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Old 12-19-2013, 06:11 AM   #41
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For profit organizations have a powerful incentive to be efficient.
Yes, and especially so when the providers are the primary partners. That does not mean they need to overbook or make people wait. I recall a weekly column by a physician in the WSJ, he discussed this topic a couple of times and shared his own experience. When his office reduced the number of scheduled appointments and programmed "open slots", wait times fell dramatically, satisfaction immediately improved, and the number of patients seen per day increased slightly.

Contrast that to my mother's ophthalmologist. It is a family owned business, perhaps 40 physicians operating in 4 or 5 locations. The typical wait in the front waiting area is close to an hour, another 30 minutes in the back. Average total appointment time can easily hit 2 hours. My father used to call it "the factory". The last couple of times I went with her I sat back and studied the flow of patients and it occurred to me that they don't book individual appointment slots. Instead, they book groups of patients all for the same time, say 25 people at 1:00, another 25 at 2:00, etc, all for 4 or 5 physicians, and then just see them in the order they arrive. They are totally unconcerned with patient wait time. And the waiting room is always crowded.
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Old 12-19-2013, 08:28 AM   #42
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What I don't understand is why people put up with that. I had one appointment with a rheumatologist once and waited 30m in the waiting room, no call no apology, nothing. I walked out.

Although (thinking out loud) maybe in the US its related to reimbursement rates. Perhaps those who serve a large medicare population (or certainly medicaid) do this type of thing more often. That could explain why I only saw it once in my decades in NYC, and that at the office of a rheumatologist, where most patients were probably on medicare.
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Old 12-19-2013, 09:03 AM   #43
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Yes, and especially so when the providers are the primary partners. That does not mean they need to overbook or make people wait. I recall a weekly column by a physician in the WSJ, he discussed this topic a couple of times and shared his own experience. When his office reduced the number of scheduled appointments and programmed "open slots", wait times fell dramatically, satisfaction immediately improved, and the number of patients seen per day increased slightly. Contrast that to my mother's ophthalmologist. It is a family owned business, perhaps 40 physicians operating in 4 or 5 locations. The typical wait in the front waiting area is close to an hour, another 30 minutes in the back. Average total appointment time can easily hit 2 hours. My father used to call it "the factory". The last couple of times I went with her I sat back and studied the flow of patients and it occurred to me that they don't book individual appointment slots. Instead, they book groups of patients all for the same time, say 25 people at 1:00, another 25 at 2:00, etc, all for 4 or 5 physicians, and then just see them in the order they arrive. They are totally unconcerned with patient wait time. And the waiting room is always crowded.
The average ophthalmologist sees 3.2 patients per hour or about 1 every 18 minutes according to the data. They are a high volume specialty. It's easy for me to see how they could fall a few hours behind seeing that many patients per day, especially if there are 5 doctors. The good news is that the per visit cost, by average, is only 118 dollars with insurance picking up most of the bill. Of course, many will pay a lot more per visit to cover those that pay little or none in order to get to the average of 118.
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Old 12-19-2013, 11:00 AM   #44
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I went to the dentist last week. Got there 15 minutes early. They brought me in 5 minutes early to do all the X rays - put me in a room in a dentist chair....for 45 minutes! I tried to take a nap, but was perturbed ....the Dentist finally came in and apologized. He spent 45 minutes on me (check up and smoothing a chipped crown). I got to the front desk and he had waived my co-pay for waiting so patiently. I guess I hid how I was feeling!
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Old 12-19-2013, 11:06 AM   #45
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What I've learned is we're bad at picking doctors (and dentists to a lesser extent). Some overbook/plan-manage time poorly (deliberately or not) while others are much better at it (being seen early, unheard of for us even though we show up early). There have been times that I came within an inch of leaving, but I thought if I reschedule odds are I will have to wait all over again. Again, I understand waiting sometimes, just not every time - especially on first appt of the day!
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Old 12-19-2013, 11:20 AM   #46
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What I've learned is we're bad at picking doctors (and dentists to a lesser extent). Some overbook/plan-manage time poorly (deliberately or not) while others are much better at it (being seen early, unheard of for us even though we show up early). There have been times that I came within an inch of leaving, but I thought if I reschedule odds are I will have to wait all over again. Again, I understand waiting sometimes, just not every time - especially on first appt of the day!

