When the ache in her lower abdomen became excruciating, the young woman was rushed to a surgery center, where the doctor diagnosed a ruptured appendix.As I read this story, I couldn't help but wonder why our quality advocates were not up in arms with outrage this morning. Why has the Agency for Healthcare Research and Quality (AHRQ) not developed specific quidelines the refuse to pay for such shoddy performance that delays a patient's care? Isn't the delay in therapy because of the medical "requirement" for insurance "pre-approval" dependent on a typed report in a case such as this the ultimate in poor care delivery? What would have happened in this case if the insurance company balked and refused to approve this patient's surgery? Would the doctor have been obligated to refused to do the surgery?
The woman needed an operation—fast. But before the surgeon could wheel her into the operating theater, he had to find out whether the patient's insurance company would pay. That meant paperwork: A report had to be dictated, typed up and submitted to her insurer for approval.
So while the woman waited in agony, her doctor dialed a toll-free number.
The instant he hung up a few minutes later, a digitized recording raced through fiber-optic cables on the Pacific Ocean seabed and into a computer server on the 17th floor of a Manila office tower, where medical school graduate Dinah Barrete was working the graveyard shift.
Chicago Tribune, 21 Apr 2009
Of course not.
One of the largest breeches of "quality" patient care in health care today are insurance pre-approvals, especially in the circumstances of true medical emergencies. And it is expensive, too. Why should the doctor have to dictate his note or have it transcribed? What potential harm came to the patient as a result of the delay to her care? Do we know? Might there be other situations like a perforated viscus, depressed skull fracture, septicemia in a patient without a spleen be even more catastrophic if we had to wait for insurance pre-approvals and dictations before treating patients?
I would propose that the decision for surgery rests entirely with the doctor to decide, not some third party as this article suggests.
Let's save a ton of money and get rid of this insurance pre-approval racket and the insurance industry's requirements for a dictated note.
Then maybe we'd start saving real money during health care reform.