EPtalk by Dr. Jayne 8/18/22

I booked my hotel for HIMSS23 this week, and I think this might be on par with the earliest I’ve ever done it. Still, my preferred dates were already sold out for the hotels closest to the convention center, which means I’ll be doing more walking but that I’ll be better located for parties.

Chicago is one of my favorite places for HIMSS when you consider the after hours scene, with plenty of interesting restaurants in close proximity when you discover that you have three events booked on top of each other. I’ve also loved the ability to just step out into the street and grab a taxi, although that might be different now in post-COVID world and with the rise of ride share services. The last time HIMSS was in Chicago I had one of those “the world is my oyster” weeks, so I have high hopes for the 2023 edition.

Hospitals claim to be running on razor-thin margins, but I still see them waste money on paper processes when they have perfectly good technology offerings ready to assist them. This week I received a letter reminding me that it’s time to schedule a mammogram, apparently without any kind of crossmatch to the fact that not only do I already have a mammogram scheduled but that it’s been on the hospital’s books for more than 11 months, so it’s not like my scheduling process crossed paths with the letter. The letter didn’t mention anything about “if you have already scheduled your study, please disregard this letter,” which made me wonder if there had been some kind of glitch, forcing me to check my patient portal and confirm that my appointment was still there.

The hospital should know that I have opted in for patient portal communications, so that’s a great way to save not only on postage, but on the service contract that I’m sure they have for mailings. They could have sent me a reminder electronically, but even better, they could have crossmatched the “patients who need a mammogram” report with the “patients who have a mammogram scheduled” report, using the magic of the very expensive analytics suite that I know they have. If they’re trying to prevent no-shows, they could use outreach tools to ask me to confirm my appointment.

Especially as a patient who is enrolled in their high-risk program and whose anxiety around the procedure is likely higher than average, I didn’t need the extra annoyance of wondering if my appointment got lost. Due to the need for taking off work since a trip to the high-risk clinic takes a minimum of three hours out of my day, I’d have been seriously irritated if it turned out to be more than just a poorly managed, wasteful, and annoying outreach effort.

Mr. H mentioned an article by physician Danielle Ofri, MD, who describes her journey to telehealth advocacy. I was excited about reading it. Many of her statements resonated with me as a telehealth physician. However, I tripped over the wording a little when she mentioned that telehealth “offers some flexibility to overburdened clinicians, who can do telemedicine from home if they happen to get grounded by a sick child or a COVID quarantine.” Seeing this kind of statement from a fellow physician makes me wonder how much Dr. Ofri actually understands the thin line that many physicians are walking with so-called work-life balance, what burnout is doing to us, or what flexibility really means. Of course, there’s a chance she was misquoted or that her statements were taken out of context, but still I ran it past a couple of colleagues who are parents to determine if I was being overly sensitive. Based on their responses, I was the least riled of the bunch.

The consensus among my colleagues (many of whom are pediatricians and primary care physicians) is that when a physician parent is “grounded by a sick child,” what they need is the same level of sick leave time that many other workers in the US have, not an expectation that they’ll just keep working at home. It doesn’t appear that the author understands what it’s like to juggle a vomiting child, or one with diarrhea, or one who’s lethargic and clingy, with basic care tasks including pumping the child full of clear liquids, doing copious loads of laundry, always having a popsicle at the ready, or watching the thousandth episode of Bob the Builder or some other show because it’s the only thing your child wants to do.

As a family physician, I would like to advocate for a world where sick children are actually cared for by their parents, not pushed to the side and only checked-on in between their parent’s telehealth visits with patients. The myth that physicians are some kind of superhumans who can work through anything (let alone should be expected to do so) needs to go away, once and for all. Of course, this should apply to all working parents, not just physicians, and the fact that families struggle with this on a daily basis shows how far we need to go as a society.

Price transparency remains a significant issue for patients, so this research letter in JAMA Surgery caught my eye. The authors looked at National-Cancer Institute-Designated Cancer Centers and how compliant they were with the January 2021 requirements for price transparency. In addition to publishing their master charge lists, hospitals are required to publish the negotiated rates that they have obtained with health insurance companies. Since cancer care is a huge segment of spending ($200 billion annually), they looked at NCI-designated hospitals to see whether the information was provided and how useful it was.

By examining the websites of the 63 designated hospitals, they found that although two-thirds of them provided some information on negotiated rates, fewer than one-third were fully compliant. Failures in compliance included lack of inclusion of the required machine-readable format and lack of documentation for all of the required price parameters. The authors had some choice commentary about the data that was provided, including a note that one facility used the word “variable” over a hundred thousand times in its documentation. They found the data difficult to use with large files that “required advanced coding and statistical experience to open or analyze.” It just goes to show that some of our best efforts to help patients fall short, and it’s going to take a coordinated effort by experienced technologists to make this information useful.

How is your institution handling the price transparency rule? Do you think patients benefit or are you missing the mark? Leave a comment or email me.

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