]:
| https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pd...
| codegeek wrote:
| Talk to me when you get a $4000 bill for 2 hours in ER where
| the actual doc saw you for 5 mins and then the nurses did band-
| aid and over the counter burn ointment. This with Insurance
| (biggest mafia). AMerican Healthcare system baby!!
| FireBeyond wrote:
| I was in one hospital ER for a kidney stone, but they had no
| urology available, so they sent me via ambulance
| ("thankfully", as a paramedic, one of our company benefits
| was that if we were ever transported, they'd bill our
| insurance and waive any charges to us) to another hospital.
| Ambulance crew wheeled me into the ER bay, where a
| 'transport' gurney from surgery, was waiting, and I slid from
| one to the other, and was wheeled to pre-op.
|
| At no point did the ER staff ever talk to me. At no point was
| I in a room. Or in an ER bed, hallway or otherwise. Just
| ambulance, transport, and then to pre-op.
|
| But, because the transfer physically happened in the ER, that
| second hospital tried to bill my insurance for an ER visit to
| the tune of $2,800 which I appealed (successfully, at least).
| anon-sre-srm wrote:
| My elderly disabled mom on a fixed income is being billed
| for an ambulance ride from a hospital to a long-term care
| facility because Medicare deemed it "unnecessary" even
| though the shuttle couldn't take her.
| sokoloff wrote:
| > At no point did the ER staff ever talk to me.
|
| How did the determination that you needed urology, "oops,
| no urology available", and ambulance transport get
| arranged? It seems like some level of triage, routing,
| unable, re-routing had to have happened, right?
| Someone1234 wrote:
| I think you misunderstood their story. They [rightfully]
| got charged for the ER at Hospital #1, but were
| mistakenly charged for the ER a second time at Hospital
| #2.
| sokoloff wrote:
| Indeed I did. It now says "second hospital" in the last
| paragraph. I can't know whether I mis-read or if it was
| edited to clarify, but I definitely did misunderstand the
| story.
| FireBeyond wrote:
| Present with abdominal pain, admitted, CT imaging, pain
| management. Imaging read, kidney stone diagnosis
| confirmed (and of such a size that it needed immediate
| management). No urology available at hospital one, and
| because of narcotics on-board, transferred to nearby
| hospital via ambulance that did have a urologist
| available, so I could go straight to theater.
|
| But yes, hospital two tried to charge me for an ER visit,
| as well as the surgical billing (which of course was
| reasonable).
| BenFranklin100 wrote:
| One of our employees decided to go to a random hospital ER
| room for a small cut on his finger. It only required a
| bandage, no stitches. The ER charged us $3,300. We are
| still fighting them.
| alistairSH wrote:
| Fighting the ER or the employee? Sounds like it could
| have been handled at a PCP or urgent care or with a
| bandage at home? Staffing a full trauma center is
| expensive, it should cost a lot to use it.
| BenFranklin100 wrote:
| Fighting the ER. The employee screwed up and did not go
| to the urgent care per policy for minor cuts. Still, it's
| bad optics to fight an employee.
| lotsofpulp wrote:
| It's bad optics to employ someone who doesn't know what
| emergency means.
| BenFranklin100 wrote:
| Lol true.
| rqtwteye wrote:
| The system should not be that complex and full of traps.
| I rarely go to a doctor and when I have to go every few
| years I have no idea how things work and what to avoid.
| alistairSH wrote:
| It's not.
|
| ER - life or death (if you can drive yourself, it's
| probably not an emergency)
|
| Urgent Care - you have the flu, and your PCP isn't
| available; minor emergencies (but you can still drive
| yourself)
|
| PCP - flu, check-ups, whatever
|
| The balance billing and OON charges are separate issues
| from over-use of the ER.
| kelnos wrote:
| Your simplistic description shows that you don't even
| know what you're talking about! The ER is for far more
| than life or death. A broken bone -- no matter how minor
| -- is a perfectly reasonable reason to visit the ER.
| Urgent care may work just as well, but there are many
| reasons why urgent care might not be a great option for
| people in their circumstances.
| BenFranklin100 wrote:
| ER is definitely not appropriate for a small cut
| requiring only a band-aid.
| rqtwteye wrote:
| If the system was honest, then the ER would send people
| to the right place instead of charging them an arm and a
| leg for basically nothing.
| dylan604 wrote:
| you're assuming that the employee had an urgent care
| center open available to them.
| BenFranklin100 wrote:
| No assumption. The employee had several.
| mjamesaustin wrote:
| My recent ER visit charged $5000 to walk in the door, without
| even accounting for any actual care.
| rqtwteye wrote:
| Wow!
| anon-sre-srm wrote:
| A long time ago, I was once charged for being browbeaten into
| entering a social security number on a keypad by a
| belligerent ER security guard at a hospital. Didn't even see
| anyone, but still charged.
| gnicholas wrote:
| Did you pay the bill or fight it? I would think that if no
| services were rendered, it would be fraud to charge
| someone.
| edm0nd wrote:
| Counter point, why did you even bother going to the ER if
| that is all that was required?
|
| That solution doesn't really scream "emergency" and seems
| like a waste of their time and resources...
| autoexec wrote:
| In the US just because a person doesn't get much actual
| care at an ER that doesn't necessarily mean that they
| didn't have good cause to go there.
|
| Some ERs don't always provide the level of care that they
| should, some doctors/insurance companies require patients
| to go to the ER for anything they need after office hours,
| and sometimes there's a need to be seen for something
| because of perfectly reasonable and valid concerns that it
| might be more serious than it ultimately ends up being.
|
| While it's possible that the commenter's visit to the ER
| was a "waste of time and resources" I don't think it's fair
| to assume that from what was said.
| Someone1234 wrote:
| Medical providers are constantly telling patients not to
| self-diagnose/self-treat/play google-doctor, but as soon as
| there is a billing problem, everyone uses that to victim
| blame. Kind of messed up if you ask me.
|
| Personally I am not qualified to determine what a treatable
| and non-treatable burn looks like. Where I went to school
| they don't teach that.
| gizmo686 wrote:
| The ER is not the only place you can go for medical
| treatment.
|
| My order of operations for medical treatment are:
|
| 1) Virtual consultation. Free through my insurance. If
| you need to pay full price, this about as expensive as
| option 2. Also worth skipping if you can tell that an in
| person visit will be needed anyway.
|
| 2) A clinic. I use CVS's minute clinic. Looking at their
| price list [0], a minor burn treatment will run you about
| $100-$150, which is about what I would expect for talking
| to a professional.
|
| 3) Urgent Care
|
| 4) Emergency Room
|
| [0] https://www.cvs.com/minuteclinic/services/price-lists
| macNchz wrote:
| A component of this is fear of liability in a highly-
| litigious environment. Nobody wants to be the one who
| told someone to wait and see instead of going to the ER,
| only to have the person wind up dying or suffering
| serious harm.
|
| This is further exacerbated by the limited safety nets in
| the US-even people who would on principle deign to sue
| others who tried to help them in a time of bad luck may
| find that a lawsuit is the only way they'll be able to
| maintain a decent lifestyle after the loss of a partner,
| or with a newfound need for long-term care.
|
| One more layer is the fact that doctors are so
| overbooked. Many people cannot reasonably get
| appointments with their family doctor (if they have one)
| on short notice, so some things that, in the past, might
| have been a "wait-til-morning then call the GP to drop in
| same-day" are now "GP is booked three months out, guess
| we're going to the hospital".
| amelius wrote:
| Maybe they couldn't really give the treatment that was
| required.
|
| Or maybe the patient didn't know what was required.
| BobaFloutist wrote:
| I mean I'm not sure that you shouldn't be charged ER prices
| for taking an over-the-counter-treatable injury to the ER.
| You probably shouldn't be charged 4000 for going to the ER,
| but just because you didn't actually _need_ to go to the ER
| doesn 't mean you didn't consume ER resources (the 24/7
| staffing, the intake logistics, the trauma expertise, etc).
|
| Probably the biggest surprise there is that a doctor saw you
| at all instead of you being filtered out by a triage nurse
| and sent to urgent care.
| dghlsakjg wrote:
| You have no idea what this person was being seen for.
|
| It is fairly common for someone to be advised to seek
| emergency treatment out of precaution to ensure that a
| minor symptom is not indicative of a severe problem.
|
| For example dizziness can be a completely nothing-burger
| inner ear problem treated with a bunch of motions from
| youtube, or it can be a stroke. The ER exists to make that
| distinction.
