“So, now that I am on Medicare, the managed care company sent a PA to my house. They told me I needed to be on a generic cholesterol medication.” He frowned disapprovingly at me, like I had done something wrong.
Oh, really, now?
“Did you tell them that you have tried all of the generic cholesterol medications and they either did not adequately treat your cholesterol or they caused body aches or other side effects that prevented you from tolerating it?”
“You know, to be honest they didn’t even ask…” He absently scratched his scalp with an index finger. His face relaxed.
It’s Ok, I get it. I know what they are trying to do when they are sending people into new enrollees’ homes to “review” their health….
The company wants to spend less, so they tell patients that they need to change their meds to generics. Except that I only use generics whenever possible. I don’t use the expensive brand name meds unless we absolutely have to.
And maybe I am being too sensitive or reading too much into it by feeling the insurance company is trying to undermine my rapport with the patient by having them question my clinical judgement but that is sure what it feels like. I worked hard for that rapport and unlike those company people, I really don’t have any ulterior motives at play here.
Too many cooks spoiled the broth…
This trend is popping up all over the place, even with private insurance. They pick the patients they are spending the most on and have a nurse call them once or twice a month.
“We see from your biometric screening that you are morbidly obese. Why won’t you loose weight?”
As a patient if you have your doctor talk to you about your weight at an office visit and then a few days later some stranger, a case manager, calls out of the blue to talk about your weight, don’t you feel like your doctor ratted on you?
I didn’t. I promise.
Weight isn’t like tobacco smoking. You cannot simply harass someone into getting skinny, but they sure as hell are going to try because that is the perceived root of all problems right now.
Skinny people cost less.
The elderly are increasingly becoming targets. I can think of certain instances where patients needed a case manager, someone to help them use their benefits, navigate the system, make it to appointments, help with medications or checking vital signs. But those people never seem to get that kind of help.
A few months ago an elderly couple grinned widely at me during their tandem appointment. They were clearly excited. Each appointment for the past ten years they have brought me a detailed list of their daily blood pressures for the months since their last visit. This time, however, they had brought no such paper.
“Doc, a lady from the insurance company came out to the house and gave us a blood pressure monitor. She told us to check our blood pressure with it once a week. It is supposed to send that reading to you! Technology is just great nowadays.”
“Uh, those numbers aren’t going to me.”
“What?” They looked at each other and then at me, confused. “We thought…”
“They are probably going to the insurance company. Did they tell you what they were going to do with that information?”
“Well, no. No they didn’t. You didn’t tell them to send it over?”
“No, I’m sorry. I did not. I had no idea they were going to do that.”
What’s worse is that they were given the wrong blood pressure guidelines by the nurse practitioner that dropped off the monitor. You don’t tell an 80 year old to keep their blood pressure under 120/80. You just don’t. Guidelines indicate under 150/90 is the correct target for these patients as lowering further increases the risk of falls. And yet she told both of them that their blood pressure was too high and that they needed to discuss changing their medication with their doctor.
But we are helping people, improving the quality of their care!
This sort of thing isn’t going away. It is only going to get bigger, more invasive. I will be placed in a more defensive position than I already am as insurance companies and managed care try to reduce costs further.
Quite frankly, I don’t even know what to do about it at this point… Can it be a good thing? Sure, if we are able to work together somehow.