Monday, June 7, 2010

Extra Fees Help Physicians Stay in Practice

I was interested in an article in USA Today about the growing number of physicians, especially primary care doctors, who are boosting their revenues by requiring patients to pay new fees for services that insurance doesn't cover.  No longer is your insurance payment "all-inclusive". These fees can include annual administration fees, no-show fees, medical report fees, and extra fees for email or phone consultations.  If private practice medicine is going to survive, these fees are a necessity.

An article in the NEJM in April, showed how much time physicians spend on activities that receive no compensation at all.  It is not unusual for an Internal Medicine physician to spend an extra 3 hours a day filling out forms, refilling prescriptions, making phone calls on patient's behalf, answering questions from patients and dealing with a myriad of patient related requests.  With overhead running at 65% or above, more and more doctors are leaving practice or burning out.  The ones who can, are joining large hospital sponsored groups where they are subsidized.  These groups know that primary care is a "loss leader" for the more lucrative procedures that insurance and Medicare reimburses.

As a physician who has practiced for over 20 years (yikes!!), I can tell you that the demands of filling out forms for everything from work questions and school physicals to handicapped stickers and travel vouchers, dealing with insurance companies, reviewing tests ordered by other doctors, overseeing and coordinating patient care, talking with pharmacists, filling prescriptions and then redoing the work when a patient switches pharmacies, emailing and countless other tasks that are "FREE" make it near impossible to remain in private practice.

What makes sense for primary care?  Instead of nickle and dimeing patients, there should be an annual administration fee that covers these extras.  Just like your car insurance doesn't cover the oil change, health insurance doesn't cover the tasks physicians perform on your behalf.  How much of an annual fee depends upon the practice.  For most practices $125/year should cover the extras.

I think most would find that a small price to pay to keep their doctor's doors open.


DBenzil said...

Great piece-I am a neurosurgeon and still these "extras" take a big toll-some patients require up to 25 pages of forms to be filled out, some require forms every 4 weeks so even if not medically necessary, they schedule visits! In the past, I just "sucked it all up" but ...the times they are a changing.

CountryMidwife said...

I don't understand all this well, but... I thought it was "illegal" to bill an insured patient anything over and above what their insurance pays?

And, clearly physicians filling out these forms, etc is a waste of time, money, and expertise. Why aren't nurses or NPs doing this? (and the doc just signing them?)

Toni Brayer, MD said...

CountryMidwife: It is not illegal to bill for services that insurance doesn't "cover". That is where it gets tricky...some insurers think their low rates cover everything but they are really just paying for an office visit. Without better reimbursement (or fees) , many physicians can't afford to hire a NP. In my area, the NP earns more than the physician.

I agree that these tasks should be handled by others.

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Jim Purdy said...

As a patient, I find this discussion interesting, and I understand your situation a little better now. Thanks for sharing your perspective.

Jim Purdy
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tracy said...

My Internest has an annual fee, which i gladly pay, i think he deserves waaaay more, he is so wonderful. (Just the kind i dread will become a Hospitalist one day...knock wood).

i pay it every year, whether i see him or not.