I see an endocrinologist that is considered a doctor's doctor. The practice is huge and doesn't participate with any insurance including Medicare. Even though there is no insurance involved the office appointments are difficult to schedule.This provider spends as much time with the patient as required. There are times when he is running 3-5 hrs behind schedule; yes that is correct. However the receptionist will tell you when you arrive or if you have been a patient long enough you call ahead. The interesting thing, not one patient ever complains.His care is worth the wait time. Another provider I went to see was a neurologist. I was his first appointment and he showed up a 1/2 hour late, and I was taking time form work to see him. After the encounter I wondered why I was even there. He didn't do anything. he didn't do any testing, or evaluation. The next visit he was again late, only this time I asked where he was. His office staff replied they had no idea where was. I faxed to the office a scathing note informing this provider of his apparent non-caring about the patients who arrive on time and sit and wait. In the immortal words of Donald Trump I told this provider "You're fired!! I also filed a quality of care complaint with the insurance company of the State Medical Board and the Medical Society. Physicians should never be allowed to run rough shod over their patients. Any time something incorrect occurs in the physician's practice I tell them. Maybe more people shouldn't be afraid to inform the physician of their displeasure.
What if a Patient Bills Your Practice for a Long Wait Time?
What if a Patient Bills Your Practice for a Long Wait Time?
Blog | August 04, 2011
I barely remember the last time I had to wait more than 20 minutes to see the doctor for a scheduled appointment (three years ago, maybe four?)
Sure, everyone occasionally suffers 45-minute waits, but when it comes to my medical care, I was willing to sit there with my book for as long as necessary. I accepted it as part of the deal (and, by the way, my U.K. friends who have subsidized healthcare often have to wait longer for the same care).
That was not the case for a woman in Santa Ana, Calif., who made news for actually going so far as to bill her physician for making her wait 45 minutes for a doctor’s appointment. The woman, who gets paid an hourly wage, reportedly deducted $150 from her $223 bill and sent a letter back to the practice explaining why she wouldn’t pay it in full.
The physician’s office agreed to the new fee.
"Over the years, I would find myself getting really mad, just sitting in a doctor's office with a magazine and waiting and waiting and waiting,” the woman told CBS News. “So, I finally decided I was going to just do something about it, and I did."
This article raises some interesting questions: Should this patient have sent the physician a bill? At what point is the time waited by a patient unreasonable?
Another physician quoted in the article told reporters he actually pays patients $50 when he runs late.
"A lot of people say, 'My time is valuable,’” Cyrus Peikari, an internist in Dallas, told reporters. “And physicians will charge no-show fees, for example, for $50. But, I think, to be truly just and fair, you have to go both ways."
Pediatrician William McAveney told Physicians Practice, via e-mail, that excessive waits usually happen for legitimate reasons, so he would not feel that sending a bill is appropriate.
“It does seem to me appropriate that there be a mechanism to evaluate issues of excessive wait times, and even offer some redress if it turns out that the patient was, e.g., put in an exam room and forgotten for a period of time due to poor office procedure,” he said.
We want to hear from you. Do you believe it’s fair to compensate patients who wait more than 30 minutes for an appointment? Post your reply below.
Disclosures
For pre-scheduled visits in primary care settings I feel reverse charging is appropriate or at the very least justifiable. Even more so if the practice has a reverse policy for charging for no-shows or patients that show up after their scheduled time. If the practice has a 2 strike then start charging policy for being late then you should understand how that could impact you and your visits. If you're prompt and late patients being seen is ok in the practice's eyes then you're signing up for late appointment start times because this is the environment that's being facilitated. If the practice stays consistent with their policies they shouldn't run late. With more cost shifting to the patient, more concern should be given to think of the patient as a client (if you're not doing this already). A client that can be lost with poor customer service or operating procedures. The practice did the right thing by respecting the value of their client's time. The same way if your cable guy is late you can call up & get free HBO for a year...
The simple method to over come long waits is to break the scheduling cycle into 4 or 6 segments (depends on the practice) and keeping a 10-15 min buffer end of each segment.
