In Healthcare, Be Squeaky

credit: wisdomenough.com

As the saying goes, the squeaky wheel gets the grease. This is particularly true in healthcare, where you are dealing with big systems that don’t always talk to each other. Today, I will tell you the story of how I squeaked loudly enough to get quick results.

Both my husband and I have chronic conditions, and we see a lot of doctors. We try to do as much as possible within a single large hospital system in our area. Because we are also both disabled, I need to get copies of our medical records on a regular basis. You might think, as I did, that keeping your healthcare within one system would make it easy to request and manage medical records.

Think again.

Over the course of seven months, I made multiple records requests to different providers and in almost every case the requests were either ignored or mishandled. The entire process is poorly designed and poorly executed. The longest time from request to receipt of records was 102 days. In one case, I received the same set of records and was charged twice.

I started to keep notes of every contact I made with the providers’ staff and the contractor who actually prints the records. Over those seven months, I documented a series of problems and roadblocks. So I did what I do best: I wrote a letter.

With a little research, I found the contact information for the Chief Administrative Officer of the health system. I wrote him a letter summarizing the problems I encountered:

The requester must contact each individual healthcare provider’s office directly, rather than going to a central request point.

At each provider’s office, there is no clear point of contact, and front office staff are either ignorant of the process and/or provide erroneous information.

Providers do not acknowledge receipt of requests, nor provide reference numbers to patients so that the requests can be tracked.

Requests take 10 to 14 days before the medical records contractor can view them in their own system.

Specific details of requests – such as a request to pick records up in person – are ignored.

Requesters must waste time repeatedly attempting to get status updates or tracking information.

Problems at multiple points in the process force requesters to resubmit requests, sometimes repeatedly.

Some providers’ offices circumvent the process entirely and provide records directly to the requester. While this is helpful in those instances, there is no rationale as to why other offices do not do the same.

When [the health system] changed contractors . . . no information was provided to requesters and pending requests were simply dropped without notice or explanation.

I also included an attachment with a the detailed chronology of all the requests. I closed the letter by saying:

The healthcare that we have received from [the system] has been very good. In stark contrast, the administrative experience of being a [system] patient has been dismal. I urge you to make rectifying the situation a priority.

I emailed the letter and attachment to the Chief Administrative Officer, and received a reply within three and a half hours. He promised to look into the situation, and apologized that I was encountering these difficulties.

Three business days later, the CAO apologized again and handed me off to the health system’s Corporate Patient & Family Liaison. She reached out to me immediately and scheduled a call to discuss the problem. She also repeatedly thanked me for providing so many specifics in the letter because it gave them actionable information for follow up.

By the time I spoke with the Liaison, the system’s Chief Information Officer was already working with the Health Information Management Department and the administrators within the clinical practices to address the problems I identified. I was reimbursed for the double charge (although I had not requested it), and was also given contact information in case I encounter problems in the future.

I shouldn’t have to go all the way to the Chief Administrative Officer of a major hospital system to get help with simple medical records requests. I didn’t want to spends spoons on it, but I also knew that I couldn’t be the only patient encountering these problems. Unfortunately, the nature of bureaucracy is to wait for a problem to be raised, rather than preventing the problem in the first place.

The moral of the story is simple: if a healthcare system is screwing up, say something. Contact the person highest in the chain of command for the issue you are encountering. Summarize the problem(s) and provide as many specifics as possible. And if you do not receive the response and assistance you require, be prepared to follow up.

It’s not fair. We shouldn’t have to expend energy to make sure people do their jobs correctly. But the reality is if you squeak, you have a better chance of getting the attention you need to solve the problem.