Responses to Comments, Part II
As per "the almighty dollar" comment: Your anger is directed to the wrong party. It is not the doctor who is consumed with the dollar but the greedy insurance companies. As a point, in my office, the 5 major insurance companies that I accept owe me hundreds of thousands of dollars for services rendered. I saw the patient. The patient was treated with compassion and expertise.
Shouldn't your insurance company pay the bill? They often do not and have many tricks to delay payments.
Doctor's offices have bills to pay and malpractice etc. Aren't doctors entitled to get paid by the insurance company on a timely basis especially since you as the patient paid a lot money to THEM for an insurance plan that the doctor is a part of?
As far as the Waiting no More than 30 Minutes in an office comment attached to the "doctors schedule 15 minutes apart to make money comment":
I do not know why you made up 30 minutes, why not 15, why not 45. The reality is that dependent upon the day I can schedule an office day with all intentions of being on time and the first patient comes to me with cancer in the pelvis and I have to discuss complete removal of half of the pelvis. This is not a 15 minute visit and can even be a 1 hour discussion.
The patient traveled 3 hours to see me. Do I tell them to come back? No. Do I discuss them and give them full attention. Yes.
If I scheduled only 2 patients an hour, after this first patient, I am already 30 minutes behind. Following that a child comes in with a fracture that takes an hour to reduce. Now I am starting 1 hour behind. This is not an excuse but reality. You can see how this can happen.
It does bring up the point- are you entitled to be seen in a reasonable amount of time or is it an expectation?
In my practice I NEVER leave a room until ALL questions are answered. In the last year we did a study of my patient hours. The average wait time was longer than your 30 minutes. In all the patient visits, 12 patients left due to the time.
Once they are in the room they get 100% from me for as long as they need. I always apologize to a patient for being late and often tell them exactly why- for example the pelvis tumor. Patients who arrive to the office are told the current wait time and are offered to reschedule if that is too much.
When I get in the room I give them my heart and my soul. That is what they are ENTITLED to in my practice. It has been also what they have learned to EXPECT. Complete attention to their problem. Do I please all the patients? No way.
On the money issue- Neurosurgery doctors pay over $130,000 in malpractice, over $100,000 in rent/supplies, over $250,000 in personnel to support the practice and $50,000 in associated expenses.
United Health Care pays about $80.00 for a visit. Assuming you saw the 10 patients a day that you want them to see that would be $800.00 a day. They do office hours 4 days a week and operate 1. That is $3200.00 a week in office hour billing. In 50 weeks a year that is $160,000 a year. If they do 3 laminectomies (spine operations) a week (which is all they would get at 8 patients a day) all in Medicare and Managed Care they were reimbursement is $2500.00 per operation. This would be at 50 weeks a year $375,000 a year. Added up- gross revenue is $535,000. Expenses are $530,000. This leaves $5,0000 a year as take home salary.
This is based on your assumption that:
The numbers don't add up. Your energy should be at TORT REFORM and INSURANCE REFORM.
Try this idea:
This piggybacks on to looselink's interesting comment:
"I recently met a doctor who told me she was a concierge doctor. She said she got really tired of the 15 minute in and out office visit. she limits her practice to 300 patients per year; all of whom pay her $1200 up front in order to get instant appointments, phone calls returned and even house visits if necessary. I'm not sure how I feel about that! It is a rather elitist concept, but she claims that she is able to provide much better medical care for fewer patients this way."
Is this what people want? Some do. Some do not. Replacing your roof costs $15,000 to $30,000. How much should replacing a hip cost? You tell me.
In answer to meloh's following comment:
"You see, sir, I have been waiting by my loved one's bedside for 10 hours today, hoping you would drop by for a hospital visit which will take you maybe 5 minutes and for which you will be paid $300."
You may have been waiting 10 hours by your family member's bedside. Most probably your doctor has a schedule of when to see the patient. You should find out that schedule. As for the 5 minutes - that is a ridiculous generalization. I have spent between 5 minutes (on a very non-complicated case) to 30 minutes depending on what the patient needs.
As far as the $300.00 for the hospital visit - there is the problem. People like you think that the average doctor is making millions in the practice. Untrue. Average pediatricians make about $120,000 a year. Surprised? Also, for the record, a hospital office visit from Medicare pays approximately $32.00. You should get your facts rights before you make such generalizations.
