Is it possible to find doctor who keeps appointments? (Phoenix: transplants, real estate)
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The solution is easy. Schedule more downtime in between patients because you need to assume some appointments will run longer than you think. If the clinic books every minute of the doctor (and some double book), then OF COURSE they are going to be late 100% of the time.
When appointments last longer, the doctors code things at a higher level (and get reimbursed accordingly) to help pay for the intentional downtime. If a patient doesn't show, you personally bill them a no-show fee so you don't have to double book appointments. Now how hard is that??
Doctors cannot lie and bill at a higher level if a patient takes up more time. For example, if a patient presents for a follow-up appointment regarding management of hypertension (high blood pressure), that is a low level visit, a Level 3. That patient may have a page of questions he or she wants answered. I have two options. I can have that patient come back for a followup visit which means the patient pays two copays which is usually met with resistance. Or I can spend additional time with them. I cannot just automatically bill a Level 5 because I spent an 45 minutes with them when they were scheduled for 15 minutes. To qualify as a Level 5, certain criteria has to be met. I'm not going to commit fraud and lie to justify a Level 5 visit. I can code for a prolonged visit but to get paid for that, the patient has to meet a certain level of extended time and you have to justify and document it. Talk to any physician and they can tell you how difficult it is to get reimbursed for a prolonged visit. AND then assuming you are fortunate enough to get reimbursed for prolonged time, it doesn't adequately compensate you for the additional time you spent with that patient. So it's not as easy you think.
Also, physician reimbursement decreases each year but our expenses continue to increase. In other industries, they can charge more money and shift the expense to the consumers but not in medicine. Insurance companies reimburse less each year but our lease, malpractice, equipment and supplies, staff salaries increase each year. So we can't just schedule an hour with each patient and see 10 a day; if we did that, we wouldn't be able to pay the bills.
And regarding no-show fees, the no-show fee does not compensate for a missed appointment. No-show fees are designed as impediments to encourage patients to show up for their appointments not to compensate for a missed appointment. For example, my no-show fee is $50 but if a patient misses his or her appointment, I lose about $200. I don't make money charging a $50 no show fee. And physicians don't want to fleece patients and charge them $200 no show fees. I will not do that. And with certain types of plans like Medicaid, you are only allowed to charge a certain amount for a no-show fee ($30 for Medicaid).
I understand there are some docs around who charge a large, flat fee - like a retainer - and then provide much higher level of service. Maybe someone knows of one.
Yes, they charge an annual retainer of $1000-$3000 but a lot of patients don't want to pay this for obvious reasons...it's expensive. However, this is where medicine is going. I know that if Medicare reimbursement falls by 30% or whatever it is now, a lot of doctors will do this and patients will be forced to paying a retainer to see their physician.
I don't believe in this for personal reasons. I'm old school and didn't get into medicine for this reason. I could do this now and I'm sure Ill lose about half my patients but I will keep the other half and still make more money than I do now but I also have to be able to live with myself and go to the grave knowing I did the right thing.
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Originally Posted by Rick Lee
My old doctor in VA left his practice to become a concierge or boutique physician. I got an invite to pay $1500 per year for 24/7 access plus cash-only payments. He and his two partners would give top notch service and cell phone numbers and help with insurance reimbursements, but took cash only. The membership fee was FSA-expensable. I'm not ready for that, as I don't need a doctor very often and can probably get my scripts through other means if I need to go that route.
The average physician practice has about 2,000 patients. Let's say 500-1000 patients agree to this and are willing to pay $1500 per year. That's 750,000 to 1,000,000 per year that they are now earning based on the retainer alone! I have friends who do this and it's kind of a joke, they get paid a big retainer to answer their cell phone and tell them to go to the ER for their chest pain. Sure, I'll give out my cell number and answer a few extra calls to make that much. That's easy. I don't do that for philosophical reasons. I don't agree with this model. I didn't get into medicine to treat only rich people. I see everyone including Medicaid when I don't have to. I think people don't realize that a lot of physicians could do this but don't for the same reasons I have.
Last edited by azriverfan.; 10-30-2011 at 01:12 PM..
That's it in a nutshell. If you scheduled 2-3 fewer patients and spaced the appointments out accordingly, this would not be happening. But then you would be making less money. I gather from the discussion that some folks would rather go to a physician who operated that way.
Or I could just hold you to your appointment and kick you out when it's done but of course you want it both ways, you want to be seen on time but you don't want to leave when your time is up.
Read the follow-up to this. I answered this issue. And you have this option now, it's called Urgent Care. Pay $90, see a physician assistant and they will give you your prescription in 15 minutes and send you on your way.
