When a patient reported “a blood clot, pain and swelling,” call center staff scheduled an appointment rather than escalating the problem for medical evaluation, according to a note in a worksheet. internal incident tracking calculation dated February 19.
Over the next two days, clinical staff reported four more call center errors involving elderly patients with urgent complaints, including stomach pain and blood in the stool, increased blood pressure, an insect bite and sudden pain in the ribs, depending on the internal spreadsheet.
Call center incidents were among dozens reported by One Medical Seniors doctors, nurses and aides between Feb. 19 and March 18 in the documents, a year after Amazon acquired the primary care service. One Medical began routing elderly patients to the Tempe, Arizona, call center with in part by newly hired contractors with limited training and little or no medical experience, according to internal documents viewed by The Post and interviews with four current and former One Medical employees.
Since Amazon officially acquired One Medical in February 2023 in a $3.9 billion deal, the company has alarmed patients and employees by eliminating free rides, shortening appointments and by laying off staff. Now, evidence of life-threatening situations at the Tempe call center is raising new concerns that Amazon’s frugal approach to health care could jeopardize patient safety.
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“A lot of things fell through the cracks,” said a former One Medical employee, who, like others interviewed for this article, spoke on condition of anonymity to avoid professional retaliation.
With its dedication to “customer obsession” and convenience, Amazon says it can add value to the failing U.S. healthcare system, plagued by long waits, high costs and widespread inefficiencies. But since entering the health care business in 2018, Amazon has struggled to protect patient privacy, provide quality care and find a business model that works for customers.
In April, Amazon CEO Andy Jassy acknowledged that the company’s approach to health care “can seem haphazard at times.” But he said he remains optimistic and Amazon has recently stepped up its efforts, offering discounts on One Medical membership to Prime members.
When Amazon acquired One Medical, it included two businesses: a $199-a-year, premium subscription-based primary care service that lets patients use an app to make doctor appointments at clinics across the United States and Iora Health, a clinic aimed largely at patients with chronic illnesses. dependent on Medicare.
In 2022, the year Amazon bought One Medical, Medicare funding accounted for just over half of its $1.05 billion annual revenue. Amazon declined to provide updated figures to the Post.
Amazon said it created the Tempe call center for its elderly patients last year “to improve access and quality of care.” Amazon founder Jeff Bezos owns The Post.
Invited to respond to incidents, Amazon spokesperson Dawn Brun responded via email: “While we are confident in our security protocol…we take feedback from our suppliers seriously and will always address anything that is not a wonderful experience. » Brun added that Amazon does not get involved in decisions regarding One Medical’s patient care.
Amazon said it is not aware of any patients who have been harmed due to call center errors.
Natalie Benda, an assistant professor at the Columbia School of Nursing, said creating a call center like the one in Tempe could actually improve patients’ access to medical care. But “if it’s not done by someone who is trained appropriately,” she said, “I can see how that would pose a patient safety issue.”
Internally, the Tempe call center is called “Mission Control.” Calls are answered by a mix of full-time employees and contract workers hired by Teksystems, a personnel placement agency.
Contract workers are not required to have experience in the medical field and the main qualifications are being able to use a computer and telephone, according to job postings and two staff members who have worked in the call center. Call center employees undergo two weeks of classroom training before they begin taking patient calls, according to a former call center employee, who spoke on the condition of anonymity for fear of retaliation.
Amazon said its contractors take calls under supervision for two weeks after classroom training, followed by a week of coaching. The company pointed to job postings stating that new hires should be “comfortable navigating or learning anything related to healthcare.” Amazon said it is more efficient to hire through Teksystems, which has its own sick leave policy, and that its training program is adequate.
One Medical’s competitors in primary geriatric care, CVS’ Oak Street Health and ChenMed also use call centers to respond to patient inquiries. (Archwell Health, another competitor, allows patients to make calls directly to clinics.)
According to training documents obtained by The Post, One Medical is aware that “speaking with someone outside the practice may raise concerns about delays in care or patient diligence,” particularly for patients who previously could call directly to their doctor’s office.
“We do not need to draw attention” to who is “managing patient concerns,” the documents state. “However, if a concern is expressed, our goal is to reassure the patient that we are a trained and competent medical support specialist and part of their care team.”
But two former call center employees called the guidelines misleading and disputed the assertion that call center workers are sufficiently “trained and competent” to handle patient calls.
One, who worked as a manager, said the company was trying to cram too much information into two weeks of class. He said he suggested extending the training period and hiring more employees directly rather than as contractors, but management rejected his request.
“What I told them is good, but understand that if we try to kick these people out of these classrooms, you’re going to have an increase in patient safety issues. Which we did,” said the manager, who said he was fired in March.
According to One Medical training documents viewed by The Post, if an elderly patient calls with one of 17 “alert” symptoms such as shortness of breath or a sudden headache, call center employees are supposed to forward the call to One Medical’s virtual medical staff.
But identifying these symptoms when talking to patients can be difficult, current and former One Medical members said. As a result, some patients “should have been triaged to the emergency room or urgent care, and that wasn’t the case,” the Colorado-based former employee said.
For example, on March 7, a doctor in Colorado reported a call from a patient experiencing chest tightness. According to the spreadsheet, the call center employee had scheduled an appointment at the office the next day.
The first of 17 warning symptoms is “chest pain/pressure/heaviness”. The doctor who reported the call stressed that it should have been escalated and expressed concern that call center staff do not “understand that they are triaging patients themselves.”
Such errors increased concerns that call center staff were making medical decisions they were not qualified to make, current and former employees said.
Amazon said the call center employee involved in the incident was retrained and the patient was not injured.
“I don’t want Amazon to take care of me”
Amazon said it created the Tempe call center as part of a centralized support system intended to respond to patient phone calls more quickly and allow clinic staff to focus on patients. The company said patient visits have increased recently, from about five per day per doctor to up to 14 per day.
But not all One Medical patients view these changes as an improvement.
Late last year, Mary Ann Stone, 92, suffered confusion, pain, affected bowels and recurring urinary tract infections – symptoms her daughter said were “difficult to describe to a clinic.” calls, especially to a call center that has no experience with these types of symptoms. thing. »
A doctor encouraged her to come make an appointment, but Stone ultimately ended up in the hospital. Her daughter said she doesn’t blame One Medical, but that she wishes she had taken her mother there sooner: Stone died in March.
“I don’t want anyone to have to go through this,” said the girl, who requested anonymity because she fears retaliation. “I don’t want Amazon to take care of me.”
A Colorado patient who said he called One Medical three times and waited between 30 and 90 minutes to speak to someone was “concerned about the lack of access to communications,” according to internal documents. Another patient’s daughter said she was concerned that her mother would “not try to contact (One Medical Seniors) for medical issues if she thinks no one will respond,” according to incident reports.
Marilyn covered, 79 years old, a patient at One Medical in Shoreline, Wash., said she waited hours to get a call back about her thyroid medication. “It’s frustrating,” said Overcast, who said she was also shocked when her doctor abruptly left the company.
Amazon said One Medical’s clinicians operate independently of Amazon and that “quality of care and positive health outcomes are their number one priority.”