Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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KevinMD understands time
16 Apr2009
Paying doctors by the hour will increase the adoption of electronic medical records
Most health care wonks ignore the value of time. As a physician, time is our commodity. Consumers understand paying for time – we pay for plumbers, electricians, accountants, lawyers, golf instruction, etc – per unit time. Why do we pay physicians for visits? When you pay piecemeal, the incentive is to make more widgets – even if the widget is a good one rather than a superior one (unless you can collect more for the superior one.) In medicine we cannot collect more for doing a better job. It does not matter how patients define a great physician – bedside manner, knowledge, diagnostic acumen, performance indicators – we are all considered interchangeable parts. In patient care if I bring extra value, you are fortunate, but I collect the same amount as a brand new residency graduate, wet behind her ears.
So we churn out patients, too often spending suboptimal time which each patient. We cannot afford to spend time making EMRs work. We can hardly afford to spend time reading the literature. Please figure out how to pay us for our time rather than this inane billing system that we currently accept.
Related posts:
- Pulling primary care out of insurance
- And this is the point
- I disagree with @DrVal – retainer medicine is the answer
- 15 days at the VA – day 10
- Who will pay for the art?
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- In: Medical Rants
5 Responses to KevinMD understands time
Lynn M
April 17th, 2009 at 9:31 am
Hmmm…interesting concept. I have to wonder what this would do for 1) waiting room time.
2) physicians spending time to go over your history and listen to all your questions and concerns vs. how they interact with patients now.
3) the willingness for people to make doctors appointments.
Just to name a few concerns.
Matt
April 17th, 2009 at 10:26 am
“Please figure out how to pay us for our time rather than this inane billing system that we currently accept.”
Who are you asking to do this for you? Wouldn’t it be YOUR job to change the way YOU get paid?
country solo doctor
April 17th, 2009 at 8:01 pm
Paying me by the hour would be great. I have days where I start at 6 am and end at 6 PM, not including after hours calls from hospitals, nursing homes, and patients in the middle of the night. Much of medicine is free currently, despite the AMA having CPT codes for telephone calls, paperwork, and holiday work. I am paid the same to work Christmas and weekends as I am on any weekday. Where is my overtime and double time for working holidays and weekends? The only current way to give myself a raise is to figure out how to see more patients each day but at the same time trying not to short change my quality patients.
Currently I have around 20 health plans paying 20 different fees for the same care. The current medical system is not a functioning business, but it is made of large insurance companies taking money from business and consumers and throwing a few dollars toward physician office visits. Most of my patients pay more in copayments for 90 day Advair across a year than the cost of my 1-2 visits a year. Example for 09: one HMO has a $122 copayment every 90 days for Advair through the mail, meaning a patient pays $488 in copays to the mail order drug company annually. I see the well controlled patient with asthma an average of twice a year for a $25 copayment, meaning I get $50 from the patient and $55.44 from the insurance company total for the two office visits. The patient and his family pay thousands to the health insurance company. Who keeps the lion’s share of the premium? The greedy, for profit health insurance company.
Matt
April 19th, 2009 at 11:26 am
“Where is my overtime and double time for working holidays and weekends?”
If you’re working for yourself, you don’t necessarily get OT and double time. Most professionals who do charge by the hour don’t.
Stephen Drugs
April 20th, 2009 at 8:56 am
On one hand these policies are supposed to help prevent doctors from gauging the patient. What does the patient know about what needs fixing, or how long it should take?
But the reality is that the insurance companies need to make their cut, and I KNOW they make their cut. It doesn’t matter who they have to walk over to get it.
But like any good marketing department, they have to do it making you think you’re getting something for the money.
Something needs to be done! For both the Doctor’s sake and the Patients.