Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, March 18, 2008

Yet Another Racket (or, Damn! I'm in the Wrong Specialty)

I sent a patient with a hard-to-figure-out autoimmune issue to a local rheumatologist a few weeks back. She came in today for (more) blood work and told me the following:

The specialist's first available appointment was April 22 (six weeks out.) That's par for the course around here, but what floored me was the demand to send a $75 check along with the required pre-visit paperwork, along with a deadline after which the appointment would be canceled if not received. The check would be returned to the patient at the time of the visit, and would only be cashed if she failed to keep the appointment.

(Patiently waiting until you pick your jaw up off the floor. I know it took me a while.)

I'm stunned.

I'm speechless.

Frankly I'm amazed they can get away with it. Hell, $75 is more than I get for a Level 3 Established patient visit!

I'm still shaking my head.

25 Comments:

At Tue Mar 18, 06:32:00 PM, Anonymous Anonymous said...

Too bad they don't have ED patients do the same thing. $75 at the triage desk, $0.00 back if your complaint isn't an emergency.

 
At Tue Mar 18, 07:17:00 PM, Anonymous Anonymous said...

Well, I guess that's one way to reduce no-shows. It probably would work. Our office bills $100 if they miss a comlete physical appointment. We don't always collect, but it gets their attention.

 
At Tue Mar 18, 07:35:00 PM, Blogger tk said...

Wow . . .

 
At Tue Mar 18, 08:29:00 PM, Anonymous Anonymous said...

Why is everybody surprised? I mean docs aren't any different then anybody that sells a product or service. They need to be paid. Docs don't do their medical stuff out of the goodness of their hearts..like a monk or nun or rabbi.
I always thought we should have charged $1.00 for any visit to the ER. I'm sure we could have eliminated some of the neer-do-wells!

Steve

 
At Tue Mar 18, 09:38:00 PM, Blogger Doctor David said...

That's staggering. I guess if they're booked for the next 6 weeks, they can afford to get away with crap like that. I would never have the audacity to even conceive of such behavior.

 
At Wed Mar 19, 03:19:00 AM, Anonymous Anonymous said...

Steve: I think Kaiser did a big study about that. They added a $5 copay, not for the money, but because it drastically reduced the number of appointments and visits. When something is free, it is undervalued.

 
At Wed Mar 19, 04:22:00 AM, Anonymous Anonymous said...

The only thing staggering about it is the demand for the rheum's services. It makes sense to do the check thing if you can get away with it. Patients are always unhappy about being kept waiting; well, one substantial part of that is having to overbook because you have no idea who's going to cancel and who's going to show. When you get an unexpected run of shows, boom, 45 minutes behind. Problem solved.

 
At Wed Mar 19, 07:54:00 AM, Anonymous Anonymous said...

send a $75 check from a closed account.

 
At Wed Mar 19, 08:02:00 AM, Blogger CrankyProf said...

I'd get behind this if the doc in question would PAY me $75 when s/he wanders in an hour late to an appointment that I booked six months in advance.

 
At Wed Mar 19, 11:13:00 AM, Anonymous Anonymous said...

i'd be interested in the rheum office's approach to contacting patients prior to their appointment.

we call 3 days ahead, if we get them, we call 1 day ahead again to remind them.
if we miss, we leave message, and call 2 days ahead and if we get them, we call 1 day ahead again.
if we left messages on day 3 and day 2 and haven't reached them and they haven't returned call, we call 1 day ahead asking them to call the morning of the appointment and confirm or cancel.
for the most part our no show rate is pretty low, maybe 1-2/day out of 6 docs. that doesn't mean patients aren't really late from another appointment or traffic or something, but the no contact no show is almost zero. it is really expensive to do this though.

 
At Wed Mar 19, 11:33:00 AM, Blogger IVF-MD said...

If this rheumatologist dares to institute such a policy, shouldn't it be his/her right to do so, even if they wanted to charge $375 to hold the appt? Because at some point it goes from being a gentle incentive to keep your appt to being a rude arrogant action and at that point, he/she will lose patients. It's a balance between how desirable and sought-after the care he/she provides is to how unattractive the down payment is. If I were a patient about to see a mediocre specialist, I might not even stand to put up $1.50 down payment. But if I were about to see someone who I judge would be the best and maybe only specialist around who could solve my problem, then I would even deposit $500 if asked. While I think it's a bad idea in general (my office doesn't do anything like this and we do have to absorb the occasional no-show), I also defend his right to do so, even if it is unwise on his/her part. =)

 
At Wed Mar 19, 11:43:00 AM, Anonymous Ian Furst said...

You're asking for payment with which you don't have a contract/relationship yet. It's their right not to show up, cancel the cheque and you would never be intitled to the money. Copay's definately cut down on utilization and money up front cuts down on no-show's -- the trade off is people will be less likely to refer to you. 6 weeks isn't that long of waiting list (come to Canada) I'd be careful of pissing of you're referring practitioners with such a heavy handed approach.
www.waittimes.blogspot.com

 
At Wed Mar 19, 12:13:00 PM, Anonymous Anonymous said...

i wonder whether payment by check(even if not cashed-as long as requested and received by physician) constitutes the start of a patient-physician legal relationship?

 
At Wed Mar 19, 12:51:00 PM, Anonymous Anonymous said...

$75 is a bargain if it gets me face time with an internist who doesn't overbook for with insurance assembly line "No shows."

