Re: medco prescription hassle.

[Guest guest]

We scanned the form into the system. We send the form with a note

to see attached prescriptions in fax. It truly is a pain when they

send it back because there may not be a birth date, etc. I am at

the point that if an insurance company wants a form filled out for a

proton pump inhibitor or cox2 the patient must come in for an office

visit to fill out the forms face to face. Merck just does not get

it with their pharmacy and they only want it there way. Keep

fighting back. You can bet we are. We will send there stupid form

with see attached following.

Brent

> Today, a very nice l.o.l.i.n.a.d. called me, rightfully upset

because the Rx

> for Synthroid D.A.W , which I spent about 15 min to confirm as

> correct-right-dose, then confirm correct fax number, then finally

> Alteer-fax to her Medco mail-order pharmacy (all as a gratis over-

the-phone

> favor), about 10 days ago, still wasn't in her mailbox... she had

called the

> 800 number, and was told that they never got my fax.

> Ah, hah ! I thought, with the clear Alteer record of a

successfully sent

> fax at my fingertips, I called these Medco weasels (they seem to be

> operating a pharmacy, with no pharmacist, I discovered)...

eventually, after

> listening to some really awful Muzak for about 10 minutes and

losing my

> temper talking to a couple of " pharmacy associates " (a.k.a.

secretaries),

> who really did not want to help me, it became clear that the only

way they

> would respect the Alteer fax-Rx is if it arrived with scotch tape

holding it

> to their " Pharmacy Form " ... since I don't have a file cabinet full

of the

> current forms used by each pharmacy system, and since my patient

did not

> actually come to my office at all 10 days ago, I did not have one

of their

> magic forms. After barely 30 minutes, the magic form arrived from

Medco by

> fax, and I only needed to cut a printed version of her

prescription down to

> their specified size with scissors, scotch tape it to their magic

form, add

> the necessary details about her P.M.H. (hx of allergies, heart

disease,

> etc., etc.), then photocopy the collage, scan it into the chart,

and

> finally fax it to Medco. In a couple of days, I can call them back

and maybe

> confirm that it did arrive, and with some luck, the mail will

deliver her

> shipment of Synthroid to her mailbox within their promised

potential

> topspeed: 8 days...(*see, she has only 10 days supply left)... or,

she will

> be forced to buy her medicine at a local drugstore, out of

pocket...

> Now, a big clinic with 32 F.T.E. and file cabinets full of the

standard

> forms, could probably do this efficiently the first time, spending

less than

> the original 10 minutes I gave this project, 10 days ago; with a

little

> luck, she would even have received the correct-current dose, and

the D.A.W.

> stipulation would have been transmitted... (and with a little more

luck,

> that stipulation might have been respected... some states where

Medco keeps

> warehouses do not respond to the initials D.A.W., I have learned,

and they

> require the words " dispense as written " , in long-hand.... and in

blood, I

> think...).

> My question, is how can a small single-doctor office deal with

this

> hassle? The movement toward these mail-order drug stores is a

tidal wave...

> I cannot blame the little old ladies for wanting to save money on

their

> medications, but the faxing of these forms takes real time, and

real work.I

> am not hiring enough staff to do this for me.

> One solution I can think of would be to print out old-fashioned

> prescription pads, write out the Rx's the old-fashioned way, and

tell the

> patient to stop by the office to pick them up; they may then

figure out how

> to mail the paper Rx's in herself, by U.S. Mail... The other

solution,

> (which I prefer), would be to require the patient to schedule a

brief visit,

> to confirm current dose of desired drug, and to work through the

> " Coordination of Care " necessary to jump through these Medco

hoops. If that

> was a 15 minute visit, for 99213, the cost to the patient (@ 20 %

of the

> Medicare-allowable for a 99213, after they reach their

deductible ) would be

> maybe $8. But, I suspect some patients would be so steamed at

this, that

> they would search for the doctor with 32 F.T.E.'s who might do

this favor

> for them, for free, without batting an eyelash. I do need

patients, as my

> patient population is growing way too slowly, but I feel uneasy

about

> setting the precedent of doing hours of free paperwork for them...

