Friday Forum

A weekly digest of our behavior – the good, the bad, the great

Behavioral Health Case Study Discussion: Tuesday Sept. 22 at 12 noon EST. Click here to register

74: Percent of medical directors from 103 plans we polled who say imaging studies for uncomplicated low back pain are a consistent problem, often ordered unnecessarily within the first month of a diagnosis. Health plans like BCBS of Illinois say they have to collect and report this type of data to the National Committee for Quality Assurance.

Like Pulling Teeth: A Midtown Manhattan dentist’s practice is thriving, despite being almost completely shut down for a few months during the peak of the pandemic. Why? Tooth fractures. The dentist, Dr. Tammy Chen, wrote in The New York Times that she’s seeing, “at least one a day, every single day that I’ve been in the office. On average, I’m seeing three to four; the bad days are six-plus fractures.” Dr. Chen points to COVID-19 related stress, poor body positions while working from home, and insomnia leading to teeth grinding at night. She advises we all pay more attention to our posture during the day, along with our teeth positioning, and find ways to stretch out and relieve tension.

Pigskin Politics: My son’s take on how the cancelled football season in Connecticut is impacting mental health. Click here

Musculoskeletal Interference: Pre authorization will now be required for lower extremity small joint surgeries under a new AIM Specialty medical review policy taking effect in November. Surgeries include total joint replacement of ankles, correction of hallux valgus and hammer toe repair. AIM, which handles all Anthem reviews and pre authorization for other payers, says they’ll evaluate both the medical need and site of surgery.

Newest Episodes: This used to be a thing in the 70s, huddling around the RCA, holding up those bunny ears to avoid the static so the whole family could watch the latest MASH event. In healthcare circa 2020, new episodes are huddled around events too – the Coronary Artery Bypass Grafting (CABG) Episode-Based Model and the Total Shoulder Specialist Rewards Program are the latest episodes from Humana as part of its expanding Medicare Advantage value programs. The CABG model has 6 participants across 6 states and will cover the entire episode of care including surgery and post-discharge care. The Shoulder program is Humana’s first orthopedic payment program and will offer additional payment for realizing better health outcomes or attaining lower costs through site of care selection.

Pre Authorization: Illinois Blue plan now will use Evicore, not Prime, to handle medical review for chronic infusion drugs like IVIG and Avastin.

Rural Addiction Treatment: The Utah Center for Rural Health at Southern Utah University started a new program that will allow specially selected people to receive expert opioid addiction treatment without even leaving their homes. One of the program’s primary benefits is how little it disrupts a person’s life. In rural communities where specialized care may be limited or nonexistent, participants will no longer have to relocate when seeking help.

Drone Care: Wake Forest Baptist Health in North Carolina is using drones to ship equipment, including PPE, to providers and patients at distant sites. Using drones to ship items like specialty infusion medicines will help make sure patients get these costly, time-sensitive medications when needed. Wake Forest is partnering with Matternet and UPS FlightForward for this program. The two companies previously partnered with another North Carolina hospital, WakeMed, and have since coordinated more than 2,200 deliveries using drones.

Skilled Care Connectivity: Northwell Health is launching a telehealth platform that will provide on-demand care to 2 SNFs in the Bronx and Long Island. The SNFs will be connected to the health system through telemedicine carts that enable SNF staff to connect with critical care nurses, intensivists and hospitalists for emergency care and supervision. Northwell hopes to expand the platform to include additional facilities in the New York area.

Extra Point: Kathleen Sarnes sings to hospice patients in Staten Island, part of a quietly rising movement in healthcare, like those first 16 seconds of Pearl Jam’s Wish List. The influence of song as a cure should not be mocked or muted. There’s more evidence that music can reduce pain and anxiety, lower heart rate and blood pressure, improve care plan adherence and extend life quality. Sarnes says her grandmother told her to remember that the people she sings to weren’t always sick. Music therapy is covered by some insurance including Medicare, though typically for severe situations and usually as part of a mental health plan, not as any sort of lead treatment. Its pitch to healthcare payers will be a difficult one but studying music’s effects on neurological disease and on slowing disease progression is worthy in my opinion. My daughter Sophia was singing at a nursing home on weekends before covid closed that door. Just 15, she says it seemed to “perk up” people with Alzheimer’s or cancer, or “people with a lot of sickness.” I asked my colleagues here on our team this week for the music that is their therapy, a so-called soundtrack of their life. Their response was a sign of the times, but also a testament to who we are. We have a daydream believer among us and someone who won’t stop believing. We have different strokes and a little Joni Mitchell to help us to see both sides. There will be growing pains ahead as we march through what seems like another pandemic wave but as music writer Kelly McCartney says “we each have all the truth and wisdom we need inside us, and the more we look outside it for answers, the further we get from it.” We are closer to fine I suppose and, I guess if I have a wish it might be the same as Eddie Vedder’s, that “I wish I was as fortunate, as fortunate as me.” -BC