1. 3.6 Million: Number of Americans who miss medical appointments due to a lack of reliable transportation, which evidently lead to the launch yesterday of Uber’s new business called “Uber Health”, according to an Uber general manager. Uber Health will provide a car service platform specifically to drive patients to hospitals and rehab centers, allowing medical facilities to book rides using a web dashboard.
2. Marriage, Is What Brings Us Together…Today: Licensed psychologists and marriage and family therapists are being invited, as of this month, to participate in BCBS of Michigan’s network. What’s sort of interesting is that the health plan doesn’t cover marriage counseling, but it will allow these licensed practitioners to bill for what the plan is calling ‘other behavioral services’ within the scope of their practice, which, as far as I can tell, is marriage counseling. ‘I’m a counselor and while 60% of my practice is family focused and 40% just spouses, the ‘family’ counseling almost always comes back to one core goal – fix the marriage and you fix the family,’ says Steve Olear, who finds policies like these overly complicated. For what it’s worth, the cost of depression is higher among teens and young adults from divorced families than other families, according to study with 151 medical directors.
3. IPM, Sleep Studies Join New Pre Approval List: Blue Illinois, as of last week, will require pre-approval for cardiac services like lipid apheresis, facility-based sleep studies, interventional pain procedures for musculoskeletal pain, ENT and outpatient surgery, such as orthognathic and mastopexy, as well as non-emergency transports.
4. Unicompartmental Knee Replacement: Interest in orthopedic practices with PT capabilities has increased and for those who provide this procedure there’s favorable news from BCBS of Tennessee – the plan updated its medical policy this month, saying it now generally considers UKR ‘standard and conventional practice’. A question for surgeons and practice owners is post-op care and opioid avoidance.
5. ACO Northwest: In January, Regence Blue Cross Blue Shield of Utah and Aledade Inc., a growing national value-based care network, collaborated to expand Aledade’s Accountable Care Organization to provide high-quality coordinated care to 4,000 Regence plan members cared for by its practices in its first commercial contract in Utah. Members will benefit from an innovative physician-led ACO model that rewards doctors for improving quality of care and patient health outcomes, while lowering costs.
6. Opioid Ups & Downs: Independence Blue Cross sends out a letter to physicians who have been over prescribing opioids outside of guidelines, Richard Snyder, chief medical officer, said on Tuesday at the Opioid Management Summit in DC. But the educational effort has worked only to some extent with about 65% of the doctors ‘dropping off the list each quarter,’ but the list isn’t getting any shorter,’ meaning new physicians are continually added. For its part, BCBS of Michigan has collaborated with Value Partnerships and Pharmacy Services to reduce fraud and abuse. This program involves identifying health care providers writing prescriptions for opioids for patients who might be “doctor-shopping;” and recognizing patients who have been prescribed the dangerous drug combination known as the “triple threat;” opioids, benzodiazepines and muscle relaxants. This combination is linked to overdose and death.
7. Disparities Huddle: About 21 MCOs tell us they’ve formed or will form in 2018 healthcare disparities and actions teams, or taskforces. What role healthcare companies can play will evolve – but presumably those with home or community based services, as well as those serving Medicaid populations may find an advantage from getting on the agenda of these teams. From 2007 to 2010, I was an independent member of the disparities, access and restrictions team, or DART, for Pfizer – the goal then was understanding treatment disparities and gaps in care at discharge and post discharge. Seems like things haven’t changed.
8. ASC vs. Hospitals: Today, CBS News reported an investigation claiming that Surgery Centers have led to more accidental deaths because something has gone wrong during a surgery, due to less preparation for a crisis situation. There are now more surgery centers than hospitals in the US. ASC payments and utilization continue to be evaluated at a local level but about 35 out of 50 facility contracting directors we polled earlier in the year said their primary emphasis is on using lower copays and other incentives to drive more commercial patients to use in-network ASCs over alternatives.
9. OB Epidural: Kansas Blue is about to change its guidelines for anesthesiologists doing epidurals to allow for one unit per hour for monitoring women during vaginal deliveries, and 1 unit every 15 minutes for cesarean. Policy relates to regional anesthesia.
10. Prostate Cancer Treatment: Aetna considers transperineal periprostatic placement of biodegradable material (SpaceOAR), a biodegradable hydrogel, medically necessary for reducing rectal toxicity in men undergoing radiotherapy for prostate cancer, but considers it “experimental and investigational for all other indications.”
11. Extra Point: A home health aide on our street who helps an adult with severe mental disability after she comes home from day treatment mentioned to her boss that she often has to wait ~30-45 minutes for the patient to arrive home each day – the van’s arrival, she said, is unpredictable. The state had been paying for that idle time, but not anymore, and the home health company doesn’t want its aide idling unpaid. The day treatment van driver told me he does his best to be on time but bringing 8 to 10 patients home doesn’t always go smoothly – ‘these are very disabled adults.’ The day treatment company won’t take the patient off the van and to the door nor will they stay with her until the aide arrives for what they say are ‘liability’ reasons and told the family that an ‘adult must be present to do this’. The two parents work full-time about 45 minutes from the house. They are using neighbors to help fill the gap for now. They say they may switch home health companies. Seems like a bit of an overly complicated outcome from a reasonable problem. I mention if only to say to those in the home health arena, both skilled and unskilled services, that there are several small but perhaps not unimportant issues to address when forming relationships with other levels of care (day treatment), transport companies, payers and of course parents.