1. 70%. Likelihood of acquiring Alzheimer’s disease has been shown to be this much lower in people who eat a vegan diet.
2. Autism’s Cliff: No, we aren’t taking about a fall-off in rates but rather a fall-off in services. Only 36% of autistic young adults attend any postsecondary education. Solutions are needed now for young people on the spectrum who are seeking an independent life. Only about 19% of young autistic adults live independently away from parents and without supervision. Read more on seeking solutions for the transition into adulthood here.
3. Lab Payment Ending: Starting in June, UnitedHealthCare will only reimburse reference laboratories that report lab services appended with modifier 90. Non-reference lab physicians or other health care professionals that report laboratory services with modifier 90 will no longer be reimbursed.
4. Aetna Exclusivity: OneTouch brand test strips are now the only brand that Aetna covers for diabetes supplies.
5. I Alone: The band ‘Live’ performed this song on SNL in 1995, major leaguers started playing baseball again and anesthesiologists at a hospital where I started to work brought in behavioral therapists to do one-hour sessions before authorizing pain treatment. That’s the kind of value that was ahead of its time so go figure that, as of today, cataract procedures will be paid for but not the anesthesiologist or nurse anesthesist services under a policy Anthem has just rolled out after a review of literature deeming the use of these specialists medically unnecessary, unless the patient is under 18 or in severe situations. A friend of mine who works at an eye group in Connecticut, an Anthem market, is planning on charging patients $300-$500 for the services unless the payer reverse course.
6. Walkback: Precedent suggests Anthem may reverse portions of its cataract anesthesia policy. They have recently walked back some policies namely rules around not paying for non-emergent ER trips (where the payer now won’t penalize the patient if they are referred by another practitioner) or their new E&M policy where they will pay 25% of the rate for evaluation and management following minor surgery if done on the same day by the same physician. In the prior policy, Anthem called for a 50% cut. For a story outlining payer perspectives on an urgent care physician’s E&M / emergency decision, click here.
7. Proposal Flurry: More than 82% of health plan directors in our poll this month say the flurry of proposals around intensive care management vendors is picking up, making it harder to differentiate and get attention and for the majority, preference is to ‘let other payers be pioneers’ and test not only the vendor’s ability to bend curve, but to see how the models impact or rather ‘disrupt’ provider networks.
8. Opioid Wire: Meridian Health of New Jersey announced more addiction treatment and mental health services in a partnership with Carrier Clinic through a signed ‘letter of intent’ to commit to lowering opioid overdoses. “For the 12-month period from July 1, 2016, to June 30, 2017, 2,284 people died of an overdose in New Jersey, a 34.7 percent increase over the previous fiscal year,” according to the CDC. Carrier Clinics have a 281-bed hospital and a 40-bed inpatient and outpatient detox facility. In Rx news, Cigna’s Comprehensive Drug List for April notes that all opioids, both long-acting and short-acting have a quality limit, excluding opiums, hydromorphones and fentanyl citrate.
9. Day In A Life: It’s controlled chaos here in the case management room at St. Francis’s surgical floor where Lynn Veith, a veteran of care coordination, does her best to advise nurses, younger physicians, residents and other clinical staff on the realities of patient crisis. The room resembles a galley kitchen with 4 EMR stations, allowing the team to read notes, check insurance, and prep for rounds with the medical team. The goal is largely to find the fastest, safest path to discharge. Rounds started 30 minutes early today, and for anyone involved in managing care, running a physician or therapy practice, or making coverage decisions, hear this: hospital-based care coordination is the epi-center of healthcare, probably underappreciated by policymakers, but coveted by hospitals. They take the most complicated cases:. An older woman hit by a bus during a visit from Greece is on day 27 here, the social workers desperately trying to connect her with family, case management feverishly keeping tabs on her neuro tests and update post-acute rehab about her discharge. The hospital won’t get a single penny for its work. A female, 32, hits a pot hole while on her iPhone on her bicycle – she’s set to be discharged, but there’s a scramble to get her into dad’s preferred rehab. Her health plan doesn’t have an LTAC benefit, though, just has acute rehab, so placing her has been difficult. A mid-20s hyperbarics patient may need more debridement, is seeing plastics tomorrow but may need CPAP. Dr. Kahn, the in-house physiatrist, needs to do a PT/OT evaluation today. She has to meet the criteria for rehab to get discharged to Mt. Sinai, but may not, so the care coordinator suggests to the mid-levels to keep all options available. A senior male is about to be discharged to intermediate care, but the team reports that the EMR is wrong, that he is really a ‘readmit’ and should have been flagged as such. He came from assisted living, but was back after 4 days. An adult male is on his 1,367th hour in observation – he has no payer source, has come from Florida but has no family nearby and has severe mental illness and poly-psych issues. The IP psych facility in town won’t take him due to his medical issues, so the hospital is basically his hotel. At one point, there are 6 of us in the room, including the pain pump infusion nurse getting instructions on how to get a woman set up and daughter educated on using the pump before they go home in 4 hours. The PA and nurse coordinator debate next steps on a hyponatremia case for a 66-year-old whose readmit likely score is high, so they are more careful about her plan of care, knowing that her payer, Aetna, is pressing for discharge soon. The team is late for the 10am case manager huddle telecon, an around-the-horn report from each floor on the number of likely discharges ‘in the house’ today – it’s going to be a busy day, 21 planned exits, which is good for flow given the volume coming in, but puts more pressure on medical, social work and case management to get it right. Exacerbating the issue are the weekend gaps, when there is limited case management and, come Monday, no plan and a host of mistakes to fix, like the Aetna patient who got injured at work and should be a worker’s comp case.
10. Extra Point: My mother-in-law, God bless her, still lets me in her Red Sox country house despite being a Yankee fan and always remembers to have a plate of pretzels and dark chocolate on the counter. Last week, after 2 months of visits in and out of doctor’s offices to deal with a respiratory issue, we decided to take another trek north to be with her because she got confused using her nebulizer and ended up taking 7 prednizone on Friday. Her breathing is worsening and so is her cough so the visiting nurse we called to help has, in just one session, fixed a lot of the what the physician’s office couldn’t. The problem could re-emerge, though, as mom deals with dementia, but at least we curtailed a hospitalization or worse. It’s not the doctor’s fault per se, but perhaps underlines the importance of the home visit. When we got to mom’s house the other day it wasn’t 5 seconds from when I stumbled through the broken sliding door I keep failing to fix when she quipped, ‘Bry, what’s going in with your Yankees—already 6 back and it’s not even May?” She may have lost a lot of her mind on things, but she hasn’t lost that.