Brian Grey Blog

This isn’t what I’d call the most significant personal horror story related to health care.  In fact, in the scheme of such stories, what I had happen this past Friday is pretty tame.  However, it does highlight in a small way how screwed up and non customer friendly dealing with health care is even in the context of very simple requests.

My story (or at least the first chapter of the story) is all about trying to get my medical records transferred from my previous primary care physician to my new physician.

The drama began a few weeks ago when I called my old doctor’s office in LA (Pacific Palisades to be exact, in case that adds any color for readers) to inquire about getting my records sent up to SF where I now live so that I could provide some history for my new PCP whom I would be meeting with soon.  Of course, I could not speak with anyone live in my former physician’s office in LA — instead I got to wade through their voicemail tree and leave a message asking that somebody call me back to explain how I get my health records.  Nobody bothered to call me back.

Fast forward to this past week when I set up my appointment to meet with a new doctor here in SF.  My new office emailed me a simple waiver form that I could sign, scan and email a PDF back to the SF office so they could forward to my old LA doctor’s office to get my records.  Great, problem solved.  So I thought.

On Friday afternoon — a couple days before I was scheduled to meet with my new doctor — a woman from the front desk crew at the LA office called to inform me that in order to get my medical records I had to pay a $35 “administrative fee” to have them copied if I wanted to come in and pick them up.  For a total of $45 they would do me the favor of sending them to me in SF.  My guess is that they would be arriving via Pony Express?

I couldn’t resist.  I just had to call the LA office back to understand how they could justify being charged $45 to get something that would take probably 3 minutes to photocopy and another 3 minutes to fax to my SF doctor’s office (for essentially no charge as part of what I imagine is a flat rate long distance phone plan, but imagine if they had the technology to scan a copy of my medical records and email them to me?).

“How do you justify charging me $35 to get a copy of MY medical records,” I asked the woman on the phone.  She informed me it was an “administrative fee” for the time it would take someone in their office to make a copy.  By my math that comes to $700 an hour to copy my records.  Wow, I think I know where to send my resume for my next job!

“What if I came in to just get my file,” I said — in all seriousness of course.  Again, the kind woman on the other end of the line had a quick reply.  “We’re not allowed to let patients take the records”.  What the hell?  I suspect I signed something along the lines of what the medical profession considers a privacy policy that includes some provision that I can’t take the files.  Do they need a paper trail for insurance purposes, auditing maybe?  Fine I thought, I’ll just go in and get them so I can “go across the street and copy them myself” I said.  “Sorry, we aren’t allowed to let the records leave our office”.

At this point I figured this was going nowhere.  I thought this might actually be considered one of the “procedures” that a doctor gets paid for by the insurance providers — just like doing an x-ray or performing a blood test.  Maybe I need my health plan to call my old LA office to negotiate a price for this service?

So at this point I’m going in to my new doctor here in LA as a clean slate.  Thankfully I have my mental faculties so I can theoretically download from my memory the essentials of my medical history for my SF doctor.  As far as I’m concerned when it comes to my medical history, my next doctor’s appointment is indeed the “first day of the rest of my life”.

One angle of the health care debate that seems to finally be getting a bit of attention is the dynamic between disease management and prevention.  Most of the spending today on health care is geared towards the former — in fact doctors get paid for doing tests and prescribing drugs, they don’t get paid for getting people to lose weight or to quit smoking.

One of the problems with how prevention is measured is the fact its benefit is measured as dollars saved, which rarely enables prevention measures to stack up.  They just don’t “save” enough money or it’s just plain impossible to calculate how much money they do save.  But there is another way to think about prevention, and that’s in terms of how much benefit one gains by spending on prevention.

Pauline Chen’s piece in today’s NY Times cites a measure called a QALY — Quality Adjusted Life Year — and utilized in numerous studies, including most recently by Dr. Steven Woolf of Virgina Commenwealth University.  Woolf uses examples like smoking cessation (e.g. a $5,000 investment in getting someone to quit smoking yields one QALY) and the case that taking a children’s aspirin daily yields QALYs at a third to a fifth the cost of angioplasty.

