More and Better

I just finished watching some very interesting reports from the front-lines of change in the health-care system in this country. In the PBS Report, a health-care provider system is trying out a radical new concept: Pay for Performance. There are many interesting issues here, but the most relevant point to the process I'm undergoing right now is this: all of the varied points of reform involve electronic records. I thought again about how much easier it would be for the Federal Government, as an employer, to screen me for the service if I could have electronic records sent. I can't even email documents. They do have a fax machine.

I spoke today with the NP at my MD's office. She seemed to find the MR nurse's attitude a bit aggressive. I've gotten accustomed to it, but she was unprepared for it. She did her best to clarify, to interpret the doctor's scrawling handwriting, and to smooth out some of the contradictory information involved. I think, however, that I am going to write my own statement, to clear up any confusion and underscore how little relevance this particular problem has for my Peace Corps service.

I have to remember that the screener is just doing her job. She has to be sure I'll be all right out there in wherever, however far from modern health care. If I can make her job easier this will go smoother.

Incremental Progress

My health-care providers have been so gracious throughout this process, filling out endless forms. I've spent about $600 and so far have been reimbursed about $45. Another, much larger, reimbursement check was mistakenly sent to my doctor, whom I had already paid in full myself. The check-processing company just got it wrong.

The medical forms are not well-designed for the purpose of eliciting the kind of information I've had to supply after the fact. The Peace Corps expects applicants to disclose everything, yet that is clearly a formidable demand when you've lived for 57 years. I found I'd overlooked a common chronic condition because it was stable for over 30 years, a more recent surgery that had been routine, issues that had been resolved and forgotten, and minor complaints that were treated without prescription medications. Re-examining the forms now, I can see why they were missed. I was focused on that which was explicitly requested, drawing in my mind the limits of what "everything" was much more strictly than was actually expected. It was not that I had any reason to hide or protect any of this information. I was merely in the habit of doing so, and habit involves the unconscious mind.

We who have been discreet and private about personal information for all of our lives are especially unprepared for how thoroughly we must "undress" for the medical review. As a former Information Architect, I believe that a lot of time and agony for volunteers and reviewers alike could be saved through a more intelligent design of these forms.

Will the Peace Corps put its medical records into a computer? It's very likely that Mr. Obama's determination to put this country's medical records into electronic form will impact Federal agencies like the Corps in the next few years. Let's hope that whoever takes on the responsibility for collecting applicant medical information will do a good job of designing these instruments.

Frustration

I got a call from the medical review office today. It seems the information sent to them by my doctors is not enough for them to decide whether and where I can serve. This process is dragging out to the point of excruciation (is that a word? if not, it should be)! So now I need to ask one of my health care providers to call the medical office and speak to the nurse. Actually, the nurse asked me to have the doctor’s office release the entire file to them, but I think that would mean faxing pages and pages. So I’m going to ask my doctor to call their office directly. I hope this is the right thing to do. I just want this phase of the application process to be OVER.

(This is for the “non-routine” part of the new information.)

Officially back in Medical Review

I have 2 more documents to provide to the medical review, one of which is pretty routine. The other is a little more worrisome, but still manageable. On Monday I see the doctor that I will beg to do the latter of the two. She is a very kind person and she will do it thoroughly and well. The routine bit I’ll take care of a day or two later. After that, if they are going to pass me, it will happen quickly. Since all my other hurdles are cleared, I could know as soon as the end of the week. I’m very hopeful now.

Update

Medical office called me this morning. My deferral is gone! I’m back on track, though I still have a few more documents to send them. It remains to be seen whether anything on those documents will result in another deferral or any denial or restrictions, but at least I’m in the running again.

Progress on this

I mailed the forms to Washington on Feb. 22. However, because the 60-day deadline was approaching and I hadn’t heard anything back, I called yesterday and spoke to the medical screener. She said they’d never received the pages and told me to fax them. She also said since she’d spoken to me, she’d consider my request for review to be filed. True to her word: this morning I was notified there was a change to my status. I’m back in the review process!

I have a few more medical forms to get to her, but things are back in motion. It’s nice to see that red exclamation point is no longer on my status page.