My ongoing regular posts regarding the daily aggravations and irritations of being a PCP.
Remember the Prior Authorization that I requested for my patient who had been on multiple anti-arrhythmics and saw a cardiologist who, after trying other medications, put her back on just digoxin and said to keep her on that? — Irritation #1– Well, Cigna decided, because apparently they know more about cardiology than the cardiologists and specifically they understand treatment of the individual better than a cardiologist who evaluated her, that she does not need the digoxin and refused the prior authorization.
REALLY? REALLY? Now my staff and I have to try to get her an expedited appeal.
As I write this post, my thoughts wonder if I’m being wooed to the dark side. Rarely (or maybe never) has an insurance company done anything that made my life easier or reduced my workload. A few days ago my medical assistant handed me a denial for a prior authorization (PA) request from a pharmacy. She attempted to do the PA online and was unsuccessful. It was a fairly straightforward diagnosis so it seemed odd that there was an issue getting the drug approved. Our patient has biopsy proven Barrett’s esophagus, a premalignant lesion for which a medication like Nexium is indicated. I sigh and flip through the denial papers to try and understand the reason and am amazed to see the name and phone number of the Humana physician who did the denial. I call her. It’s before 8 AM so I don’t expect an immediate response but a couple hours into the day I am pleasantly surprised (again) to get a return phone call from the physician herself. She tells me that the medication was approved for twice a day use but for some reason the pharmacy requested 90 pills for 30 days. It was only ordered for once a day so that’s an easy thing to fix with the drug store. Meantime I am thrilled. To be able to access a corporate physician quickly and resolve a problem for a patient in record time is a big step in improving patient care and transparency. Kudos to Humana! Don’t stop there please.
The Greater Louisville Medical Society (GLMS) hosts an annual “Wear the White Coat” opportunity for leaders in the Louisville community to spend a day with a physician and get a first-hand look at what we do. When GLMS president Dr. James “Pat” Murphy put a direct plea into my inbox it seemed easy to volunteer.
The program began with a breakfast get-together to meet our shadows. Mine was London Roth, an enthusiastic Human Capital Consultant executive with Humana. It took me a while to understand what her job is but both of us are avid social media advocates so it was a match made in heaven. On a Monday morning London joined me for five hours during which most of my patients allowed her to accompany me in the exam room. She listened to their medical issues and participated, with the patient’s permission, when they had questions of her. She was observant, interested and insightful. She was indulgent as I ranted about issues with her company, as well as other payors. She asked lots of questions.
Kathy & London Selfie
She commented on the awkwardness of our EHR system. She saw first-hand that, even if it is well-intentioned by the insurance company, sending over-worked clinicians patient information of who has not had colonoscopies, mammograms, pap smears, etc. are next to useless. Who in the office has time to work the data, especially if it is not as accurate as the insurance company believes? London also listened to patient stories about how her company’s HR policies affect employees’ ability to care for themselves and their families.
We met again at a dinner organized for the group where each “shadow” related their experience. State politicians spoke about better understanding when legislature affects physicians’ ability to practice. Business leaders talked about how seeing the effects of poor health habits reenforced the need for encouraging their employees to have healthier lifestyles. Community leaders saw how patient support systems (or lack thereof) can determine the success of patient care plans.
Personally, London gave me two gifts: she ended her comments with how well I knew about the little things that were important to my patients, the human connection that makes for a better patient-doctor relationship. And she designed the best iPhone case ever, a gift to me illustrating one of my frequent questions to patients:
Programs like this give IRL* examples of how physicians and patients are affected by the decisions of community leaders and what they can do to impact change in their companies and legislative bodies. As Dr. Murphy said “when you wear the white coat, it becomes part of you forever”.
*IRL = In Real Life a frequent expression used in Social Media. http://www.urbandictionary.com/define.php?term=IRL (caution, this link contains foul language).