Nov 17, 2009

Why Not Call? (Exhaustion and Economics of Phone Calls)

A reader writes:

Why do I have to take time off of work and make an appointment for my doctor to explain test results? Wouldn't it be much easier to do over the telephone?
It would be easier to discuss this over the phone, and cheaper. Your doctor isn't paid for talking to you over the phone. Getting info over the phone is always a win for patients and a loss for doctors.

Primary Care Doctors (like Doctor D) for whom much of the job is educating you about your health are making a less and less every year (we're the green line) and we started out as the lowest paid physicians. Primary Care clinics are just barely scraping by, so when it comes to discussing your labs they can either do it over the phone for free, taking time away from seeing patients, or bring you in and get paid by your insurance to have the same discussion. The economic solution usually beats the common sense solution.

Now, I don't want this to sound like one of those Happy Hospitalist I-don't-get-reimbursed-for-all-I-do posts. Primary Care is still a good job and Doctor D doesn't have to worry about keeping food on the table.

But when Doctor D worked at Crayzee Clinic he spent many hours every day getting patients results, refills, and forms without pay. He did his best to call patients when he could, but if he knew it was going to be a long talk he usually had you come to the office. Doctor D had to keep some work during office hours—as it was he barely saw his wife or son while working primary care. Of course, some docs avoid phone calls because of greed, but most in primary care are just exhausted having to see more patients faster and faster while doing more paperwork in the evenings. An appointment to follow up tests was usually pleasant and easy, and didn't keep Doctor D in the office later at night after office hours.

But for the patient, it sucks! You have to get off work and drive to the doctor's office, just to get information you could have gotten over the phone. You can and should ask if your doc can call you the results without an appointment. Your heathcare is already too costly without extra visits. But please realize that this is harder on you doc, so don't abuse it. If you are the sort that needs to ask lots of follow up questions please schedule a visit instead of tying up your doc on the phone for 20 minutes!

Okay, after a long blog post about money and reimbursement Doctor D feels dirty and must go bathe the Happyishness off of himself.
This is one of those annoying situations that forces either you or your doc into a financially frustrating situation. The solution proposed on most doctor blogs is billing for phone calls.

What do you think? Would you be comfortable being billed for phone calls? It would save you costlier office visits. Or do you want to keep phone contact free?


Anonymous said...

My HMO posts most ordinary lab results online, and I would certainly make an appointment if I had questions about the results. You can't have a decent phone conversation with a doctor who is wedging in the call between visits with other patients or who is exhausted at the end of his or her day.

The truly critical test results (for me at least) are never posted in my HMO's online system. My doctor calls with them. It's a very short call. I know which numbers are good and which are not. I prefer to be able to deal with my feelings in the privacy of my home right afterward if my doctor calls with bad results. He is a very kind if reserved man, but I don't expect or want him to have to console me. I am guessing that we both prefer that I not burst into tears in his office! It's better for me to have time to calm down before I see him in person.

I also always go to my hospital's medical records department to get copies of pathology and radiology reports as soon as they are available. That way I've had time to read them carefully before they are discussed at appointments. Doctors always seem surprised by this, but the reports contain far more detail than any doctor would have the time or inclination (or need) to tell me, and it's useful for me to have records to compare over time.

But yes, of course doctors should be compensated for the time it takes to communicate with patients, whether it's by phone, or e-mail, or in person. My doctors are on salary, so it may not be such a pressing question for them; I don't know. I try to ask each of them how they prefer to be contacted if I have questions. They are very clear as to what works best for them, and I'm happy to accommodate them.

Anonymous said...

I forgot to add: I would be willing to fork over a co-pay for a phone call with one of my HMO doctors. It would probably feel jarring at first, but it makes sense. I just don't know how it would be handled from an administrative angle. It would be awkward for my doctor to ask for my credit card number at the start of the phone call, and the cost of invoicing and collecting payment by mail could cancel out the co-pay itself.

WarmSocks said...

I think I'd be willing to pay for phone calls in some circumstances, but not all.

