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Drudge Retort: The Other Side of the News
Friday, October 15, 2021

Dr. Duane Mitchell didn't expect to convince a stranger to get vaccinated against COVID-19 when he went to a restaurant for dinner in Gainesville, Florida over the summer.

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This doctor is one in a million. He spent 3 hours of his time to convince a perfect stranger to take the vaccine. There was no profit motive for the doctor ~ just a commitment to his oath as a physician.

How rare is that? And refreshing, too.

One of my pet peeves against doctors is the amount of time a patient is kept cooling their heels in a waiting room ~ sometimes well over an hour beyond the time of their appointment. Plus even more time in one of a row of examination rooms as the doctor quickly skips from one room to the next as though his patients were on an assembly line ~ which, of course, they are. I always suspected that the reason for this is because doctors were more interested in their billing hours than they were in the health of their patients. They are, after all, running a for-profit business which these days seems to be their primary objective, secondary to providing health care.

Only lately did I discover that my suspicions were spot on correct and the true reason behind it.

#1 | Posted by Twinpac at 2021-10-16 03:06 AM | Reply

#1 ... It's more complicated than that, Twinpac. The fee-for-service (FFS) payment model is the biggest source of the problem. Let's just use the example of a senior who is Medicare eligible. Doctors get reimbursed by Medicare or other health plans that are FFS for every service they deliver. So it's all about quantity, rather than quality.

The value-based care (VBC) model, available in Medicare Advantage plans, pays a doctor a fixed amount per month to maintain certain health outcomes. So then the focus is on taking all the measures necessary, and spending the time necessary, to keep a patient healthy. Many insurance plans, healthcare providers and indeed the federal government are very interested in expanding the use of this value based care approach.

#2 | Posted by cbob at 2021-10-16 08:19 AM | Reply | Newsworthy 1

I got my COVID booster shot at Publix Supermarket and then I shopped for the food items I needed. The shot didn't cost me a dime and the service was excellent. And quite possibly someone is making some money for giving those shots but I'll bet you money that it is nowhere near the huge amounts spent treating the unvaccinated in hospitals because those patients were stubborn fools who refused to get vvaccinated.

#3 | Posted by danni at 2021-10-16 08:36 AM | Reply | Newsworthy 1

Yeah, that doc is a much better person than me.

I probably would have gotten up from my seat after two minutes and wished lardo bon voyage on his imminent ride on the Intubation Express.

#4 | Posted by censored at 2021-10-16 10:34 AM | Reply | Funny: 1

Great job, Dr. Duane. If he can talk this knob into getting vaxxed, he must be very successful with the ladies ...

#5 | Posted by catdog at 2021-10-16 10:49 AM | Reply

#2 | Posted by cbob

There is still the problem with how many patients they have to see. My personal physician is on a Advantage provider and on a similar plan with Blue Cross. I don't know if it results in superior care but she does actually care. She is still in and out in less than 5 minutes and I have noticed her wait time have climbed in the last few years as well. She changed her tune from a single payer system being bad to this is absolutely where we need to go. She is unable to provide the good care she wants to provide with the current insurance model. She almost always has to send everyone to a specialist now for things like MRIs and CTs instead of being able to order them herself. She isn't a GP either but an internist. Super frustrating. My wife has had a knee issue for over a year now. FINALLY able to see a specialist who says she has a torn meniscus. It took a year for insurance to allow it though - I see a huge bill in our future because her deductible is $3750.

Another big thing on the waiting room line nightmare also has to do with offices needing a good time study. They can fix most of the wait with that.

#6 | Posted by GalaxiePete at 2021-10-16 10:49 AM | Reply

My doc is an Iraqi who did his residency in Scotland. Pure gold.

#7 | Posted by LegallyYourDead at 2021-10-16 10:58 AM | Reply

CBOB @#2

Thanks for all that great information. I'm going to contact my HMO and ask some questions. Since the long waiting times have become so pervasive I'm sure I'm not the only one feeling disrespected. Since the doctors on a HMO network have agreed to accept assignment, it seems, from what I've learned lately, that the long waiting time is actually a cash cow.

