Fill out your disability form? That’ll be $25, please

If you can’t get by on the fees you collect for providing a service, start tacking on extra charges: $25 for the paperwork, $10 for the administrative overhead, $5 for copies of documents, another $25 for retrieval of said documents, etc. etc. etc.

Businesses and government do it all the time. Now the concept is being adopted by doctors as well. The practice doesn’t appear to be widespread, but according to a recent article in USA Today, it’s starting to look more and more attractive to physicians who can’t make ends meet on insurance reimbursement alone. From the article:

The extra payments include no-show fees of $30-$50 for missed appointments, widely varying charges for filling out health forms for school, work and athletic teams, and annual administrative fees of $30-$120 or more to simply be a patient in some practices, medical associations and doctors say.

"It’s not unlike the airlines," said William Jessee, president of the Medical Group Management Association, which generally advises against extra fees that may anger patients or run afoul of insurance contracts. "They’ve gone from all-inclusive to a la carte. That’s what you’re seeing with physicians."

Doctors who charge extra fees are in the minority, he said. Some have done it for years, but more are joining them because they say they need the fees to offset the rising costs of practicing medicine.

Is it fair or reasonable to charge extra? Or are services such as filling out forms and refilling prescriptions just part of the doctor’s cost of doing business?

An Atlanta mom has to fork over $10 every time the family pediatrician fills out a form, and she doesn’t like it. "It’s part of their job," she told USA Today.

Judging from the 800-some comments posted by readers in reaction to the story, there’s a lot of resentment over the concept. "Any doctor that tacks on fees will not be getting my business," one person wrote. "They are just greedy theives (sic). And on top of it they are whining greedy theives (sic)," fumed someone else.

Grousing aside, it’s valid for people to ask where the line should be drawn between the normal cost of doing business vs. uncompensated burden. A teacher who commented at USA Today wondered, "Should I be compensated extra for my student-teacher conferences? Or for having to fill out forms regarding a child’s poor behavior? What about the extra hassle of speaking on the phone with a parent who is worried about their child? Isn’t this all ‘administrative’ stuff?? Yes, but it comes with the territory."

From the physician’s point of view, though, it’s becoming increasingly difficult to stay solvent while managing the flood of unreimbursed paperwork. Dr. Toni Brayer lamented the situation in a guest post at Kevin, MD:

As a physician who has practiced for over 20 years, I can tell you that the demands of filling out forms for everything from work questions and school physicals to handicapped stickers and travel vouchers, dealing with insurance companies, reviewing tests ordered by other doctors, overseeing and coordinating patient care, talking with pharmacists, filling prescriptions and then redoing the work when a patient switches pharmacies, e-mailing and countless other tasks that are "free" make it near impossible to remain in private practice.

If health care was like other industries, it could simply raise its prices to cover the increased cost of doing business, or drop services that don’t pay for themselves. But health care doesn’t function like other businesses. For one thing, there’s limited room for negotiating reimbursement rates with third-party payers. In the case of Medicare, there’s no negotiation; providers either have to accept what Medicare is willing to pay them or opt out of Medicare altogether. For another, insurance contracts usually place restrictions on charging extra for services already deemed to be covered. In view of the fact that physicians only make money by seeing patients and/or doing procedures, administrative fees are one of the few viable options left for bringing in more revenue to subsidize their overhead costs.

I personally wouldn’t mind paying extra fees, as long as they were reasonable. (And I’m gonna add here that doctors aren’t alone in disliking all the forms they have to fill out on behalf of patients; most patients don’t like it either.) There are patients, though, who won’t be able to afford the extra fees – what then? And does it make sense to add more spending to a health care system that already consumes billions of dollars each year?

The irony in all of this is that it’s not doctors and patients who are the real problem. The real problem lies in how physicians are paid and how third-party payers set their reimbursement rates. If both these things could be changed, the burden for physician practices might be eased and administrative fees would no longer be necessary. As usual, though, doctors and patients are paying the price for the brokenness of the health care system, and until there’s a substantive fix, add-ons such as extra fees constitute little more than a Band-Aid.