Home › Archive for Medical

Medical

The Real Reason Hospitals Lose Money on Denials

Posted on by

Hospitals don’t lose millions from denials because denials exist.
They lose millions because denial ownership is broken.

Most health systems unintentionally create these patterns:

  • Billing thinks denials are coding’s problem
  • Coding thinks denials are documentation’s problem
  • Documentation thinks denials are compliance’s problem
  • Compliance thinks denials are “payer games”

And leadership thinks the teams will magically figure it out together.

They don’t.

Denial management fails for three reasons:    

1️⃣  No defined owner per denial type
CO-16 isn’t the same as CO-18 or CO-197.
Yet most orgs treat “denials” as one bucket.

2️⃣  No cadence discipline
A denial touched every 14 days is a denial destined for aging.

3️⃣  No feedback loop

If coding errors don’t reach coders…
If eligibility errors don’t reach scheduling…
Denials repeat forever.

Denials aren’t a symptom.
They’re a report card.

And most organizations don’t want to look at the grade.

By Anoop Sivadasan

CEO, Wave Online 

 

Medical Leadership in 2026: What You’re Avoiding — and What You Must Build

Posted on by

By Michael Loschke, ARISTA Advisors | For Physicians, CEOs & Practice Administrators

The most pressing threat to your practice isn’t reimbursement cuts or staffing shortages. It’s leadership abdication — the quiet habit of avoiding the obligations that only you can fulfill.

The 3 Obligations Leaders Most Often Abdicate

  1. Defining and Defending Culture Most leaders leave culture to chance. When no one names the values, the team invents them — and rarely in ways that serve patients or performance. Culture is not an HR function. It is your most powerful retention tool, and it requires your voice. If you can’t easily and frequently witness the values on a daily basis, there is work to do.
  2. Having Honest Performance Conversations Physicians and administrators routinely tolerate underperformance, conflict avoidance masquerading as “keeping the peace.” We understand the fear and staffing shortage. Still, the cost is enormous: high performers disengage when mediocrity goes unchallenged. Direct, compassionate feedback is a leadership duty, not a personality trait.
  3. Casting a Compelling Vision Your team is burned out and underwater. They don’t just need a paycheck — they need to know why the work matters and where the practice is headed. Leaders who skip vision-setting leave their people in a fog of task-completion with no larger purpose to anchor them. Imagine endlessly hiking, not knowing the direction, purpose or if there’s a summit!

 

The Skills Leaders Must Build in 2026

  1. Psychological Safety Fluency Teams that feel safe to speak up make fewer errors and stay longer. Learning to model vulnerability and reward candor is now a clinical quality issue, not just a culture nicety. When members don’t feel safe, they sacrifice commitments, goals, and relationships on their way out the door.
  2. Adaptive Communication A Gen Z medical assistant and a Baby Boomer surgeon need different things from you. Leaders who can flex their communication style — across generations, roles, and stress levels — build cohesion where others build resentment. With five generations in the workforce, this requires NEW training, practice and commitment.
  3. Strategic Storytelling Data doesn’t inspire people. Stories do. The ability to translate your practice’s numbers, mission, and direction into a narrative that moves people is the difference between leaders who retain talent and those who constantly recruit it. This is NOT a natural skill set, especially for left-brained academics. It is essential in an increasingly crowded marketplace.

The practices that will thrive in 2026 won’t just be the most efficient — they’ll be the ones led by people willing to show up fully for the human side of leadership.

 

Michael Loschke is Chairman of Arista Advisors LLC.  He collaborates with CEOs and leadership to improve organizational health, executive performance and work/life balance.  Contact him for planning, speaking, diagnostic or coaching projects www.arista-advisors.com or michael@arista-advisors.com or 209-988-2000.

Why Full Profitability Remains Out of Reach for Most Healthcare-Related Organizations

Posted on by

In home health, hospice, and healthcare-related organizations, financial success is not determined solely by patient volume, quality of care, or clinical excellence. While these elements are essential, they do not guarantee profitability. The true determinant of sustainable financial performance lies in how effectively revenue is captured, managed, protected, and optimized across the entire Revenue Cycle

 Management (RCM) process.                                                           

This is where many organizations unknowingly fall short.

