On a slow Friday afternoon, shortly after 2 p.m., my department received a call from an ER physician requesting help. A patient was brought in via ambulance from a nursing home with a dislodged PICC line that was used for a continuous milrinone drip. We agreed to the case and prepared to whisk the patient up to our department to replace his PICC line before closing up at 4 p.m. Our nurses, technicians, and I began to prepare our procedure room for the case when we were stopped by our office manager. Because this patient was admitted only to the ER, and not the hospital, an insurance prior authorization or approval would still be required in order to proceed. Our secretary jumped into action to obtain approval which was denied when the company realized he was currently admitted to an emergency room and therefore could not obtain an approval for an outpatient procedure. An admission was suggested as well as a discussion about a rapid ER discharge, but with now less than one hour before losing our support staff we feared that approval would not be obtained in enough time and the patient would be caught in limbo. He received a midline and instructions to return as an outpatient on Monday for replacement of his PICC line.
This story illustrates the many frustrations and barriers our current health care system places on passionate health care clinicians trying to do best for their patients. Instead of being able to simply perform the procedure that was clearly indicated for this patient, bureaucratic red tape resulted in what is now an essentially useless and costly emergency room visit. Adding to that, this medically fragile patient required ambulance transport for which his public insurance plan will pay for two separate transports. As physicians, advanced practice providers, nurses, and medical support staff work tirelessly to help patients get the care they need, politicians and policy-making giants continue to lay out financial obstacles that only exacerbate the problem of health care overspending. This is likely due to the fact that many of those individuals have never laid hands on a patient before, begging the question: “why aren’t those who have participated in patient care pursuing these positions of power?” As clinicians who are stonewalled by bureaucratic red tape barriers, why aren’t we running for public office? According to the Centers for Medicare and Medicaid (CMS), the United States is continuing to spend nearly 20 percent of gross domestic product (GDP) on health care spending, or roughly $3.5 trillion. Federal spending dollars have reached 8 percent of the annual budget and will likely exceed 10 percent during my practice years.
I write this article as a call to action to my fellow clinicians to become more engaged in the decision-making and policy writing processes. Start by joining your professional organization and lobbying for sensible health care practice and spending bills in your state. Support national organizations that advocate for practical billing rules for Medicare and Medicaid. But most of all, more of us need to rise up to the top and consider running for public office. We health care professionals are intelligent, savvy, and creative enough to mold a national health care policy plan that is sensible and financially responsible. After all, if you lived through your training, staffing shortages, insurance prior authorizations, patient satisfaction surveys, and billing and coding audits, you can surely survive an election campaign! So do it. Run for office. Run to make taking care of patients easier. Run to save the industry. Run like the future of healthcare depends on it.
