Our favorite guest-blogger, Certified Medical Office Manager Kelley Beloff, is back, and has the scoop on the real life implications of the latest ObamaCare© goofiness: Medical Mystery Shoppers:
As part of my daily readings for my job as a medical practice manager, I came across this article from the New York Times, “U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office and if patients on Medicaid are treated differently from those with private insurance.
After I fell out of my chair laughing, I decided I needed to point out the error of the government’s ways.
This is how the government has the phone call playing out:
“Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”
Doctor’s office: “What type of problem are you experiencing?”
Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”
In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs.
Other mystery shoppers will try to schedule appointments for routine care, like an annual checkup for an adult or a sports physical for a high school athlete. “
This is how the actual call will go:
Mystery shopper: "Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible."
Doctor’s Office: Dr. Krane is booked out for new patient appointments for three months. Before I can schedule you I need some information. What is the name of your insurance? Are you the subscriber? I need your social security number, birthdate, ID number on your insurance card and your employer for our insurance verification.
Mystery Shopper: "Listen, I just need to see a doctor. I have been in area for four months and I didn’t need a doctor until now, so just schedule me."
Doctor’s Office: Sir, you do not need to take that tone of voice with me. By federal guidelines in the HITECH Act, all physicians’ offices must verify insurance before any person can become a patient. Additionally, by the rules in the Red Flag rule, we must determine that you are you and not using a fraudulent insurance card. Now, if you would like to continue the initial intake…
Mystery Shopper: "I cannot believe you are treating me like this, I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath."
Doctor’s Office: Sir, did you go to the emergency room?
Mystery Shopper: "Why would I go to an emergency room, do you know the wait times there. I just want to see the doc and get some meds, why can’t you understand this simple request."
Doctor’s Office: Sir, it takes at least three days to verify insurance and as I said the doctor is booked out for new patients for three months. At this point I recommend that you go to the emergency room and then please call us back to start the process of becoming a new patient.
Mystery Shopper: "Listen, I can do the new patient appointment later, can’t I just come in to be seen?"
Doctor’s Office: Sir, I am sorry but by federal guidelines, all patients not seen by a physician in three years must be seen as a new patient. Our office is contracted with Medicare and these are the rules mandated by CMS. We will have to see you as a new patient and the doctor does not have any openings for three months. I must insist that you go to the emergency room. Sir your symptoms are very severe.
Mystery Shopper: "Listen, how about if I just pay you cash, that way my insurance company won’t know that I was seen."
Doctor’s Office: Sir, under federal guidelines I cannot have you pay for an appointment if we are contracted with your insurance company for a discounted rate. That is fraud under CMS guidelines.
Mystery Shopper: "Un freakin believable, so what I am supposed to do, just die. I cannot believe you people." CLICK.
The reason for the appointment is not relevant at this stage; the reality is that physicians are booked out for new patients anywhere from two months to six months. If an established patient called me with those symptoms, the physician would tell that patient to go to the ER. Physician’s offices are not the site for this type of problem.
The article continues:
And then there is this paragraph:
My practice’s specialty is not on the list for the phone calls, nor is Ohio listed as one of the States where calls will be made, but if I do get one of these phone calls it will make my day.
Thanks, Kelley!
UPDATE: Under intense pressure (ie someone finally figured out how bad this looked), HHS Secretary Shecantbeserious (et al) has apparently decided to deep-six the program.
Exit question: how much did this little escapade cost the taxpayer?
As part of my daily readings for my job as a medical practice manager, I came across this article from the New York Times, “U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office and if patients on Medicaid are treated differently from those with private insurance.
“Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.”Then the article prints out the script that will be used.
After I fell out of my chair laughing, I decided I needed to point out the error of the government’s ways.
This is how the government has the phone call playing out:
“Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”
Doctor’s office: “What type of problem are you experiencing?”
Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”
In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs.
Other mystery shoppers will try to schedule appointments for routine care, like an annual checkup for an adult or a sports physical for a high school athlete. “
This is how the actual call will go:
Mystery shopper: "Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible."
