I’ve been meaning to write an article on health care for a few months. I have parts of it outlined and an idea of what I want to say. I kept pushing it off, because I thought, “Hey this is a money blog… people don’t want to read about health care.” While there’s certainly is a great connection between the two, I didn’t want to focus on the money in the article I had planned
I had an experience last Monday that changed my opinion of writing about health care. It is a stretch to connect it with money, but I was urged by a close friend to write about it anyway. Also, since few people read the week between Christmas and New Years, why not go a little off-script?
As I approach the big 4-0, I’ve got a few minor, minor health issues. I got an occasional pain in one of my knees after long drives. I thought it might be an ACL or MCL, but it is fine as long as I have good movement with it.
More recently the skin on my fingers has started to peel. I think it is nothing more than the weather, but it’s a concern to my pharmacist wife. She’s rarely concerned about such things, so her concern has become mine. Update: On a tip from my uncle (and 800+ awesome reviews), I picked up Gold Bond Ultimate Healing Skin Therapy Lotion, which has been a miracle-worker on my hands.
In any case, it’s time for me to talk to a doctor. Like the vast majority of Americans, I see my doctor like I see my mechanic… when there’s a problem. I haven’t had any problems for a couple of years, so my primary care physician (PCP) was out of date. I picked her before my last move a couple of years ago. It’s time to get a new one.
Fortunately, as part of my wife’s job, she knows how this process works. I figured I’d call the health plan and have them assign me a doctor. There are times when I’d be picky, but in this case I simply want first available. My wife told me that’s not how getting a PCP works. I needed to call a doctors office and make an appointment.
That seemed easy enough, especially because my health plan provided me with a search of doctors in my area. Unfortunately, that was the end of a productive Monday. Five hours later, I still didn’t have a single doctor who was willing to be my PCP.
The search allowed you to enter a location and gave nearest results, “as the crow flies“, not based on driving distance. That works fine as long as there isn’t a major city across a bay… technically very close, but oh so far away. My three year old knows that that people are not crows and people drive cars. To tell him otherwise would get a response of, “That’s silly!”
Fair enough, I’d had to scroll though 10-12 pages to eliminate the places far from me. Once I realized that I needed to do this it was no big deal. It just wasn’t obvious at first and I had thought I’d gone through the close doctors in the first two pages.
The search didn’t have a checkbox for those “accepting new patients”, so I had to dig through looking for that line on each doctor. This was the most minor of annoyances, like looking for a city that was actually drivable. However, about 90% of the time “accepting new patients” was a boldface lie once I called the doctor. So 85% of the doctors are eliminated by not labeling themselves as accepting new patients and another 85% appear to be mislabeled.
About 15% of the doctor’s offices that I called last week had people answer the phone. The other 85% went to phone trees. The phone trees were mostly set up for existing patients. It makes sense that they’d be prioritized, but why not throw a bone to a person who is trying to give you business? This is the exact opposite of the telecom industry that ignores existing customers and focuses on only getting new customers. Typically I’d applaud going in the opposite direction of the telecom industry, but there has to be a middle ground where you service the existing customers while attracting new customers.
If I navigated the phone tree well, I was rewarded with a recording to leave a message of all sorts of information. I don’t mind leaving my name and number, but asking for my date of birth was very odd. The recordings also asked for my old PCP, which was not information that I had handy. Plus, let’s get to that after we actually talk in person, so I can at least ask why it’s relevant. I’m imagining that some doctors don’t want take patients who have seen other doctors… like I’m somehow a tainted human being because I had Dr. Blackburn as a previous PCP.
I did the best I could to comply with message. Since they asked for 10 pieces of information to leave after the beep, I’m sure I missed a few of them.
In any case, ZERO doctor’s offices called me back that day. I could see if I was calling at 3PM and they were close to closing, but I was calling at 11AM. One of them was the same medical group as my sons’ pediatrician, which has me concerned about choosing them.
Finally, at 4PM I found one independent doctor who had someone answer the phone. After 3 minutes and about 7 questions (such as name, address, etc.), I not only had a PCP, but an appointment for this week. The receptionist even apologized for the lengthy question process! It was the exact opposite experience of what I went through all day.
Yes, this rant was partially about getting it off my chest. More importantly though, I wanted to point out supremely flawed and inefficient the system is. The day before I made the calls, I said to my wife, “It’s Sunday, why can’t I just log into my health plan’s account, do a search, pick a new PCP, and click submit?”
I can have about a million products shipped to my door in two days… for free (thanks Amazon Prime). I have access to trillions of pieces of information, sorted brilliantly to serve me in 3 seconds (thanks Google). I can talk directly to celebrities and get a response in under a second… even if they don’t want to talk me (thanks Twitter). In 30 seconds, I can buy a limited edition Crayola Christmas ornament from 1984 to replace the one my dog ate. I can text an emoji and have a pizza delivered to my house in minutes (thanks Domino’s).
But health care can’t figure out a way to use the internet to not only save me some time, but dozens of doctor’s offices. I had to disrupt multiple receptionists of offices that weren’t accepting new patients. Theoretically, a dozen offices listened to a very long message from me about my request to become a patient. (Theoretically, because none of them called me back, so I have no way of knowing.) My health care company should easily be able to pass information like date of birth and previous PCP to the new PCP I choose. They wouldn’t have to worry about spelling errors of that previous PCP’s name in translating from my phone message, because they’d be reading it right on their computer screen.
