Tuesday, December 8, 2009

Health care challenges at a small company

The health care debate is still raging as I write this and my frustration mounts at how little we can really do as individuals or employers about improving the efficiency of our health care system.

We strive to provide good health care to our employees at FirstRain - it's an important benefit in everyones compensation - and yet the cost just keeps on climbing. We switched from Aetna to Blue Shield a few years ago to try to manage the increase in cost, and we recently raised our employees contribution percentage. We didn't do this lightly, but the percentage we were asking from our employees was well below the norm and so we decided to move it up a little bit each year to get more in line with the norms of the market.

But I recently saw first hand just how crazy the system is, why some of it is so expensive, and the false economies at work.

I suffer from lower back pain. It's been going on for years but with all the traveling it has gotten worse over the last year. I finally decided to try to figure out what was going on when my kids got on my case about it (Stop complaining Mom) but my instinct was there was nothing I could do and I didn't want to spend the time to find that out - but they insisted and so I started on the medical diagnosis journey - and what a waste of time and money that was.

Step 1 - ask for appointment with doctor - learn there are no free appointments for two weeks and am advised to see nurse practitioner - I learn this is a normal first step - guess they are cheaper than doctors
(in my head: huh? what's that? a practicing nurse - what as opposed to a retired nurse?)

Step 2 - nurse (the practicing one) says PT (physio therapy) - it's probably a degenerating disc
(Uh oh - this sounds like a time sink)

Step 3 - PT - 6 sessions, get told not to wear fashionable shoes ever again, to stretch every morning etc.
(Yeah, yeah - you try going to investor and customer meetings in sneakers lady)

Do PT, do exercises, slight relief but still weak and painful - now curious and decide to continue sleuthing

Step 4 - call back for doctor's appointment - get in to see doctor - bend this way and that, resist his hand etc.- he says yes it's lower back (duh!) and we'll do an MRI
(Great, fab technology, I get them every year for my head, time to practice my "don't panic" breathing again (where's The Book when I need it) - sure hope it's worth it)

Step 5 - MRI - 45 mins in the tube
(OK guys - lying on my back stiff as a board for 45 mins - not a great idea - you're going to have to lift me off the table)

Step 6 - takes 2 weeks to get an appointment with the back specialist - but I get one. Here's how it goes:

Doctor: Aha! You have a degenerated disc in your lower back - see here half of it is gone
(Oh no - that doesn't sound good - squinting at the murky film - yep half of just one disc is missing - weird)
Me: What's the cause?
Doctor: Aging
(OK I don't like that answer - I'll ignore the implications for now and process it later over a glass of red wine)
Doctor: You need to take anti-inflammatory drugs

(Have you been to medical school? I sure hope so)
Me: Please check my chart. I am on coumadin and can't take them
Doctor: Oh - I see it now - yes you're right. Well then you need a cortisone shot in your spine
Me: If I am on coumadin I have to come off it for the shot right? Probably not a good idea if it's not essential for surgery.
Doctor: Er... Right
Me: and I can only ever have two cortisone shots there because of bone loss as a side effect right?
Doctor: Er... Right
Me: and it's only a temporary fix right?
Doctor: Er... Right
(Hmmm... my confidence is waning)

Me: OK what's the third option?
Doctor: Pain killers - Opiates don't interact with coumadin- how about Vicodin? It'll stop the pain.
(Wow - that's a brilliant suggestion for long term care - sleepy, high and constipated all at the same time - sounds like I'd be at the top of my professional game on that one - Vicodin's OK for occasional severe pain but it's certainly not smart for long term pain management - maybe he just wants me out of his office)

Me: Vicodin - that's addictive right, and not safe for long term use?
Doctor: Yes but it will stop the pain
Me: No thank you - any other options?
Doctor: Not really, maybe muscle relaxants at night - they are also addictive but they may help
Me: How about red wine?
(thinking - another way to justify my taste in fine California pinots to my husband)
Doctor: Yes that will work, and it's better for you than drugs. If red wine manages the pain for you then go ahead.
(aha! we agree on something - wine doesn't solve it but it turns down the dial)

I walk out - 4 clinic, 1 MRI and 6 PT visits later and probably thousands of dollars worth of care - and go to the chiropractor who is effective and works both pain management and preventative treatment for the future. But the insurance has only limited coverage for chiropractic care so I just pay up - annoyed because it would be cheaper for both of us if our insurance covered chiropractic for more than a few visits a year. I then consult with my neurologist who says "no drugs" and prescribes a local anesthetic patch for the bad times - so simple with no side effects.

So here's the dilemma. The few times I have been really ill the care has been fantastic and I am profoundly grateful to get state-of-the-art health care in California. Fast, intense and precise treatment that saved my life. But my experience of out patient treatment is chronically inefficient - a huge time sink as I am processed through the layers of the system, as the doctors try to work around the insurance company's policies and have a knee jerk reaction to prescribe lots of drugs because they'll be covered (and believe me I have a stable of stories like the one above).

So what to do - no choice but to work within the system. We will continue to offer our employees the best coverage we can, and our health care costs will continue to go up, and our long suffering HR director will continue to argue with our broker and our insurance provider to make sure our employees get the treatments and procedures they need. But it is all just too complicated, there has to be a better way.... (fade to my father's voice in my head - just move home Poppet - the NHS is great....)

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