> Any other solutions/ideas?

[Guest guest]

May I use your description for an example of the hassle we have to put up with? CBM (I'll remove your name)

medco prescription hassle.

Today, a very nice l.o.l.i.n.a.d. called me, rightfully upset because the Rxfor Synthroid D.A.W , which I spent about 15 min to confirm ascorrect-right-dose, then confirm correct fax number, then finallyAlteer-fax to her Medco mail-order pharmacy (all as a gratis over-the-phonefavor), about 10 days ago, still wasn't in her mailbox... she had called the800 number, and was told that they never got my fax. Ah, hah ! I thought, with the clear Alteer record of a successfully sentfax at my fingertips, I called these Medco weasels (they seem to beoperating a pharmacy, with no pharmacist, I discovered)... eventually, afterlistening to some really awful Muzak for about 10 minutes and losing mytemper talking to a couple of "pharmacy associates" (a.k.a. secretaries),who really did not want to help me, it became clear that the only way theywould respect the Alteer fax-Rx is if it arrived with scotch tape holding itto their "Pharmacy Form"... since I don't have a file cabinet full of thecurrent forms used by each pharmacy system, and since my patient did notactually come to my office at all 10 days ago, I did not have one of theirmagic forms. After barely 30 minutes, the magic form arrived from Medco byfax, and I only needed to cut a printed version of her prescription down totheir specified size with scissors, scotch tape it to their magic form, addthe necessary details about her P.M.H. (hx of allergies, heart disease,etc., etc.), then photocopy the collage, scan it into the chart, andfinally fax it to Medco. In a couple of days, I can call them back and maybeconfirm that it did arrive, and with some luck, the mail will deliver hershipment of Synthroid to her mailbox within their promised potentialtopspeed: 8 days...(*see, she has only 10 days supply left)... or, she willbe forced to buy her medicine at a local drugstore, out of pocket... Now, a big clinic with 32 F.T.E. and file cabinets full of the standardforms, could probably do this efficiently the first time, spending less thanthe original 10 minutes I gave this project, 10 days ago; with a littleluck, she would even have received the correct-current dose, and the D.A.W.stipulation would have been transmitted... (and with a little more luck,that stipulation might have been respected... some states where Medco keepswarehouses do not respond to the initials D.A.W., I have learned, and theyrequire the words "dispense as written", in long-hand.... and in blood, Ithink...). My question, is how can a small single-doctor office deal with thishassle? The movement toward these mail-order drug stores is a tidal wave...I cannot blame the little old ladies for wanting to save money on theirmedications, but the faxing of these forms takes real time, and real work.Iam not hiring enough staff to do this for me. One solution I can think of would be to print out old-fashionedprescription pads, write out the Rx's the old-fashioned way, and tell thepatient to stop by the office to pick them up; they may then figure out howto mail the paper Rx's in herself, by U.S. Mail... The other solution,(which I prefer), would be to require the patient to schedule a brief visit,to confirm current dose of desired drug, and to work through the"Coordination of Care" necessary to jump through these Medco hoops. If thatwas a 15 minute visit, for 99213, the cost to the patient (@ 20 % of theMedicare-allowable for a 99213, after they reach their deductible ) would bemaybe $8. But, I suspect some patients would be so steamed at this, thatthey would search for the doctor with 32 F.T.E.'s who might do this favorfor them, for free, without batting an eyelash. I do need patients, as mypatient population is growing way too slowly, but I feel uneasy aboutsetting the precedent of doing hours of free paperwork for them... Any other solutions/ideas?

[Guest guest]

By all means, feel free to add my words to any struggle against this oppressor. You may either remove my name and attach your own, or Karl Marx's name, or Groucho Marx's name, or leave my name on it. That's spelled Rian Mintek (M.D.). I have many more descriptions about hassles, related to insurance companies and their minions. Let's write a book.

medco prescription hassle.

