Has anybody been following my primary health care travails? If so, you’ll recall that in my most recent post in the thread I was informed once again that I was going to get a postcard describing the results of my blood test. You’ll further recall that at the time of that last post, a week ago, I had already spoken with the physician’s office three times via telephone, in my attempt to glean the results of the May 17 tests. At that point, it was already 23 days since the blood was drawn. It gets worse.
Today, fully one month after the tests were conducted, I received the promised “postcard”—actually a piece of paper in an envelope—stating that my tests were all within normal ranges. I guess it’s good that they are, or I would have delayed treatment for at least a month (and who knows how much longer, given that it took me a month to schedule a regular appointment and five months to schedule a physical exam). I’m sounding like a broken record harping on all this stuff, but I find the nonchalance with which these issues are treated worse than offensive. It is as if we patients are incidental to the process of billing insurance companies (and Medicare) and getting paid. We’re sources of revenues (which must be maximized) and expenses (which must be controlled, usually at our expense). But most importantly, we’re the carrying case for the all-important insurance (or Medicare) card.
But I digress. Let me show you the timeline on a set of simple-ass blood tests. From scheduling the appointment to receiving notification of the results, two months transpired:
4/10/06 – I make initial appointment with Dr. D. I am told that the earliest appointment would be 5/17/06.
5/17/06 – Blood taken.
5/18/06 – (2:31 AM) Samples received at Quest Diagnostics.
5/18/06 – (7:54 AM) Results reported, according to Quest.
5/22/06 – Results stamped “RECEIVED” by Dr. D’s office. Also noted by the rubber stamp imprint was “Mailed PC 6.8.06.”
5/25/06 – Having heard nothing, I called Dr. D’s office about results. I was told, “blood tests take 7–10 days.”
6/8/06 – Still having heard nothing, I called Dr. D’s office about results. I got another stall.
6/9/06 – I was told that I would be receiving a postcard. “She did them yesterday.” (Note next to rubber stamp impression on the lab results would seem to confirm that the postcard was sent on 6/8/06. However, it must have sat around for six more days before the mail room processed it.)
6/14/06 – Got pissed off about having to wait for the postcard, so I called Dr. D’s office—Medical Records Department, this time—and told them I would be coming to the office to pick up a copy of the blood test results. Medical Records was most accommodating and I had a copy of the results within an hour.
6/16/06 – Today. Received pseudo-postcard. The metered stamp on the envelope was dated 6/14/06.
If this is not an indication of how little patients matter and how our needs are treated with insouciance, if not contempt, I don’t know what is. How difficult would it have been at any stage of the process to have done what the Medical Records heroine actually did do for me once I figured out how to get to her? It sure as hell wasn’t going to happen with the person I had talked to in my other calls. She was less than helpful, reciting the mantra, “Blood test results take 7-10 days” when I called, even though the second time was on the 22nd day. Harrumph!
Well, that’s the end of the saga for now. My test results having been within normal limits, my next visit to this practice will be for my physical exam on October 12. With any luck, I’ll be able to find a boutique practice in the meanwhile and I’ll be able to put this experience behind me. If not, I can anticipate more of the same, which could be deadly if I become seriously ill.
The Hose, Revisited
So, continuing with the health care report, I scheduled my colonoscopy for June 29. TMI, maybe, but as a lead-in to the next subject it is necessary to give you some background. Dealing with my colorectal surgeon’s office was reasonably pleasant (can anything involved with that specialty truly be pleasant?). He and his people are competent and helpful. However, the procedure has to be performed in a hospital setting, so that’s where the pleasantness and my good fortune ends. Today, I got a “courtesy call” from the hospital.
After she perfunctorily performed the “courtesy” involving the usual verification of name, address, date of birth, primary insurer, secondary insurer, etc., etc., ad nauseam, the fumbling telephone babe pissed me off by saying, “I’ve checked your coverage and found that your 20% co-pay will be $250. We accept all major credit cards for the convenience of patients making transactions over the phone. Now, how would you like to pay this amount?”
“How would I like to pay this amount? I’d like you to send me a bill after you’ve completed the damn service! I’ll send you a check. My credit is good everywhere else in this town. Why the hell should Florida Hospital not trust me to pay?”
“Well, sir, we’re just allowing you the courtesy of making these arrangements when you pre-register, for your convenience—”
“My convenience?” I retorted. “My convenience is not paying you two weeks in advance for a service you plan to perform! We don’t even know how it’s going to turn out, do we? You could totally screw up my ass! I’m sure as hell not paying you two weeks in advance.”
“OK, sir. Some people just like the convenience of paying in advance so they don’t have to deal with it on the day of their procedure.”
“Obviously, I don’t!”
“Thank you, sir, and please remember to bring your insurance card, a picture ID, and a major credit card when you come to Outpatient Surgery for your appointment.”
