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| Thanks for nothing! |
This is a rant –I hope a higher-level one – about healthcare
customer service, “service” we all endure just by being self-insured and/or
Medicare clients. As I hope my ongoing Cultural
Intelligence blog is showing, I’m a reasonably educated person, having served
as a consumer reporter for a Philadelphia newspaper, and an investigator of
group behavior and the social mind. If
I’m having this kind of difficulty in dealing with routine healthcare, I shudder
to even imagine what less well-equipped patients (and their families) are
enduring. So I’m judging that if I’m
having this much trouble, others must be, too.
(Part II talks about customer
service state of the art as the broader set of issues.)
I’m closing in on the 125th hour (all unpaid) of
trying to get ordinary patient information from my prize-winning
national-reputation healthcare organization in Philadelphia. At some point, as a new patient, it occurred
to me to actually research their mission – in just three words, “We Improve
Lives,” the pledge to make my life better.
So far, it has done the opposite: by chewing up my work schedule,
domestic tranquility, and sleep, and indeed making my healthcare mission an
impossible journey. By forcing me to repeat-call many offices, very few of
which call me back. Then it’s back in my
court to begin again the next day, telling my war stories over again to
whatever office or functionary will listen.
I’m in constant contact with the Billing office, the Rheumatology department,
Internal Medicine, my primary doctor, and three other specialists. I have insurance through Medicare, but they
seem to be less than able to help me out in my dark quest around the medical
campus in search of answers. All this effort
is just in the service of trying to understand the system’s errors as these affect
me. My health is actually fine. At over 65, I am interested in keeping it
that way by following a solid screening schedule. For the very sick and injured, this bumpy
ride through the healthcare system has to be an unimaginable unmanageable
nightmare.
First, as one of my colleagues, a psychiatrist, put it, these
days medicine is an inherently defensive practice. So just contacting anyone is a tricky wicket. At the other end of the scale is the mandate
of Patient Rights, which you would think would open up dialogue everywhere on
every topic of concern to patients. I
assumed the patient was at the center of any practice and the whole organization
(again, this headlines the hospital’s home page: "People First"). But acting as my own advocate over the past
three months has shown this to be a weak philosophy in practice. Across the many offices and practices where
I’m becoming notorious is great variability in how I’ve been treated and
regarded – almost as if they have no relationship except payroll and
signage. The fact that these entities consider
themselves almost sovereign states for policies and accountability reflects the
problems of all organizations without a strong cultural ethic. Or, it seems, accountability for their
attitudes and actions.
The patient rights issue is probably central to explain my
continued suffering. I trust this
parallels the human rights movement. My
review of this policy: 80% of all statements refer to hospital in-patients,
while I’m an outpatient only. When I
pointed this out, the Patient Experience office told me that this
hospital-based policy is nevertheless applicable to every patient type. I have difficulty seeing how smoking policies
and nursing care have any relevance to getting information from a busy front
desk at the billing office. My questions
are around why I’ve been billed twice directly as a first-person (self-pay)
case, when my insurance should be billed first, me second. I had a horrified period when the first bill
arrived by mail and I had to assume my insurance had denied payment. It took a week just to get Billing to call
back to explain that this was a back-office computer error that had happened
not just to me but many other patients.
Nevertheless, there was never anything like a notice to give those
affected a heads-up that this error had occurred. When two months later the same thing happened
in exactly the same way, I wondered how much my healthcare had paid for this
terrific new “integrated” EPIC program that couldn’t bill properly. A search on the internet under the EPIC name
confirmed that millions are being spent in fixes across the healthcare
landscape for this programming.
When I went up the ladder into the third month of this
malfunction, I got a curious response:
the billing VP said he was going to be honest about the mistakes
made. Apparently this approach did not
include any notice to anyone. I tried to
explain system theory to him – systems have their own dynamic of reward and
punishment, or inattention and denial – regardless of the moral character of
those who live and work within it. I
don’t think he paid much attention to anything I said. The ethic seems to be to get through any
discussion asap, asking along the way, “Is there anything ELSE I can do for
you?” establishing the fiction that anything at all has been taken care of.
Time and again the agents for the organization would insist
that their efforts were genuine and that they were doing their best job under
the pressures of an ever-expanding healthcare empire. That’s not possible to prove or disprove, and
it does nothing to help the patient find out what is going on—with charges or
with outliers like security breaches. Two phrases are the litany of customer
service: “I don’t have any idea,” and “You will have to call ____ office for
that.” I am often misdirected to
inappropriate people and places, costing additional time--and always added frustration--for
all parties.
