1. 3: The number of physical therapists in a small group in my home state who are creating a training guide or course to help PTs identify and address depression, addiction, and eating disorders in patients. The PTs are trying to make a less standard approach to detecting these conditions, and engaging patients about delicate topics. ‘That sounds like the definition of value based medicine if you ask me,’ according to Michelle Feller, a network contracting manager for BCBS.
2. Cataract Policy Change: Recently, Anthem Blue Cross/Blue Shield of California announced it would no longer be covering anything but topical, local, or regional anesthesia for cataract surgery, as it had determined that deeper levels of anesthesia are not medically necessary according to the American Society of Cataract and Refractive Surgery. Anthem will only cover anesthesia services, such as moderate sedation or general anesthesia, in limited cases, such as pediatric cases or if the patient cannot cooperate or communicate.
3. Rise & Fall: DME has fallen out of the top 20 in the Managed Care Investment Index of health plan priorities for the first time in several years. Respiratory moved back into the top 5 and urgent and infusion moved into the Top 10 for the first time. To see the Top 20, click here for index.
4. Social Works To Manage Risk: ‘I’m not so sure it will work, but we are pursuing….the idea is to take a bit more control over our patients and our budget’ – Peter Weller, MD, who has hired a social worker team to do home visits and remote monitoring of Weller’s Medicare patients under a full-risk arrangement his group now has with two different insurers. Dr. Weller says ‘we lost our shirt in year 1 because a number of our patients are fairly healthy but weren’t eating enough or were dehydrated….we had 23 different patients who fell and needed to be hospitalized for hip breaks or shoulder breaks or other things’.
5. General Motors Expands Benefits, But With Oversight: BCBS of Michigan will cover mental health and substance abuse benefits for some General Motors members after January 1st (those with Health Savings Accounts). New Directions will handle prior authorizations.
6. Homeless Healthcare: Premara BCBS is getting involved in helping address homeless healthcare issues by partnering with a local organization while Bridgeport Hospital in Connecticut is trying to use intervention teams to deal with homeless patients in the ED. Andrew Franco, MD, fromt Yale New Haven, thinks more ‘CMS money’ should go to supportive housing (e.g. housing should be considered part of someone’s health). Dr. Franco says there are definitely gaps in how information gets used. ‘In some medical records it’ll say, ‘Hey, this patient has been here many times,’ which ought to trigger a social work evaluation. Click here for the full story.
7. Extra Point: My bride challenged me to Orange Theory last weekend. My theory is that it makes me nauseous. It was very sad, if not telling just how happy Bridget was to see me hunched over in painful delirium sometime between the push ups and burpees. ‘I’m glad this gives you so much joy,’ I said. Thirty minutes later, I called her: ‘Um, honey I don’t feel so good....and I lost my wallet.’ Turns out it was in my pocket the whole time. I recovered by Tuesday but had to pivot to help manage my teenage daughter’s second concussion. It kept her cooped up in the dark bedroom for a couple days, her clothes strewn and life on hold. Zaggy, our 1-year old lab, took advantage, guzzling the Reece’s pieces she left in the front pocket of her unwashed Capri pants. By 2am the next morning the ER vet was lecturing me on parenting a dog. It was my third trip to the ER for Zaggy this year, the first two for swallowing socks. ‘I think it’s time for insurance’ the vet said. I paid the $395 bill and was back in bed in time to hear Jack’s annoying 545am snooze session. So tired from the prior 2 days, I missed a conference call and was an hour late to my annual physical. My doctor understood and then called my health status ‘unremarkable’, as in my lab work was perfect, and my BP and cholesterol solid. Nothing was medically or emotionally wrong with me. ‘So why do I feel like I’m running fast up a hill but gaining no ground’ I said, laughing but serious. ‘You’re a parent of 5,’ he said. ‘Stop running so hard and take a minute to be still.’