Today, a very nice l.o.l.i.n.a.d. called me, rightfully upset because the Rxfor Synthroid D.A.W , which I spent about 15 min to confirm ascorrect-right-dose, then confirm correct fax number, then finallyAlteer-fax to her Medco mail-order pharmacy (all as a gratis over-the-phonefavor), about 10 days ago, still wasn't in her mailbox... she had called the800 number, and was told that they never got my fax. Ah, hah ! I thought, with the clear Alteer record of a successfully sentfax at my fingertips, I called these Medco weasels (they seem to beoperating a pharmacy, with no pharmacist, I discovered)... eventually, afterlistening to some really awful Muzak for about 10 minutes and losing mytemper talking to a couple of "pharmacy associates" (a.k.a. secretaries),who really did not want to help me, it became clear that the only way theywould respect the Alteer fax-Rx is if it arrived with scotch tape holding itto their "Pharmacy Form"... since I don't have a file cabinet full of thecurrent forms used by each pharmacy system, and since my patient did notactually come to my office at all 10 days ago, I did not have one of theirmagic forms. After barely 30 minutes, the magic form arrived from Medco byfax, and I only needed to cut a printed version of her prescription down totheir specified size with scissors, scotch tape it to their magic form, addthe necessary details about her P.M.H. (hx of allergies, heart disease,etc., etc.), then photocopy the collage, scan it into the chart, andfinally fax it to Medco. In a couple of days, I can call them back and maybeconfirm that it did arrive, and with some luck, the mail will deliver hershipment of Synthroid to her mailbox within their promised potentialtopspeed: 8 days...(*see, she has only 10 days supply left)... or, she willbe forced to buy her medicine at a local drugstore, out of pocket... Now, a big clinic with 32 F.T.E. and file cabinets full of the standardforms, could probably do this efficiently the first time, spending less thanthe original 10 minutes I gave this project, 10 days ago; with a littleluck, she would even have received the correct-current dose, and the D.A.W.stipulation would have been transmitted... (and with a little more luck,that stipulation might have been respected... some states where Medco keepswarehouses do not respond to the initials D.A.W., I have learned, and theyrequire the words "dispense as written", in long-hand.... and in blood, Ithink...). My question, is how can a small single-doctor office deal with thishassle? The movement toward these mail-order drug stores is a tidal wave...I cannot blame the little old ladies for wanting to save money on theirmedications, but the faxing of these forms takes real time, and real work.Iam not hiring enough staff to do this for me. One solution I can think of would be to print out old-fashionedprescription pads, write out the Rx's the old-fashioned way, and tell thepatient to stop by the office to pick them up; they may then figure out howto mail the paper Rx's in herself, by U.S. Mail... The other solution,(which I prefer), would be to require the patient to schedule a brief visit,to confirm current dose of desired drug, and to work through the"Coordination of Care" necessary to jump through these Medco hoops. If thatwas a 15 minute visit, for 99213, the cost to the patient (@ 20 % of theMedicare-allowable for a 99213, after they reach their deductible ) would bemaybe $8. But, I suspect some patients would be so steamed at this, thatthey would search for the doctor with 32 F.T.E.'s who might do this favorfor them, for free, without batting an eyelash. I do need patients, as mypatient population is growing way too slowly, but I feel uneasy aboutsetting the precedent of doing hours of free paperwork for them... Any other solutions/ideas?

[Guest guest]

I've got the time. Just joking, but I may have time to write a book. For whom? to what end? I am still interested in legislation, but I do not think we can do it without the patients. They do not but want to understand especially when it hits home. We all have differing talkents and insights, but are remarkably alike in many ways. Some of of are softer than others, but we have a common ethic and stressors. This list and others do give me a group of peers. Thanks! Carolyn McCormick 27 yrs rural solo

medco prescription hassle.

