67: The percentage of hospitals where family practice doctors delivered babies, in a survey of 216 rural hospitals in 10 states. At 27% of the hospitals, they were the only physicians who delivered babies. Family doctors are heavily relied on for obstetric services in rural hospitals, and without them many patients would have to drive over an hour for care. With maternal mortality rates on the continual rise, rural areas are employing new strategies. For example, the University of Colorado’s College of Nursing received a $2 million federal grant this fall to train midwives to work in rural areas of Colorado.
You're Doing Too Good: One of the leading national insurers is going out to primary care groups succeeding in Medicare Advantage risk arrangements and telling some they will be lowering their percent of premium.
Sleep Uneasy: BCBS Kansas has seen an increase in the billing of at home sleep apnea tests that do not meet coverage criteria due to lack of clinical, peer-reviewed literature. The health plan is reminding providers to review their medical policy before ordering home sleep tests to make sure the technology the patient and provider are planning to use is covered.
Drug Price Swing: More than 500 drugs are expected to see price increases early this month, according to a new analysis from 3 Axis Advisors. Yearly price increases typically average around 5-6%. Pfizer plans to raise prices for more than 120 drugs, which will account for 25%+ of the planned increases. On the other hand, three companies said they will cut prices on at least 15 drugs, including GSK’s drugs for asthma, herpes and anti-epileptics.
Hurdle Lifted: Behavioral health providers will no longer need to apply to join BCBS Michigan’s High-Performance Network. The plan says that by removing the application process, they can better ensure members have access to behavioral health providers.
Alzheimer's-Schizophrenia Boost: Bristol Myers Squibb announced it will acquire Karuna Therapeutics, which makes drugs to treat schizophrenia and Alzheimer’s. Karuna’s drug KarXT is expected to be on the market in September 2024, pending regulatory approval. With an increasing prevalence of schizophrenia in the US, the demand for treatment is rising. AbbVie recently bought Cerevel Therapeutics, which develops drugs to treat neurological disorders including schizophrenia.
Reality Bites: Virtual reality headsets are being used to help treat Amblyopia, or lazy eye, in children. The standard treatment for amblyopia, which is the most common cause of vision loss in children, relies on an eye patch over the stronger eye to force the brain to rely on the weaker eye, but new treatments work on ways to encourage both eyes to work together. Luminopia is one of a few companies focused on designing virtual reality treatments which involves children watching videos through a VR headset which blocks out certain parts of the display for each eye.
Monitored Anesthesia Cut: BCBS Massachusetts updated its anesthesia policy for January 1 and is facing pushback from provider groups. The policy now restricts coverage of monitored anesthesia care for patients undergoing procedures like colonoscopies, bronchoscopies and certain pain procedures if they are classified as class I or class II. These patients typically do not have any comorbidities and will only be approved for conscious sedation.
Extra Point: If you get instructions from the Peaky Blinders, you follow them like your life depends on it. But get instructions from a doctor or nurse or insurance company to change your diet, run a few laps at the new gym, maybe take the meds without chianti for once then, well, yeah, you don't take these literally. You chart a different path. Instructions tend to confuse me anyway. The ones we need least seem to be right in front of us, like that sage advice on some beer cans to "tap twice and pull the tab." Then the ones we need most seem to be as clear as my wife's closet. I once asked the grocery clerk to point me to the gluten free vanilla pudding mix - it took Joe a good 20 minutes just to find the right aisle. "I could have sworn it would be next to the apple sauce," he kept mumbling as we circled the store. My Uncle Mike sent me instructions in ALL CAPS the other day - a detailed rundown of how to get from San Francisco to the Los Gatos Jesuit Center next week. He even had an "AVOID THE POTHOLE NEXT TO DIO DEKA DINER." Michael married me and my bride 24 years ago on his break from Gonzaga University classes, so I will avoid that pothole, heck I may even stop into the Deka for a milkshake. People in healthcare give us all kinds of instructions and sometimes they too are in ALL CAPS, but I often wonder if they are just testing us. My dad and I spend hours trying to decipher instructions for his medications. One bottle read "EVERY NIGHT BEFORE FOOD ONCE DAILY TO BE TAKEN FOUR TIMES A DAY THREE TIMES A DAY EVERY THREE TIMES DAILY TAKE ONE TAKE TWO TAKE THREE ONE OR TWO." I'm not a fan of commas, but dear lord these would have helped. This is a particularly cruel run-on sentence that makes literally no sense. Sounds more like my dance instructor's orders. We had a good laugh but not as much as this one for Ventolin to treat an acute bout of bronchospasms -- INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS RECTALLY....My bride got some admittedly great instructions recently from our health insurer - the flyer said to use one of the two listed GI doctors for her colonoscopy. It said SCREENING SAVES LIVES and had 5 gold stars next to the doctor's name. It even included a gift card offer if choosing the doctor. We got a $1,700 bill instead -- complements of the anesthesiologist and the GI practice. Her primary care doctor sent a referral, but the insurer said they didn't get it, so a collection agency would be sending correspondence and alerting credit agencies, which is nice. Imagine those without the wherewithal to pay that bill. I can tell you it's not exactly a gift for us with four kids 17-22. Maybe I should call the Peaky Blinders...just to send a letter of course. Perhaps something like my Aunt Nancy used to tell us when it was time to go -- "TAKE A GOOD LOOK AROUND KIDS...WE WON'T BE BACK."