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February 9, 1994

Physician Payment: Fee for Time

Author Affiliations

Washington, DC

JAMA. 1994;271(6):425. doi:10.1001/jama.1994.03510300025015

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To the Editor.  —Reimbursement for physician services based on time is not a good idea. Like Medicare and Medicaid it would assist physicians in cheating, and eventually patients would have to pay with their time and diminished access to physicians.Despite assertions to the contrary, it is impossible to guess how long a new or return appointment will take. Some patients require, and some demand, more time. A physician would lose 25 minutes for each patient who only consumes 5 minutes of a scheduled 30-minute return visit. If a physician schedules all patients for 5 minutes, he or she could be running 4 hours late at the end of the day. The only fair way to handle this will be to stop scheduling any appointments at all and handle all patients on a walk-in basis, like a barber shop. Since Medicare precludes side contracts with patients, even millionaire attorneys would

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