27: The number of urgent care centers Providence health system closed in Southern California this month, citing staffing challenges, inflation and increased competition. The health system’s virtual services will still be available to patients, as well as their in-person primary care services. As payers and providers continue to push virtual first options, we wonder if we’ll see more of these closures in other markets.
Stuck In Bed: Hospitals are struggling to discharge patients because of healthcare staffing shortages downstream, leaving many patients stuck in a bed they don’t truly need. For health systems, this is leading to significant costs – one hospital in Washington is on track to spend almost $18 million this year on nursing care for patients who no longer need to be hospitalized but can’t find a post-acute facility with room to accept them. Skilled nursing facilities are rejecting patient referrals from hospitals at higher rates than before the pandemic, data from WellSky shows.
Text Me: A study recently published in JAMA found that using a 30-day automated text messaging support program after hospital discharge led to a significant decrease in the need for post-acute services. The analysis looked at 1,885 patients representing 2,617 hospital discharges and through the text program, there were 41% lower odds that a patient needed additional resources.
Virtual Consolidation – Is It Good For Patients & OP Practices?: Amwell is reportedly in talks to purchase Talkspace, the behavioral health focused virtual company that started as a consumer-focused model but was among the first to get contracts with payers and promoted as a telehealth option for PCPs who had patients in the room with depression. It has 86 million eligible lives, and the potential merging represents a broader theme – payers buying generalist telehealth, and these telehealth companies buying specialty services, like dermatology or PT. For office-based practices, there are 2 questions—can you get on the shortlist for referrals, and will these companies “replace” your volume? For patients, it’s the same question – will this consolidation make it easier or harder to get good treatment and service, or will there be more “hoops to go through”?
VBC for Dummies: An office practice in Delaware is trying to move into value-based care and is using a service paid for by a Delaware insurer here to help them do work in simple steps to close gaps in care, like what the office manager should do first and say first after the patient with Type II diabetes finishes appointment, or what the medical scribe should do before an exam ends. The workflow support is color coded, and each task is assigned a dollar value that the practice receives each month. Reach out if you have questions about VBC enablement solutions.
Once Upon A Time: Back in 2004, health insurers didn’t cover phone calls from oncologists to patients who were in the early stages of chemo, but eventually pioneers like Blue Michigan paid for the calls and now 18 years later we are in a new world where the follow up call is not just “reimbursable” but “valued.” In a newer generation example, Cleveland Clinic will begin billing for each message sent through MyChart, whether it’s about new symptoms or general check-in questions. The health system will bill insurance and if the health plan covers these “messages,” patients may have a small copay. If the plan doesn’t cover this communication, patients may owe $33-50. This announcement caused some uproar, but physicians argue they need to be appropriately compensated for all the time they spend talking to patients outside of appointments.
Extra Point: We almost killed Grammy several times last week. It was by no means intentional, though there was some chatter coming from my in-laws on the way to the Thanksgiving table that maybe it was. On Tuesday morning I gave Grammy a potato pancake and by the time I returned she was choking – her third such event of the week. My wife gave it the amateur heimlich to save Grammy, then the labradoodle scarfed up the remains. At 6 pm, my son handed Grammy a cookie, she took her hand off the walker, then timbered like Apollo Creed in Rocky IV, her head bouncing off the kitchen countertop. This was becoming like a real life Throw Momma From The Train situation. The CT scan was negative on Wednesday but the purple eye and forehead are positively stunning – not a great look for an 85-year-old. My wife then hit Grammy in that same spot in the head with the shower door a few hours earlier, and then on Thanksgiving, just when we thought we had things under control, my dad tried to walk up the front yard and nose-dived onto the walkway, saved only by Jack’s reflexes. I realize after this week just how important personal caregivers are – I appreciate the fact that my folks now rely on them and that policy makers are trying to support them, although I can’t imagine how they have such amazing patience and attention to detail, and at such low wages and reimbursement. It’s one thing to prevent falls, quite another to prevent death by knockout. I should know – I tried. There was a silver lining. On Sunday, I sat down to play Uno with Grammy. I dumbed it down so it basically became a game of pick the higher card. “I appreciate you trying to work my brain,” Grammy said, in a startling but nice moment for someone with vascular dementia who can’t remember what happened 10 seconds earlier. “Well, it’s the least I could do,” I said. After all, I tried to kill you.