25: The number of retail pharmacies health system Intermountain is closing, citing declining business and a new deal with CVS Health. Intermountain will keep its pharmacy at Primary Children’s Hospital in Salt Lake City open as a home delivery, retail, and specialty pharmacy. All others will transfer inventory and patient files over to CVS by August.
Spartan Care: Michigan State University Health Care is partnering with Everside Health, a direct primary care provider, to provide employer-sponsored health plans with access to direct and virtual primary care across the state. Employers who choose to participate will pay a fixed cost per employee for 24/7 access to PCPs. The companies say the model is intended to complement employer-sponsored insurance, not replace it.
Onsite Doc Trend: General Motors is opening a new primary care center for its employees on July 19, contracting with Henry Ford Health System to staff the car maker’s Warren Tech Center in Detroit. GM is part of a growing group of large employers who are choosing to bring doctors to or near their workplaces. According to data from Mercer, more than 31% of employers with over 5,000 employees now offer direct primary care services. If you’re a physician practice or outpatient service like a PT clinic, perhaps these major manufacturing companies ought to be on your target list. Build on site, and you’re suddenly exclusive, but keep in mind how insurers will think of these. They may improve access and adherence, but will they lead to overutilization?
Pre-tests Now Included in Payment: Starting this October, Horizon BCBS is changing its pre-procedure testing reimbursement policy and this impacts a broad range of providers, including physicians that own ASCs. Any testing that is done on the day of or within the 72-hour period prior to the day of a patient’s scheduled outpatient procedure, including COVID-19 testing, will no longer be considered for separate reimbursement. This impacts all fully insured commercial and MA members, and covers any testing done for procedures performed in the hospital setting, as well as any ASCs or urgent care centers affiliated with a health system.
Observation an Unsung Quality Measure: Observation in the hospital is one of the key ways physician practices taking risk for admissions can lower total cost of care. When you’re dealing with Medicare patients with chronic disease and other effects of aging, there are going to be events that bring you to the hospital. It’s just a fact. Ensuring more use of observation over actual admissions is important, Michael Yanuck, MD, often told me. “Important to look at your observation status numbers” as a quality measure. Some insurers are adjusting their policies to help. In Louisiana, the BCBS plan has just increased the payment limit from 30 hours to a maximum of 48 hours. The clock begins when the patient arrives at the hospital for outpatient services, not when observation status begins.
It Takes a Village: Walgreens and Village Medical are making good on their plan to open 600 Village Medical at Walgreens clinics over the next four years. The companies have already opened 46 locations in 2021 and just announced plans to open 29 more clinics in Houston, Austin, and El Paso by the end of the year.
Extra Point: Aunt Theresa took me into Dunkin Donuts one time, walked behind the counter and started pouring two cups of coffee. “Maam. Maam! You can’t do that.” Aunt Theresa said, “I know I look frail honey, but this old girl still can pour coffee.” She dropped a sock full of nickels on the counter and said, “let’s go.” At Sunday brunch in Fairlawn one time back in the late 70s Theresa’s cigarette ashes fell into my scrambled eggs. “Um, Aunt Theresa, your cigarette….” “Oh, it’s fine dear. Just mix it up like this, it’ll look like pepper.” Aunt Theresa was a housewife for most of her life until Uncle Richard died at 57. “He never passed the meatballs, that was his problem, but boy I miss the ole’ joker.” Aunt Theresa played three sports in high school and worked at a Sunoco to pay her way through community college in the mid-1940s. She sang in the choir for 30 years down at Sacred Heart in Holyoke and used to heckle Father Burns during his homily’s. “I don’t agree with that – that’s not right – no way did Jesus do that” she would holler from the pew. “Let’s move it along Father – I can smell the donuts in hall!” She walked 5-10 miles a day raising two kids and two foster kids, but after Uncle Richard died her health declined and her bad habits picked up. She’s had more than a dozen surgeries in the last 25 years, some for her eyes, some her knees, once on her big toe. But for some reason she’s 96 and still going and on Saturday she fumbled her way to the kitchen with her walker, kicked the dog, cut one piece of blueberry pie, put it on a plate, then grabbed the rest of the pie and took that back to kitchen table. “What?” she said, giving us a look for questioning her greediness. “I figured I’d save a piece for later…..now which one of you is going to lose at Setback?” Managing aging family is awfully difficult these days and for many of us it’s a strain on our families and our own health, but sometimes you get an Aunt Theresa who may have a sharp edge and an abrasive style, but she tells it like it is. And I’m going to miss the ole gal.