Seems like every time you turn around there are new regulations with regards to healthcare in the United States.  One of my former neighbors was a family physician several years ago and although a terrific clinician, felt he had to leave his family practice and return to a job as a University Physician for college students when the paperwork that he took home every night made practicing medicine a bureaucratic nightmare.

Unfortunately, bureaucrats are good at  writing rules and regulations, but aren’t so good at common sense.

And here’s an example that came in this afternoon about a patient’s experience with “new regulations”. Ambulatory Surgical Centers that participate in Medicare must meet specific requirements. Even if you’re not a Medicare patient if you use a facility that is Medicare certified you are also affected as a patient.  New regulations from Medicare specify that patients using Ambulatory Surgery Centers must have a History and Physical conducted within 30 days prior to surgery.

Imagine you are a patient as our real life patient was, trying to schedule an appointment. Here’s what happened next.

You, as the patient, were formerly oblivious to these new Medicare rules, so you call the ambulatory surgery center that you had used before when you had your previous colonoscopy, to book an appointment for the follow up exam that your personal physician tells you is very important to schedule — your follow up colonoscopy.

What happens next may surprise you. Getting medical appointments these days is not as easy as you may think.

domorerequirementsmakeyousafer So, it’s onto the phone to speak with your gastroenterologist’s office.

But what happens if your doctor’s office won’t book your colonoscopy and your office visit at the same time, but requires you to come into the office first, for a physical, and then, and only then, will book your colonoscopy procedure? But wait, you’re told, that colonoscopy appointment must be within 30 days of your office visit, but we can’t tell you in advance if we’re going to have any openings in our schedule. You’re already a patient, and a returning one. Guess that doesn’t seem to matter.

 Surely this doesn’t mean you have to “hope” that once you take your time to do the doctor’s visit, that there will also be an opening in your doctor’s  schedule for a colonoscopy during the two week time period that you will be in town? 

Your work requires that you travel, so you know in advance what days you’ll be in town and which ones you’ll be away. Unfortunately, you are not in town for an entire 30 day time period at any one time.  So you ask the girl on the phone, “What do people do who travel, certainly there’s some other arrangements that could be made?”  All you’re asking is that the office visit and your procedure be booked in advance to make sure that you make the “required 30 day window” for your colonoscopy and office visit.   You’re told that “I don’t know you’re the first person who’s ever asked me that question.” You groan and think that scheduling your colonoscopy could be more challenging than taking the bar exam.

Think this new law and and the new rules couldn’t possibly affect you? Think again.

What if you’re scheduled for a procedure and you finish your in office doctor’s exam and your doctor is ill on the day of your procedure. No openings in his or her schedule during the 30 day window after you saw them in the office?

Guess what? You’ll have to start the process over, with another office visit, history and physical, and then try to get an appointment scheduled. Just so that you’ll be “safe.”   Think this doesn’t make any sense? Welcome to the new world of medicine in some offices.

 Do you also travel for your work, and perhaps only have certain days of the month available for doctor’s appointments?  What if you knew in advance and were calling in April of 2010, about scheduling an appointment for July 2010 when you knew that you’d be in town for two weeks out of the month and were asking if you could book your colonoscopy in advance when you knew you’d be in town.

If you’re the patient we heard from today. You’d be out of luck.

Back to your phone call. Certainly, there must be another way. “Sorry, the girl on the phone says, it’s the new law.” Ok, you’re a flexible person so you say, “Ok, how about an appointment in July, I have two weeks open during that time. Can you you book the office visit and procedure together then?” “Nope, says the nonchalant voice at the other end of the phone, gotta book your procedure after you have the doctor’s visit.”  

You can’t really believe what you’re hearing. Can this be true?  Do you mean to tell me that there’s no way to get this colonoscopy scheduled in an organized fashion?

Darn it  you’re flexible, you can give them 3 months of your schedule in advance. Just don’t make you wait for the office visit before scheduling your procedure. You really don’t have time to waste and don’t want to spend your life going to doctor’s appointments “hoping” that they can fit you into their obviously very busy schedule. Well, you wonder, no wonder they’re busy. If they’re redoing appointments over and over again that miss the 30 day time restriction then wouldn’t this add to more workload for everyone? But, hey extra office visits are more money for the practice. It’s the patient who has to pay. Both with the loss of time, and with unnecessary extra bills.  You thought Medicare was supposed to save the government money. Guess Not!

So what really are the costs involved. Well, in one day, you’ve called the doctor’s office twice, waited on hold just to get to a human for over 25 minutes each time, and you still don’t have your appointment scheduled. What about the wasted time off work for a doctor’s office visit if you can’t even get your colonoscopy scheduled?   The girl on the line tells you to keep your office visit that she booked because they “may have cancellations.”   May have cancellations you think to yourself. If my business ran this way I’d be out of business in short order. 

You run a company with many employees, and start thinking about the costs loss both in work time and insurance costs if this is truly where we are headed with regards to healthcare.  How much does it cost for an employee to take an extra day off work to go to the doctor’s visit, and then have to repeat the process again because there was no room in the schedule.

Does government really save you money on your health care costs?  Are the rules setup to protect you really helping? Do you want this kind of protection?  What do you think about these types of requirements with your health care? We don’t have to wait years for the impact of health care change to affect us. It’s happening right here, right now.

Have a healthcare story to share? Comment and less us know what you think and how changes in healthcare are impacting you and your family.