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Tuesday, November 5, 2013

I don't get paid for that

Ding!  Someone just pushed the wrong button for me, when I'm tired and cranky and low on sleep and still jet-lagged.  The question is in the handling of a bi-directional PHR, where the physician communicates with the patient, but the patient also has an opportunity to communicate with the physician:

Physicians don't get paid for that is a tired argument.

Physicians are in more control of what they get paid for than I as a patient am.  Physicians negotiate the rates that they get paid with various payers.  I'm not included in that loop, and unfortunately for me, other parties looking out for my best interests are in more control than I am in that negotiation.  I have a few choices about which insurers I can use, and I'm one of the lucky ones.  Some folks have precious little choice at all.

I'm not sympathetic to the complaint that physicians don't get paid for that. I pay for most non-preventative services out of my own pocket, based on prices physicians negotiate with someone else.

If you consider the cost to the physician of the three calls necessary to get a prescription refill in terms of office time, vs. the cost of an online patient update, and subsequent approval of the prescription in the office, that should be a no-brainer. And that's just the calls we made, there were two or three others from our pharmacy. There's no payment for that, but the change to the physicians bottom line should be obvious.

What about the repeated entering of all that history? WIth a bidirectional PHR, I could (and would) enter all that for them, every visit. Otherwise, they or someone else has to do it. They get paid for that, but it costs them more if they do than if I do it.

It is a matter of providing better service at lower cost, or providing the same level of service that we've been getting for the past decade with our costs continuing to rise. And, if it continues, other funding will dry up, because I'll leave the practice to find someone else who can provide better service.

The standard of care is changing. I tell my children to expect more than what I'm willing to put up with. When they need a doctor, they'll have greater expectations than I did when I moved in to my current neighborhood 16 years ago. And when I move again (soon), I'll be looking at what I desire in a physician (and their EHR system) in a whole new light. I likely won't change my primary care provider until then, but when I do, it will be a clean sweep with not just my primary, but the whole lot of physicians I interact with, on the basis of what services are provided, and what I want today.


If the attitude is I don't get paid for that, eventually, you won't get paid at all.  At least by me.

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