Despite best intentions and hardworking internal teams, significant revenue is often lost every single day due to inefficiencies, denials, underpayments, compliance gaps, and outdated revenue methodologies. According to the operational realities outlined in the Wave RCM for Management Home Health & Hospice framework, these losses are rarely obvious—and almost never self-correcting

Wave RCM for Management Home He…

Organizations that want to truly maximize profitability can do so by partnering with Wave Online Lines, a professional services organization dedicated to ensuring that no earned revenue is left behind.

 

 The Hidden Cost of an “Adequate” Revenue Cycle

Many organizations believe their revenue cycle is functioning adequately because claims are being submitted and payments are arriving. However, adequacy is not optimization. The difference between the two is often measured in hundreds of thousands of dollars annually.

Wave Online Lines specializes in identifying what internal teams and standard billing operations often miss:

  • Revenue leakage caused by workflow inefficiencies
  • Preventable claim denials and delayed reimbursements
  • Chronic underpayments from payers
  • Documentation and compliance gaps impacting cash flow
  • Ineffective follow-up and aging accounts receivable

Without expert intervention, these issues quietly compound. Leadership may never see them clearly, yet they steadily erode margins and restrict growth potential.

 

 Why You May Not Be Fully Realize Profits

The reality is simple and unavoidable: organizations cannot reap or realize all their profits without the use of a professional service.

Wave Online Lines does not offer generic advice or surface-level reviews. Their methodology is structured, data-driven, and purpose-built for healthcare revenue complexity—particularly in home health and hospice environments. Their services are designed to bring absolute clarity to the revenue cycle, transforming it from a reactive function into a strategic financial engine.

By applying proven RCM optimization strategies, Wave Online Lines enables organizations to:

  • Recover lost and underpaid revenue                                                         
  • Accelerate cash flow
  • Reduce denials and rework
  • Strengthen compliance and audit readiness
  • Improve operational efficiency without increasing overhead

This level of financial control is simply not achievable without specialized expertise.

 

 The Value of a No-Cost Revenue Cycle Analysis

To demonstrate both transparency and confidence in their approach, Wave Online Lines is offering a valuable no-cost analysis and evaluation of your current Revenue Cycle Management methodology. This offer is intentionally designed to remove barriers and allow leadership to see, firsthand, what is truly happening inside their revenue operations.

This analysis examines existing processes, payer interactions, workflow design, performance metrics, and compliance alignment. At the conclusion of the review, organizations receive a full, detailed written report for their personal evaluation.

This report clearly outlines:

  • Where revenue is being lost
  • Why those losses are occurring
  • The financial impact of current inefficiencies
  • Specific opportunities for improvement and recovery

For many organizations, this report becomes a financial turning point—revealing opportunities they never knew existed.

 

Insight That Changes Financial Outcomes

What makes this evaluation especially powerful is that it is not theoretical. It is grounded in real operational data and real payer behavior. Even organizations with experienced billing teams routinely discover that long-standing processes are unintentionally costing them significant revenue.

The insight provided through this no-cost analysis often pays for itself many times over—simply by revealing what must change to unlock trapped revenue.

 

Every Day of Delay Means Lost Revenue

Revenue leakage does not pause. It does not wait for strategic planning cycles or budget approvals. Every day that inefficiencies remain unaddressed, revenue is lost permanently.

This is why Wave Online Lines emphasizes urgency. The current no-cost analysis is a limited-time offer, and organizations are strongly encouraged to act immediately. Delaying action means continuing to lose revenue that rightfully belongs to your organization.

 

Contact August Trevino Today

To initiate this evaluation and secure your no-cost Revenue Cycle Management analysis, organizations should contact August Trevino who would work directly with your organizational leadership to begin the assessment process, explain findings, and ensure decision-makers fully understand both the risks of inaction and the financial upside of optimization.

