50: The percent of alcohol sales growth across the country that addiction recovery provider, Eleanor Health, has noted since the virus started. “People are using more substances to cope,” Nzinga Harrison, MD, Chief Medical Officer, reported live on our behavioral health forum April 3rd. “We know this is a high stress time.” Harrison said that the company’s value-based structure has been helpful to stay in touch with patients and continue providing services. If you missed, reach out for a recording.
Sepsis Implications: An untreated UTI can lead to sepsis, and a family doctor running a small solo practice with three allied health colleagues in Georgia’s upper northwest corner says they’ve already had one patient from their small community be admitted to the nearby Polk Medical Center for this reason. “UTIs normally get treated, but people are staying home, running fevers, or getting aches and pains or chills, and it could be a UTI,” says Susan Sumner, MD, a family doctor at Cave Spring Medical Center. Sumner says she’s struggling to educate patients about when to come in. “We’re looking at far worse problems, due to the infections, if these UTIs aren’t treated,” Dr. Sumner says.
Advance Pay for Docs: More commercial insurers are contemplating advance payments to help their providers. Blue Cross of Michigan is accelerating payments to more than 20,000 primary care and specialist doctors across the state who are part of its Physician Group Incentive Program (PGIP). The PGIP program has a set amount of funding for each year that physician organizations can earn through performance, and this year, Blue Michigan is advancing funds that would have been spent later in 2020 to give PGIP-affiliated physician organizations the immediate financial means to purchase equipment needed to test and treat patients, and to pay physicians for the care they’re providing through telehealth. Other insurers are creating similar local programs, like Blue Idaho, who is providing payments to independent practices, and Blue Shield of California.
Two is Better Than One: Lou Costello would not be “On First” without Bud Abbott, while Patrick McEnroe was way better at doubles, and far funnier as a commentator, when his brother was beside him. Ringo, well - he wasn’t a star until The Beatles. And so, does it surprise anyone that in a broad poll we did of more than 11,000 physicians and therapists from small or solo practices, 58% said the virus has made them rethink the idea of joining a larger practice?
Autism’s New Model: Parents with children on the spectrum are finding themselves thrust into at-home applied behavioral analysis and learning “to be a therapist” on the fly, like Sam Francis, one dad we talked to last week who says he was “up all night” taking a training course to help his 9-year-old son who “used to go to the center 25 hours a week.” “Long-term, the gates have been opened for tele ABA,” according to James Craig, an LCSW and former VP of Clinical Autism Services at Beacon Health Options. Craig, who spoke on our behavioral health call April 3rd, said this means both direct-to-patient clinical services as well as parent training. Studies show that tele ABA can be just as effective as in-person care, even though use of it was limited before the crisis. This should change, and this is a good development, Craig said, especially after health plans have time to study what is, and is not, working. For clinic-based ABA, this likely further accelerates the importance of diversifying services and may accelerate discussions about the appropriate level of reimbursement and payment structure, as more care shifts to a home, community, and tele model, rather than center plus home.
Post Pandemic: In a bit of depressing but not-that-surprising validation of trends already unfolding, 68% of 13,209 readers polled last week said that increasing incidence of alcohol addiction is the most likely result of the pandemic, based on a list of eight options. Divorce or separation was the second most likely scenario, according to 15%. In fact, a marital therapist we spoke with said her caseload has doubled. Colleges waiving SAT requirements was the third most likely scenario, which may benefit all those class presidents with 2.9 GPAs. Several colleges, like the University of Oregon, have already said SATs are optional, since juniors haven’t gotten a chance to take them yet. Only 8% said we’d “go back to normal,” while 23% said PTSD likely surges, limiting participation in things like public transportation, youth sports gatherings, or Uber sharing, although 40% said the isolation now likely spurs more interaction than ever after the pandemic lifts, and “actually starts to limit use of technology” among youth and adults.
Oral Health Tele Option: BCBS of Kansas sent out an email saying that their expanded telehealth reimbursement policies include dental services, at least those that are “medically reasonable to be provided via telehealth.” There will be no cost to members for these audio-visual dental services for the foreseeable future. BCBS of Florida is reimbursing virtual dental care visits at no cost to patients through June 30, 2020.
Staffing Care Contrast: Vanderbilt University Medical Center is seeking to add temporary nurses to its clinical workforce, in order to battle COVID-19, just as Williamson Medical Center, 20 miles south in Franklin, TN, says it’s furloughing over 200 of their 1,250 employees, due to a significant reduction in volume for patient visits and procedures. Vanderbilt’s center has already had 78 employees test positive for the virus and has administered nearly half of all tests in Tennessee.
Around the Horn: Allergist Kristin Sokol in Rockville, Maryland says a lot of patients are telling her through her Doxy.me app that they think they have coronavirus, but she thinks it’s more likely an allergy symptom. Deciphering isn’t easy. Sokol’s practice looks up records from the prior year to check if the patients are having similar symptoms. ChenMed, which provides services to a large population of chronically-ill Medicare patients, has been dropping off iPads to patients who lack virtual capability to try and engage, while RWJBarnabas Health in New Jersey is doing robocalls to educate patients about both the virus and related symptoms.
Extra Point: So, hearing Dr. Sumner in this week’s edition talk about the challenges associated with deciphering between coronavirus symptoms and symptoms for other things, like allergies or UTIs, is really important. My bride wonders if “dummy” is a symptom too. I suppose she’s probably referring to the ivy-looking plant garden I wrestled last weekend because I was running out of things to hammer. Now I feel like I have more ivy on me than a Wrigley field, which prompted Janine to Google “rash, itchy, and coronavirus.” I suppose I can’t blame her, but there are only so many ways that I can get out energy these days. At least our kids are finding safer ways to manage my activities. Like here, they successfully dashed my hopes of a second career dancing on Jennifer Lopez’s next world tour.