Soon after the “system theory” came up, I received several
lab test orders by mail. I assumed they
were all mine, until I was ready to walk over to the Outpatient Lab. (No office seemed to know any room numbers
within the large medical building where the lab is located – I had to
physically research and inform the organization of the exact room number.) I noticed I had, not my own, but another
patient’s name, date of birth, patient account number (patient ID is actually a
billing code), full address, and a list of ordered tests.
This is called a PHI privacy breach. What is the first thing any patient thinks of
when they get someone else’s record?
It’s “Where is MY record, why did I get someone else’s, and what happened
to breach my right to patient privacy?” Many
hours and calls later, I am still trying to find out, but this is at least
considered serious enough to send to the Privacy / Compliance office. That manager is out sick for awhile, so I
need to wait a week or more to find out what the drill is to get that
sorted. Meanwhile, if my lab order
(which I never received) is out there with another patient, I hope they don’t
have criminal intent. There’s quite enough
of my personal information there to open bank accounts and much more.
Finally talking with the practice manager in charge of said
information, she was notably focused on getting the wrong patient order back in
her hands. I reported that the lab had
confiscated it when I showed it off (and caught the fact that it was not my
order, a fact I wanted to confirm for myself).
When I asked what had happened to my information, everything was done to
dismiss my interest in the privacy breach—as personal opinion or hopped-up
anxiety. And then the topper – “I’m
sorry you feel that way.” This is the
Number One Phrase to Never Say to a Patient.
I had a rare laugh to hear that coming from a practice manager.
I don’t think HIPAA will take that view – at least, I expect
vigilance to be more active higher up. I
was shut out of any emails I could use to send a list of the normal clarifying
questions to find out how the practice handles such security breaks. Meaning I am going to be forced to walk the
document over to their offices myself.
And have it signed for at Reception.
Meanwhile I’m without answers on either issue, and seriously
wondering what has happened to patient care, and whether the same clutter,
obfuscation, and confusion is reflected on the clinical / medical side, where
it could do real harm. The Hippocratic
Oath, Do No Harm, still rules the practice of medicine. It’s just that patient care doesn’t know
about or adhere to it. So where is
Quality Control and Standard of Performance in all this mess? No one ever mentions them. Why not?
Because there is no comprehensive way of dealing with these standards. Yet it’s very clear how absent they are, and
how much leadership needs to do to begin to grapple with the service fundamentals.
Above all, however, medicine is now all about the UX or user
(patient / client) experience, as is all else in the emerging world of the
Experience Economy. And yet service is
worse, costs are higher, and answers are harder to come by than ever
before. It is astonishing how much
verbal punishment and time abuse attends just trying to find, understand, and
fix the system’s problems – not caused by patients, but left to them in order to
hold their own healthcare services together.
Of course medical staff is paid to answer my questions and fix breaches
in billing and privacy; I’m not. Yet my
sources for damage control are disconnected, siloed, largely uninformed outside
their own métiers and titles, and often within as well. I’m calling it patient hazing. It violates my rights across many aspects,
from simple policy requests to holding me responsible (on the “MyChart”
website) for big bills my insurance should pay.
I’m thinking hard about whether I want to sign again next year. The problem is that I just changed over all
my providers, including my primary doctor, to this system – if you have ever
had to endure this, you know that no one really wants to repeat this process,
much less twice in one year. (This transfer
was the outcome of insurance changes, not any issue with my former plan, which
covered another hospital center.)
Now, you must be thinking – haven’t you tried to contact the
Patient Advocate? Of course. There just doesn’t seem to be one, or it
remains disguised under another title, or their office doesn’t return
calls. So, with my growing file folders
of notes and documents I’m constantly generating to document my encounters and
clear up inconsistencies and fill gaps…I’m heading into my 125+ hours in the
coming week (and maybe this weekend), as a lone advocate for myself. I really wish I knew who had my back, but I
think I can safely say that to the system I’m Patient Zero in a whole new sense. And this is one of the country’s
leading-reputation centers. What are
things like in rural areas with less money, fewer high-end specialists, skilled
nurses, and billing clerks?
Probably better, would be my guess, because people at least
have some chance of knowing one another, other departments, how they operate, and
the System may have an intelligible culture.