If my doctor's office phoned and said that the doctor needed to discuss test results with me and I could make an appointment for either an office visit or a teleconference, that would be great. I'd be happy to pay a basic fee to avoid the trip. Likewise if I initiate a call that is determined to require the expertise of the doctor or a nurse. If it's not treated as a routine call, but as an appointment that takes place over the phone, then I'd be happy to pay (less than a 3D appointment).

But if a doctor decided to call me when I wasn't expecting it, then I shouldn't be on the hook for a bill.

Anonymous said...

I think my doc's got a great system. He reviews each result and then marks it one of three ways: no action required, wants to talk on the phone, or wants the patient to make an appointment. You then ring up and ask whether your results are back - the receptionist tells you which of the three he's marked it, and then if he wants to talk to you on the phone she asks whether you can hang on till he's between patients and he gets on the phone and talks to you. If you don't have to come in but still want a copy of your results you just ask them to print one off and they put it in an envelope and you pick it up.

K said...

I thought some doctors charged for phone calls? I know during my peds rotation some of the docs were telling me that there were practices where if you called their 24/7 hotline, you would get charged for the call

Celeste said...

Isn't this really a case where one of those secure messaging/EMR websites could come in handy? They let you bill for an online consultation, so you get paid and the patient doesn't have to get in the car.

Doctor D said...


I have heard of EMR systems that allow patients to log on to see results, but I have never heard of ones that bill for this. It is my understanding that insurance companies won't pay for this.

Also, getting you your results in a raw form is just a bunch of numbers that you would probably have trouble interpreting. You still need personal contact with your physician to understand what the results mean and what should be done about them.

A good EMR is an excellent solution for stressed physicians. Around these parts all the hospitals and clinics are still in the dark ages with paper. And unfortunately a "good" EMR is easier said than done. If Crayzee Clinic where I worked ever gets EMR you can bet they'll buy the cheapest, buggiest, most user unfriendly medical program on the planet--hence more exhaustion for physicians.

Celeste said...

Well there you go. Patients can choose between the inconvenience of coming in and having the visit covered, or staying in their office but being billed an online consultation fee that they won't be reimbursed.

I know that Medem (now MedFusion) let you do an Online Consultation and bill patients separately. I'm pretty sure that MedFusion lets you do the same thing.

The big question is which patients can actually do well with understanding their results via email, and which cannot. In a perfect world you could individualize for each person, but this ain't no perfect world and it's probably just easier to standardize and have everybody come in.

WarmSocks said...

In a perfect world you could individualize for each person, but this ain't no perfect world and it's probably just easier to standardize and have everybody come in.

Actually, this could be personalized quite simply. One or two appointments should make it apparent which approach is appropriate for a specific patient. For those using paper charts, a little sticker (standardized location) on/in the chart could help to track the differentiation. For those using EMR, a single field with online/office radio button options would make it easy to put patients into one of the two boxes - this is an ideal application for a database.

The Good Cook said...

I take my health seriously enough that if it was important enough that my doctor ordered some type of tests, I want a follow up face to face.

If the tests were routine blood tests - say for anemia - or a positive (god forbid) pregnancy test - a phone call would do - and I would not be opposed to paying for that time. Time is money - mine and yours - I mean isn't that the reason I wouldn't take time off from work for the visit?

So I guess for "serious" test results - (think cancerous or benign) an office visit is absolutely warranted - for routine - anemia, cholesterol, a phone call would do...

Is that any help at all?

WordDoc said...

To paraphrase Dire Straits, "forms filled out for nothing and advice for free." That's my 'to-do' pile every day. Considering a limited concierge practice where for some annual fee and some reasonable charge, my patients could skype with me or have phone consult. By limited I mean I still slog along with my insured (more or less) customers, but save some the aggravation of time off from work and a long cross-town drive.

Louis de Pointe du Lac said...

I'd be more than happy to pay for any phone interactions with my Primary Care. Seriously. It would be more efficient/convenient for both of us - a win/win. More than worth it for me. Hands *down*.

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