|
| Part of all those logistics and resources should be used to
| shunt people to the correct treatment center, but liability
| suits and extreme profitability mean that the incentive is
| to treat them in the ER.
|
| Put into other terms, if you were hospital admin
| incentivized on billing, and could bill someone $5k instead
| of $160 for a non-urgent issue, wouldn't you? The fixed
| costs are the same, the ER is running 24/7 with a trauma
| team, might as well make it profitable.
| BobaFloutist wrote:
| >You have no idea what this person was being seen for.
|
| I feel fairly comfortable assuming that they were being
| seen for a minor-to-moderate burn.
| dghlsakjg wrote:
| That was the treatment received, but perhaps they were
| referred to the ER by EMS for smoke inhalation.
|
| I don't know either, but the broader point is that people
| are referred to the ED by medical professionals for
| seemingly minor issues all the time, and that the
| incentives are all lined up to treat stupid shit in the
| ER rather than have someone tell them to go somewhere
| that makes more sense.
| dylan604 wrote:
| > That was the treatment received, but perhaps they were
| referred to the ER by EMS for...
|
| Isn't it CYA for any EMS to recommend you visiting the
| hospital, so they just say it to anyone. That allows them
| to later say that you failed to follow recommended
| advice.
| kelnos wrote:
| Maybe so, but so what? If a medical professional tells me
| I should go to the hospital, I'm going to go. I'm not a
| doctor. I don't know how to diagnose injuries and
| illnesses beyond a very basic level.
| dylan604 wrote:
| That's exactly the point. People forget that EMS are
| _not_ doctors. All they have is way more medical training
| than the average civilian. That 's why it's a CYA for
| them. So the person that shows up to the ER as advised by
| EMS which later turns out to be a non-emergency is not
| the fault of the patient. Why punish them with unholy
| fees?
| BobaFloutist wrote:
| >perhaps they were referred to the ER by EMS for smoke
| inhalation.
|
| In that case part of the treatment they received was
| emergency evaluation for smoke inhalation. Just because
| they don't end up giving you drugs or doing surgery about
| it doesn't mean the assessment wasn't a valuable service.
| kelnos wrote:
| Maybe true, but as non-doctors, we are not necessarily
| qualified to self-diagnose the severity of a burn. We
| shouldn't be financially penalized for injuring ourselves
| and then -- in the stress and fear of the moment -- not
| being sure if our injury amounts to an emergency, or
| something much less urgent.
|
| Well, at least, a functioning health care system
| shouldn't penalize for that sort of thing. We don't
| really have that in the US.
| kelnos wrote:
| Yup, been there, done that. Many years ago I'd gone to
| the ER for something that ultimately didn't require an ER
| visit. But I'm not a doctor. I was scared, and didn't
| know if I needed immediate treatment or not. Much better
| to err on the side of assuming I do.
|
| Insurance did try to deny coverage, but fortunately I
| appealed and won.
| jajko wrote:
| The sum is not a problem per se, the costs would be similar
| in many developed countries. Specialists can and do charge a
| lot (or hospital that employs them).
|
| What matters is who picks up a bill (or challenges hospital
| and negotiates). I see little protection in US between
| patients and healthcare corporations, but its true I look
| from afar.
| gotbeans wrote:
| 26k for an mri /w contrast last week because insurance
| decided it's not necessary despite the doctor asking for it.
|
| Now the doctor has to put an appeal to explain medical
| necessity, I'm at his mercy.
| arealaccount wrote:
| Is insurance the villain on this one of the hospital
| charging insurance 26k for an MRI?
| alistairSH wrote:
| Possibly all of the above.
|
| An MRI shouldn't cost $26k, even with contrast, and at a
| hospital.
|
| If this was non-emergency, it should have been pre-
| cleared with insurance per their policy.
| lostlogin wrote:
| I'm an MR tech.
|
| You could fly to New Zealand, have a scan on a state of
| the art machine, get a good report, have 3 weeks holiday
| and fly home. You'd have heaps of money left over.
| Arrath wrote:
| I was in a multiple rollover accident and wanted to get a
| scan because, well, I was hanging upside down by my seatbelt
| for a while so I thought it would be prudent to make sure my
| neck or something didn't get fucked up.
|
| The ambulance ride alone from the accident site to the
| hospital (like, 5 miles) was several thousand dollars.
| bachmeier wrote:
| Back in 2020, my son needed a Covid test for some event related
| to school. We called his doctor's office and made an
| appointment for the test. We showed up for the appointment, and
| we had to wait an extra 20 minutes because the doctor was late,
| only to be told "we don't do that testing". Then got a bill for
| $100 for a doctor's appointment.
| anon-sre-srm wrote:
| Change doctors. Don't reward abuse or failure.
| Libcat99 wrote:
| I'd go further and not pay the bill, document why (failed
| to provide the agreed service?) and send them a notice of
| it. At least.
|
| It's effectively a scam, don't give in to scammers.
| ToucanLoucan wrote:
| I went for a covid and strep test during the tail end of the
| pandemic, and happened to pick the closest clinic, cuz you
| know, I felt like shit and didn't want to go far. This costed
| me $240, which seemed slightly fucking insane, so I called.
| Because the place was understaffed, I had to be seen by a
| doctor instead of a nurse, which for added fun was an _out of
| network doctor._ I didn 't even _KNOW_ he was a doctor at
| all, and never bothered to check the network status of the
| clinic because, again, _it was a fucking covid and strep
| test._ The strep test costed me about $20, the covid test was
| free, and the doctor who spent about 60 seconds reading me
| the results on the page was $220.
|
| Fucking. Ridiculous.
| Gibbon1 wrote:
| I think we need to go back to having Nurse Practitioners at
| schools.
| AlienRobot wrote:
| In my country (Brazil) it's illegal for doctors to require an
| appointment just to give a prescription. I see them doing it
| all the time anyway. It's sad.
| bilater wrote:
| The whole prescription business is such a grift. Doctors
| deliberately give you max 2 years of a prescription that you
| know you will need for longer (such as allergy meds, eye
| prescriptions) and then you have to waste your time and spend
| money just to renew it.
| gnicholas wrote:
| Is this part of the reason those online pharmacy platforms
| (which include a doctor who will do a very quick
| exam/diagnosis) took off in recent years? I mostly heard
| about them with regard to ADHD meds but wonder if they are
| also useful because they don't require you to have checkups
| all the time for maintenance medication.
| sithadmin wrote:
| Most of those platforms seem to require the patient to pay
| for a virtual visit for every refill, or require some kind
| of a monthly fee.
| Someone1234 wrote:
| That is accurate. But those virtual visits are 50%
| cheaper than full telemedicine visits and 70% cheaper
| than in-person renews.
|
| It should be noted their virtual visits are mostly
| performative. You're filling in a survey beforehand and
| the doctor is just there to read the survey and push a
| big green button.
| gnicholas wrote:
| How long do the refills last? I would think that even
| with the cheaper cost of medicine, and the discounted
| telemedicine visit, it would still be more expensive than
| seeing a doctor annually and getting refills for all
| prescriptions for the rest of the year without needing
| additional appointments. But perhaps I'm underestimating
| how cheap these platforms are (both the meds and the
| docs)?
| Someone1234 wrote:
| They aren't that cheap. But when your doctors appointment
| is $120+/each, they don't need to be that cheap, just
| cheaper. They're like 20% cheaper all-in compared to the
| traditional way, and you don't need to leave the house.
|
| Plus many of these places specialize in stigmatized
| products like anti-bolding, ED meds, anti-depressants,
| etc.
| Bluecobra wrote:
| Agreed. I have been on the same generic blood pressure
| medication for ~15 years now. I was recently on a vacation in
| Mexico and surprised to see that you can just buy it off the
| shelf there. That being said my healthcare plan includes a
| free yearly checkup with my doctor so it's kind of nice to
| have a yearly baseline of bloodwork/labs and be able to see
| it my patient portal.
| godsfshrmn wrote:
| Many (most) antihypertensives need periodic monitoring for
| electrolytes or kidney function. In Mexico, they are not
| going to get sued if you go into renal failure as compared
| to the US. Partly done for you and partly because of the
| sorry tort system in the US
| tzs wrote:
| When I need a prescription refilled I request a refill from
| the pharmacy. If the prescription has expired the pharmacy
| calls or faxes my doctor's office and they send a new
| prescription to the pharmacy. There is no charge for this.
|
| I've only ever had doctors that worked that way so didn't
| even know that there were some that did not.