As per the most disgusted poster, so self-named as "disgusted101":
I will refer to a rheumatologist, neurologist, and often another Orthopaedic Surgeon as I tell the patient, another perspective may help here. If your doctors are not doing that, change doctors. Additionally you seem to think that doctors get paid for compassion. That is not true. They get paid to render a service to help you with your disease.
A good doctor adds to that service compassion and care. That is what separates that doctor as an exceptional one. When I show compassion to my patients it is not because I am getting paid for compassion it is because that is how I practice. There are non-compassionate doctors who have remarkable surgical skill. They too have a role in medicine.
If there is a Neurosurgeon who if the world's best at saving a patient's life who has a bleeding blood vessel in the brain but is not compassionate, this is a valuable person in society. Just as not all teachers have the same total qualities as others and not all in the clergy have the same as their colleagues there will be a wide range of qualities in medicine as well. To expect ALL physicians to be exactly the same is unreasonable.
In conclusion I would like to thank "anonymous":
Keep the discussion coming!
Dr. K.
Related Topics: Does Pain Keep You Up? Test Your Sleep IQ, The Emotional and Economic Costs of Pain
Technorati Tags: healthcare, medicalpractice, entitlement, expectation
Shouldn't your insurance company pay the bill? They often do not and have many tricks to delay payments.
Doctor's offices have bills to pay and malpractice etc. Aren't doctors entitled to get paid by the insurance company on a timely basis especially since you as the patient paid a lot money to THEM for an insurance plan that the doctor is a part of?
As far as the Waiting no More than 30 Minutes in an office comment attached to the "doctors schedule 15 minutes apart to make money comment":
I do not know why you made up 30 minutes, why not 15, why not 45. The reality is that dependent upon the day I can schedule an office day with all intentions of being on time and the first patient comes to me with cancer in the pelvis and I have to discuss complete removal of half of the pelvis. This is not a 15 minute visit and can even be a 1 hour discussion.
The patient traveled 3 hours to see me. Do I tell them to come back? No. Do I discuss them and give them full attention. Yes.
If I scheduled only 2 patients an hour, after this first patient, I am already 30 minutes behind. Following that a child comes in with a fracture that takes an hour to reduce. Now I am starting 1 hour behind. This is not an excuse but reality. You can see how this can happen.
It does bring up the point- are you entitled to be seen in a reasonable amount of time or is it an expectation?
In my practice I NEVER leave a room until ALL questions are answered. In the last year we did a study of my patient hours. The average wait time was longer than your 30 minutes. In all the patient visits, 12 patients left due to the time.
Once they are in the room they get 100% from me for as long as they need. I always apologize to a patient for being late and often tell them exactly why- for example the pelvis tumor. Patients who arrive to the office are told the current wait time and are offered to reschedule if that is too much.
When I get in the room I give them my heart and my soul. That is what they are ENTITLED to in my practice. It has been also what they have learned to EXPECT. Complete attention to their problem. Do I please all the patients? No way.
On the money issue- Neurosurgery doctors pay over $130,000 in malpractice, over $100,000 in rent/supplies, over $250,000 in personnel to support the practice and $50,000 in associated expenses.
United Health Care pays about $80.00 for a visit. Assuming you saw the 10 patients a day that you want them to see that would be $800.00 a day. They do office hours 4 days a week and operate 1. That is $3200.00 a week in office hour billing. In 50 weeks a year that is $160,000 a year. If they do 3 laminectomies (spine operations) a week (which is all they would get at 8 patients a day) all in Medicare and Managed Care they were reimbursement is $2500.00 per operation. This would be at 50 weeks a year $375,000 a year. Added up- gross revenue is $535,000. Expenses are $530,000. This leaves $5,0000 a year as take home salary.
This is based on your assumption that:
- Doctors should see one patient an hour
- Doctors should accept the payment of all healthcare or managed care
The numbers don't add up. Your energy should be at TORT REFORM and INSURANCE REFORM.
Try this idea:
- The government should pay all malpractice insurance premiums if the doctor accepts insurance plans
- The insurance companies charge less money each year for premiums if they make whopping profits the year before.
