757: It’s a palindrome as my smarter nieces remind me. It’s also the average cost in dollars for about 1 out of every 10 patients a day who go to some of the urgent care centers in a New England suburb, but then need to be transferred to the hospital via ground ambulance due to things like low heart rate or difficult to diagnose headaches. If you’re pursuing urgent care, keep in mind these centers didn’t really exist before this century, that 1 in 5 patients you see are “more than likely worried well” and could wait 3 days for their symptoms to resolve themselves, but some patients will be too complicated for the center," said retired medical director Mike Halen, “it’s a great site of service for acute issues, but you have to look at the clinical judgement of the staff around testing – there is often overtesting and sometimes referring to hospitals unnecessarily.”
Speaking of Palindromes: Nurses run is also a palindrome, and a good description of what nurses do every day but finding them is getting difficult. My grandmother June was a nurse in the 1930s depression era – she’d run from triage to bedside 40 hours a week, then back home chasing my dad and his brothers, all the while juggling a cup of coffee. I noticed that nurses tend to always be running in and out of coffee shops in the morning with their scrubs. On a hunch, I went to Dunkin for a week in January and Starbucks for a week in February from 6 to 7 each morning. 30 of the 43 who went to Starbucks worked for the local hospital and 11 worked at surgery offices or clinics. In contrast, 23 of the 45 Dunkin cohort are “home nurses” and 6 work at local schools. If you’re looking at how to recruit and retain nurses these days, perhaps your answer lies somewhere between the mobile pick-up lines at the local coffee spot.
Dementia Data: Bruce Willis’ story is reigniting attention to diagnosing dementia and paying for care, but a recent study shows people with dementia receive less home health and hospice care in their final months compared to those without the disease, according to non-profit RTI International. This is despite people with dementia having the same predicted average activities of the daily living score at 17 months before death compared to those without dementia. Findings suggest that people with dementia may receive less home-based care because of the difficulty to determine when they are within six months of death, which is a requirement to receive hospice care. Payers are responding, and Blue Tennessee is partnering with the home health and hospice company Amedisys to offer in-home or virtual palliative care to members at no additional cost. This development is part of a broader trend of payers focusing on home care, which is ranked at #4 for the second year in a row in our 2023 Healthcare Payer Index. Register for our upcoming conference call on 2023 payer priorities here.
Roll With The Changes: REO Speedwagon’s 1970s hit may just be an anthem for insurers and doctors these days trying to figure out how to pay for telehealth. Several insurers have rolled back telehealth reimbursement rates 20-50% for everything except behavioral health, but some like Highmark in the eastern US have decided to reverse their policy. The insurer will continue allowing reimbursement for non-face-to-face consults delivered via telephone, Internet or EHR. The health plan initially decided these codes would revert to their pre-COVID policies, but providers pushed back, saying they found “efficacy in providing these services via telehealth.”
File This Under Paying To Do Something Somewhere Else: A 15% increase in reimbursement to reward doctors just for doing procedures in ASCs is being framed as a value-based payment from several insurers. It is, in effect, a payment for performance simply for doing the same thing but in a different setting, just a lower cost one. “For the right patient without comorbidity, this makes sense – for sicker Medicare patients, not as much,” a clinical director says.
CIN City: Privia Health is partnering with Community Medical Group to launch Privia Quality Network of Connecticut, a clinically integrated network that will cover 180,000 lives, making it the largest CIN in the state. 430 of the roughly 1,100 providers are PCPs. In North Carolina, another CIN is launching, this one backed by the physician enablement platform Alo that focuses on supporting independent providers. Alo has had a presence in the Tar Heel state since its 2021 partnership with Avance Care, a network of independent PCPs.
Extra Point: In my house, we root for the Celtics, and we loved watching coach Joe Mazzulla chew gum at like 30 chomps a minute, but the coach recently stopped chewing, saying he felt like gum was messing up his heart rate and hurting his breathing and focus. That makes sense, but how do we square this with the growing evidence showing that people should chew gum to manage their anxiety? A therapist I know says about half her patients no longer take daily medication and instead chew gum and do talk therapy – at ~$15,000 less a year, but dentists say chewing too much gum causes tooth decay. I started chewing gum in the 90s after Lloyd Braun chewed it on Seinfeld to impress Elaine Benes but my first editor at The Herald in Boston told me to stop when he saw me chewing Hubba Bubba during an interview with the Swampscott, Massachusetts school committee. “What are you, 5?” he said. “Plus, it’s bad taste.” I suppose he was right – it did taste bad, and it was immature - so I learned my lesson, but 25 years later I’m honestly more perplexed than ever about gum’s role in health. Maybe I ought to just limit chewing gum to special occasions, like before plane rides the way Pilot Chuck Yeager used to do to settle his stomach, or at Thanksgiving Dinner I could try Willy Wonka’s “Three Course Dinner Chewing Gum," tomato soup, roast beef and baked potatoes. But then my cardiologist may get upset…