Sunday, March 16, 2008

Observations From the Precipice

This week I was disturbed by some continued trends in the downward spiral of our health care system and this is a bit of just rambling tid bits but I find it all somewhat disturbing as an illustration of what is amounting to healthcare these days.

First, I had the privilege of seeing a gentleman this week following a fracture of the proximal humerus and radius. While these are not atypical conditions seen everyday in Physical Therapy clinics across the country what was disturbing was his difficult navigation of the health care system prior to arriving in my clinic. This gentleman was unfortunate enough to have been talked into being a subscriber of one of the various Medicare Advantage managed (mangled?) health care programs.

After this gentleman fell fracturing his proximal humerus and radius in is driveway as a result of impaired balance and gait as a result of his battle with Multiple Sclerosis and lying undiscovered in his driveway for approximately 2 hours in the early morning hours he was transported to the local Emergency
Room where he was assessed, diagnosed with the proximal humerus and radius fractures and then sent home in a splint with instructions to see an orthopedist for further treatment (casting). First, this caught me by some surprise but apparently Emergency Room physicians in this region no longer cast fractures and instead patients are referred to a local orthopedist for this procedure in their offices. Now this is where the complications become more apparent since there is apparently a very limited number of orthopedists who are participating in this Medicare Advantage program. So, it was not until four days after an exhaustive search by the patient and his wife later that this patient was finally casted.

A second story I was told this week was by one of my support staff. Apparently her sister had taken her three young children to a local pediatrician as they were all suffering from a respiratory infection. Well after having been seen by the physician the mother went to the reception check out desk and wrote her check for the three $40 dollar copays and then started for the exit. It was at this point that the story took an odd turn. As she headed for the door she was headed off by the front desk person who informed her that she owed an additional $120 dollars for the three office visits. After a shocked "Excuse me?" she was informed that there was a $40 per visit surcharge for being seen "after hours". I guess my question is exactly how does it qualify as "after hours" if the office is open and waiting room is full? It wasn't exactly like the pediatrician was dragged out of his bed in the middle of the night? It seems more like a gaming of the system more than anything else. Not that I'm not sympathetic to the plights of the pediatrician with respect to reimbursement but this once again smacks of the continued capitulation mentality and allowing reimbursement to drive practice.

A third disturbing story also came to light this week when a friend of mine informed me that his primary care physician now charges a $15 surcharge for a referral to a specialist if there is no office visit.

Things are bad and are seemingly only getting worse.