Where We Are and Why

I appreciate that everyone is eager to hear the news from Sandy's most recent scans, so I thought I would let you know where we are and why. She had one CT scan done on her spine last Thursday, but the remaining scans of her chest and abdomen have been rescheduled a number of times. So, we will not have a complete picture until those scans are done and interpreted.

The holdup has been with insurance approvals. Sandy's scans have been delayed for three weeks because of administrative inefficiencies. A person would think that Aetna would approve all of the scans that her doctors order if they approved any, but, as we are reminded throughout this process, there are a lot of left hands that just don't seem to know what the right hands are doing. Adding to the complexity is the fact that, although Hopkins and Aetna participate together (ie, Hopkins is "in plan"), the radiology service at Hopkins is not an approved provider by Aetna. Go figure. This requires that Sandy actually go to a third party, a dedicated radiology service, that is approved by Aetna. That's right-- the low bidder. Naturally, their systems do not talk to each other, the data is shared in paper report format via fax, and there are delays in collecting and interpreting data. Amazingly, requests and approvals such as this are handled manually and often take weeks to settle. Different systems on either end, the output from which are paper documents that have to then be sent via fax...and then processed manually into another system. Further, the radiologist who reads the images is largely unfamiliar with Sandy's case and inexperienced with this rare form of cancer, particularly in this setting. This ultimately compromises and delays patient care, whether it is Sandy's case or someone else's. Health care decisions and the execution of treatments can be confused and delayed simply because the ideal resources are not properly aligned and integrated.

To combat the lethargy of the system, we have worked out informal processes with the individual physicians. I think many patients come up with something like that that suits their needs and personalities. The vast majority simply wait to be told what to do next. Our approach speeds time to information for us, but it does not actually improve care or save time for the physicians or the system. It introduces new inefficiencies that, if fully analyzed, probably cost the insurer and the medical institution more money than they realize.

I am reminded almost daily that in our medical system, no party owns responsibility for the overall process of managing cases. In the business world, leaders would never allow business processes to go unmanaged like this. Yet, that is exactly the type of system we rely on for medical care. No process management, no case management. Simple fee for service. Crude performance measurement, at best. Health care attracts billions of dollars in research funding each year, which remains focused largely on diagnostic technology and treatment of specific diseases. Billions more are wasted each year by pushing funding and new advances through the same, wasteful processes.

"Enough already!" you say. So where does that leave us with Sandy? Actually, she is finally getting the remaining chest and abdomen scans today. She has another spine MR ordered but not yet scheduled. It is virtually guaranteed that the process of simply gathering the data that needs to be analyzed will take more than a month to execute.

So, now you know where we are and why. Stay tuned.