Comments on: How do patients define quality physicians? http://www.medrants.com/archives/4417 Contemplating medicine and the health care system Fri, 12 Mar 2010 16:17:54 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Roy M. Poses MD http://www.medrants.com/archives/4417/comment-page-1#comment-528283 Roy M. Poses MD Thu, 18 Jun 2009 20:58:32 +0000 http://www.medrants.com/?p=4417#comment-528283 Why do so many physicians regard 15 minute (and shorter) visits as inevitable? Such short visits are, as Dr Centor noted, a product of the system used for physician reimbursement. Practically, Medicare sets the payments, and nearly all insurance companies and managed care organizations simply follow the lead. Furthermore, Medicare gave control of payments to the opaque RBRVS Update Committee (RUC), which is dominated by specialists who do procedures. They then manipulated the system to increase payments for procedures, which has resulted in decreased payments for "evaluation and management services," including office visits. See our latest post on this subject on Health Care Renewal: http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html If we could fix the RUC, or eliminate its control of Medicare's payment system, we could come up with a more rational system that would allow us to spend more time with patients when they need us to do so. Why do so many physicians regard 15 minute (and shorter) visits as inevitable? Such short visits are, as Dr Centor noted, a product of the system used for physician reimbursement. Practically, Medicare sets the payments, and nearly all insurance companies and managed care organizations simply follow the lead. Furthermore, Medicare gave control of payments to the opaque RBRVS Update Committee (RUC), which is dominated by specialists who do procedures. They then manipulated the system to increase payments for procedures, which has resulted in decreased payments for “evaluation and management services,” including office visits.
See our latest post on this subject on Health Care Renewal:
http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html
If we could fix the RUC, or eliminate its control of Medicare’s payment system, we could come up with a more rational system that would allow us to spend more time with patients when they need us to do so.

]]> By: solo dr http://www.medrants.com/archives/4417/comment-page-1#comment-528217 solo dr Thu, 18 Jun 2009 01:30:27 +0000 http://www.medrants.com/?p=4417#comment-528217 Most office visits on routine patients with HTN or Diabetes can be done in 10-20 minutes. There are times I would like to spend 30-40 minutes with my patients, but the AMA makes a 99213 a suggested time of 15 minutes or 1-3 illnesses. Unlike an attorney or accountant, a doctor can't charge in 10 minute increments. Both charge for phone calls and emails. In my area, quality doctors, according to hospital administrtors and other doctors, are the ones who make lots of money by seeing 40+ patients a day and doing lots of procedures to make the hospitals wealthy. I personally don't see the conveyer belt medicine helping patients in the long term. I also find that my capitated colleagus are good at talking healthy patients out of screening colonosocpy after age 70 and are good at pushing the sickest patients onto other doctors to keep their efficiency and quality ratings high. Quality should not be measured in time but on outcomes. Providing rapid short visits has a risk of the doctor missing things. Only the large items will be addressed at each visit, max 1-3 things per visit and times is up. Most office visits on routine patients with HTN or Diabetes can be done in 10-20 minutes. There are times I would like to spend 30-40 minutes with my patients, but the AMA makes a 99213 a suggested time of 15 minutes or 1-3 illnesses. Unlike an attorney or accountant, a doctor can’t charge in 10 minute increments. Both charge for phone calls and emails.
In my area, quality doctors, according to hospital administrtors and other doctors, are the ones who make lots of money by seeing 40+ patients a day and doing lots of procedures to make the hospitals wealthy. I personally don’t see the conveyer belt medicine helping patients in the long term. I also find that my capitated colleagus are good at talking healthy patients out of screening colonosocpy after age 70 and are good at pushing the sickest patients onto other doctors to keep their efficiency and quality ratings high.
Quality should not be measured in time but on outcomes. Providing rapid short visits has a risk of the doctor missing things. Only the large items will be addressed at each visit, max 1-3 things per visit and times is up.

]]> By: amidoc http://www.medrants.com/archives/4417/comment-page-1#comment-528179 amidoc Wed, 17 Jun 2009 14:58:04 +0000 http://www.medrants.com/?p=4417#comment-528179 So is there any evidence out there which looks at how many physicians have one or all of those traits when patients were asked these questions regarding their own doctors? May be it will be good to know where the physicians are on these 7 traits for their patients. Obviously, their will also be a patient bias when they answer these questions depending upon thier experience. Also, you would expect every professional interaction (e.g a lawyer to client) to be similar; may be than we can compare how physicians fare in comparison to lawyers, nurses, other professionals etc........... So is there any evidence out there which looks at how many physicians have one or all of those traits when patients were asked these questions regarding their own doctors? May be it will be good to know where the physicians are on these 7 traits for their patients. Obviously, their will also be a patient bias when they answer these questions depending upon thier experience.

Also, you would expect every professional interaction (e.g a lawyer to client) to be similar; may be than we can compare how physicians fare in comparison to lawyers, nurses, other professionals etc………..

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