Posted on 01/16/2007 1:35:06 PM PST by shrinkermd
Some of the newest players in health care are rubbing doctors the wrong way.
You may know them: those small clinics at your neighborhood Wal-Mart, Target or CVS that promise quick attention for routine visits -- sore throats, minor aches and pains, flu shots -- with no appointments needed. The clinics, which go by such names as MinuteClinic, RediClinic, QuickClinic, Medpoint Express, Curaquick and MediMin, offer convenience and low price -- scarce commodities in today's medical marketplace. But while consumers are taking to the concept, physician resistance is building.
...Not that many are convinced this trend is good for patients. Within the past six months, the American Medical Association and the American Academy of Pediatrics have both decried it.
(Excerpt) Read more at washingtonpost.com ...
That is a valid concern, however, my mom is not elderly (I'm 22, she's 48 the reason I go with her is because she's deaf).
Even though she has been very prone to needing antibiotics in the past, I carefully watched her and gave her vitamins and good care and she did not end up needing them.
She also carries a full list of her meds and allergies and we make sure to inform the doctor.
Due to her insurance, her specialists and general doctor are 30 miles away and are extremely hard to get in to see, otherwise we might use her doctor more often.
Under the circumstances, with precautions, these clinics are the best many people can do.
Our local hospital complex has an Ergent Care unit in-hospital, and also an Emergency Room. If your doc is not in or it's after hours and you can't wait, you go to Urgent Care. If you are sicker than you thought Urgent Care will admit you or tell you to see your doctor the next day. If it's something that requires an anti-biotic or something like that, then they take care of it. I imagine most hospitals will do this in order to compete with the store clinics.
You don't need a physician to lecture you about your weight, your b/p, your cholesterol or your last mammogram when you have strep throat.
BTDT! The first time I made an appointment at a civilian pediatric practice, saw the doctor in 15 minutes, wrote a check for $35 (it was a while ago ...), and got the prescription filled at the grocery store, I thought I'd died and gone to heaven.
I'm not any of those things, but I don't mind seeing a nurse or P.A. for our usual needs.
Is that so? You mean you regularly get charged for two office visits when you've only had one?
The Van Vleck quote is about continuity of care--treating a patient instead of an illness. Family medicine. Opportunity to screen a patient for other problems, like, why does this patient catch so many colds?
These clinics are good mostly for minor acuity, which is great. I'm glad they exist.
But if your doc charges by the question--I'd sure like to see how he gets paid for that with the rules the way they are. Bills are not coded that way.
Even now that I do have medical insurance, making the appointment and taking the time off work can be a real bother. These are places to take care of hangnail type ailments, not to get a heart bypass.
Of course, I suppose I could learn Spanish, pretend to be an illegal (I'm dark enough) and just show up to the friendly freebie taxpayer supported ER.
I am a physician and have no problem if patients want to go to these type of clinics for minor things. But do not go for routine care. As a matter of fact if we get Hiliary care I plan on doing something like this. I do not want to have to directly work for the government and have made up my mind I will quit or do something like this. I have even seriously though of writing a letter to Wal-Mart headuarters and letting them know if they want to open one up in the town I live in I would be glad to work for Wal-Mart. I have about had it with .gov interference and poor pay by .gov and after today I am tired of running off all the drug abusers who try to get me to prescribe the two favorites--Vicoden and Xanax. Had a patient drive 3/4 across the state hoping I would be his doctor cause no one between here and there would prescribe him the meds he wanted. I said no and did not charge the guy.
I went to the Wal Mart clinic...they cut the price of everything. What I love about PAs and the other techs is that they actually listen carefully. If they feel it's out of their hands they tell you to go to a specialist.
OTOH, there are "some" Gen Practice doctors that are horrible in everyway. And when they can't answer the problem, they want to go further instead of admitting their clinic of specialists can't help.
The first time I made an appointment at a civilian pediatric practice, saw the doctor in 15 minutes, wrote a check for $35 (it was a while ago ...), and got the prescription filled at the grocery store, I thought I'd died and gone to heaven.
