- The payment amount is such that primary care offices have to limit visits to 15 or 20 minutes in order to schedule enough visits in a doctor’s day to cover the expense of running a practice, which includes staff salaries, rent and other overhead.
- The fee-for-service method does not pay offices for responding to phone calls or emails. For this reason, most practices reserve a small amount (if any) time on physicians’ schedules for non-visit care. Of course, physicians have to review lab results and contact patients about them, but explicitly allotting doctor time for such things would take away from the face-to-face visits that pay the practice.
- No time is reserved for another essential aspect of patient care: the documentation required in order to bill the payer. Electronic records have actually made that more cumbersome and time-consuming. Some documentation can be done during the visit: With practice, most of us can learn to look at the patient while typing, but the majority of the documentation simply must be done afterward—for instance, checking boxes for a certain number of physical exam findings, selecting numeric codes that represent problems, typing up a plan, etc.
Because of the fee-for-service method of payment, patients often find that they are asked to come in for many things that could be handled by phone or email. They also discover that, although they may have several concerns to discuss, the doctor may say to them (as many are trained to do): “We have time for one or two problems today. What’s on your mind?”
The reason my practice can allot time for things that don’t pay the bills: We charge insurance AND we have a membership fee.
How Membership-Based Practices Can Fix the Problem
My job today at a membership-based practice is much different from my old one. In a half day now, I have four to six 30-minute visits, plus a small amount of time set aside for phone calls and emails. And since visit times are longer, I can even fit in a call or email response between patients. Nowadays, I finish most clinic days feeling like I did an adequate job—which is great!
The reason my practice can allot time for things that don’t technically pay the bills: We charge insurance and we have a membership fee. It’s typically called a “per member, per month” fee, and it covers all the work that insurance doesn’t. Individual patients either pay for it or their employers do, and the price, which is based on age, ranges from $120 annually for minors up to $756 for those 70 and older.
There are other practices like ours, such as One Medical, which has offices in San Francisco, New York City, Washington, D.C., Boston and Chicago. A lot of pilot programs from both insurers and public payers are also moving in the same direction: