71/100: The portion of cardiologists from our national poll who are in the process of or contemplating whether to enter an affiliation with the local hospital to tap into EMR upgrades, reimbursement increases, and referral volume. 19 are contemplating merging with other groups, staying independent, and finding a way to partner with health plans, and 10 will retire. Of those looking to align with hospitals, the insurer isn’t surprised but wonders about cost – that Duplex ultrasound to test for a leg clot in a 79-year-old 2 weeks after quadruple bypass may be necessary, but at a 3x higher cost when done in the hospital.
How Urgent Is It? The next great challenge for the healthcare system may just be figuring out how to get patients into treatment after they end up at an urgent care psych center or call into the 988 suicide hotline. The wave of urgent care psych centers is growing – 5 years ago there were less than a dozen in the US and some filled up so quickly with commercial patients that their intent of serving the uninsured failed, like at the Mental Health Cooperative in Nashville. Efforts by hospital systems to open these with funding from corporate support, including pro sports teams like the Miami Dolphins and insurers like BCBS of Florida, are likely to grow. But as is the MO for US healthcare, we fix one problem and create another – calls to some of the operators at these centers suggest difficulty placing patients into a bed or the right level of care quickly enough and sometimes given their suicidality, they up in the hospital anyways. It will be important for these centers to establish local and regional partners – PHPs, RTCs and outpatient psychiatrists if possible.
Double Trouble: A BCBS of Massachusetts study has found that the insurer’s annual spend on mental health services doubled from $610M in 2019 to $1.3B in 2022. BCBS MA also says to meet demand its mental health provider network has grown by over 50% in the last 5 years and now includes more than 18K clinicians. Other Blues say spend has grown from 1-2% to 6-8% of total medical in recent years.
Lifting The Cloud: Google Cloud and Mayo Clinic have partnered to develop a generative AI-enabled enterprise search capability for the system’s healthcare providers and researchers, with the goal of making it easier for clinicians to access critical medical information at the point of care. Cardon Health announced this week it is introducing an AI-enabled voice-to-text- tool to help clinicians write medical notes in its electronic health record system.
Drug Price Change: In case you missed it, insurer Highmark in September will move from a tiered pricing model for generic and brand drugs or biologicals to a standardized reimbursement method based on the average sales price plus 20%. The change applies to facilities and physicians. ASP, according to some studies, can be up to 30 percent below AWP at the median for brand drugs and 70 percent below AWP for generics.
Extra Point: There is an air of frustration seeping through society lately but I’m hopeful it will fade. A pair of doubles tennis players smacked a ball toward the baseline after losing a game at the French Open last week, only to be disqualified because the yellow ball hit one of the ball girls in the head. A few nurses in London have been suspended for kicking uncooperative patients and a doctor was docked pay reportedly at an Iowa medical center for kicking the monitor because it wasn’t bringing up the patient’s medical history. I can actually relate – as a high school senior in 1990, I kicked a basketball that ended up ricocheting off the wall and landing on poor Heather Duckett’s head, knocking out the cheerleader. This not only hurt my chances of Heather agreeing to go to prom with me, but I was suspended from the next game. In healthcare, there seems to be a bubbling of frustration up and down the health system about the cost of labor, the long hours, and difficulty getting attention of government and commercial payers to help out. There’s no one solution but you’ll kick yourself if you’re not preparing data about how you save these insurers medical, pharmacy and social costs – are you using your influence, data and staff to bend the cost curve – like sending a staffer home to do a follow up visit with seniors who don’t come into appointments with a caregiver. Said a friend who manages contracting for a BCBS plan, “I think there are situations when we should absolutely increase reimbursement if you can show how you help save downstream costs – otherwise, as frustrating as it seems, probably not.”