Why Your Doctor Appointment Is So Short

There’s an invisible price tag influencing your doctor visit. But that could be about to change.

Michael Millenson
Elemental
Published in
7 min readNov 20, 2019

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Credit: Lauren Burke/Getty Images

IfIf you’ve ever wondered why your doctor lingers with some patients and seemingly whisks others out the door, you probably chalked it up to individuals’ differing medical needs.

That may be true, but there’s another factor: Every patient enters the exam room with an invisible price tag.

“It’s a business,” says Jeff Gorke, managing director of the health care practice consulting firm Stout, “and it’s also about the delivery of quality care.”

Both aspects have gotten more complicated recently.

TToday, doctors appointments are brief: about 13 to 16 minutes long, according to 2016 data. Dr. Saul J. Weiner, professor of medicine, pediatrics, and medical education at the University of Illinois at Chicago, recalls how the system used to work. “Especially if you knew a patient well, you could just write afterward something concise like, ‘Patient is doing fine, continue present management,’” he says.

That informality has mostly vanished as more oversight has been implemented. The shift came as a response to what were seen as abuses of the “more care, more money” model of fee-for-service payment, which has been a part of U.S. medicine for centuries. A 1980s-era analysis of physician payment helped set the stage for the advent of a blizzard of new rules. While in theory, fee-for-service can “reward those physicians who are efficient, hardworking, and attractive to patients,” wrote researcher Bruce Rosen, the reality was that without “control mechanisms,” physicians can easily “bill for procedures not carried out” or assign procedures “to the more lucrative billing codes.”

Medicare, as the nation’s largest payer of medical bills, decided in the mid-1990s that those “control mechanisms” desperately needed a revamp. The Medicare program instituted computerized billing codes analogous to the fare codes on an airline ticket. Each “evaluation and management” code corresponded to a set of clinical requirements, an estimated doctor visit time (from 10 minutes to an hour), and a payment. Medicare’s criteria were promptly adopted by private insurers, too.

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Michael Millenson
Elemental

As author, researcher and consultant, I focus professionally on safe, high-quality and patient-centered health care. I also write on more personal concerns.