My grandmother went to the doctor this week with a sore on her leg. She came home with a bill for $3500. The bill had nothing to do with the treatment of her leg wound. The bill was to cover the doctor’s new annual membership fee. If she does not pay it she will be forced to seek care elsewhere. She is 95 years old and on a fixed income and will need to either pay up or move on.
Her doctor left me a lengthy voice mail explaining his fee, informing me that it will allow him to spend more time with each patient and provide high quality care. What it won’t do is cover any of her visits for the year. Those are extra and will be billed to her insurance. The $3500 is for access alone.
The fee seems exorbitant and it is. A typical senior citizen goes to the doctor 6 times a year. The fee works out to a payment of an additional $600 per visit, an astronomical sum.
While the charges are insanely high they are becoming increasingly common. Doctors who cannot make ends meet on what insurance companies pay are looking to their patients to pick up the slack. Especially for older and sicker patients, insurances don’t pay enough to cover the time needed, typically only about $120 for a 30 minute visit. This may seem like a lot, but after factoring in overhead ($160 an hour) and unpaid time spend on refills, phone calls and emails, the end result for the doctor paid this fees could be a salary of about $120,000 a year. While this is a good wage for many people it isn’t enough for a doctor with student loan debt to live in Southern California, where mortgages for a modest home can exceed $4000 a month. Many doctors are desperate to find a way to increase their income.
While this is understandable, the $3500 fee seems excessive. It seems that a doctor with 2000 patients in his practice could make ends meet by charging much less. $100 a year would result in a $200,000 a year increase in salary and make up for what insurance pays. Why charge $3500.
My recent experience answers the question. The majority of patients won’t pay the smaller amount either. My office provides a wide array of services, from guaranteed same day access and short wait times to digital visits and email communications, that are not covered by insurance plans. To cover the cost of these services, on January 1 of this year we started charging an annual access fee of $120. While we thought this was reasonable and affordable we have lost over half of the 1000 patients to whom we billed the fee. In their minds the additional access and services just aren’t worth it. It is apparently easier to find 200 patients willing and able to pay $3500 a year than it is to find 1000 patients willing and able to pay $120. My grandmother’s physician has figured this out.
This does not bode well for the future of medicine. None of the current health care plans being discussed in Washington D.C. or Sacramento address the reality that good medical care costs a lot of money and that quality doctors require competitive salaries. Patients unwilling or unable to pay extra for services will find it increasingly difficult to find a primary care doctor willing to see them and will be increasingly unhappy with the options available. It seems we are headed for a crisis of inaccessibility.
The solutions to this problem are too complex for a blog post but there is one thing of which I am certain. These solutions will not be easy and will be expensive.