Regis, I'd Like to Phone a Friend
Written by: Dr. Michael Weiss

The next thing I remember, I was sitting in a television studio. There was an audience behind me and nine other contestants beside me. I recognized some of them from medical school.

"Hey," I said to my former classmates. "Did you skip the class on surviving managed care, too?"

Directly in front of me, there was a keypad with buttons marked A, B, C and D. As I reached for the keypad, the producer yelled through a megaphone, "For the last time, Mr. Weiss, stop playing with the buttons. You’re annoying the other contestants."

Just then, a spotlight illuminated the stage, and Regis Philbin emerged from a shadow.

"Welcome to ’Who Wants to be a Health-Care Millionaire?’" he said. "Tonight, these contestants will compete for a chance to win one million dollars and the privilege of never being at the mercy of an HMO again. You know the rules, so let’s get started with the fastest-finger competition."

I leaned forward in my seat.

"O.K., contestants," Regis said. "Here’s the question. Using the corresponding letters on your keypads, put these four ICD-9 codes in order of least confusing to most confusing, starting right now."

As I looked at the responses on the screen in front of me, I couldn’t believe my good luck. All the codes were related to orthopedic conditions. I knew them well because they had confused me for years!

I glanced at the other contestants. The ophthalmologists and cardiologists were stymied. The CFOs were frantically paging their reimbursement people. The CEOs were telling the CFOs to page faster, and the I.T. guy was trying to hack into the HCFA database but couldn’t. Slow Internet connection.

I glanced back at my keyboard and confidently punched in D, C, B and A, finishing just as the buzzer went off.

"Time’s up," Regis said. "Let’s see who got the correct response in the fastest time. The order we’re looking for is D, C, B, A. Computer, show us who won."

I closed my eyes and crossed my fingers.

"Mike Weiss," he said. "Do you want to be a health-care millionaire?"

"You bet!" I shouted as the audience cheered. I jumped out of my seat, hugged Regis, then followed him to center stage, where I climbed onto the tall seat across from his.

"OK, Mike," he said. "You know the rules. The more questions you answer right, the more money you’ll win and the less you’ll have to listen to HMOs. You have three lifelines to help you — poll the audience, 50-50 or phone a friend — and you can stop any time. Are you ready to play?"

"I’ve been ready ever since managed-care companies started messing with my reimbursement, Reege," I said.

"OK then," said Regis. "Here’s your first question: In the Pittsburgh health-care market, which insurance company is generally known as the 900-pound gorilla? Is it . .."

"Reege, you don’t have to bother reading the list because I know this answer: The 900-pound gorilla is B. Highmark."

"This is a little unconventional, Mike. Usually, contestants let me finish talking because, after all, I am the host. But you seem pretty confident so we’ll take that as your final answer. Computer, show us if Mr. Weiss is right."

I waited with breathless anticipation.

"Sure!" said Regis. "The correct answer and the 900-pound gorilla is B. Highmark. Congratulations, you just won $100 and are one question closer to $1 million."

The audience applauded. The next several questions were no-brainers; and by the time we took our first commercial break, I was at the $4,000 level with all my lifelines in tact.

"So, Mike," Regis said when we returned from the break. "I understand you’re an orthopedic surgeon. Guess there’s not much you can do without pre-authorization. Must be pretty frustrating for an independent-minded guy like you."

"That’s right," I said. "Can’t even splint a finger without asking for permission."

"I’ll bet you’re be pretty anxious to win, so you can finally use those HMO contracts for scratch paper," he said.

"Reege, this is a dream," I said.

"A lot of our contestants say that, Mike," he replied. "They wait for an opportunity like this all their lives. Then, when it gets here, they just don’t believe it."

"No, Reege," I said. "I mean, this is really a dream. I’m asleep right now, and I’d like to hurry this along, since I have early surgery."

"In that case, let’s move on to the next question. Here it is: Some managed-care companies are now decapitating providers. What does ’decapitate’ mean?

