Well, after a 78-day wait, Max finally got in for his free annual preventive exam on 10/30/2019. As a completely healthy person, I guess I don’t know what I expected. Perhaps I was needlessly consuming a healthcare service that I really didn’t need to have. But ultimately, I was disappointed with the thoroughness of my 24-minute exam.
Thankfully, my $21,574 insurance plan covered the exam in full with no out-of-pocket costs. Money well spent I suppose.
Since we like to document all things healthcare here at Max Out of Pocket, I thought I would take the time to walk through my exam. Hopefully, we can get some feedback from our provider community on how thorough an exam like this should look.
Keep in mind, it has been over five years since my last preventive physical exam, so perhaps my expectations are unreasonable. As always, my experience only represents a sample size of one.
Checking In For My Annual Preventive Exam
I arrived at the clinic bright and early. Unfortunately, I don’t own this particular medical office building so I was not supporting my passive income stream.
I strategically scheduled my exam as the first appointment of the day. This little strategy helps me prevent delays that might occur later in the day if the doctor or medical provider gets behind schedule. Like any responsible patient, I arrived 15 minutes early for my 8:00 am appointment to take care of any paperwork. Our healthcare system loves paperwork.
I’ve heard this exam called a lot of different things. Wellness checkup. Annual. Annual Physical. Preventive exam.
Preventative exam. Wellness exam. Annual wellness exam. Complete Physical Exam or CPE. Comprehensive medical exam. Routine physical. The list goes on.
I know my exam is free since I already checked with my insurance. So I usually go out of my way to call it my free annual preventive exam. I use all the right buzz words to make sure this thing gets billed correctly. I don’t want to accidentally incur out-of-pocket cost.
So I told the registration clerk.
“Hi, I’m Max. I am checking in for my free annual preventive exam.”
No complaints about the check-in process. I had already made sure this particular doctor was in my insurance network. The Healthcare Hustlers have some nice tips on how to find an in-network provider.
The check-in process went pretty quickly considering I didn’t pre-register for the appointment. The front desk registered me, took my insurance card, collected a few signatures, and told me to grab a seat in the waiting room. There I waited until approximately 8:03 am (yes I was watching the time) when the Medical Assistant (MA) opened the office door and invited me into the clinic. I can deal with a three-minute delay, but as this industry gets more competitive, we should start watching this closely. Millennials don’t like to wait for anything.
It’s 8:03 am and my annual exam has officially started. Max is finally going to get to check the status of my health.
Visit With The Medical Assistant
Before leading me to the exam room, we stopped at a weigh scale where the medical assistant took my height and weight. I took my jacket off and stepped on the scale. This stop at the scale mirrors how my exams from previous years started. I have been pumping a lot of iron this last year, so my weight came in at about 175lbs. This is about ten pounds more than I have been weighing in recent years. Finally, validation that my weight routine is working well and I have been able to put on some real muscle mass. The height/weight process probably took less than a minute and we made it to the exam room by approximately 8:05 am.
When we get to the exam room, the medical assistant begins by asking me the following question.
“So before we get started, are you here today for any reason other than to get your annual exam?”
I need to be careful here. If I accidentally talk too much about a recent ache or pain, we may drift out of the “preventive” category. The visit could then quickly turn into a “problem-focused visit”, at which point it will no longer be free and it will hit my deductible. We need to make sure the Z00.00 (Encounter for general adult medical examination without abnormal findings) diagnosis code gets on the claim. This is is the code that waives my deductible. I stuck to my script.
“Nope. I am here for my free preventive annual exam. I would like to get my annual labs ordered as well. This should include a free lipid panel screening that will be paid in full by my insurance.”
The MA then went through a series of questions.
“Has anyone hurt, freighted, or threatened you in the last year?”
Our healthcare system frightens me at times, but I decided to keep the jokes to myself.
She also asked two questions that were geared toward screening for depression. I answered no to both of those since I am generally a pretty happy person. She then asked when I had my last tetanus shot, to which I had no recollection. She said she would suggest to the doctor we discuss it since it can help prevent whooping cough. I remembered later that day that I had this updated a few years back before a trip to China, but no harm in getting a booster shot.
She also took my resting pulse, blood pressure, and temperature. I passed with flying colors.
This whole encounter with the medical assistant took just less than 10-minutes. This put us at about 8:15 am. I waited approximately 2-3 minutes for the doctor to come in.
