490,000: The number of surprise billing disputes submitted by providers and insurers from April 2022 through June 2023. 61% of those are still unresolved, according to a new report from the Government Accountability Office. A single disputed claim can take up to six months to settle.
Broken Record: By the end of the year, the FDA is expected to have approved 51 specialty drugs in 2023, which would break the previous record of 40 approvals back in 2021.
No Room At The Inn: 80% of mental health provider listings in Medicare Advantage directories are inaccurate or, as a recent Senate Committee on Finance found, lead the patient to a psych professional who isn’t taking patients. These so-called shadow networks are even more prevalent in the commercial population where, in places like Washington state, psychiatrist panels are full when patients call. Digital/tele companies are trying to fill the gaps.
Wait For It: WeightWatchers launched a telehealth service last week focused on GLP-1 medications. WW acquired telehealth weight loss provider Sequence in March - clinicians will prescribe eligible patients GLP-1s and other weight loss drugs along with a behavioral program focused on nutrition and physical activity. The program can be used by anyone on GLP-1 drugs regardless of who prescribed them. Several other telehealth companies have also jumped on the GLP-1 trend. Some self-insured employers and health insurers are closely monitoring the uptick in utilization and likely adjust coverage requirements next year as spend rises.
Nursing Home Star: A handful of nursing homes with low STAR ratings are actually in close partnerships with hospitals to take their highest risk patients – those on vents, trachs, and with complex substance use addiction. Interestingly, the hospitals find these low STAR ratings irrelevant because these nursing homes have changed capabilities to take the higher risk off their hands. “We round in the hospital, go see the patient, help with the discharge – the hospitals really just want to avoid the bounceback readmission penalty,” Alice King, a care coordinator told us. Many SNFs are closing or struggling - St. Louis’s largest nursing home, which housed 170 residents, closed suddenly last Friday, forcing transfers for the residents of Northview Village Nursing Home to other centers. The shutdown followed an employee walkout after 130 employees went unpaid. From 2020 to August 2023, 579 nursing facilities have closed, according to CMS Quality and Certification Oversight Reports data. Nursing facilities will likely continue to face staffing challenges in 2024, particularly in the wake of CMS’ proposed minimum staffing rule. 94% of nursing homes across the country do not currently meet at least one of the requirements.
Closing Time: VillageMD, the primary care provider backed by Walgreens, is closing its 12 locations across Indiana following Walgreens’ cost-cutting plan announced in October. VillageMD closed 10 clinics in the Jacksonville, Florida area earlier this month and plans to close 60 locations in five different markets. Amid primary care closures, the demand for services is rising and so is consumer frustration - with an average wait time of 21 days to see a family medicine doctor, according to an AMN Physician study. Patients, especially younger ones, are turning to urgent care and retail primary care to dodge the wait. Our consumer report, coming out in January, will talk about these trends that are far more pronounced in specialty care – including a 320-day gap for a patient to see a cardiologist for an initial visit after getting a referral from his internist.
Brush Rush: A review of 15 clinical trials found that "rigorous, regular" daily toothbrushing was associated with a 33% lower risk of hospital-acquired pneumonia among patients on ventilators, according to a study in JAMA Internal Medicine. Brushing patients’ teeth also was associated with a 20% lower mortality rate and shorter ICU stays. Maybe toothbrushes should be the must-have stocking stuffer this year. Santa, did you hear that?
Extra Point (From The Archives): Great Aunt Mary used to hate this time of year. “I don’t get what all the gifts are about – I have everything I need right here,” she’d tell me, pointing to her Virginia slim cigarettes and mini powdered donuts. “Mary!” my Uncle Auggie would say, “it’s not about what you have, it’s about giving to others.” She would shrug with a distasteful Ebenezer look and puff on the cigarette. But every once in a while, Mary would surprise me. “Comere kid – you play Gin right? Let’s play Carmella. She has the dementia so it’s an easy win.” My aunt Adeline once described Mary as a real-life dry heave. To her face. You can’t make this up. We would see Mary at Sunday suppers throughout the year but never on Christmas Eve or Christmas Day. Mary was a nurse, an LPN, over at the Mercy Medical Center in Springfield, Massachusetts. She worked double shifts on those days. “Someone has to,” she’d say. When I was old enough, I interned there in the early 90s and I remember visiting the hospital on Christmas Day for a small holiday party for staff. Mary wasn’t there at the party. I was told she was sitting bedside with a patient up on the 8th floor of the 300 bed hospital. Best I could see, she was holding a full house in her left hand, and holding the patient’s hand with her right. I’m not sure I miss Mary in the way you miss the fun aunt who gets down on the floor and plays football with you and races matchbox cars, but I bet her patients miss her. She wasn’t exactly the model of compassion we talk about, but she was there. On Christmas. And I suppose as I think about it, maybe Mary was the gift.