Bound by Medical Regulations

Marcy ZwellingGeneral, Health ReformLeave a Comment

Published in the Orange County Register: January 24, 2014

It is understandable Americans are distraught about the health care exchange and about losing insurance and their doctors. But, so are doctors. And it is not all about the money. The frustrations and cost of providing care mostly due to regulations and the costs are enormous.

My office spends hours of time in order to execute the recommendations we make for our patients. To order a CAT scan we must often get an authorization and provide a reason that satisfies a clerk armed with a list of check boxes.

Just last week, an elderly patient called my office complaining of pain in her lower arm. The patient was told to come in immediately and upon exam, we found no pulse in the artery. After confirming the problem with an ultrasound we were challenged with treatment. Many doctors would have admitted that patient to the hospital for a procedure to remove the clot. The cost would have been tens of thousands of dollars to the taxpayer.

We called the local pharmacy. They could get us the medicine but not until the morning. So, we borrowed the medication from the hospital and started treatment immediately.

The following day my office spent six hours on the phone with the mail away pharmacy to get her medications. We called the following day to confirm that things were sent out only to find that nothing had happened.

In the end, it took daily calls and finally threats to get the patient the meds. The cost of that service is “not a covered benefit” nor is it accounted for in the “cost of care.”

Every day, doctors are on the phone or filling out forms begging a clerk to “allow” their patients the care or medications they need. In the meantime, the regulators, pharmacy benefit managers and other non-professionals are “eating up” your dollars and my time. Because the costs are hidden and doctors “just do it” you hear little about the onerous time consuming paper work until we just say “no.” That time is approaching.

There are some things that are beyond the power of the president and his executive privilege: the day is only 24 hours long.

Marcy Zwelling-Aamot, MD FACEP, is a member of American College of Private Physicians.

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