Not Your Father's Travel Coverage

Only a few years ago covering for a colleague's practice while she traveled consisted almost entirely of taking the occasional crisis call, often to authorize a refill. Rarely you might meet with a patient in the office. Things have changed. I just returned from a ten day vacation. Thanks to the cloud I did not need anyone to cover for me, but a sampling of what came at me will give you some sense of some potential coverage duties.

Prior authorization has become an emergency, at least for patient and pharmacy, thanks to payers. Imagine trying to get authorization for a patient you have never met, especially without access to the medical record.

Record requests. Three of them came in by snail mail in the days before I left town. These can wait. But why should they? My records reside on a server somewhere in the cloud. I have no problem with my patients granting electronic view-only access to whomever they wish, whenever they wish. Alas my vendor does not seem to offer that capability. Yet.

Letter for a judge. A patient has run afoul of the law, and the attorney wants me to write a letter. This time it can wait, but I can envision a situation where delay could jeopardize the patient's defense. Regardless, I refuse to write letters if an opinion is requested, so we fall back on providing access to the medical record.

Nursing order. A patient taking clozapine needs regular blood draws, and the nursing service claims to urgently require my signature on the order form. Would you want to sign this if you were covering for me? Since I received it by electronic fax you probably would not know it had come in, but I suspect the nursing service would start frantic phone calls as the deadline approached. Seems like faxing the order form a few weeks early might help. Hint, hint.

Refills, other than controlled substances, rarely pose a problem. 

The one that really challenged me involved a recovering alcoholic who relapsed, no longer trusted oral naltrexone and desperately wanted a Vivitrol injection before leaving on an extended trip abroad. I met with the patient via video conference and agreed this plan made sense. I downloaded, signed, and faxed back the order, something a covering colleague could probably have handled (assuming room in the schedule). But then I received, while out of town, a confirmation letter, which indicated that Alkermes had shipped the drug to my office. But a representative assured me that the drug had been shipped to another office for injection and that the company just sends the same letter regardless. Any unemployed writers out there? This may seem like a minor discrepancy, but suppose the patient failed to get the injection after the physician relied on an erroneous form letter and drank again with some kind of terrible consequence. Please get that language right Alkermes.

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