A message to my Congressman

[Tommy]

I've reached the point in life where doctor visits are not uncommon, and it annoys the hell out of me to be sitting in a small, dull room a full hour after my scheduled appointment time. I've reached the point where I will not wait more than 45 minutes unless it is to see a one-of-a-kind doctor. With that in mind, I wrote and sent the following message to my Congressman via his web site. If you agree with my sentiments, I encourage you to copy it and send it to your elected officials and friends who might agree. If not, you must be a doctor.

As long as the health care reform bill is being reconsidered, I'd like to suggest the following no cost change that should dramatically improve service for patients. I suggest the bill require health care providers who receive federal payments (e.g., Tricare and Medicare) be required to monitor and prominently post their most recent average monthly waiting time for patients. For example, if the average patient was actually seen by the doctor an average of 75 minutes after their scheduled appointment time, that information should be posted prominently. This would give patients valuable information when selecting a health care provider and would encourage providers to improve their customer service.

[Bill Bess]

Great idea and suggestion. Most regular businesses must compete....you know, good service, qualiity product, good value for the buck and prompt service.
There are however many businesses that must schedule their services differently, like plumbers, service companys etc. ( 8:AM to noon)
It will be difficult to get the doctors to improve much because they can only see so many folks during a day and some of the visits take longer than the average alloted time.
Here in Lake Havasu City, AZ, the majority of the patients are old farts like me and require a lot of doctoring, so waiting is just a good time to read my copy of Kit Kar mag.
Most of the time my appopintments are pretty close on schedule but occasionally they get pushed back.
I'm not disaggreeing with you, some quality and performance guidelines are needed to force the doctors to upgrade their service.

[rustyBob]

I think if they are going to make you wait they should give you a break on the price of the office visit........or put in a stripper pole and hire strippers.........
every time i go to the doctor i loose wages.......giveing me a break
on the price would ease the cost out of my pocket........

[joyridin']

My dentist charges $75 if you miss an appointment without 48 hours notice. A few years ago, I went to my appointment. I was about 15 minutes early as I always am. I waited almost 45 minutes, which put my appointment 30 minutes late. The receptionist informed me he would not be able to make the appointment as he had had an emergency in the morning and everything got pushed back throughout the day. I asked for my $75. She was dumbfounded. Although I wasn't rude, I was pretty adamant about getting my money.

My time is worth a lot as I had to leave work for 2 hours to visit the dentist, plus gas to drive there etc and nobody called to tell me about canceling the appointment. I got my money...or at least they credited my account. Good enough for me.

[Tommy]

Following a move a few years ago, I was establishing myself with a new family doctor. His staff asked me to sign the document agreeing to pay $25 if I failed to show without canceling at least 24 hours in advance. I said I would agree if the doctor would agree to reimburse me if I were not seen within 30 minutes of my scheduled time. Neither of us agreed so the document was not signed. Of course they can't file against your insurance for a no-show, so all they can do is send bills which can be ignored.

[Anthony]

Originally Posted by Tommy

I've reached the point in life where doctor visits are not uncommon, and it annoys the hell out of me to be sitting in a small, dull room a full hour after my scheduled appointment time. I've reached the point where I will not wait more than 45 minutes unless it is to see a one-of-a-kind doctor. With that in mind, I wrote and sent the following message to my Congressman via his web site. If you agree with my sentiments, I encourage you to copy it and send it to your elected officials and friends who might agree. If not, you must be a doctor.

As long as the health care reform bill is being reconsidered, I'd like to suggest the following no cost change that should dramatically improve service for patients. I suggest the bill require health care providers who receive federal payments (e.g., Tricare and Medicare) be required to monitor and prominently post their most recent average monthly waiting time for patients. For example, if the average patient was actually seen by the doctor an average of 75 minutes after their scheduled appointment time, that information should be posted prominently. This would give patients valuable information when selecting a health care provider and would encourage providers to improve their customer service.

You can actually do a search on your doctor (their name), and look for a listing in healthgrades or vitals, and there will be patient ratings on waiting times, as well as their perceived competency, as listed by random patients.

If you don't like your doctor, then change to another (unless you're Kaiser or VA )

Originally Posted by Tommy

Following a move a few years ago, I was establishing myself with a new family doctor. His staff asked me to sign the document agreeing to pay $25 if I failed to show without canceling at least 24 hours in advance. I said I would agree if the doctor would agree to reimburse me if I were not seen within 30 minutes of my scheduled time. Neither of us agreed so the document was not signed. Of course they can't file against your insurance for a no-show, so all they can do is send bills which can be ignored.