|
| I now wonder which is more common, and if there is some way
| to tell beforehand when choosing a new doctor which kind they
| are?
| JTbane wrote:
| Call me old-fashioned but I really hate the idea of
| telemedicine.
| gnicholas wrote:
| It can be good for some things, and is more convenient to
| schedule (don't have to drive there, no risk of getting sick
| from other patients). Plus, there's a chance that in the
| future it could enable people in HCoL areas to get medical
| care from providers in LCoL areas, which would lower costs
| dramatically. I think for now the state-by-state cartel is
| still quite strong though.
|
| But I agree that for some appointments it obviously doesn't
| work because you can't examine the patient or take vitals the
| same way/at all.
| Libcat99 wrote:
| My son takes ADHD meds and it would be great if we could do
| the med checks (which are almost entirely questions for the
| parents) remotely, instead of taking him out of school and
| one of us out of work for several hours.
| Someone1234 wrote:
| It is a mixed bag.
|
| For certain things, like common illnesses, it is pretty good.
|
| But that being said, use caution. I had something minor turn
| into an ER visit because I used telemedicine instead of going
| to my GP. Telemedicine prescribed antibiotics, which was
| correct, but GP would have done a drain too. Lack of drainage
| caused uhh unpleasant problems down the road.
| dghlsakjg wrote:
| Totally context dependent.
|
| Call me new-fashioned, but I don't want to spend a few hours
| of a workday several times per year to see a doctor for less
| than 5 minutes for prescription refill for a drug that I have
| been taking for years.
|
| Why in the world would either of us need to see each-other in
| person when he can ask me the same 3 questions he always does
| over the phone?
| symlinkk wrote:
| It sounds like you shouldn't need to meet with him at all.
| Johnny555 wrote:
| I love it -- I have an annual blood test to check on a
| condition, after the blood test results come in, it's
| followed up with a doctor appointment to discuss. It's so
| convenient to be able to Zoom in for a 5 minute visit instead
| of driving 30 minutes away to the doctor's office and waiting
| 30 minutes to see him for that 5 minute visit.
| stuckindoors wrote:
| Just go to Mexico or an online pharmacy and get your meds at
| cost. /s
|
| The US healthcare system is completely broken. Hospital systems
| and doctors offices in general lost a shit ton of money last
| year. There has been massive layoffs throughout this sector.
| There will continue to be this year. This year they all are
| going to try to survive by recouping their prior losses. Get
| ready for more fees.
|
| In addition - there is consolidation in the physicians groups.
| Mom and pop groups are almost unfeasible at this point. Look
| for venture capitalists to scoop in. Guess what - you won't
| have better care with after those changes - I can promise that.
|
| Lastly, the pharmaceutical industry is out of control. They
| hike prices on any and all medications that they are able to.
| They recently hiked flovent to a cost that no insurance
| companies or hospital will pay for it. There are limited
| alternatives at least for kids. This is medications that that
| has been out since the mid 80s. It is a controlled market, with
| high barriers to entry - you can either permit a wide west time
| of pharmaceutical environment or you can understand the need
| for a regulated marketplace and meet with with equivalent
| regulation in terms of pricing.
|
| Finally the insurance companies are the worst. I don't know
| anyone with a good experience...the only ones that have a
| positive experience are those that don't use it. I try not to
| hate any single group but I hate insurance companies.
|
| The system needs to be burned to the ground. It is fragmented
| and burdensome for healthcare providers and for patients. It
| benefits no one at this point. It creates additional workload
| for providers hospitals and patients alike.
|
| I am afraid of what will come in it's place but can't we worse
| that this shit.
| wolverine876 wrote:
| > Hospital systems and doctors offices in general lost a shit
| ton of money last year.
|
| It costs 2-3x of healthcare in equivalent countries, with
| worse results. Where is that money going?
|
| > In addition - there is consolidation in the physicians
| groups. Mom and pop groups are almost unfeasible at this
| point. Look for venture capitalists to scoop in.
|
| Private equity already has, from what I've read.
| ktosobcy wrote:
| Uhm... in Poland there are usually "refill forms" at your
| chosen / doctors office, you fill it out, drop at the reception
| and then you get prescription code via sms with which you can
| claim it at any pharmacy (that has the drug)
| betaby wrote:
| Won't work in USA or Canada. Won't somebody think of poor
| doctors making 300k+ annually? Won't somebody think about
| insurance companies? It's all GDP after all!
| bdunks wrote:
| Only 10% of the increase in medical cost in the US is
| attributable to doctor salaries. The remainder is
| administrative overhead, Rx costs, insurance
| administration, etc.
|
| There are now 10 administrators for every 1 doctor.
|
| Since 1970, the number of physicians has increased by 2x.
| The number of administrative staff has increased by 38x.
|
| If each administrator is making 100k+ - 150k+, that's
| significant cost.
|
| Some of these crazy billing practices are due to the
| private equity buy-ups and consolidation, creating
| workflows and fee structures that are hostile to patients
| and doctors, but benefit the PE firms.
|
| https://www.commonwealthfund.org/publications/issue-
| briefs/2...
|
| Lots more data here: https://www.healthsystemtracker.org/
| Eric_WVGG wrote:
| That kind of lazy thinking drives me up the wall. There's
| a huge swatch of America that thinks elementary school
| teachers are bringing home FAT BUCKS because college
| tuition costs are high.
|
| It's the corporations, stupid.
| bdunks wrote:
| Absolutely. I used the number of administrative personal
| * administrative salaries because it's a quick mental
| visualization. I just reviewed United Healthcare's 2022
| 10k. In 2022, they had $324B in revenue, and paid $210B
| in medical expenses. Of the $114B remaining, $85.5B was
| various operating costs, $28.5B (25%) was corporate
| profit / operating income (before interest & taxes). Even
| if all 40,000 employees of UnitedHealth Group were making
| 200k (they're not), that'd only account for $8B of their
| $85.5B in non-medical costs. https://www.unitedhealthgrou
| p.com/content/dam/UHG/PDF/invest...
| ktosobcy wrote:
| Well, we also do have an overhead here and doctors usually
| make way more than the average person but still majority of
| the doctors work in public sector. It's not completely rosy
| though - the biggest downside is that quite often you have
| to wait quite long to visit a specialist, especially if
| it's any good (our previous government said "let them
| leave" so lots of medical stuff just migrated to the
| west...) but hopefully with the increase of spending on
| health (we are around 6% of gdp...) things will improve.
| ClarityJones wrote:
| Prescriptions should not be required.
| twobitshifter wrote:
| Had an eye doctor set up a follow visit appointment for my
| wife. We went for the follow up and he said "I don't know why
| i'm seeing you for this" said it looked fine and then asked us
| to come back again in a month.
| QuantumGood wrote:
| One Medical charges $9/month (through Amazon), all video visits
| are free (if you click the proper link), and I've had multiple
| prescriptions renewed that way. Three times waited less than a
| minute, longest wait was 15 minutes, and the app will call you
| back if you wish so you don't have to keep the app open.
| CoffeeOnWrite wrote:
| +1. They also will write new prescription for low-risk
| things. And you don't necessarily need video, they do it over
| messages and just ask for photos of symptoms, in some cases.
| kettro wrote:
| My company pays for One Medical, and it's honestly the best
| practice I've been to in the US. I can typically get an
| appointment the next day, there are tons of offices (in SF),
| and everyone is kind and efficient.
|
| They ask you to set a primary care doctor, but I have had
| more success with seeing a small group of their more
| available non-MD physicians.
| gnicholas wrote:
| What is a non-MD physician? Is that a physician assistant?
| derbOac wrote:
| This is why I think US medicine should be deregulated,
| especially licensing laws.
|
| Everything you're describing is screaming monopoly and
| artificial lack of competition.
|
| If providers of class X are too busy to see you, then there's
| plenty of people who could, or you're just going to do it on
| your own. It needs to be more like that.
|
| Obviously there are some limits, but educational pathways could
| be much more diverse, and there are many things that patients
| are capable of accessing on their own or through providers like
| pharmacists.
| gnicholas wrote:
| One easy step is to allow telemedicine visits across state
| lines.
| kelnos wrote:
| Reading a lot of the responses here, I've realized another
| reason why the fight for a better health care system in the US
| goes so poorly. People are so used to the costs and being
| jerked around by the system that they've completely normalized
| it. "Oh, you should have known those symptoms didn't require an
| ER visit; it's your fault you got such a large bill." "Every
| hospital or doctor is going to try to push extra charges like
| that; you have to contest them or just not pay and hope the
| problem goes away; that's just how it is."
