Sunday, October 25, 2015

A duck walks into a doctor's office...

A few days ago a friend asked me to write about some things I look for in a doctor's office. I've been wanting to write about doctors behaving badly for a while now, but kept getting stuck because I couldn't pick a place to start. The doctor's office is perfect.

I'm sure our libertarian pals rejoice in the knowledge that consumer-patient satisfaction is becoming a key metric in determining quality of care and in the not too distant future, all health businesses will be paid based on the quality of care they provide. This will eventually invisibly backhand a certain number of health care providers into shape or, out of the free market. But that doesn't mean the consumer-patient today has to wait for the future.

Judging a doctor's office can be split into three categories: Evening wear; Bathing suit; Talent. Organization, Attitude, Appearance. I'm going to focus on organization here because it's something you can judge when you make (or try to make) the first appointment.

Also, serious disorganization pisses me off at the best of times. A severely disorganized business that provides health care makes me really nervous. The owner-doctor may blame his/her dumb administrative staff, but guess who hired the admin staff (or isn't hiring enough of them, or doesn't pay attention to what they're doing, or can't keep them because s/he's a big old jerk)?  I don't want that kind of person near me with a tongue depressor, much less a scalpel.

So starting with the first phone call, here's the ideal, with some not ideal things to watch for:

  1. You call the health care business during normal office hours and get an an easy to understand message that gives the office hours, tells you to call 911 if you're having a medical emergency and the usual spiel about what number to push if you're a pharmacy, physician, a new patient, established patient, pharmaceutical company with a sack full of cash. Yadda.

  2. You're a new patient, so you pick that. You're on hold for a reasonable amount of time or not at all (miracles can happen). Once someone picks up the call you aren't put on hold repeatedly or for long periods of time. The scheduler easily answers such questions as "Do you take my insurance?" If you don't ask about insurance, she should. If she doesn't ... I don't know what to say other than something's very wrong and maybe you ought to hang up.

  3. Once someone has verified that the practice does indeed take your plan, the scheduler gets some basic information about why you want to ruin your day with a visit to a health care business. She needs this information so she can figure out which appointment slots/providers would work for you, what additional information you may need to bring and possibly whether the practice will need a pre-authorization (see above re: asking about insurance). Making the actual appointment is straightforward - you're given some dates and times, you pick one.

    Note that when I talk about a health care business seeing you, I mean any appropriate health care provider at the business: doctor, nurse practitioner, physician assistant, etc. People who insist on seeing an MD/DO are being numbskulls should expect to wait longer.
  4. The scheduler tells you what to bring. This being the 21st century, she may direct you to the practice's website where you can download forms to fill out in advance. She also ought to reiterate the date and time of the appointment and tell you the appointment cancellation policy.  
  5. And you're done. Or you ended the call somewhere early because you were put on hold one too many times and the hold music was Lenny Kravitz.
Keep in mind throughout the scheduling process that short of hunting down people in the street or some other exciting but illegal activity, seeing consumer-patients is how money gets into the normal health care business. No appointments, no patients, no cash.

A health care business that can't schedule an appointment without a lot of stumble-bumming is a business that is failing Health Care Business 001. So really, you can stop reading here, because if the scheduling process is a disaster, it's only going to get worse. I've never encountered a practice that muffed the scheduling process that didn't also have some of the problems I outline below: