28: Amount of market share on average that commercial payers say you probably need to have a fighting chance at leverage in reimbursement rate negotiations. The number varies by sub-sector and service and definitely geography. More recently payers are trying to hold the line on increasing rates, only allowing them if you are performing well, particularly around where you refer and how you treat. For instance, an OBGYN practice in the South has a high postpartum care and colorectal screening rate – 95% better than everyone else – and credentials all of its mid-levels with the payers, a requirement for pay for performance.
Labor Fix: A physician practice in the Midwest has hired health science students from high school and college to call patients and visit them to see if they have questions about their medicine or if they are feeling dizzy. It’s a small fix for a big problem, born largely out of necessity as the health system tries to adapt to a labor crisis. Trinity Health plans to start using virtual nurses at its 88 hospitals, following a successful pilot at the Trinity Health Oakland Hospital in Michigan. The initiative includes a floor nurse, either a certified nursing assistant or licensed practical nurse, and a virtual, on-screen nurse working together to provide patient care.
Closing Time: No, not the title of that 1990s alternative rock song but a positive reimbursement change for dermatology practices who use other physicians to close the wound site after Mohs surgery. A few payers will stop reducing the payment in these situations, in part due to labor dynamics. If the same physician performs the Mohs and closes the site, a 50% MPPR still applies.
What’s Your Combination: It took me nearly an hour to finish the latest wordle, Mucky, which I’m not sure is a word so I asked my son Tommy what it even means, and he said, “You know, yucky, just with mud.” We like to combine things a lot in healthcare too. Putting doctors with data, apple cider vinegar with tummy aches, Amazon with supplies, modifiers with CPT codes. Some combos are gaining traction, like urgent care clinics just for psychiatric situations or Medicaid payers giving allergists spirometers to give to frequently admitted asthma patients in rural areas. What can you combine to solve healthcare?
IDD Root Canal: Partners Health Plan in New York is working with Solvere Health to bring specialized mobile dental clinics to people with intellectual and development disabilities who often wait up to one year for specialized dental services.
Military ER: Any military veteran in an "acute suicidal crisis" will be able to access emergency health care at any facility for free starting next week, the VA announced. Veterans must be enrolled in the VA system to be eligible for most medical benefits, but that requirement won't apply to emergency suicide care. The new policy grants access to care to up to nine million veterans who are not currently enrolled, according to the VA.
Food For Thought: Hospital systems continue to change their business. Memorial Hermann Health System is joining as a founding member of Foodsmarts' Foodscripts Network of dietary assessment, nutrition counseling, and personalized meal planning services, while MetroHealth Health System announced a partnership with Cleveland Heights-University Heights City School District to open a Wellness Center in their local high school to offer services such as physicals, chronic disease management, immunizations, urgent care and mental health screenings.
Caregiver Support: In one of our recent consumer polls, nearly 91% of 45–60-year-olds say their biggest challenge is managing the health of their parents, which has had a negative effect on their own health. Avanlee Care is one company trying to help, teaming with Walmart to bring its digital tool to the 65 million Americans caring for aging family members. Its app integrates appointments, medication reminders and grocery lists in one place, and can also connect to wearable devices, like a smart watch, to provide health info. It will be displayed and promoted in select Walmart supercenter locations in Arizona, Florida, New York and Texas.
Extra Point: So I grew up listening to Crosby Stills & Nash and haven’t until lately really understood what Crosby meant by teaching your children well…but when your teenager asks you what he needs on his mid-term to maintain a B- in his math class, you sort of have two problems – he’s looking to avoid studying or maybe worse, he’s relying on you for help with math. Tommy asked for my help last night. “Dad I think I need a 47, but can you check?” “Can I check what,” I said, “if your math is right or if you are indeed redefining what it means to be an underachiever?” “So you’ll check?” Tommy said….Doing the bare minimum is a lifestyle for some of us, like my 19-year-old who texted me from 5 feet away if I could make him an omelette, while he was in the kitchen…next to the stove. Or for one of our girls whose bare minimum is often her struggle, and ours, because it’s usually the best she can do. In matters of health, I like to think men are often experts in bare minimum, skipping dental cleanings like church on a rainy Sunday or telling the doctor “I’m fine” even when they’re not. Imagine if healthcare workers did the bare minimum? It’s not an option really, at least not anymore, nor is it part of the DNA of doctors and nurses. Parents don’t have much of an option either I suppose. We have to do more to try to understand, not fix the younger generation, even if it sometimes means we struggle. As the late great David Crosby would say, “Teach your children well” – yes, to do more than the bare minimum and to take risks, but also not to be afraid to struggle — to be thankful for being.