The man on the other line sits in a cubicle in a far-away city.
He is a physician, another “provider,” as we are called on their website. The accent is British (how ironic), and his voice suggests to a trained observer, he is older.
All I wanted to do was a simple stress test with an ultrasound. The patient, an overworked woman who devotes her life to the spiritual needs of others, presents with an arrhythmia. The irregular heartbeat scared her. This I can see, because, well, I am seeing her as a patient.
The arrhythmia in question was in a grey area. It’s nature was not so minor that I was comfortable dismissing it with pure, old-fashioned reassurance, which I do a lot, and in doing so more than my peers, always had hoped that when I needed said imaging study, a pass would be available. Like the free sandwich notion: with every 12 patients reassured with simple doctoring (when others would order many more expensive tests), you get one free pass on the next grey-area patient.
“Dr Mandrola, compared to your peers, you order few expensive, radiation-laden imaging studies, so go ahead and get that simple non-invasive, inexpensive and radiation-free ultrasound on this newly symptomatic patient.”
Oops, day-dreaming again. Sorry.
It turns out that this patient’s third-party payer, Anthem (Blue-Cross, Blue Shield), has a RQI, Radiology Quality Initiative.
Blue Cross and Blue Shield of Illinois has partnered with American Imaging Management (AIM)* to implement a Radiology Quality Initiative (RQI) program designed to meet the challenges of monitoring rapidly increasing utilization and managing rising high-tech imaging costs.
Who is AIM? From the first line on their website: American Imaging Management, Inc. (AIM) is the intelligent solution for managing outpatient diagnostic imaging services. (Translation: Our business model centers on intrusion into the doctor-patient relationship, and in so doing, we will enhance your profits.)
And there is more.
The RQI program includes a prior authorization process promoting the utilization of relevant and cost-effective services by giving providers access to evidence-based guidelines that support ordering the most appropriate services for BCBSIL members.
Compliance with the RQI program is required.
For starters, as cardiologists go, I am pretty easy going, but the “provider” thing really irks me. It shouldn’t. Really, I should get past semantics, but it is a nasty boil.
Back to the point.
The point is: rationing of health care by erecting barriers. Placing obstacles in the way of getting simple diagnostic tests has become reality–for obvious reasons: profit motives of insurance companies, increased costs of diagnostic tests, and to be fair, occasional physician over-zealousness in ordering of tests.
It is not fair. And I am frustrated. Jumping this particular barrier took significant time, emotional energy and some inflammation. Energy that would be better spent caring for others.
And I repeat: we will not have more healthcare, higher quality healthcare, and cheaper healthcare. This equation is unsolvable.
In my dream world, it will be a fine day indeed, when patients ask their third-party payer how many providers-in-cubicles they will unleash on real doctors trying to do what is best for them.
You bet, I am aggravated. I hang a lot on the doctoring peg.
JMM
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