Patients say health system 'reforms' are making it harder to see the doctor


As the nation debates loftier and more complicated health care matters, countless Americans consider their biggest medical problem to be an age-old complaint: how long it takes to get a doctor's appointment, and how long they have to hang around the waiting room reading old magazines.

Across the country, patients say the major changes shaking the nation's health care system are making it tougher to see a doctor.

"Where are these doctors that can just help you? I don't know if I'm going to get sick next week," said a Baltimore woman who turned up in a hospital emergency room last week because she couldn't get a doctor's appointment.

The woman, 60, didn't want to be identified for fear she would anger her doctor.

But physicians say some patients are no-shows and others ask for the impossible, expecting to be seen at an hour's notice for non-urgent conditions.

"You can't just change everything because somebody wants to be seen today, tomorrow or this week," said Dr. Ted Lewers, an Easton nephrologist on the board of the American Medical Association.

Today in Washington, Dr. Bob Blendon, a Harvard researcher and nationally known expert on public opinion and health care reform, plans to release a comprehensive survey that may give a clearer idea of how patients fare in two types of plans, managed care and the traditional fee-for-service.

Some experts say that, by its nature, managed care -- which works to eliminate unnecessary visits and treatment by requiring the patient to go through a primary care doctor -- puts up more barriers.

That sort of care is rapidly expanding, and fewer people still have what's known as fee-for-service, where no restrictions apply on which physicians patients see or how often they see them.

But recent surveys indicate the public has had trouble with both.

In a national survey of 93,000 federal employees and retirees, comparing more than 250 different health care plans, some of the most negative ratings came in response to questions about access.

About 21 percent of respondents rated plans fair or poor on getting appointments for checkups and other preventive care, according to the Consumers' Guide to Health Plans, published this month.

Nearly a third of those surveyed rated plans fair or poor for how long people spent waiting in the doctor's waiting and exam rooms when they arrived on time for an appointment.

In another survey, 19 percent of Medicare beneficiaries enrolled in health maintenance organizations reported busy lines all or most of the time when they tried to call.

Eleven percent of the group said they gave up on making appointments because of the busy lines, according to a March report by the Office of Inspector General at the U.S. Department of Health and Human Services.

Consistently, studies show that getting care right away is one of the public's top priorities.

"It's crucially important to people," said Art Caplan, bioethicist at the University of Pennsylvania.

"They [politicians] got caught up in trying to sell the public on issues like cost containment, preserving quality and security, but I think most people have no idea whether their care is good or not."

Sometimes, patients say, quality and waiting times are linked.

Paula Ford, 44, said she suffered from bouts of sinus infections and bronchitis every winter for 10 years, waiting at least an hour in the doctor's office and never feeling that her problem was addressed.

After she got angry enough to change physicians, she said, her new doctor discovered that she suffered from asthma. She could sleep through the night and no longer missed days of work.

"If there's a doctor who doesn't care if you're sitting in the waiting room for an hour, he probably doesn't care that you're miserable with a sinus infection, either," said Ms. Ford, who lives near Altoona, Pa., and responded to an Internet question on the issue.

The clinical director of the emergency room at the University of Maryland Medical Center, Dr. Brian Browne, said a proportion of emergency room visits have always come from patients who have health insurance but can't get to their physician. But hospitals don't track those numbers.

For Medicare patients, though, Dr. Lewers said he is beginning to see signs of an access problem. Some Medicare patients, for instance, are arriving at the doctor's office, and the hospital, sicker.

As a member of the Physician Payment Review Commission, which advises Congress on Medicare issues, Dr. Lewers said his group is trying to determine if this is a widespread problem.

In Maryland, the state's Health Care Access and Cost Commission plans next year to survey enrollees and physicians in 19 HMOs on satisfaction issues.

The nation's largest HMO, Kaiser Permanente, already has taken steps to address complaints by remaking its appointment system in areas such as the Northwest, allowing patients to pick which day they want to come in.

Locally, Kaiser's Baltimore administrator, Barbara Hoffman, said the HMO works to get patients with urgent conditions in the office within a day or so, and patients with other concerns in within two weeks.

Experts say the best way to ensure access is for businesses and government to put clauses in health plan contracts requiring physicians to see patients within a specified amount of time.

Patients such as Lisa Knight, 34, suggest an aggressive approach, including checking out the physician before signing on, and calling before going to the doctor's office to see if there is a delay. Ms. Knight, who suffers from asthma and allergies, said hours of waiting wasted her time and sometimes landed her in the emergency room.

The Atlanta woman finally got fed up and left the doctor she loved.

Now, she arrives ready for her appointments with a list of questions for her new physician, makes it clear to office staff she can only wait 30 minutes -- and in attempt to improve her access, gets friendly with the nurses and receptionists.

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