Who said 15 minutes was the amount of time a doctor should take to examine a patient? This is the same amount of time men spend on the toilet, and patient care is much more complex.
Insurance reimbursement is the reason for this time allotment and dictates much of what is done in medicine. Medicare made a decision back in 1992 that the “relative value unite” (RVU) formula should be the standard way to calculate physicians’ fee:
(Work RVU x Geographic Index + Practice Expenses RCVU x Geographic Index + Liability Insurance RVU x Geographic Index) x Medicare Conversion Factor
This now archaic formula was to reduce variation in physician fees. According to this formula, a primary care office visit should be 1.3 RVUs, which translated into AMA codes means 15 minutes.
Managed care took over in the mid to late 1990s, as NSync and dial-up modems came and went. These 15 minute doctor visits are now the norm with no change on the horizon, unless you opt for an insurance-free practice. Times have changed in the last 25 years, as has medicine. New and different treatments, tests, and rules have emerged, along with electronic medical records.
A recent study found doctors spend 37% of their time doing paperwork, so the 15 minute visit just became eight. What can you do in an eight minute visit?
- Minute Eight – Take care of any social greetings and make sure the patient speaks and understands English. Patients, don’t talk; just smile and say hello.
- Minute Seven – Since the patient is already undressed and waiting in a paper smock in the cold exam room, ask the patient why they are there. Patients, do not take more than two minutes to tell your story, as this is the average length of a commercial break and the doctor will be able to pay attention for this amount of time. Stay concise and to the point. There’s no crying in baseball or the doctor’s office. No additional questions.
- Minute Five – Doctor washes hands: 30 seconds of hand rubbing with soap, rinsing and drying for another 30 seconds. Throw the paper towel on the floor to save time.
- Minute Four – Time for the exam. Have the patient hold all the equipment or don’t use any equipment, saving valuable time.
- Minute One – Doctor tells patient what to do. If doctor is unsure, they can say “who knows” and leave. As a patient, don’t ask questions because that takes time. Other patients are waiting.
- Time’s Up – Doctor says goodbye while walking out, perhaps directly into another patient room, since doctors aren’t allowed to rest for insurance purposes.
Specific visits may vary, be it an unexpected emergency which needs more time or a specialist who has even less time allowed. The bottom line is that there is little time to actually listen to patients and carefully examine them in 15 minutes. Short visits are hurting the quality of care.
It is time to reevaluate the length of doctors’ visits and their reimbursement. Changing the payment structure could improve patient satisfaction, quality of care, and cut costs. The physician should determine the length of an office visit, not an insurance company.
Lee, Bruce. “Time To Change The 15-Minute Limit For Doctor Visits.” Forbes, 10 Sep 2016. Web. 18 Sep 2016.