Most doctors in Poland supplement in-person visits with remote contact, via telephone, medical messaging or e-mail. Although 80% of them offer such services, only one in five is paid for it1. They do it free of charge, driven mainly by a sense of duty and mission, all in an effort to guarantee the highest possible quality of medical care.
Although hybrid medical care, combining inpatient visits with remote contact, is crucial to the continuity of treatment for patients with chronic diseases, treating remote contact as an additional and gratuitous duty for the physician is unacceptable, as it leads to professional burnout and ultimately a decrease in the quality of care2.
Therefore, in this article, we will discuss the different models of remote patient contact billing, both in private and public care.
Private care: payment for the service .
In the per-service billing model, the patient pays the doctor a one-time fee for each service received, such as a prescription, test referral or remote consultation. Among the 20% of doctors in Poland who bill patients for remote contact, this is the most common model1. Doctors use bank transfer or BLIK transfer to finalize transactions.
Whento offer patients one-time billing for a service
Ad hocand occasional consultations with healthy patients
One-time payments for individual services work best when remote contact with the patient is occasional and the patient does not require ongoing health monitoring.
Specificneeds of the patient.
A one-time payment is also the optimal form of billing when the patient has clearly defined and limited medical needs, such as obtaining a second medical opinion or consulting on test results. In such cases, payment for a specific service is more transparent and fair.
Paymentfor service from a physician's perspective .
Benefits ofone-time payments according to a doctor
Flexibility: the doctor can flexibly adjust the price of services according to the complexity of cases and demand.
Convenience: we are all used to making and receiving transfers, so this is also a familiar and convenient form of billing for the doctor, who does not need to use additional tools or methods.
Disadvantages ofone-time payments according to a doctor
Unpredictability of revenues: 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 bills patients each time for services, which can require additional time and resources, especially with a large number of remote contact patients.
Fragmented care: the per-service remote contact payment model makes it difficult for a doctor to build a long-term relationship with a patient, which can affect the quality of care.
Paymentfor service from the patient's perspective .
Benefits ofone-time payments by patient
Flexibility: patients pay only for the services they actually use and when they use them.
Cost transparency: patients always know exactly what they are paying for.
No long-term commitment: patients are not required to pay regular fees if they do not require ongoing remote medical care.
Disadvantages ofone-time payments according to patient .
Higher costs with frequent needs: for patients who require frequent contact with a doctor, the per-service model becomes more expensive and not viable in the long run.
Lack of continuity of care: single-service billing does not allow a doctor to build a long-term relationship with a patient aimed at keeping them healthy. Due to rising costs with more frequent needs, a patient in such a billing model contacts his doctor only to "put out fires." This transactional model of doctor-patient collaboration 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 certain range of medical services, such as access to remote contact with a doctor, health review, preventive measures or analysis of test results. This model operates in the spirit of Value Based Healthcare, or value-based healthcare. Value means recovery or significant improvement in a patient's quality of life, for which the patient is willing to pay.2 Paying a doctor for an outcome significantly reduces healthcare costs and leads to improved population health.3 There are already tools on the market that allow doctors to create so-called subscription care plans. In Poland, the Doctor.One medical communicator works well for this.
Whento offer subscription care to patients
Caringfor patients with chronic diseases
Subscription works best for patients with chronic conditions who require ongoing medical care, i.e. regular consultations, monitoring and adjusting the treatment plan, and education about treatment and living with the disease. Such a model is especially suitable when remote contact is a key component of patient care, as inpatient visits are postponed or not always needed (e.g., for follow-up consultations or regular analysis of test results).
Completemedical 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 preventive planning. Subscription allows the doctor to better manage health and preventive measures, which is why it works especially well in pediatrics, lifestyle medicine and gynecology.
Subscription carefrom a doctor's perspective
Benefits ofsubscription payments according to doctor
Regular and predictable revenue: with a per-patient subscription, the doctor receives regular and predictable revenue regardless of his or her illness, vacations or time spent in remote contact with the patient (it could be 0 minutes, or it could be 15 minutes in a given month). Such a model makes financial planning much easier and increases the stability of a medical practice.
Long-term relationships with patients: the doctor can build lasting relationships with patients, which contributes to higher quality medical care and greater patient satisfaction.
Workflow optimization. Fixed patient payment for remote contact means that the doctor no longer has to bill for each individual service, significantly saving time and administrative effort.
Disadvantages ofsubscription payments according to doctor
Risk of overcharging: with a large number of patients (+200) that the doctor takes care of remotely, there is a risk of overcharging.
Subscription carefrom the patient's perspective
Benefits ofsubscription 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: subscription promotes continuity of care and better management of chronic conditions, as it allows the patient to maintain regular remote contact with the doctor, reporting on treatment effects and modifying the therapeutic plan on an ongoing basis.
Lower costs for patients with chronic diseases: for patients who require regular contact with a doctor, a subscription may be more economical.
Disadvantages ofsubscription payments according to patient
Not cost-effective for occasional patients: for patients who rarely need medical care, a subscription may not be cost-effective.
Fixed financial commitment: regardless of actual use of medical services, patients must pay a subscription on a regular basis.
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Public care: billing for patient care
Units that operate under the National Health Service are also implementing a physician's remuneration model that includes both inpatient care and remote contact (via phone, email or medical messenger). It is worth noting that the time a doctor spends on remote contact with patients must be included in the doctor's working time.
Freeremote contact as an exception to the rule
Free remote contact with the patient should be the exception for the doctor, not the rule in a well-functioning health care system. This form of remote collaboration is only recommended for pro familia care.
- New definition of health care and its impact on improving the quality of treatment. Value Based Healthcare Opening Report, Nojszewska E., Walewski J. (eds.), Warsaw 2019, 14-18.
