AT THIS HOUR

March 18, 2022 —

1,300: Number of hospitals, payers and students who weighed in on the nursing shortage in our special report. Like Arleth Flores, the 24-year-old nursing grad who wants to work at a local school and urgent care center but is waiting due to delays in administering the board test.  Nurse staffing challenges are likely here to stay over the next few years but lawmakers, health systems and even educators are trying to create solutions in real-time, like Evolve Health’s new hospital alliance that shares HR best practices on employee well-being, diversity and inclusion program implementation, and reciprocal agreements to help staffing. Its members include AdventHealth, Atrium Health, Intermountain, Northwell, OhioHealth, and Henry Ford.  Details on Congress’s latest efforts, implications for healthcare companies, insight into the future of travel nurse pay rates, plus results from our poll. Read more here.

Dog On It: Kramer once got his vet to unknowingly prescribe him dog pills for his own cough in one of the funnier Seinfeld episodes that had Kramer trying to treat his hack with dog medicine, because his cough sounded like Fido’s, which is, of course, a logical thing for someone to try.  Dogs themselves can be therapeutic – emergency department patients who were visited by a therapy dog team reported reductions in levels of pain, anxiety, and depression and a greater feeling of overall well-being after spending time with the dogs, according to a recent study published in PLOS One. Insurers have been slow to adopt these non-traditional therapies but there is some growing evidence canines can help with treating PTSD. Read our full story on therapy dogs here.

PT Coach Or Competitor? Physical therapy continues to migrate from clinic to the kitchen with the onset of new at-home training tools. This is probably good for patients with chronic pain issues in the lower back, neck or shoulder, and for employers looking to improve productivity, but might be a new challenge for clinic-based PTs. Will these home PT training solutions start to limit the lower acuity, non-post-surgical volume that’s been the bread and butter for PTs, and will these virtual tools allow insurers to start reducing allowable visits per authorization as they did aggressively in the early days of meaningful PT benefits, circa 2010? Most signs suggest not yet, given the improved appreciation of PT as a cost saver or alternative. But think about it – most of what the PT does is diagnostic and then creating a plan that most of us can, theoretically, do ourselves. Not for every injury or issue – but many. The question has always been one of adherence. I am personally 2 weeks into a shoulder PT plan my dad gave me but haven’t actually done a single exercise. Maybe programs like One Step, a 24/7 PT coaching and recovery app that reports data to its motion lab and creates parameters for recovery, will elevate adherence.

Diagnostic Switch: 49.4% of patients had their diagnosis changed by their doctor based on a bedside imaging tool from Butterfly Network’s handheld ultrasound machine and Ambra Health’s cloud-based medical image system.

Out Come What May: “I’ve found some differences in the outcomes for some of the SUD, eating disorder and mental health companies – some do a nice job solving the addiction, but we did an analysis of 150 cases across different providers – some had patients who ended up back in treatment for a different behavioral addiction, others didn’t have any of that. It’s not always clear if success stems from the providers or the patients. It’s difficult to measure and I’m inclined to say it’s a combination.” –Sean Halston, PA, who analyzes behavioral health claims

Concierge: 9 out of 10 in our poll of the week do not use a concierge medicine service and are unlikely to make a change, despite most liking the concept. “I have been thinking about it, but the cost of commercial insurance and an additional cost of concierge medicine can get expensive.”

Pharmacist Pressures: Amazon Pharmacy is offering a prescription drug discount card to BCBS customers in 5 states (NJ, NE, AL, FL, and KS), through their pharmacy benefit manager, Prime Therapeutics. When members use Amazon Pharmacy to buy their medications, they will be able to get a discount through a MedsYourWay card. Unlike most other prescription drug discount cards this card will apply to the members out of pocket maximum and deductible. Pharmacists more broadly have played a large role in testing, vaccinations and recently, dispensing antivirals, but they cannot prescribe the antivirals themselves and only receive dispensing fees.

Drink Up Or Down? Tom Hanks was the poster child for alcohol addiction in an old episode of the 80s show Family Ties when he swept through the pantry searching for booze, happy to find Vanilla Extract. “It may not be Miller time,” he said. “But it is vanilla time.” The scene showed a young Hanks as desperate and showed his nephew as scared. This fiction has become truth 40 years later as alcohol addiction prevalence has risen dramatically since the earlier days of the pandemic. It’s putting pressure on every part of the health system, including treatment centers that in recent years shifted models and staff expertise to focus more on opioids. New delivery models are emerging to help those most impacted, particularly affecting women aged 37 to 42, males 44 to48, and college students who have accounted for the biggest jump in many regions. Monument and Cigna (now Evernorth) launched an online alcohol treatment program with virtual peer and professional therapy, specialized treatment from licensed physicians and specialists and medication support. Monument began offering coverage options at the end of 2021 and is in-network with more than 20 commercial payers and Medicare plans.

Extra Point: I bet that my final 4 picks Seton Hall, Loyola, Gonzaga and Providence will need more than divine intervention to win their brackets. I also bet the March Madness tournament games will be good theater for people’s mental health, but quite possibly bad for the rising population addicted to gambling. It is our next epidemic, and as we enter the heart of sports betting amid March Madness basketball, I’m reminded of what is fast becoming a national problem with pretty serious health implications, particularly for 16 to 25-year-old males. Ben, 19, says he spent the $6,200 he earned last summer that was to cover his 2nd semester at college. His parents know, but don’t know how to help. Abe, 21, took the $139 left in his checking account two months into his $80,000 job and bought just enough drugs to land him in the hospital. His mom is with him. It’s a bit perplexing that 20 some states and counting have legalized online sports betting, but these same states and others won’t allow mental health therapists or programs to treat these addictions unless they have a license in the state where the patient is. We’ve made a bet that people can gamble responsibly. It’s the same pact we made to drink responsibly. Kenny Rogers was probably right – we ought to know when to fold ‘em, if we only knew how to walk away and replace the addiction with something different, something healthier. Therein lies one of the least discussed but most important quality measures for behavioral health providers and insurers to prioritize – don’t just fix, solve. Don’t treat, find a way to get paid for “recovery.” I suppose March Madness tells us a lot about our behavior—our impulse control and our allegiance, our unity to rally around an underdog like St. Peter’s, and, if we play it right, perhaps our collective response to the latest addiction we aren’t remotely ready to fix.