Study: Telehealth Doesn't Lead to Excessive Healthcare Use | HealthLeaders Media

Contrary to what Medicare and Private health payers said, telehealth does not lead to excessive healthcare use.

A popular criticism of telehealth is that people will be using it more than they should, leading to unnecessary healthcare appointments and expenses. But researchers at the University of Michigan say that's not true in the Medicare market.

An analysis of Medicare data through 2021 finds that while virtual visits have increased considerably as a result of the pandemic, with roughly one-third of traditional Medicare members taking part in at least one telehealth visit last year, those numbers aren't excessive. This means that the Medicare population, comprised primarily of older Americans, is using the platform to replace in-person care, rather than just because they can.

“As telehealth use hits its stride in the Medicare fee-for-service population, the fears that flexible telehealth rules might lead to an increase in the total volume of outpatient visits have not panned out,” Chad Ellimoottil, MD, MS, director of the Telehealth Research Incubator at UM's Institute for Healthcare Policy and Innovation and lead author of the study, said in a press release. “With all the evidence we have to date, it appears that telehealth has been used as a substitute for in-person care rather than an expansion of care.”

The distinction is important, especially as the nation moves away from the pandemic and the healthcare industry looks to adopt a long-term telehealth strategy when the public health emergency ends. Advocates say telehealth should be a standard practice of care, comparable to in-person care, and regulated along the same lines. Opponents argue the platform is ripe for misuse and abuse, and that it should be governed more strictly to prevent waste and abuse.

Ellimootil and his colleagues found that about 9% of all outpatient appointments made by people with traditional Medicare coverage were virtual in the latter half od 2021. That represents a decline in virtual visits compared to the time period between mid-2020 and mid-2021, but a large increase compared to prior to the pandemic in 2019.

The surge in telehealth use during the pandemic was helped by a series of federal and state waivers aimed at increasing access to and coverage of telehealth so that health systems could protect their staff and isolate those infected by the COVID-19 virus from others. Those waivers will end with the end of the PHE, and telehealth supporters want new or revised regulations in place to continue the momentum and allow health systems to continue their programs.

Whether this will occur remains to be seen.  My bet is that it will, because both physicians and patients need it.

Study: Telehealth Doesn't Lead to Excessive Healthcare Use | HealthLeaders Media

Telehealth Diagnoses Match In-Person Clinical Visit Diagnoses in 86.9% of Cases, Study Finds | HealthLeaders Media

The COVID-19 pandemic created a dependency on remote patient visits using telehealth.  Studies from several credible sources reveal how accurate a diagnosis is in a telehealth visit.

 In non-primary care specialties, a diagnostic agreement between telehealth visits and in-person visits ranged from 77.3% for otorhinolaryngology to 96.0% for psychiatry. Diagnostic agreement between telehealth visits and in-person visits was significantly higher for specialty care compared to primary care (88.4% versus 81.3%).

There is a significant level of agreement between telemedicine diagnoses and in-person outpatient visit diagnoses, a recent research article found.

In the early phase of the coronavirus pandemic, telehealth utilization increased exponentially—one published estimate pegged the increase in utilization in April 2020 at 20-fold. A concern associated with this increase in telehealth utilization is the accuracy of telemedicine diagnoses compared to in-person visits.

IMPORTANT TAKEAWAYS 

Among the 313 (13.1% of the total) cases where there was no agreement between the telehealth diagnosis and the in-person visit diagnosis, 166 cases had the potential for morbidity and 36 of those cases had actual morbidity.

 Among the 313 cases where there was not an agreement between the telehealth diagnosis and the in-person visit diagnosis, 30 had the potential for mortality, and 3 of those cases had actual mortality.  

Telehealth diagnoses often should be paired with in-person visit diagnoses, the study's co-authors wrote. "These findings suggest that video telemedicine visits to home may be good adjuncts to in-person care. Primary care video telemedicine programs designed to accommodate new patients or new presenting clinical problems may benefit from a lowered threshold for timely in-person direct follow-up in patients suspected to have diseases typically confirmed by physical examination, neurological testing, or pathology."

There are important caveats about using telehealth for diagnosis.

INTERPRETING THE DATA

Telehealth Diagnoses Match In-Person Clinical Visit Diagnoses in 86.9% of Cases, Study Finds | HealthLeaders Media

Weight-Loss Drug Semaglutide Making People Disgusted by Coffee, Fries

Staci Rice had been a daily coffee drinker since the seventh grade. A marketing professional and mom in Georgia, she likes the taste, the routine, and how it makes her feel: awake. 

