Doctors Tend to Do Only What They Are Paid to Do or to Know

You get what you pay for.

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January 24, 2012 - Why are doctors so reluctant to accept phone calls? Why do so few doctors use email? Why are doctors so slow in adopting electronic medical records compared to their foreign counterparts? Why do most doctors not know the price of drugs, how brand names compare to generics, and where in town to get the best deal? Why don’t they spend more time educating patients on the principles of good health and self-care?

The short answer, according to John Goodman, in his January 23 blog, “How Doctors Are Trapped, Part 2,” is that doctors, being reasonable economic beings, tend do only what they are paid to do or know. Goodman uses telephone consultation as an example.

“Medicare doesn’t pay for telephone consultations. Medicare has a list of about 7,500 tasks it pays physicians to perform. And talking on the phone isn’t on the list. Private insurance tends to pay the way Medicare pays. So do most employers."

"At a time when doctors feel they are being squeezed on their fees from every direction by third-part payers, most become much focused on which activities are billable and which are not. And most are going to try to minimize their nonbillable tasks.”

Considering that talking on the phone in response to patients can absorb as much as 25% to 33% of practice time, these physician attitudes make sense. The same sense applies for activities such as answering patient emails, learning and training staff to use electronic records, educating patients about self-care, and dispensing knowledge about where to find and use the most economical drugs.

Goodman concludes doctors are relatively helpless to alter the situation, given how they are paid and the constraints of repackaging and repricing their services.

These restrictions, Goodman asserts, are deleterious to effective reform, “Of all the people in the health system, none is more central than the physicians. Fundamental reform is almost inconceivable without physicians leading and directing the changes.”

Cost constraints about these time consuming but essential activities are not universal, nor do they necesarily add to costs. In Denmark, where health care costs half of what it does here, physicians are paid to talk on the phone, send and receive emails, install and use EMRs, educate patients, and facilitate referrals. Patient convenience is the goal.

Tweet: In U.S., 3rd parties don’t pay MDs to talk to patients by phone, to consult by e-mail, to use EMRs, to educate about drugs and health.