|
| Then someone from outside the US says, "that would never happen
| in my country; here's how it works here..." and it's
| immediately assumed there's some sort of huge catch, that
| never, nowhere could a health care system work that well
| without some sort of major trade off or downside.
|
| No! Stop this! A health care system should work _for_ patients,
| not against them! Injured or suddenly-sick people are not in
| the best head space to make rational, informed decisions as to
| what level of care they need in the moment. Even if they were,
| nearly all lack the specific medical training that would always
| allow them make that decision with a comfortable level of
| certainty.
|
| And even if someone _should_ have known better, I just don 't
| get the ire. Why should we put people into tenuous financial
| situations just because they made a mistake in how they sought
| medical care? Medical care! What the hell is wrong with people?
|
| The US health care system is awful, despite having so many
| great and talented doctors, nurses, and staff! Let's get that
| through our heads! We pay so much more than other developed
| countries, for so much less care. And the reason we don't have
| something better is because the right public policy is labeled
| "socialism". This is so exhausting.
| chadash wrote:
| I met with a new accountant yesterday. He told me that if I email
| him and ask if I can expense a lunch and it's a 1 minute answer,
| he's not gonna charge me. But if it's gonna take him a good
| amount of time to respond, then he will. And I think that this is
| completely fair.
|
| I'd expect the same from a doctor. If I am asking a very
| occasional and non-urgent question with a quick answer (e.g., can
| I take my medicine and drink alcohol safely) then yeah, I'll be
| annoyed if I get a $25 fee. But typing out responses to question
| might take my doctor 30 minutes, so it's fair if they charge me,
| so long as I get a good answer in a reasonable timeframe.
|
| Obviously there's exceptions. If it's a brain surgeon who just
| made $25,000 on a single procedure and I have a 15 minute
| followup question, it seems a little nervy to bill me $25 more,
| but not if I'm emailing my kid's pediatrician a picture of a
| rash.
| burkaman wrote:
| Several issues with your analogy:
|
| 1. The accountant will tell you that pricing up front, so you
| can make a decision before you send an email. No doctor in
| America will answer any question about pricing ahead of time.
|
| 2. The vast majority of Americans know precisely when they need
| to pay taxes and roughly how much work they will be, how many
| accounts they're dealing with, what types of questions might
| arise, etc. It is extremely rare for most people to ever have
| an urgent question for an accountant. Healthcare on the other
| hand is inherently unpredictable, and urgent questions are very
| common.
|
| 3. Most people don't have, and never will have, an accountant.
| Every single living human of any age needs at least one doctor,
| and often quite a few.
|
| 4. If you don't like your accountant's pricing, you can easily
| shop around for a different one. You can't do that with a
| doctor (see point 1). You can sort of do it with insurance, but
| that isn't the same thing, can only be done once a year, and
| the options are very limited for most people.
|
| 5. If you don't like dealing with an accountant at all, you can
| just get a normal job and never talk to one again. It's
| entirely within your control. If you don't like dealing with
| doctors, you're out of luck unless you want to die.
| unsupp0rted wrote:
| You've painted a picture in which doctors charge for time. This
| is (or should be) incongruous with what a doctor is for.
|
| Doctors charge for identifying and telling you things non-
| doctors can't, with a high degree of non-harm-doing.
|
| They've already put in the 10,000 hours to know which bolt to
| turn.
| 627467 wrote:
| > occasional
|
| Well, it would be occasional for you to ask questions to your
| doctor, but your doctor wouldn't be just occasionally answering
| questions from their patients
|
| > Non-urgent questions
|
| Imagine everyone sending non-urgent questions... Isn't it even
| more irritating to be receiving non-urgent questions than
| urgent ones if you're a doctor? I guess the doctor could reply
| with a FAQ.
|
| Honestly, this is where I think personal LLMs should come to
| the rescue. Just ask a doctor-sanctioned/fine-tuned LLM for
| trivial questions.
| HumblyTossed wrote:
| I don't mind paying for my Dr's time. If my insurance starts
| doctor blocking by making me chat with an AI first AND charging
| me for that? No, that's not going to be acceptable.
| gnicholas wrote:
| Yeah that wouldn't be a good outcome. How would you feel if the
| doctor were messaging you through a platform that had extensive
| predictive text features, possibly trained on that particular
| doctor's past messages, and allowed her to send a message in 30
| seconds that would have taken 10 minutes to type out? If you
| used that system for years and paid for it happily, would you
| be upset to learn that the doctor was spending so little time?
| buran77 wrote:
| In some countries in Europe, if you have private insurance
| they'll pull off the "call charge" trick as often as they can.
| Need to make or reschedule an appointment? Make a call. Did some
| blood test and need the results? Call to get them. They call you
| to tell you they can't make the appointment and need to
| reschedule? You still get charged. If it's not a call it's a fake
| shot. Fake disinfection charge. And so on. The principle is
| "anything that can be charged, will be charged". The level of
| insurance fraud with this is ridiculous.
| hiddencost wrote:
| I run into a lot of these personal anecdotes when talking about
| fraud, healthcare and privatization. In my experience they tend
| to not be well supported by the numbers.
| smallmancontrov wrote:
| A user named "hiddencost" doubts that privatized healthcare
| follows its incentive to create hidden costs.
|
| _Chef 's kiss._
| buran77 wrote:
| > they tend to not be well supported by the number
|
| Personal opinion or did you ever talk to anyone investigating
| these things?
|
| First of all, the fraud is committed by the patient, they're
| the one submitting the claim to their private insurance
| without validating it. Secondly, it will always be called a
| mistake if you object to it. But nobody does because
| remember, private insurance pays anyway. On top of it once
| you object and have a few arguments with them you may even
| find yourself having difficulties to get an appointment if
| it's a desired doctor with a queue at the door.
|
| There are no numbers because this is not investigated, there
| just aren't resources for this. Nobody with a private
| insurance bothers reporting a $5-10 shot they never received
| and nobody wastes resources to investigate it. I've seen
| attempts to swindle me out of 5 digit sums of EUR that would
| have otherwise been blindly paid by the insurance. I actually
| checked everything, I objected, it was called a system error.
| I have acquaintances who work with the authorities and they
| confirmed that even if you find a pattern it's impossible to
| prove intent, so it never goes further than "we correct the
| mistake for those who report it".
|
| Politician corruption is basically non-existent, and Al
| Capone just didn't pay tax. According to the numbers.
| onlyrealcuzzo wrote:
| Fraud and waste are estimated to be 10% of healthcare costs:
| https://www.justice.gov/archives/jm/criminal-resource-
| manual...
|
| Which is almost ~2% of GDP alone...
|
| 0.1% of credit card payments are fraud: https://www.federalre
| serve.gov/newsevents/pressreleases/othe...
|
| That's a more typical number.
|
| Something is _extremely_ broken with US healthcare.
|
| The interesting thing is that every side seems to be losing.
|
| The winners are certainly not average doctors.
|
| Compared to the size of the market - health insurance is one
| of the worst insurance businesses.
|
| Hospital administration is also not a great business.
| tonymet wrote:
| I worked for a mature healthcare company and much of our
| marketing centered around healthcare provider surveys of doctors
| and nurses. The results were unsettling. Extremely high rates of
| burnout, typically due to administrative overhead. Horrifying
| medical error rates.
|
| Doctors should be compensated for the amount of time to send an
| email. Every other industry is capable of restructuring support
| to satisfy demand. It's up to the healthcare providers to manage
| this channel properly as any other would.
|
| The real question is: what would it take for the healthcare
| industry to restructure itself to actually function?
| pydry wrote:
| >The real question is: what would it take for the healthcare
| industry to restructure itself to actually function?
|
| Strike the words "over 65" from the medicare bill.
| tonymet wrote:
| that's a poor excuse. We can provide much better care for the
| elderly. the bulk of the operating cost growth in the past
| generation has been from administration.
| dragonwriter wrote:
| > Strike the words "over 65" from the medicare bill.
|
| If you mean "universal single-payer", its worth noting that
| Medicare is very much not single payer and striking the
| population restriction for Medicare would not produce
| universal single payer (or even a single comprehensive plan
| for each individual, unless they are opting for privately-
| provided, publicly subsidized main insurance -- otherwise
| hospital [Part A], outpatient [Part B], and prescription drug
| [Part D] are separate insurance systems, and only the first
| two are public.)
|
| Medicare is a particularly complicated implementation of
| partially publicly subsidized private insurance with an
| (incomplete) public option.