But about six months ago, she walked into the kitchen to make a pot — and poured it out. "All of a sudden," she said, "I had no desire for it." 

Rice, 40, had recently gone on the popular weight-loss drug semaglutide, which has since helped her lose nearly 50 pounds. She's now wearing pants she shelved 16 years ago, and seeing results she could never sustain on diets like Weight Watchers and Optavia. 

But Rice still isn't able to stomach her morning coffee. "Every morning, I would try to make coffee, thinking that one day it would just taste good to me again." No such luck. "I miss having energy," she said. 

Rice has lost her taste for other food and drinks she once loved, and acquired a few new ones. Long a fan of Chick-fil-A's "Number 1" — a 440-calorie fried-chicken sandwich served on a white buttered bun — she now describes the chain's kale salad as "delicious." 

Ground beef is off the dinner rotation ("my husband and son are kind of upset," she said), and chocolate's lost its appeal, too. 

When Rice tried a Kit-Kat, which she believes is the superior chocolate bar, for Halloween, she winced. "I can't even describe what kind of flavor it had," she said. "I just didn't want it." 

Rice before, left, and after six months on semaglutide. 

Staci Rice

Others on the drug have reported similar experiences. They anticipated that semaglutide would decrease their appetite, but in some cases, it seems to have hijacked their taste buds, turning french-fry fiends into kale enthusiasts and coffee snobs into smoothie kings. 

And while many people say the trade-off is worth it, the unexpected hit to their identity and social lives can be tough to swallow.

"Food is so much more than just fuel. Culturally, we have rituals around food that bring us joy and fond memories," Rachel Goldman, a New York City psychologist who specializes in weight management, said. "What do you do to fill the void?"  

Semaglutide is making people miss their favorite foods

Semaglutide, sold under the brand names Wegovy and Ozempic, is an injectable drug that boosts the production of insulin, a hormone that helps regulate blood sugar. While semaglutide was originally developed to help manage diabetes, Wegovy was approved as a weight-loss drug in June 2021. 

Some obesity-medicine experts have called the drug a "game changer." Research has found it can lead to a 15% to 20% reduction in body weight over 68 weeks when paired with a reduced-calorie diet and regular exercise. 

Weight-Loss Drug Semaglutide Making People Disgusted by Coffee, Fries

A patient’s ode to healers

MICHELE LUCKENBAUGH 

PATIENT

Pages of my life turn over
As the breezes of time flow over me.
Remembrances of your presence
As the world welcomed my firstborn so many years ago.

Your calming voice and words of wisdom reminded me that life
Would be different, but oh so much better.
My little baby girl would grow to be a healer just as you,
Offering hope and consolation to those who seek her out.

Expert hands stitching the brow of my rambunctious toddler,
Telling me that my son would be fine.
Now he is a man grown tall and strong,
Finding his own pathway in this world.

How time has raced on.
When my heart waged a skirmish against me
You were there standing at my side,
Talking me down from the mountain of fear.

Your words of wisdom and compassionate care
Were a salve for my wounded heart.
The encouragement is given to spur me on,
Telling me the “sky is the limit”

And so it was.

As chapters of my life are being written, you are there to guide me.
Share advice, but always maintain our partnership, the give and take.
In this sacred clearing, we are each co-creators of this story that is my life.
One telling the story, the other patiently listening.

Roles flip back and forth as life moves forward.
You are the cushion to soften the fall when life deals a harsh blow.
Always encouraging, always hopeful.

What will happen when your kind is absent,
Forced out by clutching hands, greed, and impatience
Making you feel unimportant and powerless?

Who will be there for comfort and support,
For the healing, we search for?

The unconcerned do not see the forest for the trees,
Trees forming a  wall blurring the truth.
But the truth must shine forth.

It has to.

Healers, do not lose hope!
To lose hope is to surrender.
To let them win.

Hold your head high, and cluster together.
Let your voices make a resounding clamor, far and wide.
We, who need your healing touch, will be your support
as you have done for us.

This story has not reached its end.
We both have lines to write
And words to be spoken.

Our partnership is worth fighting for.

This is dedicated to all physicians, to all healers, who have played a significant role in helping us move safely past the roadblocks in our lives. Most recently, our physicians and nurses have served tirelessly on the front lines combatting the coronavirus, a pandemic that has brought a huge loss of life to all parts of the world. Often, they have done this without adequate facilities, protective gear, and supplies at their disposal. To them, we owe our deepest gratitude. They have potentially sacrificed their own lives to attend to the sick and dying during this terrible time.

