Have you ever been to a new doctor’s office and been totally impressed by every person that worked there? Totally pleased with the registration and appointment process? Thrilled with the follow-up communication from the entire medical team? Read on, and read with amazement!
About a year ago my family of three moved to the Phoenix area, and I felt it was finally time to cut the ties with my long-time primary care physician back in Tucson. I’d been seeing him since I moved to Arizona in 1987, and even drove over 60 miles to see him regularly during the 3 years I lived in Arizona City, a little dust bowl of a town half way between Tucson and Phoenix. I had an excellent relationship with him, even though his one-doctor/one-nurse practice was embedded in a typically over-crowded larger medical office with a huge staff that seemed to herd everyone through like cattle.
When we first moved to Phoenix, we located a small practice conveniently located near our home, only to learn a couple of months ago that the doctor “no longer works there” when we called for follow-up visits. Frustrated at the lack of communication both prior to and after his departure, I longed for a medical practice that would communicate with me on my terms – easy to talk with, follow-up via Email, great web site with information I can actually use. You know… a health CARE provider. (See the “Back-Story” section below for more.)
I asked for guidance from a Phoenix-based neurologist I’ve known for a few years after some involvement in the IT side of a telemedicine project. One of his recommendations was to consider a “concierge practice”. Wikipedia says “concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer”. I had read a little about concierge medicine before, but I had an impression that this type of healthcare would be way outside of my price range.
Choosing and Signing Up with One Medical
The week after getting the input from my neurologist-friend, I received a flyer in the mail from One Medical Group announcing that they were now open in the Phoenix area. After looking at their web site and exchanging a couple of Emails to them with questions, I decided to try it. The $99 annual fee seemed much more affordable than what I had first thought this would cost!
One Medical Group has three offices in the Phoenix metro area, but the one nearest to me was up in Scottsdale, just under a 30 minute drive from home. Since my experience with my new short-distance provider was pretty bad, I decided that maybe “driving some distance for good service” was a reasonable option, and their flyer and web site promised a full refund if not satisfied. What did I have to lose?
I registered and signed onto the One Medical web site at OneMedical.com, paid their annual fee, and I was now a member. But now what?
Their site guided me through a couple of web pages to submit medical history, current prescriptions, select a primary care provider… and then the most magical button appeared: Appointments! I clicked the link which took me to a page that of course indicated I had no scheduled appointments and no previous appointments, but then I clicked the “Schedule a new appointment” link.
What? Schedule my appointment online, less than 10 minutes after joining? I tried not to rush through the appointment options, but quickly selected “I would like to see my primary care team” (“any available provider” and “specific provider” were the other two options), I selected “Standard Visit” (“Brief Visit” and “Physical Exam” also available), selected “First Available Appointments” (as opposed to “Specify Date”) and typed why I wanted to be seen into the “I want to cover” box, then clicked the “Search” button.
I was then presented with available time slots. Open slots starting the same day! Thirty minutes apart! Really? Thirty minute appointments? I could pick any of several open appointments available over the coming week! I selected a 10:30am appointment for the very next morning, and it was done! Minutes later I received an Email confirmation of my appointment, with the following paragraph at the top:
Thank you for scheduling an appointment with us. Our appointments actually start on time! So please arrive 5 minutes prior to your scheduled appointment to allow time for check-in.
Appointments start on time? That would be new and different!
My First Appointment
The next morning I left home early, not wanting to be late for what I hoped would be a pleasant experience. My appointment was for 10:30am, but traffic was light so I arrived shortly after 10am. The Scottsdale clinic is located adjacent to the Scottsdale Fashion Mall, but they were easy to find, and there were reserved parking spots within a hundred feet of the door. I parked and went in, and was immediately impressed. This didn’t look like a doctor’s office… it looked like the waiting area at a professional business! No lines, and immediately greeted with a smile. Not by someone in medical garb answering the phone and putting everyone on hold and getting interrupted every 15 seconds. No… I had her full attention, and other than requesting my insurance card, it was quick, easy, and done.
Shortly I found myself relaxing in their waiting area – a large, open space, sparsely but professionally decorated with comfortable seats, and floor-to-ceiling glass exposure to the outside. Spacious; not cramped and closed in, like most waiting rooms I’ve been in. A couple of minutes later – ten minutes before my scheduled time, in fact – my doctor appears, greets me, and leads me back to his office.
Wait a minute! Where’s the medical technologist? You know, the person that sits you down in a tightly cramped space with a bunch of equipment, takes your blood pressure, temperature, weight, and asks you why you’re being seen today. Not here, apparently. The doctor greets you and you go straight back to his office.