Actually, I think it is truly illegal to bill for missed appontments. The other side of the coin is that doctors donlt want their staff to be standing around, paying for them to stand around for no-shows. You have to understand that the business of medicine, as established by medicare, followed by most insurance companies, has "set" the reimbursement pay schedules for all medical providers (doctors, hospitals, DME suppliers, etc., unlike dentistry which is still significantly out of network), and the reimbursement amounts are really kind of low such that to be profitable, a medical provider has to be efficient with their operating costs. As reimbursement continues to dwindle, it will force medical providers to be even more efficient and eliminate some of the "old freebees" such as calling in prescriptions, that is paying staff to make phone calls with no revenue generation, which is why many doctors are now requiring patients to come to the office. It's only going to get worse over time. The more government gets involved, the more regulations, the worse it is for all of us, providers and patients.

How long is the waiting time for the "free" VA healthcare ? That's the target of efficiency were aiming at.

[Tommy]

Anthony,
I appreciate the thoughtful response and the suggested sources of information. Unfortunately for me, when I tried to check up on my family physician, healthgrades wanted $12.95 to see what they had to say and vitals.com had only one review. In the past I also tried angieslist and found it does not cover my rural community. That, in a nutshell, is the problem with voluntary and customer review based systems.

I understand that doctors who are paid on a fee for service basis need to see as many patients per hour as possible to maximize their incomes, and I have no more concern about doctors wanting to maximize their incomes than I do about mechanics wanting to maximize theirs. I just want them to make it easy for those of us who are picking a doctor to know which of them care even a little for the amount of their customers' time they are wasting in order to afford that second or third condo on the beach.

[Anthony]

Originally Posted by Tommy

Unfortunately for me, when I tried to check up on my family physician, healthgrades wanted $12.95 to see what they had to say and vitals.com had only one review. In the past I also tried angieslist and found it does not cover my rural community. That, in a nutshell, is the problem with voluntary and customer review based systems.

I understand that doctors who are paid on a fee for service basis need to see as many patients per hour as possible to maximize their incomes, and I have no more concern about doctors wanting to maximize their incomes than I do about mechanics wanting to maximize theirs. I just want them to make it easy for those of us who are picking a doctor to know which of them care even a little for the amount of their customers' time they are wasting in order to afford that second or third condo on the beach.

I had thought both healthgrades and vitals had that info for free, but I went back, and it's only vitals. I would say talk to some locals, neighbors, call the local hospital and ask for the nursing supervisor, she'll know who is good in the area. Lastly, there's trial and error.

The younger doctors don't have multiple vacation homes, unless they were already well to do, as some already are. The older doctors made better money years ago, and may have accumulated significant assets, but not always.

Finally, the medical system cannot be efficient for everybody at the same time, and the way the medical system is going, it's only going to become more inefficient for patients. Reimbursement drives staffing strategies, and with less reimbursement every year, there's going to be less staff on duty at any one time, to do the work, meaning more waiting time. You can't pay staff to stand around and do nothing, whether it's in an ER, radiology dept, doctor's office, etc. That's the direction it's going. Expect to see more PA's (physician assistants) and NP's (nurse practitioners) providing care to you with the doctor somewhat out of the loop unless there is a somewhat serious problem. That's where we are headed. Maybe more foreign doctor's as well.

[Tommy]

Originally Posted by Anthony

.... Expect to see more PA's (physician assistants) and NP's (nurse practitioners) providing care to you with the doctor somewhat out of the loop unless there is a somewhat serious problem. That's where we are headed. Maybe more foreign doctor's as well.

I personally have no problem seeing a well trained and competent PA for routine matters. That is especially true if the PA has access to a good computer system to help them ask the right questions and determine the right course of treatment. In fact, I can envision a time in the near future when much of the work being done by doctors is being done by technicians assisted by computers that do a much better job of cross referencing symptoms and remembering my medications and last visits. ... But if the PA/technician/computer make me wait for an hour for their convenience, I'm still going to be pissed.

[Jamo]

I simply get even...

We represent more than a few doctors and doctor-owned clinics. While I am exceedingly prompt for most other client appointments, I enjoy making the doctors wait a bit. They never complain, given their own hectic schedules, but it still makes me feel good.

[Anthony]

Originally Posted by Tommy

I personally have no problem seeing a well trained and competent PA for routine matters.

You really will have no way to tell if someone is really competent.

Originally Posted by Tommy

That is especially true if the PA has access to a good computer system to help them ask the right questions and determine the right course of treatment. In fact, I can envision a time in the near future when much of the work being done by doctors is being done by technicians assisted by computers that do a much better job of cross referencing symptoms and remembering my medications and last visits.

I really don;t know if that would really improve care or not. All I know is that I don't want to be the first to test it. You'd be a better candidate.

Originally Posted by Jamo

I simply get even...
.

I think that's what the Bible says.

[Jamo]

amen........

[Tommy]

Originally Posted by Anthony

You really will have no way to tell if someone is really competent.

True for doctors as well as other health care providers. Other than the waiting room time thing, I evaluate doctors the same way I evaluate auto mechanics. I can't always tell on the first visit, but over time it becomes obvious whether or not their skills match their fee schedule.

