As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.
I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.
I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen.
Among the information I had to provide:
• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number at a doctor’s office, the doctor refused to see me. Keep in mind that there is no legal requirement to provide your SSN to a medical office, but, at this point, I just wanted to get the appointment out of the way. So I wrote it down.
• A list of medications I’m currently taking and a recent medical history. This information is in my online medical chart, which is maintained by the very hospital where this doctor practices. But guess what? The doctor’s computer system and the hospital’s computer system don’t talk to each other. The doctor can access my online medical record from the hospital system, but I guess it never occurred to him to have this done before I came into the office so his staff could have already updated the medical record in his system.
• My address and age. Um, isn’t this on the driver’s license that you also copied?
• A HIPAA form outlining my privacy rights and listing who can have access to my medical information. I put down my husband’s name. I did not, however, put down the names of the receptionist and the medical assistant, who now have access to my medical information.
At 3 p.m., the medical assistant called me in. She proceeded to ask me the very questions I’d answered on the medical history form in front of her. She then manually entered the information into the computer. It took about 15 minutes.
At 3:25, the doctor entered. We talked for about 10 minutes, during which time I learned that the medical assistant had written my weight incorrectly (she made me 10 pounds heavier, which did not endear her to me). And although I told her I had some pain in my lower right quadrant, she wrote “lower left quadrant.”
The doctor did a quick exam, explained the prep for the, um, procedure, wrote me a prescription, and said he’d see me after the holidays. He handed me a piece of paper with the prep directions on it.
It was now 3:40. I sat in the room another five minutes before the medical assistant escorted me to the hallway and told me to wait for the scheduling person to schedule my procedure. Said person was on the phone. For about 10 minutes. Finally, she called me over, and we scheduled the procedure. She handed me a piece of paper with more instructions.
I left the office at 4 p.m., an hour-and-a-half of my workday down the drain. Why, I want to know, couldn’t I have entered my information online directly in my chart? Why couldn’t I have booked my appointment online for both the pre-visit and the procedure itself? Why did the medical assistant get two very important pieces of information wrong? And why did my instructions come only on paper? How about an app for my smart phone or tablet explaining not only the procedure, but providing the instructions so I can refer to them whenever I need them rather than searching my house in three weeks looking for those two pieces of paper?
This was a simple doctor visit for someone who wasn’t sick. Just consider the waste and errors that result when something serious is going on.
The Institute of Medicine estimated in its recent report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, that we waste at least $340 billion a year due to inefficiently delivered services, including operational inefficiencies at “care delivery sites” (ie, doctor’s offices and hospitals) and excess administrative costs.
Add in the waste from providing unnecessary or inappropriate care, not providing recommended preventive care and screenings and prices that are simply too high, and the Office of Management and Budget estimates that healthcare waste exceeded the 2009 budget for the Department of Defense by more than $100 billion. Keep in mind that’s while we were fighting two wars.
To put this into perspective, the IOM noted, “Health care waste also amounts to more than 1.5 times the nation’s total infrastructure investment in 2004, including roads, railroads, aviation, drinking water, telecommunications, and other structures.”
If we cut out this waste, we could provide health insurance coverage for more than 150 million workers (paying both the employer and employee contributions), which exceeds the 2009 civilian labor force.
Or, we could use that waste to pay the salaries of every firefighter, police officer, and emergency medical technician in this country for more than 12 years.
It might not seem that the 75 minutes of wasted administrative time in the doctor’s office amounts to much. But multiply that by the sheer size of our healthcare system and you start to see the problem.
In my next post, I’ll tell you how some hospital systems in the United States are attacking and eliminating this waste and, in the process, providing better, more cost-effective care.