The Sick Truth
Healthcare reform may not change a thing for Mom -- or you.
My mom, Dianne, is 76 and lives in an assisted living facility in Newton. Over the years, she's had a variety of conditions needing occasional treatment, and the trips to her doctor were getting to be a nightmare. We'd battle our way through traffic into the Longwood Medical Area and park in a dark, crowded lot. It was tough for my mother, who uses a walker, to get to the elevator. And the doctor had all the bedside manner of a Filet-o-Fish. When medical issues arose, such as a painful rash or bruises from a fall, Mom would be sent off to specialists. But none of these doctors seemed to be in synch. They didn't even talk to one another.
Late in 2007, I came across what I believed would be the solution to this disjointed, care-by-numbers approach: case management. As a reporter who covers healthcare and health insurance, I happened to be interviewing Debra A. Geihsler, then chief executive of Atrius Health, one of the largest medical practices in the state. She told me seniors don't need more care from more doctors and specialists; they need one doctor who can oversee all of their care. And Atrius's best-known doctors group, Harvard Vanguard Medical Associates, offered just that kind of service. For me, a light bulb went on.
What followed was a six-month journey into the maddening, spirit-killing bureaucratic crannies of the US healthcare system.
I found a Harvard Vanguard doctor who agreed to treat my mom. They hit it off at an initial meeting. One hurdle crossed. But then I learned the case management service was available only to patients with Medicare Advantage -- a kind of private Medicare with extra bells and whistles. It wasn't available to Mom. I was disappointed but decided to move forward with the new doctor. I filled out a patient intake form at Vanguard and asked the old doctor's office manager to forward Mom's medical records.
A few weeks went by. The new doctor's receptionist called. No records. Another call to the old practice. They needed another copy of the request form and a copy of my power of attorney. More faxing ensued. Another month passed. Still no records. I called the office manager. This time, she said she didn't handle medical records. I needed to speak to a records specialist deep in the bowels of Beth Israel Deaconess Medical Center. After one more call, it seemed as if they would finally comply.
Then another issue arose: Mom's insurance wouldn't pay for a routine checkup. Seems Medicare pays only for actual treatment, not checkups. I was told to call her insurance company, so I did. The representative, with a tone of distinct disinterest, said there was a different problem. The refusal to pay, she said, was because Mom's new doctor wasn't on an approved list of physicians. I was baffled, because the need to choose an "in-network" doctor hadn't once come up in the 17 years my mom has lived in Massachusetts. Her suggestion: "Call Medicare." (I wisely ignored it.) We kept the same doctor.
On the next visit, the payment issue mysteriously resolved itself. How? I found out that many doctors deal with Medicare's rules by using a billing code that makes a checkup look like a treatment visit. Maybe, I thought, I was better off not knowing this.
Months later, it seemed as if I had succeeded. Bills were getting paid by insurance. The care seemed better. Then I got a call from the new doctor's office. A letter to my mom with results from a blood test had been returned in the mail. Using those hard-won medical records, Harvard Vanguard had sent the results to an address that was seven years out of date.
Healthcare reformers are now descending on Washington with buzzwords and catch phrases such as case management, universal care, evidence-based medicine, and electronic medical records. Here's the frightening truth: Nothing will change at the only level where it really matters -- the patient -- unless reforms address the single most basic necessity: having the left hand know what the right hand is doing.
Ask doctors about insurance, and they'll send you to the insurance company. Ask insurers about care, and they'll send you to the doctors. At each stop, you'll speak to a customer service rep with nothing but an infuriating script to follow. Until the different parties in the system actually start speaking to one another and working together to serve -- gasp -- the patient, the vicious cycle will continue: grand ambitions, good intentions, zero progress.
Jeffrey Krasner is a Globe staff writer. E-mail him at firstname.lastname@example.org.