Inpatient Workups Would Reduce Patient Anxiety, Save Time, and Maybe Even Save Money
On Veterans Day, I published a 2017 piece about the no longer common or even existing inpatient workup. I often think about how efficient it would be if we went back to doing them again. If we could do the necessary tests to diagnose or rule out cancer and other serious diseases in one or two days at a dedicated diagnostic center, healthcare would be a lot more efficient.
Not only would patients get their diagnosis quicker, but equipment like MRI and CT scanners could be used more efficiently - scheduled tighter- when patients are right there, already registered and on site. Both imaging and labwork could have more reflex testing - if the result of test A is x, then also run test B.
Compare this to today’s multiple steps, with wait times in between: First the patient has the less expensive ultrasound. Then the overworked primary care doctor, who is seeing patients all day long, eventually sees the result and orders a CT scan. Then there is the wait for a Prior Auth, then the wait for an appointment, followed by the same steps again before am MRCP reveals a pancreatic mass, suspicious for cancer. Then there is the referral to gastroenterology for tissue diagnosis via an ERCP.
Inpatient workups could virtually eliminate Prior Authorizations at the Primary Care level. The doctors overseeing such centers could have direct access to the insurance companies’ algorithms. The insurance companies could then eliminate many of the clerical staff that listens to or reads outpatient doctors pleading their cases for getting imaging tests approved, just like the primary care offices could get by with less clerical staff working the prior authorizations.
And just think about how much a system like this would reduce patient anxiety by shaving many weeks off the time to diagnosis. In some cases, this could also affect clinical outcomes by avoiding the inhumane bureaucratic delays we now have to deal with. I have seen too many times how patients end up in the emergency room with advancing symptoms while waiting for the imaging I ordered for them.