So, it’s not bad enough that in a couple of weeks I’m going to get a six-foot hose up my ass. The reaming has to start via the telephone two weeks in advance.
Now, I realize that the health care industry suffers a lot of accounts receivable attrition due to non-payment by patients, for whatever reason. We’ve all seen the obnoxious reactionary measures. Doctors have taken to collecting co-pays in advance before they see patients. Hospitals pull the two weeks in advance crap I described above. They don’t care about the convenience of their customers. They just care about collecting the money. I keep asking, “Would you accept this crap from your auto repair shop, from your house painter, or from your exterminator?” No, because your credit is good with them. It used to be that my doctor would send me a bill if I owed any money. I’d pay the doctor bill whenever I paid the rest of my monthly bills. I know that we’re all different and some people just don’t pay their bills. However, that’s what credit checks are all about. If they weren’t useful, Experian, Transamerica, Dun & Bradstreet, Fair Isaac, etc., would all be out of business. Why can’t the health care people check credit and bill us if we’re good, instead of treating us all like deadbeats?
You know why. We’re not regarded as customers, so no need to do anything courteous, or for our convenience. It is ok to pay lip service to those concepts in making “courtesy calls” (translation: pay me) for our “convenience” (translation: pay me). We’re the aforementioned carrying cases for insurance cards. Carrying cases should be seen and not heard. Thus, it is not necessary to extend us the courtesy of billing us even if our credit is good. After all, what the hell are we going to do about it? Not pay? Then, they would just deny us service and say to hell with us. So, they reduce it to the least common denominator—they treat us all like deadbeats. Why? Because they can!
The revenue maximization attitude that has pervaded medical practices over the past 20 years is also responsible for that “courtesy call” you get from your dentist’s office to remind you of your appointment. Not content to just leave you a message, they’re now demanding that you call them back to confirm that you’re actually going to keep your end of the bargain. They warn you that if you don’t show up, you have to pay a $25 cancellation fee. I know some people miss appointments, but when I’ve used the same damn dentist for 18 years and have never so much as been late for an appointment—let alone cancel one—I don’t expect to have to confirm something I committed to six months beforehand. In the case of my ex-periodontist, who is a dick, he was the one who didn’t show up for a couple of appointments, yet he charged me the same amount as if he were there. I’m sick and tired of this one-sided crap.
What’s more, the prevalent attitude inherent in today’s health care providers is that we’re not really paying them. For example, in the course of the hospital conversation today, the babe explained, “You’re not paying for the procedure. The insurance company does that. You’re only responsible for your co-payment.” Duh! Tell me something I didn’t know. This patronizing utterance tells us that they think we’re all idiots. We can just happily sing and dance, knowing that we aren’t really paying for anything. The insurance company is paying. Ain’t life grand? Well, who the hell pays the damn insurance company? I pay the insurance company a $975/month premium. What’s that? Isn’t that money? Yeah, the insurance company is paying—with my dollars! They just try to pay as little as possible so they get to keep as many of my dollars as possible. They consider any treatment I get as a deduction from their bottom line. They even have a euphemism for treatment payments: medical loss ratio. I don’t begrudge them their profits, but this third-party payment system bites the big one. It creates “attitudes” in the health care providers that they really don’t have to care about the patient—only the billing code and the process of collecting from the insurance companies (and Medicare). Meanwhile, for the insurance companies (and Medicare), the patient’s welfare is the last of their concerns. Who is looking out for the patient?
Have I made my point? We patients are not customers. There is no need for health care providers to try to make us happy. They don’t even care if they piss us off. We have no leverage with them—that all is in the hands of the insurers and the government (which screws up everything it puts its hands on, including health care—big time!). These health care operations consider their primary payers as their real customers. It’s kind of like bringing your dog to the veterinarian. The dog is incidental to the process of billing, paying, etc. So, the dog sits there, bewildered by what’s going on, while people do things to him and then he gets to leave. He has no idea what they did or why, and nobody feels the need to explain it to him. Best of all, he doesn’t have to pay the bill. He is just a bystander. So, when we go to our doctor’s office, we’re like the dog at the vet. They do with us whatever they want. However, in the dog’s case, he trusts the owner and the vet, and that trust is not misplaced. In our case, we sure as hell don’t trust our insurance company to act in our best interest and, with managed care being the way of health care in this country, we’re trusting our doctors less and less to act as our health care advocates with those insurance companies, and to act in our best interest in general. It’s a damn mess!
The only way to make this mess worse is to hand it over to the government. I’ve observed through close friends how screwed up health care is in Canada and England. Socialization is not the answer.
Going back to a fee-for-service situation is probably out of the question due to the embededness our the current payment system, even if that fee-for-service system worked well for many, many years before the managed care scourge became a reality.