I understand and respect that but that's not me. It's a relationship. I provide a certain level of care and the patients I see desire that type of care and would rather wait and receive that. It's not for everyone and I get that. Do what suits you.
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Originally Posted by observer53
I didn't say you weren't, Capt. Bill. I said, "since when do all paid professionals always start their appointments on time". Good for you that you do. It's still true that not every paid professional always does.
Not only that but it's a different industry. You can't compare the real estate industry to the medical industry. Try telling a patient their time is up and they have to reschedule for next week if they want more time. It doesn't really go over well with patients.
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Originally Posted by Phoenix lady
At Mayo, you seldom wait. I think they just "get" that a patient/consumer can shop around for the best fit--and that people aren't expected to tolerate long waits.
Mayo doesn't accept Medicaid and most insurances so most people can't qualify to be seen at Mayo in the first place so of course the wait is going to be considerably less. At one point, Mayo was discussing not accepting Medicare either. Most physicians could do the same if they screened for wealthy patients like Mayo.
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Originally Posted by Rick Lee
Unreasonable to expect paid professionals to take appointment times seriously? Just wow. In what other line of work is this acceptable? This doctor wasn't making hospital rounds. He was seeing one or more of the several others who had appt. times at the exact same time I did, thereby guaranteeing appt. times were nothing more than suggestions and that, at best, only one patient would be seen when they were told to appear.
Again, it's a different industry. You can't compare what physicians do to the outside world. For example, if a primary care physician is doing a procedure, there could be complications that result which would then result in a longer wait time for the next patient. Yes, doctors do procedures in the clinic, it's not limited to the hospital or hospital rounds. These are unforseable. You can't estimate that something is going to take a long time. For example, I do procedures in the morning and see patients in the afternoon. If I have a complication during a cath, I can't leave the patient during the middle of the procedure and say "Sorry I gotta be at clinic, Ill just leave you here at the cath lab" Even if it's a 30 minutes procedure, if a complication results, I can easily be in there for 2 hours. And no, I can't schedule 2 hours for every cath because the hospital won't allow that since other physicians will need the cath lab and it's not practical. Again, it's a very different industry.
Last edited by azriverfan.; 10-30-2011 at 01:42 PM..
Or I could just hold you to your appointment and kick you out when it's done but of course you want it both ways, you want to be seen on time but you don't want to leave when your time is up.
Read the follow-up to this. I answered this issue. And you have this option now, it's called Urgent Care. Pay $90, see a physician assistant and they will give you your prescription in 15 minutes and send you on your way.
I understand and respect that but that's not me. It's a relationship. I provide a certain level of care and the patients I see desire that type of care and would rather wait and receive that. It's not for everyone and I get that. Do what suits you.
Actually I go to an internist who has a solo practice who is always on time and always has all the time for me that I need (and I often need some extra time). Once in 10 years has he been late and he was hugely apologetic, complaining that the patient before me was late. I have never been seen by a physician's assistant. He just schedules fewer patients (he is not currently taking new patients). He is no hack, either, he has been (like yourself) on the Phoenix Magazine list a couple of times.
Actually I go to an internist who has a solo practice who is always on time and always has all the time for me that I need (and I often need some extra time). Once in 10 years has he been late and he was hugely apologetic, complaining that the patient before me was late. I have never been seen by a physician's assistant. He just schedules fewer patients (he is not currently taking new patients). He is no hack, either, he has been (like yourself) on the Phoenix Magazine list a couple of times.
I'm a cardiologist not an internist. It varies with each type of physician and what they do. For example, if my patient is having chest pain and needs an emergent cath, I'm leaving clinic right then and there and going to the ER and taking them to the cath lab myself and putting a stent right then and there. My patients expect that of me and they are getting that. Ill have to cancel clinic that afternoon or have two patients wait until I get back. Its not fun for the patients in clinic but if they want to be seen by me they will wait. However, my patients are wonderful and dont complain about my being late. They know me, I have a personal relationship with my patients and I treat every patient like I'm treating my mom good or bad. They deal with me and my insanity but they keep referring their family members (which I take as a courtesy to them but I don't take new patients) I don't cut patients short, if they need an hour or 15 minutes, they will get whatever they need so my patients wait knowing this.
Internists vary too. Some do in-office procedures whereas others don't so it's easier to keep times if you aren't doing any procedures and only seeing patients and don't see patients at the hospital.
I worked for many years for a physician. We had one exam room. Our schedule was tight and for the most part, every patient was seen within minutes of the appointment time. If, on the rare occasion when the doctor was held up at the hospital, (or sometimes even called out in the middle of office hours) we always informed the patients on their arrival and offered to reschedule the appointment if that would be more convenient. Because most of our patients were regulars and knew that we ran pretty much on time, they were very understanding of emergency situations and we only ever had one person be obnoxious about it. She was quickly put in her place - not by the staff but by the other patients waiting.
