Why your doctor won't talk to you on the phone

To quote from the NY Times:

Nationally, Medicare and commercial insurers pay an average of only about $60 a visit to the office of a primary-care doctor and rarely if ever pay for telephone or e-mail consultations.

That’s the reason your doctor won’t deal with you on the telephone. For the same amount of time talking to you in his office, he gets paid $60.

The "no phone consultation" policy is incredibly inefficient. Doctors are the only service providers who won't talk to you on the phone. The rest of the world has discovered that telephone conversations are a lot less time-consuming than arranging face-to-face meetings.

This is also an example of how healthcare is not a free market. This pricing policy is set by Medicare (the government), and all of the insurers (an oligopoly) follow suit. The system gives doctors and their patients no freedom to agree upon a reasonable fee for telephone consultations.

Comments

[Φ]

Doctors usually say that there are patient privacy/confidentiality issues for why they won't talk to patients except face-to-face.

[Half Sigma]

Of course they need to make up some excuse. Saying "because I'm greedy" doesn't work well.

Lawyers have no privacy problems talking to their clients on the telephone.

[Buckaroo]

I agree that the refusal of insurance (both government and private) to reimburse for physician telephone consultations leads to unnecessary and non-trivial waste of resources. This includes the significant ancillary cost to the patient who is inflexibly forced to take time off from work in order to go to the doctor's office.

However, I am not sure what you mean by:
The system gives doctors and their patients no freedom to agree upon a reasonable fee for telephone consultations.
Is there some common stipulation in insurance contracts that actually forbids doctors from offering telephone consulations for a fee payable by the patient? There certainly exist so-called boutique practices that charge their patients extra (usually in the form of an annual flat fee) for better access to doctors. This is in addition to fee-for-service reimbursement that "normal" insurance pays to the doctor just as in a conventional practice.

[Half Sigma]

Buckaroo: "Is there some common stipulation in insurance contracts that actually forbids doctors from offering telephone consultations for a fee payable by the patient?"

Generally, contracts DO restrict doctors' freedom to set prices outside of the insurance framework. This applies double to doctors who accept Medicare.

Whether this would specifically restrict charging extra for telephone consultations, or if doctors just aren't interested in charging extra for premium services, is not clear to me.

[doctor]

Rules for lawyers are not the same as for doctors. No HIPPA rules for attorneys. Also, crosscheck legal malpractice fees with medical malpractice fees.

[MD]

Lawyers charge any phone call to teir clients. Yet doctors are never get any compensation for their phone call on patient's behalf. Physicians migh document the phone call for consultation with other doctors in the chart. But there is no pay for such service. When thing goes wrong, even physicians in consulation without any financial benefit get lawsuit.

It is truely unfair. But money enventually come from other patients.

[dreamin]

"Rules for lawyers are not the same as for doctors. No HIPPA rules for attorneys."

I normally don't correct peoples' spelling, but when somebody claiming to be a doctor misspells "HIPAA," I am immediately skeptical.

In any event, the professional responsibility rules forbid attorneys from divulging most client information. As an attorney, I regularly get phone calls from a client's spouse and I generally refuse to discuss client matters with them.

If I call a client at home, I generally do not reveal that I am an attorney to the client's family members. Just the fact that the client is seeing an attorney may be a client secret.

Anyway, my guess is that doctors would call patients a lot more frequently if they could be reimbursed for it.

[dreamin]

"Of course they need to make up some excuse. Saying 'because I'm greedy' doesn't work well."

I agree, but I think it's an overstatement to use the word "greedy." It's hardly outrageous that doctors are reluctant to do work they are unlikely to be paid for.

[Vim]

"I normally don't correct peoples' spelling, but when somebody claiming to be a doctor misspells "HIPAA," I am immediately skeptical."

dreamin:

Ha ha. I wrote almost exactly this when I first saw the comment but decided to leave it be.

I wholeheartedly agree with the sentiment, however.

[quadrupole]

The thing is, while physicians do not generally substitute phone calls for appointments, they do 'take call' evenings and weekends, fielding calls from patients after clinic hours. They will frequently call in prescriptions, recommend follow up appointments (or, in serious cases, a trip to the emergency room), etc. It's not everything *I* would want in physician teleconsultation... but it's not true to say that physicians do not do phone consultation with their patients.

[ed]

One more reason to like the pure HMO model. I can email my doctor and get a prompt response, and he's paid by the HMO on salary.

[doctor]

How about an HMO for legal representation?

[Ned]

Physicians are mostly paid through claims submitted to "third parties" (i.e., Medicare, Medicaid, insurance companies) using CPT codes. CPT stands for current procedural terminology. The codes are changed slightly every year, and they are published by the AMA in a book which runs over 700 pages. Just about everything a physician can do is in the book, from abdomen to zygomatic arch. All claims submitted must be properly coded, and uncoded procedures won't be paid for. Consultations are paid through the E&M (evaluation and management) codes. There is no CPT code for telephone consultation, unfortunately. Therefore, it's not paid. A typical E&M CPT code is 99244, an office consultation which, the standard states, usually requires about 60 minutes of the physicians time. For this hour of "moderate complex medical decision making," the physician receives $208 in Manhattan, less in most other ares of the country. I think this is a lot less than most Manhattan lawyers get paid for an hour with a client. And, HS, please don't call physicians "greedy" for wanting to be paid for telephone calls, when lawyers charge for them all the time (and rightly so, in my opinion).