This piggybacks on to looselink's interesting comment:
"I recently met a doctor who told me she was a concierge doctor. She said she got really tired of the 15 minute in and out office visit. she limits her practice to 300 patients per year; all of whom pay her $1200 up front in order to get instant appointments, phone calls returned and even house visits if necessary. I'm not sure how I feel about that! It is a rather elitist concept, but she claims that she is able to provide much better medical care for fewer patients this way."
Is this what people want? Some do. Some do not. Replacing your roof costs $15,000 to $30,000. How much should replacing a hip cost? You tell me.
In answer to meloh's following comment:
"You see, sir, I have been waiting by my loved one's bedside for 10 hours today, hoping you would drop by for a hospital visit which will take you maybe 5 minutes and for which you will be paid $300."
You may have been waiting 10 hours by your family member's bedside. Most probably your doctor has a schedule of when to see the patient. You should find out that schedule. As for the 5 minutes - that is a ridiculous generalization. I have spent between 5 minutes (on a very non-complicated case) to 30 minutes depending on what the patient needs.
As far as the $300.00 for the hospital visit - there is the problem. People like you think that the average doctor is making millions in the practice. Untrue. Average pediatricians make about $120,000 a year. Surprised? Also, for the record, a hospital office visit from Medicare pays approximately $32.00. You should get your facts rights before you make such generalizations.
As per the most disgusted poster, so self-named as "disgusted101":
Most physicians I know will often tell a patient when appropriate that they SIMPLY HAVE NO IDEA and send out to another physician. I do that whenever it is needed- often 2-3 times a week.
"It would also be nice to hear a physician be HONEST from time to time when they SIMPLY HAVE NO IDEA, then say I HAVE NO IDEA and send us to someone who may be more qualified, HOWEVER doing this shows they arent all they would like us to believe they are.
GET OFF THE HIGH HORSE AND BRING BACK THE COMPASSION THAT YOU ARE BEING PAID FOR is exactly what I would like to tell most physicians."
I will refer to a rheumatologist, neurologist, and often another Orthopaedic Surgeon as I tell the patient, another perspective may help here. If your doctors are not doing that, change doctors. Additionally you seem to think that doctors get paid for compassion. That is not true. They get paid to render a service to help you with your disease.
A good doctor adds to that service compassion and care. That is what separates that doctor as an exceptional one. When I show compassion to my patients it is not because I am getting paid for compassion it is because that is how I practice. There are non-compassionate doctors who have remarkable surgical skill. They too have a role in medicine.
If there is a Neurosurgeon who if the world's best at saving a patient's life who has a bleeding blood vessel in the brain but is not compassionate, this is a valuable person in society. Just as not all teachers have the same total qualities as others and not all in the clergy have the same as their colleagues there will be a wide range of qualities in medicine as well. To expect ALL physicians to be exactly the same is unreasonable.
In conclusion I would like to thank "anonymous":
Though perhaps a little rough around the edges, the doctor's answer strikes me as basically correct. The covenant relationship between doctor and patient entitles the patient to the best care within the doctor's capability and to conscientious and respectful treatment and service. In actual practice, the latter entails that I am I entitled to your conscientious effort to see me on time and to give me your full attention when you do. But it would be madness to insist that my rights are somehow being violated if the reason I am being kept waiting is your conscientious treatment of another patient.
Keep the discussion coming!
Dr. K.
Related Topics: Does Pain Keep You Up? Test Your Sleep IQ, The Emotional and Economic Costs of Pain
Technorati Tags: healthcare, medicalpractice, entitlement, expectation
7 Comments:
"Shouldn't your insurance company pay the bill? They often do not and have many tricks to delay payments."
Yes, they should. I have individual insurance, and I switched insurers because of this. Doctors in my area were dropping out of the first insurers network because of delayed payments. My new insurer, when I've called them and asked, appears to pay within a month of a bill being sent to them.
However, the grand majority of patients to not have the option to switch insurers. It is their employer who chooses the insurer, and employees have no choice in the matter. And even if a patient is unhappy with the insurer, they cannot withhold their premium payments, since these are automatically deducted from their paychecks.
Although it may appear to you that it is the insurers who are greedy, and who choose to play all these payment games, it is in reality the employers who pull the purse strings, since they foot 70-80% of health care costs. It is employers who put pressure on insurers to keep health care costs down, hence the games that insurers play with doctors, and to some extent with patients too, with their arcane rules about copays amounts, referrals forms, coverage exclusions, etc.