In the times we live in, the role of the physician has been severely impacted from all sides. The corporatization of medicine and all that it entails has led to the weakening of the once-valued doctor-patient relationship. Visits to our physicians have become little more than business transactions between “providers” and “consumers.” Clicks on a keyboard replace face-to-face discourse.

Doctors are disheartened, overworked, and feeling powerless. Their voices have been silenced for fear of retribution. Many are leaving the profession they have worked so hard to obtain and have sacrificed so much for. We ask that their story be told so that the truth of just how dire the situation is becomes known. We deserve and need to have the complete story.

Our brightest are seeking other careers outside the field of medicine. Residencies are being underfunded by Medicare thereby further diminishing the supply of fully qualified doctors. So the shortage of physicians continues to increase with no real solutions in sight. The time will come when we all will have to be content in seeing a “substitute dressed in a white coat”. Someone without the knowledge or experience that you, our physicians, possess. America, this is our wake-up call. Hopefully, our recent experience with COVID-19 has taught us valuable lessons. We are, indeed, all in this together. Now is the time to write a different “ending” to this story, before it is too late.

It looked like his HEAD EXPLODED! 😱

The Cure for the Morning Headache

Clinical Whole Genome Sequencing - by Eric Topol

I remember a day when genetic testing was very expensive and only used for rare diseases.

Times and our ability have changed diagnosis and treatment for many diseases previously thought to not be worth genetic analysis.

So much attention has been placed on the cost of whole genome sequencing (WGS) over the years, from about $300 million for the first one in 2000 (some estimates are as high as $3 billion), to now starting to approach $100. That’s a long-sought and remarkable reduction in cost.  

But what is equally impressive is that a team at the University of Washington, led by Danny Miller, set a world record in September 2022, reducing the time from the sample (at the birth of a baby) to interpretation to 3 hours! That diagnosis (of lacking the pathogenic gene variant of concern) in a newborn was facilitated by knowledge of familial risk. Nevertheless, that acceleration of sequencing and analysis comes in the wake of the Stanford team, led by Euan Ashley, performing WGS in 12 people ranging from 3 months to 57 years, in a critical care setting, in as little as 7 hours and 18 minutes.

This acceleration of gene technology almost allows genetic testing to be available at the bedside for a cost approaching a complete blood count.

At times the advances are announced first in lay publications such as the NY Times.

Time course from presentation to diagnosis

At Scripps Research, our SRTI team works closely with Rady Children’s Institute for Genomic Medicine, the group that has pioneered WGS in sick newborns who do not have a diagnosis, accomplishing this from sample to interpretation and management recommendations all within 13 hours, using multiple AI tools (labeled 1-3 below) to expedite the readout and care of the baby.

An automated 13.5 hour system for scalable diagnosis and acute management guidance for genetic diseases

The reduction in cost and time for whole genome sequencing is historic and one of the most important advances that has occurred in life science in recent years. With the increasing use of AI tools to make the variant calling and interpretation more accurate and rapid, along with contextualizing the medical literature for a molecular diagnosis and possible treatment, this could become someday an exemplar, beyond the prediction of protein folding from the amino acid sequence (AlphaFold), for AI’s contribution to biomedicine. Hopefully, someday we will harness its value to advance individualized medicine.

Clinical Whole Genome Sequencing - by Eric Topol

Why Some People Might Never Get COVID

8 prior authorization terms that drive every doctor crazy | American Medical Association

Prior authorization

This is a health plan cost-control process that restricts patient access to treatments, drugs, and services. This process requires physicians to obtain health plan approval before delivery of the prescribed treatment, test, or medical service in order to qualify for payment.

According to an AMA survey (PDF) of 1,004 practicing physicians, more than nine in 10 respondents said prior authorization had a significant or somewhat negative clinical impact, with 34% reporting that PA had led to a serious adverse event such as a death, hospitalization, disability or permanent bodily damage, or other life-threatening events for a patient in their care. 

The vast majority of physicians (88%) described the administrative burden associated with PA as “high or extremely high,” and physician practices complete an average of 41 prior authorizations per physician per week. 

Utilization management

Prior authorization is just one subset of the larger field of insurer practices called utilization management (UM), which the Institute of Medicine—now known as the National Academy of Medicine—defined way back in 1989 as “a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision.” That has a familiar ring to it.

The AMA is fighting for the passage of a bill that would require Medicare Advantage plans to implement prior-authorization reforms, easing the burden on physicians and their practice staff.