None of this is new or revolutionary. It was commonplace a decade ago.
Maybe I’m stuck with a health plan whose technology is in the dark ages, but that would be even more telling how bad the system is. If every health plan is reinventing the wheel in creating it’s own technology infrastructure for communicating with doctors’ offices, we have a terrible, inefficient mess.
It may sound like this is a little tiny thing, but multiply it out to hundreds of million of people across the United States and it is huge.
Once again, I wasn’t going to write about this, but when I told a friend about it, she urged me to. She said, “People should read how messed up health care is.” I responded, “Aren’t I just telling them what they already know? This isn’t exactly ‘breaking news’.” In the end, I think I went with her advice if for nothing else other than to write about it and get it out of my system.
The only thing that made me more frustrated with the experience was when I realized that I was a (relatively) healthy person who had the guidance of my wife who tangentially does stuff like this for a living. I can’t begin to imagine the frustration level of anyone who is sick or doesn’t have the guidance.
Some might ask why I don’t go to an urgent care clinic for these minor issues. My health plan doesn’t cover them… only the much more expensive emergency room and doctor’s visits. I don’t know why this is, but that’s their decision. My goal in getting a PCP was to avoid spending a whole day in the emergency room. If I only knew, I would spend the day on the phone anyway, I could have done both.
Paul Schmidt says
As a military physician in California, I also “enjoy” complaining about the healthcare system. I agree with having a primary care physician to see for non-urgent things. This would include skin conditions that improve with Gold Bond cream and possibly intermittent knee pain. In a previous post, you mentioned you have military insurance, so I am assuming this is Tricare. Are you sure Urgent Care is not covered? My Tricare patients are covered for Urgent Care, they just need a referral often including those placed up to 72 hours AFTER the urgent care visit. I authorize urgent care referrals a few times a month. Otherwise, yes the system is broken and no systems really talk to each other, small physician offices sometimes still use paper charts due to expense of upgrading. I am not sure why other offices would care where you’ve been seen before prior to booking an appointment but it would help to get previous records once an appointment has been made and perhaps they just want to get as much information ahead of time. To get everybody on board would need all the insurance companies to agree to a standard and then have the hospital and office software companies make compatible software with everyone else that is also HIPAA compliant and otherwise secure. I think there is progress being made but it’s going to be a messy process in the meantime. Larger groups/hospitals do have the capability to have patients book appointments online as well as other medical information. Some things however, would still need to be entered by hand for new patients as the insurance company isn’t going to be able to send all that information. I’m guessing some laws would need to be altered to allow some of this information to be shared as you are envisioning.
Lazy Man says
When I made the appointment I hadn’t discovered the Gold Bond cream. Aquaphor wasn’t working and I thought that was the best thing ever invented. The knee pain is 100% replicatable, so I feel it is worth consulting.
I don’t have TriCare. I have US Family Health Plan. I was urged to switch to that because the doctor choices in New England are much better in MA/RI area. Since this is my wife’s area of expertise, I’m taking her word for it.
I agree with you that we need to get some standards together to make this work. I read somewhere that the government’s biggest expenses is military and health care. I’m not sure if that’s true, but it makes sense to me. If we had an efficient system of standards/sharing we’d probably save taxpayers tens or hundreds of billions of dollars. Seems like a problem that could be figured out. We have a relatively secure banking system, so I’m not worried about creating a system with security. HIPAA compliance could be difficult, but we should be able to figure something out… even if we have to change HIPAA to get it done.
And some of what I want shared is details of my address, date of birth, etc. from the health plan to the doctor’s office. If that’s at risk of a HIPAA violation when I’ve authorized both, we are truly screwed.
Sherry Martinez says
It’s possible it may seem to some that this is a tiny thing… it’s not and it is. I have been in the health insurance industry for going on 15 years. It is currently a major disaster from every angle. This issue just being one ‘tiny’ part of it. What I have seen this open enrollment is, quite frankly, very frightening. One major issue being just this. There are so many health insurance plans out there now that require a PCP (commonly referred to as HMO’s) and unfortunately, everyone is having this same issue. I personally am one of them. I was forced to an HMO, as the majority of folks in Texas were, if carrying their own indiv/fam policy. I live in the country in a very small town. The nearest PCP to me is 1 1/2 hours away. I’ve not even checked to see if they are taking new patients because I’m not going to drive that far. It doesn’t make sense to. But… I will continue to be a responsible and upstanding citizen of this beautiful country and pay for a health insurance plan that will essentially serve me no good other than to avoid the tax penalty. Unless of course, there is a major/catastophic illness, in which case, someone’s going to need to request I be airlifted to a hospital that will take my health insurance and hope that my flight is covered under the emergency transportation ‘benefit’. I could go on for days but quite frankly coming off of the first major sector of “open enrollment” which really is a HUGE problem, the last thing I want to talk about at this moment is health care and/or health insurance and the companies that offer it. It’s quite a cluster and we can only hope something changes.