 

Contact Information

August Trevino:

Availability is limited, and this offer will not remain open indefinitely.

 

 

The Bottom Line

Clinical excellence alone does not guarantee financial success. Organizations that fail to rigorously examine and optimize their Revenue Cycle Management will never fully realize their profit potential.

Wave Online Lines professional services are not optional—they are essential.

The choice is clear…

Healthcare Leaders Spotlights San Antonio-based MR3 Health

Posted on by

Over the years, one of the most gratifying aspects of our monthly networking events has been learning about new San Antonio-based companies and meeting the visionary entrepreneurs behind them. San Antonians are justly proud of our city’s reputation for innovation and leadership in the healthcare industry so occasionally we like to highlight and celebrate these companies. This month, we shine our spotlight on MR3 Health.

MR3 Health is an innovative remote patient monitoring company focused on preventing the costly and life-altering complications associated with the foot ulcers associated with diabetic neuropathy. And, as most of us are aware, both the San Antonio and South Texas population in general have an unusually high prevalence of diabetes. The company integrates advanced medical devices, daily monitoring protocols and clinical oversight to identify early physiologic changes before they can escalate into acute events.

The company’s flagship monitoring device, TempTouch™, was likewise developed here in San Antonio by a distinguished group of local clinicians and engineers. An FDA-cleared dermal thermometer, the efficacy of the device was clinically proven in the field in partnership with the Veterans Health System and additional researchers associated with the University of Texas at San Antonio Health Science Center. Results of the clinical trials were documented in three peer-reviewed journal articles available on the company’s website. The company possesses proprietary patient management software and maintains a number of strategic industry partnerships that position it, according to MR3 president, Stan Marrett, as a credible and scalable partner for podiatrists, physician practices and health systems.

Given the ongoing prevalence of diabetes, the toll in human suffering in terms of repeated surgeries and amputations, and the staggering medical costs, estimated to be in the billions, that could be prevented by preventive monitoring for the range of chronic conditions including, not only diabetes, but hypertension and COPD as well, MR3’s business model and mission align closely with national public health priorities.

Another example of a San Antonio company helping people while setting the pace for its competition.

Right Health Systems hosts DreamHealth: Community Health Fair

Posted on by

Right Health Systems is proud to host the upcoming Dreamhealth: Community Health Fair, a collaborative initiative created to improve access to quality healthcare resources while promoting education, prevention, and overall well-being within our community. Phoenix Management International is honored to support and promote the DreamHealth initiative, a cornerstone of the annual DreamWeek San Antonio Summit. This initiative unites healthcare providers, wellness advocates, local businesses, educational institutions, and community-focused organizations around a shared mission to expand access to essential health resources for individuals and families at every stage of life. By bringing services and support directly to the community, DreamHealth strengthens collective well-being, fosters meaningful collaboration, and advances long-term health equity throughout San Antonio and surrounding communities.

Event Details:
Date: January 24, 2026
Time: 12:00 NN – 4:00 PM
Location: San Antonio Botanical Gardens
555 Funston Pl. San Antonio, TX 78209

We invite you to come and join us for an afternoon of connection, education, and community empowerment as we work together to build healthier futures for all.

Add your support as a sponsor! Download the sponsor prospectus here. And then fill out the form to be a sponsor, or an exhibitor, here!

Right Health Systems, a 501(c), licensed health care system forged on the pillars of
Advocacy, Collaboration, and Education. EIN: 39-4092536
RIGHT HEALTH SYSTEMS:
MARQUEE COMMUNITY HEALTH FAIR
A Dreamhealth feature

 

 

Medical Funding for Service and Healthcare Providers.

Posted on by

12/2025 By August Trevino commercial strategist

Introduction:

Nature of Transaction: Funding is a debt (a loan), while factoring is considered the sale of an asset.

 Medical Receivable funding (MRF) is designed as a quick funding solution for service companies that bill healthcare providers directly. Examples would be staffing, transcription, hospice, supplies/devices, etc.