A. Take away their caps on reimbursement
B. Don’t let them wear hats at the table
C. Off with their heads if they order too many expensive diagnostic tests
D. Remove the caffeine from their coffee

"Hmm," I said. "I’m pretty sure that D means decaffeinate, not decapitate, and I think we can eliminate B, which is a correct answer but doesn’t pertain to health care. That just leaves A and C. I have a hunch which one is correct, but I’d like to poll the audience."

"Audience," said Reege, "using the key pads in front of you, please select an answer."

While the audience voted, I fidgeted in my seat. Finally, the music died down and Regis spoke up.

"We have the results of our poll. Ninety-nine percent of our audience said that decapitation of providers means ’C. Off with their heads if they order too many expensive diagnostic tests.’"

"That’s what I thought, Reege," I said. "I’ll go with the audience and make C my final answer."

Regis paused while the computer flashed the correct response.

"Yes!" he said. "The correct answer is ’C. Off with their heads if they order too many expensive diagnostic tests.’ You’re now up to the $8,000 level and well on your way to being a health-care millionaire. You still have two lifelines in tact."

I zipped through the next three questions, but I knew my luck couldn’t hold indefinitely.

"O.K., Mike," said Regis. "Here’s your next question for $64,000. When health-care providers merge, who derives the most financial benefit? Is the answer:

A. The community
B. The providers
C. Attorneys
D. Consultants

"Gee, Reege. The community is supposed to derive the most benefit from mergers, but that rarely happens, especially when the merger falls apart and the lawyers move in. I think I better use another lifeline. Let’s try the 50-50."

Regis arched his eyebrows and smirked. "Computer, take away two of the wrong answers, leaving one wrong answer and the correct one."

I watched as the computer eliminated ’A. The community’ and ’B. The providers.’

"That’s what I was afraid of," I said. "Well, I guess I’ll just have to give it a shot. The attorneys generally make more per hour, but I think that the consultants tend to hang around a lot longer, so I’ll pick ’D. Consultants’ as my final answer."

I could feel the suspense building as Regis paused again. Then, his face relaxed suddenly when the computer flashed a green light.

"Yes!" he said. "When providers merge, consultants derive the most financial benefit! You’re now at the $125,000 level and just a few questions away from becoming a health-care millionaire."

The game was getting tense. I squeaked by on the next question but nailed the next two, which meant that I was just one correct response away from a million bucks and freedom from HMO tyranny.

"OK, Mike," said Regis. "You have one lifeline left. This is your last question. If you get this right, you’ll be our winner. Ready?"

"I’m as ready as I’ll ever be, Reege."

"OK," he said. "Let’s go. For one million dollars, here’s the question: What’s the best way for a health-care provider to survive managed care? Is it:

A. Pray
B. Retire early and get a job at Wal-Mart
C. Become a health-care consultant or attorney
D. Suck up to HMO executives

I could feel my stomach turn and the muscles in the back of my neck get stiff. "Oh, man," I mumbled. "They all could be the right answer."

"Our staff has researched this subject extensively and determined that there is only one right answer," said Regis. "You have one lifeline left to help you. Would you like to phone a friend?"

"Reege, I only have one friend."

"Most orthopedic surgeons have only one friend, Mike" he said. "But that’s all you need to play this game. What’s your friend’s name? We’ll have Verizon get him on the line."

"You don’t understand, Reege," I replied. "My friend’s name is Spike. He’s a dog."

"Does he know anything about health care?" Regis asked.

"Well, he knows more about health care than some people I’ve worked with, but I don’t think he can help with this question. He starts barking the National Anthem whenever the phone rings. Besides, he thinks the receiver is a chew toy."

"Guess you’re on your own then, Mike. What’s your final answer?"

I took a deep breath, then looked at the four responses again. I took another deep breath, then began to answer. "Regis, I’m going to say that the best way to survive managed care is to . . . . "

The next thing I knew, I was lying in my bed. The sheets were a mess around me, and the alarm clock was blaring in my ear. I opened my eyes and looked around. Regis was nowhere to be found. He had disappeared, along with the stage, the audience, Spike and all my dreams of becoming a health-care millionaire.

I got up, got dressed and went to work. The chaos we call health care was waiting.

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