HFMA VIEWS

MarieAnn North, MBA, FACMPE
Director, Navigant Consulting, Inc.

Recently, I took my first real vacation in four years. I left the lap top and cell phone at home, and went overseas. In reading the tour brochure (admittedly not until I was actually on the vacation), I noticed it informed me should I have a medical need, health care was free and available. I wondered what travel brochures say for people traveling to the US. Do we tell people we have excellent healthcare, but if you are uninsured and need to access it, it will likely bankrupt you?

The positive effects of vacation wore off quickly. A week after my return, my 81-year-old uncle, visiting me from Canada, fell and broke his hip. I dialed 911 for the first time in my life, and waited. It took several attempts for the ambulance to find my home.

I spent a Saturday night in the emergency department. The initial set of x-rays taken had the cardiac leads obscuring a critical part of the images, and we had to again move a patient with a broken hip to repeat the studies.

Multiple hours later, my uncle was in a hospital bed, and I started the process of dealing with coordinating care for a patient insured under the Canadian system. My phone call to Canada resulted in the insurer easily identifying my uncle and his primary care physician in the one and only database, and also resulted in clear directions for me to follow. 

The 72 hours spent at my local hospital proved to be an exercise in frustration. In the countless hours I spent there, I saw the primary RN once, and never could get the attending physician to speak with me. The same insurance information was asked for countless times. Forms that needed to be faxed weren’t. Sections of the medical record weren’t forwarded and tests needed to be repeated. But I discovered something. If I wanted to know what was happening, I called Canada! For some reason the medical case worker there could update me continuously. At one point, my uncle wasn’t in his room. I went to the nurses’ desk to inquire where he might have been taken, and discovered it was possible for about a dozen people to give you that “deer in the headlights" look simultaneously. I waited an hour and a half, and then called Canada to find out what was happening (at the hospital I was calling from). They informed me my uncle had been taken for a cardiac echo and would return shortly.

I resorted to more drastic measures to seek information. I wrote a note and taped it to the chart rack in the room. The note would be obvious each time vital signs were checked. A day later, the note was still there. Time was lost when the orthopedic surgeon in Canada insisted that an 81-year-old with a hip fracture needed to have surgery as soon as possible, but the attending physician in the US insisted he was stable enough for transport. Just when I was getting desperate for information and was considering shopping for a flip chart and brightly colored markers, I received a call from Canada that an air ambulance had been arranged and was on the way.

My uncle had surgery in Canada. He ended up with a hip replacement. He is recovering well. I am trying to regain my strength to face the billing process. I’ll let you know how it goes in a year or two.