A few things.
Medicine is probably the only profession I can think of where people expect you to do you job for free. I can't tell you the number of messages I get from a patient I haven't seen in 2 years with content like: "Has sinus infection, wants antibiotics". Hmmmm, a simple request....why not just call in some amoxicillin? Make life easier on the patient. Let's say that guy is a mechanic. Does he tell people how to change their alternator belt for nothing? Nope. Suggest it to him, he'll tell you you're an idiot. Even better are the messages like "has severe abdominal pain, can't come in for an appointment, wants to discuss with you." Hmmm, since my crystal ball is broken, you need to either come in to I can press on your belly, or you need to go to the ER so someone there can press on your belly. These people get mad when you don't treat them over the phone. My liability in treating someone over the phone is huge. "No, your honor, I didn't examine them, but they TOLD me they weren't having rebound on the phone, so it sure didn't sound like a ruptured appendix....and I did send flowers to the funeral"
Pay for performance.
This is going to do more to hurt patients than Medicare Part D. As primary care docs the most glaring example is treatment of diabetes. Lets say to get a bonus, we have to make sure that 80% of our diabetics have a Hemoglobin A1C below 7%, a blood pressure below 130/80, and a LDL of less than 100. I work in a suburban/urban area. I have quite a few patients that are not compliant no matter how much time I spend with them. (I have 2 ladies who I call once a week to adjust their insulin, but they never get it right). So I look over my roster and note that only 72% of my patients are at goal. I'm gonna miss out on many thousands of dollars I could use to pay my >$200,000 in debt I accrued so I could be the wealthy doctor I am
. Can you predict what may happen? If you guessed that a bunch of people are going to get a letter telling them they need to find a new doctor....you guessed correctly. Now I have over 80% compliance. Now I get my extra money. (not saying I will do this, but I'm sure you will agree it will happen, a lot.)
No charge for follow-up visits:
Someone mentioned the surgery office they worked in didn't charge for follow-ups. That is correct. The follow-up visits are built into the fee schedule for the procedure, so the surgeon has already been paid for it.
Multiple Follow-up visits for the same problem.
I have people I have been seeing for years for the same problem. They keep coming with it, and I can't figure out what the problem is. I have sent them to specialists (including some at Johns Hopkins, supposedly one of the greatest hospitals on the planet) and they can't figure out what it is. Should I still see them when they come in with the same complaint? Should I charge them? I saw a woman in the office last week who for 2 years has had unexplained weight loss and abdominal discomfort. She has had every test you can imagine. CTs, Ultrasounds, MRIs, tumor markers, a laparoscopy, colono, EGD, the endoscopy with the little camera you swallow...all normal. Labs are always stone cold normal. Last week was different. She had small palpable masses in her abdomen on exam. I think I may have found her problem. It isn't good, most likely.
I get paid mostly for thinking about your problem or researching your problem. Just because I didn't come up with an answer, does that mean I shouldn't get paid for the time I invested? Lawyers can charge you for time they spend thinking about your issues.
That being said, there are a lot of docs who bring people back pointlessly. I call people with their lab/imaging results, I don't bring them back in....