| Projectiboga wrote:
| Medicare only covers 80% and the providers are specifically
| prohibited from waiving that copay. Yes we need single payer
| but the Trojan horse of expanding Medicare to lower the age
| incrementally is just PR it is a way for insurers to reduce
| the average age of their insured cohort.
| mherkender wrote:
| Maybe it wouldn't fix everything but I'd like to see a great
| increase on the cap of the number of medical residencies
| supported by the government. The AMA and doctors in general
| shouldn't be artificially limiting the number of doctors.
|
| I'd like to see the other usual suspects addressed too but it
| seems like the doctor shortage is a big part of the problem.
| ejb999 wrote:
| Do you think if there are more doctors, they are going to be
| more willing to provide free services? I don't - doctors want
| to get paid for their services - insurance companies (in
| general) don't pay for doctors to respond to emails - having
| more doctors doesn't solve this problem.
|
| Not saying we don't need more doctors, but seems unrelated to
| to the problem being discussed.
| tonymet wrote:
| i agree this is a big problem. but as long as you have 10+
| admins for every doctor , costs will be through the roof.
| __MatrixMan__ wrote:
| > what would it take for the healthcare industry to restructure
| itself to actually function?
|
| I can't quote it precisely, but here's a gist from The Glass
| Bead Game:
|
| > Intelligence can find its own way, the teacher's job is to
| address stupidity.
|
| Overlooking the crudeness here, I think it's a good idea, and
| translates to medicine. Most of us are not qualified to define
| good care, but we know bad care when we see it.
|
| One example of bad care is when you don't discover how
| expensive a treatment will be until 3 months after it has
| occurred.
|
| Another might be cases where medical professionals are expected
| to work insane long shifts with insufficient sleep time in
| between.
|
| Whatever the examples are, let's make a list of them. Build
| consensus around the worst offenders, and then start revoking
| counts-as-medical-insurance tax status from the insurers who
| fund the bad behavior. If you want pre-tax-medical-insurance
| dollars, you must:
|
| - be able to turn a "what if" treatment scenario into a dollar
| amount in less than 10 minutes
|
| - not have organizations be in-network which create
| unsustainable working conditions for medical personnel
|
| - [other example of bad care goes here]
|
| ...and we add to that list over time. Markets don't do design,
| they do evolution. We have to kill off the ones we don't like
| if we want more of the ones we like.
| tonymet wrote:
| We dont even recognize bad care. People are overweight and
| suffering from chronic disease , but since they are "alive "
| and taking meds we still call that a good outcome
| ejb999 wrote:
| sadly, a lot of patients consider that good care - around
| me, doctors stopped weighing patients, and don't ever
| discuss lifestyle changes or dietary changes (patients by
| and large don't want to hear it) - they just give the
| patients the pills they want to offset the poor lifestyle
| choices.
| medmunds wrote:
| Every time my lawyer replies to my email, it costs me $35. At
| least. That's just for one or two line responses. Anything that
| requires research or (gasp) looping in a partner gets a lot more
| expensive, very quickly. This doctor sounds like a good deal.
| strangattractor wrote:
| $750 dollar office visit for a GP for 20 minutes no procedures
| performed ($2250 per hr) sounds even better. Welcome to US
| healthcare.
| rpearl wrote:
| Typically, when you are talking to a lawyer, you have signed a
| contract, paid a retainer, and have an explicit hourly rate
| negotiated for interactions with that specific firm.
| freeAgent wrote:
| Yeah, and typically when you do the same with a doctor the
| fee you pay has been negotiated with your insurance provider.
| This is no worse than anything else billing-related in
| healthcare.
| BobaFloutist wrote:
| >This is no worse than anything else billing-related in
| healthcare.
|
| I don't think I've ever seen a lower bar.
| freeAgent wrote:
| I agree. Im just saying that this is not uniquely bad or
| unfair in context.
| JustBreath wrote:
| This is a pretty privileged perspective.
|
| There's also quite a difference between the ethics of
| healthcare and legal services.
|
| Most of the time if you need a legal answer from a lawyer who
| charges like that, it's because you know you'll net more money
| from having the answer than it will cost to get a reply.
|
| With healthcare, you're not trying to make money you're just
| trying to live.
| freeAgent wrote:
| There's a lot to unpack here, but in the US healthcare is
| delivered in a fee-for-service model very much like any other
| service you use. Unless and until we change that model, why
| do you expect doctors to give up income they could receive
| from seeing patients in-person in order to read and respond
| to your emails for free?
| ericd wrote:
| It's both much harder and more expensive to become a doctor
| than a lawyer.
|
| And usually I'm paying my lawyer to protect me from risks to
| my financial health, not because I think checking with them
| will make me money. My doctor helps protect me from health
| risks. It's pretty similar. A mess-up in either area could
| easily mess up my life very badly.
| medmunds wrote:
| There are many situations in the ordinary course of life
| where, if not strictly required, an attorney is at least
| strongly advised. Things like immigration, adoption, divorce,
| disputes with your landlord, probate, personal bankruptcy,
| seeking power of attorney for a family member with dementia,
| etc.
|
| You're correct that I'm in the privileged position of being
| able to afford my lawyer. (And my doctor and health insurance
| provider.) I'd just point out that not everything that
| involves a lawyer is about making money.
|
| But you raise a fair point, and I apologize if my somewhat
| flip comment came across as insensitive.
| danielschonfeld wrote:
| Every time the topic gets of healthcare comes up I always wonder
| how many doctors have tried themselves to interact with their own
| clinic (has to be their own)
|
| Trying to do simple things like:
|
| - Setting or getting an appointment.
|
| - Calling to sort out their office's coding error that resulted
| in me getting an erroneous bill
|
| - Trying to get access to their portal or getting results for
| tests transferred in a realiable manner to another doctor's
| office.
|
| I truly think that they would be mortified beyond words and
| wouldn't believe their name is on the sign up front.
| freeAgent wrote:
| Trust me, they are all aware of this. The problem is that, for
| the majority of doctors now, they do not own or control their
| clinics. They are either: 1)employees of the health system or
| 2)partners or employees of a provider's group that essentially
| contracts with the system to provide doctors. The doctors
| themselves have no real control over how their clinics operate
| outside of contractual negotiations.
| avgDev wrote:
| The doctors are just cogs in a machine. The problem is that
| if your compensation is $200k-$1000k why would really want to
| tackle the issue.
|
| Specialists make so much money they can hire a personal
| assistants to handle all the annoying things.
|
| I know several pharmacists, one is highly intelligent and she
| is the only one who wants to get out of the field because
| healthcare in the US is toxic and profit driven.
| freeAgent wrote:
| Yeah, most of the time when patients send emails, they get
| responses from a nurse. At least at my wife's clinic, they
| do not always charge for emails. They only choose to charge
| when an email is asking something non-obvious or for the
| doctor to take some action that requires additional
| work/time outside of just reading and responding to an
| email.
| anon-sre-srm wrote:
| That's the problem. The doctors should form employee owned
| co-ops and be sure profiteering administrators and suits
| aren't the ones running things.
| freeAgent wrote:
| That is basically scenario #2 (which is common), but for
| whatever reason they haven't been very successful at
| pushing back against some of the changes that cause these
| issues. I don't have much insight to offer there since I'm
| not at the negotiating table there.
| BobaFloutist wrote:
| I mean I think the answer is that good doctors _do_ form
| employee-owned co-ops, which are often very successful
| and establish a great deal of trust in their community,
| but then when the time comes for them to retire they very
| understandably cash out and sell to the private
| organizations that proceed to run them for profit first.
|
| I've been playing with the idea for a while that any time
| a company uses its name, it has to disclose its ownership
| (first the company at the top of the chain, then the
| ownership structure of that company). So like for example
| the company name "Gerber" would have to always be coupled
| with "owned by Nestle, a publicly traded company.", and
| "Dave Franklin, a Dentist in your Community You can
| Trust" would have to be coupled with "Owned by Private
| Equity Incorporated, mostly owned by pension funds".
|
| This would make it easier to keep track of if the same
| company is just screwing you over and over again with
| different faces, while still allowing some value to
| remain to brands that are consistently good for
| customers.
| ReallyAnonymous wrote:
| actually, the problem is that Congress continues to LOWER
| physician reimbursement, but RAISE hospital reimbursement.
| When I became a surgeon in 2002, medicare paid $600 for me
| to take out a gallbladder. I had to pay my overhead (50%)
| so my take-home was $300. Today, in 2024, after price
| reductions, medicare pays $600.
