Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 In judging patients, we have to consider our own behavior. What makes US open the wallet ? What is important for us ?For example, I have been postponing my own pap for one year now because 1) it hurts 2) I have to spend 30 minutes in the waiting room 3) I have to play phone tag with the secretary 4) I know I am low risk.Medical visits are not desirable because they usually unveil an "inconvenient truth" about ourselves and sometimes are associated with pain, anxiety and bad news. You will rather pay for something that gives you pleasure than for something that makes you uncomfortable. On top of that, the presence of a third party payor has eroded the normal feeling of responsibility that you have when you purchase a service. My cash patients are the best patients I have because they value my service the most. We devalued our services when we entered into contracts with insurance companies and now it is difficult to escape.We can change the public opinion and push for political reform but I know one thing : unless they will be really stubborn about it, I will not guide any of my three children towards medical school.Anemaria LutasYes, yes, yes…. And I know my patient’s pay similarly for services and products that they value. Personally, I don’t have satellite or cable and have to do pay-as-you-go thing for HVAC repair…Last year, when Medicare didn’t pay me for 6 months, we did without AC until August because we didn’t have the money for repairs…. I wish we could do some real research on human behavior in regard to this subject. You and I can argue all day that it is only fair that we be paid fairly, that people obviously have money if they can pay $90 per month for cable (what a patient told me he pays the other day)or they can drop $250 cash to take their dog to the doggie Urgent Care Clinic, or they pay $80 for a visit to the hair salon…. So it seems that paying for medical care should not be that big a deal, but reality: IT IS LIKE PULLING TEETH. There is something that makes otherwise reasonable people believe that it is somehow WRONG for them to have to pay money when they come to see me. Or for service that doesn’t involve coming in. Very few people are willing to pay anything beyond the copay and coinsurance, and they make me wait months for the coinsurance. I stayed late at the office last night writing letters to about 20 medicare patients who are now >90 days on their deductibles that they owe me. I seriously would like to research this somehow… One interesting observation: Recently I bought 100 copies of that little HSA book “Healthcare Happily Ever After”, the price was subsidized (by Farm Bureau I think) on the condition that the books NOT be resold. OK, fine, I’m not selling them. But I put 3 or 4 in the waiting room at a time and several people have asked if they could have one. It’s a small trade paperback of 88 pages. In a store, I would expect to pay $4.95 for something similar. I, and my office helpers, have told people quite plainly that they aren’t for sale, but we would really appreciate a small donation of a dollar or two to offset the fact that I did have to pay for them. But if they feel that a dollar is too much, they can have one for free. This just floors me, but 100% of people have declined to take one at all, free or for a buck…and this conversation take place while they are pulling a $5 out to tip the valet driver when they get their car. Similar experience last Christmas: I make some killer toffee, and after they tasted it, a number of workers in my office building asked if they could buy batches from me to give a Christmas gifts. Fine, I sold a bunch to office employees. I thought,maybe patients would also buy some. Similar product from mail order companysells for $15/lb. I priced mine at $5 for 12 oz and packed it up in little gift baskets. Although patients would stand at the front desk and eat the entire plate of samples, exclaiming the whole time how delicious it was, NOT A SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal bought, the drug reps (and I don’t even see reps) bought, the janitors bought. But patients….they’d take all the free samples I put out, but they would not pay a penny to buy in my office. WHY IS THAT??? What are we missing about human behavior? Annie Re: emails from patients> > Online communication is the new "platform" of communication with> patients. I started giving my email to all my patients in 1997 and have> not looked back. I answer online health questions every day for> Revolution Health and eDocAmerica. It makes access to health care> communication continuous for our patients. You should have an access> fee to cover this service. Remember, $30 a month for 1000 patients is> $360,000 a year.> > Don't do anything by email that should be done in person, or even over> the phone. Email is a nice way to set up telephone appointments (again,> get paid for this). I predict in the near future we will handle more> than 60% of our daily patient communications online, reserving time for> relaxed and professional visits and telephone calls as needed.> > Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal"> through eDocAmerica to add this service. That way it is done through a> secure website meeting recommended HIPAA standards.> > Joe> > ph E. Scherger, MD, MPH> Clinical Professor> University of California, San Diego> Medical Director, AmeriChoice> 8840 Complex Dr. Suite 300> San Diego, CA 92123> Phone: > Fax: > JScherger@...> > >>> "Annie Skaggs" 6/11/2007 9:25:44 AM> >>>> > This is an actual email that I got from a patient. I do not have an> "e-visit" policy per se, and have not jumped on putting one in place> because local insurers are not paying anything on "virtual visits"> anyway, but more and more I get this sort of thing. How are you guys> handling this? Do you just tell everyone they need a visit? Do you> answer the emails with a link to something like the Mayo Clinic website> and say "come to the office if that doesn't answer your question"> I'm currently getting one like this every few days and it's getting out> of hand.> Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM> this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim> is now. I have had iron-poor blood in the past, and wondered if the> aspirin would affect that. I only know this because they wouldn't let me> donate blood a couple of times. Anyway, I told mom I was going to check> with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 I agree. Put that fancy label under your name, like "Oh, you know, that's the fancy doctor that does that fancy care and I become special because I go to that special doctor..." and you will be valued. Not that I'm doing it, I am too shy and lack self-confidence but the older I get, the more I manage to get rid of my east-european timidness. Nobody wants to pay for medical care. But, many people will pay for a close relationship with you. As they say in the Mastercard commercials, your relationship is "priceless". Don't just give yourself away. Of course not everyone will pay (what 80% of people can easilty afford). Many will choose what what they (do not) pay for, frustrating health care. You offer something very special as an IMP. Be valued for it. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> "Annie Skaggs" 6/14/2007 7:21 AM >>> Yes, yes, yes…. And I know my patient’s pay similarly for services and products that they value. Personally, I don’t have satellite or cable and have to do pay-as-you-go thing for HVAC repair…Last year, when Medicare didn’t pay me for 6 months, we did without AC until August because we didn’t have the money for repairs….I wish we could do some real research on human behavior in regard to this subject. You and I can argue all day that it is only fair that we be paid fairly, that people obviously have money if they can pay $90 per month for cable (what a patient told me he pays the other day)or they can drop $250 cash to take their dog to the doggie Urgent Care Clinic, or they pay $80 for a visit to the hair salon…. So it seems that paying for medical care should not be that big a deal, but reality: IT IS LIKE PULLING TEETH. There is something that makes otherwise reasonable people believe that it is somehow WRONG for them to have to pay money when they come to see me. Or for service that doesn’t involve coming in. Very few people are willing to pay anything beyond the copay and coinsurance, and they make me wait months for the coinsurance. I stayed late at the office last night writing letters to about 20 medicare patients who are now >90 days on their deductibles that they owe me.I seriously would like to research this somehow…One interesting observation: Recently I bought 100 copies of that little HSA book “Healthcare Happily Ever After”, the price was subsidized (by Farm Bureau I think) on the condition that the books NOT be resold. OK, fine, I’m not selling them. But I put 3 or 4 in the waiting room at a time and several people have asked if they could have one. It’s a small trade paperback of 88 pages. In a store, I would expect to pay $4.95 for something similar. I, and my office helpers, have told people quite plainly that they aren’t for sale, but we would really appreciate a small donation of a dollar or two to offset the fact that I did have to pay for them. But if they feel that a dollar is too much, they can have one for free. This just floors me, but 100% of people have declined to take one at all, free or for a buck…and this conversation take place while they are pulling a $5 out to tip the valet driver when they get their car.Similar experience last Christmas: I make some killer toffee, and after they tasted it, a number of workers in my office building asked if they could buy batches from me to give a Christmas gifts. Fine, I sold a bunch to office employees. I thought, maybe patients would also buy some. Similar product from mail order company sells for $15/lb. I priced mine at $5 for 12 oz and packed it up in little gift baskets. Although patients would stand at the front desk and eat the entire plate of samples, exclaiming the whole time how delicious it was, NOT A SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal bought, the drug reps (and I don’t even see reps) bought, the janitors bought. But patients….they’d take all the free samples I put out, but they would not pay a penny to buy in my office. WHY IS THAT???What are we missing about human behavior?Annie Re: emails from patients> > Online communication is the new "platform" of communication with> patients. I started giving my email to all my patients in 1997 and have> not looked back. I answer online health questions every day for> Revolution Health and eDocAmerica. It makes access to health care> communication continuous for our patients. You should have an access> fee to cover this service. Remember, $30 a month for 1000 patients is> $360,000 a year.> > Don't do anything by email that should be done in person, or even over> the phone. Email is a nice way to set up telephone appointments (again,> get paid for this). I predict in the near future we will handle more> than 60% of our daily patient communications online, reserving time for> relaxed and professional visits and telephone calls as needed.> > Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal"> through eDocAmerica to add this service. That way it is done through a> secure website meeting recommended HIPAA standards.> > Joe> > ph E. Scherger, MD, MPH> Clinical Professor> University of California, San Diego> Medical Director, AmeriChoice> 8840 Complex Dr. Suite 300> San Diego, CA 92123> Phone: > Fax: > JScherger@...> > >>> "Annie Skaggs" 6/11/2007 9:25:44 AM> >>>> > This is an actual email that I got from a patient. I do not have an> "e-visit" policy per se, and have not jumped on putting one in place> because local insurers are not paying anything on "virtual visits"> anyway, but more and more I get this sort of thing. How are you guys> handling this? Do you just tell everyone they need a visit? Do you> answer the emails with a link to something like the Mayo Clinic website> and say "come to the office if that doesn't answer your question"> I'm currently getting one like this every few days and it's getting out> of hand.> Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM> this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim> is now. I have had iron-poor blood in the past, and wondered if the> aspirin would affect that. I only know this because they wouldn't let me> donate blood a couple of times. Anyway, I told mom I was going to check> with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 I agree. Put that fancy label under your name, like "Oh, you know, that's the fancy doctor that does that fancy care and I become special because I go to that special doctor..." and you will be valued. Not that I'm doing it, I am too shy and lack self-confidence but the older I get, the more I manage to get rid of my east-european timidness. Nobody wants to pay for medical care. But, many people will pay for a close relationship with you. As they say in the Mastercard commercials, your relationship is "priceless". Don't just give yourself away. Of course not everyone will pay (what 80% of people can easilty afford). Many will choose what what they (do not) pay for, frustrating health care. You offer something very special as an IMP. Be valued for it. Joe ph E. Scherger, MD, MPHClinical ProfessorUniversity of California, San DiegoMedical Director, AmeriChoice8840 Complex Dr. Suite 300San Diego, CA 92123Phone: Fax: JScherger@...>>> "Annie Skaggs" 6/14/2007 7:21 AM >>> Yes, yes, yes…. And I know my patient’s pay similarly for services and products that they value. Personally, I don’t have satellite or cable and have to do pay-as-you-go thing for HVAC repair…Last year, when Medicare didn’t pay me for 6 months, we did without AC until August because we didn’t have the money for repairs….I wish we could do some real research on human behavior in regard to this subject. You and I can argue all day that it is only fair that we be paid fairly, that people obviously have money if they can pay $90 per month for cable (what a patient told me he pays the other day)or they can drop $250 cash to take their dog to the doggie Urgent Care Clinic, or they pay $80 for a visit to the hair salon…. So it seems that paying for medical care should not be that big a deal, but reality: IT IS LIKE PULLING TEETH. There is something that makes otherwise reasonable people believe that it is somehow WRONG for them to have to pay money when they come to see me. Or for service that doesn’t involve coming in. Very few people are willing to pay anything beyond the copay and coinsurance, and they make me wait months for the coinsurance. I stayed late at the office last night writing letters to about 20 medicare patients who are now >90 days on their deductibles that they owe me.I seriously would like to research this somehow…One interesting observation: Recently I bought 100 copies of that little HSA book “Healthcare Happily Ever After”, the price was subsidized (by Farm Bureau I think) on the condition that the books NOT be resold. OK, fine, I’m not selling them. But I put 3 or 4 in the waiting room at a time and several people have asked if they could have one. It’s a small trade paperback of 88 pages. In a store, I would expect to pay $4.95 for something similar. I, and my office helpers, have told people quite plainly that they aren’t for sale, but we would really appreciate a small donation of a dollar or two to offset the fact that I did have to pay for them. But if they feel that a dollar is too much, they can have one for free. This just floors me, but 100% of people have declined to take one at all, free or for a buck…and this conversation take place while they are pulling a $5 out to tip the valet driver when they get their car.Similar experience last Christmas: I make some killer toffee, and after they tasted it, a number of workers in my office building asked if they could buy batches from me to give a Christmas gifts. Fine, I sold a bunch to office employees. I thought, maybe patients would also buy some. Similar product from mail order company sells for $15/lb. I priced mine at $5 for 12 oz and packed it up in little gift baskets. Although patients would stand at the front desk and eat the entire plate of samples, exclaiming the whole time how delicious it was, NOT A SINGLE BATCH SOLD TO PATIENTS. The mail man bought, the UPS gal bought, the drug reps (and I don’t even see reps) bought, the janitors bought. But patients….they’d take all the free samples I put out, but they would not pay a penny to buy in my office. WHY IS THAT???What are we missing about human behavior?Annie Re: emails from patients> > Online communication is the new "platform" of communication with> patients. I started giving my email to all my patients in 1997 and have> not looked back. I answer online health questions every day for> Revolution Health and eDocAmerica. It makes access to health care> communication continuous for our patients. You should have an access> fee to cover this service. Remember, $30 a month for 1000 patients is> $360,000 a year.> > Don't do anything by email that should be done in person, or even over> the phone. Email is a nice way to set up telephone appointments (again,> get paid for this). I predict in the near future we will handle more> than 60% of our daily patient communications online, reserving time for> relaxed and professional visits and telephone calls as needed.> > Mimi Doohan, an model IMP in Santa Barbara, has just set up "eDocLocal"> through eDocAmerica to add this service. That way it is done through a> secure website meeting recommended HIPAA standards.> > Joe> > ph E. Scherger, MD, MPH> Clinical Professor> University of California, San Diego> Medical Director, AmeriChoice> 8840 Complex Dr. Suite 300> San Diego, CA 92123> Phone: > Fax: > JScherger@...> > >>> "Annie Skaggs" 6/11/2007 9:25:44 AM> >>>> > This is an actual email that I got from a patient. I do not have an> "e-visit" policy per se, and have not jumped on putting one in place> because local insurers are not paying anything on "virtual visits"> anyway, but more and more I get this sort of thing. How are you guys> handling this? Do you just tell everyone they need a visit? Do you> answer the emails with a link to something like the Mayo Clinic website> and say "come to the office if that doesn't answer your question"> I'm currently getting one like this every few days and it's getting out> of hand.> Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM> this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim> is now. I have had iron-poor blood in the past, and wondered if the> aspirin would affect that. I only know this because they wouldn't let me> donate blood a couple of times. Anyway, I told mom I was going to check> with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 anemaria nails it i think patietns keep cigaettes and cars and cell phones becasue they derive pleasure from those What's the pleaseure in waiting 30 min to gat a painful exam that will bring bad news or get you nagged at huh? NO WOnder people do not spend money on health care when it is out of pocket. duh. I do think that people should pay me for perfroming a servoce I strongly belive that BUT given the service I happen to provide for a living ain't gonna ahppen So third party payors- god I hate that word-are where its at. The problem is to reform t eh payment system so it is fair to all patietns all docotrs and gets folks to effective care Don't get me started My lap top keeps shutting off The phone will take no incoming calls only outgoing andthe VFC lady fromthe state wants me to give her temperture logs for months that have long since gone by I need drugs today where IS that discussion about online drugs when I needit and the second part is the culture . insurancs have led people to think they have to have insurance for years now, e ven though it is laregly a worhltess prodcut now -peopel resetn pay as you go and regard having someone pay for medical care assomthing to be entitiled to-- so they have as patietns largely paid through the nose to get that plastic card they feel entitled to not have to pay cash out of pocket Culturally constant new tests and meds are waved in front of people so they want them .They want consumer products also and frankly they are NOT paying for them either! Many folks are running up huge debt to get the things they want, but not paying .Paying cash hurts plunking down plastic doesn ot so people accumulate painlessly Alot of it is culture. Cheer everyone up did I?? Re: emails from patients > > Online communication is the new " platform " of communication with > patients. I started giving my email to all my patients in 1997 and have > not looked back. I answer online health questions every day for > Revolution Health and eDocAmerica. It makes access to health care > communication continuous for our patients. You should have an access > fee to cover this service. Remember, $30 a month for 1000 patients is > $360,000 a year. > > Don't do anything by email that should be done in person, or even over > the phone. Email is a nice way to set up telephone appointments (again, > get paid for this). I predict in the near future we will handle more > than 60% of our daily patient communications online, reserving time for > relaxed and professional visits and telephone calls as needed. > > Mimi Doohan, an model IMP in Santa Barbara, has just set up " eDocLocal " > through eDocAmerica to add this service. That way it is done through a > secure website meeting recommended HIPAA standards. > > Joe > > ph E. Scherger, MD, MPH > Clinical Professor > University of California, San Diego > Medical Director, AmeriChoice > 8840 Complex Dr. Suite 300 > San Diego, CA 92123 > Phone: > Fax: > JScherger@... > > >>> " Annie Skaggs " 6/11/2007 9:25:44 AM > >>> > > This is an actual email that I got from a patient. I do not have an > " e-visit " policy per se, and have not jumped on putting one in place > because local insurers are not paying anything on " virtual visits " > anyway, but more and more I get this sort of thing. How are you guys > handling this? Do you just tell everyone they need a visit? Do you > answer the emails with a link to something like the Mayo Clinic website > and say " come to the office if that doesn't answer your question " > I'm currently getting one like this every few days and it's getting out > of hand. > Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM > this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim > is now. I have had iron-poor blood in the past, and wondered if the > aspirin would affect that. I only know this because they wouldn't let me > donate blood a couple of times. Anyway, I told mom I was going to check > with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 anemaria nails it i think patietns keep cigaettes and cars and cell phones becasue they derive pleasure from those What's the pleaseure in waiting 30 min to gat a painful exam that will bring bad news or get you nagged at huh? NO WOnder people do not spend money on health care when it is out of pocket. duh. I do think that people should pay me for perfroming a servoce I strongly belive that BUT given the service I happen to provide for a living ain't gonna ahppen So third party payors- god I hate that word-are where its at. The problem is to reform t eh payment system so it is fair to all patietns all docotrs and gets folks to effective care Don't get me started My lap top keeps shutting off The phone will take no incoming calls only outgoing andthe VFC lady fromthe state wants me to give her temperture logs for months that have long since gone by I need drugs today where IS that discussion about online drugs when I needit and the second part is the culture . insurancs have led people to think they have to have insurance for years now, e ven though it is laregly a worhltess prodcut now -peopel resetn pay as you go and regard having someone pay for medical care assomthing to be entitiled to-- so they have as patietns largely paid through the nose to get that plastic card they feel entitled to not have to pay cash out of pocket Culturally constant new tests and meds are waved in front of people so they want them .They want consumer products also and frankly they are NOT paying for them either! Many folks are running up huge debt to get the things they want, but not paying .Paying cash hurts plunking down plastic doesn ot so people accumulate painlessly Alot of it is culture. Cheer everyone up did I?? Re: emails from patients > > Online communication is the new " platform " of communication with > patients. I started giving my email to all my patients in 1997 and have > not looked back. I answer online health questions every day for > Revolution Health and eDocAmerica. It makes access to health care > communication continuous for our patients. You should have an access > fee to cover this service. Remember, $30 a month for 1000 patients is > $360,000 a year. > > Don't do anything by email that should be done in person, or even over > the phone. Email is a nice way to set up telephone appointments (again, > get paid for this). I predict in