I am very much in favor of boutique practices (also called retainer practices or concierge medicine), which will cost real money out of our own pockets, but it will be worth it to be treated like a customer again. Insurance companies disdain these “rogue doctors” who have temerity to buck the system, while “social engineers” are unhappy that access to boutique physicians would depend on a patient’s ability to pay. We’ll have to get over those obstacles if we’re to straighten out the mess. I, personally, would not mind paying a few hundred dollars a month to have a doctor who would make himself available at any time, and who would spend 45 minutes with me during an office visit insted of the current industry average of seven minutes. Of course, my health insurance company wouldn’t reimburse me for the retainer fee. I can live with that, particularly if I can raise my insurance deductible and handle most of my routine health issues with my boutique doc. It would be like getting back to fee-for-service with a major medical policy for catastrophic illnesses and surgeries.
Don’t you all see the sense in returing to a scenario in which individual patients actually matter to their doctors? How best to get back to that being the norm? Share your ideas, please!
Patricia Madden says
I applaud you on this excellent essay. It is time that we start speaking out about this serious life and death issue.
Physicians’ staff, etc., don’t treat us like customers because then they would have to acknowledge that medical practice is a business. I guess they think we couldn’t handle what we’ve already figured out. The irony is that practicing medicine is a bigger business now than it ever has been, and the industry people argue to the contrary to protect their image as concerned caregivers. What a joke!
The Nittany Turkey says
Patricia, I appreciate your compliment, but I must disagree with your commentary.
If I were to interpret what you\’ve written the way you want me to interpret it, I would have to say that you\’re convinced that business is evil. Furthermore, I don\’t hear anybody arguing that medicine is NOT a business. We live in a capitalist society. Everything is a business.
So what if medicine is a business? That\’s not the issue. The health care business just needs to orient itself toward the real customer, but our screwed up third-party payer system makes it beholden to whom it perceives to be the customer—in other words, insurance companies, government, drug salesmen, and anybody but the patient. If WE, as consumers, were controlling the purse strings, as we do with our house painter, our lawyer, or our exterminator, then they would have to treat US as their customers. Our dollars would talk and they\’d have to listen. But by accepting this third-party payer system, which has gone out of control in the past 20 years, we\’ve ceded that right to the payers. They talk and the health care industry listens. We talk and we\’re told to shut up. It\’s not health care being a \”dreaded\” BUSINESS that\’s the problem; it\’s the irresponsible system we\’ve created.
The joke, as it were, is on US for treating health care as an entitlement to be paid for by somebody else. We made our bed, and now we must lie in it.
Patricia Madden says
Understood. My point is that the industry exploits the idea that doctors are caring, benevolent creatures, above reproach. Many–not all–people are intimidated by physicians and view them as sort of “god-like,” so they don’t make a stink about poor care. Of course, it’s a business but the system is set up to make us think that the people in it are “caring” with their “courtesy calls.” It’s a fraud.
The Nittany Turkey says
For a retired doctor’s perspective on the dwindling role of patient advocacy in the primary care specialty, see http://mdredux.blogspot.com/2006/05/presumption-seems-to-be-doctors-will.html.
The Nittany Turkey says
pj posted the following comment, which somehow wound up in the wrong thread:
her a a couple of web pages that rather quickly explain why finding availaible primary care doctors is very hard.
the average number of med students choosing primary care family practice was about 2,500 year pre 1996â€¦now the number is just barely above 1,100
a quick estimate from this data is that cumulatively there are @ 7,000 less doctors practicing family practice over the past 10 years. this amounts to some states experiencing a drop of 300-500 less primary care physicians in 2006 compared to 1996.
The numbers of Internal medicine docotors choosing primary care is only about 200/year.
and to make availabiliy issues worseâ€¦. about 50% of physcians since 1996 are women and thus a majority of these young docâ€™s work part-time for several years while trying to raise families as well.
and since 9/11 the number of froeign doctors coming to the US has dropped significantly.
all this while are population is growing more numerous and getting older.
a recent article highlight the impending collapse of primary care.
Why the drop in primary care? For most docs it boils down to too much work,hassle and stress.
It makes me very glad reading this that I live in the UK! the NHS has its fauls but it is not money up front!
credit checks to insure pts pay copays and deductibles??? have you lost your mind? for those of us that work in healthcare; we have enough to do.
The Nittany Turkey says
Precisely my point, Hayden. You spend all your time doing what? Paperwork to satisfy insurance companies, Medicare, and nebulous HIPAA requirements? That leads you to believe that THEY, NOT THE PATIENTS, are your customers, which in turn leads to the type of cattle herding treatment that I detest. Once you get YOUR mind screwed in properly, you’ll realize that you’ve been slave to the wrong master for all these years, and that the patient is getting screwed in the process. Now, go make your insurance companies and Medicare happy, and stop asking sane and rational people whether they have lost their minds!