94: Percentage decline in screening appointments for breast cancer in March this year, compared to the last few years, according to data pulled by Epic. Komodo Health, which analyzed the billing records of 320 million patients across the country, found that screening for cervical cancer was down 68% from March 19 to April 20, compared to the previous 11 weeks and a comparable period last year. Tests for cholesterol, diabetes, and active and recurrent cancers were down, too, with the sharpest declines in geographic areas like New York and Massachusetts.
Hard to See Bruising is Cancer Problem: “Leukemia symptoms, like bruising, don’t always show up, so with in-person primary care visits down there have been fewer physicals, which means fewer CBCs ordered, reducing the likelihood that a physician could catch an abnormal blood count.” This is from Susan Buchanan, an adult leukemia assistant at Dana Farber Cancer Institute, but while it sounds like it could be the result of COVID-19, it’s not. I did the interview back in 2009, during the economic downturn that delayed care and drove up the number of Medicaid patients due to unemployment. At that time, Buchanan said they saw more complex cases for rare leukemia and bone marrow transplants, which was due more to commercial payer policies to encourage physicians to refer these types of cases to institutions with expertise, like Dana Farber. This trend helped offset the dip on less complex cases, but it came as cancer patient outcomes deteriorated for a time. About 40% of patients with myelodysplastic syndrome, for instance, convert to full-blown leukemia, and many of them were diagnosed too late.
Patients Love It, Doctors Don’t: If you guessed telemedicine, you’re right. Elderly patients with chronic illnesses across Pennsylvania have started seeing their doctors via telemedicine and they’re finding it easier and faster; instead of a 3-hour round trip, they just head to the living room for instant care. But doctors are worried their patients aren’t getting the full care they need. Ravi Ramani, the Director of UPMC’s heart failure program, said, “The biggest thing I rely on is the eyeball test. Just being able to see them, how they are sitting in their armchairs, how their skin color looks — those things are critical.” Patients and doctors will need to work together post-COVID-19 to decide what’s best for both of them.
Multi-Specialty Mindset Shift: At first it sounded more like a bad, albeit G-rated, joke your Uncle Joe would tell you at the Memorial Day barbeque, but it’s not that farfetched: a physical therapist, psychologist, orthopedist, social worker, and a former gym teacher-turned-exercise physiologist walk into a Zoom room. Seems inevitable, at least after we did a Zoom call with these practitioners this week. Several are linking up to create a new kind of multi-specialty service that blends in telehealth, remote monitoring, and home visits (when they can happen safely again) in a platform to serve seniors, MA plans, addiction treatment companies, employers, and schools. Diverse and ambitious, to be sure, but the offering is interesting because it hones in on one thing: pain.
Here’s the Skinny: One area of definite savings to monitor in the year after the pandemic settles, according to our own poll of payers, will be dermatology. One payer says they think they can use benefit design and network changes to shift up to 40% from office to tele and cut the cost of evaluation 25% or more. Seems ambitious, but there were signs before this year that some plans would try to move in this direction. Broadly, 52% say they will evaluate whether to keep paying telehealth at office levels while close to 20% will resort to pre-COVID-19 policies across services, usually paying less for tele; others say rates will vary based on location and provider type - as some may ‘be capitated’ if doing utilization management and evaluations.
EMR Gaps: 70% of home health and hospice organizations have experienced an increase in the number of referral sources requesting referral data to be sent electronically over the past two years, but many agencies aren’t equipped. 36% still use fax machines to obtain referrals, and another 20% rely on phone calls, according to a Brightree report. COVID-19 is only making the handoff worse, with patients coming in and out of hospitals more quickly and hospital systems overwhelmed with COVID-19 challenges every day.
Extra Point: All of you clamoring to watch or play sports with someone other than your teenager or spouse or seven-year-old, here’s some modest hope and a few healthcare warnings. 1) The NBA is considering re-starting its season with a made-for-TV game. Players would quarantine at an arena for two weeks, then play. If it happens, and I bet it won’t, don’t expect any defense. Players will probably be six feet apart, which I suppose wasn’t all that different from before. Steph Curry should have a field day. 2) Be careful: gambling addiction specialists are expecting a wave of cases as the recently unemployed try their hand at predicting how many steals Lebron will get. One therapist tells us she’s "busier than ever” with “mostly 40-something males” betting on things like British darts. 3) Insurers will cover gambling addiction treatment but will be tough on medical necessity and the COVID-19 trend likely accelerates telepsych as the preferred model. If Kenny Rogers could read this now. 4) Playing any sort of sport with your spouse is not advisable. Better to keep it friendly as I’ve learned in my 20 years, and if you must compete, avoid playing on the same team. 5) Golf is ahead of things but a cautionary tale. “Lefty” Phil Mickelson and Tiger Woods will likely play a live match on TV this month. Many weekend hackers are already out on the links in states allowing it but worries about virus spread are overblown, in my opinion. Golfers often keep their distance unintentionally so as not to get hit by a shank. My dad usually hooks his tee shots left into the woods while my Uncle Hank slices right into the water. Many times, they just give up before getting to the green. “See you on the next tee”, they’ll say. 6) Tennis should see more play than it currently is, as long as people wear gloves. I’ve already dusted off my Stan Smiths to rally with my 12-year old in the driveway. To prepare, I made him watch Luke Wilson’s epic shutdown as tennis legend Richie Tenenbaum in the Royal Tenenbaums. The “Baum” committed 72 unforced errors on the way to losing every game to Gandhi. “Why in the world did you show me that dad?” I told him it’s a good lesson on the perils of distraction. In tennis, like life, “only the ball,” I said. Tommy could sure use some help focusing these days. Please pray for him. He has to write four sentences by next Wednesday.