What Is The Waffle House Theory Of Patient Experience: IDD?

Sometimes these little blogs write themselves.

Let me begin by explaining the Waffle House Theory of Patient Experience, and by telling you what the acronym IDD stands for.

The Waffle House Theory of patient experience is as follows. If the Waffle House where you live is open, there is a zero percent probability that your provider’s or payer’s call center will solve your problem. You see, the cool thing about Waffle Houses is that they are the restaurant industry’s equivalent of nature’s cockroaches—no, I am not saying that they have cockroaches. I am simply pointing out that neither rain nor sleet nor snow will prevent them from being open. So, if they remain open, no matter what, your chances of having your needs met by calling your provider or payer are zero.

(I’ve even thought that if healthcare firms changed their recorded message to, “Thank you for calling Comcast, that message might help to level-set their caller’s expectations as to what type of experience they should expect.)

IDD stands for Inattention Deficit Disorder. I think IDD is a deliberate collaboration between providers and payers to not meet the needs of patients, members, and consumers. Its premise is simple—if we do not acknowledge that a problem exists, how can we be expected to solve it?

Last week I was speaking with an executive vice president of a large payer. As a courtesy, he asked me not to mention his name because he was trying to protect the guilty party, namely his firm.

The situation is the following. His wife had been treated at a large health system. The names of the system, and the name of the payer, are not important. They are not important because you can substitute different providers and payers and it would not change the discussion.

She received a letter from her provider stating that her reimbursement claim for several thousand dollars had been denied. Two sentences. One dollar amount. Zero explanation. She started calling.

Dialing for dollars.

She called the provider. She called the payer. She asked for an itemization of the denied amount. Eleven total calls. “You have to request an itemized copy of your bill.”

“That is exactly what I am doing,” she told the person. (It does not matter whether she told a provider’s employee or a payer’s employee; knowing which it was would not affect the outcome.)

“I can’t give you that information. You have to send us a letter; something with a stamp on it. And you have to prove you are you.”

“But, I am me. I am the person to whom you are speaking.”

So, back to my conversation with the EVP about this flawed process. “Is there anything you’ve seen that can make this process better?” He asked.

“There are two possible solutions,” I said. “One of them requires that your wife likes to sing.”

“She’s in the church choir,” he replied.

“Well then, since it looks like she will be spending way more time than she wants being placed on hold as she tries to solve her problem, I find it helpful to find an activity that she enjoys to occupy those long periods of inactivity. If she likes musicals, I would recommend that she use all of her time on hold to learn each of the roles of Les Misérables. That is what I do.” (In case you are interested, I will be presenting a one-man performance of Les Misérables this summer at the National Theater in Washington, D.C.)

The EVP did not sound too keen on my first idea. “Well,” I said. “There is another way to solve the problem, and this way works one hundred percent of the time. Tell her to stop calling. Tell her not to reply to any of their emails, and if she receives any letters from either firm, just tell her to throw them away.”

“But we probably owe them money,” he said.

“I’m not suggesting that you do not pay the bill. I am only suggesting that you quit working hard trying to figure out what it is for and how much of it you actually owe. After a few months, she won’t have to call any more. They will call her. And when they call, they will be very helpful. The whole idea is for you to put the monkey on their back. Get things to the point where their whole focus is on convincing you to send them money. You’ll be surprised by how helpful they will be when they initiate the call.”

Dialing for Dollars: Part Deux.

The CEO of a large health system calls to schedule an appointment for himself. He does not know that his health system implemented the Waffle House Theory of Patient Experience in 1947.

He was unable to schedule an appointment.

Pshaw, you are thinking. (Apparently, pshaw is actually a word.)

Many of you are probably thinking that his health system is an anomaly. Once again, my response is pshaw. When you finish reading, call your health system and pretend that you want to schedule an appointment. By the thirty-minute mark of your call you will be screaming epitaphs into your phone—Sic (intentional error).

IDD—Inattention Deficit Disorder. It could also stand for Intentional Deficit Disorder.

If we do not know there is a problem, how can we be expected to fix it?

Well, now you know. Payers and providers make it very difficult for patients and members and consumers to meet their needs. Either they do not know that the problem exists. Or they know it exists, and they just don’t care.

You and I care.

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