EPtalk by Dr. Jayne 10/7/21

In telehealth news, California’s governor recently signed a bill (SB 306, the STD Coverage and Care Act) which requires health plans to cover at-home test kits for HIV and sexually transmitted infections (STIs). The state has had recent increases in STIs, and the bill is aimed to help reduce those numbers. Patients can self-collect samples for many STIs. Studies have shown that self-collection (even in the physician office) increases rates of adherence for recommended testing. Coverage is required for health care contracts that are issued, amended, renewed, or delivered after January 1, 2022.

If I was working at a telehealth vendor that didn’t already offer a business line that addressed this kind of testing, I’d be spinning it up right away. There are some nuances to managing these types of tests (including being able to report results to local public health authorities) but the COVID pandemic accelerated automation of these functions so that they’re much less onerous. Developers have about three months to get their functionality in gear, so it’s ready-set-go for anyone with clients in California.

The National Institutes of Health announced that its All of Us Research Program will make more COVID-19 data available for researchers. This could allow better exploration of the long COVID symptoms that some patients experience as well as help identify factors that might identify which otherwise healthy patients will do poorly if they become infected. The expanded dataset now includes data on over 300,000 patients, with nearly 80% of them representing groups that are typically underrepresented in medical research.

Having access to such a robust dataset is going to be key to ensure artificial intelligence technologies don’t have bias from the data used to train the models. A testimonial from researcher Sally Baxter, MD, MSc explains the limitations of using a single-site dataset from her own institution versus the improved performance after using the All of Us data for training the model.

In the “healthcare folks behaving badly” category, a pharmacist in Puerto Rico enters a guilty plea after administering COVID vaccine to children who did not meet the age minimum approved by the FDA. In addition to improperly vaccinating children aged 7 to 11, the pharmacist billed Medicaid for the services. Additionally, since the vaccines were part of stock provided by the US government, not only were the administrations clinically inappropriate but also “unauthorized and unlawful.” The vaccinations were identified by the Puerto Rico Department of Health, which suspended the pharmacy’s participation in COVID-19 vaccination efforts. Only a couple of dozen patients were involved, but since the dosing for that age group hasn’t yet been approved, it’s not clear what they were given and if they received the full adult dose or something else. I hope all the children involved are doing well and didn’t experience any complications from the situation.

The COVID-19 pandemic has placed a tremendous burden on provider organizations, many of whom tapped the US government’s $178 billion 2020 Congressional Provider Relief Fund. STAT news has created a database showing how much funding physicians and healthcare organizations received. Not surprisingly, large health systems and those in major metropolitan areas received large pieces of the pie. Altogether, there were 412, 591 payments, with 90% of them being below $192K. The median payment was $12,530.

Looking at the data from my state, it’s difficult to see how much some of the large health systems received since some of them are listed separately and have a number of hospitals, clinics, and affiliated entities. I found it interesting that my former urgent care employer received more funding than many of the smaller hospitals in the state, but I wasn’t surprised given the volume of care they deliver and the acuity of patients, as well as the number of employees. What I did find surprising was the number of optometry practices that received several million dollars each. Also, at the bottom of the list, there were over 200 practices that received less than $100, which I’m sure didn’t even cover the money spent filling out the application. A couple of dozen practices were between $1 and $20. I found the fact that they issued checks for $1 to be bizarre since it probably cost many times that amount to create the check and will cost the practice more than that to cash it when you figure in staff salary and the potential for bank transaction fees.

It’s always interesting to use the various available databases to see what kinds of payments physicians and other healthcare providers are receiving. One of the more well-known data sources is the Open Payments database, which gathers numbers on payments made by drug, medical device, and other companies to physicians and other covered recipients. If a pharmaceutical rep buys a physician lunch and it’s over a certain amount, it’s reportable. CMS recently released adjustments to the reporting threshold for the 2022 Program Year, based on the Consumer Price Index. In case you’re curious, anything less than $11.64 doesn’t need to be reported unless the total annual value of payments to a covered recipient exceeds $116.35. I searched for myself in the Open Payments database, which goes back to 2014. I had exactly one payment for some consulting work that I did as a clinical informaticist, looking at specs for a new diagnostic testing apparatus. I’m not sure it should have been subject to Open Payments, but I’m not about to argue it.

I’m nearly back to normal after the side effects of my recent COVID-19 booster, with only some aggravating itchy sensations remaining at the injection site. Several readers weighed in on my request for good shows to watch while recuperating. There seems to be a general theme to some of the options, with many of them being on location in the UK. Fortunately, I was able to reserve a couple of the recommendations at my local library, so I’ll be able to stay well entertained as soon as they’re ready for pickup. In the mean time, I’m venturing into the great outdoors this weekend. I’m about to start a very big project that will take up most of my time for the foreseeable future, so I’m looking forward to kicking back around the campfire and enjoying some delicacies cooked in cast iron. There’s more to fall than pumpkin spice, y’all.

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