Why Can’t The Doctor Afford To See You Now?

Imagine this. They asked you to arrive 15 minutes early, which you did, but only to sit there in the waiting room for another 45, totaling an hour of what seems like a lot of wasted time. The nurse finally calls your name, and you follow her to a small room where she offers you a seat. Without looking up, she reviews your medication list and asks if there have been any changes to your medical history. You say no.

She stands abruptly, and informs you the doctor will be right in. Another 20 minutes go by before you hear a rapping at the door signifying the doctor’s on their way. They shake your hand and walk to their desk to turn on the computer. They ask how you’re doing, and as you start to explain the side effects you’re having with a new medication, they interrupt and ask you to wait a minute because of an issue with the computer. You watch as they shut the computer down and wait for it to reboot while you discuss your issues.

As soon as the screen’s back on, the doctor’s fingers move in a blur as they explain that your nausea is a common side effect, and that you’ll be switching to something different. The doctor stands up, shakes your hand again, and says that they’ll see you again in four months. You glance at the clock as you wait for the nurse to bring you a prescription, and realize only five minutes have passed with the doctor in the room. When you get the bill from the insurance company asking for your $100 co-pay, you begin to question if that five minutes was worth the $100, let alone the $500 you spend a month on your insurance premium. Sound familiar?

Systems Gone Haywire

In a traditional doctor’s office, it’s estimated that for every five minutes a doctor spends with a patient, 20 to 25 minutes is spend dealing with the systems to document the appointment and bill for services. Although you may think it’s your doctor’s bad practice that’s caused it, that’s not always the case. It’s the whole healthcare, insurance, and billing system that’s gone completely haywire. Most insurance companies have created a system that’s based on a fee-based service, where the service a doctor provides determines the fee he gains.

While at first glance this system seems to make sense, in the world of healthcare it’s not effective. Prevention is a necessary component of health and wellness, as is the doctor-patient relationship, but a patient may not require specific services. Add to that high co-pays for doctor’s visits and procedures, and many patients start opting out of recommended treatments, simply because they can’t afford them. With prescription medications that cost $1,000 a pill and medical equipment that costs $10,000, it’s no wonder doctors spend just as much time talking about the cost of procedures as they do about their effectiveness.

Thinking Outside the Office

As doctors and medical office staff are spending more time on paperwork and billing than patient care, it’s no wonder so many doctors are starting to break away from the standard American insurance system. Some doctors are using a completely cash-based system, charging patients a flat rate of $50 a visit regardless of the issue and opting out of using insurance companies all together. Other physicians are looking into monthly membership fees, cash based home-based practices, or starting a TeleMed service, where information is shared between doctor and patient over the phone or through an app. These types of programs allow more direct interaction between doctor and patient, and require less of the paperwork and stress that come with insurance companies.

Technology’s Solution

While technological innovations do offer some help, there’s still no solution that puts patients back in the forefront of a doctor’s practice. Even with electronic health record (EHR) systems and software that detect common insurance coding errors, the process is far from perfect. Some doctors end up paying more for back office staff than they pay for staff involved in direct care, needing extra hands to process claims, handle payments, recode and submit rejected or denied claims, bill patients, and turn unpaid accounts into collections.

Hopefully a solution can be created where a patient’s needs determine what he or she receives, not what the insurance covers or what can be afforded. In a world where even doctors’ hands are tied with bureaucratic red tape and people are not getting the medications they need because the insurance company says they don’t need them, something needs to change.