How many minutes did you talk the last time you called your lawyer? How long did it take your auto mechanic to install that new part? How many hours did your plumber spend fixing your pipes? Chances are, you can find out exact answers to these questions by looking at your bill, where every minute is accounted for.
Why are other professionals able to charge for their time while physicians are forced to spend dozens of hours per month "off the books," doing administrative paperwork, with nothing to show for it? That question has driven physicians crazy for years.
But recently, with paperwork piles getting ever higher, more physicians have been trying to buck the trend by charging their patients administrative fees. Internist Tim Smith of Seattle, for example, charges patients between $15 and $50 for copies of medical records, for letters describing patient status, and for disability paperwork and other forms.
"If it's part of the visit, that's one thing," he says. "But when someone sends me [a form] I have to fill out and sign and make it a legal document, I will bill for it."
Other physicians charge for patient behaviors and requests that generate more work, like failing to show up for appointments, prescription refills outside of a clinic appointment, and phone consultations requested by the patient.
Debbie Hack, a solo family medicine physician in Muncie, Ind., charges $8 for prescription refills and $25 for phone consultations. The charges, Hack believes, are an effective way to get patients in for their regular appointments. "I don't want them to become ill before they can be seen," she says. By not coming in, "they're not fulfilling their responsibility to me or to their own health. This makes them do it - they learn."
Peter Dehnel, medical director at Children's Physician Network in Minneapolis, Minn., has noticed several practices in his network experimenting with fees like these.
"It takes a certain amount of staff time and physician time" to perform these tasks on patients' behalf, he says. "Most people would say it should be paid for just like if you were an auto mechanic or plumber."
The types of administrative fees some physicians have begun charging for include:
- forms for schools, sports, or camp (when requested outside of an office visit);
- forms for life insurance and legal uses such as Family and Medical Leave Act eligibility and disability;
- e-mail/phone consultations requested by the patient;
- prescription refills;
- copies of medical records.
Fees typically range from $5 to $50, depending on the nature of the service performed, the amount of time it takes to complete, and what the physician's time is worth on an hourly basis. But most doctors say their administrative fee policies are less about generating revenues than they are about recovering costs and encouraging patients to think about what they're asking for.
"The people that I know ... are not looking to make this real profitable," says Dehnel. "They're just trying to cover some of the losses. Most of these things take a fair amount of time. It's either family or community time or time spent volunteering on hospital committees. They only have so much time in a day. There's no way to cover all of it, but this helps a little bit."
According to Smith, the fees add only a couple of thousand dollars a year to his practice's coffers, but they have been valuable in the statement they make to patients. "The bottom line is, you're losing ground" even with the fees, he says. "But it's important that people understand it's a business. Most people have one thing in mind: their specifics (what they need). Not yours, and not your other patients and their needs for your time. If you don't set some limits and parameters, people are bound to take advantage of that."
The practice of charging for nonclinical paperwork has become more common as the volume of such paperwork has exploded. The amount of time physicians spend filling out forms has been spiraling upward, research shows. For example, Merritt, Hawkins & Associates recently surveyed older doctors on the subject. The vast majority said that when they started their practices, they spent no more than four hours per week on nonclinical paperwork chores. Today, a third report spending seven to 10 hours per week on paperwork, and another 12 percent say they spend 11 to 14 hours per week.
Put a different way: almost half of doctors are spending nearly a full workday per week filling out nonclinical paperwork, and some are spending almost two days. That doesn't even include the time spent on clinical documentation. Is it any wonder that physicians feel overworked and stressed out, and that patients feel they're not getting enough one-on-one time with their doctor?