Lawyers tend to charge by the hour. Should doctors?
BY Nathan Carroll & Adi Y. Segal
You pay an attorney hundreds of dollars per hour. You don’t pay doctors per hour. Should you?
If a doctor spends more time with you, the patient, that doesn’t mean a higher bill. For many medical practices, it means earning less.
What determines a doctor’s income? Procedures, RVU’s (Relative Value Units, or how Medicare reimburses physicians), ICD codes (International Statistical Classification of Diseases), and overhead.
Your fee is calculated when the doctor selects jargony labels — not in time spent with you. That leads doctors to spend nearly double their time pecking at the keyboard (52% of their workday) and half the time (27% of their day) with you.
Rather than schedule face-to-face interactions with the patient, providers prioritize inputting data into electronic medical records. That’s so the visit is properly documented, coded, and billed. But that leads to perverse incentives — with a divide between value-creating and revenue-generating activities.
Our med schools are training students to be great physicians. Yet our insurers are evaluating and reimbursing doctors with little regard to time.
With such a pricing structure, is it any wonder that our healthcare system system lacks price transparency and our physicians are burning out at a rapid pace?
Would that change if doctors made a living by spending time with patients?
Your physician could earn money by advising, diagnosing and treating you — instead of benefiting financially only from inputting procedures and codes (aka Medicare’s RVUs). And often, RVUs undervalue a physician’s time and energy.
Maybe we need to rethink how to approach medical reimbursement. A quick look at Econ 101 shows that time is our most valuable resource. It’s finite — you can’t create, mine, or buy more. Once it’s been used, it’s gone.
Consider how many more hours, minutes, seconds are left in your career. It’s no different for healthcare providers. Why are doctors only indirectly reimbursed for providing care? Why aren’t they paid for their time?
More time is what patients want from the their physicians, so why don’t we give them just that?
Patients value time, but how do doctors value theirs? Can you quantify the cost of each procedure or consultation in the day?
For providers: Try to see each procedure or patient visit through a price tag lens. How long does it take for a patient’s annual physical? How long does your nurse or secretary spend with the patient? On average, how much time do you want to spend with that patient for the physical? How much time does your staff spend with that patient? Figure out the timing — both for yourself and for your staff.
It’s time to earn a living based on your time. Your patients may prefer it.
Max Schindler contributed to this reporting.
Adi Y. Segal is the CoFounder and CEO of SeeThru.
Nathan Carroll is a medical student and MBA candidate at Rowan University. When not buried in the books, he is usually training in martial arts or playing with his dog. He can be reached at nate@seethru.healthcare.
