Blog | Tuesday, February 18, 2014

Can doctors charge late fees?

I admit that I have a rudimentary knowledge of the business world, but I’m improving. I now know, for example, that a C-suite does not refer to the procedure room where I do colonoscopies. I am aware that executive coaching does not refer to advising top managers on their golf swing or tennis overhead. I used to think that LLC stood for Long Live Colonoscopy, but now I know better. CFO, Chief Flatulence Officer?

While patients and physicians operate under oral agreements, business agreements are generally established in writing. In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop. Oftentimes, the 2 parties do not agree that a contractual term has been violated. This is when the fun begins. With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a matter of several years after impoverishing both sides.

A common contractual feature is a requirement that goods and services be delivered on time and on budget. A contractor might be subject to a penalty if his project is not completed by the agreed date. This is a reasonable concept and serves as an incentive for on time performance. In real life, this may not be as clean as it sounds.

Customer: “You’re a week late so you owe me half a gazillion dollars.”
Contractor: “It’s not our fault that the city planner delayed us. Go fight City Hall.”

Other professions are not subjected to financial incentives to deliver on time. Consider our beloved airline industry where customers are hassled and fleeced before they are herded onto airplanes to sink into a seat narrower than most humans. Air travel has delivered some celestial benefits to us. It has increased our spirituality. We pray that our luggage won’t arrive in the wrong continent. We pray that our bottle of mouthwash in our carry-on bag won’t be confiscated. (This critical security policy is from the same TSA brainiacs who initially gave a green light to bringing pen knives on board.) We fervently pray that the passenger seated in front of us will not lean his seat back while our tray table is down which would impale us.

Shouldn’t the airlines be penalized when flights are delayed? At present, they game the system by artificially lengthening the estimated travel time so that many flights will arrive “on time” even when there are delays. When a flight is delayed an hour, what loss do passengers incur? Shouldn’t they be made whole for their loss? Perhaps, an extra bag of honey roasted peanuts would mollify the restive crowd.

On time performance is a live issue in the medical profession.

Do patients deserve to be compensated when physicians are late? Should it depend upon the reason? Is a delay because of a medical urgency non-compensable? Should there be a no fault system where patients are compensated for delays regardless of the explanation?

Stand down readers. This concept might work in both directions. What pound of flesh should be exacted from patients who wander in late or simply fail to show up? The latter occurs even when patients have been contacted the day prior to remind them of their solemn obligation to keep their appointments. It is particularly vexing when a colonoscopy patient fails to show leaving us with nurses, a nurse anesthetist and a doctor with unscheduled time off that could have been used by another patient.

Insurance carriers will not permit physicians to charge patients who leave us flat. It’s in our contract, a document that offers us no relief when these companies don’t deliver.

If you have suggestions on what should be done to late physicians or patients, you are encouraged to do so at this time.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.