A few days ago I brought this matter up with the Office Manager of my doctor's office after noticing on my EOB the words "long visit" when I knew for a fact that the visit was less than five minutes. She told me that billing started at the time I signed in and included the hour long wait time.

That's quite a racket if you ask me. It appears they've found a way to offset the lower "agreement to accept assignment" clause of their contract.

#8 | Posted by Twinpac at 2021-10-16 12:14 PM | Reply

"She told me that billing started at the time I signed in and included the hour long wait time."

Please report them, to your state medical board. It's unethical, if not downright illegal.

#9 | Posted by Danforth at 2021-10-16 12:24 PM | Reply | Newsworthy 1

Thank you DANFORTH.

First I'm going to get better educated as to the legality. I'll run this past the legal department of my HMO since it's the HMO and Medicare that's getting gouged.

What troubles me about whistleblowing is that the overbilling practice is so pervasive that I can't believe the HMOs don't already know about it. If I complain loud enough the most they'll do is remove this particular medical practice from their network.

#10 | Posted by Twinpac at 2021-10-16 12:47 PM | Reply

"What troubles me about whistleblowing is that the overbilling practice is so pervasive that I can't believe the HMOs don't already know about it."

You never know, but every complaint (i.e., informing them of the truth) helps.

Here's an example: My city was sending out "estimated" tax bills to non-filers, and threatening to ding their credit if they didn't pay. When I pointed out a fake bill, sent out on a non-existent balance due, could deny the person a job, or an apartment, the Commissioner's assistant assured me that it was okay...they really didn't send the delinquent bills to a credit company that would ding credit.

Did you catch that? That's the good news: the city was lying to the public under the color of authority.

I demanded a meeting with the Commissioner and my City Council rep. The CC guy in charge of the tax department was there, along with six other lawyers and assistants. You should've seen the look on the CC guy's face when he heard the city was lying to its constituents.

That threat was gone in the following year's notices.

Another:
Cigna was my Rx provider at one point, and I was late ordering a daily maintenance drug for my thyroid. It was Friday, so I chose "overnight delivery" for an extra $17.50.

The Rx didn't arrive the next day. Or Sunday. Finally it arrived Monday, so I called Cigna to get my "overnight" money back. "You didn't choose "Saturday Delivery"", I was told. We went to the website, and I asked her to find "Saturday Delivery". She couldn't. Did that mean I'd get my money back? "No", she explained, "we're not responsible for how many days it takes to fill your prescription".

I pointed out "overnight delivery" is pretty worthless if it's not overnight.

I then had to keep going up the ladder, even after folks said I'd get a refund that never came, for over six months. But finally, two things happened: I got finally got to a company honcho, who was appalled at my treatment and immediately sent my full refund...

...and Cigna put a disclaimer on their website about "overnight delivery does not include processing time".

Some win, huh?

#11 | Posted by Danforth at 2021-10-16 02:12 PM | Reply

"If I complain loud enough the most they'll do is remove this particular medical practice from their network."

Which is good, but that's why I suggested telling the state medical board. The practice won't know where the complaint originated, and over the years, the doctors in my family have assured me the state medical boards are the ONE entity they fear, and must heed.

#12 | Posted by Danforth at 2021-10-16 02:17 PM | Reply

Could the polite argument between them be made into a movie?

#13 | Posted by Tor at 2021-10-16 03:56 PM | Reply

Thank you again, DANFORTH

First I'll examine of all my EOBs (I keep copies of everything) to see how many times the doctor's office has overbilled. I'm not by nature a crusader and I like to be on firm grounds with my argument. I don't start arguments unless I'm fully prepared to stand my ground for the win.

I do have a feeling that what my doctor's office is doing is at least unethical. I've been to other medical offices that do an end run around the wait time by calling me in at my appointed time only to put me in a second waiting room to wait for an examining room to be free. They consider that keeping the appointment.