|
| That is why I have to be employed. I guarantee that after
| 22 years, office expenditures (rent, salaries, supplies,
| health insurance) would eat up the remaining $300. So
| taking care of Medicare patients would be charity. Medicare
| is 60% of my practice. Private insurance is 25%. Medicaid
| is 10% and unfunded is 5%.
| chromatin wrote:
| Well, despite that physician-owned hospitals have better
| outcomes than profit-above-all-else hospitals run by MBAs,
| Congress outlawed future physician-owned hospitals in the
| Affordable Care Act (Obamacare).
| ttymck wrote:
| The problem is that they do not care, and they are not
| incentivized to care.
| freeAgent wrote:
| My wife is a PCP and she does care and is endlessly
| frustrated by the BS. There's just not anything she can do
| about it.
| NegativeK wrote:
| > I truly think that they would be mortified beyond words
|
| My primary knows and gives me tips for navigating the
| administration of their own (as in, they own it) practice. I
| guarantee they hear quite a bit of griping and moaning from
| patients about phone tree and waiting room delays.
|
| Retaining good admin staff in my area is very difficult, but
| doctors aren't going to close their practices because of it.
| oefrha wrote:
| > Dr. Lauren Oshman, a family physician and associate professor
| at the University of Michigan Medical School, says she initially
| experienced some patient resistance and anger about the prospect
| of being billed for emails.
|
| > Now, she says, patients are typically pleased that they are
| able to get a direct response from her through a portal message.
|
| > "They're thrilled when they get me directly," she says.
|
| Geez, this could make corporate PR people blush.
| kergonath wrote:
| > Geez, this could make corporate PR people blush.
|
| Yeah, it's embarrassing. I am not "thrilled" to talk to a
| doctor directly. I pay for it, and when I do it's because I
| have a reason to, which kind of limits the thrilling aspect. I
| expect it, and I need it, sure. But it's _not_ being able to
| talk to my doctor that elicits an emotional response, and it
| tends to be anger.
| skzv wrote:
| I'm thrilled to be able to message a doctor, even if I have
| to pay for it.
|
| In Canada I had no such option.
| qudat wrote:
| Hmm. I'm not sure if this is just a difference between
| private practice and hospitals, but there is a ton of
| questions that can and should be serviced by non-physicians
| (e.g. RNAs, nurse practitioners, physician assistants). Their
| role in patient care is consistently growing in importance.
| It's rare for me to send a message through a patient portal
| and have a physician answer it. It's always someone on the
| staff.
| ellisv wrote:
| It's ironic because I almost never want to message my doctor -
| there just simply isn't another option.
|
| In the Michigan Medicine system the 3 main message options are:
| refill a medication, ask a medical question, and ask a billing
| question. If you select "ask a medical question" the next and
| final choice is whether you're submitting a question in English
| or Spanish.
|
| Most often I want to ask a scheduler (because each
| office/department schedules differently) or a nurse a question,
| but for that you have to call. Something as simple as
| scheduling a flu or covid shot can't be done via messaging.
| annoyingnoob wrote:
| You think that is bad. Try working with an attorney, they charge
| you to read your email and not respond at all.
| mindslight wrote:
| That's nicer than my experience! My attorney charged me to
| respond to my emails without reading them. And when the
| relationship inevitably ran aground at the 11th hour, he
| feigned ignorance of everything I had been telling him. I do my
| own low-pressure legal work now.
| D13Fd wrote:
| I honestly think we'd be better off if doctors and nurses
| charged for their time like the good lawyers and paralegals
| due.
|
| No fixed fees. No per-visit charges. Just bill for the time
| spent (including pre- and post-visit paperwork) and the direct
| expenses actually incurred. Everything else is built into the
| hourly rate.
|
| It will never happen, but it would be much better.
| otterley wrote:
| Did you ask for a refund of those billings? If they refuse, you
| should report them to the State Bar if they're doing that. It's
| unethical to charge for services not rendered.
| annoyingnoob wrote:
| https://www.avvo.com/legal-answers/can-a-attorney-charge-
| for...
|
| https://lawstuffexplained.com/can-a-lawyer-charge-you-for-
| em...
| moal wrote:
| Doctor-patient written communications (email, whatsapp whatever)
| can put doctors in legal risk whether they answer or not.
| Answering in a meaningful way also takes from the physician's
| time, much of it during their after-hours. The clinic where I
| practice requires making a telephone number and email available
| to patients. A lot of patients might use them sensibly but some
| patients just abuse this. If it were up to me, I would also put a
| cost on each form of communication as if it were a visit to the
| office!
| throwaway2016a wrote:
| I think the ridiculous thing here is not the doctor charging but
| that all insurance doesn't cover it.
|
| I bet there are a ton of consultants and lawyers (and maybe some
| accountants) on HN and most of them will charge you for time
| spent replying to emails.
|
| Edit: inserted the word "all" before insurance to clarify my
| intent.
| gnicholas wrote:
| from TFA:
|
| > _Health plans covered the full cost of about 82% of claims,
| according to the Peterson-KFF analysis. Patients who shared the
| cost paid $25 on average._
|
| I would be very curious to know if my insurance is paying for
| the useless messages that my doctor's office sends. I sure hope
| not -- they are next to worthless!
| throwaway2016a wrote:
| Regardless of if you feel they are worthless, IMO, the people
| who create them should not be asked to work for free. I've
| never found the notes from mine to be "worthless", you may
| want to find a new doctor.
|
| Also, your TFA is kind of unnecessarily vulgar (You do know
| what the F in TFA is for?) here seeing as it doesn't change
| the point of my original comment. I did, however, add the
| word "all" incase someone took my comment to read that I
| didn't think any insurance covered it.
| gnicholas wrote:
| > _I 've never found the notes from mine to be "worthless",
| you may want to find a new doctor._
|
| Thanks for the thought, but unfortunately our whole system
| (Stanford Health Care, FWIW) is like this. My doctor is
| better than my kids' doctor, and my wife's doctor. The
| incentives are just not there for them to engage, so mostly
| I get nurse messages that are useless. It appears to be a
| copy/paste from google (or some internal system),
| basically.
|
| As for "TFA", I do know what it means and see it used here
| regularly [1] and without meaning anything harsh. It's not
| like some people say "TA" and some people say "TFA". It's
| just TFA. Regardless, I didn't meant to offend you or make
| it seem like I was demeaning you. I was just pointing out
| that the article addressed your complaint, and indicated
| that the vast majority of insurance plans don't leave the
| cost up to the patient. I nonetheless appreciate your
| feedback and will consider "TFA" more carefully in the
| future. If you have any equally pithy alternatives, I would
| welcome them!
|
| 1: https://hn.algolia.com/?q=tfa
| throwaway2016a wrote:
| Maybe there would be an incentive for them to engage if
| they were getting paid for it... granted there would also
| need to be an incentive for them to not abuse it. But
| that's already an issue, for example: I had a dentist who
| would routinely recommend procedures I didn't need.
|
| I know a few primary care doctors and they are all
| overworked and overbooked. I can't imagine any of them
| going above an beyond unfortunately (not because they
| don't want to but because they don't have the time). But
| most of the one's I know hate the system too.
|
| I appreciate the clarification on tone. As a dev I read
| TFA in the same time as RTFM (as in: why didn't you read
| the article you moron?). But I get your usage as well.
| dml2135 wrote:
| I would think that there are very few scenarios where an email
| isn't cheaper than the alternative.
|
| I would guess that fully covering patient emails would save
| insurance companies money in the long run, but why do that when
| you can boost short-term profits?
| david422 wrote:
| There's a really interesting clip in the documentary "What The
| Health" where the interviewer attempts an interview with one of
| the doctors and gets rejected by the hospital PR person:
| Transcript: actually i understand that doctor said that you
| could film here today but 51:04 unfortunately that's
| not going to be able to happen i know that he advocates for
| patients changing their diets but the 51:10 hospital
| makes money off these surgeries and the reality is he does too so
| we can't do anything that's gonna 51:16 negatively
| impact the hospital so unfortunately you're not gonna be able to
| film here today
|
| https://youtu.be/obx7cJtk3fE?t=3064
| ericd wrote:
| A 15 minute email from my lawyer costs about $150, I don't see
| why we should be outraged about $25? It's much harder and more
| expensive to become a doctor.
| adolph wrote:
| Lawyers did pricing better than doctors. Medicine hid costs
| through a payment plan lumped in with hazard insurance. Now
| that the game of hide the money has played out, people see real
| costs and they act shocked.