[Anthony]

Originally Posted by Tommy

True for doctors as well as other health care providers. Other than the waiting room time thing, I evaluate doctors the same way I evaluate auto mechanics. I can't always tell on the first visit, but over time it becomes obvious whether or not their skills match their fee schedule.

The flaw with some of your logic is that the fee schedule is basically the same for all doctors, the fee schedule as set by medicare and followed by most insurance carriers. So unless you plan to see a doctor out of network, there really is no difference in the fee schedule between doctors. The difference lies in your insurance plan, your deductable and copays and number of in-network doctors. Few patients will pay for out of network doctors. The main exception being patients with only VA medical insurance.


The other issue concerns services provided by PA's and NP's. Your co-pay will be the same whether you see the doctor or his assistant all the time, most of the time. Patients can/often feel like they're getting ripped off having to pay their $40 co-pays only to seee the PA or NP. Often they feel they should get a discount on their co-pay accordingly. Unfortunately, that won't happen.

[Tommy]

Anthony,
The flaw in your logic is to imply that something less than providing patients top notch care and comfort is acceptable for care providers if their fee schedule is not as high as they'd like it to be. ... I'm just curious. Do you work in the health care field per chance?

[TButtrick]

A quick glance, this site RateMDs seems to be free.

[Anthony]

Originally Posted by Tommy

Anthony,
The flaw in your logic is to imply that something less than providing patients top notch care and comfort is acceptable for care providers if their fee schedule is not as high as they'd like it to be. ... I'm just curious. Do you work in the health care field per chance?

I do.

What is considered to be the standard of care is different between different insurance providers and hosptial systems, all of which may be different than what I consider top-notch care.

I'm a physician, own two different practices, own a small radiology facility, and most recently an ambulatory surgical center. I was on staff at 4 different hospital systems, only 1 now. I see about 250 patients/week, including procedures. I have contracts with multiple insurance companies, and deal on a daily basis with government regulatory offices concerning my businesses. I've learned alot, the hard way.

[Tommy]

Anthony,

I genuinely appreciate the civil discourse even though we may not agree on everything. I'm also willing to defer to your knowlege of and experience in the system from the point of view of a health care provider. However, I think my experience as the parent of a child who was hospitalizd for more than 600 days, and as a patient who was nearly killed by the self serving actions of a general practice doctor gives me the right to speak for many of the customers of our health care system. I suspect our differences are because we have fundamentally different views on the purpose of the health care system.

[DougD]

Originally Posted by Tommy

I've reached the point in life where doctor visits are not uncommon, and it annoys the hell out of me to be sitting in a small, dull room a full hour after my scheduled appointment time. I've reached the point where I will not wait more than 45 minutes unless it is to see a one-of-a-kind doctor. With that in mind, I wrote and sent the following message to my Congressman via his web site. If you agree with my sentiments, I encourage you to copy it and send it to your elected officials and friends who might agree. If not, you must be a doctor.

As long as the health care reform bill is being reconsidered, I'd like to suggest the following no cost change that should dramatically improve service for patients. I suggest the bill require health care providers who receive federal payments (e.g., Tricare and Medicare) be required to monitor and prominently post their most recent average monthly waiting time for patients. For example, if the average patient was actually seen by the doctor an average of 75 minutes after their scheduled appointment time, that information should be posted prominently. This would give patients valuable information when selecting a health care provider and would encourage providers to improve their customer service.

Tommy
I, like you, hate to be made to wait. It's rude, and I agree with your dislike for this practice.

I have a simple solution for you to try. It has worked for me, and I suspect it will for you.

Make an AM appointment. The earlier in the day, the better. They run over time on virtually every patient. This builds up during the day, and by afternoon, they're 30-60 minutes late. Make you appointment bright and early in the day, and you'll be rewarded with prompt service and a nearly guaranteed on-time appointment. Works for me.

[Tommy]

DougD,

I'm pleased you've found a tactic that works for you with your doctor. I thought of that one too and it does work sometimes for me. However, I've found that for some doctors even the first appointment of the day is not seen on time because the staff will allow people without appointments to walk in and be seen. I also learned that several of my doctors schedule appointments in clumps. For example, they'll schedule three people at 9:00 AM and then three more at 9:30 AM. This says that even if things go exactly on schedule, one patient will be seen ten minutes late and the next twenty minutes late. It's a great way to assure the doctor has no empty spots in his schedule at the expense of making patients wait. I just happen to think that an hour of my life is as important to me as an hour of his life is to him.

Incidentally, I've discussed this problem several times with the staffs of several different doctors. The two most common excuses for long waits are (1) we want to make sure each patient gets all the time he needs to be treated properly, and (2) an unexpected emergency arose that required the doctor's time. The problem with both of those excuses is they ignore the fact that the doctor could factor in time for both of those situations if he (1) cared about wasting his customers' time, and (2) monitored the average wait time for his patients and adjusted future scheduluing to reduce the waiting time. I agree that there is no way to assure a particular patient will not have to wait on a particular day, but over a period of a month the average wait should not be excessive.