Medical factoring (MF) is designed as a quick funding solution for healthcare providers that bill insurance directly (Insurance Companies, Medicare/Medicaid, etc.). Examples would be physician medical practices, hospitals, rehabilitation centers, nursing / assisted living facilities, etc.

Let’s start with Medical Receivable Funding. (MRF) has emerged as a vital financial tool for service companies that bill healthcare providers directly. In industries where cash flow is often strained by delayed reimbursements, MRF offers a streamlined solution to bridge the gap between invoicing and payment.

The challenge of delayed working with payments for healthcare providers, including hospitals, clinics, and long-term  care facilities, is that they operate within complex reimbursement structures. Payments may be delayed due to insurance verification, compliance checks, or administrative bottlenecks. For service companies that support these providers, such delays can create significant financial stress. Payroll obligations, vendor payments, and operational expenses continue regardless of when invoices are settled. Without reliable cash flow, even well-established businesses can struggle to maintain stability.

MRF is designed to address this challenge by converting outstanding receivables into immediate cash. Instead of waiting weeks or months for healthcare providers to pay invoices, service companies can sell or finance their receivables through specialized funding firms. These firms advance a percentage of the invoice value—often within 24 to 48 hours—providing the company with quick liquidity. Once the healthcare provider pays the invoice, the funding firm collects repayment, deducts its fees, and remits any remaining balance to the service company. This process is similar to commercial factoring but tailored specifically to the healthcare ecosystem. By focusing on receivables tied to medical providers, MRF firms understand the unique payment cycles and compliance requirements of the industry.

The advantages of MRF are multifaceted:

  • Immediate Cash Flow: Companies gain access to funds quickly, ensuring they can cover payroll, purchase supplies, and manage day-to-day operations without disruption.
  • Operational Stability: Predictable funding allows businesses to plan growth strategies, expand services, and invest in new technologies.
  • Reduced Financial Stress: By eliminating the uncertainty of delayed payments, MRF helps companies focus on service delivery rather than collections.

This next section deals with medical factoring (MF).

Healthcare providers operate in a financial environment unlike most other industries. Physician practices, hospitals, rehabilitation centers, and nursing or assisted living facilities often deliver services upfront but must wait weeks—or even months—for reimbursement from insurance companies, Medicare, or Medicaid. This lag in payment can create significant cash flow challenges. Medical factoring (MF) has emerged as a practical solution, offering immediate liquidity by turning receivables into cash.

What Is Medical Factoring?

Medical factoring is a financial transaction in which healthcare providers sell their insurance receivables to a factoring company. Instead of waiting for insurers or government programs to process claims, providers receive a cash advance—often within 24 to 48 hours. The factoring company then collects the payment directly from the insurer when it becomes due. Importantly, this arrangement is not a loan. Funding through traditional debt instruments adds liabilities to the balance sheet, while factoring is considered the sale of an asset. This distinction makes MF an attractive option for providers seeking liquidity without incurring debt.

Why Healthcare Providers Use MF

Healthcare organizations face high operating costs, from payroll and medical supplies to rent and compliance expenses. Delayed reimbursements can disrupt operations, even for financially stable practices. Medical factoring addresses these challenges by:

  • Accelerating cash flow: Providers gain immediate access to funds tied up in insurance claims.
  • Avoiding debt obligations: Factoring does not involve interest payments or loan covenants.
  • Reducing administrative burden: Factoring companies often manage collections, freeing staff to focus on patient care.
  • Supporting growth: Reliable cash flow enables providers to expand services, hire staff, or invest in new equipment.

Who Benefits from Medical Factoring?

Medical factoring is particularly useful for organizations that bill insurance directly. Examples include:

Physician practices: Smaller clinics often struggle with reimbursement delays. Factoring ensures they can cover payroll and operating costs.

  • Hospitals: Large institutions face significant overhead. Factoring stabilizes cash flow during periods of high patient volume.
  • Rehabilitation centers: Extended treatment programs rely heavily on insurance payments. Factoring provides predictable funding.
  • Nursing and assisted living facilities: With ongoing care needs and high staffing costs, these organizations benefit from faster access to receivable funds.

