Doctors Ought To Get Paid However They Choose To See Their Patients

Hans Duvefelt explains the strange world he lives in: He can freeze some warts in less than a minute and send a bill to a patient’s commercial insurance for way more money than if he spent fifteen minutes changing someone’s blood pressure medication.

Why’s this the case? For one, he’s a victim of red tape i.e. governmental market manipulation.

He can also see a Medicaid or Medicare patient for only five minutes or a full forty-five, and, until recently, the payment he received was the same.

He can chat briefly with a patient who comes in for a dressing change done by his nurse, quickly assess the wound and the dressing and then charge for a complete office visit. But he can’t bill a penny for spending a half hour on the phone with a distraught patient who just developed terrible side effects from their new medication.

As a primary care physician he receives copious reports daily — from specialists, emergency rooms, a local Veterans’ clinic and so on. Everybody expects him to go over them meticulously.

A specialist might write “I recommend an angiogram”, and then he has to call his office to check if that means it was ordered, or that he himself needs to order it.

An emergency room doctor orders a CT scan to rule out a blood clot in someone’s lung and gets a verbal reading by the radiologist that there is no clot. But the final CT report, dictated after the emergency room doctor’s shift has ended, suggests a possible small lung cancer.

Now he wonders: “Did anyone at the ER deal with this, or is it up to me to contact the patient and arrange for followup testing?”

All of this takes time, but he can’t bill for it. Meaning that if he wants to keep his lights on while he does this work, he’ll need to book additional appointments.

Most people are aware these days that procedures are reimbursed at a higher rate than “cognitive work”, but many patients are shocked to hear that fee-for-service doctors essentially cannot bill for any work that isn’t done face to face with a patient. This fact, not technophobia, is probably the biggest reason why doctors and patients aren’t emailing, for example.

Of the following three professions, physicians probably have the most confusing payment arrangement: Members of the clergy tend to make a straight salary regardless of how busy they are, lawyers bill for their time whether spent with the client or without, but fee-for-service primary care physicians only get paid if someone is watching them see a patient.

Hans asks, “If a tree falls in the forest, does it still make a noise? If a doctor isn’t face to face with a patient, is he still a doctor? Is he still doctoring?”

Yes, they are definitely doctoring. And yes, they deserve to get paid. But the likelihood is that they won’t under the status quo primary care model.

That means they’ll need to change their situation to one where docs watch over themselves.

We’re paving the way for more doctors to do exactly that. There’s immense subjective value in being able to communicate with our patients freely — via phone, text, skype, Twitter. We’ll even come to your house if you need us to.

Yes, it’s risky. But we’re glad to provide a high quality service, that keeps our lights on, and gives us the power to see patients how they need to be seen, when they need to been, and where they need to be seen.

Can fee-for-service docs really answer ALL THREE of those conditions?