Chris Perry Column: DOGED

I got axed.

I was dropped, booted, and sent packing.

I thought I was on the team, but I got cut and sent down to the JVs.

I haven’t felt this way since Sandy Kurth dumped me for Walter Rogers at the 8^th-grade spring dance.

When I first saw the call from the Nantucket Cottage Hospital, I thought it was the hospital’s pharmacy announcing that my prescription refill was ready. Instead, it was a pleasant voice advising me that my primary care doctor via the Nantucket Cottage Medical Group was “dropping me.”

At first, I thought it was a scam. I’m healthy, I exercise, and over the years, I have paid more than my fair share into the hospital’s coffers.

Instead, the hospital’s rep told me, “You haven’t been here enough…”

I said, “Excuse me?”

“Yes, you have not been seen by us for over three years…”

Pausing for a moment and knowing that I have spent way too much time lately on the hospital’s campus between grandchildren’s ER visits, lab work, X-rays and MRIs, prescription refills, ortho consults, cortisone injections, an urgent care visit for Lyme disease, and a mother-in-law who passed away not that long ago on the second floor, I certainly have been “seen” enough for Gerri to wonder if I wasn’t a regular visiting physician.

The voice followed up: “Your primary care doctor hasn’t seen you in three years.”

Still not convinced this wasn’t a scam, I ask, “Are you affiliated with my primary care doctor?”

The trainee quickly passed me over to her supervisor, who said, “Dr. Koehm has not seen you in over three years…”

I grew up in a time when my parents’ and my grandparents’ generations received red badges of courage for not going to the doctor’s office, so rhetorically I asked, “Well… isn’t that a good thing?”

The short answer was no.

I still can’t wrap my hands around that logic. I just assumed that the last thing the Nantucket Cottage Medical Group needed from me was to schedule an unnecessary office visit. I’m busy. They’re busy. There are plenty of people on-island who could use the services of one of Nantucket’s primary care physicians far more than I, so why was I getting Doged?

“It’s a health care insurance-driven issue,” said Nantucket Cottage Hospital President Amy Lee when I had an opportunity to sit down with her and NCH’s Vice President of Strategy & Community Development, Chris Glowacki.

In a nutshell, roughly 10 years ago, medical insurance companies in Massachusetts implemented new guidelines, including a three-year rule. These new policies impacted claims, eligibility, and reimbursements. But at the same time, it created medical angst among patients who were blindsided when they found out their primary care physician had dropped them as a patient.

While I believe the insurance companies are forcing local primary care physicians and NCH to do their dirty work, the notification process on Nantucket – at least in my experience and according to others whom I’ve spoken to - has been less than ideal.

Access to a primary care physician on Nantucket has certainly improved from the days of a waiting list to get on the roster of one of the island’s doctors. During our meeting, Lee and Glowacki quickly pointed out that the hospital now has 13 PCPs available to the community. Frankly, that’s an encouraging number and a figure that I doubt most people in the Nantucket community are aware of.

It is well known that Nantucket’s Mount Rushmore of longtime primary care physicians – people like Dr. Tim Lepore, Dr. Diane Pearl, and Dr. Mimi Koehm - have full practices. So, if you were advised that your primary care doctor has dropped you and you must “re-establish,” one would think a seamless solution would be to simply re-up with the primary care physician that you have used over the years by scheduling an appointment.

Not so fast.

Once dropped due to the insurance rule, you are now considered a “new patient,” and health care providers can bill at a higher rate, which can affect insurance reimbursements and out-of-pocket costs for patients. With a few well-established practices on-island not accepting new clients, some patients have been forced to “re-establish” with a different doctor as physicians try to balance a workable number of patients with adequate care.

I asked Lee and Glowacki if they knew how many community members have been impacted by these insurance guidelines and forced to "re-establish” on Nantucket, causing some patients to wait in abeyance without an official PCP. Initially focusing on those patients who received letters, they could not definitively answer the question, seemingly unaware that community members also received the bad news for the first time when checking in at urgent care, registering at the ER, and via the hospital’s “call center.” With a segment of the local population sitting at home right now unaware they might have been dropped by their primary care physician, I believe that number is higher than some would care to admit.

Navigating today’s medical landscape is not easy. With unsympathetic insurance companies constantly moving the goalposts, it is often intimidating, frustrating, and overwhelming despite efforts on both sides to make it an intimate working relationship. Consequently, if this partnership is going to work, local patients, primary care physicians, the Nantucket Cottage Hospital, and especially the insurance companies, must remember that an ounce of patience and understanding is worth a pound of cure.

Speaking on behalf of those who need to re-establish, because I am one, we as patients need to do a better job.

You do not need to be a thoracic surgeon to know that scheduling an annual physical allows for regular, ongoing medical assessment, ensuring issues are identified. It fosters direct interaction between patient and health care provider, ultimately strengthening that relationship. Almost universally, data from studies that followed patients who routinely scheduled annual wellness visits (AWV) showed a significantly positive impact on their health and quality of life.

But as much as we need them, they need us.

Primary care physicians and the Nantucket Cottage Hospital need to do a better job, too. There is a story with each patient who is forced to re-establish, and as Martin Fischer once said, “Ten cents’ worth of human understanding equals ten dollars’ worth of medical science.”

A letter sent by mail to a patient advising them that they need to “re-establish” is not enough. The Nantucket community, dominated by a year-round, hardworking middle class who barely have enough time to take their own temperature, let alone that of a sick child, deserves more from primary care physicians and the cottage hospital – even if the insurance companies are driving the problem. Instead of burning the bridge that exists between patient and primary care physician, build a bridge with better communication and an avenue for patients to be reinstated before being forced to re-establish with another doctor.

For the record, I have succumbed to medical pressure and have taken the first step in my re-establishment journey. Not wanting to break any HIPAA laws, I will only say that I have successfully nailed down a future date for an office visit, and I am happy to report that a medical professional will be checking under my hood. It won’t be pretty. After two rotator cuff surgeries, six orthopedic procedures, two transforming epidural injections, a handful of drainings, and what I think was three quarts of 10W40 motor oil boosted into various joints over the years, frankly, everything hurts.

But seriously, I suggest you check with your PCP and confirm your present medical status because things have changed, and Dr. Voorhees, Lucille Giddings, and Dr. Hinson are not walking through that door.

Like Sam Rayburn once said: “If you want to get along, go along…”