| onlyrealcuzzo wrote:
| > A 15 minute email from my lawyer costs about $150
|
| Unless your lawyer is an equity partner, he's not getting much
| of that $150.
|
| In the US, the median doctor makes almost 75% more than the
| median lawyer...
| ericd wrote:
| Yeah, they're a partner. I can believe your stat for
| specialists, but not for the general practitioners you're
| most likely to be emailing.
| D13Fd wrote:
| Honestly, I wish I could pay my doctor $25 after insurance and
| get a prompt response from him to an e-mail. That would be
| incredible.
|
| As things stand, I have to call. He doesn't take e-mails. If I
| have a quick question, I can schedule a virtual appointment.
| There is usually a 2-3 month wait. The appointment is scheduled
| for a day, not a time, and is limited to 15 minutes. They'll let
| me know the time about 30 minutes in advance, and it could be any
| time of day. If I miss or can't make the video call, it's usually
| another 2-3 months before he has availability again. There are no
| other doctors with the relevant specialty nearby, so this is what
| I get.
| BenFranklin100 wrote:
| People talk a lot about prescription drugs, but the real driver
| of costs are the hospitals, both public and private. Drugs
| account for 10-15% of total healthcare spending; it's the
| hospital reimbursement & compensation framework along with
| private insurance that is driving the bulk of costs. It's evolved
| into a patchwork, opaque, dysfunctional system where the end
| consumer has little view into the inner workings and is left
| staring at a massive bill.
| Workaccount2 wrote:
| "Non-Profit" hospitals with incredibly bloated administrations
| paying a CEO $10MM a year to order constant hospital expansions
| and ever growing outpatient care so they can reliably spend off
| any possible profits.
| Buttons840 wrote:
| Last I checked about 15 to 20 percent of all US workers were in
| the health industry. It's basically a patriotic duty to pay
| your medical bill, because you have to pay all the insurance
| industry workers, and all the hospital administrators and CEOs,
| and all these people, and there might even be a few bucks left
| over for the doctor in the end. I don't see how healthcare can
| ever cost less until we simplify these systems and eliminate a
| lot of jobs (which wont be politically popular).
| otterley wrote:
| > Drugs account for 10-15% of total healthcare spending
|
| And still, drugs are too expensive in the USA, especially old
| drugs like insulin and albuterol (asthma inhalant) that seem to
| find new ways of being re-patented (e.g., through new delivery
| devices that are just novel enough to be granted a patent, but
| provide no significant improvement to the patient).
|
| If drugs, pricey as they are in the USA, are only 10-15% of
| healthcare spending, that should frighten you as to how cost-
| inefficient our health care system is.
| throwaway118899 wrote:
| I'm at the point now where I blame American doctors just as much
| as the industrial health insurance complex. They're complicit in
| its assholery.
| ilrwbwrkhv wrote:
| Most doctors are pretty dumb and can be replaced with a LLM soon.
| Waiting for that to happen.
| thaddeusmt wrote:
| My spouse is a physician, and "patient messages" (aka "non-face-
| to-face" encounters) usually aren't reimbursed by insurance.
| Having a friendly online conversation with a patient doesn't
| generate the "RVUs" they need (contractually!), so time spent
| messaging is time taken out of their personal day on top of their
| regular workload.
|
| Responding to messages can also just be very difficult and time
| consuming. Maybe you ask concise, clear, pertinent messages to
| your doctor (or think you do!), but most do not. It's similar to
| problems HN readers might be more familiar with: user-created
| support tickets, and comment moderation. Medical office staff
| help with this triage and moderation, but it has become a big
| problem to manage with how easy it now is for bored/sick/scared
| patients to send messages.
| ultra_nick wrote:
| Same, my wife works a 10 hour day, comes home, gets yelled at
| by neurotic patients for an hour, then does paperwork for
| another hour.
|
| We're not even making money yet due to student loans. Sucks.
| codemac wrote:
| If my actual doctor responded to my messages within some SLA (2
| days?) then I'm more than happy to pay much more.
|
| Now a days what happens is I send a message with photos or many
| details, and some poor nurse who is assigned message triage is
| going through many and responds with generic pointless text for
| my issue.
|
| Then I get charged $15.
| matsemann wrote:
| I agree that charging a fee can be fine. For me it's often a
| win-win. I spend less time having to go there, and the doctor
| can spend less time than an in-person visit and even do it on
| some down-time. But it's still a service, so paying about same
| as a regular doctor visit (about ~$20 or so here in Norway) is
| fine.
|
| My biggest gripe here is that if the doctor answers me outside
| office hours, an additional "emergency / inconvenience fee" is
| added. Like, I can't control when you answer, and I didn't
| choose it. If I send in something during daytime and you didn't
| get to it, answer me the next day, then. Or make it a choice
| that I want a prioritized answer so at least I decide. It's
| just bonkers.
| Aeolun wrote:
| So the doctors only respond late in the evening for all that
| free extra cash?
| thayne wrote:
| > about same as a regular doctor visit (about ~$20 or so here
| in Norway)
|
| In the US, a regular doctor's visit can cost hundreds of
| dollars.
| qudat wrote:
| My wife works at an academic hospital and bills for messages
| sent through the portal. If it hasn't arrived yet, it will.
| Patient care specialists (nurses, physicians, etc.) are
| spending a ton of time everyday responding to patient "text"
| messages.
| NegativeK wrote:
| A friend is a vet and frequently rolls their eyes when I
| mention that I'm going into a doctor's office to review lab
| results. But in that meatspace discussion, we talked about
| dietary changes, upcoming medications and potential
| interactions, how my primary should get some records from
| another doctor, and I was able to ask about if an elective
| medical procedure was advisable, given my medical history. It
| was easily 20 minutes of relaxed discussion about an actual
| medical plan.
|
| If it was three minutes of "these are your lab results; you
| should/shouldn't come in for a follow-up," I'd agree that it
| should be a phone call that's covered under the cost of the
| original appointment. But given that vet friend is constantly
| pressed for time and doesn't get to bill separately for those
| callbacks, I can't imagine why my primary doctor would want
| to do the same.
|
| I don't want medical professionals responsible for my care to
| squeeze things in when they have time. Insurance is likely to
| be even more of a pain in the ass, and cramming in tasks
| because they're unpaid means lower quality of care.
| antisthenes wrote:
| American health care is basically about 550,000 parasites in the
| US economy ensuring their own stream of income by denying people
| health care and price gouging those who can afford it.
|
| The culmination of the American middle-man capitalism.
| balderdash wrote:
| $39 a each message seems expensive - but I don't think $39 per
| thread/conversation is unreasonable with the actual doctor (would
| not pay not that for staff).
|
| I'm making up numbers but if a private practice physician earns
| $250k/year for 2000 hours that's $125/hr + taxes and benefits +
| rent/overhead + nursing and staff, you figure that cost is
| probably closer to $300/hr then you you assume they have to do
| ~30min of prep/admin for every patient hour that's closer to
| $450/hr that's ~$37.5 per 5 min of patient time (and none of that
| is factoring in reimbursement rates), people can disagree as to
| how those costs should be borne but let's not kid ourselves as to
| what the cost of doctors time is...
| chriskanan wrote:
| This could potentially increase the number of useful questions
| being asked. My spouse is a physician. Recently she had to answer
| a phone call from a patient in the middle of the night where they
| were asking a question from a party about something non-urgent
| for their child. In another case, she got called by a parent at
| 2am because their kid was having trouble sleeping but nothing
| else was wrong with them (welcome to parenthood). If people had
| to pay, maybe they would _think_ before asking questions.
|
| I've been in meetings with healthcare providers about
| incorporating LLMs into text-based patient-physician messaging to
| improve triage and routing. It is just overwhelming for many
| providers. A large percentage are getting burnt out, and much of
| their time is uncompensated.
| Scoundreller wrote:
| Did those patients press "4" for "urgent problems to be
| responded to immediately" or something?
|
| > If people had to pay, maybe they would _think_ before asking
| questions.
|
| Be careful, a lot more people might be calling at 4am because
| they figure it's okay because they're paying for it. At least
| other contractors can give people a "fuck off" quote for work
| they don't want to take, but might be difficult to implement
| that here.
| resoluteteeth wrote:
| I have mixed feelings about this.
|
| On the one hand I don't want doctors to charge for an email
| consultation every time I need a prescription refilled.
