Trump the Bureaucracy

About 6 weeks ago I referred a patient of mine with a knee problem to an orthopedic surgeon in my group. He ended up seeing someone else in the same group about 3 1/2 weeks later, and the doctor prescribed a knee brace.

A few days ago my patient said his insurance company wanted me to do a new referral, because I had referred him to a different physician than the one he ended up seeing. Even worse, he still did not have the brace because they required his primary care physician (that’s me) to write them a letter saying the brace was necessary.

I did write a letter saying that I’m not qualified to say whether or not the brace is necessary, and that if they wouldn’t approve it, then their medical director should contact the orthopedic surgeon to explain why not.

Physicians have far better things to do with their time than waste it on unnecessary paperwork. If we could only channel our collective anger and frustration with the system, as Donald Trump has been doing in the realm of politics, maybe we could spend more of our time treating patients, rather than placating the government and insurance companies.

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old!

5 thoughts on “Trump the Bureaucracy”

  1. While I understand that this is a nuisance for physicians, this is a great chance to get ancillary staff involved in the process to minimize physician downtime. I created an interactive online form for Letters of Medical Necessity which is user-friendly and basically requires little to no physician involvement (except to sign the form which keeps them in the loop that the insurance company has requested such a letter and also allows them room to add additional comments above and beyond the fact that the item/s are medically necessary). Utilizing ancillary staff is a great way to take the pressure off of the doctor and empower staff to feel like they are part of the care process.

    1. I’d be interested in seeing your form. The problem, though, is that many times the ancillary staff can’t write down much of the information they need because they don’t know the answer. Even if they do, it ties them up so they are not available for other things. The amount of information requested is often ridiculous. If I’m prescribing a new diabetes medication, they often want to know every other diabetic medication tried, and that may be quite a few, the dates they were on it, and what happened with each medication. I’m not sure the staff feels empowered by such drudgery and I think the nursing staff often get burned out..

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