If this guy is good enough, it is worth every penny, and I will GLADLY pay!

 
At Wed Mar 19, 01:21:00 PM, Blogger The Independent Urologist said...

I'm not the least bit surpised. Actually, I thought of soing the same a while back for my evening and Saturday hours which are the most sought after and no-showed time slots simultaneously. Though I'd have requested a CC number.

 
At Wed Mar 19, 01:35:00 PM, Blogger feminizedwesternmale said...

Man, I frickin' love you.

AND is why I read medical blogs.

 
At Wed Mar 19, 09:39:00 PM, Anonymous Anonymous said...

Why wouldn't they get away with it? You have to prepay to get a hotel to hold a room for you or to hold a seat on an airline. I prepay to hold my kids place in private school, in their sports programs, and in church activities. How is a time slot on a professional's calender any different?

I find that the guys who are shocked and speechless are usually the next one to adopt these things if they perceive and advantage.

I can see where this especially makes sense for someone who has to book a large block of time. My wife consulted a Rheumatologist. He spent a full 60 minutes with her face to face doing a thorough interview with complete ROS. If she had not shown up he would been financially hurt as he does not do this. If he has a no show problem, he should.

 
At Wed Mar 19, 09:43:00 PM, Anonymous Anonymous said...

Ultimately this should result in better and cheaper service due to reducing the financial losses and poor time management associated with thoughtless no shows.

It also weeds out those who resent paying for medical care and who don't consider an appointment a commitment to be kept.

 
At Wed Mar 19, 10:40:00 PM, Anonymous Anonymous said...

I actually think it is fair and a good idea. Here's why:

The doctor is asking for a commitment to an appointment. A lot of people shop around for the initial appointment but forget to cancel. This way they will remember that they made an appointment. I'm sure that other people pull the no-show act, but it's probably worse if you haven't established a relationship in the first place.

I recall a few years ago being referred to a specialist whose wait for new patients was 4 weeks out. My schedule was fairly flexible at the time so I asked to be put on a waitlist for any last minute cancellations. I received two calls for appointments which I couldn't take- because the other person cancelled a couple of hours before the time and by the time I recieved the message I wouldn't have been able to fight traffic, find parking and get there on time. This was a loss of income to the doctor and a loss of opportunity for me.

I say ask for the 'appointment reminder fee' and save the overhead on the 2-3 reminder phone calls. Ultimately, I think the check thing would keep costs down.

 
At Wed Mar 19, 11:38:00 PM, Anonymous Anonymous said...

I hear a discrepancy. On the one hand, there is a complaint the wait was too long to see a rheumatologist. On the other hand, there is a complaint about something which is being done to try to free up more new patient slots and shorten the waiting list.
I am a rheumatologist, and every day I have one to two new patient no-shows with no cancellation notification (we do give appointment reminder phone calls). Because of this, patients on the waiting list are missing the chance to be seen sooner. I lose a lot more than $75. I lose a potential level 4 new patient consult, along with future follow up visits. Or, I lose 4 to 5 return visits that could be put in a new visit slot. That is a lot of money to lose while at the same time I am paying my staff to be there while there is no patient. I don’t want to double book slots, because many new rheumatology visits are complex and need 45 minutes to an hour.
To turn it around, why should we accept the behavior of people who make appointments and choose not to show up without the courtesy of cancelling them? With patient rights come responsibilities. While there are rare emergencies explaining a no-show, most no-shows are patients not treating their visit as important. As a patient myself, I am embarrassed if I miss an appointment, not indignant about a no-show fee. Although we do not have such a policy, I support it. If patients decide to go elsewhere, then the process will self select a practice of responsible patients. If you act as if appointments are optional, and double book patients expecting no-shows, then patients will follow suit in their attitudes. What would the no-show rate of a hotel be if there was no down payment and cancellation policy?

 
At Fri Mar 21, 04:13:00 AM, Anonymous Anonymous said...

Dr. Dino, As a specialist (neurology), I am booked six weeks out. Not because I am so busy, but because I spend a lot of time with every new patient. Each new patient gets an hour face to face with me. My staff spends at least 30 to 60 minutes getting authorization. After the visit, I spend more time coordinating care. If a patient no shows, I lose way more than $75.00. So why are you surprised, when a patient doesn't take the time to call and cancel their appointment?

 
At Fri Mar 21, 04:16:00 AM, Anonymous Anonymous said...

I guess you are a Dinosaur- get a clue!!!!

 
At Fri Mar 21, 08:05:00 PM, Blogger Midwife with a Knife said...

I actually think it's probably a good idea. Each slot is worth money. If you make an appointment and then no-show at the last minute, you have made it so the rheumatologist does not have the opportunity to make money off of that slot. And with overhead, etc. what it is.....

I say good for him, as long as people put up with it, but the caveat is that he might find that they don't.

And it may actually help to decrease overbooking and increase face-time with patients. And that would be good for everybody.

 
At Fri Mar 28, 10:03:00 AM, Blogger Dkswife said...

I think that is a wonderful ideaas long as they would agree to reimbursing me compounded interest for every minute over my scheduled visit that I have to wait on them. I think I could become rich! :)

 
At Sat Jun 21, 11:13:00 PM, Anonymous Anonymous said...

I don't understand you. One moment you're writing like a good little uber-capitalist USAian, the next you're worrying about the ethics of a perfectly reasonable measure to avoid losing money and having long waiting lists.

 

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