[conper]

Doctors may not come to the phone and talk to a patient, but my daughter's pediatrician's office is very good about responding to any and all questions she has via email. It is quite effective for her without the time and expense of an office visit.

[totwtytr]

As others have noted, doctors can't charge for phone consultations while lawyers can. Which is why doctors will generally have a nurse or nurse practitioner call the patient first. They can hand a large percentage of the routine stuff for the doctor and leave him free to see patients in person.

HIPAA is the most commonly misspelled acronym I've ever run across. I've seen HIPAA related documents that have it wrong.

HMO doctors make me shudder. My interactions with them leave me with the distinct impression they exclusively come from the bottom 1/4 of med school grads. That's why they work at Health Maintenance Organizations and not "Make you better when you are sick unto death" organizations. I've run into more misdiagnoses by HMO doctors than by lay people.

[fuggy]

Not one member of my family has spoken to or seen a doctor in 2 years, except for one child's orthodontist.
We pay $340 a month for health insurance with a $10,000 deductible. With the $130 a month we pay for the ortho, that means we pay $470 a month for almost ZERO health care. No exams, no consultations. No emergency room visits, No dental care.
We are supporting a congressional candidate who is for Single Payer Health Insurance, like they have in Canada, and we will work like heck for him to be elected.

We are supporting a congressional candidate who is for Single Payer Health Insurance, like they have in Canada, and we will work like heck for him to be elected.

And when this person who will "fix" healthcare in the US is elected, where will you head for medical treatment? You'll have to travel to Mexico the same way Canadians travel to the US today. Sounds like a plan.

[superdestroyer]

Laywers get to charge you for the paralegals time. Physicians have to pay for the nurses out of their insurance reimbursements.

Another odd rule is that in some cases, physicians cannot charge for a procedure and a consult on the same day. Thus, you get the PET scan or the endoscopy on day and come back to review the results later. Even though it would be more easier on the patient to do both in the same day, the physician would make less money.

I doubt if single payer is going to help with physicians and phone calls since the government does not pay for phone calls anymore than private insurance.

[fuggy]

"And when this person who will "fix" healthcare in the US is elected, where will you head for medical treatment? You'll have to travel to Mexico the same way Canadians travel to the US today. Sounds like a plan."

Just because you like urban legends, the one about Canadians going for healthcare in the US, does not make it true. I live in Florida and I ask the French speaking Canadian tourists I meet about their health care system. They love it. They wouldn't dream of going to a doctor here even when they are on vacation in Florida for 6 weeks.

I also like legends about rationing:

http://www.parapundit.com/archives/005337.html

[fuggy]

Rationing? My family pays $500 a month and get no health care for it. Isn't NO health care quite a bit of rationing?

[Turambar]

Here are a couple of "legends":
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070914/belinda_Stronach_070914/20070914
http://www.city-journal.org/html/17_3_canadian_healthcare.html

Examples of two Canadians who cant get cancer treatment and go to US hospitals. One is a liberal MP.

http://www.cbsnews.com/stories/2005/03/20/health/main681801.shtml?cmp=EM8705

A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."

Overall satisfaction:
http://www.cbc.ca/health/story/2007/08/20/cma-healthcare.html
According to the CMA's seventh annual national report card on health care, which surveyed 1,001 Canadian adults on their views about Canada's health-care system, 62 per cent of Canadians grade the overall quality of health-care services available to them and their families as an A (21 per cent) or B (41 per cent), a decrease from 67 per cent in 2006.

[Tired_Of_It]

****
However, I am not sure what you mean by:
The system gives doctors and their patients no freedom to agree upon a reasonable fee for telephone consultations.
Is there some common stipulation in insurance contracts that actually forbids doctors from offering telephone consulations for a fee payable by the patient? There certainly exist so-called boutique practices that charge their patients extra (usually in the form of an annual flat fee) for better access to doctors. This is in addition to fee-for-service reimbursement that "normal" insurance pays to the doctor just as in a conventional practice.

Posted by:Buckaroo | July 21, 2008 at 12:50 PM

Buckaroo: "Is there some common stipulation in insurance contracts that actually forbids doctors from offering telephone consultations for a fee payable by the patient?"

Generally, contracts DO restrict doctors' freedom to set prices outside of the insurance framework. This applies double to doctors who accept Medicare.

Whether this would specifically restrict charging extra for telephone consultations, or if doctors just aren't interested in charging extra for premium services, is not clear to me.

Posted by:Half Sigma | July 21, 2008 at 12:55 PM
****
I understand that Buckaroo is just playing stupid by not understanding the difference between paying for a service once, and paying for it twice, but really, people need to stop humouring scumbags like him.

Having to pay for the doctors consulation through insurance, and then AGAIN privately, for a phone consultation is paying for it TWICE. As everyone here knows.

Medicine is NOT a free market in America.

[fuggy]

"The Ugly Truth About Canadian Health Care
David Gratzer"
Who the heck is David Gratzer? Why should I believe this blogger who vilifies Canadian healthcare when I have spoken to many Canadian tourists who love their health care system and I have friends in Quebec who love the Canadian health care system?
(I live in Florida in a tourist town, I talk to Canadians at the park almost daily.)
I have this skin condition and the pharmacist I asked about it said "you should see a doctor". I told her that the $500 we spend on no health care a month is all I can afford. I am saving up to take everyone in my family for a teeth cleaning. That annual dental visit will cost $500 or so for all of us so my skin condition be damned. I am a US citizen, I know ALL ABOUT medical rationing. I live it.