In this article, our Managing Director Jane Braithwaite turns troubleshooter to answer independent practitioners’ frequently asked questions on business matters. Today she is answering a question on patient communications This article was originally written for Independent Practitioners Today. 

‘Should I charge patients for phone calls and answering their questions sent by email? These take up a lot of my time

The traditional model of seeing patients face to face has been challenged over the last couple of years and patients have become more accustomed to talking to their doctor by video, phone and emailing questions. Many private GPs and consultants were challenged by the number of patient phone calls and emails prior to Covid, but we have definitely seen a marked increase. Being able to provide patient care in a number of different manners brings advantages, and a mix of approaches can be adopted to improve the patient experience. But in private healthcare, we need to be mindful of how we charge for these different interactions, what the insurance companies allow and also how patients react to different fees. Pre-covid, most private doctors charged for face-to-face consultations and accepted there might be a couple of phone calls or emails as follow-up, especially if surgery were needed, and there would be no charge for these follow-ups. 

At no cost
I recently met a consultant who had seen a patient for one face-to-face consultation and had received 28 follow-up emails from them in the following 12 months and had replied to each one at no cost. Taking into account the amount of time invested in the care of this patient, the one-off consultation fee did not nearly cover the cost of care provided. So how do we charge patients appropriately for these new interactions? There is a convincing argument to charge the same fee for a virtual/video consultation as for a face-to-face one. The length of discussion is the same, as is the nature of the discussion, and so it follows that the fee should be equal. Some patients may prefer to meet via video either due to time or geographical constraints and see this option as advantageous to them.

Major insurance companies allow consultants to charge for consultations that are not face to face and they describe them as ‘remote’. Initially, the amount allowed was capped to a maximum limit, but this was challenged and it is now possible to charge the same fee for a virtual consultation as a face-to-face one.

Remote consultation
Bupa themselves run a virtual GP service where the fees are based on the meeting time. A 15-minute call with a GP will cost £49 and a 30-minute call will cost £89. A remote consultation can also cover a consultation via phone call rather than video, and some patients prefer this, as they don’t like the perceived intrusion of video or they see no added benefit in being able to see their consultant’s face. I make no comment! The big question is how will patients react to being charged for a phone call when they have come to expect these ad hoc calls as part of the overall service and thus free? Some patients will feel that introducing a fee for these calls is too much and will object strongly. This is obviously less of an issue for insured patients, although many of them may incur an excess fee. For self-pay patients, we need to think very carefully about how these fees are introduced.

One tip I would offer is to ensure that phone calls are positioned as appointments rather than ad hoc interactions. I would set up a process with your medical PA whereby phone calls are scheduled into your clinic even if your preference is to add them at the end of your face-to-face clinics. The message your medical PA delivers to the patient will feel different. The patient will understand that they have a scheduled appointment within your clinic rather than a perception that you will call on a slightly ad hoc basis at the end of your clinic.

Time-consuming job
But how do patients feel about paying for emails and prescriptions? Replying to patients’ emails can be very time-consuming, especially if the patient is asking lots of detailed medical questions. Most doctors I know do not charge for these responses, but maybe they should? It is far more common to see a charge for prescriptions, though. To the best of my knowledge, most insurance companies do not cover costs for emails or prescriptions. As with all fees, it is essential that the patient knows in advance the cost of their care. When a patient books an appointment, they must receive confirmation of the likely cost of treatment. Most medical PAs have a standard email they send to confirm an appointment, which also details the likely cost of treatment, and this should also be used when confirming a video consultation. If you are charging for email responses and prescriptions, these costs must be provided in advance too.

The ability to charge appropriately for the services offered in private healthcare will continue to be a challenge and it is important to continually review the actual cost of providing the care to our patients and attempt to recover these costs.

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