Recently, the 375th Medical Group leadership received some information about wait times for specialty care appointments. As our beneficiaries know, they receive the majority of their primary care, consisting of family practice, pediatrics, and internal medicine within clinics located in our building.
We do offer some specialty care with our physical therapy, optometry, dermatology and women’s health clinics. Should any of our patients require some sort of specialty care not available within our medical group, we have a robust private care network of providers and hospitals located within 30 minutes or so of our medical group available to care for you and your loved ones.
In order to visit one of our specialty care providers, the first step is to book an appointment with your primary care provider. During that appointment, the provider and patient determine what specialty care is needed.
The PCP will enter a referral for the patient with details about what specialty care is required, and our patient will be notified within a few days of the approval and given provider information to make the appointment.
If our patient prefers a provider other than the referred provider, he may call Humana to have it changed or visit the referral management office at the clinic to get assistance with changing it.
Our medical facility is required to have a network of providers that can provide the necessary specialty medical care to our patients within 28 days, a standard imposed across the entire Department of Defense Military Medical System.
However, there are some specialties in our network that can’t meet that 28-day requirement, and after reviewing this data, leadership looked into why this was happening with the intent to improve it.
Currently, our network consists of 45 medical specialty providers and facilities. After looking at our most recent data, we found that we were not meeting the 28-day requirement in four specialty care areas: dermatology, gastroenterology, orthopedic surgery, and physical therapy. We were close to going over the 28-day requirement in a few other specialties, such as cardiology and pulmonology, but we weren’t outside the timeframe.
After looking at the data to figure out what could be done, leadership set up a meeting with our managed care support contractor, Humana, to see if we could add more specialty care providers to our network to help lower the wait times for getting specialty care appointments.
Likewise, our group commander, Chief Medical Officer, and Medical Operations Squadron commander had been talking with civilian medical institution leaders to see if we can partner in bringing in more specialty care providers.
However, we also noticed another trend as to why we were going over our 28-day requirement: patient choice. As our patient, you are entitled to speak up and take a leading role in your healthcare decision-making. Our medical staff welcome your input. But one of the driving factors in our longer wait times is that many of our patients prefer to stay on this side of the river rather than heading into St. Louis. This is a challenging barrier to care to overcome.
So in most of our the cases in which we were not meeting our 28-day timeframe, it was because our patients had chosen to wait longer to visit a provider that was closer to base rather than drive into St. Louis.
That’s OK as long as patients know that they can get care sooner if they drive to St. Louis, and it is documented that the patient made this choice. However, many patients do not understand this process and still wonder why they can’t get care sooner.
We are extremely fortunate to be located so near a city like St. Louis where many world-class health organizations exist. For example, I received my approval to make an orthopedic surgeon appointment after seeing my PCP.
After I received the approval in just three days, I made the phone call and received an appointment within the week. (Remember I mentioned earlier that orthopedic surgery was one of the areas in which we were going over the required timeframe. In this case, patients were waiting an average of 55 days to make appointments by choosing to not drive to St. Louis.)
My appointment was with an orthopedic practice associated with Washington University, and my particular doctor was also the doctor that took care of the St. Louis Blues hockey players. The only catch—I had to drive across the river rather than wait more than 28 days for an appointment with a provider that was closer to base.
Patient choice is important to us, and the 375th Medical Group wants to provide the best care possible to our patients. And if our patients choose to stay closer to home, then we will of course honor your choices in providing your care.
We just wanted all of you to know that we offer, and continue to build, one of the best networks of healthcare providers available in the United States. Thank you for allowing us the honor of providing care to you and your families.