Most doctors in Poland supplement their in-office visits with remote contact, via telephone, medical communicators or email. Although 80% of them offer such services, only one in five is paid for it1 . They do this free of charge, guided mainly by a sense of duty and mission, and all in order to guarantee the highest possible quality of medical care.
Although hybrid medical care, combining in-patient visits with remote contacts, is crucial for the continuity of treatment of patients with chronic diseases, the treatment of remote contact as an additional and free duty of the doctor is unacceptable, as it leads to professional burnout and, as a result, a decrease in the quality of care2.
Therefore, in this article we will discuss the different billing models for remote contact with patients, both in private and public care.
Private care: payment for the service
In the per-service billing model, the patient pays the doctor once for each service received, e.g. for prescribing a prescription, referral for examinations or remote consultation. Among the 20% of doctors in Poland who bill patients for remote contact, this is the most common model1. To finalize the transaction, doctors use a bank transfer or BLIK transfer.
When to offer patients a one-time billing for the service
Occasional and occasional consultations with healthy patients
One-time payments for individual services work best when remote contact with the patient is sporadic and the patient does not require constant health monitoring.
Specific needs of the patient
A one-time payment is also the optimal form of settlement when the patient has clearly defined and limited medical needs, such as obtaining a second medical opinion or consulting the results of tests. In such cases, the fee for a particular service is more transparent and fair.
Payment for the service from the perspective of a doctor
Advantages of one-time payments according to the doctor
Flexibility: The doctor can flexibly adjust the prices of services depending on the complexity of the cases and the demand.
Convenience: we are all used to making and receiving transfers, so this is also a familiar and convenient form of billing for a doctor who does not need to use additional tools or methods.
Disadvantages of one-time payments according to the doctor
Revenue Unpredictability: due to the lack of fixed and predictable revenues, the doctor has difficulty in financial planning and his remuneration depends on the fluctuation of patients' needs (e.g. seasonality).
Increased administrative burden: the doctor accounts with patients each time for services, which may require additional time and resources, especially with a large number of patients in remote contact.
Fragmentary care: The pay model for remote contact per service makes it difficult for the physician to build a long-term relationship with the patient, which can affect the quality of care.
Payment for the service from the patient's perspective
Advantages of one-time payments by patient
Flexibility: patients pay only for those services that they actually use and when they carry them out.
Transparency of costs: Patients always know exactly what they are paying for.
Lack of long-term commitment: patients are not required to pay regular fees if they do not require constant remote medical care.
Disadvantages of one-time payments by patient
Higher costs with frequent needs: For patients requiring frequent contact with a doctor, the per-service model becomes more expensive and unprofitable in the long run.
Lack of continuity of care: billing for individual services does not allow the doctor to build a long-term relationship with the patient, aimed at keeping him healthy. Due to the increasing cost with more frequent needs, the patient in such a billing model contacts his doctor, only to “extinguish the fires”. Such a transactional model of doctor-patient cooperation leads to fragmented care and prevents long-term prevention planning.
Private care: subscription payment
In the subscription model, the patient pays a regular, usually monthly or annual, fee that covers a specific range of medical services, such as access to remote contact with a doctor, health check-ups, preventive measures or analysis of test results. This model works in the spirit of Value Based Healthcare. Value means recovery or a significant improvement in the quality of life of the patient for which the patient is willing to pay2. The doctor's remuneration for the effect significantly reduces the cost of health care and leads to an improvement in the health of the population3. There are already tools on the market that allow doctors to create so-called subscription care plans. In Poland, it works for this medical communicator Doctor.One.
When to offer subscription care to patients
Care for patients with chronic diseases
The subscription works best for patients with chronic conditions who require ongoing medical care, i.e. regular consultation, monitoring and adjustment of the treatment plan, and education about treatment and living with the disease. Such a model is particularly suitable when remote contact is a key element of patient care because in-patient visits are delayed or not always needed (e.g. for follow-up consultations or regular analysis of test results).
Comprehensive medical care
Doctors opt for subscription billing when they want to offer patients comprehensive health care that includes not only remote consultations, but also regular check-ups and prevention planning. The subscription allows the doctor to better manage health and preventive measures, which is why it works primarily in pediatrics, lifestyle medicine and gynecology.
Subscription care from a doctor's perspective
Advantages of subscription payments according to the doctor
Regular and predictable revenue: Thanks to the subscription per patient, the doctor receives regular and predictable income regardless of his illness, holidays or the time spent on remote contact with the patient (it can be 0 minutes, or it can be 15 minutes in a given month). Such a model greatly facilitates financial planning and increases the stability of medical practice.
Long-term relationships with patients: the doctor can build lasting relationships with patients, which contributes to a higher quality of medical care and greater patient satisfaction.
Optimization of work. Constant payment of the patient for remote contact means that the doctor no longer has to account for each single service, which significantly saves time and administrative effort.
Disadvantages of subscription payments according to the doctor
Risk of overloading: with a large number of patients (+200), whom the doctor cares for remotely, there is a risk of excessive strain.
Subscription care from the patient's perspective
Advantages of subscription payments by patient
Permanent access to medical care: patients are provided with unlimited access to a doctor and medical care for one fixed fee.
More effective long-term care: The subscription promotes continuity of care and better management of chronic conditions, as it allows the patient to maintain regular remote contact with the doctor, inform about the effects of treatment and modify the treatment plan on an ongoing basis.
Lower costs for patients with chronic diseases: for patients requiring regular contact with a doctor, a subscription may be more economical.
Disadvantages of subscription payments by patient
Uncost-effectiveness for sporadic patients: for patients who rarely need medical care, a subscription may be unprofitable.
Permanent financial commitment: regardless of the actual use of medical services, patients must regularly pay a subscription.
.png)
Public care: billing for patient care
The entities that operate within the National Health Fund also implement a model of physician remuneration, which includes both inpatient care and remote contact (by telephone, e-mail or medical messenger). It is worth emphasizing that the time that the doctor spends on remote contact with patients must be included in the doctor's working time.
Free remote contact as an exception to the rule
Free remote contact with a patient should be the exception for the doctor, not the rule in a well-functioning health care system. This form of remote cooperation is only recommended in the case of pro familia care.
- Nowa definicja ochrony zdrowia i jej wpływ na poprawę jakości leczenia. Raport otwarcia Value Based Healthcare, Nojszewska E., Walewski J. (red.), Warszawa 2019, 14-18.
.png)