Is this the same doctor who dropped you for not seeing him/her for six years (when you were getting company physicals) Doctor/GP dropped me without warning? ?
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Old 12-19-2013, 11:49 AM   #47
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As a test of everyone's sincerity regarding docs keeping to schedule.........

If you're with doc, in an appointment booked for the normally scheduled amount of time, and he/she finds an "issue," are you OK with the appointment cutting off promptly on schedule with instructions to book a follow-up to see what's going on? Or do you feel doc should blow off his/her schedule, spend an additional 15 mins with you?

If your doc could pretty much eliminate schedule slippage by seeing 10% fewer patients and allowing some "padding," would you be OK with your personal cost for the visit going up to compensate?
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Old 12-19-2013, 12:19 PM   #48
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The average ophthalmologist sees 3.2 patients per hour or about 1 every 18 minutes according to the data. They are a high volume specialty. It's easy for me to see how they could fall a few hours behind seeing that many patients per day, especially if there are 5 doctors. The good news is that the per visit cost, by average, is only 118 dollars with insurance picking up most of the bill. Of course, many will pay a lot more per visit to cover those that pay little or none in order to get to the average of 118.
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As a test of everyone's sincerity regarding docs
keeping to schedule.........

If you're with doc, in an appointment booked for the normally scheduled amount of time, and he/she finds an "issue," are you OK with the appointment cutting off promptly on schedule with instructions to book a follow-up to see what's going on? Or do you feel doc should blow off his/her schedule, spend an additional 15 mins with you?

If your doc could pretty much eliminate schedule slippage by seeing 10% fewer patients and allowing some "padding," would you be OK with your personal cost for the visit going up to compensate?
There are physicians that fall off schedule because their patients need more time, and there are practices that deliberately over-schedule in an attempt to maximize billing. As we all here know, one instance does not indicate a trend, when it happens most of this time, it is probably deliberate.
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Old 12-19-2013, 12:34 PM   #49
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Great points, yesterday I was at my always on time Dr. It was a routine follow up after a recent hospital visit. He spent 30 minutes with me, not the normal 15, I hadn't asked for a double appointment. So I'm sure someone waited.

I was very appreciative of his extra time, given that they have no idea what is wrong with me. If there was an extra charge I would have happily paid it.
I did have to wait for labs(30 minutes) as the tech had to look up what what he wanted.

He saw me last week, I had taken wife her Dr., his nurse saw me and pulled me, him in, to review the CT of my head, that was chalked up to a nurse visit, no charge.

Now the neurologist appointment, scheduled today, first available is 3 1/2 weeks. I'll be in 20 minutes early with paperwork in hand. I won't be surprised or upset if she's an hour late.

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Old 12-19-2013, 01:02 PM   #50
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Is this the same doctor who dropped you for not seeing him/her for six years (when you were getting company physicals) Doctor/GP dropped me without warning? ?
He's one of several, it's not just one. It's been pretty universal for DW and I...
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Old 12-19-2013, 01:03 PM   #51
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There are physicians that fall off schedule because their patients need more time, and there are practices that deliberately over-schedule in an attempt to maximize billing. As we all here know, one instance does not indicate a trend, when it happens most of this time, it is probably deliberate.
So Michael, would you be willing to pay a little more for docs that schedule fewer patients and are more likely to see you on time? Would it be worth, say, a 10% kicker?

Would you be in favor of a system where gov't insured patients (Medicare, Medicaid, Tri-care, etc.) either are seen within 30 mins (or whatever) of their scheduled appointment or the gov't doesn't pay, maybe even fines the doc?
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Old 12-19-2013, 01:07 PM   #52
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If your doc could pretty much eliminate schedule slippage by seeing 10% fewer patients and allowing some "padding," would you be OK with your personal cost for the visit going up to compensate?
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There are physicians that fall off schedule because their patients need more time, and there are practices that deliberately over-schedule in an attempt to maximize billing. As we all here know, one instance does not indicate a trend, when it happens most of this time, it is probably deliberate.
+1. From the outset the question was about doctors who almost always run late on appts, even the first one of the day I haven't seen a post where anyone here said they couldn't understand and accept some schedule slippage for any number of reasons.

