EPtalk by Dr. Jayne 1/24/19

I had a chance to sit in on a Medicare Chronic Care Management (CCM) webinar from Greenway Health while I was on site with a client today. It was nicely done, with a concise agenda and a strong presenter. The sales component was kept to a minimum, with the majority of time being spent educating attendees about chronic care management in general and only a small part was spent on the vendor’s solution. The webinar was also 30 minutes rather than the hour we sometimes see scheduled for these events, which made it easier for a busy practice to squeeze into their day. My client had a response to her follow up request within three hours of the end of the webinar, which was much appreciated.

While the US federal government shutdown rages on, there’s a bill pending in the Senate that would allow for importation of prescription drugs from Canada. When I first started in practice, we used to refer patients to an Ontario-based pharmacy to obtain a particular respiratory medication that had been proven effective around the world but wasn’t available in the US. For some, it’s not just about a potential cost savings, but about helping patients with access. It’s unlikely to get through the Senate, but it’s the thought that counts. Thanks to senators Chuck Grassley (R-IA) and Amy Klobuchar (D-MN) for giving it a bipartisan try.

The Food and Drug Administration is running out of money to fund reviews of new drugs, according to a Fortune piece online. During the shutdown, they’re not collecting user fees paid for drug and device reviews, so they’re trying to use leftover money from 2018 to keep the lights on. FDA Commissioner Scott Gottlieb plans to furlough more employees to keep things moving since drug reviewers aren’t allowed to work unpaid as they’re not considered “essential.” Gottlieb first caught my attention last month when he used Dr. Seuss-style poetic meter to warn against the hazards of eating raw cookie dough.

It’s barely more than two weeks until HIMSS and they’ve released the #HIMSS19 Hashtag Guide. There are more than 20 of them, which is about 19 more than I’m going to be able to keep track of unless they come as part of a snuggly quilt like this one. I’ve already had my quota of below-freezing days this year and there is no end in sight, so it’s definitely time to pile on the blankets.

It’s the last week to comment on ONC’s draft “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” I hope they make the public comments available to all of us, because it will make for some excellent snow-day entertainment. You can comment through 11:59 p.m. on January 28. Get those creative juices flowing. Feel free to share any amusing entries with the rest of us while we wait for the full report.

I’m always excited to see startups or other vendors making it easier to diagnose and treat diseases, particularly ones that either (a) no one wants to talk about; or (b) those who want to talk about it only want to do so to make a political point. Nurx is best known as a telehealth company specializing in birth control pills for women, but now they’re moving into at-home testing for the Human Papilloma Virus (HPV). The test is limited to existing customers, but will be expanded to new customers in 2019. Commercial insurance provides good coverage, although there is a $15 shipping and processing fee. They also offer PrEp, a treatment that reduces the risk of acquiring HIV. These are areas where some of the more mainstream telehealth groups aren’t ready to tread, so hats off to them.

Speaking of telemedicine, the American Academy of Family Physicians (AAFP) blog “In the Trenches” says the Academy is “working to make sure telemedicine is real medicine.” There’s much greater insurance coverage for telehealth services of late, and most states require payment for certain services whether they’re delivered face-to-face or through telehealth technology. It sounds like their focus is on helping traditional family medicine practices to add telemedicine services rather than seeing how telehealth might fit into the broader scheme of things.

The blog author refers to solutions that compete with their ideal traditional practice as “leakage” and makes it clear that he thinks that patients using urgent cares, retail clinics, or direct-to-consumer telehealth services are part of the problem, specifically calling out vendor Teladoc and citing his own “Twitter rant” about its partnership with Aetna. He goes on to demonize telehealth providers as “Snapchat for antibiotics” and “basically Tinder for healthcare.” The gloves are off, apparently.

AAFP has a partnership with Zipnosis for telemedicine, but it is only available for “small, private practices with less than 20 physicians.” It doesn’t support billing when patients have telehealth coverage through insurance and doesn’t integrate with EHRs. They recommend physicians (or their administrative users) download a PDF of the visit (which is documented using a third-party platform) and update EHR medication and diagnosis lists manually. That’s not exactly revolutionary, and if AAFP is serious about having a great solution, I can recommend a physician informaticist who might be able to help.

Regardless of how much AAFP continues to preach about longitudinal relationships with primary care physicians, that scenario just isn’t the reality for many patients in the US. Insurance plans change, networks change, and then there’s the situation where people change jobs and get new insurance and have to switch physicians. Our culture has changed, and many patients don’t value that relationship with a physician because they’ve never experienced it or are turned off by the way that a lot of practices run. Convenience and accessibility trumps that relationship. People are willing to risk counterfeit products via online purchases rather than going to a brick-and-mortar store, and those kinds of sentiments spill over into other facets of our lives.

Not to mention that there are many physicians who have left traditional primary care practices because of lifestyle issues, relatively low compensation for long hours, and burnout. AAFP would do well to encourage physicians to explore practice situations outside the organization’s historical ideal in an effort to keep people working as physicians. As an urgent care physician, I’m part of their “problem,” but it’s gratifying to be the family physician (albeit temporary) for patients who can’t see their own. I’m starting to wish I hadn’t paid my dues for 2019, but I don’t think they give refunds. I haven’t seen that level of vitriol from professional organizations that represent pediatrics or internal medicine.

What do you think about the future of telehealth? Leave a comment or email me.

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