#14 | Posted by Twinpac at 2021-10-16 05:03 PM | Reply

"I've been to other medical offices that do an end run around the wait time by calling me in at my appointed time only to put me in a second waiting room to wait for an examining room to be free. They consider that keeping the appointment. "

That's okay; delays happen all the time, especially when you're trying to give quality care versus timed care.

The issue here is "long visit" when the truth is "long wait". If they're charging more for the latter, it's unethical. Meanwhile, if these folks putting you in an anteroom aren't charging extra for "long visit", they're at least being aboveboard.

#15 | Posted by Danforth at 2021-10-16 05:09 PM | Reply

DANFORTH

I understand. That's why I have to examine all my EOB's carefully. I still object to the long wait because I think it's because they're deliberately overbooking so they can squeeze every dime out of a billing hour. I find that the inconvenience they cause to their patients is disrespectful. I know by the time I finally see a doctor I'm already boiling over.

#16 | Posted by Twinpac at 2021-10-16 05:41 PM | Reply

DANFORTH

To be clear, yes, you are right. I know I have two issues. I'll make sure I keep them separate.

#17 | Posted by Twinpac at 2021-10-16 06:00 PM | Reply

Twin,

Medical billing is done through "codes." An extended office visit will have a code and definition. See i.e. www.cms.gov

#18 | Posted by et_al at 2021-10-16 10:42 PM | Reply

re #18: Find out what the billing codes are, they should be listed on your bill.

Here are the commonly used Office Visit CPT codes: medicarepaymentandreimbursement.com

Be aware that the Current Procedural Terminology (CPT) is copyrighted by the American Medical Association, so you probably won't find the whole thing online, and you'll need to pay a licensing fee if you do use the codes in business.

#19 | Posted by snoofy at 2021-10-16 10:53 PM | Reply

ET AL

Yes, I'm aware of the codes. The code on my EOB from my HMO is followed in parenthesis by (long visit). That's what drew my attention in the first place and what caused me to have a conversation with the doctor's office Manager for an explanation. And that's when she told me "billing starts when you sign in."

#20 | Posted by Twinpac at 2021-10-17 03:29 AM | Reply

" And that's when she told me "billing starts when you sign in.""

I would counter with "Does that mean the more you overbook, the more you overbill?"

Let me know their response.

#21 | Posted by Danforth at 2021-10-17 03:36 AM | Reply

DANFORTH

"Does that mean the more you overbook, the more you overbill?"

That's my contention. When a doctor is on an HMO network they agree to accept "assignment" which is the lower amount that Medicare pays. Overbooking and then adding wait time appears to be their way of making up the difference.

I'm going to talk to the legal department of my HMO. I need more input.

#22 | Posted by Twinpac at 2021-10-17 04:02 AM | Reply

"Waiting" isn't a medical procedure so there shouldn't be a code that they can use for reimbursement on that.

Maybe these are bills that you pay, that aren't tied to any medical procedure? Like a lot of the stuff they tack on when you buy a car at the dealer.

#23 | Posted by snoofy at 2021-10-17 04:15 AM | Reply

SNOOFY

"Waiting" isn't a medical procedure so there shouldn't be a code that they can use for reimbursement on that."

They don't. They tack it on to the code for office visit to indicate that the office visit was extra long.

I want to find out if there are two separate codes ~ one for routine (whatever that is) and one for long.

There seems to be a reason why (long visit) was in parenthesis on the EOB. Was it to explain to the HMO why the code was different than usual?

#24 | Posted by Twinpac at 2021-10-17 05:09 AM | Reply

I had an appointment with a specialist a couple of months ago. Arrived early to fill out paperwork and sat in the crowded waiting room for over an hour. I finally had enough and told the office manager I was leaving, and that I was leaving because they seemed to show so little regard for patient's time.

#25 | Posted by AMERICANUNITY at 2021-10-17 03:10 PM | Reply

AU

I can't tell you how many times I've done that. They couldn't care less.

One time, after complaining about waiting an hour for a 9:00 a.m., (first appointment of the day), I snapped at the doctor. I told him he should try getting out of bed earlier. He wasn't amused. But then, neither was I.

#26 | Posted by Twinpac at 2021-10-17 09:40 PM | Reply

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