the near future we will handle more > than 60% of our daily patient communications online, reserving time for > relaxed and professional visits and telephone calls as needed. > > Mimi Doohan, an model IMP in Santa Barbara, has just set up " eDocLocal " > through eDocAmerica to add this service. That way it is done through a > secure website meeting recommended HIPAA standards. > > Joe > > ph E. Scherger, MD, MPH > Clinical Professor > University of California, San Diego > Medical Director, AmeriChoice > 8840 Complex Dr. Suite 300 > San Diego, CA 92123 > Phone: > Fax: > JScherger@... > > >>> " Annie Skaggs " 6/11/2007 9:25:44 AM > >>> > > This is an actual email that I got from a patient. I do not have an > " e-visit " policy per se, and have not jumped on putting one in place > because local insurers are not paying anything on " virtual visits " > anyway, but more and more I get this sort of thing. How are you guys > handling this? Do you just tell everyone they need a visit? Do you > answer the emails with a link to something like the Mayo Clinic website > and say " come to the office if that doesn't answer your question " > I'm currently getting one like this every few days and it's getting out > of hand. > Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM > this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim > is now. I have had iron-poor blood in the past, and wondered if the > aspirin would affect that. I only know this because they wouldn't let me > donate blood a couple of times. Anyway, I told mom I was going to check > with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 We (healthcare in general and IMP's in particular) need good commercials just like the drug companies and auto makers (... etc) have commercials so people will think that if they pay for our services they'll be good looking, have more free time, be popular, be sexy, be happy, get rich and have sex whenever they want it. ;-) All joking aside, this is serious -- people pay for what they THINK they are getting and not what it's real value is. It's the emotion and profound feelings people have that draw them to purchase things. It's like the " perceived " doctor shortage comment earlier; even if there are enough docs, if people perceive a shortage, more of them will be willing to pay. How to proceed? I don't know... but finish my last note for the pt with DM/htn/esoph reflux/obesity, then submit the claim to insurance and wait to get paid ($93) for the 50 minutes I spent doing the work of her care (including lab follow up etc) ... all the while I walk to the bank this afternoon to deposit the check from this morning's Botox treatment (25 min casual appt with no work outside of appt) and pay other bills. .... did someone say the system is broken? Tim PS - LL " the enforcer " , I'd change the subject line, but I'm not sure what to call this thread at this point! ;-) -- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. > anemaria nails it i think > patietns keep cigaettes and cars and cell phones becasue they derive > pleasure from those > What's the pleaseure in waiting 30 min to gat a painful exam that > will bring bad news or get you nagged at huh? > NO WOnder people do not spend money on health care when it is out of > pocket. duh. > I do think that people should pay me for perfroming a servoce I strongly > belive that > BUT given the service I happen to provide for a living ain't gonna > ahppen So third party payors- god I hate that word-are where its at. > The problem is to reform t eh payment system so it is fair to all > patietns all docotrs and gets folks to effective care > > Don't get me started My lap top keeps shutting off The phone will take > no incoming calls only outgoing andthe VFC lady fromthe state wants me > to give her temperture logs for months that have long since gone by > I need drugs today where IS that discussion about online drugs when I > needit > > > > and the second part is the culture . insurancs have led people to think > they have to have insurance for years now, e ven though it is laregly a > worhltess prodcut now -peopel resetn pay as you go and regard having > someone pay for medical care assomthing to be entitiled to-- so they > have as patietns largely paid through the nose to get that plastic card > they feel entitled to not have to pay cash out of pocket > Culturally constant new tests and meds are waved in front of people so > they want them .They want consumer products also and frankly they are > NOT paying for them either! Many folks are running up huge debt to get > the things they want, but not paying .Paying cash hurts plunking down > plastic doesn ot so people accumulate painlessly Alot of it is culture. > > Cheer everyone up did I?? > > > > Re: emails from patients >> >> Online communication is the new " platform " of communication with >> patients. I started giving my email to all my patients in 1997 > and have >> not looked back. I answer online health questions every day for >> Revolution Health and eDocAmerica. It makes access to health care >> communication continuous for our patients. You should have an > access >> fee to cover this service. Remember, $30 a month for 1000 > patients is >> $360,000 a year. >> >> Don't do anything by email that should be done in person, or even > over >> the phone. Email is a nice way to set up telephone appointments > (again, >> get paid for this). I predict in the near future we will handle > more >> than 60% of our daily patient communications online, reserving > time for >> relaxed and professional visits and telephone calls as needed. >> >> Mimi Doohan, an model IMP in Santa Barbara, has just set > up " eDocLocal " >> through eDocAmerica to add this service. That way it is done > through a >> secure website meeting recommended HIPAA standards. >> >> Joe >> >> ph E. Scherger, MD, MPH >> Clinical Professor >> University of California, San Diego >> Medical Director, AmeriChoice >> 8840 Complex Dr. Suite 300 >> San Diego, CA 92123 >> Phone: >> Fax: >> JScherger@... >> >> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM >> >>> >> >> This is an actual email that I got from a patient. I do not > have an >> " e-visit " policy per se, and have not jumped on putting one in > place >> because local insurers are not paying anything on " virtual visits " >> anyway, but more and