EPtalk by Dr. Jayne 8/1/24

I’m catching up on a lot of healthcare IT news after coming out of a whirlwind of travel. I’m just reading the HHS press releases about the changes at ONC. I always struggle with typing the wrong thing when organizations rebrand or merge, so I’m thinking I’m going to have to just set my autocorrect to ensure I stay current with ASTP/ONC moving forward.

My inbox is bursting at the seams and my work calendar is full, so I’m sure I’m missing interesting newsy tidbits along the way. I have a couple of large projects wrapping up soon and will be happy to have some catch-up time once they do.

The US Senate passed two pieces of legislation this week that would create additional safeguards to protect young people online. Both the Kids Online Safety Act (KOSA) and the Children and Teens’ Online Privacy Protection Act (COPPA 2.0) passed with overwhelming majorities. KOSA, which has been working its way through the halls of Congress since 2022, requires social media platforms to incorporate “reasonable” technologies to reduce the risk of cyberbullying. Features like autoplay that are designed to keep children and teens glued to their phones would be restricted. COPPA includes provisions to ban advertising that targets minors. It also allows young people or their parents / guardians to delete their information from online sites. It’s unclear what will happen with the companion bills in the House of Representatives, where committee hearings won’t even be an option until September.

From Get A Room: “Re: return-to-office policies. I have to go into the office despite the fact that no one on my team lives in this city. I just got to hear an entire Zoom call in stereo, because the participants were sitting on either side of me.” I asked my correspondent if the attendees knew they were in the same office and he wasn’t sure. With the ubiquitous presence of noise-cancelling headsets in the office, it’s a distinct possibility. I think I would have been tempted to send instant messages to both of them, adding my own commentary to their call just to be sassy. Another option is to use in-house scheduling functionality to have a conference room send an appointment to both of them.

One of the hot topics in the virtual physician lounge this week was what one described as the “escalating arms race” of AI-enabled insurance preauthorization requests, denials, and appeals. Tired of struggling to get insurers to cover expensive treatments that they believe would benefit their patients, physicians have begun to leverage tools like ChatGPT to summarize patient information and increase the changes of approval. Payers have responded by using AI-powered systems to deny requests even faster, leading to AI-generated appeals. There was a new physician in the conversation who recently graduated from his residency training program and he was incredulous at the discussion. As a reminder, folks: for-profit insurance companies have to deny care in order to drive value for shareholders. They’re willing to pay for an enormous infrastructure to do so. Those who don’t think we ration care in the United States need to consider the definition of rationing.

Another hot topic was that of private equity groups purchasing hospitals and physician practices. A research letter that was published in the Journal of the American Medical Association this week certainly spiced up the conversation. Key points from the article: PE firms spent half a billion dollars on health care between 2018 and 2023, with a strong track record of loading them with debt and selling assets to increase shareholder profit. The authors compared acquired facilities with non-acquired controls, matching for year, region, and bed count. They found that acquired hospitals had nearly 25% less assets after two years. They note that further study of the impact of private equity ownership on patient care is needed, and I would bet that the vast majority of physicians trying to provide care in PE-owned facilities would heartily agree.

I ran across an article this week about virtual MRI programs. Rather than transfer inpatients from one facility to another for advanced MRI services, AdventHealth is allowing community hospitals to perform the procedures under standardized imaging protocols. The program allows seasoned staff to collaborate with those building their skills, through a combination of audio / video and chat features. It reminded me of a conversation I had with the team that was conducting my own MRI a few months ago. One technologist mentioned that they had completed a research protocol, copying a longstanding program in Germany where radiologists managed MRI scanning at multiple locations from a centralized command center.

Although the clinical outcomes were similar, the program encountered resistance here due to concerns about liability and regulatory compliance. Clearly other parts of the country are more accepting of this kind of change, so it will be interesting to see how many years it takes my region to think outside the box. In the mean time, I just have to hope there’s not a snowstorm or ice storm when it’s time for me to go for my next exam, since trying to reschedule will introduce at least a 90-day delay due to lack of available slots at the academic medical center.

I was excited to see the launch of the All of Us project several years ago, charged with better understanding how genetics, lifestyle, and environment play a role in health outcomes. More than 770,000 patients have enrolled in the program as of March 2024. As a way of sharing the value of research with study participants, leaders of the project provided summaries of the research done to date. A recently published article looked at the impact of those summaries, specifically with how participants engaged with digital communication. The summaries reached more than two-thirds of participants, exceeding the rates of other program communications. Those most likely to engage with the summaries included those with higher income, age greater than 45 years, and higher levels of educational attainment. The authors conclude that more personalized summaries may yield even greater engagement in the future.

Have you ever participated in a research study, and at what point did you learn about its results? Leave a comment or email me.

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