The Sargasso Sea of Medical Care

Warning: this is a Rant Post.

One of the first steps when we got back from the hospital was for me to schedule an appointment with a PCP and a Cardiac Specialist. One would THINK that would be a pretty easy process.

I thought I had a primary care physician. Years ago I had a checkup and follow-up exam at the PCP listed on my insurance card. The kids go there regularly. I had not personally gone in years. So I call this summer to get a checkup and they tell me that I have been away too long so they took me off of their list of active patients.

I was a bit confused, but I asked to get back ON the list. They'd have to talk to their people about that. They'll get back to me.

Two or three weeks later I call again...thinking simple administrative oversight. Same runaround. The say they will call back and never call. They don't want my business, or are simply incompetent in the area of patient retention.

So I pick another place to start up as a PCP, a new facility 2 miles from me, affiliated with a major local hospital. They will consider me as a new patient, but they need my medical records from old people. I call old people. "We destroyed your records".

Now I'm stuck in a hard place. Old guys not competent and won't take me anyway. New guys stubborn on medical records which don't exist.

So I call a NEW, new place. They need to ask the physician if they will take me, even though they say they are accepting new patients. Once more in a holding pattern...this one can take a week they say. I started the timer on Wednesday 10/21.

Meanwhile I call the leading cardiology practice in Erie to get set up with them...'cause I KNOW I have some issues there. They won't take me unless I get a referral from my PCP. Which I don't have, and don't exactly know when I will have.

So I am in medical limbo. No PCP, no specialist, no idea when I'll get either...and specific discharge instructions from the hospital to see both asap.

In reality, the only medical care I can get right now is to go to the ER. At least if I complain of chest pain they'll move me up the waiting line.

I know much of it is my own fault for not going for years...but this process of changing a PCP should not be this hard or time consuming.

Putting my Six Sigma hat on from my Black Belt days, I see a repeated breakdown in the practice's "transactional process" of new patient screening and acceptance. I don't know what their process requirements are (Critial To Quality characteristics, or CTQs). Usually it's cycle time, accuracy and maybe volume or capacity, and of course, customer satisfaction. If a business doesn't think about the process CTQs, they end up with a home grown process that optimizes some other parameter, such as the workload or satisfaction of the new patient administrator. As a customer/user of their process (regardless of whether they accept me, I'm input to the process), I am obviously not aware of their process CTQs, nor do I feel that the "normal" CTQs are being measured or considered.

I realize that the main processes in a practice are: Scheduling, Appointment/Care Delivery, Billing, Prescriptions, and Emergency, but Patient Onboarding is a key process as well. You miss this one and your practice will get a bad rep from those alienated or rejected, and your patient volume could come down.

I predict that the practice I find that can screen and accept me immediately is the one in town that actually has a support staff that is competent, and has a set of "onboarding" processes that were thought out with the intention of minimizing the waste associated with starting new patients.

Here's my advice to medical practices in Erie: Know your customer base, both those you have accepted and those who apply. Spend a bit of time to define the common processes and what should be important to the customer during those processes. Little things like telling them how long it may take for screening, and regular updates will go a long way to improving your reputation and making the processes better from the customers' eyes. And gather some data during the process - how many inquiries per week, how many turn into applications, how long each application took through various stages of the process, how many you accept, how long until first appointment. Basic stuff that you can collect and analyze with little effort. Having a standard process with standard measurements will let you know how you are doing.

And here's my advice to medical consumers: Know your PCP. Make sure they think you're still alive and haven't shredded your medical records. Give them feedback on which processes work well and which don't.

Oh, and don't try to live with a heart attack if you live in Erie. Better to do that in a small town in Ohio, where they still know how to care for you.