That's because you're not losing business to them.
Sounds great!
Doctors, like most professionals, charge for their time on an hourly basis. Most doctors, though, set up their bills so you are just charged a flat rate for an office visit; however, that fee is based on an estimated time that he'll spend with each patient and then calculated out to determine what he wants (or needs) to earn.
Thus, when the doctor is spending more time with each patient (performing services that the patient doesn't request), then the fee for the visit needs to be higher so the doctor can continue to cover his nut.
Don't think your time with the doctor is free. It's not.
P.S.: That's not really what this doctor is saying. Read what he says again:
"'When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection.'"
I've got scoliosis. When I go to a doctor for a sore throat, I don't want him checking my back. I want a prescription for an antibiotic. Checking a patient for back trouble has NOTHING to do with why he has a sore throat--it's merely a way to run up the bill.
"Oh, so you've got a sore throat, huh? Great...say, I see you haven't had your Typhus fever immunization this year....Hmmm. What, you say you're not going to be aboard an 18th Century British sailing ship and don't need it? Well, you never know. Let's just get you set up with Typhus fever, huh? Great...that'll be $100. Thanks for stopping by!"
If you knew anything about the laws concerning billing and medical regulations, you'd know that he CAN'T run up the bill! An office visit is an office visit. Actually, I wish they'd OTC some antibiotics and have done with it, and let people medicate themselves.
re: Oh, so you've got a sore throat, huh? Great...say, I see you haven't had your Typhus fever immunization this year....
Something tells me that a doc recommended that you get current for tentanus, and you thought he was a greedy b@stard for suggesting such a thing.
LOL...they have to "code" their billings, unlike lawyers. Although it was lawyers who came up with the idea.
That's why surgeons make so much more (if you go by hourlies) than a subspecialty internist, but their yearly salaries work out very similar. Doctors can charge by procedures, like sewing up an idiot hunter who got drunk and fell out of his blind, but he can't charge extra for recommending that he get a tetanus shot if the hunter's going to be outdoors and stupid at the same time.
An office visit IS an office visit, but a $50 office visit is a lot different than a $100 office visit. All office visit fees are not created equal.
Doctors see patients to make money. That's what they do. Extras are not free. The copy of People in the lobby--not free. The pen with the doctor's name on it--not free. The fancy building that your doctor practices in--not free. The "check of your records"--not free either. You (or your insurance company) pays for all of it. The cost of ALL of that is built into the office visit. If he is seeing fewer patients (because he is "giving" patients services that they don't want) the cost of the office visits will be higher than they otherwise would be because the doctor has to cover his nut. That's just how it is. Doctors are businessmen like anything else. If you don't believe me, just ask a prescription drug sales rep on how they sell prescription drugs to doctors. It's money. Doctors have boat payments, too.
But I'll give you a for instance on running up the bill with unnecessary services. I went to the doctor for a sprained ankle. He took some x-rays, told me it wasn't broken. That's good. All I needed to know.
But did my visit end there? No. The doctor told me that I needed an aircast for my ankle. This is one of those plastic bubble things you can buy at Wal-Mart for about $7.97. The nurse came into the office, opened the box, put the cast on my foot, and velcroed it. The entire procedure took about twenty seconds.
Several weeks later, I got the notice of payment from my insurance company. The doctor's bill for the cost of the cast and for the nurse putting it on my foot? $95. Fortunately for everyone (except the doctor), my insurance company refused to pay the charge, but it's these type of bills that encourage people to see doctors that will only treat them for what they've requested. If I didn't have insurance, I would have had a very difficult time getting that doctor to drop that $95 charge off his bill. This is precisely what spurs people to visit these immediate care clinics at Wal-mart. No surprises. You want a flu shot? Great, here you go. That's $8.
There is absolutely a market for doctors that won't give you a bunch of crap that you don't want, and the idea that doctors are just doing all this extra stuff "for the patient" is bogus. It's about money. Period. "What can I bill medicare for?"
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