more I get this sort of thing. How are you > guys >> handling this? Do you just tell everyone they need a visit? Do > you >> answer the emails with a link to something like the Mayo Clinic > website >> and say " come to the office if that doesn't answer your question " I'm >> currently getting one like this every few days and it's > getting out >> of hand. >> Hi Dr. Skaggs ~ >> My 52 year-old brother recently had a CVA. He had been dx'd w/ > type 2 DM >> this January and had since lost 50+ lbs. >> My mother thinks all of us need to be on daily aspirin therapy > like Jim >> is now. I have had iron-poor blood in the past, and wondered if the >> aspirin would affect that. I only know this because they wouldn't > let me >> donate blood a couple of times. Anyway, I told mom I was going to > check >> with you. My last checkup was December 21st. >> Thanks ~ Kim Xxxx >> > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 We (healthcare in general and IMP's in particular) need good commercials just like the drug companies and auto makers (... etc) have commercials so people will think that if they pay for our services they'll be good looking, have more free time, be popular, be sexy, be happy, get rich and have sex whenever they want it. ;-) All joking aside, this is serious -- people pay for what they THINK they are getting and not what it's real value is. It's the emotion and profound feelings people have that draw them to purchase things. It's like the " perceived " doctor shortage comment earlier; even if there are enough docs, if people perceive a shortage, more of them will be willing to pay. How to proceed? I don't know... but finish my last note for the pt with DM/htn/esoph reflux/obesity, then submit the claim to insurance and wait to get paid ($93) for the 50 minutes I spent doing the work of her care (including lab follow up etc) ... all the while I walk to the bank this afternoon to deposit the check from this morning's Botox treatment (25 min casual appt with no work outside of appt) and pay other bills. .... did someone say the system is broken? Tim PS - LL " the enforcer " , I'd change the subject line, but I'm not sure what to call this thread at this point! ;-) -- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. > anemaria nails it i think > patietns keep cigaettes and cars and cell phones becasue they derive > pleasure from those > What's the pleaseure in waiting 30 min to gat a painful exam that > will bring bad news or get you nagged at huh? > NO WOnder people do not spend money on health care when it is out of > pocket. duh. > I do think that people should pay me for perfroming a servoce I strongly > belive that > BUT given the service I happen to provide for a living ain't gonna > ahppen So third party payors- god I hate that word-are where its at. > The problem is to reform t eh payment system so it is fair to all > patietns all docotrs and gets folks to effective care > > Don't get me started My lap top keeps shutting off The phone will take > no incoming calls only outgoing andthe VFC lady fromthe state wants me > to give her temperture logs for months that have long since gone by > I need drugs today where IS that discussion about online drugs when I > needit > > > > and the second part is the culture . insurancs have led people to think > they have to have insurance for years now, e ven though it is laregly a > worhltess prodcut now -peopel resetn pay as you go and regard having > someone pay for medical care assomthing to be entitiled to-- so they > have as patietns largely paid through the nose to get that plastic card > they feel entitled to not have to pay cash out of pocket > Culturally constant new tests and meds are waved in front of people so > they want them .They want consumer products also and frankly they are > NOT paying for them either! Many folks are running up huge debt to get > the things they want, but not paying .Paying cash hurts plunking down > plastic doesn ot so people accumulate painlessly Alot of it is culture. > > Cheer everyone up did I?? > > > > Re: emails from patients >> >> Online communication is the new " platform " of communication with >> patients. I started giving my email to all my patients in 1997 > and have >> not looked back. I answer online health questions every day for >> Revolution Health and eDocAmerica. It makes access to health care >> communication continuous for our patients. You should have an > access >> fee to cover this service. Remember, $30 a month for 1000 > patients is >> $360,000 a year. >> >> Don't do anything by email that should be done in person, or even > over >> the phone. Email is a nice way to set up telephone appointments > (again, >> get paid for this). I predict in the near future we will handle > more >> than 60% of our daily patient communications online, reserving > time for >> relaxed and professional visits and telephone calls as needed. >> >> Mimi Doohan, an model IMP in Santa Barbara, has just set > up " eDocLocal " >> through eDocAmerica to add this service. That way it is done > through a >> secure website meeting recommended HIPAA standards. >> >> Joe >> >> ph E. Scherger, MD, MPH >> Clinical Professor >> University of California, San Diego >> Medical Director, AmeriChoice >> 8840 Complex Dr. Suite 300 >> San Diego, CA 92123 >> Phone: >> Fax: >> JScherger@... >> >> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM >> >>> >> >> This is an actual email that I got from a patient. I do not > have an >> " e-visit " policy per se, and have not jumped on putting one in > place >> because local insurers are not paying anything on " virtual visits " >> anyway, but more and more I get this sort of thing. How are you > guys >> handling this? Do you just tell everyone they need a visit? Do > you >> answer the emails with a link to something like the Mayo Clinic > website >> and say " come to the office if that doesn't answer your question " I'm >> currently getting one like this every few days and it's > getting out >> of hand. >> Hi Dr. Skaggs ~ >> My 52 year-old brother recently had a CVA. He had been dx'd w/ > type 2 DM >> this January and had since lost 50+ lbs. >> My mother thinks all of us need to be on daily aspirin therapy > like Jim >> is now. I have had iron-poor blood in the past, and wondered if the >> aspirin would affect that. I only know this