And oh by the way, he knows why you’re here. You typed it in when you made the appointment, and he has it right in front of him. Yes, on a computer screen. But don’t think for a moment that he’s focused on the computer. He was personable, engaging, and attentive. Yes, he typed into the computer on occasion, but I always felt like the focus was on me. He asked if there was anything additional I needed to discuss beyond what I initially wrote, and I mentioned this spot on my arm my wife wanted me to have looked at. Immediately he leaned forward and began to examine my arm. “I see you were looking for a dermatology referral, and we’ll get that for you, but based on what I see,” and he went on to explain that it appeared to be nothing to worry about, based on a few factors he mentioned, “but since you’ve previously had a history of melanoma, we want to be sure to get the dermatologist’s opinion.” He had read my history!
We discussed lab work, which as a 61 year old diabetic with hypertension, I’m accustomed to getting every 6 months or so. He entered some info on his computer and said, “We can do that lab while you’re here if you like, or you can go to another lab if you prefer.” I indicated I’d go ahead and get it done today, and with another click, he said the lab phlebotomists name and indicated she would draw my lab work shortly. After a little more discussion of my history, we discussed which of my prescriptions needed refilling, and he tapped a little more on the computer and replied, “There you go, the refills will be sent to your pharmacy in a moment.”
As we made the short, direct walk back with my doctor to the waiting room, I noticed it was just a couple of minutes before 11am. I had been in there with the doctor for almost 40 minutes! I was also shocked because normally whoever is the last person to see you (and often it’s a med tech, not the doctor) simply points in the general direction of the exit and hopes you can find your way through the maze. In the waiting room the doctor shook my hand saying, “Welcome again to One Medical, it was great to meet you.”
The In-Office Lab Visit
The phlebotomist was there in less than a minute with the same warm greeting I received from everyone else at One Medical, and she led me back to the lab space. Again a personable, friendly professional. After drawing blood I was handed “the cup”; you know… that cup! But wait, there’s a small fabric bag that goes with it. “When you’re done in the restroom, you put the cup in the bag and place it here” near the lab. Wait! No “public pee shelf” with everyone’s multiple-shades-of-yellow bodily fluids with their names prominently displayed on the outside? The cups are neatly hidden from view, and you don’t even notice them.
But wait, there’s more: the bathroom! This bathroom rivaled those at nice hotels, with small rolled hand towels, hand lotion, very nice (and very clean!) faucet, sink, and… well, everything! Not the institutional-feeling (and sometimes worse) space I’m accustomed to seeing.
After discreetly dropping off my covertly-disguised sample, I stopped by the front desk and paid my co-pay. Yes, after seeing the doctor. And she wanted to make sure I knew that I could contact them with any questions, any time, any way: call or email. “Do you have our app installed?” Yes I did. “You can schedule appointments there, or contact your doctor, or request prescription refills.”
At this point I knew One Medical Group to be exactly what I always hoped for! But the story doesn’t end there.
Out of the office and back in my car (parked in the reserved spot just outside the office, remember?), I checked my Email. I had already received an Email from the One Medical system indicating that my refill prescriptions had indeed been sent to my pharmacy (confirming details on the prescriptions and my pharmacy). Less than an hour later my Walgreens pharmacy app alerted me that my prescriptions were ready for pickup.
But another amazing thing happened. (Have I mentioned I’ve been amazed the whole time?) Thirty minutes after walking out of the One Medical office I receive an Email confirming the approval of my dermatology referral, along with a PDF copy of the referral with information about the provider we had discussed. And then mid-afternoon I received an Email about the cardiology referral I requested.
For some, this amount of communication might seem like overkill, but for me, this is how I like to be communicated with! At the bottom of each of the confirmation Emails is the following notice:
If you would prefer not to exchange personal health information via email, please contact us at the above phone number
So if you don’t want these emails, you can opt out. But what Internet Email troll is going to want to snag my medical-related emails
Maybe some day if I’m rich and famous… but not me, not now.
I had mentioned to the doctor that it was close to a 30 minute drive to their office from my home, but that it was worth the trip. He assured me that for many things we can simply communicate by email, and only come into the office when necessary… and not make an appointment every time we needed to communicate.
If there’s only a $99 per year difference between One Medical and “everyone else”, I’m happy to pay it. It’s certainly not for everyone, but if you’re a busy person, it’s worth that amount to establish a relationship that works.
Two Weeks Later: Prescription Refills
I needed a refill on one of my diabetes medications, and dutifully went to the Walgreen’s app on my iPhone and ordered it on a Sunday evening. Monday morning I got their notice that my prescription wasn’t ready, as they had to contact my doctor since there were no refills remaining. I waiting til the next day.
On Tuesday I stopped by Walgreen’s to ask about the status. Apparently they had sent a FAX to the doctor’s office that wrote the original prescription – my “old doctor”. Now, the middle of the second business day after that, they hadn’t responded!