A Meet And Greet With My Doctor
After the MA left the room, I remember looking at my watch and it was 8:17 am. I must assume the doctor walked in at approximately 8:18 am. The doctor briefly introduced himself and went directly to the computer to start documenting my chart. He asked a few questions about medication and past medical history. I am not on any medications and my past medical history is boring except for a couple of broken elbows.
This is where I will go ahead and call out the thoroughness of this physical exam. It really wasn’t much of anything. My shirt didn’t even come off. The doctor listened to me breathe two or three times through the stethoscope, felt my neck very briefly, and went back to documenting on the computer. That was literally the extent of the physical exam. He didn’t even look in my ears, mouth, or up my nose.
Is this standard for a healthy person?
I did carefully mention the abdominal pain I experienced in May, but he suggested it was likely just from my new weightlifting routine. I guess he didn’t think it was necessary to check for a hernia, something I have done at previous physicals. At the very least, I recall previous doctors asking if I wanted to be screened for a hernia. Since I thought it would be a little weird to ask for a hernia exam, I just let it go.
At least I won’t have to worry about getting a botched price estimate for hernia repair surgery.
He mentioned the tetanus shot as well. Without much discussion, he said he would order one and have the medical assistant administer it after he was done. He also agreed to order my annual labs which included a free lipid panel and a comprehensive metabolic panel. Luckily, I already knew the potential cost for each of these labs. This is a real reason I scheduled this exam in the first place. The clinic isn’t a draw site, so I would take my order and have my labs done later down the hall in the hospital.
We then talked about the weather for another minute, he shook my hand, and the physical was over. He then exited the exam room.
A second MA returned a minute or two later, administered the tetanus shot, and we were done. I asked her if I needed to check out as I left. She seemed slightly confused and said I could just leave.
I was out of the office at 8:27 am.
Seriously, he didn’t even tell me to open my mouth and say “aahhhhhhhh”? I thought that was a staple of the physical exam?
The retail price for the 24-minute exam was $251. This doesn’t even include the $87 for the tetanus shot. I encountered five different people throughout the process including the scheduler, the registrar, the two medical assistants, and finally the doctor. We call these “touch-points” in healthcare.
Less than 10 of those minutes were spent with the actual doctor. Some will argue there is “care coordination” and “documentation” that occurs behind the scenes. Maybe for a more complex case, but for me, it seemed like all the documentation was done right in front of me.
My insurance gets this type of service at a discount. We like to call this the T.J. Maxx sales price here at Max Out of Pocket. Their price comes in at $199.70 and they paid this full amount on my behalf. If I round the exam up to 30-minutes, we are looking at about $400 per hour for my annual physical exam.
Let’s go ahead and call this exam what it really was – a “meet and greet” with my doctor. In fact, he was a pretty nice guy overall.
But it seems like this exam was a waste of my time and healthcare dollars. The doctor came off a little rushed and his attention to detail was lacking. Then again, I could also be called out for not engaging more and asking questions.
Perhaps I need to start considering studies and other sources like WebMD who question the usefulness of this exam. I wasn’t footing the bill directly, but I would be more comfortable paying $200 to get a tune-up on my car than the services I received here.
As we continue to promote these free annual exams, are we considering the cost? If a practice has 3,000 patients and 50% of them get this exam annually paying the same rate I did, we are looking at over $300,000 per year. Is that a good use of healthcare dollars? It is also just another price that patients don’t see if their insurance carrier pays it in full.
1,500 Annual Preventive Exams X $200 = $300,000
But then again, I needed this exam. It was the gateway for me to get my lab order for my free cholesterol test. I also now have established care with a medical provider. This should make it easier for me to access care when I actually need it.
I am not sure what best practices are for a comprehensive preventive exam, but this exam certainly didn’t seem to fit the bill. Pun intended. The time and resources that went into this exam do not seem to line up with the retail price tag of $251. The doctor didn’t check my reflexes, skin, hair, or mobility. These are just a few of the things I remember getting reviewed at previous exams.
I will research this exam a bit more and try to report on what a typical exam should look like. We will even get into technical terms like RVUs and take a closer look at the billing and coding. For my 2020 exam, I may experiment with a new doctor so I can compare notes between two different medical providers.
Have you had your annual exam yet?
Max Out of Pocket for my 2019 preventive annual exam = $0.00. Unless, of course, you count my $20,000 in annual premiums.