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Patient Visit By Phone or Email

Started By: advice_rn, Nurse, Other, 11:23AM Aug 01, 2013

Kaiser Permanente in Northern California does a large part of their practice by phone only. They rarely see patients in the office anymore. Patients with multiple co-morbidities are not only kept from seeing specialists, they rarely see primary care doctors in the office either. A couple of years ago, the Emergency Department in San Raphael did a pilot project to treat patients over the phone. The family of a 91 year old male who could not stand, even with the help of two male family members. The ER doctor spoke to the family over the phone and offered to prescribe stronger pain medicine. The nurse instructed the family to call 911. The daughter of a female in her 70's with malignant hypertension called and spoke the same ER doctor over the phone. She called to report her mother's symptoms and blood pressure readings. The ER doctor reviewed her EMR. He told the daughter "I know your mother, I've taken care of her before." The daughter was reluctant to come to the ER, the physician took advantage of her reluctance. He suggested she give her mother an Ativan, gave her his cell phone number to contact him with any further symptoms or concerns. Not only did the ER doctor influence the daughter to not bring her mother in, he treated the patient without speaking directly to the patient much less see the patient in person. How does Kaiser obtain Medicare reimbursement when treating people over the phone? In another case, a primary care physician diagnosed pertussis over the phone and prescribed antibiotics. The patient called back demanding more antibiotics for two family members since they were exposed to her. Pertussis is a reportable disease. Does Kaiser report pertussis to the county and thus the CDC without confirmation from a lab? EMRs allow Kaiser physicians to be lazy and intellectual incurious. They note a prior diagnosis and assume any current condition is what the patients were diagnosed with in the past. A patient booked a telephone appointment for a headache and was diagnosed with "viral syndrome" by a primary care doctor over the phone. Soon the headache became intolerable, he went to the ER. Within hours he was diagnosed with a stroke. Kaiser lobbyists are pushing for telephone appointment reimbursement in the legislature. California's regulatory commissions are permeated with Kaiser physicians and thus have been rendered useless to protect patients from unsafe practices. Jerry Brown appointed a lawyer who retired from Kaiser to head the Department of Managed Health Care in California.Poll: Do you agree with this course of action? Yes|No|
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#1 of 2, Added By: anpcns, Nurse Practitioner, Psychiatry/Mental Health, 7:29PM Aug 12, 2013

Strange that no one has replied to this? From my experience, and we tried, there is zero "over the phone" reimbursement to my knowledge in NY , in fact you leave yourself open to great liability if someone calls with symptoms that should be seen and you advise them over the phone. I resigned my job the same day in 2009 when I was told that was how things were going to be handled (one month's notice given). I have no knowledge of Kaiser organization, this was a small practice. The usual problem is the opposite, where people are seen excessively and unnecessarily just to collect the dough. I can't believe Medicare reimburses anywhere for this. They shouldn't.
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#2 of 2, Added By:, Nurse, General Practice, 11:43AM Oct 10, 2013

This seems appalling. Patient visit by phone or email is only acceptable if the geographical location does not permit a physical visit, say the patient went on a long vacation outside the country. To check up on his condition, you can either call or email the patient since it is not very convenient for you and your other patients if you followed that patient to wherever he is just to ask how he is recuperating after an illness. But, to do prescriptions over the phone without seeing the patient first to see his actual condition (there are people who tend to exaggerate their illness) is just plain laziness and unprofessionalism. Where is the "Care" in the term "Health CARE Provider" in that?
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