Saturday, September 27, 2008

What's in *your* MIB?, part 2

A few weeks ago I linked to a video and post on the e-patient blog, about a woman who says she's been turned down for insurance repeatedly. According to Consumer Reports, she found out that the reason was an error in her MIB record. And as a consequence, her 401(k) has been completely drained by covering her ongoing health costs without insurance.

So I wrote my post, and for the time, that was that. But then I was contacted by an MIB official, and I had an extended exchange of emails with him. I asked the questions I posted on the e-patient blog:

  • Is anybody, anywhere responsible for the accuracy of your MIB record?
  • Is anybody liable for the consequences of reckless or negligent errors, or even for simple human mistakes?
  • Is anybody required, under penalty of law, to correct such errors and make restitution for benefits that were wrongly withheld due to the errors?
In all our exchanges I didn't get direct answers to any of those questions, but here's the bottom line as I read it:

  • Nobody (not nobody, not nohow) is responsible for whether their information in your MIB record is accurate. It's entirely up to you to detect and fix any errors. Most of the responses I got amounted to detailed repetition of how to request your MIB (during the hours that their robot phone answerer is turned on) and how to request a fix.

  • Nobody (not nobody, not nohow) is responsible for any economic damage suffered by a patient as a result of such errors. Nobody, that is, except the patient (aka the victim).

In other words, the MIB and its contributors are not the least bit responsible for doing anything right, and if they don't, it's entirely and exclusively your problem.

I think you ought to contact them every year and get your annual free copy of what's in your MIB record, because it could be wrong, and it could cause you real harm.

But don't call right now - they shut off the phone answering computer on weekends and evenings, when most people are free to call and spend the seven minutes it takes to file your request through their robot.

Personally, I think the whole situation is disgusting, and I think some legislation would be in order.

Saturday, September 20, 2008

Waking Up Is Hard To Do


How often do my two after-work passions come together? Singing and healthcare? (And they're from Minnesota, no less, like me.) A group of nurse anesthetists, singing medical parodies.

(From the amazing Toni Brayer MD, via KevinMD, all brought to my attention by Paul Levy. Looks like these boys are goin' viral in the medical blogosphere.)

Thursday, September 18, 2008

"Patient Centered Medical Home" makes it into NEJM

In May I posted some slides from PCPCC, the Patient Centered Primary Care Collaborative, which has been working for years to promote the value of having a "medical home," a place where doctors and staff know you. We grew up with a family doctor, but PCPCC says 40% of Americans no longer have a medical home; increasingly we're handled just by specialists, and so many of us only get care by going to emergency rooms.

The "medical home" is not a concept that's widely acknowledged in America as something we should strive for. Even though most of the industrialized nations in the world have it, and even though their costs are better, and even though their health is better, we don't have it as a common concept in our healthcare conversations.

I'm very, very pleased to say that today's New England Journal of Medicine has an important column about this concept.

How ironic that it's described as a "new model of care delivery." Look at the slides in that PCPCC post, with all the data they have from every other modern country in the world - this is a new idea?

Perhaps it's American arrogance, thinking "Well, if we didn't think of it, it's new." (In business, that thinking is a good way to go out of business, as the American auto industry has been doing for decades.) I don't know. I'm just heartened to see a major journal like NEJM finally recognizing this information.

Friday, September 5, 2008

What's in *your* MIB?

As regular readers know, the "e" in e-patient stands for "empowered, engaged, equipped and enabled." Usually we're talking about "power" in the sense of who has a say in a medical episode, but there's more to it than that: who owns your information, and who's responsible for keeping it accurate?

This is a story of a woman who's experiencing real harm from a doctor's condition coding error in her MIB record (Medical Information Bureau) and says her attempts to get it fixed were unsuccessful, leaving her in real financial trouble and completely powerless.

In the past I might have politely sat by and said "Gosh, that's bad news." But as an e-patient (empowered), I say "Hey, that's not right - that doesn't make any sense - can't we change this??"

I know the MIB exists to keep insurers from harm (fraud), but patients are vulnerable to harm, too. (Listen up; patient = YOU.) Looking into the story, I requested my own MIB record (like requesting your credit report) and was quite surprised at how one-sided the power is, in that world.

The full story, with short video, is over on the e-patient blog, where I also write.

Given the opacity of the system, I shudder to think about my chances of correcting any error.

See what happened after I spoke with them: part two of this series.

For more about the e-patient movement, see E-Patient? Yes, e-Patient.
For why I blog, with links to my excellent cancer story, see Why I Blog.