Billable Hours

One of the culprits frequently blamed for burnout in medicine is the amount of work that's done that isn't paid, isn't really medical, and largely isn't recognized. The American model of healthcare is also already bloated and too expensive, so tacking on more costs is probably a non-starter, but after (of course) talking to a lawyer about billable hours, I started thinking about all the things that could at least conceivably change.

For example, for every patient visit, there is also time required for documentation. Sometimes that can be done during the visit, but that often leaves patients dissatisfied because we look at the screen instead of talking to them. Plus, it often can't be finished, leading to the infamous crush of notes to be finished at the end of the day, either at the office/hospital or taken home. What if, instead, time and cost for doing that were built in? Your appointment is X minutes, and you (or your insurance) pays for X+Y minutes, where Y is a reasonable amount of time to write a note? (In reality, I think physicians—and especially companies/organizations employing physicians—would use any extra time to cram in more patients, though.)

Or take calls for prior authorization. Put together all the time on hold, transfers, waiting for someone to make a decision, faxing, and calling back, and it can really add up. If physicians could just bill for that time it would create a perverse incentive to intentionally waste time on useless prior auths that we really had no intention of getting approved. But I do think that having insurance pay for time wasted on prior authorizations that do go through would create a useful incentive for insurance to be reasonably efficient and responsive. (Tracking time would be a little bit difficult, and I worry that it would ratchet up insurance's efforts to deny all meds so they could also deny all prior auth bills.)

Patient phone calls, FMLA/SS(D)I paperwork, coordinating with other doctors, all of these take time. Getting paid might be a fight, but it would also cut down on wastes of our time, which would allow us to care for more patients and maybe make the system work more smoothly.

The insurance pays for wasted time idea is the one I think is most conceivably workable. I'm interested in any thoughts others have, at least for the sake of imagining a better system.