Charged to Medicare: how much is too much?

Editor's note: Royce Haiman is a freelance writer and former reporter for The St. Petersburg Times. When she told me this story at a social gathering, I suggested she write about it. The entire country—and certainly Baylor University Medical Center—are working now to both avoid wasteful health care spending and increase customer satisfaction. Although the story occurred in Florida, it could easily have occurred anywhere, and health care professionals can learn from a patient's perspective. I t was just a tiny spot on my leg, but the dermatologist said it should come out soon—and he was booked for the month. So he called a plastic surgeon who was able to work me in right away—and whose specialty, we both knew, would result in a smaller scar. That, of course, appealed to the vanity in me. I had had some shoulder tissue removed years ago by a plastic surgeon, and I recalled it as a relatively simple office procedure. But this plastic surgeon said his preference was to remove the tissue in the hospital where a pathologist was standing by to determine, immediately upon removal, if sufficient margins had been taken, obviating the need for a return visit if more tissue needed to come out. I protested that I didn't want to go through conventional prehospital testing and was assured that such preliminaries were unnecessary. I was to show up at 11:30, sign some papers in " admitting , " and the brief procedure would get under way about an hour later. " No need to have anyone accompany you—just drive yourself because all you'll need is a 'local.' " I figured I could swing into a favorite, nearby seafood spot for a delayed lunch on the way home—about 1:00. Wrong. I showed up at 11:30, but admitting didn't get around to admitting me to the clerk's desk until 45 minutes later. Then the deluge of papers—and questions—began. What was my highest level of education? My religious preference? Did I want a chaplain to speak to me? " No, " I said, " I'm not in extremis—just here to have a tiny little spot removed from my leg. Please—I'm due to see the surgeon in 10 minutes. " But we still had miles to go—copying insurance cards, filling out forms on my medical history, signing privacy notices, etc. The clerk printed out a white plastic bracelet with my name and birth …