because they wouldn't > let me >> donate blood a couple of times. Anyway, I told mom I was going to > check >> with you. My last checkup was December 21st. >> Thanks ~ Kim Xxxx >> > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 frankly Tim I have thoguht indeed for along time that a nice media campaign would be a good idea Frequent repetitive messages from the aafp about family docs in lots of setting doing their jobs. My opinion. Re: emails from patients >> >> Online communication is the new " platform " of communication with >> patients. I started giving my email to all my patients in 1997 > and have >> not looked back. I answer online health questions every day for >> Revolution Health and eDocAmerica. It makes access to health care >> communication continuous for our patients. You should have an > access >> fee to cover this service. Remember, $30 a month for 1000 > patients is >> $360,000 a year. >> >> Don't do anything by email that should be done in person, or even > over >> the phone. Email is a nice way to set up telephone appointments > (again, >> get paid for this). I predict in the near future we will handle > more >> than 60% of our daily patient communications online, reserving > time for >> relaxed and professional visits and telephone calls as needed. >> >> Mimi Doohan, an model IMP in Santa Barbara, has just set > up " eDocLocal " >> through eDocAmerica to add this service. That way it is done > through a >> secure website meeting recommended HIPAA standards. >> >> Joe >> >> ph E. Scherger, MD, MPH >> Clinical Professor >> University of California, San Diego >> Medical Director, AmeriChoice >> 8840 Complex Dr. Suite 300 >> San Diego, CA 92123 >> Phone: >> Fax: >> JScherger@... >> >> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM >> >>> >> >> This is an actual email that I got from a patient. I do not > have an >> " e-visit " policy per se, and have not jumped on putting one in > place >> because local insurers are not paying anything on " virtual visits " >> anyway, but more and more I get this sort of thing. How are you > guys >> handling this? Do you just tell everyone they need a visit? Do > you >> answer the emails with a link to something like the Mayo Clinic > website >> and say " come to the office if that doesn't answer your question " I'm >> currently getting one like this every few days and it's > getting out >> of hand. >> Hi Dr. Skaggs ~ >> My 52 year-old brother recently had a CVA. He had been dx'd w/ > type 2 DM >> this January and had since lost 50+ lbs. >> My mother thinks all of us need to be on daily aspirin therapy > like Jim >> is now. I have had iron-poor blood in the past, and wondered if the >> aspirin would affect that. I only know this because they wouldn't > let me >> donate blood a couple of times. Anyway, I told mom I was going to > check >> with you. My last checkup was December 21st. >> Thanks ~ Kim Xxxx >> > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2007 Report Share Posted June 14, 2007 frankly Tim I have thoguht indeed for along time that a nice media campaign would be a good idea Frequent repetitive messages from the aafp about family docs in lots of setting doing their jobs. My opinion. Re: emails from patients >> >> Online communication is the new " platform " of communication with >> patients. I started giving my email to all my patients in 1997 > and have >> not looked back. I answer online health questions every day for >> Revolution Health and eDocAmerica. It makes access to health care >> communication continuous for our patients. You should have an > access >> fee to cover this service. Remember, $30 a month for 1000 > patients is >> $360,000 a year. >> >> Don't do anything by email that should be done in person, or even > over >> the phone. Email is a nice way to set up telephone appointments > (again, >> get paid for this). I predict in the near future we will handle > more >> than 60% of our daily patient communications online, reserving > time for >> relaxed and professional visits and telephone calls as needed. >> >> Mimi Doohan, an model IMP in Santa Barbara, has just set > up " eDocLocal " >> through eDocAmerica to add this service. That way it is done > through a >> secure website meeting recommended HIPAA standards. >> >> Joe >> >> ph E. Scherger, MD, MPH >> Clinical Professor >> University of California, San Diego >> Medical Director, AmeriChoice >> 8840 Complex Dr. Suite 300 >> San Diego, CA 92123 >> Phone: >> Fax: >> JScherger@... >> >> >>> " Annie Skaggs " 6/11/2007 9:25:44 AM >> >>> >> >> This is an actual email that I got from a patient. I do not > have an >> " e-visit " policy per se, and have not jumped on putting one in > place >> because local insurers are not paying anything on " virtual visits " >> anyway, but more and more I get this sort of thing. How are you > guys >> handling this? Do you just tell everyone they need a visit? Do > you >> answer the emails with a link to something like the Mayo Clinic > website >> and say " come to the office if that doesn't answer your question " I'm >> currently getting one like this every few days and it's > getting out >> of hand. >> Hi Dr. Skaggs ~ >> My 52 year-old brother recently had a CVA. He had been dx'd w/ > type 2 DM >> this January and had since lost 50+ lbs. >> My mother thinks all of us need to be on daily aspirin therapy > like Jim >> is now. I have had iron-poor blood in the past, and wondered if the >> aspirin would affect that. I only know this because they wouldn't > let me >> donate blood a couple of times. Anyway, I told mom I was going to > check >> with you. My last checkup was December 21st. >> Thanks ~ Kim Xxxx >> > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2007 Report Share Posted June 16, 2007 You really think sugar-free, low carb toffee would be worth putting in your mouth? I put splenda or nutrasweet in a lot of things, but the toffee calls for REAL butter and REAL sugar... Annie Re: emails from patients > > > > Online communication is the new " platform " of communication with > > patients. I started giving my email to all my patients in 1997 > and have > > not looked back. I answer online health questions every day for > > Revolution Health and eDocAmerica. It makes access to health care > > communication continuous for our patients. You should have an > access > > fee