Immediately (still standing in Walgreens), I called up the One Medical app on my iPhone and clicked the “request a refill” on that specific medicine in my online medical profile, and went on out of the store. Before I could get to my car in the Walgreen’s parking lot, an Email came in from One Medical, telling me that my prescription request was “in process”, and while sometimes it can take as long as 2 days, most such requests are responded to in under 4 hours. One hour later I got another Email from One Medical alerting me that they had communicated my prescription to the pharmacy! And ten minutes later I got an alert from Walgreen’s that my prescription had been refilled!
This is the way healthcare should work.
There is, unfortunately, one thing that didn’t go well. Not with my healthcare from One Medical, but from the One Medical administration staff.
Remember early in my story, I mentioned I exchanged Email with One Medical with some questions? One of those questions was, “are you in-network with my healthcare insurance?” The response I received indicated my healthcare insurance was indeed “in-network.” However, I later found out this was not the case, when my insurance administrators contacted me regarding my attempt to change my Primary Care Physician to my new doctor.
Can’t do it? Damn!
At that point, I spent several hours working in-between my healthcare insurance and One Medical’s administrative staff, attempting to resolve what seemed to be a case of misidentification. “Try this Tax ID,” the One Medical person said. “No, that’s not in our database,” the insurance folks said on the next call. One Medical provided me another Tax ID, which also wasn’t in the provider list. Ultimately the insurance folks said “We’d love to have them as a primary care provider in that area,” and I provided information back to One Medical, hoping they would get on the ball and get in-network.
After two weeks, I called One Medical again, and was told by one person that the application was “in-process”, but of course couldn’t tell me when it would be completed. She gave me an Email address to One Medical’s credentialing department, the folks responsible for insurance contracts and such.
The credentialing office sent me several emails in the process of researching, but ultimately the answer boiled down to this (I’m paraphrasing parts of several emails):
We are not in-network for your provider, and we are not pursuing a relationship with them to become in-network. You are welcome to see us as an out-of-network provider, or change your insurance plan during your next enrolment period.
So now what? I experienced the most responsive, personal healthcare in all respects, and now it seems if I want to continue, I have to pay a premium price on top of their smallish membership fee. It’s kind of like getting a free weekend stay at a fancy hotel, and on check-out being offered future stays at an exorbitant price.
My recommendation: find out for sure if they are in-network for your healthcare insurance, and if so, give them a try by joining up. If they can get their administrative team to be as effective as their medical team, it’ll be worth it.
One Medical’s web site is here.
Back-Story to “Why A New PCP?”
Here’s a little background information about why I began searching for “a better way to receive health care.”
Around Labor Day last year my family and I moved to the Phoenix area. We selected a small one-physician office not far from where we live, and this office is a part of a larger practice with several offices around the metro area.
During our visits over the last 9-10 months, each of us – myself, my wife, and our 20 year old son – were prescribed a variety of new medications and asked to undergo a few new test procedures. My wife asked me to call and set up a follow up appointment for her, which I attempted on a Friday mid-June.
When I reached the scheduling line and asked to make an appointment with our doctor, I was informed he left the practice three weeks ago, and I was offered an appointment with a PA – a name I’d never heard before. (We had seen an NP at this office before, but this was not the same person.)
Since I was calling on behalf of my wife, I indicated I would need to confer with her before proceeding, and well – that was the end of it.
I’m surprised that nobody has called or written us informing us of the doctor’s departure, and no instruction on “what the heck do we do now with our ‘care in progress’?” And while I didn’t have the presence of mind to ask, it also surprises me that no “transition plan” or other guidance was offered during my phone call Friday.
The following Monday we dropped by the doctor’s office, and greeted by a new receptionist. After some friendly get-acquainted chat, we asked who – if anyone – was still in the office. Apparently, only one person still worked there that we knew. Everyone else – doctor, NP, their intake person (who I’m relatively sure was not a nurse, and hardly even seemed trained as a med tech most of the time) – was gone. There was only the PA to be seen, and so we made a follow-up appointment with her.
At the appointment a few days later, my wife was told that the PA didn’t necessarily have the background to do follow-up care on some of the medications the previous doctor had prescribed, and simply referred her to the compound pharmacy for any follow-up questions. At least she was honest and open about it, but still… three months into a six-month course of medications, my wife felt a little abandoned.
After doing some research, I was amazed to learn that it is not a requirement for the physician who supervises and oversees a Physician Assistant to be “on site” with the PA. Think “remote worker” whose supervisor works at another facility. I guess this is okay as long as you trust your PA to communicate with the physician whenever there’s a question, but given our previous history and lack of communication from this overall medical practice, we decided we needed to look elsewhere for health care.