Wednesday, October 05, 2016

Regulating Doctors Like Wall Street

As I've written about in times past, I'm disabled and manage several chronic illnesses simultaneously. I have been a resident of the same city and metro area for nearly a decade, which eventually grants a person greater insight, As a result, I’m beginning to see the overlap between doctors and hospital centers. No longer am I flying blind. I've learned of medical systems to avoid, individual providers to steer clear of, but I don't want to fixate upon nefarious people with sinister motives. I must rely on doctors to improve my health and quality of life, and, most of the time, I obtain exactly what I need. Ninety percent of doctors, specialists, and assistants who I routinely consult are consummate professionals and extremely skilled in what they do.

More about that later. My foremost fly in the ointment has little to do with face to face encounters in the company of those wearing white coats and stethoscopes. Getting medical records transferred in between hospital system is the most current bane of my existence. No matter how many times I sign consent forms, no matter how careful I am to squeeze my handwriting into impossibly tiny blanks, no matter how cautious I am to ensure that said forms are faxed and electronically transferred, most of the time the great link-up never happens.

This week, for example, though I shouldn't have had to do it, I made a deliberate, strong-willed, resolute decision to hand deliver a medical order from one system to another. In an hour and a half, I took off by cab to one hospital, waited, obtained the record I needed, and then sped rapidly across town to another treatment center.

For starters, finding the proper medical records department at the first hospital was not easy. The system in place, as I discovered, was comprised of two fully separate units. For whatever reason, a person or entity decided that utilizing a centralized single unit made less sense than sharing loose responsibilities with another. That said, these departments knew little about the other, aware only that the other existed, but not much beyond that. I could not obtain a phone number or physical address from either with a telephone call, meaning I had to go to both in person, madly seeking correct directions, bouncing from hallway to hallway, until I found the right one.

And then when I did reach the proper office, the overwhelmed man I confronted with a needlessly complicated problem flashed an undisguised look of great terror and confusion when I explained my situation. It was fortunate that the paperwork I needed was at least there. To be sure, it was buried within forty pages of assorted other documentation. I must confess I was still unsure I had precisely what I needed before I departed. Hustling to arrive at my final destination by the end of office hours that afternoon, I was gratified to discover that the doctor's order I needed was gratefully included.

Nothing quite like success. I had been afraid I'd be off on another wild goose chase, still no further to any resolution.

Underneath the frustration and delay, as well as the lack of transparency, there is an answer available of why this happens with such frequency. Naturally, it's not a highly publicized one, for reasons of public relations and sometimes plain ignorance. Though they perform an essential service for millions of Americans, hospital systems do not place a high priority on the competence and efficiency of their medical records departments. Most of these entities are understaffed, under-motivated, under-trained, and shockingly unaware of the particulars of the system.

Employees have no incentive to do a competent job and likely are not given needed training to read legalese and bureaucratic mumbo-jumbo. As I noted above, the paperwork required to obtain medical records is complicated and fussy. If completed incorrectly, even by a micrometer, doors will not open. Stalemate will remain in its place. Nothing will happen.

And here's is where I return to where I left off earlier. This is where the issue is transformed from inefficient to infuriating. I was diagnosed five years ago with sleep apnea. Medicare, my primary insurance, will pay for a new CPAP machine every five years. I should have been given a new model from the outset, but my insurance was charged the full price for an obsolete machine that was already a decade out of date. Perhaps the supply company in tandem with my doctor was trying to move inventory out of its warehouse.

If that's the case, the practice is not illegal, but such conduct does not endear itself to its customers. Since then, I've signed up with a new supply company who promises that they'll never treat me like that themselves. I'm holding them to that promise. We may be viewed by healthcare providers as customers only, but in our medical system, we ought to be seen as something more important: patients with fundamental needs. Our health is at stake, not our consumerist aspirations, nor our offerings to a disposable income. The sleep disorders doctor who prescribed my CPAP machine is, as I have learned, something of a mill.

Nearly everyone he treats is diagnosed with sleep apnea, no matter what results a sleep study reveals or does not reveal. I'm having his business practices investigated within Medicare itself, because he may be running a racket, or he is at least not being held accountable for his slight-of-hand tricks. Ninety percent of the doctors I have seen are highly competent, hardworking, and ethical. But along the way I have encountered a handful whose practices are, if not illegal, certainly unethical. I think of the primary care doctor who would only phone in prescriptions outside of office hours (that is, on Saturdays and Sundays) for a $150 flat fee, regardless of the severity of illness or discomfort.

The same provider ran every single test my insurance would cover, and at each visit, whether I had a sore throat or a hangnail. Most, if not all of it, was highly unnecessary work. Instead of receiving a two or three page summary of results, I'd be given fifty or sixty pages’ worth.

I will obtain my new CPAP machine in February of next year. That is when I am due for another. But in the meantime, I have to manage with old parts that need to be replaced, but cannot be obtained. The only way I might be able to receive what I need in the meantime is to contact the manufacturer myself, but that does not guarantee anything. Fifteen years out of date might as well be half a century these days.

Learn from my lesson. Be your own advocate. We don't have to treat every doctor and medical system with suspicion, but we need to scrutinize those who don't pass the sniff test. If it seems wrong somehow, it likely is. No matter what reforms are proposed, passed into law, and then enacted, our healthcare system should never be confused for a benevolent single-payer, socialistic model. And even if it were, those with the financial means would willingly pay for superior, specialized care.

No reform will ever prevent some unscrupulous doctors from padding their own pockets. What makes the American model as it currently exists that much more dangerous is the lack of what we really know about our own care. Designated surrogates that separate providers from patients disguise how money changes hands and how business is really transacted.

One has to dig hard to expose the truth, then stomach the full knowledge of what really happens. We need to avoid the instances where our attention is diverted elsewhere, like a skilled conjurer, and where we are kept almost completely in the dark. If it takes time away from our busy days, we have no choice but to be our own regulators, and sometimes to regulate the regulators. Doctors are not hot-shot real estate investors or hedge-fund operators, but they should never be seen across the board as nice people with hearts of gold. There's too much money in the game and too much profit to be made.

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