BY MARTA HEPLER DRAHOS
My husband needs to refill a prescription for a maintenance medication he's been taking for years.
He calls the doctor's office but is told he needs to see the doctor first. He explains that he has an appointment for a complete annual physical in a few weeks and asks if he can get a partial refill until then. Negative, comes the reply, so in he trots for the requisite blood tests.
A few weeks later he keeps the original appointment for his lengthy annual physical, which, since it comes in a new calendar year and we haven't yet met our deductible, will involve considerable out-of-pocket expense. All is well and he goes off to Colorado to visit his new grandson with a clean bill of health.
The next month he's scheduled for cataract surgery, something he's put off for a while. Knowing it was coming, he timed it for soon after his physical, which the hospital requires before he can go under the knife.
He calls the doctor he saw five weeks earlier, to get authorization for surgery. He's told he'll have to come in for a pre-operative exam and tests, all of which he had the month before as part of his annual physical.
Pre-operative tests, he learns, have to be performed up to 30 days before surgery -- and he's eight days past the limit.
Eight days?! And some still question whether our health care system is in critical need of reform?
All of this might be funny if it weren't for the fact that cataract surgery is the most common operation among the elderly, who are the least able to pay for medical care. That routine pre-operative testing before the surgery is estimated to cost Medicare $150 million each year.
And that such testing has been shown not to improve patients' health or clinical outcomes, according to a study sponsored by the Agency for Healthcare Research and Quality -- the country's lead federal agency for research on health care quality, costs, outcomes, and patient safety.
Further, say the study's authors, the standard battery of tests -- electrocardiogram, complete blood count, measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose -- should be ordered only when they would have been indicated even if the patient were not planning surgery.
Physicians will say they don't make the rules, that pre-operative testing within a certain time period is a hospital requirement. Even if an individual physician thinks that a patient's medical history and physical examination provide enough information to authorize surgery, he or she still may order pre-operative tests because of guidelines, institutional requirements or the belief that another provider wants the results.
I don't care who's at fault, or how deep the fault line is. As long as this quaking system of ours gets fixed.
Reach staff writer Marta Hepler Drahos at mdrahos@record-eagle.com.