You certainly do seem concerned about providing decent care to your patients, more so than most of my doctors. I think that many of the strong comments you saw on the previous thread reflect the experiences of patients like myself, rather than being a critique of how you treat your own patients, since nearly all of us would have no idea of how your run your practice.
Dr. K: I am a regular on the joint board so I have talked to you before. I agree with alot of what you say. I think very much that I would like you for my personal orthopaedic doctor. Believe me, I have enough arthritis to keep you busy for many years to come but alas, I live in Iowa. I also agree with Ren. I personally have Medicare for my primary insurance, and my secondary is through my husband's job. He works for a company that has less than 100 employees. (I've had to explain that a million times). In the state of Minnesota Medicare reimburses the hospital for surgery almost 95%. My secondary insurance pays the rest. But for doctor visits it is the poorest pay I have ever seen. Even I think it stinks. For a visit of $104 they may pay say 48.00 if that. It's pretty bad. And my husbands insurance is employer paid. It is dictated by what the employer wants paid and how. And my husband has to pay $30.00 a week. If you think that's not bad, remember we live in Iowa. He only makes $12.00 an hour. We have a teenager and 5 guinea pigs. I so far doctor pretty much in Minnesota and adore my 64 year old orthopaedic surgeon who is retiring in July. He actually puts his own casts on and removes them (on the patients, give me a break!) and can still run circles around everyone else there but believes in QUALITY Patient Care so figures his time is about up so I'm a little scared about having to develop a whole new relationship with another doctor. That's a thing that takes time and I really don't have it. Oh, well. I'll deal. Anyway, I agree with you Dr. K and I hope insurance reform comes soon for all doctors sakes because there sure are some great ones out there and I for one cannot afford to lose any one of them.
The issue of waiting is symptomatic of what is wrong with the prevailing culture in medicine. Like most doctors, I was trained with the same attitude: the beginning and end of my obligation to the patient was to intend to be on time. Therefore, a patient should not be angry if I wasn't on time.
Intention, though, is not enough. No doctor doubt thats simply intending to cure a patient is acceptable. We recognize that it is our responsibility as physicians to be knowledgeable enough to apply the appropriate techniques, medications, etc. to actually treat and hopefully cure the patient.
Similarly, it is not enough to intend to be on time, if we are not knowledgeable about whether our intentions are realistic. If, in actual practice, a doctor is never on time, he or she is scheduling patient appointments inappropriately.
There is a tendency among doctors to believe that "the system" is the way it is because it has to be that way. However, scheduling is not some sort of willy-nilly process that cannot take into account the realities of a doctor's life. It is possible to look at a practice and figure out just how often each day or week a particular doctor has patients that require more time than originally scheduled and build that time into the appointment schedule.
Just by way of example: if examining a doctor's practice reveals that on average he sees a patient a day with an unanticipated complication that eats up an extra hour, then he can build an extra hour into the schedule when there are no appointments.
Yes, yes, yes, I am aware that this lowers income. However, if a doctor is finishing each and every day 1-2 hours behind, the reality is that he is overscheduling for his benefit and to the detriment of the patients.
The unfortunate fact is that most doctors don't know how long the average patient waits, and if you don't know, you can't fix it.
I realize that doctors get behind schedule and I don't mind waiting in the waiting room. However, I hate having to wait more than 5 or 10 minutes in the exam room for the doctor to come, espcially when waiting for the OB/GYN. I really don't understand why many practices bring patients back to the exam room and then leave the patient waiting in that little room for at least 30 minutes. It can be unbearable. However, I do appreciate it when my doctor stays and answers all my questions.
