Saturday, February 09, 2008

Part III: The Opportunity

“If you change a patient’s appointment don’t forget to enter a reason why in the comment field. Do you know, is he a H.M.O., P.P.O. or P.O.S.?”

“Probably a P.O.S.” I thought, chuckling as I kept the double entendre to myself. With that, the receptionist looked up.

“Hi, may I help you?”

“Yes, I’m here for my 2:45 appointment.”

She looked at her computer screen again.



“Bad weather out there today, huh? Did you hurt yourself shoveling?”

“Sure did. I’ll bet you’re seeing lots of people for that, huh?”

“You’re the first today,” she said matter-of-factly as if to want to make me feel even older. “Here are a few forms I’d like you to fill out. Would you like to sit down?”

“Uh, I’m sorry. It feels better if I keep standing right now.”

I looked at the clipboard she handed me. Six pages of fine print paperwork: one page for demographic information like my name, address, date of birth, insurer and so on and, what, my social security number? Hmm. I wonder what bank accounts they could open with all of this information? The opposite side of the page for brief background medical history – all meant to reassure that someone actually looks at this stuff, but more likely to entrap me for possible insurance fraud if I should lie or forget something, I thought.

The next four pages were ludicrous examples of the follies of bureaucracy: a “Privacy Statement” (2 pages) and explanation of the Health Insurance Portability and Accountability Act (HIPAA) and what it means to me – carefully juxtaposed to the pages containing my entire life and medical history, social security number, date of birth, etc. Bureaucracy to Content ratio: 3 to 1. What a waste, I thought. Pages and pages of text were provided just to explain an obscure and effectively meaningless document to the average Joe, just so my information can whir about cyberspace with nary a liability concern to the Great Third Party.

I stood in agony as I completed the forms; most of which had nothing to do with facilitating my care.

Rather, it was all about jostling for the few dollars afforded by my insurer because in the eyes of the rehab facility and our health care system, I had become an opportunity to collect.

And as I looked down to replace my insurance card back in my wallet, I saw it. Up in the upper right-hand corner of the card. Like a piece of beef and in bold letters for all to see:

"Plan Option 3 - Choice P.O.S."



Lisa said...

Hope you feel better soon.

Doctor David said...

Doesn't being a patient stink? I had my own experience last fall (Lyme myocarditis), and being on the other side of the stethoscope really alters your perspective.

You hit on one of my (many) pet peeves about out health care system: "Bureaucracy to Content ratio: 3 to 1" you said. Not only does that apply to HIPAA forms like the one you were handed, but I think it's even worse in the informed consent documents my patients have to sign before enrolling on a clinical trial. I hand 30-page documents to the parent of a child just diagnosed with cancer, and someone thinks they are going to read and digest all of that information before signing on the dotted line? And 5 pages of it (I'm not exaggerating the number) has to do with HIPAA and related bureaucratic issues. I can assure you, not one parent in the last 10 years that I've sat with has given that section more than a cursory look.

Lisa said...

I hope you are feeling better, Dr. Wes!

I can certainly sympathise. As a professional zebra patient I send my doctors' offices lots of goodies to help smooth my path, but even then it is a crapshoot.

When you get better, try rolfing to help tune up your back. Worked great for me. :)

Anonymous said...

Hilarious. How does it feel to be on the "Choice P.O.S." plan? Well, Dr. Wes, I feel your pain - just yesterday I re-activated my old back injury and am hobbling around. The best thing I found (other than a tincture of time of course) is McKenzie exercises and ibuprofen. Good luck!

Jim said...
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Anonymous said...

Dr. Wes.

As a physical therapist, I'm hoping you get the best evidenced-based care available.

And that Mrs. of yours is a smart one recommending PT as the first line of defense!