Curbside Consult with Dr. Jayne 11/21/22

I’m back in the patient trenches again, getting ready for an outpatient medical procedure and loathing the process. I’m an active patient of the physician who will be performing the procedure, with an up-to-date chart at the practice. The ambulatory surgery center where the procedure will be performed is owned by the physicians (although it’s a separate legal entity than the practice) and I’m also considered an active patient there due to a previous procedure.

Even though it would have been perfectly easy for the performing physician to send an appropriate History and Physical document to the surgery center (and for all I know they might have done so), I received an enormous “snail mail” packet to complete that basically treats me like a brand-new patient. Once could claim that it was an artifact of trying to keep the surgery center separate from the practice entity, but all the paperwork has both entities’ logos on it, so that claim doesn’t hold water.

The surgery center called me on Wednesday to pre-register me for the procedure, which is pretty typical. Unfortunately for me, I was still in Las Vegas, so the call came in at 6 a.m. local time and my grogginess was probably entertaining for the registrar. The staffer basically asked me all the information that is already on my chart, although it was from the perspective of confirming existing information rather than being from scratch. I asked about the paper packet, and she indicated that it was mailed from the practice side of the organization rather than the surgery center, and that I should plan to complete it.

I enjoyed answering the COVID screening questions, since I was at a conference with probably 8,500 unmasked people compared to the few of us who might have been masking when we could, and certainly I was exposed to someone with COVID. Another great question was whether I have a Healthcare Power of Attorney, but they didn’t seem interested in knowing who my personal representative is or having me bring a copy. The call took less then five minutes, though, and I was able to get another half hour of sleep before I needed to get ready to head to the airport.

As I went through the paper packet today, I noticed the addition of a new form that might actually be useful to patients, especially those who might not have a lot of experience in our fragmented and messy healthcare system. The page listed out all the different entities that will be involved in my care – including the physicians, the surgery center, the anesthesia group, and the pathology group. Each column had the name of the entity, a description of how they fit into the procedure, the services they provide, and the fact that I will receive a separate bill from each group.

Although it fully illustrates the absurdity of healthcare in the US, I appreciate the fact that they’re trying to educate patients prior to their having a procedure so that there are fewer surprises down the road. I found it interesting that only the surgery center requires payment of my portion of the estimated co-insurance in advance. If I recall correctly, the anesthesia group waited until just shy of the timely filing deadline to submit their claim, so any hopes of wrapping up the procedure and payments will likely be delayed until well into 2023.

I’ve been keeping it low key since I got back from HLTH, partly to avoid having a COVID-related reschedule for the procedure. I’ve heard from two colleagues who brought COVID home from the HLTH conference as an unwanted souvenir, although based on the notifications from the contact tracing app, I suspect there were more cases than we will ever know.

It’s been a good opportunity to catch up on email and some of my virtual water cooler venues. The hottest topic seems to be Amazon’s foray into message-based virtual visits. Most of the physicians I’ve connected with aren’t impressed by the offering, since it’s more of a marketplace than a cohesive service. They’re concerned about the further fragmentation of patient care since these records won’t be making it back to primary care physicians, and the fact that patients may end up receiving care from multiple providers or practices as part of the marketplace arrangement without fully understanding the concept.

There were also some concerns about the business model and how it makes sense for the physicians who are part of the offering. The fees are low, which is good for patient access, but are set at a level which drives physicians toward high-volume processes in order to make it tenable as a major source of income. The virtual visits also include the ability to “message your clinician with follow-up questions at no additional cost for up to 14 days” which further lowers the desire to participate for many physicians, who want to practice telehealth urgent care in a “one and done” type model. Several colleagues guessed that the provider organizations are likely using considerably greater numbers of nurse practitioners rather than physicians.

The main patient-centric concern that was voiced was that of clinical quality, but given the fact that this is Amazon we’re talking about here, I also have concerns about patient privacy. The Amazon Clinic site has a lot of information on how they use Protected Health Information. Things I didn’t like included the fact that patients are asked to accept an authorization for disclosure of contact information, demographic information, account, and payment information, and “my complete patient file” to Amazon.com Services LLC and its affiliates. It notes that “information disclosed pursuant to this Authorization may be re-disclosed by the recipient, and this redisclosure will no longer be protected by HIPAA.” Although I’m not an attorney, it sounds like a bad idea to me. The FAQ page says this authorization is voluntary, but if patients want telehealth services but to not sign the authorization, they will need to reach out to the healthcare providers directly. I’m betting (as I’m sure Amazon is betting also) that patients will just click through the fine print. Patients are exhausted and often just want to get care in the quickest and cheapest way possible, and no one likes to read a wall of text.

What are your thoughts about Amazon Clinic? Will it revolutionize healthcare or just further fragment the patient experience? Leave a comment or email me.

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