How the Process Works

  1. Claim submission: The provider submits insurance claims as usual.
  2. Sale of receivables: The factoring company purchases the claims, typically advancing 70–90% of their value immediately.
  3. Collection: The factoring company collects payment from the insurer.
  4. Settlement: Once payment is received, the factoring company remits the remaining balance to the provider, minus a small fee.

Advantages and Considerations for these types of funding.

Medical factoring and funding offers clear advantages: speed, flexibility, and reduced financial stress. However, providers should carefully evaluate these companies. Fees vary, and transparency in contract terms is essential. As example disclosures, some companies alter the client that you are factoring and some companies will keep this confidential. While factoring improves cash flow, it does not increase reimbursement rates or eliminate systemic delays in insurance processing. It is always advised to seek advice from a professional with experience in this field.

 

August Trevino

FRACTIONAL EXECUTIVE

COMMERCIAL STRATEGIST 

Direct: ‪(210) 951-9268

e-Mail: au.ent9@gmail.com

Webpage: linkedin.com/in/acttoday

Navigating the Complexities of Medical Billing: Coding Errors and Medicare Denials

Posted on by

Medical billing remains one of the most persistent administrative challenges for physicians. Coding errors and the high rate of Medicare claims denials are among the top perennial issues—and both can significantly impact practice revenue and operational efficiency.

Coding errors, whether due to outdated codes, misinterpretation of clinical documentation, or simple clerical mistakes, are a leading cause of claim rejections. Due in no small part to the complex and changing nature of the code sets. The ICD-10  updates for FY2025, for example, included 252 new codes, 36 code deletions, and 13 code revisions. These changes, along with the similarly evolving CPT codes, require ongoing education and rigorous attention to detail. Even minor discrepancies—such as mismatched procedure and diagnosis codes—can trigger denials, delay payments, or invite audits.

The need for vigilance in billing and coding is nowhere more apparent than with Medicare, the largest payer in the U.S. healthcare system. According to recent data, average Medicare denial rates for physicians can range from 5% to 10%, depending on specialty and region. Common reasons include insufficient documentation, incorrect modifiers, and lack of medical necessity. These denials not only reduce cash flow but also increase administrative burden, as practices must invest time and resources into appeals and resubmissions.

The financial implications are substantial. Rejected claims can lead to lost revenue, especially if not corrected promptly. Moreover, repeated errors may flag a provider for compliance reviews, adding legal and reputational risks.

To mitigate these challenges, many practices are turning to third-party revenue cycle management companies, certified medical coders, automated billing software, and regular audits. However, even with these tools, the human element remains critical—accurate documentation and clear communication between clinical and billing teams are essential.

In an era of value-based care and tightening reimbursement models effective medical billing skills and solutions are indispensable to sustaining your practice.

 

Editor’s note: We discovered this Linkedin post by Anoop Silva, President of Wave Online, shortly after publishing article and wanted to add it as a postscript because it resonates so closely with the things we hear at our networking events, i.e. less than optimal documentation habits, poor modifier usage and workflow inconsistencies contribute greatly to revenue loss.

Strategies for Engaging Patients Who Self-Diagnose via the Internet

Posted on by

Author: ProAssurance

Time pressures1 and lack of patient trust2 are factors that can contribute to physician burnout. Patients who self-diagnose based on internet research combine these factors. Expecting self-diagnosing-patients to passively receive physician-delivered medical information will likely increase the frustration of both parties. Therefore, it can be more productive with these challenging patients to integrate their internet information into patient education.

This approach can improve clinical communication, strengthen the physician-patient partnership, increase patient satisfaction, and result in better outcomes. Time management strategies can help physicians keep discussions about internet content limited to the confines of the scheduled visit. When handled correctly, there is a silver lining to patient internet use.

Internet Websites for Patient Education

There are many websites that offer health advice and information. The Medical Library Association provides guidance on finding good health information. The websites listed below can get you started on your own recommendations for patients:

References

  1. Cory Pitre, et al. “Physician Time Management.” MedEdPORTAL, February 2018.
  2. James F. Sweeney. “The Eroding Trust Between Patients and Physicians.” Medical Economics, 4/10/2018.

