1. Where There’s Smoke: People with schizophrenia are 3 times more likely to smoke than other people and tend to smoke more heavily in an effort to control their symptoms related to their mental illness, according to the Mental Health Foundation. Of note, Rhode Island’s BCBS insurer just partnered with OutcomesMTM and schizophrenia is among the focus areas. Overall, patients taking 8+ Part D drugs and have incurred at least one quarter of their annual drug cost in the last 3 months are ‘targeted’. Patients pay nothing to be involved.
2. Diamonds Are a Doctor’s Best Friend: A care manager and consulting psychiatrist embedded in primary care practices are able to bill Minnesota’s BCBS insurer monthly under a new depression improvement program across Minnesota dubbed DIAMOND. Using a special code (T2022) via a professional claim (form 837P), this new care team can earn $100 per month per enrolled patient. Teams needs to be ‘approved’ by the insurer and its benefit manager, New Directions, in order to bill up to 12 months a year. ‘2022’ is probably just coincidence, but if I’m doing my math that’s about the window healthcare investors are looking at for deals just initiated, and payers here in the Gopher state believe the model should begin to ‘give a window into whether this type of ongoing depression management saves money elsewhere’.
3. The New Addiction: 32% of 12th graders, up from 27% in our poll last year, said they have ‘vaped’ in the past year; the percentages are higher in more affluent communities. The trend of smoking e-cigarettes is on the rise with even younger people and researchers are afraid that it will normalize smoking regular cigarettes again. Even more concerning, young people are ‘vaping’ with illicit drugs. Full story here
4. Evaluation Up or Down: ‘I’m waiting for the day when we do a claims review and we find significant down-coding….I suppose that would mean that people are healthier and health reform has worked.’ This from Arnie Solter, MD, who admits evaluation and management in some practices is, indeed, becoming more complex as physicians and their staff try to decipher potential risks and adjust to a payment system rewarding outcomes. A recent BCBS of Louisiana claims review is proof times have yet to change. It revealed up-coding by physicians related to evaluation and management of patients, and the insurer has advised physicians to bill based on visit complexity; it’s possible audits of larger offenders may follow if the trend continues, a source told us.
5. Air Transport Trend: Newman once said that Zip Codes, well, ‘they are meaningless,’ a funny line from Seinfeld that made you wonder if the mailman was on to something. Well, BCBS of Tennessee doesn’t think so. The plan now requires pick-up and drop-off zip codes, plus mileage and a host of other details from air ambulance providers. Air transport companies must get pre-approval for any so-called non-emergent transports; basically anything other than from the scene of an accident when ground transport may pose a threat. The billing rule changes are a small step to help the plan manage the high cost of out of network. Another effort, initiated last year, had BCBS offering in-network payments to air transport companies at 5x the Medicare rate ‘to get them into the network.’ Results still being evaluated.
6. Izzy Mandelbaum Healthcare: This Seinfeld icon once barked at Jerry that ‘it’s go time’, a plea from the Lloyd Bridges character for the weaker, unhealthier comedian to shed some pounds. Managed care organizations are in a bit of their own go time these days, more willing to entertain contracts with medical groups offering a new site of care. One managed care medical director in Indiana is talking to a medical group here that is turning an old apartment building into a basketball court and gym for patients who need more activity – office visits, check-ups will take place at the facility. The health plan, Welborn, would try to pay the group a PMPY to track BMI, obesity and other measures, including presenteeism in school and work. ‘This is the sort of thing that gets my attention – rather than come in saying you want a 10% increase because you added a clinic, show me how you’ll change the course of life for these patients’
7. Separate Payment No More, Separate Ways Forever: I wore a Separate Ways t-shirt to school for nearly 30 days straight in 6th grade, just so my classmates knew that it was the best Journey song. But being separate isn’t so good for supplies these days. Syringes, catheters, parenteral infusion pumps and other equipment used in various procedures and settings are no longer separately reimbursable by Aetna, under a new payment policy in which it says items like these are ‘part of the overall episode.’
8. Where’s My Kid: 62% of families of children surveyed said they avoided bringing their children to activities outside the home due to fear of wandering, according to the National Autism Association. Accidental drowning, wandering and traffic injuries are worst case scenarios and Miami’s Police Department is holding training for its officers to better understand autism and how to communicate and react in various situations. 48% of children with an ASD attempt to elope from a safe environment, 4 times higher than their non-ASD siblings. Two in three parents of children with ASD “elopers” reported their missing children had a “close call” with a traffic injury.
9. Extra Point: My cousin Chris served two tours in Afghanistan and Iraq and his dad, a decorated Army Colonel served in Vietnam and in his later years helped manage Veteran’s services in Carlisle County Pennsylvania. Both used to tell my kids stories on their back porch about their zany times on base. There are two things that can definitely get you kicked out of the military, Uncle John would say with a serious look that had the youngsters scared – if you can’t play handball, and if you have bad teeth. ‘I haven’t had a checkup in 5 years,’ Chris quipped last month as we shared stories about his dad who was buried at Arlington National with full military honors. ‘Dad would always get on me about that.’ Chris said what many guys say, that there’s nothing wrong if you don’t go. But the emphasis on oral health prevention as a guard against other diseases is getting more traction these days, and the incentives for going are improving – in one case a commercial dental insurer in California is offering $100-200 to attract members to their plan for check-ups. In 2019 or 2020 it would not be surprising to see a marriage of dental and healthcare giants, or more dental-insurer practice acquisitions. 31% of pediatricians in our poll last October said they are contemplating ‘ways to innovate’ in the ‘face of urgent care’s stealing patients’ and many mentioned oral health as a possible extension service. Maybe that’ll help get my youngest, Chris’s godson, to the dentist. Tommy is 11 and actually likes going to the doctor because Tyler Stanley, PA, uses the word ‘boogies’ when diagnosing his colds. So if the dental hygienist chair is one door down, maybe it’ll be easier to get those teeth cleaned. A handball court in the waiting room may not hurt either. -BC