If a patient can charge for her time, why can’t the doctor charge for his?

By Brandon Betancourt

Today I came across an article on CNN Health that talked about a woman that billed her doctor for the time he made her wait.

“It’s ludicrous — why would I wait for free?” said the woman that billed her physician. She billed the doctor $100.

I work at a doctor’s office and I think billing the doctor for the time she makes a patient wait is a great idea. But why should we stop with doctors?

Why not bill everybody that wastes our time?

For example, I could bill the IL Tollways for the hours I sit in traffic thanks to their tollbooths. They are huge funnels, thus creating unnecessary traffic jams. Pay for tolls and wait too? Ludicrous.

We could also bill restaurants that tell us it will be 5 to 10 minutes for a table when in fact, it is really 20 minutes before me and my family gets to sit down. You know? Who they think they are? Our time is valuable too.

How about if we bill the movie theaters? Movies don’t start when they say, but rather roll advertising and previews for 20 minutes. I paid to see a movie on time, damn it! By the time the movie begins, I’ve already eaten all my popcorn. That ain’t right!

Oh, and let’s not forget amusement and parks like Disney. Waiting for “It’s a Small World” for over an hour… “pay up Mickey!” My kids’ time is valuable too.

Doctors should be able to get in the game too. How about if doctors charged patients when patients wasted the doctors time with unnecessary questions or for questions that already have been answered, phone calls, filling out forms, sending out pre-authorizations, calling the pharmacy, billing the insurance on the patient’s behalf or waking up in the middle of the night because the patient is not feeling well and can’t wait a couple of hours to be seen in the morning?

How about we do this…

If the patient takes up more than 15 minutes (the patient’s insurance company doesn’t pay for more) we bill by the minute which is paid at the time of service.

One last thing, when doctors run late, it usually isn’t because the doctor was doing something for themselves, but rather because they were doing something for another patient.

Perhaps an even better idea is to have patients like Elaine Farstad (the woman in the CNN story) that want to bill their doctor for the “wasted” time, bill all the other patients the doctor saw before her. Because in fact, they are the reason the doctor was running late for her appointment.

Brandon Betancourt is a practice administrator and blogs regularly at PediatricInc.com

Docs not tech-savvy? Not so fast…

By David Sullo, MD

Electronic medical records (EMRs) are slowly making headway into both hospitals and doctor’s offices.  My office has now been paperless for six years, and there are many benefits.  However, I cringe when I see the mainstream media declaring “if those old-fashioned doctors would just get with the times, medicine could all be electronic!”  There are legitimate reasons why many pediatric offices have not gone electronic, most of which get overlooked in the press.  Here’s a few:

Cost

Yes, these systems are quite expensive.  There is software, computer terminals, a wireless network, antivirus software, several printers, a central server to hold the information, a battery backup for said server in case the power goes out…you get the idea.  Usually we’re talking six figures when all is said and done.

Lack of standards

Right now, each EMR has it’s own way of storing data.  As a result, it is nearly impossible to share data from one system to another.  If a practice buys one system, and is displeased, switching systems means losing data, or printing every chart out of the old record and scanning it into the new system.  As you can imagine, this makes doctors highly apprehensive about buying a system and getting stuck with a lemon.

The outside world

Some local pharmacies still do not e-prescribe.  We are able to access information about a patient’s insurance plan (copays, etc) electronically from some insurers, but not from others.  Summer camps require health information “on their form only,” even though we can print out the same information from our system.  My favorite is the state, which is receiving federal funds to encourage EMR adoption, and then decides that things must also be “on their form only!”

Skewed incentives

The federal government has allocated funds to partially reimburse offices which have gone paperless.  However, the criteria to receive these funds are heavily weighted against pediatricians.  An office is required to have a certain percentage of Medicaid patients, of which most pediatric offices fall short.  Even if they qualify, they are still only eligible for 2/3 of the money that an internal medicine office would receive through Medicare for the same program.  So pediatrics, which is the lowest paid medical specialty, also gets the least help in subsidizing purchase of an EMR.I hope it is clearer now why doctors, and pediatricians in particular, might be slow to adopt this new technology.  Rather than aggressively pushing adoption of an imperfect system, we should improve the system until incentives are not needed.  In my next post, I’ll talk about a few basic fixes that could achieve this.

Dr. Sullo is a board-certified pediatrician and a Fellow of the American Academy of Pediatrics. He is a practicing pediatrician in Rochester, New York