56%: Cataract surgery costs this much more when performed in a hospital outpatient department compared to an ASC. This is according to data from the BCBS Association. Analysis was performed on claims data for six common outpatient procedures across 133 million BCBS members from 2017 to 2022, which showed costs are consistently higher when procedures are performed in the hospital versus a lower site of care. Differences ranged between 31% more for clinical visits in the HOPD to 58% more for diagnostic colonoscopies.
Closing The Gap: A new incentive program BCBS of NC started this year focuses on closing care gaps for D-SNP members. Providers can receive $100 for each care gap closed – things like cancer screening, eye exams, and controlling high blood pressure. Providers will also receive another $200 for completing annual planned visits. Payments will be made in spring 2024 for services provided between September 1 and December 31 this year.
Off On The Wrong One Of These: So the average US adult has about 205 bones in their body and believe it or not, about one-quarter of them are concentrated in this one spot. Any guess? It's the most important tool you have to get from your bedroom to the bathroom every morning. Your two feet have combined about 50 bones. Foot and ankle injury and chronic ankle and foot pain both before and after surgery are among the most underappreciated challenges in health care spend. "A sprain is worse than a break and a break is awful," my cousin Mark, a doctor of PT at Mass General always tells me. On Wednesday in Dorchester, Massachusetts I heard union reps at a Labor Guild meeting say that more of their 50,000 workers are suffering with addiction due to pain from foot and ankle issues. "It never subsides, no amount of massage and PT really do it," one worker dealing with opioid use said. Insurers, meanwhile, would like to find ways to manage the spend but it's difficult. It's hard for them to figure out what the true time of the episode is for bundled payment purposes.
Linking Menopause: A new survey by Delta Dental highlights that 84% of women 50 and older are unaware that menopause can lead to oral health complications. Decreases in estrogen and progesterone throughout menopause commonly lead to dry mouth, an increase in cavities and sensitivity, and tooth decay. The survey aims to raise awareness and encourage women experiencing menopausal symptoms to discuss their oral health changes with their providers.
Wait For It: Patients are spending a longer time in the ER, according to data from CMS. Data from the most recent 12-month period, ending in the third quarter of 2022, shows that the median time nationwide was 2 hours, and 40 minutes, compared to 2 hours, and 18 minutes back in 2014. Times varied quite a bit between states. Average ER wait times were the longest in DC, at 5 hours, 29 minutes, and lowest in North Dakota at 1 hour, 48 minutes. It's not just a worker shortage that's the issue. If you dive deeper, that wait time is indirectly linked to the flood of youth and young adults coming in with overdoses and vomiting from vaping. Charlene Vega, associate director of nursing for the Massachusetts Nursing Association, says at her hospital things like synthetic marijuana 30x stronger than THC are bringing 12-year-olds into the ED with seizures and kidney failure. The waits, she says, are usually the less urgent cases.
Voice Journal: AI-powered tools are now being used to help screen for mental health conditions. The tech company Kintsugi recently conducted a pilot with a large health insurer that used data from 250,000 people who made voice journals to identify those at risk of depression. The National Health System in the United Kingdom is utilizing an “e-triage” tool from Limbic to screen patients across the eight most common mental health disorders. So far, they’ve found that misdiagnosis is down, along with fewer treatment changes. Limbic is presumably named for the brain's system that hosts our memories and our impulsive, irrational thoughts.
Lower Reimbursement: Beginning December 1, Aetna will no longer allow additional payment for E&M services when billed by a radiologist for commercial and Medicare members. Also beginning in December, the health plan will only reimburse physical therapy assistants and occupational therapy assistants at 85% of the allowed amount, a change many other payers, including Medicare, have already made.
Tailored Meal: Kroger Health is expanding into the food-as-medicine space by partnering with Performance Kitchen to offer medically tailored meals and support from their registered dieticians to people with chronic conditions.
Hospitals Align: Terre Haute, Indiana, home of Indiana State University and the greatest basketball player ever, at least from my vantage point, will soon have less hospital competition for its 60,000 citizens as Union Health has agreed to buy Terre Haute Regional Hospital from HCA Healthcare. Union would then own every hospital in the city, which could be a challenge for Indiana health insurers. In related news, Dana-Farber Cancer Institute is partnering with Beth Israel Deaconess on a new standalone cancer hospital, which will move inpatient cancer care away from Brigham and Women’s. Dana Farber has long been partnered with Brigham and Women’s.
Extra Point: If only we all just had more Neti pot. Wait, no no - I don't mean more pot. That would be awful given how the youth of America are flooding hospitals these days, sick from too much cannabis and fentanyl in their system, and addicted to a behavior that may not make sense until you see what today's youth see and hear on social media. No, no. I'm talking about the actual neti pot - this green plastic, mini teapot contraption my wife brought home in 2012. She asked me to come over to the kitchen sink. "We're going to try this new thing," she said with that look of 'stay with me Bry - I know you think I'm ridiculous'. "It's called the Neti Pot and it's going to help us clear out our mucus problem." So, naturally, I’m like, "I didn’t know I had a mucus problem." She holds up the pot and says "here's what we do...fill it with water, then you're supposed to tilt your head to the side and back a bit, then take the spout and put it up your nose. It's going to go up and out the other nostril. She begins to have the suppressed laughter I used to have in front of the altar on the way to communion. But I’m like, "What do you mean WE?" Then with a straight face, she says to me, "You go first." Now I’m a good sport with a lot of things and so I fill the green plastic pot with water, tilt my head back and to the side a bit, and after a deep breath and a look of fear, I take that elephant-trunk looking stem and put it up my nose. My eyes begin crying, water is flowing out of my nose and ears I think but then, just like that, I'm done. Supposedly mucus and allergy-free. Bridget is laughing the entire time and I say, "Ok. Your turn." And she says, "Oh no. I’m not doing that. No." Now mucus is a problem in society. Perhaps not on the level of fentanyl addiction and cannabis addiction, but it's an issue. If you've spent any time in an urgent care waiting room you know that at least 60% of the people are in there because they have a stuffy nose or some respiratory symptoms and potentially chronic mucus issues. My grandma would call it phlegm. "Give it a good blow - you got a lot phlegm you do," she'd say. That was the last time we used the Neti pot. It sat on the 3rd shelf of our coffee cup cabinet for a few years, probably jealous every time we opened up and grabbed a mug instead. I never could see myself getting addicted to jamming a mini teapot up my nose for a daily drowning. Then again, as addictions go, it seems quite a bit healthier and perhaps a real health system cost saver than say inhaling a rag of gasoline because you are a bit lost and unsure where you fit, and the other kids said it feels amazing.