Could You Bill Your Doctor for Making You Wait?

July 7, 2011— -- Cherie Kerr sat in the doctor's office for four hours as she waited for the nurse to call her name. As a freelance writer in 1969, Kerr missed four hours of her hourly wage that day. Upon receiving her hospital bill, Kerr refused to pay it. The move set off a lifetime of standing her ground, refusing to pay, and sometimes billing her doctors, when they kept her waiting too long.

"I know if I sit there, I'm going to get really mad, and then I'm not polite," said Kerr, 67, of Santa Ana, Calif.

Now, in an attempt to avoid such standoffs, Kerr makes sure her appointments are slotted for first thing in the morning, or for the first time slot after lunch.

"I know doctors have emergencies, but if the doctor keeps you waiting for hours, that's wrong," Kerr said. "Anytime I choose a new doctor, I shop around to find out how their office runs, and whether they respect my patient rights about time."

Most people have been in a situation similar to Kerr's, watching the minutes slowly tick by, waiting waiting waiting for their names to be called. And some have refused to waste anymore time in waiting rooms without something to show for it, such as compensation for their time.

"I think this is a fantastic idea, especially when the doctor is clearly in the wrong," said Dr. Pamela Wible, a family physician in Eugene, Ore., who gives her patients gifts of lotions or soaps if she's running more than 10 minutes late for an appointment. "This is about mutual respect. It's time to do this."

Other doctors have followed the same path as Wible by offering gift cards, presents or even cold hard cash if they leave their patients waiting too long. Other offices keep patients abreast of the doctors' schedules by calling or sending text messages when running late.

But Dr. Ari Brown, a pediatrician in Austin, Texas, and author of the "Baby 411," said that billing a doctor or writing a scathing blog post may make a person feel better, but it is not solving the problem.

"The answer is to be an empowered consumer -- and find a new doctor and write a brief note to the doctor to explain why you are leaving the practice," said Brown. "A successful medical practice relies on satisfied patients who, in turn, refer their friends and family members. When enough patients leave due to excessive waits, the physician and the practice should reassess their business model."

Experts noted that there are several reasons why physicians run behind schedule, and most of those are caused by the unpredictable nature of health care. Patients can cause delays by misrepresenting the reason for their visit, adding on complaints, arriving late to the appointment or being unprepared for the visit, Wible said.

And Brown said that many doctors run behind schedule because they "try to address the needs of each patient, and some patients come in sicker than anticipated, need more care [or] need to be hospitalized. It's not because we are enjoying a latte, schmoozing with other doctors and watching the news in the breakroom."

Patients Bill Doctors for Waiting too Long

Primary care physicians are also in short supply. Lower reimbursement rates and perpetually rising overhead costs have resulted in an increase in daily volume, Brown said.

"The crux of this issue is time, and it is an important commodity for patients as well as physicians," said Dr. Randy Wexler, an assistant professor of medicine at the Ohio State University. "However, it cannot be discussed in a vacuum."

Wexler noted that Tuesday he spent an hour and 15 minutes talking to a family with a member who'd been recently diagnosed with a terminal disease.

"What should I do?" Wexler asked rhetorically. "Tell them their 15 minutes is up, and that they will have to leave?

"If we are going to have a discussion as to the value of time, and patients want to be paid for theirs, then the change must encompass the physicians time, too," said Wexler. "That means paying for after-hours advice, forms that are needed ... or [paying] if you need more time than scheduled so the physician can pay all the patients who will now be late."

Wexler said recent research found that primary care physicians typically spend up to 50 percent of their work time performing tasks for patients that are not reimbursable because the health care system only pays for face-to-face visits.

But in an industry filled with life and death emergencies and medical complications, Dr. Mark Fendrick, professor of internal medicine and health management and policy at the University of Michigan, said it's too difficult to guarantee an exact schedule every day.

"If I cannot get a cable repairman or furniture delivery to commit to a window of less than four hours in duration, how can we expect a physician -- with all the variability of patient complexity and needs -- to always be on schedule?" asked Fendrick.

MedPage Today's Kristina Fiore contributed to this reporting