A man sits in an exam room. His appointment is with a specialist to help with his serious and chronic condition. After a few minutes a nurse walks into the room. The nurse asks him the standard list of intake questions and puts the information into a laptop. When she is finished, she leaves the room and tells the man she will be right back. Ten minutes later the nurse returns to the room.
Nurse: “Mr. Johnson, here is your prescription and an order for an MRI. You can schedule your MRI when you check out as well as another follow up visit in the next 6 weeks. Do you have any questions?”
The man is a bit confused and says, “Well yes. When am I going to see the doctor?”
Nurse: “Oh, you don’t see the doctor anymore. You see we found it to be much more efficient and profitable if we just put your information into our new care delivery algorithm. The computer will tell us what you need. But don’t worry, a doctor signs off on every chart. This is so much more efficient. Why yesterday one of our doctors signed off on over 25,000 charts in one day!”
Patient: “But wait. That means the doctor only spent about 1 second reviewing each chart before signing off.”
Nurse: “I didn’t say he “reviewed” the charts. I said he signed off on them. You see, this is much more efficient than spending the time to review the charts. But don’t worry, we have the utmost faith in the new computer algorithm.”
Patient: “So a computer is actually practicing medicine now and telling me what care I can get?”
Nurse: “Oh no. Of course not. That would expose us to liability. You can get whatever care you want. We are not limiting the care you can get. We are only telling you what our computer recommends. It’s up to you if you want to follow that recommendation or not. The other interesting thing is right after we got our new MRI and started making money on MRIs the computer started ordering them on every patient. It’s almost like the computer is programed to do what is good for our bottom line and not necessarily what the patient needs. You have a great day Mr. Johnson, and I will see you again in 6 weeks.”
So, I ask you, how is this different than what the payers are doing when denying care? I will tell you how it’s different. One is immoral and illegal and the other is just immoral.
