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Curbside Consult with Dr. Jayne 11/11/13

November 11, 2013 Dr. Jayne 4 Comments


Jayne Goes to the Doctor

Like many Americans, I’m going through my employer’s open enrollment period for health insurance and other benefits. Additionally, my health insurance is changing at the beginning of the year, so there’s a bit of a double whammy trying to pick a new plan that has the physicians I see as well as coverage that works for me. Trying to read through the various summary plan descriptions is a bit like reading a foreign language. If it’s that difficult for someone who is a healthcare professional, I can’t imagine how difficult it is for the average patient.

My hospital requires that I complete a health risk assessment (online, of course) and have biometric testing done in order to receive a discount on the employee portion of the premium. I got the results today after receiving an email to access the lab vendor’s secure portal. There I experienced what I’m sure many patients also experience – confusion and misleading information.

First, there were graphics with screaming red exclamation points indicating problems in the “heart” and “other” categories. Navigating through the results showed that anything outside the reference range flags an alert. Looking more closely, it flags the same alert whether a value is high or low, which I think is confusing for patients. My cholesterol was a few points below the reference range. Having been through several epidemiology and biostatistics classes, I know how reference ranges are derived, but the average person doesn’t understand this.

According to the accompanying text, low cholesterol “can indicate malnutrition, intestinal malabsorption, hyperthyroidism, chronic anemia, liver disease, or other medical conditions.” I happen to know I don’t have any of those conditions since I just had other (more extensive) lab work done a few weeks ago with my new primary physician. Unfortunately, my employer’s third-party health contractor wouldn’t accept that lab report and made me go again to have blood drawn. Why is this kind of waste in healthcare OK? Could they not trust labs I had done at the same national reference lab? Did I really need to fast again and have another needle stick?

Conversely, had I not been to my primary physician recently, wouldn’t it have been nice if there was a way to securely send the results to my physician? No such luck unless I wanted to print it. I’m baffled that physicians and hospitals are being required to view / download / transmit patient data but the rest of the health vendors such as pharmacies, labs, etc. are not held to the same standard.

Going forward through the website’s report for me, it displayed the US Preventive Services Task Force recommendations for a person my age. It wasn’t surprising that USPSTF recommends screening less frequently than my employer requires. Based on my age and values, I don’t need another blood pressure screen for two years. I don’t actually need a cholesterol screen at all – I have no risk factors and am below the screening age. I don’t need a diabetes screen either, yet I was required to have both of these two tests done in order to receive a discount on my insurance premium. I’ll also have to do them again next year despite the fact that I still won’t need them.

There were some things about the visit to the biometric screening lab that were less than optimal – they relied on my reported height rather than measuring me and didn’t bother to ask if I had fasted or not. I don’t advocate cheating on health-related tests, but I wonder how many people do? Another inch of height always makes a girl’s BMI look a little better.

At the draw station, tubes from multiple patients who had gone before me were sitting in a rack with names visible. I was required to sign a form that said the blood tubes had been labeled in my presence and were accurate, but I didn’t actually see the tubes and the phlebotomist didn’t actually ask me to sign the form but instead pointed and shoved a pen at me.

Bottom line, though: I did my health assessment and got my discount. Now I get to spend the next couple of weeks trying to fit in various health appointments before my insurance changes. I’m sure it will be fine, but it’s always a pain to figure out new coverage and I’d rather just get things done on the plan I’m familiar with (and with my deductible already satisfied for the year).

My previous physician’s practice had issues with its patient portal, including erroneous demographics that they never could correct and a kludgy user interface. My new physician has a slick portal and actually sent timely and relevant information to me after my visit, so I’m glad I get to keep her.

Have a good health IT story from the patient side? Email me.


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Currently there are "4 comments" on this Article:

  1. Well, so I guess many of will be experiencing this new drill. I do applaud the ability to get a discount on my employer provided insurance for my efforts to improve my health, so I, too, went through the same drill you did, Dr. Jayne. In my case, the company outsourced by my employer required me to use a Quest or LabCorp lab which I was surprised to learn was about 30 mile from my home. So I couldn’t go to the hospital or practice lab that was two blocks away, in spite of being affiliated with a leading University nearby. That was the first hiccup. I was willing to forego the first morning coffee to get a fasting lipids if it was nearby, but having to drive 30 minutes there and back when I should have been able to go across the street was a deal breaker and totally unnecessary. Eventually, they relented and let me submit labs from last December, but I never had a glucose because, like you, my doctor had never felt the need based on PMH and Family Hx. I am hoping that this well-intended approach will smooth out in time, but to protect myself for next year, I will probably ask my PCP to order an unnecessary test or two at my annual exam next spring in anticipation of next year’s drill. So it goes.

  2. “Conversely, had I not been to my primary physician recently, wouldn’t it have been nice if there was a way to securely send the results to my physician? No such luck unless I wanted to print it. I’m baffled that physicians and hospitals are being required to view / download / transmit patient data but the rest of the health vendors such as pharmacies, labs, etc. are not held to the same standard. ”

    My hospital sends out to one of the big national labs. They send results for cooties back on transactions in an HL7-like format. We can file the results in the patient’s chart because we have a PID and a PV1. However, the results are all in comment fields, the exam names and result items are generic, and they give the name and address of every lab possible (they use reference labs too). None of these elements are HL7 compliant. This makes electronically sending these lab results to the state health department impossible. But it’s required for the hospital to electronically report public health results for MU2. The lab has no incentive to do this for us (except maybe our lab director will beat on them). My weekly emails to the reference lab go unanswered: “We’ll get back to you.”

  3. You’ve always got to ask who gets the financial value. Health risk assessments are for the benefit of the payors. They get to use the data you provide to profile you for financial risk and add you to their database of risk assessments. Always read the small print before you agree to take a health risk assessment around who has access to the data and for what purpose.

  4. I believe there would also be a benefit to the employer, but you are correct HRA. But what employee is going to turn down an “offer” to save 20-30% off their insurance premium, HRA, by not complying with this “suggestion”.

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