Is the system broken?

Before moving to Sisters in 2004, I researched the medical community in Central Oregon – doctors, clinics, hospitals, emergency services – and was encouraged that quality medical care would be readily available. And it was, in the beginning.

When I moved, I had just turned 60 and was not yet eligible for Medicare. My first job at hospice offered me excellent group health insurance coverage. I quickly established relationships with several medical practices where I found it easy to book timely appointments with doctors who spent time getting to know me and my medical conditions.

Prior to turning 65, I made sure I had established my medical team in preparation for going on Medicare, at a time when some practices were already limiting the number of patients they would see on Medicare. My internist was a gem! She was younger and I figured she’d be my doctor to the end. During COVID, she quit practicing. Now in my 70s, a new doc needed to be found, easier said than done.

Over my 20 years in Sisters, the medical environment in Central Oregon has undergone a disappointing decline, hugely impacted by the COVID epidemic. Gone are relaxed appointments involving meaningful conversations about “how I am doing.” Fifteen to 20 minutes max.

Timely appointments for immediate needs don’t exist anymore unless there happens to be a last-minute cancellation. Booking three, four, or more months out is the norm. More often than not, it is not the doctor who I see but the physician’s assistant. If I need to be seen right away, the standard directive is to go to urgent care.

During my Medicare annual wellness check I was told if I wanted to discuss anything other than what is on the checklist I would be charged for a second appointment. Given how difficult it is to get an appointment I figured as long as I was there, I would ask some questions. My bill reflected the second appointment charge.

I recently contracted COVID-19 while visiting in Portland, and the state of our broken healthcare system was made glaringly evident. After testing positive for COVID, I called my doctor’s office in Central Oregon to request a prescription for Paxlovid be sent to a Portland pharmacy. My very brief phone call never got beyond the person who answered the phone. I was informed the office didn’t do that anymore, and I would have to be seen in the office first (which made no sense to bring my COVID-positive self into the public) before I could receive a prescription. I had just seen the PA and had lab work done two months before. When I re-iterated that wasn’t possible because I was in Portland, the voice at the end stated dismissively, “Then go to urgent care.”

That wasn’t the first time I had been offered that advice by that office. It happened last winter when I was very sick (with what, I didn’t know) and couldn’t get an appointment. I did go to urgent care in Redmond, and tested positive for strain A of the flu which had me down for two months. Being seen in Sisters would have been easier.

Last week, I did find another of my doctors who immediately sent the prescription to Portland.

The following 24 hours were a nightmare of misinformation from the Portland pharmacy and my insurance company, and long holds on the phone with both. It was only because of my persistence and the friend with whom I was staying being willing to make several trips back to the pharmacy that I finally prevailed. Had I not made three separate phone calls to my insurance company until I reached someone who knew what they were talking about, I would have been on the hook for a $1,745.09 payment for Paxlovid.

Every time I run into these all too often recurring situations, I am thankful that I am familiar with the healthcare system and still have the cognitive ability to pursue the appropriate action. With large pharmacies and other bottom-line entities buying up medical practices and hospitals, healthcare is becoming about profit and not what’s best for the patient. This is a scary time to be an elder citizen with healthcare needs. I recently heard about a new physician who moved to Bend and was highly recommended. She doesn’t take Medicare patients.

In the news recently was word of The Center and St. Charles merging. Desert Orthopedics closed their doors. The earth is moving under our feet, and we are powerless to stop or redirect it. Our healthcare system is broken. What are our elected officials doing other than taking pot shots at each other?