YES YOUR INSURANCE COMPANY SHOULD PAY THE BILL. You pay the insurance company for a service. They use every trick under the sun to cheat you out of your money and NOT pay the claim. How do I know this? For many many years, I worked at a hospital. I was the one who called all those insurance companies in order to make them pay. Guess who they usually first blamed the non-payment on? YOU - the patient. They would lie and say you hadn't paid your premiums, though there you were in my office, with a receipt. They would lie and say they requested additional information from you, when in fact you received no such request. They would lie and say they requested medical records and did not receive them. I had a signed certified mail slip for those records. The next excuse? Oh well the mail room guy signs those. We don't know what happened to them. No we don't accept faxes. You have to send a new claim and records to our review department. It will take up to 90 days to process and review the claim & records and another 30 to 45 days to issue payment. Meanwhile, six months has already passed and the doctor or hospital still has not received payment, my letters and phone calls and messages have been ignored, the state insurance laws are not enforced. (Although I must say that here in Florida, I have reported several companies to the insurance commissioner and did get results - but I should not have had to lodge so many complaints!!) After waiting 30 days, I call the insurance company to make sure the new set of claims and records arrived (again sent certified mail in spite of "the mail room guy" who apparently eats packages for lunch) - and I'm told the package was received but is in a "hold area". For what? Waiting for medical records. The package IS medical records!!! Oh - well it has to be in the hold area for ten days. WHY? What hold area? Can I have a supervisor please? She's at lunch. ITS 9 AM!!! She's at lunch? Oh I'm sorry she's in a meeting. Call back in 30 days and we might be able to tell you if the claim is in process. CLICK. I'd call back, ask for a supervisor, be given yet another lame excuse until finally I would make enough calls to find out the name of the CEO of the company and bully his secretary into letting me speak with him. The CEO would delegate someone to check into it, sometimes I'd receive a callback only to be told they never received a claim or records at all. The whole process would start all over again.
Doctors are typically the last to get paid for their services. How they manage to pay their staff, their malpractice premiums, their expenses, their additional ongoing education requirements, licensing fees, mortgages, car payments, student loans, child care, and on and on and on - it is beyond me. I have a name for it: Image Rich, Pocket Poor. People expect doctors to look professional, dress sharply, nice office, comfortable chairs and tables, state of the art equipment - but insurance companies are not paying the claims that they owe to the doctor who rendered your care. You are paying the insurance company to NOT pay your doctor while they invest your premiums and make enormous profits.
Insurance companies have more money than Bill Gates. They have it hidden in every nook and cranny available. Regardless of pressure from employers to keep healthcare costs low, insurance companies hold the purse strings. They set the charges, and employers have to pay what they can and pass the rest of the cost on to the employees. Believe me, it IS the insurers who are greedy. Have you seen their profits? No, because they use every loophole available to make it appear that they lose money - they poor-mouth about every car accident, hurricane, illness, etc. All the while, politicians are jingling in the pockets of the insurance companies. Their lobbying power is immeasurable. Don't blame the business owners or the doctors. It is the insurance companies - trust me.
This is going to sound like I'm a "doctor defender," but I'm not. I've had plenty of docors over the span of my life and some have been good and some irresponsible, bordering on incompetant.
I have a GP that I always have to wait for. He can be up to an hour behind (or more). If he is his office generally calls to tell me or will tell me when I get there and let me know I can go run some errands or some such thing. This is a doc I will wait for. He runs late because he sees patients on short notice and doesn't run out to see the next patient but spends the time he needs. Sorry to all you specialists out there, but a good GP is worth more than a specialist any day. A GP is generally a person's "first line of defense" and has to wear many hats. I know my guy won't run me out of his office and he'll talk to me about where I'm at and what I need. He knows I don't like docs much, so he makes referrals, when necessary, to docs he thinks will be good with that.
I'll wait for my GP any day, now the hemotologist I saw recently...both conversations were completely content-free and him I won't see again. That's my choice and I take responsibility for my own medical care. I am knowledgable enough to know when I'm not getting an answer that fits ("You can just stop taking your anticonvulsant," ah, no thanks) and I move on to someone who will point me in a direction to pursue.
I don't know what possesses folks to go into medicine these days. It seems to me that it doesn't pay off for the hours, resources, hassles, expectations, etc. I make more than some doctors and don't have the responsibility and hours involved. There just ain't enough money to go into medicine these days with the litigation, insurance, and personal liability involved. Docs aren't gods and shouldn't be expected (or treated) to be.
I have Meniere's Disease; arthritis; RSD; herniated disks (against the spinal column). My neurologist says surgery. Neurosurgeon says not with RSD. After multitudes of tests, I can't get an appt for a followup. Thanks to Meniere's, arthritis, and spine,I fell, hurt my knee, months ago. That's why the current pain. Nobody listens. What can I do?
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