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Curbside Consult with Dr. Jayne 6/16/14

June 16, 2014 Dr. Jayne 3 Comments

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I’m sure those of you that follow me on Twitter were wondering what could possibly have happened last week to make it one of the strangest days of my career. In retrospect, it wasn’t just one of the craziest days of my IT career, but of my physician career as well.

My hospital is part of a larger health system. When have to have a representative on some kind of IT-related committee, I am usually tapped to attend.

We’re a decent-sized organization with plenty of employed physicians. One of my CMIO friends in a similar situation has employer-paid medical co-payments to encourage staff to see the physicians in their group. Another offers their “associates” early access to office appointments that aren’t available to other patients. Theoretically, when you’re caring for your own people, it should be like a miniature accountable care organization and might give you insight into the best way to maximize health and lower costs for a defined patient population.

I have to admit I am way behind on my email and didn’t read the agenda for our Emerging Technologies meeting prior to heading uptown for the session. I’m barely keeping my head above water and didn’t think it was a big deal because usually the topics are things I can handle on the fly. This time, however, I was seriously wrong.

The meeting happens over lunch and I was trying to grab a quick bite while scanning the agenda as people arrived. One of my IT colleagues thought he was going to have to perform the Heimlich maneuver after I started choking on my salad.

Apparently our brilliant “ET” group decided to bring in a third-party solution for “advanced access” to physicians. Unfortunately, it’s a telemedicine solution staffed not by our own physicians, but by others in the market. As the meeting started, a glossy marketing slick was passed around. I thought it might be some kind of Friday the 13th prank until I realized they were serious.

Our human resources department wants to roll this out as part of our benefits package in the fall. They wanted to vet it with our group as far as our thoughts on HIPAA and other regulatory issues. The health system would pay a fee to the vendor, which offers “doctor visits anytime, anywhere!”

I’m not opposed to the concept of virtual visits, but I’m truly surprised that we wouldn’t give our own physicians the opportunity to not only serve the employee community, but to maybe make a little extra cash as “advanced access” physician resources. Given the recent draft policy from the Federation of State Medical Boards regarding telemedicine, we would be ideal. We’re licensed in the states where most employees live (and are usually located), so that’s easy. We already have unified medical liability coverage, so that’s easy, too. We also have a vested interest in keeping our collective employees healthy as a means to strengthen the community.

I also like the idea of employees being able to receive care without disrupting work schedules, although the service promises access to physicians “at home, at work, or anywhere you need care.” We have enough issues with staff using cell phones to take care of personal business in patient care areas and don’t want to encourage them to talk about their medical issues in the workplace. There aren’t a lot of private places in most of our ambulatory practices (the physicians don’t even have private offices any more) so I’m not sure that’s a benefit.

What really got me was the assertion that the third-party physicians would become “your doctor.” Are they really advocating conducting a longstanding patient-physician relationship established via smart phone? Are they going to be accessible 24/7 to handle all the health issues that typical patients should be addressing with their personal physicians? What is their plan for continuity of care?

I was trying to see the other side of the equation. Maybe they were worried about patient privacy. Employees might not want to see network physicians because their records would become part of our central database. That’s certainly valid. Maybe they were worried about accessibility and that’s a factor, although more and more of our employed practices are extending their hours and providing walk-in accessibility. Maybe they think offering this will differentiate us as an “employer of choice,” as the HR people like to describe it.

One of the other physicians at the table who wasn’t distracted by lunch managed to access the telemedicine website and find out more about it. Apparently they’re willing to partner with healthcare organizations to involve their own physicians, but our HR department didn’t think that was important. They figured they’d just offer it to our employees with the existing provider network because that would be faster.

I wonder if they seriously considered the public relations and morale repercussions of offering our staff having virtual visits with providers from a competitor health system. I’m sure the various medical executive committees at our hospitals will have a field day with this if it moves forward. That’s likely to happen since HR didn’t seem to understand our objections or find them valid. One of the physicians actually got up and walked out. The rest of us stuck it out, if for nothing else than to gather information to help inform our next steps.

Since we’re a technology committee and we couldn’t find any significant technology objections (I have to admit their setup looks pretty slick), it’s likely to move forward. I’m interested to see what the hospital administrators will think since it will likely have an impact on their bottom line.

I’d be interested to hear from organizations who have done something like this, including whether your providers participated or whether you used an existing or external network. We’re having a discussion with the vendor in a couple of weeks, assuming roadblocks aren’t thrown up in the interim. I’m putting together my list of questions and “what if” scenarios for the meeting.

Got ideas? Or alternatively a potential job with a seaside location? Email me.

Email Dr. Jayne.

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3 Responses to “Curbside Consult with Dr. Jayne 6/16/14”

  1. 1
    Brian Too Says:

    I too have encountered employee reluctance to use their employer for health services. It caught me by surprise because I had no such personal reluctance and I’d not seen that reaction before. This was in a small-medium hospital environment.

    The concern as I understood it was the problem of privacy. I suspect that there was additionally concern about the mixing of business and personal lives and that employee’s perceived ability to operate in a fully professional environment, post-care.

    Employees often develop opinions about their employers and those opinions aren’t always positive. In healthcare those opinions can extend to specific healthcare providers, departments, or facilities. Of course the reverse is possible too (a favourable opinion).

    I can also imagine certain employees feeling that there is some risk to in-house medical care, and why take that risk? Probably things will be fine, but if a service or procedure goes wrong and there are complaints or worse, the employee is in danger on both the personal and professional parts of their life. So the risk control perspective may be the operative issue for an employee.

  2. 2
    Been There Says:

    I have heard that the schedules required by consumers/staff are not easily staffed by our employed providers who would like to have a personal life.

  3. 3
    Michelle Hager Says:

    Disappointing but all too common that organizations rush to telemedicine as the new nirvana for patient care but exclude providers of care in their planning, design and sometimes implementation. It is a clinical program and should be treated as such regardless of who the patient population is. Dr Jayne you may be encouraged that they are willing to partner with local docs but disappointed once you understand the plan. Negotiating power for the docs is pretty low now thanks to your HR dept playing doctor. Maybe they stayed at a holiday inn express last night?

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