Today, a very nice l.o.l.i.n.a.d. called me, rightfully upset because the Rxfor Synthroid D.A.W , which I spent about 15 min to confirm ascorrect-right-dose, then confirm correct fax number, then finallyAlteer-fax to her Medco mail-order pharmacy (all as a gratis over-the-phonefavor), about 10 days ago, still wasn't in her mailbox... she had called the800 number, and was told that they never got my fax. Ah, hah ! I thought, with the clear Alteer record of a successfully sentfax at my fingertips, I called these Medco weasels (they seem to beoperating a pharmacy, with no pharmacist, I discovered)... eventually, afterlistening to some really awful Muzak for about 10 minutes and losing mytemper talking to a couple of "pharmacy associates" (a.k.a. secretaries),who really did not want to help me, it became clear that the only way theywould respect the Alteer fax-Rx is if it arrived with scotch tape holding itto their "Pharmacy Form"... since I don't have a file cabinet full of thecurrent forms used by each pharmacy system, and since my patient did notactually come to my office at all 10 days ago, I did not have one of theirmagic forms. After barely 30 minutes, the magic form arrived from Medco byfax, and I only needed to cut a printed version of her prescription down totheir specified size with scissors, scotch tape it to their magic form, addthe necessary details about her P.M.H. (hx of allergies, heart disease,etc., etc.), then photocopy the collage, scan it into the chart, andfinally fax it to Medco. In a couple of days, I can call them back and maybeconfirm that it did arrive, and with some luck, the mail will deliver hershipment of Synthroid to her mailbox within their promised potentialtopspeed: 8 days...(*see, she has only 10 days supply left)... or, she willbe forced to buy her medicine at a local drugstore, out of pocket... Now, a big clinic with 32 F.T.E. and file cabinets full of the standardforms, could probably do this efficiently the first time, spending less thanthe original 10 minutes I gave this project, 10 days ago; with a littleluck, she would even have received the correct-current dose, and the D.A.W.stipulation would have been transmitted... (and with a little more luck,that stipulation might have been respected... some states where Medco keepswarehouses do not respond to the initials D.A.W., I have learned, and theyrequire the words "dispense as written", in long-hand.... and in blood, Ithink...). My question, is how can a small single-doctor office deal with thishassle? The movement toward these mail-order drug stores is a tidal wave...I cannot blame the little old ladies for wanting to save money on theirmedications, but the faxing of these forms takes real time, and real work.Iam not hiring enough staff to do this for me. One solution I can think of would be to print out old-fashionedprescription pads, write out the Rx's the old-fashioned way, and tell thepatient to stop by the office to pick them up; they may then figure out howto mail the paper Rx's in herself, by U.S. Mail... The other solution,(which I prefer), would be to require the patient to schedule a brief visit,to confirm current dose of desired drug, and to work through the"Coordination of Care" necessary to jump through these Medco hoops. If thatwas a 15 minute visit, for 99213, the cost to the patient (@ 20 % of theMedicare-allowable for a 99213, after they reach their deductible ) would bemaybe $8. But, I suspect some patients would be so steamed at this, thatthey would search for the doctor with 32 F.T.E.'s who might do this favorfor them, for free, without batting an eyelash. I do need patients, as mypatient population is growing way too slowly, but I feel uneasy aboutsetting the precedent of doing hours of free paperwork for them... Any other solutions/ideas?

[Guest guest]

> My work-around with Medco:

> I print out the prescription from Alteer. The only missing data

element is

> the patient's social security number. I write it on the Rx by

hand, scan

> it into the system, then fax to Medco.

> It works unfailingly, and only takes about 30-45 seconds of my

time. I can

> do it while the patient is on the phone with me.

>

> I don't use the Medco form.

>

Thanks, Gordon. For those of us who use Alteer, it is possible to

copy the present Rx format to create a new Rx form and then to ADD

the patient SSN to the format. Name it something like Medco-blankety

Rx-Blank and use it to print mail order Rx's. No handwork and just a

bit faster. Too bad it won't do the allergies.

Jim in KC.

[Guest guest]

> For anyone on Alteer,

> Is there a way to print out patient's addresses onto envelopes (

like WORD

> let's you do)... I had a trainer trying to find out how to do it

and she

> couldn't figure it out. She says I may have to buy a special label

printer

> to do it? How annoying.