If things are going as schedule. Use the buffer to complete the administrative activities or just relax -
Warning!! You may become more efficient and relaxed provider when you take breaks. Life may improve!! So avoid it if you want to continue a stressful work-life. . . .
If the appointments are delayed due to items beyond control then the buffer will ease the pain of long waits.
If things are going as schedule. Use the buffer to complete the administrative activities or just relax -
Warning!! You may become more efficient and relaxed provider when you take breaks. Life may improve!! So avoid it if you want to continue a stressful work-life. . . .
If the appointments are delayed due to items beyond control then the buffer will ease the pain of long waits.
I disagree with the concept of patients billing a doctor for running late. The reason the clinic is running late is often due to circumstances beyond the doctor's control. Patients often have multiple problems that they want addressed in the same visit. Also patients do show up late and emergencies happen. If we are going to use this concept then patients will have to get used to the idea of only having a set time for their appointment. If the revisit is scheduled for 20 minutes then at 20 minutes regardless of what is left to cover the visit ends and the patient is free to schedule a second visit. Patients often only think of themselves and do not take into account what may be happening with other patients and the doctor's clinic. I spend has much time has the patient needs to address their medical issues and yes this does mean I run late. Each patient expects this but if it is them feeling inconvenienced then suddenly they get upset. If a patient wants to charge me for running late for legitimate reasons then it is best for them to find another doctor and see if they get the undivided attention they are demanding.
How about a 3 hour wait? This recently happened to me and I stepped out of the examination room and asked how much longer it was going to be because I had dentist appt that same day that I needed to get to. What was I told. Oh, he just got back from lunch and he'll be in in a few minutes. I waited another half hour before I got up and left to make my next appointment.
This is unacceptable to me.
There are always times when providers will run late because of the needs of the patients before them and/or an emergency.
These factors have to be considered and good communication with the front office can prevent such issues - some patients may prefer to reschedule their appointment if they know there is a particular problem that day. But most are glad to be told up front there will be an increased delay today.
However the provider that always runs late - that is a different story.
These factors have to be considered and good communication with the front office can prevent such issues - some patients may prefer to reschedule their appointment if they know there is a particular problem that day. But most are glad to be told up front there will be an increased delay today.
However the provider that always runs late - that is a different story.
As a practice management consultant we work with physicians and medical businesses to identify why patients have long wait times, amongst other things. What we frequently see is that the doctors, pa's, rn's, pt's, etc. do not organize their business and practices efficiently. As an example, a physician has an office in a hospital auxilary buildong, and the doctor mixes hospital patients with office patients. while tos might work if both patient types were in one place, but the doctor takes 5-10 minutes to walk back and forth, resulting in a loss of over 1 hour per day. We recommend that practice managers take a time management class to identify ways to b more efficient. We also recommend that a doctor keep track of why their patients are waiting for an extended time and offer the patient some type of reward for waiting.
The real key here is to not develop a reputation for being a "late"doctor, as patient behavior will essentially change to one of "Well the doctor is always an hour late, so I will be an hour late to my appointment" and thus we have the schedule creep we call it. People will adjust their behavior to the doctors, thus taking the control from the practice and giving it to the patient.
The real key here is to not develop a reputation for being a "late"doctor, as patient behavior will essentially change to one of "Well the doctor is always an hour late, so I will be an hour late to my appointment" and thus we have the schedule creep we call it. People will adjust their behavior to the doctors, thus taking the control from the practice and giving it to the patient.
Only if it's fair to halt the office encounter after the delegated 15 minutes. Should we start timing the interactions, say, like psychologists do??! In short, no...
Our practice tries very hard to let patients know if the physician is running more than 20 minutes late so they can reschedule if they want. When a patient is upset, I explain to them that we make every attempt to see sick children the same day instead of making them wait a few days to be seen. As a result we are sometimes running late and that when their child is sick, we will see them on the same day also. Our other choice is not to see any extra patients and stay on time. My experience has been parents prefer to wait and have their child seen rather then wait a few days and be seen on time. In all the years I have been in practice, I have only had one family transfer due to lateness. Most families are grateful for our same day policy.
I am a patient. Marissa is dreaming- she hasn't waited longer than 20 minutes? Where does she live? On Mars?
