One of the big challenges facing the viability of the Patient Protection and Affordable Care Act (PPACA) is the concept of the “high-quality narrow network.”
In practice, it seems as if that will mean people in the narrow network exchange plans will have to wait forever to get in to see the doctor. The networks are supposed to meet federal provider access standards, but it’s hard to believe states or the government will do a great job of enforcing network access standards.
Whenever I dare to go through my plan’s provider directory to try to find a primary care provider, I feel like a telemarketer. I create a list of about 10 or 15 offices that someone without a car can reach, then start dialing and trying to sell myself to the receptionists.
Most of the time I give up about a third of the way down the list and go without the checkup, or, if I’m actually sick, end up in a CVS retail clinic. The last time I tried to see an actual doctor, I went in for what I thought was a free checkup and ended up with a $400 bill.
It’s a little scary to think about how I’ll go about getting care if and when I’m in a plan with a narrow network. Maybe I’ll stand on a street corner with a sign stating, “Will trade filing work for you telling me whether those weird morning shin cramps I’m getting matter.”
My sense though, is that as hard as it may be for me to find the slots I want, doctors may also struggle to fill some of the many slots they have to fill just to look like efficiency stars.
One way to start addressing the difficulty of matching patients with appointment slots might be to get away from the patient-telemarkets-to-doctor appointment model and have a much-expanded version of ZocDoc.com. Or maybe a Web-based restaurant reservation service, like OpenTable.com or RestaurantReservations.com, take over the process of helping patients make appointments with doctors.
Let patients use an automated system to find conveniently located, moderately priced doctors with the right kind of appointment slots available at the right times, and book those, rather than going through some mystical effort to use data dowsing rods to find healers with the power to charm bad germs out of inflamed tissue.
On the one hand, widespread use of that kind of service might interfere with the wonderful relationships patients supposedly have with the Marcus Welby types who run their medical homes.
On the other hand: Marcus Welby has been off the air for a long time. Taking a more down-to-earth approach to helping patients locate suitable open slots might go a long way toward maximizing physician office efficiency and patient access to physicians.
On the third hand, the people at the medical home are supposed to take over all of this leg work and envelope me in a comforting blanket of administrative efficiency.
On the fourth hand: How exactly do I find one of these medical homes without hiring a telemarketing firm to help me?