Wait wait... Don't tell me!
How wait times for help have only gotten worse and what to do about it
Every weekend, while running errands or heading back and forth from some kid activity, inevitably I hear the brilliant show 'Wait Wait... Don't Tell Me!' on NPR. This jewel, a rare blend of news, humor, and trivia, always sucks me in with its lighthearted mockery and insightful commentary on current events. Peter Sagal and Bill Curtis (and who can forget Carl Kasell) are such charismatic hosts who bring on an always entertaining panel of comedians, journalists, and celebrities, to take the week's headlines and turn them into a playful battleground of quips and quizzes. Despite the seriousness of of all that’s happening in the world, it’s nice to take a moment and find humor.
While we sometimes need a second to find the answer to a question, hence the name of the show, there’s one place we shouldn’t have to wait for help, and that’s with our health. Sadly, wait times, a proverbial canary in the coal mine for many facets of our health care system, are continuing to get worse. A recent Merritt Hawkins report reveals that, as of 2022, new patients face a 26-day wait for medical appointments, marking an 8 percent increase since 2017 and a 24 percent rise since 2004, indicating the longest wait times ever in the 15 largest U.S. metropolitan areas. Never mind how long we have to wait once we are actually in the exam room - that’s a whole other problem!
This escalating issue of prolonged wait times not only signifies a system under strain but also sheds light on a deeper, more systemic problem - the uneven distribution of health care resources. And sadly, this problem only makes exacerbates disparities in underserved communities who often face the longest waits.
We know the power of relationships, often found in the comforting consistency of continuity where care is delivered by the clinician we know and who knows us. This, in fact, is a cornerstone of essential health care services like primary care, and is the secret ingredient in other professions like mental health. What do we do when faced with longer wait times? Sometimes we accept the first available appointment even if that’s with someone we don’t know; sometimes we go out of network because there are simply no providers in network who can see us (and this is much worse for mental health!).
For some time now, health care has grappled with the declining continuity of medical care, a trend exacerbated by many things including increased demand and a shortage and maldistribution of primary care physicians. This erosion of continuity, has been linked directly to increased emergency department use, hospitalizations, and costs, while reducing satisfaction by all parties involved. Continuity involves more than just physician handoffs; it encompasses patient values, family involvement, and trust, which are not always captured in medical records or communicated during handoffs. And when it’s working? Well, it helps improve outcomes and lower health care costs.
Unfortunately lack of continuity is another trend emerging alongside our increased wait times. Whatever our situation, it appears that the loss of continuity and longer waiting times has become our default in health care, and is often even worse in mental health. So some of us just stop seeking care when it’s not available when we need it, which has all kinds of bad outcomes associated with it.
For example, research has show how postponing care is not just a minor inconvenience on our ever busy schedules but increases morbidity and mortality, especially for those with underlying health conditions. With life expectancy on the decline, putting off much needed care due to a variety of factors, which often include affordability and availability, isn’t going to help reverse this trend.
The irony is stark – in an age where information is at our fingertips instantly, many are left waiting for what is most vital: timely and effective care. This seems like one of the most significant issues of our time.
In an interesting move that could help push along some of this log jam in health care, the Biden-Harris Administration, through CMS, has unleashed a final rule aimed at transforming the notoriously sluggish and bureaucratic prior authorization process. As most of us know all too well, prior authorizations are procedures where a health care provider must obtain approval from a patient's insurance company before delivering a specific service, treatment, or medication to ensure that work will be covered.
This rule change, which is part of a larger agenda to enhance health data exchange and access to care, mandates a swifter, more streamlined method for health care providers to gain necessary approvals for patient treatments. If you have ever languished waiting on a follow up appointment, chances are a significant piece of it may have been the health insurance prior authorization process.
By enforcing tighter deadlines on health plans, and integrating interoperability technology, this rule promises to cut wait times for urgent medical procedures, empower clinicians with more direct care time, and potentially save somewhere around $15 billion over a decade. It's a pretty big step towards dismantling the red-tape-laden labyrinth that has long plagued both patients and providers, hopefully pushing us towards more efficiency and patient empowerment in health care.
While it’s a positive move, there’s a lot more we need to do to help address the wait time issue. Consider the perennial promise of integrating mental health into primary care. When mental health is onsite, one has the ability to have seamless access to a clinician who can help; when it’s not? You have to wait however long it takes to get your mental health appointment, which can be weeks for some, months for others. Wait times are plaguing us in the mental health space, and integration is one way to begin to address that issue in one setting assuming of course you can get into your primary care practice!
Integration also got some love this week from the Administration. The Centers for Medicare & Medicaid Services unveiled the Innovation in Behavioral Health (IBH) Model, an initiative aimed at enhancing care quality for Medicaid and Medicare recipients grappling with severe mental health issues and substance use disorders (SUD). Central to their proposed model is the integration of mental and physical health care, primarily facilitated by community-based mental health practices. The model is distinct in that it’s a state-led approach, seeking alignment in Medicaid and Medicare payments for comprehensive, integrated services.
This is a pretty big deal.
Participating practices, encompassing a range of community mental health and SUD treatment facilities, will play a pivotal role in coordinating an extensive care spectrum, addressing both health and critical social needs like housing and transportation. The IBH Model is underpinned by a value-based care framework, where compensation aligns with patient outcomes and quality of care. This plan also emphasizes health equity, mandating the creation of Health Equity Plans to tackle disparities in care. This eight-year program, set to commence in Fall 2024, marks a significant stride towards more mental health and primary care integration.
All this progress, it’s still impossible to solve our problems around wait times if we don’t do three things at once:
Invest more deeply in prevention (upstream, please!)
Create a new workforce that exists outside of clinic walls who can be deployed to address needs a lot quicker
Integrate as many services together as possible to allow for more comprehensive care to be delivered without a disruption of continuity
As we tune into the witty banter and insightful humor of "Wait Wait... Don't Tell Me!" each weekend, it's a reminder of how seamless and immediate joy can be in our lives. Yet, in the realm of health care, we are starkly reminded of the frustrating delays and fragmented services that too many face. The recent initiatives by the Biden-Harris Administration, aimed at transforming the cumbersome prior authorization process and integrating mental and physical health care, herald a hopeful shift towards a more efficient system. These changes, while crucial steps forward, remind us of the ongoing journey towards a future where the immediacy and continuity of care are not luxuries, but the norm - the standard for all. Imagine a future where no one has to wait for vital care, mirroring the instant connection we feel with our favorite radio show, but this time, in the context of our health and well-being.