 

Full Article Link: https://proassurance.com/knowledge-center/strategies-for-engaging-patients-who-self-diagnose-via-the-internet

 

Read more from ProAssurance: https://proassurance.com/knowledge-center

When Healing Others Becomes a Way to Avoid Ourselves: The Quiet Cost of High Performance in Healthcare

Posted on by

If you work in healthcare—whether you’re a nurse, a doctor, a manager, or someone who works with data—you carry a lot of responsibility. People count on you for their health, safety, and care. And you’re probably really good at handling that pressure.

You’re used to pushing through tough days. You solve problems, stay late, and make hard decisions. You always show up. That’s what makes you great at your job.

But there’s something many people in healthcare quietly struggle with: perfectionism. The pressure to always do everything right and never make mistakes might seem like a strength. But it can also lead to something more serious—emotional fragility.

When you believe your worth depends on your performance, it can be exhausting. You might start to wonder if you’re ever doing enough. Over time, this stress can build up, and you may feel disconnected from yourself and the people around you.

Research shows that perfectionism is linked to higher risks of mental health problems, including depression and suicide. This doesn’t mean perfectionism always leads to those things—but it does mean we need to be aware of how much pressure we’re putting on ourselves.

In healthcare, it’s easy to tie your value to things that can be measured: how quickly you care for patients, how many tasks you complete, and how good your reviews are. But things like connection, reflection, and rest don’t show up on charts or dashboards—and yet, they’re just as important.

So we keep working. One more patient. One more meeting. One more emergency. And slowly, we lose touch with the things that bring us peace, joy, and meaning.

That’s when the real cost shows up.

We become leaders who are respected but feel alone. Healthcare workers who are great at their jobs but drained. Parents or partners who are present, but distant. We care for everyone else but forget to care for ourselves. I know this because I have been there: carrying work performance stress to my kids or not being present in meetings because I feel like I am failing at managing my house.

But here’s the truth: your value isn’t in how well you do things. It’s in who you already are.

To live a life that’s not just sustainable—but also satisfying—we need more than hard work and success. We need emotional resilience: the ability to stay grounded, connected, and strong even when life gets hard. Really, the key to emotional resilience is the ability to accept grace.

Moving from emotional fragility to emotional resilience is the key to staying well in a demanding field like healthcare. It helps you stay present in your relationships, enjoy your work more, and remember why you chose this path in the first place.

Want to know where you stand? Take our free Emotional Fragility Quiz—a simple way to check in with yourself and start building more resilience in your life.

👉 [Take the free quiz now]

You don’t have to carry everything alone. And you don’t have to be perfect to be enough.

by Dr. Uejin Kim, MD

www.uejinkim.com

 

O’Connor, R. C. (2010). The relations between perfectionism and suicidality: A systematic review. Suicide and Life‑Threatening Behavior, 37(6), 698–714. https://doi.org/10.1521/suli.2007.37.6.698 Wiley Online LibraryUniversity of Stirling

Smith, M. M., Sherry, S. B., Chen, S., Saklofske, D. H., Mushquash, C., Flett, G. L., & Hewitt, P. L. (2017). The perniciousness of perfectionism: A meta‑analytic review of the perfectionism–suicide relationship. Journal of Personality. Advance online publication. https://doi.org/10.1111/jopy.12333 ray.yorksj.ac.ukPubMed

Hewitt, P. L., Flett, G. L., & Turnbull‑Donovan, W. (1992). Perfectionism and suicide potential. Journal of Abnormal Psychology, 101(4), 602–607. (Note: Publication details match findings; but source indicates the study on psychiatric patients) PubMed

Authors, (Year). Perfectionism, prospective near‑term suicidal thoughts and behaviors: The mediation of fear of humiliation and suicide crisis syndrome. International Journal of Environmental Research and Public Health, 17(4), Article 1424. https://doi.org/10.3390/ijerph17041424 PubMedMDPI