|
| On the other hand, maybe insurance companies should encourage
| doctors to do this by paying them (and not charge a copay)
| because it will reduce the need for office visits which will
| probably be cheaper for them overall?
| ejb999 wrote:
| one of the problems is, how can a doctor in good conscience
| continue to renew your prescriptions, if they don't see you and
| re-evaluate the need?
|
| Maybe they put you on 5MG on amlodipine for your moderately-
| high blood pressure 18 months ago, but since then you have put
| on an extra 75lbs and now you have critically high blood
| pressure - lots of liability if they just keep re-prescribing a
| low-dose that doesn't match your current conditions.
|
| Everyone wants the easy path to getting the pills they think
| they need - then there is a bad outcome and some greedy lawyer
| and client come along and want $10Million in damages for the
| poor care they got.
| astraelraen wrote:
| I am a CPA with 20+ years of experience. I laugh at the
| lawyer/accountant/medical analogies, not because they aren't
| true, mostly for people who insinuate medical professionals
| should work for free or are obligated to work for free because
| medical is sacred?
|
| I have no problem telling clients these days, if you don't want
| to pay me for my knowledge/skill/experience, I will go home and
| spend time with my family or doing something I enjoy. My time is
| not yours unless we both agree you will pay for it or I give it
| to you for free out of my own choice. You do not own my time and
| you do not own your medical professional's time either.
|
| PS: To the person who said you can willingly go to the open
| market and find professional "X" somewhere in this thread. Good
| luck. CPAs, lawyers, any professional with experience is in such
| high demand its hilarious. We name our price and chose the
| clients we want to work with these days. I know people in my
| industry from a variety of locations across the US, same problem
| everywhere. If you don't want to pay for experience from any
| professional industry, go ask ChatGPT or spend half your day
| watching Tiktok or Youtube videos, good luck. Not saying it to be
| pompous, it's reality and has been for ~5 years.
| xirdstl wrote:
| If you're in the US, and can afford it, I think direct primary
| care is the way to go.
| Simulacra wrote:
| I guess I'm really lucky, my doctor sends me emails and responds
| to emails, as does his nurses. During Covid my doctor gave me his
| cell phone number to text him if things got worse. If your doctor
| charges money for emails, find another doctor or pay the fee.
| There's plenty of doctors.
| ineedaj0b wrote:
| The hospitals are poorly run. Please hate your hospitals
| management more. Or if you are a good manager, convince some
| friends to run a hospital. Imagine
|
| 10 appointments a day, 30 mins each.
|
| You have to write /everything/ down the patient tells you. You
| often have to go over the 30mins because some patients need it.
| You need to follow up to order extra tests, you need to
| occasionally google something.
|
| You skip lunch often. You need to find time to reply to messages
| from previous patients. Nurses will mess up something or a
| patient will show up late. Want to see patients past 5? The
| nurses have left and you can't legally 'bill' or code the
| appointment without the nurses.
|
| day is over and you review tomorrow's patients. You read through
| their histories. Now you check the messages. There's between 5-45
| a day. You see a lot of patients.
|
| Then you're told that your department isn't bringing in enough
| money. They want you to see 11 patients a day. The reason? They
| didn't bill people correctly. For the past year.
|
| A lot of doctors quit.
| lokar wrote:
| And to get to this we spend far more (as a percentage of GDP)
| then other western nations.
| pseudocomposer wrote:
| It seems like we just need more doctors, no? The AMA is
| notorious for trying to limit the number of new doctors. They
| do that more than much of anything to do with public health.
| lotsofpulp wrote:
| Supposedly, AMA reversed course in 2019:
|
| https://www.ama-assn.org/press-center/press-releases/ama-
| fun...
|
| https://www.openhealthpolicy.com/p/medical-residency-
| slots-c...
|
| But don't know how much is talk versus walk. It is not clear
| to me why only the US Federal Congress can fund residencies.
| Surely, with how much doctors can earn, a private underwriter
| would be willing to finance a residency.
|
| https://www.washingtonian.com/2020/04/13/were-short-on-
| healt...
| screye wrote:
| > trying to
|
| That's an understatement. It is blatant and deliberate.
| danlugo92 wrote:
| Is it greed? Is it all doctos tacitly agreeing to this so
| they can get bigger paychecks?
| whiterknight wrote:
| Yes. They sign up for big salary at hospital where their
| schedule is managed for them.
| whiterknight wrote:
| The problem is doctors are expensive so the management is
| economizing their time.
| wighty wrote:
| > _The nurses have left and you can 't legally 'bill' or code
| the appointment without the nurses._
|
| What? I've never heard this requirement and I cannot think of
| why it would be the case (I'm a PCP). The rest of your comment
| is pretty much the issue as PCP though. I have at least 30
| minutes a day of "out of visit" requests (reviewing documents
| from outside hospital/consults, labs, imaging, other results,
| extra nurse patient triages) in addition to anywhere from 30
| minutes to 2 hours of completing my notes each night.
|
| The payment methods for primary care do not work.
| prirun wrote:
| Another thing happening is that phone calls to book appointments
| are sometimes being charged as televisits. I had service lines on
| one of my insurance EOBs with names of people I didn't recognize
| and the billing description was "phone support", or something
| like that.
|
| Around here, doctors have been mostly forced to work for
| hospitals now, because IMO doctor practices can't afford
| malpractice insurance, clerical staff to deal with all the
| insurance paperwork, computer systems, and computer software
| licenses. There are also huge groups of specialty doctors working
| together to avoid having to work for hospitals. Here it's
| urology, dermatology, and gastroenterology. In my experience
| these doctor group operations are run even worse than the
| hospitals: they have a monopoly on their specialty and know it.
| neilv wrote:
| > _"It just feels a little intimidating when you open the portal
| and the first thing it says is 'be aware, we're going to bill,'"
| she says. "We have to send these messages and we shouldn't have
| to think to ourselves, 'Should I send this?'"_
|
| If the provider _doesn 't_ bill, problems from the patient's
| perspective:
|
| 1. Some patients are reluctant to message when they should,
| because they don't want to impose when they know the provider
| isn't set up to charge. Same "Should I send this?" problem.
|
| 2. Providers end up needing zealous triage/gatekeeping/diverting
| on messages, so more messages might end up handled with more
| generic responses.
|
| 3. Providers might have incentive to shift messages to billable
| nurse calls, just for fiscal sustainability, turning a message
| into phone tag and/or long hold times.
|
| Personally, I'd prefer to pay for good message responses.
| (Initially I assumed I was, but the charges didn't seem to show
| up on the EOBs/bills.) Much like with a lawyer, but maybe priced
| lower than the effective rate for minutes with patient in an in-
| person appointment (since messages do have more async
| flexibility, and lower office overhead).
| e_i_pi_2 wrote:
| My partner has had issues that could be fixed with a few messages
| and the doctor just refused to respond and said they have to wait
| until the next appointment. It begins to feel like malpractice
| when they're refusing to fix simple issues because of billing
| limitations. I think the core issue here is that we're trying to
| make healthcare profitable when it probably shouldn't be. Stuff
| like healthcare, housing, and education _should_ be losing money
| because it's an investment in the population. If you have a
| hospital that's making money that seems like a bad sign
| ToucanLoucan wrote:
| The fact that so many messages in this thread are variations on
| "well this should be covered by insurance" to other stuff like
| "I understand they need to charge" makes me think we will never
| see a proper system of any kind in this country because
| everyone is just too heavily propagandized into thinking
| healthcare just _must be expensive_ and that any attempt to
| have the Government in any way pay for it will quite literally
| destroy the United States, which is of course failing to take
| into account that _insured Amercans_ spend vast, vast amounts
| more than anyone else on the planet while receiving... middle-
| to-low quality care. And that 's just what the _people_ spend,
| the insurance companies when they can be arsed to actually pay
| what they 've agreed to are also paying through the nose for
| every last service and minute of a doctor's time.
|
| The only people actually winning in our health insurance system
| are the shareholders and the executives. Everyone else is being
| left worse off than they'd otherwise be.
|
| TL;DR: The arguments against socialized healthcare make sense
| if you believe healthcare actually costs what American
| providers charge. It doesn't. They just know you have to, you
| know, not die and that they can charge whatever they want for
| that service. That's why it's fundamentally unethical for
| medicine to be a for-profit industry.
| atum47 wrote:
| I believe in the near future we gonna have LLMs answering common
| questions related to medical care.
|
| Not gonna get in the merit of saying if it is ok or not, but I
| believe some already have the capability of answering screening
| questions and even exams results.
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