Why American Health Care Stinks

Recently I saw a patient in my office for a workplace accident. I had seen him 3 weeks prior to that, and at that last visit I ordered an MRI scan.  The scan had to be pre-approved by insurance, but it was, and we scheduled the scan. On this most recent visit, I reviewed his chart, only to find that we had never received the MRI report. We contacted the facility that did the MRI and asked to have the report sent by fax, but by the time the exam was over there was still no report. I had to send the patient home with medication and a promise that we would call him when the MRI report came in and I had made a decision about what to do next.

An MRI costs about $1500. Now, I consider this price scandalous, considering that in most developed countries MRIs cost a fraction of that, but no matter. The main point is that a hospital charged an insurance company $1500 for a test and never bothered to send the results to the doctor who ordered it. For $1500 the test report should be printed in gold leaf and hand-delivered to my desk by a Persian eunich.

This kind of thing happens all the time. I doubt 50% of the tests I order with a dollar value above $500 appear on the patient's chart in 2 weeks. 

I don't have a degree in business, but I have worked long enough to see that every business has a Top Priority, something that they value more than anything else. Top Priority may be making good hamburgers, or picking up the garbage on time, or having every order fulfilled by close of business. In the case of medicine, Top Priority too often is getting paid. In this case, we had to make phone calls in advance to get this MRI pre-approved. No money, no test. The MRI center made certain the check was in the mail before the patient was in the machine, but as for delivering the report to the right person on time, well, they'll get to that later.

Lest anyone think I am scapegoating the MRI people entirely for this situation, I will say that I have been on the other end of it. I have provided services to a patient, expecting to be reimbursed, only to be later denied. It's not a good feeling, and it is the kind of thing you don't forget the next time you are in the same situation. No one likes being cheated.

So many medical organizations put "Pay Me First" at the top of their priority lists. The problem is that when you make something #1, it tends to take the shine off whatever is at #2. I see it often: Medical organizations that worry so much about getting paid  that quality of care starts to slip. It's not greed -- well, not greed entirely -- that drives this. Most medical practices consider themselves lucky if 70% of the services they bill for are eventually paid. When 30% of your bills go into the uncollectible file for one reason or another, you tend to focus on getting your money whenever you can.

That being said, I alight again on "there's no exuse." The object of medical treatment is good health, not getting paid, and it is distressing that many organizations in medicine don't see it that way. If there is any urgent reason for health reform in this country it is this: Everybody worries about money all the time, and it puts us all in bad humor, and bad habits, and bad medicine.