This week’s column includes some of the most read items of the past two years and a few new ones. Happy Memorial Day!
$4,229: The average total savings when using bundled payment programs for surgeries, according to a Rand study of one payer’s program in which procedures including knee and hip replacements, spinal fusion and bariatric weight loss surgeries used a set bundled payment for all care within a 30-day period.
Finding Oneself In A Non-Binary: Healthcare is getting an education on the fly of how to manage and document their encounters with patients who are non-binary. My 78-year-old father just got his lesson after Sophia’s dance recital last week. “I always love watching you kiddo, but I gotta be honest I couldn’t exactly see your plie’s since the boy in front kept blocking my view.” He’s not a boy, papa - he’s a they, Sophia explained. “He’s a what?” A they – non-binary. “I don’t know what he is but he’s certainly not a dancer like you.” “Oh my gosh papa! Let me explain – it is a boy, but he doesn’t want to be identified as that. He’s in the middle if you will. Not a he or a she. “Well he was certainly in the middle of my view.” In healthcare, non-binary is coming up in more patient encounters namely for young patients and teens who are changing from Ava to Atlas and forcing a new world of education for clinicians and office managers. At least most of the documentation is already non-binary, a case manager we spoke to said. “It’s not been a major change in terms of the medical record, but it is a big deal for our clinicians – we lost a few patients because of this.”
Multiple Sclerosis Pilot: Highmark has partnered with AllianceRx Walgreens Prime to launch a Social Determinants of Health (SDoH) pilot outreach program targeted at Highmark members who have multiple sclerosis (MS) and use AllianceRx as their specialty pharmacy. Through a voluntary member survey, the program will identify and notify patients impacted by social risk factors in order to refer them to necessary social or behavioral resources. This program began on April 19th and will initially be one year long, with future phases dependent on the success of the pilot.
Bundle This: A maternity MAT initiative kicks off this month for all OB/GYNs and maternal and fetal medicine doctors in Blue Michigan’s physician performance program, this one focused on addiction. Providers who participate will receive initial funding of $10,000 and will then be eligible for $1,000 per patient treated with medication assisted treatment in 2021.
20% Swing: The difference in reimbursement rates for ABA providers now that BCBS of Texas will begin tiering them for ABA therapy, effective April 2021. RBTs, Board Certified Assistant Behavior Analysts or clinicians with a bachelor’s degree will receive the existing rate, while clinicians with less than a bachelor’s degree and no RBT certification will receive 20% less. BCBAs and master’s level clinicians will receive an increase in rate of 20%.
Toothpaste, GoldFish & Therapy: CVS is adding virtual and in-person behavioral healthcare services in select HealthHUB locations but in a straw poll of shoppers I talked to while waiting for my 13-year-old’s vaccine appointment to end I heard low enthusiasm. Brianna Jenkins, a mom of 4, said “It doesn’t seem too private or calming – I have used telehealth.” Anyone needing services will be connected with a clinical social worker who will do an assessment and refer to specialists if needed. As of now, HealthHUBs are only available in select locations in Houston, Philadelphia, and Tampa but 34 new locations are slated to open in the spring of 2021.
Doctor Amazon?: The online retailer runs health clinics near worksites in Dallas-Fort Worth, Phoenix, Louisville and, more recently, Michigan and California. Amazon’s clinics are operated by Crossover Health and have provided services to over 115,000 workers and their dependents since the program first launched in late 2020. Earlier this month, Amazon also expanded its virtual and in-person care program into 21 states through the company Care Medical.
A Richard Kimble Moment: At about the same time as my oldest son was leading the marching band down main street on Memorial Day a couple years ago my dad was pulling a Richard Kimble back home, wrapping a deep shin wound with one hand using amateur tape and gauze like the Fugitive character, driving himself to the urgent care in what was a race against time. He had fallen in the garden trying to relocate a hosta only to slip or get dizzy and slam his right shin into a rock. He would later tell me he ‘wanted to get it stitched up before mom found out….’ But the so-called 24-7 urgent care was closed—two of them in fact—so I made my way to dad’s house to pick him up. We averted going to the hospital ER, finding the only urgent care open in the region. The PA was sharp, and a great teacher – allowing his assistant, a Bay Path College student, just enough independence to clean the wound and put in 8 stiches on his own, with a small bit of oversight. I think back to Memorial Day – yeah, I missed the barbeque, but I spent a day with a veteran, my dad, and stories about his penchant for falling and first aid. Here’s to all the vets out there.
A Point (From The Archives): My kids complain a lot about how I go down the ‘when I grew up’ road way too often. It’s just so easy sometimes. Helps me make a point, like my latest rant: When I grew up, we ate supper together on Sundays. At 2 o’clock. Not because we were hungry, or it was raining, but because grandma said so. Afterwards, we played kickball ‘til dark. We didn’t have hover boards or Fortnite or Twittergrams or Snapbook. When we fell on the driveway during a game of ‘Red Rover’, mom didn’t rush us to urgent care. There was no urgent care. She layered on three Band Aides and gave you a slice of warmed up apple pie. We didn’t have depression—at least not in the way it’s understood today. Yes, we were sad when the Yankees and Sox were in a rain delay, but dad cheered us up by putting the Polka on the record player and throwing us on his shoulders. We danced. We had a simple life with at most three principles, and I’m pretty sure two of them had something to do with mashed potatoes. We didn’t text or Jabber or FaceTime, we stood by an answering machine hooked up to the rotary dial, replaying Sam’s message because you couldn’t hear the phone number the first dozen times. ‘Download’ was not a word. To hear Survivor’s You Can’t Hold Back, we had to rewind Side B for six seconds, then flip the cassette at least a half dozen times to get to Side A to just the right time. When we were bored, we picked up a shovel and dug a hole, found some worms and put them under my sister’s pillow. Our friends were mostly the seven people we shared the upstairs bathroom with. The same seven we fought with for the Raisin Bran. We wrestled with grandma, played ‘setback’ with papa, and listened to Joe Castiglione call the game on the AM dial. On a good day, I would hold the bunny ears on the RCA, so we could watch the game on TV. What strikes me about then is how strikingly familiar it is to now. Last weekend, I asked Tommy to lean the phone against the wheelbarrow when we weeded the driveway. We listened to a replay of the inning Fisk hit that homerun. We ate spaghetti around two and then played Twister, until the dog peed on the green circle. What’s past is prologue. I would argue that, for some of us lucky enough to be safe and healthy, we aren’t standing still at all as it may seem. We are going back, and there’s some good to come from that...