Before you get a medical test, it has to be scheduled, right? Just like getting a reservation at a restaurant, both you and the place you're going have to agree on a time. Here's the real-life story of my recent MRI, starting with scheduling it. The point of this post isn't to whine about what happened to me, but to illustrate deep, widespread problems in the medical business by means of a concrete example.
Background
First some background. My doctor was at Mount Sinai. While he was treating me, I had several MRI's at Mount Sinai. Then he moved to another major hospital system in the NYC area, Northwell Health. Both are excellent places with modern, up-to-date systems. I told the story here of the amazing breakthrough in EMR electronic interchange that allowed me to get the MRI's that had been taken at Mount Sinai and get them to the doctors at Northwell so they could do their jobs. It was true breakthrough technology, since the interchange was almost completely electronic, with the truly minor annoyance of a dozen phone calls, a couple paper forms and faxes, and a couple packages carried by hand. I know it's hard to believe that such giant systems could be so modern and electronic, which is why I give all the facts and associated proof here.
I felt my tumor growing again. I quickly got an MRI that showed that, unfortunately, I was right. My doctor, the MRI and the follow-on to it were top-notch. The subsequent billing events are an object lesson in how the business of medicine can be improved, see the posts here for details.
My doctor, who had treated my tumor and greatly reduced it with chemotherapy, now felt it was small enough that radiation was the best approach for treatment. He recommended I go to a radiation specialist, who happened to work at Mount Sinai, my doctor's former employer, and where I had originally been treated. Naturally, I took his recommendation. I got radiated. 30 times.
It is standard practice to check the results of radiation 3 months after the treatment. In my case, that meant getting an MRI.
Scheduling the MRI
Here's what I went through to get the appointment. Nothing horrible here; I'm pleased that something so effective as MRI technology is available and that I was able to get it. But the cost, time and convenience all reflect a broken business model. Fixing the model isn't hard in principle, but would require serious change. This is an example of how it works today.
On my final visit with my radiation doctor post-radiation, he told me about the follow-up MRI I should have in 3 months. He told me his office would contact me and get it scheduled "shortly."
Nothing happened. I waited for the 3 months to pass. No one contacted me. Fortunately, I kept track of the time, so I got on it myself.
I started with my radiation doctor's office at Mount Sinai. Sure, they said, you can use the Northwell imaging center to get your MRI. It's convenient for you, so why not? We'll set it up for you.
I wait a few days. Nothing. I call again. Oh, sorry, we'll set it up. I wait a few days. Nothing. I tried again. Nothing. Finally I called the Northwell imaging center and explained the situation. Sure, no problem let's make the appointment. What about the pre-auth? Oh, don't worry, we'll take care of it. You've got all my information in your system from last time, right? Yes. Don't worry.
Two days before the scheduled MRI, I get a call. Hey, about this MRI you're scheduled for, there is no pre-auth for it, so we're going to have to cancel the appointment, there's not enough time to get one. Great. I don't bother complaining, what good would it do?
I realized that I had been totally wrong in my strategy about this. This medical stuff must be making me lose my mind. Or I'm getting colossally stupid. What was I thinking?? I was choosing where to get my MRI done based on what was best for me. WHAT an IDIOT I am!! I know that the smart thing to do is always do what's best and easiest for the medical system. Duhhhhhh!!
Having returned to sanity, I called the Mount Sinai radiation doctor's office. They said they'd set it up. The whole thing, pre-auth and appointment. A couple days pass. I call again. Same thing. A couple more days pass. I call again. Oh, sorry, excuse excuse excuse. I said, no problem can you just please send me the doctor's order? After more shenanigans, I get the order. Giving in completely to the world as it is, I call the Mount Sinai imaging center, where I've been a few times in the past, and make the appointment, making sure that they've got the doctor's order.
Conclusion
I got the appointment. That's the good news. I know that others have had it far worse. But I also know that this peculiar state of affairs, where there's no equivalent of, say, the Open Table scheduling service for making MRI appointments, is a HUGE time-waster for everyone involved. Do you want a job doing what the people I talked with on the phone sort of try to do? Would you want to cope with constant hassle and frustration?
My insurance company knows the treatments I've had. All the information is in the EMR's of the two major systems I've used. It wouldn't be hard to know that getting an MRI at my stage of treatment is something to authorize. The process could be completely automatic. And I could maybe even have made my MRI decision based on my needs rather than the peculiarities of a deeply flawed, broken system.
Next step: getting the MRI.
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