Frustration at the apparent waste of money in the U.S. health care industry by federal and state governments, insurance companies, and some commercial providers is nothing new. Increasingly, however, patients and doctors are growing frustrated by the industry’s waste of a more precious resource: time.
Most patients are keenly aware of the contrast between the hours they invest in visiting their doctor’s office and the few minutes they spend with their doctor during an exam. On average, patients enjoy a paltry eight minutes of face time with their doctor during appointments. Doctors often spend the remainder of the patient’s 12- to 20-minute appointment on administrative tasks, such as meeting burdensome electronic health record (EHR) reporting requirements issued by the federal Centers for Medicare and Medicaid Services (CMS).
The up-to-20-minute block of time an average patient spends in an exam room receiving care from a doctor is often a fraction of the time he spends on the premises of his doctor’s office. Patients spent an average of 84 minutes at clinics per visit in 2010, according to a 2015 study published by the American Journal of Managed Care (AJMC).
To these 84 minutes, add 44 percent, or an average of 37 minutes of travel time per visit, rounding out the average total time patients spend on each doctor appointment to just over two hours—121 minutes—the AJMC study states.
Time Is Money, Remember?
Patients who live in rural areas and who need highly specialized care must travel farther and longer. “For multiple sclerosis, there’s very few specialists around the country in Georgia,” telemedicine provider Dr. Jeffrey English, director of clinical research at the MS Center of Atlanta, told me in an August 4 episode of the Health Care News Podcast. “They’re only in Atlanta, so I would have patients who would travel four hours each way … and I would spend 20 minutes with them.”
In contrast to doctors, patients don’t bill for time spent at appointments, but patients’ time still carries a price tag above and beyond their out-of-pocket costs (not to mention costs of car fuel and maintenance or other transportation). “Opportunity costs added 15 additional cents in indirect costs to every dollar spent in physician visit reimbursement,” the AJMC study states.
An extra 15 cents per dollar may not sound like much, but extrapolating these pennies across all patient visits yields a staggering figure. The total dollar value the study assigned to the time patients spent on doctor appointments was $52 billion among America’s adult population in 2010. This includes, among the employed, $25 billion in the lost productivity of 1.1 billion hours spent on doctor appointments.
Doctors Don’t Enjoy This, Either
On the other side of this equation is doctors, many of whom suffer from the prevailing system’s inefficiency almost as much as patients do. Doctors mired in the mainstream third-party payer system—i.e., who primarily bill patients’ insurers, Medicare, or Medicaid—typically must treat 2,000 to 3,000 patients across 6,000 to 9,000 doctor visits per year in order to earn enough to make their career worth it to them. At that pace, minutes are scarce, and federal EHR reporting requirements make time scarcer.
“I see 30 patients each office day,” Dr. William Strinden of Memorial Hospital in Lufkin, Texas told the American Medical Association for a Break the Red Tape event, Becker’s Healthcare reported in October 2015. “If I wasted only three minutes per patient, that would add up to an extra hour and a half of work. I have a [registered nurse] and three employees who have been with me at least 12 years and do a good job and are well-compensated. It would cost me at least $100 per day extra just in lost time.”
Becker’s reported Dr. James Smith, a practitioner in Lawrenceville, Georgia, tried to save time by inputting history and orders while talking to patients. “I could tell that they felt I was very detached and more focused on this,” Smith said—so he hired a scribe to facilitate EHR reporting. “That has alleviated a portion of that and allows me to sit at the bedside and be more engaged with a patient, but that’s now at a cost of between $25,000 and $30,000 a year out of my pocket.”
Laws such as the Affordable Care Act, federal regulations such as EHR reporting requirements, and restrictions on telemedicine reimbursements purport to increase patient access to affordable, high-quality health care. Their success is doubtful, as evinced by Republicans’ and Democrats’ renewed calls for vigorous—although different—government responses to the current health-care landscape.
Our government programs fail to keep pace with the opportunity cost of a single patient’s doctor appointment. No government program can keep pace with the opportunity cost of confining free-thinking patients and enterprising doctors to a centrally planned system.