Doctor’s Office: Dr. Krane is booked out for new patient appointments for three months. Before I can schedule you I need some information. What is the name of your insurance? Are you the subscriber? I need your social security number, birthdate, ID number on your insurance card and your employer for our insurance verification.
Mystery Shopper: "Listen, I just need to see a doctor. I have been in area for four months and I didn’t need a doctor until now, so just schedule me."
Doctor’s Office: Sir, you do not need to take that tone of voice with me. By federal guidelines in the HITECH Act, all physicians’ offices must verify insurance before any person can become a patient. Additionally, by the rules in the Red Flag rule, we must determine that you are you and not using a fraudulent insurance card. Now, if you would like to continue the initial intake…
Mystery Shopper: "I cannot believe you are treating me like this, I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath."
Doctor’s Office: Sir, did you go to the emergency room?
Mystery Shopper: "Why would I go to an emergency room, do you know the wait times there. I just want to see the doc and get some meds, why can’t you understand this simple request."
Doctor’s Office: Sir, it takes at least three days to verify insurance and as I said the doctor is booked out for new patients for three months. At this point I recommend that you go to the emergency room and then please call us back to start the process of becoming a new patient.
Mystery Shopper: "Listen, I can do the new patient appointment later, can’t I just come in to be seen?"
Doctor’s Office: Sir, I am sorry but by federal guidelines, all patients not seen by a physician in three years must be seen as a new patient. Our office is contracted with Medicare and these are the rules mandated by CMS. We will have to see you as a new patient and the doctor does not have any openings for three months. I must insist that you go to the emergency room. Sir your symptoms are very severe.
Mystery Shopper: "Listen, how about if I just pay you cash, that way my insurance company won’t know that I was seen."
Doctor’s Office: Sir, under federal guidelines I cannot have you pay for an appointment if we are contracted with your insurance company for a discounted rate. That is fraud under CMS guidelines.
Mystery Shopper: "Un freakin believable, so what I am supposed to do, just die. I cannot believe you people." CLICK.
The reason for the appointment is not relevant at this stage; the reality is that physicians are booked out for new patients anywhere from two months to six months. If an established patient called me with those symptoms, the physician would tell that patient to go to the ER. Physician’s offices are not the site for this type of problem.
The article continues:
“To make sure they are not detected, secret shoppers will hide their telephone numbers by blocking caller ID information.”To ensure against identity theft, one of our first lines of defense is a phone number. If a new patient calls with a blocked number then we become suspect of the true intentions of the person calling. In gathering information to make a new patient appointment, a physician’s office will require an address, phone number of home, work and cell, as well as employment status.
And then there is this paragraph:
“Eleven percent of the doctors will be called a third time. The callers will identify themselves as calling “on behalf of the U.S. Department of Health and Human Services.” They will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers.”No reputable physician’s office will give out this information to a stranger. If I received this phone call I would ask for a name and reason for this request, since all physicians taking Medicare or Medicaid have already registered with the U.S. Department of Health and Human Services, thus this is a scam phone call.
“Federal officials said the initial survey would cost $347,370. …Jennifer Benz, a research scientist at the center, said one purpose of the study was to determine whether the use of mystery shoppers would be a feasible way to track access to primary care in the future.”Ms. Benz, let me save you some time and our government some money. This will not produce the results you are seeking. I can give you your answer for free. There is a shortage of primary care physician’s because the payments from insurance companies, the government included, are too low. In fact, in another posting today, I came across this article which details physicians compensations by category. Family Practice is dead last with a compensation of $178,000. The average compensation of $65.87 from an insurance company to a doctor for a mid-level office visit will not motivate physicians to go into primary care. The compensation has been stagnant for over a decade and it is doubtful that any primary care physician will ever get a raise.
My practice’s specialty is not on the list for the phone calls, nor is Ohio listed as one of the States where calls will be made, but if I do get one of these phone calls it will make my day.
Thanks, Kelley!
UPDATE: Under intense pressure (ie someone finally figured out how bad this looked), HHS Secretary Shecantbeserious (et al) has apparently decided to deep-six the program.
Exit question: how much did this little escapade cost the taxpayer?
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