As for double-booking, the only way that ever happened was if another doctor called us and said his patient had to be seen right away. With an already-full schedule, the only thing we could do was squeeze the person in to an already-booked slot. We didn't like to do it, but the practice depended on referrals from other docs and if we got the reputation for turning patients away, well...
Or sometimes an emergency arose and a patient took extra time - example: The day a patient was being seen by our doc, in our exam room, and became ill. We had to call 9-1-1 for an ambulance, and alert the patient's family that he was being admitted to the hospital with a stroke evolving.
So, yes, sometimes the doc falls behind. He/she doesn't like it. The office staff doesn't like it. The patients don't like it. BUT we all don't like it together. What I would like is that if I was the one having the stroke, I'd get the care required.
People are quick to complain about long waits at the doctor's office, but yet will wait in line at a book store to get an author's autograph, or stand in line to buy concert tickets or tickets to a sports event.
Just remember, when you are finally seen, you're done. When the doc finishes, he still has to go over charts, return phone calls, order refill scrips at the pharmacy, and probably still needs to make hospital rounds.
Right now, I have lots of medical professionals caring for me. My Primary Care - I've been seeing him for almost 20 years. My cardiologist - he takes care of me since I had my aorta replaced. My surgeon who resected my colon when I was diagnosed with Stage II cancer. My oncologist who watches me to make sure the cancer doesn't come back. The GI guy who does the periodical colonoscopy to check my innards for any signs of recurrence. Sometimes, I get in at the appointed time and sometimes I have to wait. Sure, I'm not thrilled about it, but I've been on both sides of the sliding glass window so I bring my Kindle and try to smile.
Unbelievable. Some of you want the doctor to hurry the visit to stay on time and yet you'll be the first ones to retain a lawyer if you're misdiagnosed. Building more "down time" into a schedule means fewer patients that are sick will be treated. How would you like have to wait three or four days to get in if you have strep? Too bad more of you didn't go to medical school so you could just treat yourselves entirely.
OP, This outburst was for a refill of Ambien for overseas flights, that says a lot, not a regular followup, but I-need-meds type followup because I have something important to do....maybe call and say all I need is a refill, maybe stand there instead of having a tantrum with people not responsible and say all I need is a refill of Ambien, they may have gotten someone to fill it,...or get some Dramamine and have a couple drinks at the airport or on the plane, heck stay up all night the day before so you can sleep on the plane. Some "professionals" have more complicated schedules than others, just saying since in OP you stated so you had something important to do or could get on here and whine, I am guessing it was the latter since that is what you did.
The Specialty Building next to the hospital on Mayo Blvd at 56th St is where you have doctor visits, lab work and out patient procedures.
My insurance allows me to go to any doctor. I don't need my family doctor to send me. Perhaps yours is the same. They are a little more expensive, and your insurance may not cover their full cost, but you'll find any extra cost well worth it. You can call them and they can tell you if there is an extra cost over what your insurance will pay. Possibly if they aren't in your network, you can still go, but have to pay extra.
One visit will impress you because their system is so well organized. We didn't start going there because of doctors not being on time. I've only had the one complaint about on-time with the opthamologist.
We went there because of the bad experiences we've had with doctors careless misdiagnosis. We believe Mayo only hires top doctors in their field and that's a reason people travel from all over the country to be treated there. So far we've been highly impressed. Their on time policy is secondary for us.
They ask you to arrive 15 minutes before your appointment to check in. (There may be a line checking in.)
Mayo is excellent, world-class medical care for many specialties. But for every-day general medicine, I don't think it's necessarily the place to go, especially if you have an added cost beyond what the insurance will cover (out of network).
I'd also add that there are certain specialties where they are not necessarily the best in the area. Neurology, pediatrics, and obstetrics, for example. I'd even venture a guess that there are better heart surgeons and cardiologists. Now that we have CCA and MD Anderson in town, we have many options for oncology care. And If I had a seriously sick kid, that kid is going to Children's Hospital.
No, it's not possible to find a doctor who keeps his or her appointments unless you want a bad doctor...
Again, the Mayo Clinic is on time. We have never waited. However, they do tell you that if you have not been called within 30 minutes of your check in time, to come back to the check in desk.
They request you check in 15 minutes before the appointment, (in case there is a line) and we have always been called within 5 minutes on either side of the appointment time.
It would be a stretch to call doctors at Mayo bad.
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I said, "since when do all paid professionals always start their appointments on time". Good for you that you do. It's still true that not every paid professional always does.
