The two hot topics around the virtual physician lounge this week, not surprisingly, involved comments or policies from the new Secretary of Health and Human Services.
Physicians are dreading upcoming changes in vaccine reimbursement, which will likely come if vaccines are no longer recommended by the reconstituted Advisory Committee on Immunization Practices. Commercial payers follow the actions of government payers, which could lead to a fair amount of work for everyone with an EHR and billing system as they reconfigure their systems to follow new rules.
I can also already see the new policies fueling burnout in the organizations that I’m closest to, as physicians again have to defend their practice of evidence-based medicine. It’s not a great time to be a frontline physician, particularly one in primary care.
The other hot topic was around statements that everyone in the US should have a wearable medical device in the next four years. Continuous glucose monitoring devices appear to be the darling of the day, with much skepticism from physicians who have already had to deal with the data provided by current users. There’s not a lot of data that supports the use of the devices unless a person is diabetic, prediabetic, or has one of a handful of other medical conditions.
Just wearing a device doesn’t drive the needle, either. Other services are needed to support patients as they make changes in their health, such as dietitians, nutrition counseling, and behavioral health interventions. Those also have a cost.
It’s great to say that people should take charge of their own health, but for those of us who have been in the public health trenches for decades, we know that patients can’t always control the fact that they live in a food desert. They can’t control their genetics. We live in a nation where health literacy is close to rock bottom.
Kennedy stated, “They can see, as you know, what food is doing to their glucose levels, their heart rates and a number of other metrics as they eat it, and they can begin to make good judgments about their diet, about their physical activity, about the way that they live their lives.” Having cared for thousands of average Americans during my medical career, I would hypothesize that less than a quarter of the patients I’ve seen would be able to take a device out of the package start managing their diet in the way that he describes without some serious intervention.
I don’t disagree that the nation needs a crash course in self-care. I’ve seen it myself as patients come to the emergency department for the common cold without having taken so much as an acetaminophen tablet. We see wounds that haven’t been washed with soap and water and sprains that were never iced, among other things, as the patients come to us and leave with a $1,000 hospital bill.
I would much rather see the country start pouring money into public health interventions that have been proven effective than see us throwing money at technology without all the ancillary services needed to truly drive the needle for patient outcomes. The nation’s many Federally Qualified Health Centers know a thing or two about this, as do the many county, city, and state health departments.
Speaking of high tech public health, I continue to be fascinated by the data and analytics around using wastewater for disease monitoring. I first heard of it during the height of the COVID pandemic, when it was being used to model the level of disease in our community, especially when we were having shortages of testing supplies for use in the office.
WastewaterSCAN is a nationwide system that is based at Stanford University in partnership with Emory University. It monitors 11 infectious disease indicators via bottles of wastewater that are shipped from around the country. Viral RNA material is sturdy stuff, and the diseases tracked include COVID, influenza A and B, respiratory syncytial virus (RSV), enterovirus, norovirus, hepatitis A, and many more. CDC also conducts testing, as do many municipalities, and most of the data is publicly available.
The higher-level information that is gleaned from wastewater can help public health agencies and care delivery organizations understand what viruses are surging in their communities and might be useful for creating recommendations on when to start testing for various diseases. It can also be used to inform staffing levels within facilities or to pinpoint increases that might result in an outbreak, such as high levels of a virus at an airport or tourist spot.
The next frontier in wastewater research involves identifying bacteria, although the process poses challenges. You can have two bacterial species that are similar, but only one causes a serious disease, and it can be difficult to differentiate between the two. Here’s to seeing what the next decade of innovation brings in this field, and to knowing that many of us are contributing to scientific advancement with every flush.
For some time now, I’ve been trying to clean up my provider data, including my NPI registration that still lists an address where I haven’t worked in a very long time. There are also problems with my CMS data, and the process to try to correct that is even worse.
In a typical employed provider situation, an office manager or administrator usually manages that for the employed physicians. But when you’re a 1099 contractor working for multiple organizations it’s up to the physician to make it work. The governmental data is particularly pesky, because it feels like you have to get a log in to site A that then gives you access to site B but the passwords time out and are a pain to reset. If anyone has a cheat sheet for cutting through all of this, feel free to send it my way. My current clinical situation tells me I’m on my own. Maybe someone could create an AI-powered bot that could take care of it all.
I was back on the patient side of the equation this week and was surprised by the speed at which I received a message that I had “new test results” in the chart. Once I made it through some pesky password issues that involved using my laptop instead of my phone, I was disappointed to find that the “result” was simply a message from the lab that said my specimen had been received. It’s been a long time since I’ve done lab interface work, but I would hope that such messages might be filtered to avoid causing extra anxiety for patients.
I was also disappointed by the quality of the visit notes that I could see. I was weighed during my visit, but my height was not measured. However, the note had a documented height but no weight, although a BMI was there. The combination of vitals showing up in the note seemed odd. The note from the first physician that saw me had no fewer than six exam findings that were most certainly not examined. Although one could blame templated documentation, there really is no excuse. If you’re not doing an ear, nose, and throat exam on every patient, it takes about 12 seconds to remove that from your template forever.
When you’re a patient, what’s your biggest frustration with healthcare information technology? Leave a comment or email me.
Email Dr. Jayne.
"A valid concern..." Oh please. Everyone picks the software they like and the origin of that software is an afterthought.…