Sunday, January 26, 2014

Can Doctors Charge Late Fees?


I admit that I have a rudimentary knowledge of the business world, but I’m improving.  I now know, for example, that a C-suite does not refer to the procedure room where I do colonoscopies.  I am aware that executive coaching does not refer to advising top managers on their golf swing or tennis overhead.  I used to think that LLC stood for Long Live Colonoscopy, but now I know better.  CFO, Chief Flatulence Officer?

While patients and physicians operate under oral agreements, business agreements are generally established in writing.  In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop.  Oftentimes, the two parties do not agree that a contractual term has been violated.  This is when the fun begins.   With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a matter of several years after impoverishing both sides.

A common contractual feature is a requirement that goods and services be delivered on time and on budget.    A contractor might be subject to a penalty if his project is not completed by the agreed date.  This is a reasonable concept and serves as an incentive for on time performance.  In real life, this may not be as clean as it sounds.

Customer:  “You’re a week late so you owe me half a gazillion dollars.”
Contractor: “It’s not our fault that the city planner delayed us.  Go fight City Hall.”

Other professions are not subjected to financial incentives to deliver on time.  Consider our beloved airline industry where customers are hassled and fleeced before they are herded onto airplanes to sink into a seat narrower than most humans.   Air travel has delivered some celestial benefits to us.  It has increased our spirituality.  We pray that our luggage won’t arrive in the wrong continent.  We pray that our bottle of mouthwash in our carry-on bag won’t be confiscated.  (This critical security policy is from the same TSA brainiacs who initially gave a green light to bringing pen knives on board.) We fervently pray that the passenger seated in front of us will not lean his seat back while our tray table is down which would impale us. 

 Air Travel - More Relaxing than Root Canal

Shouldn’t the airlines be penalized when flights are delayed?  At present, they game the system by artificially lengthening the estimated travel time so that many flights will arrive ‘on time’ even when there are delays.   When a flight is delayed an hour, what loss do passengers incur?  Shouldn’t they be made whole for their loss?   Perhaps, an extra bag of honey roasted peanuts would mollify the restive crowd. 
On time performance is a live issue in the medical profession.

Do patients deserve to be compensated when physicians are late?  Should it depend upon the reason?  Is a delay because of a medical urgency non-compensable?  Should there be a no fault system where patients are compensated for delays regardless of the explanation?

Stand down readers.  This concept might work in both directions.  What pound of flesh should be exacted from patients who wander in late or simply fail to show up?  The latter occurs even when patients have been contacted the day prior to remind them of their solemn obligation to keep their appointments.  It is particularly vexing when a colonoscopy patient fails to show leaving us with nurses, a nurse anesthetist and a doctor with unscheduled time off that could have been used by another patient.

Insurance carriers will not permit physicians to charge patients who leave us flat.   It’s in our contract, a document that offers us no relief when these companies don’t deliver.

If you have suggestions on what should be done to late physicians or patients, you are encouraged to do so at this time.

5 comments:

Anonymous said...

I agree that both patients and physicians can be thoughtless and both need to be mindful of the value of the others' time. Establishing better physician-patient relationships and improving communications can be far more effective than trying to assess reciprocal fines, which necessarily require allocations of fault -- another impediment to better relationships.

I recently had an office appointment with a dermatologist. I arrived a few minutes early to fill out the requisite forms, then waited for nearly an hour, with no explanation from the front office. After advising the office manager that I couldn't wait any longer, I left. Two weeks later, I got a bill for a "missed appointment," to which I responded with a bill for my time at my current hourly rate. Of course, the relationship was irrevocably broken and I found another physician.

Patients understand that physicians must sometimes respond to emergencies and may get behind in their schedules. (Although that seems less likely for a dermatologist.) That information should be communicated to patients either before immediately after they arrive at the office so they can decide whether to wait or to reschedule. Similarly, patients need to be educated about the consequences of their failure to keep appointments, including, for repeat offenders, dismissal from the practice.

Michael Kirsch, M.D. said...

I appreciate your thoughtful, albeit anonymous comment. We don't want to fine anyone, but we are frustrated at how many folks simply do not show up, even when they are scheduled for a procedure, when we have nurses, a nurse anesthetist and me waiting for them. It's not only unfair to us, but deprives another patient of an appt slot that they could have used. Thanks again for commenting.

HARDworkingDERM said...

I am a dermatologist and do Mohs surgery. Let me educate "anonymous" about the unpredictability of Mohs surgery. This procedure is where the dermatologic surgeon acts as the surgeon and pathologist but removing the skin cancer and then reading the slide (i.e. looking for residual skin cancer). It is a laborious process. I have started cases in the morning only to have them go 10+ stages and then require tissue rearrangement for closure. I have been in the office taking additional samples at 10 pm. Thus, your underhanded comment ("seems less likely for a dermatologist") and tone seem to degrade what a dermatologist does. I believe you should have been billed for leaving the appointment. Did the physician leave? He or she would have stayed well beyond working hours to service your medical need. An appointment is more like a reservation -- you will get to see a physician. Get used to this arrangement with Obamacare recepients flooding our schedules.

Michael Kirsch, M.D. said...

I hope that 'anonymous' is "thick skinned"!

Anonymous said...

I certainly did not intend my comment to be an indictment of dermatologists or their practices. My point is that consideration is the obligation of both the patient and the practice, and that patients should be advised of a delay in their scheduled appointment times, just as patients should timely notify the practice if they are unable to keep an appointment.

An appointmnet is not a "reservation" to see a physician when he or she gets to the patient -- it is an agreement between the parties (patient and practice) to meet at a specified time. And as any good restaurant will tell you, even a reservation requires a specific time.

Finally, there is nothing in the Affordable Care Act that requires providers to schedule or treat more patients than they want. People who are considerate will continue to be considerate and those who are not . . . well, there's nothing any law can do about that.

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