Another way to look at QALYs is the fact that by one estimate 100,000 lives could be saved a year by investing in 5 key preventitive measures:

1. breast cancer creening in women 40 and older

2. flu immunizations in adults 50 and over

3. colorectal cancer screening in adults 50 and over

4. smoking cessation counseling

5. daily aspirin in high risk cardiovascular patients

Now, it’s just my nature to think about the other side of the QALY equation — you know, the top 5 what I would call “non-preventitive” measures that would surely reduce your QALYs:

1. increased volume of bungee jumping and/or base jumping — particularly with bad ropes or parachutes

2. consumption of soft serve ice cream – especially chocolate dipped cones

3. exceeding the recommended “one glass of wine” a night rule — by like 3-4 glasses a night

4. having any special family nights that sound like “family steak night” or “family pork rind and ranch dip night”

5. convincing yourself that playing World of Warcraft is a form of exercise

All kidding aside, it’s refreshing to see some effort being made in trying to measure what real preventitive health measures might be worth — doing this just might lead to more aspirin consumption and fewer angioplasty procedures.

Living in San Francisco I have pretty much written off Safeway as a grocery shopping option.  I mean, c’mon, it’s just not cool to shop at there.  Maybe when I’m in a pinch and need a gallon of milk, sure I’ll zip over to the Market Street Safeway.  Or if I need to get cash from the Wells Fargo, a coffee from their mini Starbucks, or a lottery ticket (how else am I going to pay for my kids to go to college?), okay, I’ll do the Safeway thing.  But they have disappeared from my grocery shopping radar, replaced by the ever cool Whole Foods Market and Trader Joe’s outlets sprinkled around the City, and the plethora of neighborhood specialty markets like Harvest and Real (“Expensive”) Foods.

But Safeway may have enticed me to comeback based on what I read this morning.  Their CEO Steven A. Burd wrote an Op-Ed piece in the Wall Street Journal outlining how the grocery store chain has turned their employee health care plan somewhat on it’s head by introducing novel concepts like accountability and incentives into the equation.  The quick summary of Safeway’s health-care program is that employees can receive significant discounts on their monthly premium payments by actually being healthy.  Basically, Safeway is thinking of it’s health-care plan more or less analagous to the way auto insurance works.  Why should the employees who don’t want to get healthy (e.g. the “bad drivers”) cause premiums to be increased for the healthy workers (e.g. the “good drivers”)?

Now I know that many people will read Burd’s article and claim how unfair it is to people who for whatever reason can’t pass the health tests that would result in lower premiums.  (In fact, an interesting sidebar with the Safeway program is the fact that it doesn’t apply to union workers).  And while I am sure there are cases where heredity may predispose someone from being able to lower their cholesterol through diet and exercise or otherwise pass the tests that qualify them for a discount, I also suspect a lot of the critics of what Safeway is doing just don’t want to be held accountable for a significant portion of what they pay for health insurance.  For employees who receive healt-care benefits from their employers, this perk has become an entitlement that in their mind comes without the requirement that they quit smoking, start exercising and/or get their hand out of the Doritos bag.

As Burd explains, Safeway has been able to essentially keep it’s health-care costs flat over the past four years (compared to an average 38% increase in company health-care expenses nationwide), there are other real benefits from Safeway’s approach here.  The company is clearly prioritizing healthy living as a core element of Safeway’s culture and exposing employees to information they might not otherwise have access.  In turn, this has to increasingly manifest itself in the form of happier, more productive and more retainable employees.  Now all of these so called “soft” employee-level benefits have to lead to a business benefit eventually, right?  Well, over the past 5 years Safeway’s stock has actually outperformed Whole Foods (though, Krogers has outperformed Safeway, so maybe Krogers is keeping treadmills and ellipitical machines in the back of their stores for lunch break workouts?).

The more far reaching takeaway from the Safeway example is that with all of the debate bubbling up around national healt-care legislation, a grocery store chain of all places has institued a very basic principle that would be worth inserting more broadly into the national dialogue.  Accountability and incentives need to be important concepts addressed in the health-care debate, and when used properly as in the Safeway example, they can be very powerful tools to help naturally guide us towards being a healthier, more competitive workforce that ultimately isn’t directing more than 1/5th of our resources to health-care spending.