Prior Authorizations, Drug denials, and Big Brother IS Watching.

This is a rant.

Doctors are getting inundated with prior authorization forms for prescription drug refills this year.

• Drug companies are limiting the number of pills per month, even if the pill doesn't come in the right dosage and the patient has to take two pills a day or the larger dose is too big to swallow, so they need to take 2 smaller pills.  They will only approve one pill a day unless you get prior authorization. Prior Authorization is a form the doctor has to fill out, reviewing ALL the other medications you've ever taken in that class, and why you have to have that specific drug in the quantity you need it. 
• Drug companies are denying certain generic drugs now, in favor of OTHER generic drugs.
• Drug companies are sending us lots of letters for patients whose drugs will no longer be covered in 2016 with suggestions on which drugs to change them to. 
• Insurance companies send us letters telling us that our patients aren't taking their drugs as prescribed based on refill pick ups. I get those in big envelopes with 10-20 patients to review.
• insurance companies are sending us reminders that our diabetic patients should be on a certain type of blood pressure pill and on statin drugs, without understanding the nuances of the patient's medical problems. Sometimes you just CAN'T for a MYRIAD of reasons.
• Insurance companies are driving us NUTS. 

If you think big brother isn't watching, think again. 

I suspect that in the future, patients will be held responsible for a larger premium or portion of their bills based on adherence to therapy, medications, weight loss, diet and exercise and follow up appointments. 

I have to prove that my Medicare diabetics are checking their sugars by having a copy of their blood sugar logs in the chart

I have to fill out a form giving the diagnosis, diagnosis code, and last Hemoglobin A1C and justify why my Medicare patient is testing their blood sugars more than once or twice a day.

If a Medicare patient is getting home care, I have to fill out a "Face to Face Encounter Form" on which I need to explain the LAST office visit (within 90 days of start of therapy) and why the patient is home bound. Then, the latest slap in the face is that they don't BELIEVE us that we saw a patient on such and such a date. We now have to send a COPY OF THE LAST NOTE with the form. 

I understand that fraud is prevalent. I've reported it myself. Home Care is rife with fraud. It drives me NUTS that the doctors who are honest and hard working are getting buried by paperwork. It is MADDENING!

I am part time. 

I spend at least 15-20 hours a week doing paperwork. This is in between seeing patients in the office, going to the hospital, and making the occasional home visit. 

I don't get paid for paperwork or phone calls. 

A lot of the paperwork is solely to make insurance company's bean counters happy. It is to fill out flow sheets, document that our patients have had all of their health maintenance procedures (vaccinations, colonoscopies, mammograms, Bone densities, PSA's, lipids, glucoses, etc.) so they can decide what form of payment they will provide to the organization. It's all couched under patient safety, and it IS helping, but really, do I need to be a clerk? 

Instead of collating that information on their own through the use of shared claims data, they make physicians become clerks. 

I am a highly paid clerk. 

Just so you know, when it takes 1-2 weeks for me to fill out your YEARLY FMLA form so you don't get fired for taking off work for that pesky asthma attack or killer migraine, that is why. 

I am drowning in  paperwork. 

DoctorDiva 12/19/15

Spring Forward/Fall Back and Stop Messing With My Clocks, Dad!

"My watch is haunted." 

I watched the jeweler's face to see how he would react but he must have heard it all and kept a blank expression. He nodded and said dryly, "I think that is out of my field of expertise."


I should start from the beginning.  Every year at the changing of the clocks, my father would try to convince us that we were gaining an hour when we were losing an hour or vice versa. He had elaborate arguments to convince us of his brilliance and he was tenacious and very convincing. Of course, we were little kids at the time and were easily confused. 

As we got older he would call us twice a year to remind us how much sleep we were losing or gaining. After we were grown we learned not to argue with him because it gave him nothing but glee and irritated the crap out of us.

Last year my mother died and exactly 16 weeks later my father, who was still in the same nursing home, also died. My sister was their primary caregiver. One day she called me up and said, "I hope you're sitting down. I think Dad is haunting me. It's actually kind of funny."

She had gone into her bedroom to get something, came out and looked at the microwave clock and it was an hour ahead. She reset it and thought nothing of it until a day later when her coffee pot clock jumped ahead an hour. She thought, "Hmmm, that's odd." 

THEN, she started having problems with Dad's anchor clock. It was in her living room and the clock was starting and stopping. She changed the batteries, but it kept happening, so she yelled out into the ether, "OK dad. I know you're here. Stop f**king with my clocks!" 

She called me up to tell me the story and no sooner did she start telling it to me, while she was on the phone with me---the anchor clock stopped. After she hung up, it started up again.

I had started having my own clock issues before she called me. I had this really nice watch that I had bought myself. It started and stopped so I took it to the jeweler and he replaced the battery. It worked for a day or two and stopped again.  I brought it back and he replaced the battery again and cleaned it. He figured the first battery was defective or maybe there was some schmutz inside the workings. I took it home and it worked for about a week and then it stopped again. This was the point where my sister called me and told me what was going on. 

Meanwhile at my office, the clocks in my examination rooms and office kitchen stopped working. Batteries were replaced, and the clocks refused to function. It was weird.

Fast forward a couple of weeks: I'm in the jewelry store and my watch is still not working. I hand to the jeweler and tell him that my watch is haunted. 

"We'll have to send it to the factory. It'll be expensive. Do you still want to do it?"  He gave me a price and I said, OK.

I got it back after Christmas and it worked for a week and then it stopped again. I didn't go back.

I started wearing my my mother's old watch which has a nice big face and a secondhand. I haven't had a single problem with it. My sister says that she hasn't had any problems with her clocks lately either. I wonder if my dad just wanted me to wear my mother's watch and/or to remind us that he was still around. 

My parents and I didn't part on great terms. I wonder if this is his way of making me remember them with a smile on my face and a laugh.

Oh and by the way, next year when you spring forward and you get that extra hour of sleep because the clock is a whole hour ahead, think about my dad.

DoctorDiva 12/8/15