>

> Lee

I just printed a patient envelope in ALTEER. I set up a new form

(ADMIN FORMS)with my return address upper left and ADDRESS BLOCK a

few lines down in larger type. The trick is to set the margin for

the address block over about 3 " or so. This is good only for

printing one envelope at a time (selected from within CHART select

new form PtEnvelope(or whatever you named the form) and works on my

inkjet printer which lets me load an envelope right on top of the

normal paper stack. It does NOT rotate the image 90 degrees like WORD

does which uses the envelope slot. Works for me. I hadn't thought

about it until your post. Thanks.

Jim in KC

[Guest guest]

It will not do it. You have to use a dynamo label printer or

something similar and then pick what kind of form you are going to

print, address label, change the printer and then hit print. There

are several clicks to do this. It would be nice to have a box to

hit to just print a label. It is a feature we have suggested.

brent

> > > My work-around with Medco:

> > > I print out the prescription from Alteer. The only missing

data

> > element is

> > > the patient's social security number. I write it on the Rx by

> > hand, scan

> > > it into the system, then fax to Medco.

> > > It works unfailingly, and only takes about 30-45 seconds of my

> > time. I can

> > > do it while the patient is on the phone with me.

> > >

> > > I don't use the Medco form.

> > >

> > Thanks, Gordon. For those of us who use Alteer, it is possible

to

> > copy the present Rx format to create a new Rx form and then to

ADD

> > the patient SSN to the format. Name it something like Medco-

blankety

> > Rx-Blank and use it to print mail order Rx's. No handwork and

just a

> > bit faster. Too bad it won't do the allergies.

> >

> > Jim in KC.

> >

> >

> >

> >

> >

> >

[Guest guest]

I've decided it's easier to just keep copies of the Medco and Express forms on file and handwrite the script the first time. Then I open up Amazing Charts and click the update refill button in the medication part of the chart. I agree the mail orders are a tremendous hassle and I do, whenever possible, insist that the patients come by my office and pick up a handwritten script to mail in themselves. There are so many small meaningless insulting details in practicing that I can either get extremely frustrated and angry on a given day, or just do the paperwork simultaneously while I'm answering one of the umpteen calls everyday. I was in a clinic where all this stuff was supposed to be done for me and it rarely was, correctly. It's faster to just do it myself most of the time.

Guinn

[Guest guest]

Right on . !!

I too have worked in clinics where harrassed LVNs and clerks sullenly and grumpily did these "meaningless insulting details" all day.

They hated their work, and it showed. I would end up telling them what to do, then what they did wrong, then re-instructing them to do it right.

It took three times the time.

Unfortunately, my income still went to pay them.

So now I write and print Rx's ( use Alteer);

we keep Medco forms in paperport and print em out, tape Rx on and fax 'em off...

I answer my own phone at times; if my office manager is busy;

make follow up phone calls if it is important enough to me;

make sure the hundreds of little details in charts are done right;

I speak to pharmacists, patients, nursing home nurses and family members - most who are surprised the doctor takes the time to speak with them.

and I also get to see the patients and to enjoy the rich trusting relationships.

And you know?

It's better. It's faster most of the time.

Because it's done properly ( meaning the way I wanted it) the first time.

And if I mess up, or get it wrong, then I learn to do it properly the next time.

At least I am not paying someone else to make mistakes for me.

Dennis Galvon

-----Original Message-----From: phoxtrotter@... Sent: Wednesday, March 24, 2004 8:21 PMTo: Subject: Re: medco prescription hassle.I've decided it's easier to just keep copies of the Medco and Express forms on file and handwrite the script the first time. Then I open up Amazing Charts and click the update refill button in the medication part of the chart. I agree the mail orders are a tremendous hassle and I do, whenever possible, insist that the patients come by my office and pick up a handwritten script to mail in themselves. There are so many small meaningless insulting details in practicing that I can either get extremely frustrated and angry on a given day, or just do the paperwork simultaneously while I'm answering one of the umpteen calls everyday. I was in a clinic where all this stuff was supposed to be done for me and it rarely was, correctly. It's faster to just do it myself most of the time. Guinn