Etherson, M. E., Smith, M. M., Hill, A. P., Sherry, S. B., Curran, T., Flett, G. L., & Hewitt, P. L. (2024). Perfectionism, feelings of not mattering, and suicide ideation: An integrated test of the Perfectionism Social Disconnection Model and the Existential Model of Perfectionism. Journal of Psychoeducational Assessment, 42(6), 725–742. https://doi.org/10.1177/07342829241237421 SAGE Journalsray.yorksj.ac.uk

 

Healthcare As We Once Knew it is Dead

Posted on by

The healthcare landscape has changed over the last 20-25 years.  Primary care physicians used to manage overall patient care, coordinating with specialists for care that was outside their training and expertise.  Now, it seems that the primary care physician sees the patient a few times a year and might even request labs or perform a well-exam.  These exams have been greatly watered down over the years due to government red tape, ill advice from the U.S Preventive Services Task Force and declining reimbursement.  What used to be a true 40-minute history and physical has become a 10-to-15-minute checklist of things that the patient’s insurance company will likely reimburse the physician for providing.  The list of what won’t be done is longer than the list of things that will be done.  For specialty care, I notice that patients are increasingly arranging for care on their own, which often leaves the primary care physician out of the loop.

Primary care physicians used to have a trusted network of specialists to whom they could refer for evaluation and management of concerns outside of the primary care physician’s scope of practice.  A simple phone call once served as an introductory transfer of the patient from primary to specialty care.  Progress notes and polite thank you notes followed upon returning the patient to the primary care setting.  Today, insurance regulations and paperwork have become the primary focus, while the actual diagnosis and treatment of the condition(s) have become a distant secondary focus.  Medicare starts something and commercial insurers follow their lead, whether the policy is beneficial or harmful to their beneficiaries.

Referrals can be difficult to obtain, even for large academic medical centers.  In certain instances, the return of the patient to the primary care setting is delayed or halted altogether, with the specialist’s employer or accountable care organization assuming the role of the primary care physician.  Communication between offices has become something of a nightmare due to absent consultation notes in the patient’s chart.  In years past, referrals could be arranged quickly and easily.  The tides have changed over the last 20-25 years, with referrals becoming increasingly more difficult to obtain.  Due to insurance participation/non-participation, arranging referrals may take quite a while, and the patient’s condition might have worsened during the waiting period.

It is the author’s belief that the healthcare system is still recovering from the COVID-19 pandemic.  Preventive care was delayed to re-focus on the medically complex.  Patients who were not taking an active role in their care are now of higher acuity and require more resources to return to a more optimal state of functioning.  Referrals to specialists in large healthcare systems are still being impacted to due continued care for those medically complex patients who never fully recovered during the pandemic.

Referrals can be hard to come by, even in large cities with more than one major healthcare system.  Timeframes to obtain referrals varied for the author: 2 weeks for urology; 2 months for otolaryngology; 4-6 months for pulmonary evaluation after 1 round of COVID-19 and three rounds of pneumonia; 9-12 months for cardiology; and 24-36 months for a routine colonoscopy with gastroenterology.  For three of the above referral requests, the author was told there just weren’t enough good providers in San Antonio to see all the patients.  That waters down the prospects of finding a great provider to treat one’s medical conditions.

Is this the best we can do?  Is the status quo good enough?  While I share the same sentiment as my cardiologist and pulmonologist, “Healthcare as we once knew it is dead,” I say that we can do better, and the status quo isn’t something we should brag about.  While I’m grateful for the providers on my care team, I am disappointed that the healthcare system has changed for the worse.  I see patients being treated like numbers rather than human beings, band-aids being applied until the next care episode arrives, less emphasis on preventive care and fewer people taking part in their own care plans.  Will healthcare return to the glory days of 20-25 years ago?  Probably not.  However, I believe that if enough patients and providers start protesting the state of the current system, we could return to a better state within the next 5-7 years.

By Scott J. Grandjean, LFACHE