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nuns vs. heartless corporations
By | December 30, 2011
Backstory: When I moved to town, I signed up with the biggest, fanciest lab, went there and toured the facility, listened to a presentation in a conference room with a complementary bottle of water, and found out the details of how they do their work, which was cool.
Then I was gently told that no, they can’t allow any discounts for patients who pay out-of-pocket, except for HIV tests (provided to them for free by the state), and that if I needed an interface between the lab and my electronic medical record, that would be $300 please.
So naturally I took my business to the other lab in town, which provides same-day service for my homebound patients, sends results to my secure email, and provides a hefty discount for all out-of-pocket labs – and what else? They’re really nice. They remember who I am, despite my small practice providing almost no business to them. My lab rep and I commiserate about adjusting to western Oregon, since we both moved here the same year, from very different climates. When I have weird questions about arcane lab tests (as a recovering biochemist), we conduct chatty email conversations about them.
(This is also why I send Paps and biopsies to a particular pathology lab; they have a ridiculously extravagant commitment to both cutting-edge science and full accessibility, including rock-bottom prices for out-of-pocket payers. Oh, and that independent radiologist in town, with the advanced training in women’s imaging? I send him all the business I can, too.)
However, sometimes a patient (with insurance) prefers to go to the giant corporation instead, where they always went before. And that’s okay. Shouldn’t be any problem.
So three weeks ago, a patient dutifully got blood drawn at the “old branch” of the giant corporation, downtown near her work. It was just a routine cholesterol screening. She was getting frustrated because I never sent her any results.
However, I never received notification of the test, or any results, by fax or by snail, even though I have received (from them, for other patients) prior records, specialist reports, warnings not to prescribe certain drugs, and plenty of advertisements for their glossy new facilities and their amazing new specialists – both by fax and by snail.
So I called the “old branch” downtown. The operator transferred me to medical records and put me on hold. Ten minutes later, I was told they had no records of the patient since 2009. (I explained that her insurance company had already paid for it and sent her a receipt, however.) I was told to call the “new hospital” medical records department “which is the main one.”
Here I was given the option of pressing 1 to ask for a release of records, 2 to get their fax number, or 3 to hear their hours. (Why is there never “Press 666 if you are a doctor in a hurry”?) Then I had the option of leaving a voicemail.
Eventually heard back. Was told by the medical records-keeper, who was looking at his computer screen, “I can see the patient, but I can’t see the lab test, because it’s an outside physician.” He asked, “Who are you with again?” I replied, “Nobody – I’m a family doctor in private practice,” and he said under his breath, “Ohhh, you’re not with anyone…” Finally he decided to connect me directly with the lab itself, who could straighten it out directly.
Here I spoke to a somewhat embarrassed lab tech who said, “I’m so sorry, this is just a draw station, I don’t know why they sent you here!” She told me I needed to call Client Services, because “only they have that kind of information.”
Called Client Services, where they promised to fax the results immediately. I asked if the original results had been sent to some other doctor, but no, it was my name and contact information on the original lab order. So what happened? (You need to understand, dear reader, that lab orders always-always emanate from a doctor and then results go to a doctor. They never-never just float around homeless in limbo – theoretically.)
The Client Service person explained that even though she could see that my fax number has been active in the files since 2009, it was, nevertheless, chronically in the inactive stack, and the backup system of telephoning-the-doctor-with-results was simply never activated.
I went, “Huh?” …and I may be reporting this conversation incorrectly, because it was such a complex set of stacks and piles and lines and actives and inactives that I’d never heard of before.
This person was clicking many buttons and saying, “Huh. But why – That’s weird… Huh. I don’t know… Hmmm.” Her final solution was, “I’m gonna print up the lab slip, hand-write a note on it that this fax number is the correct number, and send it back in, so somebody can re-enter your information into the right part of the system.”
So maybe soon, after this hour-long process, I’ll be getting this lab result that I didn’t even know was drawn (three weeks ago), even though I am “an outside physician.” Yes, here I am, “outside,” pressing my nose against the glass, looking in at the big shiny information network reserved for the “inside” doctors, who are on the payroll…
By the way, earlier this year, the giant corporation (note to self: stop calling it “heartless”) did break down and start offering lower prices to people paying out of pocket. A few of these prices are lower than those offered by the lab I usually use. Most are not. If you are insured but obliged to pay out of pocket (for example, with a high deductible policy), the price is generally about 300% higher than it could/should be. This, of course, is not sustainable for most of the folks I know. (I can’t be more specific, because doctors are not allowed to discuss fees or prices specifically, by law; see here, and scroll to the bottom for last year’s Justice Department ruling.)
Do you also want to hear the story about how a long chain of command amongst the corporate doctors led to a friend paying full price for an MRI of her child’s wrist, with inconclusive results, leading them back to doing the simple office exam, for a common harmless condition, that they should have done in the first place? Do you want to hear how I spoiled the Christmas of a rural family by sadly telling them their child really will have to have a belly CT, which they had to pay cash for, to make sure it’s not a ruptured appendix? Why aren’t we occupying medical corporations?
You know, the main reason I originally gravitated to the corporate lab was that it had once been founded by nuns, and I like nuns. The founder, Sister Francis Clare (nee Margaret Anna Cusak) was an Irish proto-feminist who once said, “I do not believe in offering the gospel of talk to starving people.” This was at the end of the second Irish Famine, which killed a million people – about 1 in 8. She also said: “What kind of liberty of conscience is it which tolerates, or rather encourages, oppression in one place and cries with wild shrieks of rage against what is a simple matter of duty?” She ended up quitting, finally, as her order’s website describes, “sick and disillusioned with a patriarchal Church.”
I have to wonder what Mother Clare would be saying about the heartless corporation today. In an article this year about the disappearance of nuns from leadership roles in Catholic – often charity – hospitals, one 73-year-old nun-boss said, “We can’t be maudlin about this… I mean, yes, we are a dying breed. We are disappearing from the face of the earth and all of that. That being said… there is this thing called Presence,” explaining that she was trained to see Jesus in the face of every patient, “and I think that’s the piece that is lost.”
Her replacement states that he will be “trying to drive more efficiencies in the system.”
“It is almost six years since Katrina. Charity sits empty.”
So anyway… Waiting for those lab results, and wishing for the thousandth time that socialized medicine would reduce the temptations of filthy lucre to people of conscience.
Topics: Uncategorized | 1 Comment »
December 30th, 2011 at 1:37 pm
I’m surprised you have any hair left! Where is the outrage by the people?
I’m supposed to fill all my prescriptions with a mail order service, Medco. Only, they won’t transfer the prescriptions because you apparently don’t have a “secure” fax. AND, they will charge me more for the prescriptions than going to my locally owned and operated pharmacy. It’s crazy.