Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Your 10 minute office visit needs 8 people and 45 minutes of work

Mary Pat Whaley
Physician
January 7, 2011
Share
Tweet
Share

shutterstock_84093160

I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation.  If you haven’t worked your check-in and check-out desks recently, I highly recommend it.

An insured patient that I checked out was shocked when I said the charge for her visit was $100.  She said, “But he was only in the room for ten minutes!”  I was briefly at a loss for words.  I recovered, we agreed on a payment plan, I made a note on her encounter form for the billing office, and she left.

I’ve been thinking about our conversation, and thinking about what that $100 is supposed to cover.

  1. First, we scheduled the appointment, which was a work-in, so it took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
  2. When the patient arrived, we checked to make sure her address and phone were the same, quickly checked her eligibility to make sure the insurance on file was still in force, and asked for a photo ID for red flags.  An encounter form was generated at the nurse’s station to notify her of the patient’s arrival.
  3. The nurse called her from the reception area, weighed her, and took her into an exam room to take her vitals, take a brief chief complaint, review the medications she is taking and check to see if she needed any chronic medication refills while she was there.
  4. The physician came in to see her, asked about any changes since she’d last been seen, reviewed her history of present illness and examined her. He talked to her about her illness and described a treatment plan for her upper respiratory infection given her chronic health problems.
  5. He prescribed a medication for her problem, updated her medication list and made a copy for her to take with her.
  6. He marked the encounter form with the level of service and her diagnoses and gave her the form to take to the check-out desk.
  7. He refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled.  The chart was filed, and the encounter form was sent to the billing office.
  8. At the billing office, the charges and any payment was posted, and the claim was filed.  If there was no problem with the claim, it electronically passed through two scrubs and a final one at the payer.
  9. If payment was not denied for any of a dozen reasons, the payment would arrive at the billing office and would be posted.
  10. Since the patient did not pay at the check-out desk, the patient-responsible balance is billed to the patient.  If the patient pays on the first statement, it has taken 45 to 60 days to receive complete payment.  Since the patient has BCBS, there is a negotiated rate, so the payment will not even total $100.

I know that patients often say “But he only spent 10 minutes with me.”  Checking back with the provider, I find it was typically longer.  Patients tend to underestimate the time as it goes very fast.

The total visit encompassed the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller.  It took eight people, and at least 45 minutes of work to make that appointment happen.  Plus, that visit had to help pay the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable.  It’s what we all want.  And it ain’t cheap.

Mary Pat Whaley is board certified in healthcare management and a fellow in the American College of Medical Practice Executives.  She blogs at Manage My Practice.

Image credit: Shutterstock.com

Prev

YouTube CPR videos a reflection of health care social media

January 6, 2011 Kevin 1
…
Next

Little Patient Big Doctor: One Mother's Journey, an excerpt

January 7, 2011 Kevin 6
…

Tagged as: Patients, Primary Care

Post navigation

< Previous Post
YouTube CPR videos a reflection of health care social media
Next Post >
Little Patient Big Doctor: One Mother's Journey, an excerpt

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Mary Pat Whaley

  • a desk with keyboard and ipad with the kevinmd logo

    What Jay-Z can teach doctors about marketing their practice

    Mary Pat Whaley
  • a desk with keyboard and ipad with the kevinmd logo

    The 3 biggest HIPAA myths debunked

    Mary Pat Whaley
  • a desk with keyboard and ipad with the kevinmd logo

    Why patient complaints are an opportunity

    Mary Pat Whaley

More in Physician

  • The broken health care system doesn’t have to break you

    Jessie Mahoney, MD
  • How a $75 million jet brought down America’s boldest doctor

    Arthur Lazarus, MD, MBA
  • The dreaded question: Do you have boys or girls?

    Pamela Adelstein, MD
  • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

    Muhamad Aly Rifai, MD
  • How grief transformed a psychiatrist’s approach to patient care

    Devina Maya Wadhwa, MD
  • Fear of other people’s opinions nearly killed me. Here’s what freed me.

    Jillian Rigert, MD, DMD
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • What prostate cancer taught this physician about being a patient

      Francisco M. Torres, MD | Conditions
    • Why fearing AI is really about fearing ourselves

      Bhargav Raman, MD, MBA | Tech
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 100 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • What prostate cancer taught this physician about being a patient

      Francisco M. Torres, MD | Conditions
    • Why fearing AI is really about fearing ourselves

      Bhargav Raman, MD, MBA | Tech
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Your 10 minute office visit needs 8 people and 45 minutes of work
100 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...