EPtalk by Dr. Jayne 6/16/22

The American Medical Association Annual Meeting is happening in Chicago this week, with the group gathering in person for the first time since the beginning of the COVID-19 pandemic. Many physicians feel the AMA has lost relevance and doesn’t speak for the majority of physicians. Regardless, I found the list of issues that the House of Delegates plans to address to be an interesting commentary on the times:

• Addressing public health disinformation by health professionals.
• Regulating ghost guns.
• Declaring climate change a public health crisis.
• Banning cannabidiol ads in places that children frequent.
• Preventing loss of insurance coverage after the COVID-19 public health emergency ends.
• Urging the Food and Drug Administration to swiftly review and approve over-the-counter status for oral contraceptives.
• Decreasing bias in evaluations of medical student performance.
• Ensuring accessibility of quality childcare for physicians in training.

Additional special sessions will include talks on the need for ethical guidelines around private equity acquisition of physician practices; Hattiesburg Clinic’s results when it looked at the impact of nurse practitioners and physician assistants; having physicians work at the top level of their licensure and not performing non-physician work; and reducing burnout.

I’m not sure how you miss this on a background check, but Bay Area Hospital in Oregon recently fired its chief operating officer after only four days on the job. It was discovered that in 2015, he had been sentenced to serve half a decade in federal prison for committing wire fraud and false representation of a Social Security number. Additionally, he used company credit cards for personal purchases. The hospital claims that it conducts criminal background checks across multiple jurisdictions, so I’d be interested to understand how this one slipped through the cracks.

In other legal news, a New Hampshire hospital has lost more than seven gallons of the drug fentanyl, which is a synthetic opioid that is 50 times more potent than heroin. Multiple hospital employees have been suspended. Drugs continued to disappear despite precautions that were added after initial losses were identified. A single nurse admitted taking more than half of the missing drugs, but the fate of the rest of the missing drugs continues to be unknown. Board of Pharmacy documents state that the nurse in question stated she took the fentanyl “for her own use as a way of coping with the stress of working during the pandemic” and also gave some to a friend. The nurse died unexpectedly in March. Nursing and pharmacy leaders at the hospital have also been suspended, with decisions on whether the hospital will lose its pharmacy approval expected later this month.

CMS has started levying fines against hospitals for noncompliance with federal price transparency laws. Atlanta-based Northside Hospital was fined more than $1 million due to problems at two facilities. One didn’t have the required consumer-friendly list of standard charges and the other didn’t have the searchable list posted in a prominent manner. CMS has issued a number of warning notices to noncompliant hospitals, but these are the first fines. Of note, neither hospital submitted a plan for corrective action which might have helped them avoid the penalties. One health policy expert cited in the article describes the hospital’s behavior as “contemptuous” in its lack of response or remediation.

A recent report from the Center for Connected Medicine (which is a partnership of Nokia and UPMC) looks at the reasons why patient self-scheduling isn’t advancing. Not surprisingly, lack of physician buy-in is a major factor. The report notes that 88% of respondents plan to prioritize investments in self-scheduling technologies in the coming year.

My primary care physician is part of a large medical group affiliated with a major integrated delivery network, and their efforts towards self-scheduling have been haphazard at best. Each office within the group is allowed to do their own thing, and then within the office, providers can opt in or out. Although I can’t even request an appointment with my physician online (other than sending a message, which I know is annoying to the staff) I can directly book with the nurse practitioners in the office. I’m overdue for calling to schedule my visit since he’s got a six-month wait, but I never seem to find time to make the call. At least I could self-schedule in those precious minutes between Zoom calls while I’m waiting for attendees to arrive at a meeting or while I’m waiting for the next patient to pop into my virtual waiting room. I definitely can’t make a phone call at either of those times.

Being a patient seems to be getting more and more difficult. I waited more than two weeks for some recent results, only to find that the ordering clinician failed to include the clinical history with the order, which might have made a difference in the results. It took four days from when the results posted in the EHR to when my clinician finally messaged me with note that “all is well, have a great summer,” which is a somewhat useless comment when you’re a patient who wants to know what the follow-up plan should be given the clinical history. Additionally, my physician eye detected a comment in the actual result report that called into question the adequacy of the specimen and that doesn’t feel like “all is well” to me.

I was forced to see this clinician because my own physician was out on a medical leave and the wait for new patient visits for other physicians in this specialty can be several months long. The visit itself was less than satisfactory, and after seeing how the results were handled, I’ll be looking to transfer. I’m fortunate to be a physician with plenty of resources, who not only knows how to research clinical guidelines but who could also reach out to friends in this specialty for advice. Both of my favorite “phone-a-friend” docs agreed with my self-created care plan so that’s something, but overall, the situation is just disheartening.

I feel bad for my physician colleague who is out on leave, because I know the backstory and that she not only feels terrible that her sudden illness left the practice in the lurch, but that there’s a good chance that she may not be able to practice medicine again. She’s an employed physician, though, so it falls on the group’s leadership to ensure that patients receive appropriate care in the face of the unexpected. I wonder how many other patients received less than outstanding care in the last few weeks and whether there will be any long-term consequences.

How have physician or other medical staff shortages impacted your own health or your patients’ care? Leave a comment or email me.

Email Dr. Jayne.