No. Not for 30 minutes. There are many reasons it might take longer to see patients. However, if the wait is longer than 45 minutes, the office staff should let patients know why there is a delay and give them an estimate of how long the wait will be.
Over 20 years ago, I had to wait over 3 hours- in that case, yes, reimburse me for my time. I threatened to bill the MD for the wait time. My next visit I was escorted into the exam room in 20 minutes - and preceded to wait 2 hours.
Where is the cut-off? Maybe an hour & perhaps a little longer for OB's who are delivering.
I am a patient and not a physician.
No. Not for 30 minutes. There are many reasons it might take longer to see patients. However, if the wait is longer than 45 minutes, the office staff should let patients know why there is a delay and give them an estimate of how long the wait will be.
Over 20 years ago, I had to wait over 3 hours- in that case, yes, reimburse me for my time. I threatened to bill the MD for the wait time. My next visit I was escorted into the exam room in 20 minutes - and preceded to wait 2 hours.
Where is the cut-off? Maybe an hour & perhaps a little longer for OB's who are delivering.
I am a patient and not a physician.
I believe the key here is to distinguish between "legitimate" reasons for lateness and a process that is designed to run late. While I have seen legitimate reasons -- unforeseen circumstances, emergencies, etc. -- I have more often seen a patient flow process that creates wait, through redundancies of work, unnecessary travel through a facility, functional silos, poor communication, inefficient work triggers, over-scheduling, batching of work (dictations, etc.) and other factors. This is the norm in our medical practices and we should admit that, not blame patients for wanting to spend a reasonable amount of time both with the doctor and waiting for him/her.
No one is saying a physician can't take whatever time is required to address a patient's need. But we shouldn't schedule patients in 15 minute blocks when 15 is the best we can ever do. We should either refine our process or adjust our schedule to reflect reality. Otherwise, patients will continue sending a bill.
No one is saying a physician can't take whatever time is required to address a patient's need. But we shouldn't schedule patients in 15 minute blocks when 15 is the best we can ever do. We should either refine our process or adjust our schedule to reflect reality. Otherwise, patients will continue sending a bill.
I think if patient's are going to charge physicians for being late; then we need to charge patients by time as well and leave the insurances out of the picture. Primary care should go back to a direct payer system and have patients submit the superbills for reimbursement from their insurance company.
Physicians have for too long acquiesced to insurance companies - to their payments, to their metrics, to their prior authorizations, to their demands for emr's and ebilling.
Why did we go into medicine? To treat the patient or listen to insurance companies? Who should we be accountable to? If it's the patient, then they should pay us and let the insurance company reimburse them.
The current 3rd party reimbursement system doesnt make sense anyway.
How can I spend 5 min removing splinter and charge hundreds of dollars; but if I deal with someone for 1hr for suicidal depression and charge $150. Makes no sense.
If we are too cowardly to separate ourselves from insurance, then we need to institute the one concern per visit rule to avoid losing money for patients who want to charge us. Personally, I would tell the patient that our therapeutic relationship has been nullified by her actions and it would be grounds for dismissal. I'm sure if she tried this tactic with other clinics, she would runout of clinics that would see her. Now if she found a concierge practice or a practice that billed by time, she would probably be fine.
Physicians have for too long acquiesced to insurance companies - to their payments, to their metrics, to their prior authorizations, to their demands for emr's and ebilling.
Why did we go into medicine? To treat the patient or listen to insurance companies? Who should we be accountable to? If it's the patient, then they should pay us and let the insurance company reimburse them.
The current 3rd party reimbursement system doesnt make sense anyway.
How can I spend 5 min removing splinter and charge hundreds of dollars; but if I deal with someone for 1hr for suicidal depression and charge $150. Makes no sense.
If we are too cowardly to separate ourselves from insurance, then we need to institute the one concern per visit rule to avoid losing money for patients who want to charge us. Personally, I would tell the patient that our therapeutic relationship has been nullified by her actions and it would be grounds for dismissal. I'm sure if she tried this tactic with other clinics, she would runout of clinics that would see her. Now if she found a concierge practice or a practice that billed by time, she would probably be fine.