28: Percent of families in a quick poll we did with parents of students in college or medical school who say they will likely need to either transfer their students to a lower-cost community college or forgo continuing medical school, due to changes in job income.
Underappreciated Pediatric Risks: Pediatric practices are having to revise their usual procedures during the pandemic but are having difficulties doing so. In California, Berkeley Pediatrics has split its office into two parts, a separate back entrance that leads upstairs for healthy patients and the downstairs area for sick patient visits. The practice sees about 40 patients daily right now, down from 100 pre-COVID-19. They are using telehealth extensively, but many of their patients need to be seen in-person in order to receive recommended vaccinations, and telehealth has led to a probable over-prescribing of antibiotics for suspected strep and ear infections, or prednisone for rashes that can’t be confirmed with lab work over a virtual visit. The group’s doctors worry about long-term health risks for their young patients who are not getting the care they normally would.
The More Things Change: Leo Distefano, MD, runs a small pediatric practice in Connecticut that has had to adjust, like so many, in recent years to urgent care competition and now a pandemic, but Dr. Leo takes a page out of Dr. Baker’s book from time to time. This past weekend, a young girl dislocated her elbow and called the practice - it was an emergency, but they did not want to go to the hospital, so Dr. Leo told them to meet at the office, where he fixed the kid’s arm.
Phase Two Payer Strategy: Insurers seem to be moving from policy to partnership as COVID-19 continues. In Oklahoma, the Blue plan has partnered with DispatchHealth to deploy medical mobile units that can deliver in-home care, while Centene has partnered with Feeding America’s network of food banks. In Arkansas, the Blue plan says it will now allow telehealth through May 15 for PT, OT, and speech therapy, but there is no waiver for cost-share. The tele PT coverage trend is interesting, as there has been historic reluctance to cover these visits and for payers to contract with tele PT companies. “Tele PT is just not the same, much harder to get the patient to comply,” according to my cousin, Mark, who heads up PT at UConn. Insurers I have talked to say the tele check-in has some value for training and follow-up but that “it would be a mistake” to expand tele PT in any meaningful way after the virus departs.
Hitting Pause on Auditing: Providers of outsourced services to health plans may see a temporary shift in need for their products as health plans pause some auditing and utilization management requirements to make it easier for providers to focus on access to care. For pharmacies, Humana will not initiate new desktop and onsite audits and will suspend any in-progress audits until at least April 30, 2020, except for those requested by CMS or initiated due to fraud, waste, and abuse concerns. For medical providers, Humana has paused pre- and post-paid claims review, as of April 1. However, claims submitted during this time period may be subject to reviews at later dates.
Cross Country Triage: On April 14, Intermountain Healthcare, a health system based in Salt Lake City, deployed a team of physicians, NPs, PAs, and respiratory therapists to fill in at New York Presbyterian and Northwell Health, hospitals with severe staffing shortages. Hospital systems across the country can now also submit data daily around ICU bed and ventilator supply and utilization, COVID-19 test results, and total number of healthy patients discharged to a platform created by HCA and Google Cloud.
In Case You Missed: Our Behavioral Health panel featured addiction medicine specialist Nzinga Harrison, MD, former YMCA Volunteer of the Year, who is now running an addiction recovery company taking risk for relapse in the Southeast. Their model and why it’s working during the pandemic, featured here.
Extra Point: Many of us have family on the frontline, serving in any way they can. My cousin, Erin, raises three kids at home but is needed overtime right now as a nurse at Women & Infants Hospital in Rhode Island. My cousin, Mark, heads up PT at UConn’s Musculoskeletal Institute, where elective surgeries are down but research and clinic visits for emergent needs continue. My dad, retired head athletic trainer and sports medicine director at the University of Hartford for three decades has offered, even at age 75, to lend a hand with PT consults over the phone. Our cousin, Chris, already served two tours but is still willing to help at a military hospital. And Jack, our 16-year-old, plays this every night around 8 o’clock, his trombone pointing out to the sky, the song his way to remember the fallen and with any luck, help heal the sick (click here).