There is No Such Thing as a 10-Minute Office Visit
I will never forget something a patient told me several years ago when I was covering the front desk in a practice I was managing. If you manage a practice and haven’t worked at your check-in and check-out desks recently, I highly recommend it.
An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in the room for ten minutes!” I was briefly at a loss for words. I recovered, we agreed on a payment plan for her co-pay, I made a note on her encounter form for the billing office and she left.
I’ve been thinking about our conversation, and thinking about what that $100 – actually the payer would probably only pay about $35 and with her co-pay, the grand total would be $55 – and what that $55 is supposed to cover…
- First, we scheduled the appointment, which was a work-in, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
- When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID. An encounter form was generated at the nurse’s station to notify her of the patient’s arrival.
- The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief Chief Complaint and History of Present Illness, review the medications she is taking and check to see if she needed any chronic medication refills while she was there.
- The physician came in to see her, asked about any changes since she’d last been seen, reviewed her History of Present Illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.
- He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.
- He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.
- He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled. The chart was filed, and the encounter form was sent to the billing office.
- At the billing office the charges and any payment was posted and the claim was filed. If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.
- If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.
- Since the patient did not pay her co-pay at the check-out desk, the patient balance is billed to the patient. If the patient pays on the very first statement, it has taken the practice from 45 to 60 days to receive the complete payment of $55.
I know that patients often say “But he only spent 10 minutes with me.” Checking back with the provider, I find it was typically longer. Patients tend to underestimate the time as it goes very fast.
The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller. It took 8 people, and at least 45 minutes of work to make that appointment happen. Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.
The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable. It’s what we all want. And it isn’t cheap.
Even though healthcare and healthcare reimbursement have been sizzling hot topics in the past few years, most patients – already anxious and often sick – do not have a strong grasp of what actually goes into the services they receive. They see very little of the behind-the-scenes efforts. I don’t think the patient visit is necessarily the perfect time to educate patients on what goes into an office visit, but maybe each of us should be prepared to offer a meaningful answer when the patient says ““But he only spent 10 minutes with me.”
What folks need to understand is that you’re not paying for their time, you’re paying for their expertise. If you knew what was wrong with you (because you went through the trouble and rigor of attending Medical School) then you wouldn’t have to go through the process.
Here’s an example from another industry. I know a locksmith. He often is called out to open cars for people who have locked themselves out and he charges depending on the time of day, distance to travel (considering the price of gas these days) and threat-level of the neighborhood anywhere from $50 to $100 to open a car. One such encounter with a stranded motorist yielded this result:
– He arrives at the scene and quickly determines exactly what he needs to do to open the car door for the motorists’ type of vehicle.
– Retrieves his tools from his truck and in 30 seconds has the door opened.
– Motorist then decides that this process looked too easy and does not want to pay the fee that was agreed upon before the car was opened stating that he could not believe that they’re charging that much.
– The locksmith sympathetically said that yes, that’s what the fees are because of many factors.
– The motorist wasn’t pleased and refused to pay, so the locksmith threw the keys back in the car and re-locked it. Explained to the motorist that if it was so easy, why did he call him to begin with?
The point was, that the motorist wasn’t paying for the locksmith’s time, but rather for his expertise in opening cars. Same applies in healthcare. If the patient is competent enough to self-diagnose and write his own prescription, then why does he need the doctor at all?
Pay for the skills and knowledge… not the time!!
Thanks for the story – it’s a wonderful analogy to healthcare!
Wow- thank you so much for breaking this down! As a professional/licensed realtor in Marin County, I find myself often having to explain to my sellers and buyers the breakdown of the sales commission. Most people do not understand that I do not personally benefit from the entire amount. Putting these facts in perspective helps one gain a more objective outlook.
Perhaps a pamphlet of some sort is in order to help educate “our public”.
Thanks for the suggestion. Much more education is needed and much more transparency!
My GP usually takes two and one half hours and he is worth the wait. I take my I Pad and get caught up on all my mail
I have gone through this explanation of why healthcare costs so much- not to mention the long years of training for everyone to have the knowledge to provide the service in the least amount of time, but from the patient’s view, all they wanted was a couple of minutes with the doctor of his advice.
How much does the patient earn to pay for those 10 minutes?
With a complete electronic medical record system it indeed can take only 10 minutes or even less. And the receipt of payment can be less than a month. 6 patients an hour at $55 is a rate of $330hr. That’s between $400-600k a year if everyone does their jobs expeditiously. Hopefully, there are better paying procedures to balance that and a good payer-mix. If insurance pays well, we can feel less guilty about telling the patient the fee rate.
As a Practice Manager I found it was a tight budget to work with and still offer top quality services. Volume leads to exhaustion and mistakes. Not to mention how much overhead costs there are for the facility, utilities, equipment and supplies. Sometimes I think Health Insurance mostly pays for expensive hotel style rooms in NYC.
Still, I believe it is all worth it to get good healthcare. Add research and tests and treatments and I survive cancer and get to live a longer and healthier life. That’s one of my major priorities when looking at my budget!
Thank you for your comments.
Rather than “educate patients on what goes into an office visit”, let’s eliminate the waste that is non value add. The patient is willing to pay for the 10 minutes that the provider spent with them, not the 45 minutes that 8 other people spent.
In healthcare process improvement we are working to eliminate the waste. We are automating eligibility and address checking, providing kiosk check-in for patients who prefer that option, developing ways for patients to go directly to exam rooms upon arrival, putting scales in exam rooms for more private vitals collection, automating Rx refills directly from the pharmacy, etc. We are tracking patient wait times and consistently decreasing them.
While we will never be able to totaly eliminate all non value add activity, we can reduce it considerably.
Thank you for an excellent comment. We need to be making changes, not excuses.
Great article; breaks it down perfect! Thank you for the information.
I’m glad you liked it.
The commentator who said “The patient is willing to pay for the 10 minutes that the provider spent with them, not the 45 minutes that 8 other people spent.In healthcare process improvement we are working to eliminate the waste.” is missing the key ingredient about the system. We have thousands upon thousands of insurance companies that create this monster for no other reason than to profit financially. Even though most American consumers of care complain about the bureaucracy embedded in the system, they are unwilling or unable to accept the notion of one-payer system. By extension, their vote is essentially for a 10 minute visit with the doctor and perhaps 35 minutes with 6 people (instead of 8) who must handle one office visit. In family practice we can only WISH to average $55.00 per visit. I am just saying.
I know that it is difficult for patients to understand that part of the current insurance system is the significant administrative expense carried by the physician practice. Any patient who had the opportunity to observe what it takes to have a claim accepted and paid for in the US would be very, very surprised!
Thanks for your comment.