1. 45: Dr Karens felt a bit like Larry David did during that classic Curb Your Enthusiasm scene when a woman got called in to see the doctor before Larry, only because she signed in first, even though Larry’s appointment was earlier. ‘I call Shenanigans!’ Larry argued. Dr. Karens, a pediatrician at a busy practice in the northeast I’ve known for about a decade, told me this week that she had to cancel our monthly chat because she lost her two best NPs to the local hospital and was knee deep in patient visits for sniffles and ‘the angry mob of helicopter moms’ whose children’s ‘red finger tips are somehow emergency cases…’. ‘These aren’t emergencies,’ Karens laments. ‘The kids were swimmers – so their finger tips got red from pressing up on the cement to get out from the pool.’ The parents, she says, didn’t have appointments and just treated ‘my office like an urgent care.’ She apologized for missing our conversation but ‘I’m losing my mind…’. We can all relate on some level. Here’s my list of the top 45 things I seem to be losing: See the list here
2. Santa Fee On Schedule: New Mexico’s new fee schedule for behavioral health providers is now in effect for evaluating and treating Medicaid patients: Click here to access it
3. Drug Screen Limit: A new BCBS of Tennessee policy now limits urine/serum testing to 20 episodes a year per patient. An episode is either a screening/presumptive test or a confirmatory test. Billing for both for the same patient on the same day is one episode.
4. Genetics: Evicore now requires 9 more genetic tests to run through their pre-approval department, starting in September. If you are involved in genetic testing, reach out for the list.
5. Labor & Delivery: Alternative payment models are taking shape in the maternity world, Horizon BCBS of NJ the first commercial payer to launch a pregnancy bundle a few years ago with a retrospective, upside risk-only model. The bundle now includes over 300 practice sites, covers all pregnancies, and extends to 30 days following birth. I asked a group of moms at my wife’s book club last week what they thought about pregnancy bundles and Ruth, a case manager in the work comp world who’s a mom of four, laughed: ‘That’s nice they are paying the doctors more…let me know when they will pay moms!’ So far in 2018, a pair of national payers have announced bundles: Cigna with an upside risk-only model that includes 1,700 providers from the U.S. Women’s Health Alliance, who get bonuses for limiting C-sections, infections, and postpartum depression. Humana has contracted with practices from IN, KS, OH and TX for its retrospective model that covers the perinatal period spanning from 200 days before birth to 45 days after discharge. Medicaid is also entering the dance: A non-profit Medicaid HMO launched a pilot program for a maternity bundle in the Houston/Galveston area, in which providers took no downside risk in the first year but partial risk in the second year.
6. Bookworm: Our behavioral reporter Erin O’Donnell sat down with thirty-something Damian Smith, who admits to a lifelong struggle with depression and other mental health challenges, and has turned this into a social media business. Check out their conversation here: https://thebehavioralhealthhour.com/
7. Pick up a shovel and dig a hole: It’s my kids’ favorite line from an underappreciated Matt Damon flick and a good metaphor for this healthcare story—Joe Filler, who has run a solo geriatrics practice in Nebraska for several decades, has turned a weekend hobby fixing sheds into a new preventive care model. The story goes like this: last year, Dr. Filler started fixing up an old run down warehouse, giving a few of his underworked Medicaid patients who had carpenter skills a chance to help with the restoration. He invited a couple larger contractors in to ‘see their work’ and one of them hired these patients for part time jobs. The area schools and sports teams needed indoor gym space during winter months so one of the floors was converted into a track and gym. Filler appointed two of his patients to ‘manage the gym’ and eventually Filler moved his office there. The ‘mixed-use’ building is now part community center, part housing. Before and after each appointment, Filler requires patients to take part in a workout – 2 times around the track…’not asking for much,’ he says. I asked him what he thought about value based reimbursement. ‘Oh, I don’t know much about that. I just like to fix things. This has been good for the people here. They don’t have much, but now they have a nice place to come together.’ Turns out Dr. Filler got a message from a local hospital this month as well as one of the insurers (he didn’t remember which one), inquiring about the property. It’s another sign that the health system is thinking more and more about community as its patients.
8. Sugar, Butter, Flour: Remember when dad slung a heaping tablespoon of sugar onto the cheerios at breakfast and, in his version of affection, handed you the back page of the sports section – the one with all the AL and NL standings. He’d hand it over and then grunt a bit, his mouth still working through a piece of rye-toast and jelly. My pop would tell me to figure out how many games back the Sox were from the Yanks, and what Marty Barrett’s batting average was. This was before the newspapers did this for you, and many years before ESPN ruined moments like these. Labor Day mornings were the best because the US Open was usually on that day and pops and I would take out the old Bancrofts and volley down at the local park before Borg and MacEnroe would duel. Mom and my sister would bake a cake with red white and blue frosting left over from independence day. My dad worked really hard so I liked these days. Ironically, despite our caloric intake, they feel a whole lot healthier than today’s version of the end of summer holiday. When you wake up Monday, what will you do?