AT THIS HOUR

July 22, 2022

60: The percent of doctors who said they’d retire if they could, according to one of our polls. The number is both alarming and unsurprising, but there may be hope, according to Paul Rudd’s character in Anchorman. “60% of the time, it works every time,” Rudd said about his potent cologne, which Ron Burgundy sternly replied in a way that only Will Ferrell can, “Well that just doesn’t make sense.” But Rudd’s stat isn’t so illogical if you think about it.  In baseball, 60% gets you in the Hall of Fame, in high school it gets you a diploma and in healthcare it can get you “coverage” for novel treatments if you can show efficacy. 60% is also a kind of target number these days for a new series of commercial contracts – if physicians can follow a treatment regimen for 6 out of 10 patients or get patients to goal 60% of the time, they are eligible for big bonuses. Maybe this will stem the tide of retirement and encourage more people to become doctors.

Help Wanted To End Chemo: Seattle’s Fred Hutchinson Cancer Research Center is looking to recruit 20 participants in a Phase 1 trial with the goal of developing personalized vaccines for breast cancer and melanoma that could eventually replace the need for chemotherapy. The center is partnering with Amazon to develop cancer vaccines as part of the recently launched FDA-approved trial.

Tele Pay Policy Change: Harvard Pilgrim replaced their temporary COVID-19 telehealth payment policy with a permanent policy that will continue to reimburse all telehealth services at parity, effective September 2022. Providers will need to indicate appropriate place of service and use correct modifiers and, under the policy, will not be paid for telephone calls on the same day as an E&M or if an in-person E&M was done in the prior week.

Watch Out: For health insurers who realize they set the target goal too low in value-based contracts and end up “paying out too much”, needing to reset the terms.  This is especially a risk for PCPs and specialists like orthopedists. Our story on this topic first appeared in 2019 and it’s a reminder to practitioners about the challenges in value-based contracting. Read it here.

One Baby, $18,000: Did you know that the average total cost to have a baby in the US is about $18,000, according to a new Kaiser Family Foundation report. $2,854 is the average amount of out-of-pocket costs for those with insurance, though for all you parents out there you know that is a fairly comical estimate given all the diapers, Band-Aids, piano lessons, pizza pies, prom dresses, frantic runs to the ER and, oh right, college tuition!  But, when isolating maternity and delivery by itself, out-of-pocket costs are $3,214 for C-sections and $2,655 for vaginal deliveries. Out of pocket includes more than just the delivery – it includes psychiatric care, prenatal visits and other medical services that stem from being pregnant and carrying the pregnancy to term.

Time To Visit Down: Since the start of a new collaboration between BCBS of NC and Headway, children and adolescents have attended their first mental health appointment within 5.4 days, an improvement over national averages that suggest delays often as much as several weeks to more than a month or longer. 

Alzheimer’s Treatment: Whole blood exchange treatment could decrease the formation of amyloid plaques which are thought to cause Alzheimer’s, according to a new study from UTHealth in Houston.

Diabetic Care Plan: RxBenefits is partnering with Tria Health to find members with diabetes and comorbidities, reach out to create a customized care plan, and share the info with the members’ physicians. Patients can get a $50 gift card or a copay card, which offers $0 generics and $25 off some brand diabetes drugs. UnitedHealthcare and its PBM, OptumRx, meanwhile will offer insulin and some emergency-use drugs at $0 copay for some fully-insured members in 2023. Other drugs include epinephrine for allergic reactions, naloxone for opioid overdoses, albuterol for asthma attacks and glucagon for low blood sugar. The health plan announced the new offering in order “to address inflationary pressures and keep patients out of the ER.”

Lifeline: The new suicide and crisis hotline, 988, went live last week. The number is meant to simplify texting or calling the existing National Suicide Prevention Lifeline’s network of over 180 call centers across the country. Many of those local crisis centers were in “different phases of readiness for the 988 rollout” due to issues like workforce shortages and lack of coordination across multiple stakeholders. SAMHSA expects the volume of texts and calls to the National Suicide Prevention Lifeline to rise to 7.6 million next year, compared to 3.1 million in 2021 and 3.6 million so far this year. There are some reported issues - 988 allegedly performs nonconsensual active rescue, meaning the operators will contact emergency services without a person’s consent if they deem the situation is dire enough.

It’s Urgent, Right? Will Farrell once asked everyone to just stop what they are doing and listen because he was handed an urgent news story. Well, Tufts Health Plan members in Rhode Island now have access to something urgent in their homes, effective July 18 – urgent care. The health plan is working with intsED to provide the visits. The member’s PCP or care manager can request them, which seems like a way for the plan to limit unnecessary visits. Sounds a bit like telehealth meets home care but it is yet another example of a consumer-focused healthcare service.  Ready Responders is an example of another urgent care type service that payers have adopted – Ready Responders can go into homes and do strep tests or check vitals.

Extra Point: So 83-year-old Uncle Mike, the tenured political science professor at Gonzaga and the Jesuit priest who married Janine and me, is in town this week – bringing all his peccadillos with him. He has fallen asleep at least a dozen times mid-sentence since arriving. 'What’s wrong with Uncle Mike?' my daughter Sophie asked yesterday, scared for the answer. 'I think he’s dead' Janine said, 'go check him Bry.' My mother-in-law Ellen was in the corner laughing for some reason. Uncle Mike simply fell asleep and when he awoke to the dog barking, he repeated the same story about how his parents used to take him to the 5 and 10 for Christmas but one year didn’t because he got Bs in grammar class. Both Michael and Ellen live somewhat independently most of the year, which is moderately alarming and yet remarkable, battling an encyclopedia of conditions, dementia, vertigo, osteoarthritis, prostate cancer, skin cancer, anxiety and the diabetes that Michael swears he doesn’t have. 'Well, I do take this pill every day to control my blood sugar….my regular endocrinologist gave it to me…and my feet really bother me, but I’m not diabetic,' he said. I’m pretty sure you are Uncle Mike, but say this for him, he may have some idiosyncrasies, but he can eat what he wants as far as I’m concerned because, nearest I can tell, he’s blessing all the food and he’s the one who may be a key vote for me when it’s my time. He and his sister are the face of aging in America and highlight so much of the challenge ahead….but when they are here, thank goodness, because they sure do bring a bit of levity.