The pandemic has caused many changes. Many have not taken hold, but one has definitely taken hold. Telemedicine is booming in America. This golden age of electronic engagement has one big advantage. Unfortunately, this advantage has also proven to be telemedicine’s biggest problem. Although it is very convenient for patients to be able to contact their doctors by video visit, phone call, or email, doctors are overwhelmed by constant communication. All interactions, no matter how casual, now count as some form of “visit”.
At the beginning of the pandemic, telemedicine was lauded for: beginning of a revolution of medicinePatients quickly became adept at contacting their physicians using the online portal, frequently emailing them with simple questions and concerns between visits. But when in-person visits largely resumed, the volume of online messages increased. did not disappearIn fact, it didn’t even look like it was going down. And while a doctor’s daily schedule can alternate between video appointments and office visits, busy doctors have found little time for these small-scale communications.
Some doctors and medical systems have been started to stay afloat charge for many of their responsesOnce considered a standard part of care, these in-between interactions have been reconfigured as separate services, many of which require additional fees. is now only fiction.
When Jed Jacobson first contracted COVID in May, he started gathering information. How long will he have to isolate and how will he keep his two young children healthy? He told me he decided to make a quick call to his doctor and five minutes later he hung up satisfied. The next thing I noticed was that he had a $180 bill. His satisfaction evaporated.
For a patient, five minutes is an instant. For a doctor, her 5 minutes on the phone can result in a series of related tasks, such as reviewing patient charts, updating notes, ordering medications, tests, and referrals. Most doctors work in a healthcare system that uses “relative value units” to calculate how to get coverage. “You can think of it like a productivity point,” says Jay Holmgren, an assistant professor at the University of California, San Francisco. Asynchronous messaging research, said to me. In order to get paid, doctors have to do a certain amount of work. Since March 2020, billing for both synchronous telemedicine (i.e. video visits) and asynchronous telemedicine (emails and other online his messages) has been allowed by the majority of providers, Holmgren said. . His one explanation for billing for messages is that the health care system recognizes time spent responding as work, allowing doctors to answer questions without working off-duty hours, reducing the burden on patients. reduced or cut salaries. For private practices, messaging billing acts as self-accountability. When Reid Wilson, a physician in internal medicine and cardiology, ran a private practice, he rarely had time to answer or respond to phone calls and online messages by the end of his long workday. He feared they would be pushed away. “That’s why I paid the administration fee,” Wilson told me. “I was providing a service.” Of course, health systems and private practices are also businesses and benefit from new revenue streams.
Painfully high bills for seemingly small increases in health care costs nothing newSo why does the idea of charging $180 for a single call hit so hard? Some of the resistance may stem from differences in cost and value, writes Jeremy Greene, a physician and researcher at Johns Hopkins University. books on telemedicine, said to me. For example, Jacobsohn only called doctors to take responsibility and avoided using Twitter or Google as sole sources of information. Telemedicine certainly has the potential to replace face-to-face consultations, but when it’s just a quick phone call with a doctor to confirm what the patient already knows, especially if the patient himself is coughing. Paying the bill may feel like a waste of money…cash.
Jacobson paid a particularly high price for his insurance plan, but even if the insurance company bore the bill, being billed could still be uncomfortable. Doing has long been part of standard treatment. Paying for it is new. The disconnect between the patient’s past expectations and the new reality results in hidden costs of treatment. At the same time, a five-minute phone call is more work for doctors than many patients realize, but it can also be less satisfying than other types of visits. For some people, a physical visit to a doctor (either in person or via video call) is required to feel truly watched by a doctor.
Patients rate different types of doctor interactions differently. Burt Rosen, a patient advocate who works with two types of cancer, said: Call should be lower than that. ” If each of these services takes the same amount of time, due to certain logic, the charges should be the same. But for most people, it can’t be measured like that. “When televised consultations are not enough and cost as much as face-to-face consultations, you are effectively creating a substandard treatment regimen,” he said. This does not mean that telemedicine is substandard per se, but that paying for unsatisfactory telemedicine visits is more likely to register than paying for disappointing in-person visits. Even the supposed conveniences of telehealth may not be the panacea they once seemed to be. Create what counts as a full doctor’s appointment for a simple query that you can. “There were days when I was definitely pulling my hair out because of a little issue with telemedicine that I have,” she said.
Ultimately, these bills for every doctor encounter are a more honest representation of how healthcare works today than a friendly doctor can answer your questions as a free service. The field has long shifted towards corporatisation, away from the more genteel norms once associated with care. This latest trend is gradually eliminating one of the remaining areas that was not fully transactional. Yes, being a doctor means building meaningful and intimate relationships with your patients. But like many other jobs, being a doctor is becoming more and more standardized.
