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Fee-for-service system extends patients’ wait times as providers seek to maximize profits

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Many patients are becoming increasingly frustrated and angry because of the very long waiting times  in many hospitals and physicians’ offices, in part caused by overbooking.

Providers say they recognize the problem but don’t see it as a priority. That’s because their revenue and profit depends on keeping a steady flow of customers to ensure that  examining rooms (and waiting rooms!) are kept as full  as possible.

As an article in The New England Journal of Medicine noted:

“Physicians and practices might think they minimize the clinical consequences of long waits by prioritizing the patients they squeeze in by double-booking. For example, all else being equal, a hematology–oncology practice might schedule the patient with a known cancer faster than the one with a benign hematologic issue, or a cardiology practice might accommodate a patient with complex arrhythmia sooner than one with stable angina. This approach not only makes sense clinically; it’s also good business. Higher-acuity conditions tend to drive more tests and procedures, which translates to more services billed and more dollars collected. In fact, in busy practices that maintain a patient mix heavily weighted toward sicker patients, improving access for patients across the board could bring down the average weighted productivity and profitability.

“The painful reality is that the fee-for-service system rewards long waits and overbooking to squeeze in sicker patients. Practices maintain a higher-acuity mix, while health systems benefit from care spilling over into more costly settings. The system does not reward providers who organize care to reduce waits for all patients, even though that might keep some patients from becoming sicker. And that may be why most providers have been slow to invest in systems that might reduce waiting time.”

To read the NEJM article, please hit this link.

To read a Boston Globe article on this issue, please hit this link.

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