A delayed date with N.E.D. – but no news is good news

Before we left Johns Hopkins Hospital this morning I thought we might actually have some results to report today – but alas, it was not to be. The fellow who made up the CD of Robert’s brain MRI said that if we waited about 10 minutes, he could print out the report for us. Our wait was a lot longer – and then he came and said the doctor hadn’t signed off on the report yet. It was lunch time, and he didn’t want to keep us waiting.

Bummer! But even so, I came home without the anxiety I’ve been carrying around – despite the screw-ups that make me want to take back some of the good things I’ve said before about Hopkins.

At the outset, let me say that the people we dealt with today (including the guy who tried to get us the report) were wonderful, and we still haven’t run across an apathetic soul there. But the inefficiencies we came across this time, coupled with some questionable billing practices (see below), knock the place down a star in my book.

I’m not sure what happened with the scheduling – but Dr. Lipson and our study nurse, Susan Sartorius-Mergenthaler, attribute some of the problem to a new computer system that will be great when they get it working right. Our troubles started when Robert got a call yesterday reminding him that he had an appointment today at 6:30 a.m. Now, that’s not what Susan had told us! We got a little relief when the person from Nuclear Medicine called a little while later to say the appointment was at 7 and we needed to get there “a little beforehand.” We were up early and on our way by 5:45, arriving just on time. I’m very glad we didn’t arrive in Nuclear Medicine at 6:30 – there would have been no one there, and at least one of us would have been pretty grumpy about that ... (Note to Hopkins scheduling folks: When people have appointments very early in the morning, don’t tell them they need to arrive ½ hour before the department doing the test opens for business. Some people are punctual!)

The brain MRI was first, and all went smoothly there. It took a little longer than we thought it would, but even so, we were able to make our way back over to the Weinberg Cancer Center by 8 for the CT scan, which was scheduled for 8:10. Robert drank two cups of Crystal Lite laced with a contrast dye (better known as Hopkins Cool-Aid) and then went with the technician for the test. After it was done we headed for the area where blood is drawn and appointments with the oncologists take place. All was well, we were moving smoothly through the system as usual, and it looked like we could be home by noon.

That would have made a good story if the CT scanners had done the right test – but for some reason, they scanned the GI tract and lower body instead of the upper body. Dr. Lipson called his assistant at Sibley (one of two D.C.-area hospitals Hopkins has swallowed up of late) and arranged for the CT scan of Robert’s thorax to take place there on Thursday. We couldn’t schedule it for tomorrow, as Dr. Lipson asked – Robert goes to see his dermatologist in the morning, has a conference call at 2 p.m., and then we head back to Baltimore for dinner with our friend Eydie. We are absolutely certain our priorities are right! If you know Eydie, you know why ...

If Dr. Lipson had found anything amiss in his examination of Robert today, that might have come out differently – but he didn’t, and that’s where the “no news is good news” part comes in. In June, we will mark the one-year anniversary of Robert’s wide local excision. We made it past the six-month mark without a recurrence, and Dr. Lipson reiterated today that that was the first hurdle. If we make it past one year, that will be worth celebrating! With each milestone, the chance of recurrence is smaller. We’ll take them as they come, and I’m sure the world will look brighter with each one.

That doesn’t mean we let down our guard. Robert has his quarterly skin check tomorrow, and then we will have another appointment with Dr. Lipson (including scans) at Sibley in August. Robert feels fine, has plenty of energy, and shows no symptoms that cause Dr. Lipson to be concerned. So, I’m pretty positive about the whole thing.

Billing woes

In a February post about the health care finance system, I mentioned our positive experiences with Johns Hopkins and commended their “consolidated billing” system. Perhaps I was too quick to praise ... Since then I’ve had occasion to rethink that assessment.

Now I understand that Johns Hopkins Hospital assigns a new account number for every encounter a patient has there. This cannot be the best system!! Those bills come separately, and if you put the wrong account number on the check it might not get credited properly. That makes it difficult to pay several small bills with one check, particularly when using a bank’s automatic billpay system that limits the number of characters you can put in the memo field.

The consolidated billing system I wrote about is for the Johns Hopkins Clinical Practice Associates, which has its own inefficiencies. I’ve discovered, for example, that copays charged on the date of the visit don’t necessarily get credited against the right services, or even to the right account. It is possible to get it all straightened out by talking with someone on the phone ... but honestly, that should not be necessary. Patients should not need to create a spreadsheet to keep track of what’s been paid, by whom, and when in order to know what’s still owed when a bill comes in marked “delinquent.”

When I called to find out what was going on, the nice billing clerk I spoke with said she would open an investigation and send me a letter in a few weeks with the results. When the letter came, it only dealt with one of the three charges I had called about. I called again, and once again the clerk I spoke with was very pleasant to deal with. This time, I asked about each charge separately and was told no balance was owed on any of them.

I’ve gotten to be much more easy-going about these bills – I no longer take them so seriously. But it shouldn’t be an issue. Someone needs to shake whoever’s responsible, or smack ‘em upside the head. People who are dealing with health issues have enough to worry about. Sending threatening notices (even if it’s just a memo on the bill saying your account is “seriously overdue”) can’t possibly make it better.

Enough, now! I’ll post again when N.E.D. takes me to the dance – or before, if I have something else to say!