EPtalk by Dr. Jayne 4/7/22

A bill introduced in the US House of Representatives last week would allow employers to offer separate telehealth plans to its employees, much like they offer separate dental, vision, and medical coverage now. The Telehealth Benefit Expansion for Workers Act bill is a bipartisan effort, and it would also modify HIPAA and the Affordable Care Act to allow all employers (including seasonal and part-time staff) to benefit. It would allow freestanding telehealth programs to be separate from traditional medical coverage.

I haven’t seen any commentary on this from hospitals and health systems, which are probably still digesting how it will impact them if it passes. I haven’t had time to dig into the specifics of the bill, but I suspect the devil is in the details as far as what constitutes a freestanding telehealth program. For organizations that are already offering services but want to be able to capture their piece of the standalone pie, I imagine there will be a need to customize platforms to allow for different types of billing as well as to comply with any other program-related definitions. We’ll see how this bill navigates through the committee process and other parts of the legislative journey. If you’ve got any insider scoop, do tell.

In other telehealth news, the Government Accountability Office urges Medicaid to assess how its beneficiaries are using telehealth and to ensure that they are receiving quality service. The call to action is based on data from five states that showed significant increases in the number of services delivered via telehealth as well as the number of Medicaid beneficiaries participating. There are certainly challenges in delivering high-quality telehealth visits to Medicaid patients, who often have difficulty accessing healthcare in general. Technology may pose additional barriers due to cost, particularly when video is required for telehealth services. It will be interesting to see what types of studies are designed and what the outcomes are. A well-managed telehealth program can delivery high quality care, so let’s hope the studies are completed quickly so we can build upon the findings.

Despite spending the majority of my time on clinical informatics these days, I’ll always be a family physician at heart. With that in mind, I was disheartened to see a recent report from The Commonwealth Fund that showed the US ranking last for women’s healthcare among wealthy nations. Specifically, we had the highest rate of preventable deaths for reproductive-age women, with 200 avoidable deaths per 100,000. The UK was next with 146, followed by 132 in Canada and 90 in Switzerland. The maternal mortality rate in the US was three times the rate of other countries in the report, with high death rates among black women. The US also posted high rates of chronic health conditions, mental health issues, and difficulty paying medical bills. Although many of the people in legislative roles in the US are neither women nor of reproductive age, hopefully they have some family members who might fit into those categories and will consider taking action.

Back when my state’s Board of Healing Arts used to send out a paper newsletter listing its disciplinary actions, I often marveled at the ignorance, recklessness, and sometimes downright stupidity of some of my peers. Now I have to settle for digital snippets depicting doctors behaving badly, and a recent article. The Office for Civil Rights, which is charged with enforcing HIPAA, recently announced findings in a few investigations. Two were particularly salacious: one was a dental practice who provided patients’ protected health information to those running a state senate election campaign and another was a dental practice who disclosed a patient’s information on a website while replying to a negative online review. Seems to me like specialty medical certification boards should consider dropping some of their exam questions that deal with esoteric disease processes and consider adding basics of HIPAA (and being a decent human being).

News of the weird: a man in Germany received 90 COVID-19 vaccinations so that he could sell vaccination card forgeries that included actual vaccine batch numbers. Staff at a vaccination center became suspicious when he presented for immunizations two days in a row. He was found to have blank vaccine cards, and although he was not detained, criminal proceedings are under way. Forged documentation is a hot commodity in Germany, where vaccine passports are needed to enter public venues.

Insomnia is a big problem around the world right now. I attended a couple of presentations at HIMSS that discussed solutions. One looked a prescription digital therapeutics as a potential intervention, while the other discussed a smart pillow to gather data as part of an overall sleep management program. During a recent trip, I had four straight days of poor sleep and felt the effects. I couldn’t control the heating and cooling in my room the way I needed to, and of course there were random hotel noises in the hallway and loud pipes in the bathroom. I’m sure stress was also a contributor, but sometimes there’s not a lot you can do to mitigate that compared to the other factors. With that in mind, I ran across an article discussing a recent study of sleep data that revealed 16 distinct ways that people sleep.

The data was gathered from smart wristbands used by the United Kingdom Biobank. The bands tracked patterns of sleep and wakefulness by measuring arm movements. Clusters of sleep patterns were then divided into five categories with a number of subcategories to total 16. Groups ranged from those waking up mid-sleep to those sleeping well without naps, and everything in between. The researchers also identified disruption that was likely due to shift work as well as those with fragmented sleep. I don’t know where I fall on the continuum other than knowing that my recent sleep has been “a cluster,” but I hope I can get things to reset soon. I’ll be spending several nights in the upcoming weeks sleeping in a tent, which usually does the trick since I crash hard after being active in the outdoors.

Have you found your sleep suffering in the third year of the pandemic? What strategies have you taken to improve things? Leave a comment or email me.

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