FFS. Fee for service. If you have ever wondered why the doctor is so concerned about the computer screen and spends more time clicking and typing than engaging with you, fee for service is the reason. As the name implies, doctors only get paid when they see you in the office, and now through video visits. This obviously encourages frequent patient appointments, as any phone calls, emails, communication with specialists, reviewing records, labs, images etc. are not billed, and the practice doesn't make any money doing it. The entire clinic, from the billing department, to the receptionists, to IT and even payroll departments, depend only on the revenue from seeing patients. This is why the 15 minute visit exists, this is why clinicians see 18-24 patients per day. 15 minutes is supposed to cover front desk paperwork, getting vitals like weight and blood pressure, the doctor visit, reviewing your medical chart and completing a note for your visit, ordering appropriate labs/images/medications/referrals, billing, and coding the visit. In 15 minutes. Just because a doctor doesn't make eye contact, doesn't mean they don't care. It just means they are furiously trying to multitask to provide the best care they can within their constraints. What about those who choose not to multitask? "Pajama time" has been used to describe the hours of work doctors do on nights and weekends trying to catch up. Reviewing results on your portal, or getting messages from your doctor? Check a time stamp and see for yourself when the doctor has time to follow up with you.
There are a few ways organizations are trying to combat this. First, organizations hire teams of billers and coders to comb through charts to try and claw every penny they can from the insurance companies. They encourage doctors to add a series of meaningless codes and edit their notes to qualify for higher payments to try and reflect the work they are actually doing. This is the majority of why doctors have to spend so much time on the computer, the note has to be perfect with all the right boxes checked, or the clinic suffers. Insurance companies have an obligation to shareholders, they can either raise premiums, minimize payments to doctors, or deny coverage of procedures. Often, its all of the above.
Capitation refers to getting a bonus by the number of patients you juggle. The national average is close to 3,000 and I, like most doctors, was overwhelmed. According to the American Academy of Family Physicians, doctors would prefer to have a panel size of 1000 or less. Capitation would incentivize doctors to manage even larger numbers of patients. Imagine an ideal student teacher ratio of 18:1 for your children in grade school. Now imagine a school system that averages a student teacher ratio of 54:1.
As a Family Physician I take pride in taking time with patients and addressing as many concerns as possible to help them reach their goals. Thanks to my broad training with uninsured or underinsured patients, I can treat the vast majority of their medical concerns given enough time. The traditional system may be full of money (held by insurance companies), but it lacks the most important resource of all, time. Direct Primary Care fixes that, and a growing number of physicians are realizing you don't need insurance for the most of healthcare, just for catastrophes.
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