Why Is a “Medical Care Opportunity” a Waste of Time?

October 8, 2014

Those friendly reminders; you get them every day-Mrs X hasn’t refilled a scrip; Mr J needs an eye exam; Ms Q may be noncompliant with her ARB. Listen, I promise I DO know what the guidelines say!

They go by many names: Health Guides, Medication Therapy Management Services, Patient Highlights, The Medicare Stars Initiative, Safety and Health Considerations, and Potential Medical Care Opportunities.

I call them a colossal waste of time and resources.

You know what I’m talking about. Those letters and faxes we receive every day from patients’ insurance companies telling us to do our job better. “Your patient has diabetes and isn’t on an ACE inhibitor.” “Your patient has not filled his prescription as scheduled suggesting nonadherence to his regimen.” “Your patient has had diabetes and hasn’t had an eye exam in the past 12 months.”

Okay, I understand the purpose of the letters. Adherence to guidelines means healthier patients, healthier patients mean fewer health care dollars spent. All right. I get that. However, very frequently, the letters are either wrong or the “missed opportunity” is missed for a reason. The majority of the time, patients are on their statin or ACE or whatever it is the claim says they are not taking. And if they aren’t, it’s because they had an adverse reaction or have no indication for therapy or have some other contraindication.

So, you may ask, what’s the big deal?  Why do I care if the letters are wrong if I’m doing the right thing? Because it is a black hole of time. Each letter means bringing up a patient’s chart (thank goodness we have an EMR or it would also entail finding a physical chart) and checking the med list or the notes. Does it take long? No, not really, but even if it only takes 5 minutes to read the letter, pull the chart, find the information and document “health care consideration already addressed,” if you have to do it 10 times a day, that’s almost an hour!

And the most recent insult to a colleague of mine was a letter that not only “identified a patient as not being on an ACE or ARB,” it offered an incentive of $100 to prescribe one. Now this patient had a well-documented contraindication to the class, so my colleague was tempted to write an angry letter, but she put the letter in her “to-do” pile and didn’t get around to it. Three months later, she received a letter from the same company apologizing for the first letter, since it was brought to their attention that he had a contraindication. They “regret if (she was) offended by the financial incentive.” Really? 

The thing that scares me is that a less scrupulous person may prescribe things purely for the money. Heck, even without the financial incentive, is every physician who gets these letters taking a good look at their patients’ charts, or are they just writing scrips like they’re told?  Maybe that’s how some of my patients end up on two statins.

I have asked that I not be sent these letters, to no avail. They are a waste of time and effort, a waste of postage and a waste of trees. Is this where our insurance premiums are going? I hope that there are insurance administrators readings this. Please, stop bombarding us with these letters! Hmmm, another advantage of going cash-only.