And in your hypothetical, costs wouldn't necessarily increase. The patients who had to come back for follow up visits/tests would generate additional revenue with another appt, vs arguably getting extra attention at no cost with the status quo.

Are you suggesting there are no efficiencies left in health care, no ways to improve productivity? What profession hasn't been asked to more with less for decades?
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Old 12-19-2013, 01:12 PM   #53
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So Michael, would you be willing to pay a little more for docs that schedule fewer patients and are more likely to see you on time? Would it be worth, say, a 10% kicker?

Would you be in favor of a system where gov't insured patients (Medicare, Medicaid, Tri-care, etc.) either are seen within 30 mins (or whatever) of their scheduled appointment or the gov't doesn't pay, maybe even fines the doc?
Not sure why you are asking me, lots of people participating in the discussion. Since you asked, I can't answer because I haven't yet found any physicians or practices that publish prices for reference or comparison.
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Old 12-19-2013, 01:13 PM   #54
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+1. From the outset the question was about doctors who almost always run late on appts, even the first one of the day I haven't seen a post where anyone here said they couldn't understand and accept some schedule slippage for any number of reasons...
So, would you be willing to accept a token, say 10%, price increase so the doc could schedule fewer patients and increase the probability that you'd be seen on time?
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Old 12-19-2013, 01:18 PM   #55
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So, would you be willing to accept a token, say 10%, price increase so the doc could schedule fewer patients and increase the probability that you'd be seen on time?
See above (in fairness I may have edited while you were replying).
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Old 12-19-2013, 01:19 PM   #56
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Not sure why you are asking me, lots of people participating in the discussion. Since you asked, I can't answer because I haven't yet found any physicians or practices that publish prices for reference or comparison.
No need for an absolute number. Would you be willing to pay, say, 10% more for the doc visit to compensate the doc for seeing fewer patients per day and increasing the probability you'd be seen on time?

Everyone seems to agree that "overbooking" so that doc always has a patient in queue leads to schedule slippage. Why not increase fees a bit so that doc can slightly under book and likely not have schedule slippage due to whatever reasons he/she experiences delays?

Seems like a small price to pay to eliminate major stress on both sides of the equation.

edit: BTW, I totally agree that prices for doc services should be published and readily available. Full open kimono. I'd like to know what I'm going to pay, what the Medicaid folks will be paying for the guy sitting next to me, what doc gets from the insurance company, what doc gets from private pay patients, etc. Sadly, I think readily available full price disclosure is a ways off...........
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Old 12-19-2013, 01:23 PM   #57
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See above (in fairness I may have edited while you were replying).
If you think your doc overbooks so that he/she always has a patient ready to be seen and the number of patients per day is maximized (likely causing a lot of schedule slippage), would you be willing to pay a bit more so that doc receives the same total daily revenue but sees fewer patients? Your probability of being seen on time would increase and doc would receive the same compensation (and have less stress). Sounds like a win - win.
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Old 12-19-2013, 01:35 PM   #58
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If you think your doc overbooks so that he/she always has a patient ready to be seen and the number of patients per day is maximized (likely causing a lot of schedule slippage), would you be willing to pay a bit more so that doc receives the same total daily revenue but sees fewer patients? Your probability of being seen on time would increase and doc would receive the same compensation (and have less stress). Sounds like a win - win.
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Are you suggesting there are no efficiencies left in health care, no ways to improve productivity? What profession hasn't been asked to more with less for decades?
Amazing what can be achieved with competition...just watched a report last night about New Balance who took the time to manufacture a shoe from 8 days to 2-1/2 hours. Is it apple to apples, no. Does it apply in principal, yes.
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Old 12-19-2013, 01:40 PM   #59
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Amazing what can be achieved with competition.
+1
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Old 12-19-2013, 01:44 PM   #60
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I've had way better luck with my docs than with plumbers, electricians, cable and internet providers, etc. Heck, many times they don't show up at all! I'd have to say that healthcare, in my experience, ranks very high with me in customer service. Airlines are probably at the bottom. Restaurants are hit or miss.
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