to cover this service. Remember, $30 a month for 1000 > patients is > > $360,000 a year. > > > > Don't do anything by email that should be done in person, or even > over > > the phone. Email is a nice way to set up telephone appointments > (again, > > get paid for this). I predict in the near future we will handle > more > > than 60% of our daily patient communications online, reserving > time for > > relaxed and professional visits and telephone calls as needed. > > > > Mimi Doohan, an model IMP in Santa Barbara, has just set > up " eDocLocal " > > through eDocAmerica to add this service. That way it is done > through a > > secure website meeting recommended HIPAA standards. > > > > Joe > > > > ph E. Scherger, MD, MPH > > Clinical Professor > > University of California, San Diego > > Medical Director, AmeriChoice > > 8840 Complex Dr. Suite 300 > > San Diego, CA 92123 > > Phone: > > Fax: > > JScherger@... > > > > >>> " Annie Skaggs " 6/11/2007 9:25:44 AM > > >>> > > > > This is an actual email that I got from a patient. I do not > have an > > " e-visit " policy per se, and have not jumped on putting one in > place > > because local insurers are not paying anything on " virtual visits " > > anyway, but more and more I get this sort of thing. How are you > guys > > handling this? Do you just tell everyone they need a visit? Do > you > > answer the emails with a link to something like the Mayo Clinic > website > > and say " come to the office if that doesn't answer your question " > > I'm currently getting one like this every few days and it's > getting out > > of hand. > > Hi Dr. Skaggs ~ > > My 52 year-old brother recently had a CVA. He had been dx'd w/ > type 2 DM > > this January and had since lost 50+ lbs. > > My mother thinks all of us need to be on daily aspirin therapy > like Jim > > is now. I have had iron-poor blood in the past, and wondered if the > > aspirin would affect that. I only know this because they wouldn't > let me > > donate blood a couple of times. Anyway, I told mom I was going to > check > > with you. My last checkup was December 21st. > > Thanks ~ Kim Xxxx > > > > > ---------------------------------------------------------------------- > -- > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.472 / Virus Database: 269.8.16/849 - Release Date: 6/14/2007 12:44 PM > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2007 Report Share Posted June 20, 2007 I don’t think many of our patients would contribute to this fund either. But your reason for the refill appointment caught my eye. We are struggling to get patients in for all the refills instead of over the phone. When we talk to them about the economics of it, they seldom even hear anything other than we want more money. So we try never to go that route. We discuss the benefits of the med review at appropriate intervals and patient safety and improved results ONLY, no economics or time spent by physician. It works better for us. Ernie > > Wow, " access fee " .. $30 per month. I can't imagine anyone paying that. > On average, my patients expect to have to be seen in the office no more > than twice per year, and they expect eleven free services between > visits. > > Does anyone actually research what people value, what they will pay for? > " $30 a month for 1000 patients " . at least twice a month I have to calm > down someone who is irate about not getting their phone in refill: " I'm > sorry I upset you, Ms DiamondsAreaGirlsBestFriend. I would love to be > able to do everyone favors, but did you know that if every one of my > patients wants only one special favor a year, that is still two favors a > day, every day, 365 days a year. And I haven't taken a single day off > since 2004 " Do they care? Not a bit. > > There will have to be WAY more of a shortage of primary care docs before > I get any kind of " access fee " > Annie > > Re: emails from patients > > Online communication is the new " platform " of communication with > patients. I started giving my email to all my patients in 1997 and have > not looked back. I answer online health questions every day for > Revolution Health and eDocAmerica. It makes access to health care > communication continuous for our patients. You should have an access > fee to cover this service. Remember, $30 a month for 1000 patients is > $360,000 a year. > > Don't do anything by email that should be done in person, or even over > the phone. Email is a nice way to set up telephone appointments (again, > get paid for this). I predict in the near future we will handle more > than 60% of our daily patient communications online, reserving time for > relaxed and professional visits and telephone calls as needed. > > Mimi Doohan, an model IMP in Santa Barbara, has just set up " eDocLocal " > through eDocAmerica to add this service. That way it is done through a > secure website meeting recommended HIPAA standards. > > Joe > > ph E. Scherger, MD, MPH > Clinical Professor > University of California, San Diego > Medical Director, AmeriChoice > 8840 Complex Dr. Suite 300 > San Diego, CA 92123 > Phone: > Fax: > JScherger@... > > >>> " Annie Skaggs " 6/11/2007 9:25:44 AM > >>> > > This is an actual email that I got from a patient. I do not have an > " e-visit " policy per se, and have not jumped on putting one in place > because local insurers are not paying anything on " virtual visits " > anyway, but more and more I get this sort of thing. How are you guys > handling this? Do you just tell everyone they need a visit? Do you > answer the emails with a link to something like the Mayo Clinic website > and say " come to the office if that doesn't answer your question " > I'm currently getting one like this every few days and it's getting out > of hand. > Hi Dr. Skaggs ~ > My 52 year-old brother recently had a CVA. He had been dx'd w/ type 2 DM > this January and had since lost 50+ lbs. > My mother thinks all of us need to be on daily aspirin therapy like Jim > is now. I have had iron-poor blood in the past, and wondered if the > aspirin would affect that. I only know this because they wouldn't let me > donate blood a couple of times. Anyway, I told mom I was going to check > with you. My last checkup was December 21st. > Thanks ~ Kim Xxxx > Quote Link to comment Share on other sites More sharing options...
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