Barb, a hospital administrator, was thinking about the work her staff does day in and day out with our broken health care system. She told us a story based on those thoughts. Her story is a parable of sorts, describing what it would be like if a business outside of health care treated its customers the way patients are treated when they see their physicians. The story goes something like this…
Joe hears a noise from his car and decides he better have a mechanic look at it. So Joe calls Bill’s Auto, a nearby auto repair business. Bill’s Auto is Joe’s designated “Primary Care Mechanic” (PCM). Joe gets a busy signal when he first calls. So, he tries again on his lunch break, but he can’t get through because the phones at his PCM are turned off. Joe doesn’t leave a message, because he knows it can take days to get someone to call him back from any auto shop, not just his PCM.
After several tries, somebody at Bill’s Auto answers the phone, and Joe schedules an appointment a couple of days out. Joe worries if the problem is serious that he could get stranded while waiting for an appointment.
When Joe arrives for his appointment, the harried receptionist tells him that the mechanic will see him but is running “a little” late, then hands him a stack of paperwork to fill out. While Joe writes down his name and address, he wonders why they need that information again since Bill’s Auto has been his PCM for years. The papers ask him to explain the problem in detail (but isn’t that why he’s here?), and requires that he provide payment details, all before he is told what the problem is and what it might cost to have it fixed.
Joe sits in the waiting room for 30 minutes, worrying when he can get back to work. Then he’s called into a service bay where he is asked to wait for his mechanic who, he is told, will “be with you shortly.” The service bay is closed off and he waits beside his car for another 10 minutes before his mechanic joins him.
After a three-minute interview, Bill’s mechanic tells him that he needs to be seen by a Mufflerologist (a muffler specialist), so the mechanic will refer him to one he’s worked with a lot. Joe leaves Bill’s shop with his car and a small note on which the mechanic has scribbled the name and telephone number of Sam’s Muffler. Joe is told that someone from Sam’s muffler will call him.
A week later Joe hasn’t received a call from Sam’s Muffler. So Joe calls, and Sam’s tells him that they did not receive a referral from Fourth Union Bank, which is Joe’s bank. Joe wonders why his bank is involved now – he thought this was between his PCM and his new Mufflerologist. Joe calls his PCM and (after several tries, of course!) talks to a referral coordinator at Bill’s Auto whom he has never met. The referral coordinator tells Joe that his bank has to approve the referral for his suspected broken muffler in advance. But even with that approval, they may not pay to the Mufflerologist and he still has ultimate financial responsibility for the costs.
Now a full two weeks after Joe first saw his PCM he calls Sam’s Muffler to schedule an appointment. They tell him that the Mufflerologist typically doesn’t deal with people who bank at Fourth Union Bank, but as a favor to Bill’s Auto, they will see Joe’s car. Joe wonders who’s doing who a favor. When Joe gets to Sam’s for his appointment he waits for an hour, again filling out forms that describe the problem he’s having with his car. The forms also ask him for every problem he has ever had with his car and when it happened. Then Joe is seen by an assistant to the Mufflerologist who asks him all the questions that were on the forms. Joe finally sees the Mufflerologist, who asks him the same questions again.
Later…
Now four weeks after his first visit to Bill’s Auto with muffler problems, Joe leaves Sam’s Muffler with a new muffler. Then the problems begin!
About a month later, Joe receives a bill from Sam’s Muffler. The cost seems high; much higher than he had expected. Joe notices that Sam’s Mufflers lists a “base price” that is three times the “negotiated” rate he is asked to pay. Reading further, he sees that the discount doesn’t apply to Joe specifically, but to people who bank with Fourth Union Bank. He wonders why? Confused, Joe pays the discounted invoice.
Two weeks later, Joe receives a separate bill for the muffler itself from Sam’s Durable Muffler Equipment Supply. Now Joe is upset! He thought the muffler would be covered by the first invoice – it certainly looked like enough to pay for a whole new engine! As with the first invoice, he had to pay a lot, but it was a fraction of what was listed as the “base price” because he is a Fourth Union Bank customer.
A week later, Joe receives yet another invoice, this one from the Mufflerologist who actually worked on Joe’s car. He notices that there is no discount on this invoice. Reading the fine print, the invoice explains that the Mufflerologist was not certified by Fourth Union Bank, so no discount applies. Now Joe is really mad. He calls Sam’s Mufflers but can’t get through – it was lunch time and the phones were turned off.
Posted by akassam 
