EPtalk by Dr. Jayne 12/19/24

The US Congress is delivering an end of year cliffhanger in the form of expansive legislation designed to fund the government so that there’s not a shutdown when current funding runs out on December 20. The continuing resolution that is under consideration is over 1,500 pages and includes some healthcare tidbits, including the extension of some Medicare telehealth flexibilities for another year and the extension of acute hospital at home flexibilities through the end of 2029.

The continuing resolution took a beating on the platform formerly known as Twitter this week, with Elon Musk personally posting about it more than 100 times. My heart goes out to all the families that will be impacted if there is indeed a government shutdown, especially essential workers who are expected to continue working but who might not be paid in a timely fashion. National parks and monuments will close in the event of a shutdown, so if those activities were in your holiday plans, stay alert. Even if the resolution passes, it will only cover the nation through March 2025, so there are plenty more budget conversations to come.

From Rotisserie Gal: “Re: predictions. I always make an email folder where store predictions that caught my eye, or announcements of seemingly hot new tech that I want to watch over time. With that, I give you a prediction from CES 2024 – the macrowave oven. I haven’t seen a word about it since then.” Looking back at the article, the device was called “the Tesla of kitchen appliances” and there was plenty of gushing over its ability to revolutionize cooking. I guess it wasn’t that revolutionary though, because an internet search today only brought up articles mentioning the CES debut. I even went to the manufacturer’s website and couldn’t find anything about it, so unless someone else informs us to the contrary, it seems to be a prediction that fizzled.

In addition to looking at predictions for 2025, I’m also a sucker for “year in review” articles covering the one that’s winding down. JAMA Health Forum released its list of most viewed articles for 2024. The titles are telling and align with the hot topics I’ve heard discussed in the physician lounge, whether virtual or in person:

• “Changes in Permanent Contraception Procedures Among Young Adults following the Dobbs Decision.”
• “US State Restrictions and Excess COVID-19 Pandemic Deaths.”
• “What Would Another Trump Presidency mean for Health Care?”
• “Evaluation of Changes in Prices and Purchases Following Implementation of Sugar-Sweetened Beverage Taxes Across the US.”
• “Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage.”
• “Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic.”
• “What Would a Trump Administration 2.0 Mean for Health Care Policy?”
• “Job Flows Into and Out of Health Care Before and After the COVID-19 Pandemic.”
• “Patient-Level Savings on Generic Drugs Through the Mark Cuban Cost Plus Drug Company.”
• “Patient Safety and Artificial Intelligence in Clinical Care.”

Another year in review article listed the most expensive Epic EHR projects worked on or completed in 2024. Top-tier spenders were in the $800 million to $1.2 billion range, with the low-end contenders seeming rather paltry at $50 million. I’d love to see someone approach the data in a different way to see how it resonates. Although it might be interesting to see the expenditure as a percentage of net and/or gross revenue, it might be even more intriguing to see it compared to patient stats that are commonly used when discussing volumes. I can just see health system CEOs standing around comparing their “Epic dollars per licensed bed” or “Epic dollars per emergency department visit.” I know that these large numbers often represent a cost savings, especially when an Epic implementation allows retirement of multiple unwieldy systems or the efficiencies of standardization. But it doesn’t change the fact that the numbers are indeed staggering.

I recently applied for a committee position and was asked to identify whether I was an early career individual versus mid career or late career. I asked for specific criteria and found that their idea for distribution was substantially different than what I had expected. They define “early” as five years or less, “mid-career” as six to 10 years, and “late career” as more than 10 years. Thinking back, there’s so much I didn’t know before hitting what they would consider late-career. I wonder how they would describe those of us who have been at this for 25 or 30 years, which is what I would truly consider late career. I’m curious how other organizations define this and if this was just an anomaly since I’ve never been asked this question.

I saw a headline about UnitedHealth’s Optum inadvertently making its internal AI-powered chatbot available to the public via an IP address, but I didn’t have time to read it. I finally circled back today and was glad I did, since the story goes well beyond the headline. The chatbot was trained on internal materials that describe standard operating procedures for managing claims. Optum claims it was a “demo tool developed as a potential proof of concept” but was never in production use by employees. That’s all pretty vanilla, but I was glad I read to the end and heard about what happened when TechCrunch asked the tool to “write a poem about denying a claim,” producing a seven-paragraph work which is featured in part at the bottom of the article. Well worth the read folks, well worth the read. I’d love to see the other five paragraphs, though.

Winter is upon us, and I’m wholeheartedly embracing the hygge lifestyle with plenty of books, sweaters, cozy socks, and of course seasonal baking. The different varieties of cookies amaze, me and whether you need a concentrated punch of chocolate in a lumpy form factor or whether you prefer a more demurely dunk able option with greater surface area, I probably have a recipe for you.

What are your favorite holiday cookies? Leave a comment or email me.

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