AT THIS HOUR

May 13, 2022

63: Portion of 316 retired physicians polled who say too many doctors, PAs and nurse practitioners over test. If you’re looking for a measure of quality, I say take Hamlet’s cue and look at your practice’s testing behavior—to test or not to test is increasingly an important question in healthcare. Most of the retired doctors say we ought to use our personal experience with patients more often—our clinical judgment—as a guide when making decisions about whether to order a clinical lab or imaging to figure out what’s wrong. Too many do not lean on that personal experience enough, and it matters a lot, particularly when you are in a payment model that is based on total cost, a majority in our straw poll acknowledged. Martin Frost, a retired internist, said “for patients who are high risk with something like diabetes that extra test may not always add new info – that’s what I always thought about – how is this patient similar to others I’ve treated, what can I draw on from that and will this test result really help.”

Surgery Reimbursement Hike: BCBS Texas recently increased reimbursement for nearly 1,500 surgery services if performed at an in-network ASC. The increase took effect April 1, 2022, and applies to procedures across a range of specialties, including orthopedic, gynecologic, and cardiovascular, for commercial members. The health plan notes that the initiative could mean up to 15-20% reimbursement increases for providers who perform these surgeries in an ASC instead of a hospital.

Recruiting Nurses: In an effort to combat the nursing shortage, some hospitals are creating their own in-house staffing agencies. Nurses are paid a premium rate to rotate within their systems, allowing hospitals to compete with external staffing groups that often pay more and allow nurses more flexibility. In December 2021, UPMC launched UPMC Travel Staffing with plans to recruit 800 nurses at a set rate of $85 per hour, with extra incentives for working nights and weekends. Of the workers recruited into the program so far, 35% have been staff nurses who moved to the travel side.

House Meet Health: Health insurers, recognizing the importance of social determinants of health, are increasingly focusing on access to stable and affordable housing as a key component of healthcare, particularly for youth. In one example, BCBS North Carolina partnered with SaySo, a youth advocacy organization, to help young people moving out of the foster care system obtain affordable housing. Foster children typically make up a small portion of any payer’s membership, but programs like these pay off. A study by the Center for Outcomes Research and Education in 2016 found that better access to affordable housing led to a 12% reduction in healthcare spending among Medicaid recipients, as well as 18% fewer ED visits. 

Where Art Thou Sub Specialist: BCBS of Massachusetts is expanding its mental health provider network by adding providers who specialize in obsessive-compulsive disorder (OCD), serious mental illness, trauma and substance use disorders (SUD). They are also contracting with primary mental health groups, including Thriveworks, Headway, Refresh Mental Health and Valera Health, that have sorting and matching capabilities that help match patients to the right type of therapist or psychiatrist. 

Pediatric Reward: BCBS Michigan recently launched a Pediatric Weight Management Initiative with the goal of decreasing pediatric obesity in the state. During the pandemic, the national rate of obesity among children ages 2-19 increased from 19.3% in 2019 to 22.4% in 2020. The initiative will reward pediatric practices who reached a specified performance threshold, or an improvement threshold based on the BMI of their overall attributed pediatric population. The incentive for practices meeting their goals in 2022 will be paid out in September 2023.

Payment Conversion: Empire BCBS, an Anthem plan, is converting to a new reimbursement system called the Commercial Outpatient Pricing Payment System (COPPS), which is heavily based on the CMS Outpatient Prospective Payment System. Empire will convert all outpatient facilities to the system throughout 2022 and 2023, followed by all other contracted providers.

Poll Of The Week: May is Mental Health Awareness Month, so in our poll of the week, we asked providers and payers about the top mental health needs in their communities. Respondents identified early detection and prevention programs as most needed, especially for adolescents and new moms. One respondent said, “Kids in school are stressed – they need early access to care, and new moms often suffer in silence from postpartum depression – it needs to be identified and detected early on.” Increased access to care was also identified as a top need. As one respondent noted, “None of us are immune to mental health challenges - that has never been more evident than now.” 

Copay Assistance: Priority Health is launching a specialty drug savings program in July of this year. The program, through SaveOnSP, will be available for fully funded commercial group members. SaveOnSP will contact eligible members and enroll them in a manufacturer copay assistance program, which will then require members to fill their prescription at a preferred specialty pharmacy, Accredo or Meijer. All members participating in the program will pay $0 out of pocket for their entire plan year.

Extra Point: So only in my town would parents get in an uproar over high schoolers running through 4-way intersections like Frogger, hiding in bushes, and chasing each other through cul de sacs with water pistols in a seemingly innocent game they call Assassins. Seems harmless, but our town’s helicopter families have gotten so upset over the unfortunately named game that the Police Log had more than 100 calls in one week and a town forum was held this week to ‘get to the bottom of this terrible game.’ They have a point, right? I mean kids running after school in the neighborhood, often sprinting to chase down their target, working together in teams, getting wet. Outside. Not inside. This IS terrible…..One kid, Ben, was hiding in the backyard of my house for so many hours that his phone was ‘losing juice’ so he asked for a charge. ‘Um, Mr. Cote, I know I’m here to get your son, but could I come in and charge my phone?’ The Helicopter parents complained about ‘kids wasting time’ and ‘trying to hurt each other’. I see the opposite – kids who never would interact are playing together, competing. Kids of all shapes, colors, backgrounds, and economic and school status classes, are on an even playing field, brought together in a good ole fashion water fight. Many of them sit on the bench on their high school team, or spend 7 hours learning algebraic formulas they’ll never use….some are labeled by their schools or the medical community with letters like IEP or ASD, but out here in the neighborhood, there are no labels. They are just kids playing.  A little community camaraderie shouldn’t scare us. In fact, Assassins may be the healthiest thing I’ve seen in this town in years.

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