Step therapy

Another utilization-management technique that can drive doctors crazy is step therapy, sometimes called the fail-first requirement. Under such a policy, payers will require that patients first try and fail lower-cost tests, drugs or other treatments before moving on to higher-cost options, sometimes in cases when the patient has already unsuccessfully tried the therapy under a previous insurance plan.

Find out what doctors wish patients knew about prior authorization.

Medical necessity

Everyone agrees that patients should not get a drug, test or surgery unless it is medically needed. The reason why this common utilization-management term drives doctors crazy is that it seems as though each payer has its own definition of medical necessity, which makes navigating the process highly frustrating for physicians who just want their patients to get the care they deserve.

The AMA believes that what constitutes medically appropriate treatment should be based on clinical guidelines developed by the appropriate national medical specialty society and be consistent regardless of a patient’s insurer. There should be a standard medical necessity definition so that all insurers in a state are playing by the same rules and everyone understands what those rules are.

Learn more about what the AMA’s research has uncovered about prior authorization and share your story to help guide advocacy efforts to fix prior auth.

Peer-to-peer review

This is a process in which an ordering physician discusses the need for a procedure or drug with another physician who works for the payer in order to obtain a prior-authorization approval or appeal a previously denied PA. If properly implemented, the process can be helpful, as it affords the physician the opportunity to speak with another clinician. What drives doctors crazy is that it usually comes after days or even weeks of bureaucratic wrangling, and the health plan's “peer” often is from a completely different specialty and knows nothing about the disease or treatment in question.

The AMA says peer-to-peer review should be available at any point following an adverse PA determination, and that the peer to whom the physician speaks should be a genuine peer—a doctor practicing the same specialty and subspecialty as the ordering physician.

Learn about a gastroenterologist so sick of the runaround from payers that he has taken his prior auth pains to Twitter.

Related Coverage

House voice vote sets U.S. on the path to fix prior authorization

Standard pharmacy electronic prior authorization

Also called ePA, this capability automates prior authorization by integrating it into the physician’s electronic prescribing workflow and can make the PA process faster, consistent across insurers, and more efficient. Unfortunately, physicians interested in using this technology are often stymied, as ePA is far from the norm.

Too often, physician practices and health care organizations are stuck navigating telephone trees, waiting on hold, or feeding forms into their fax machines. Even when health plans offer electronic prior-authorization options, they often involve proprietary portals that require workflow disruption to exit the EHR, log into the insurer’s unique website, and time-consuming reentry of the patient and clinical data—not the streamlined standard ePA process embedded within the EHR. Astoundingly, the Cleveland Clinic has racked up a $10 million annual tally just to push their PA requests through the process.

Learn more about how ePA technology that integrates with practices' current electronic prescribing workflows can improve the drug prior authorization process, just one of the AMA’s PA practice resources.

Gold carding

This is a process under which a payer exempts physicians who consistently order or prescribe treatments and drugs in accordance with evidence-based guidelines, or have high approval rates from PA requirements. So if you’re not an outlier physician—if your prior-authorization requests are approved like clockwork—at, let’s say, a 90% rate—then payers should be happy to grant you that proverbial gold card, allowing you to get your patients quick access to the care towards which they have been paying their premiums.

While Texas has enacted prior-authorization “gold card” legislation and a bill in Congress would advance the idea in Medicare Advantage, such programs are not prevalent in health care today, and it drives doctors crazy that such a commonsense concept—one that would reduce PA burdens for both practices and insurers—hasn’t yet taken hold.  

The essential idea was outlined in a set of principles put forth (PDF) by the AMA and 16 other physician, patient and health care organizations: “Health plans should restrict utilization management programs to ‘outlier’ providers whose prescribing or ordering patterns differ significantly from their peers after adjusting for patient mix and other relevant factors.”

Moreover, a consensus statement (PDF) released by the AMA and national associations representing both providers and insurers encourages just these sorts of programs to lower the overall volume of PAs by selectively applying these requirements.

In 2018, payers agreed to rein in prior auth. Learn why the clock is still ticking.

The not-so-hidden cost of prior authorizations from the Cleveland Clinic

8 prior authorization terms that drive every doctor crazy | American Medical Association

Narrative Medicine: Every Patient Has a Story |

Every patient has a story that goes beyond the symptoms they bring into the doctor’s office.

Those stories can illuminate how a person became ill, the tipping point that compelled them to seek help, and, perhaps most importantly, the social challenges they face in getting better. Stories can offer the kind of contextual richness that promotes and nourishes empathy, prompting a provider to switch from asking “How can I treat this disease?” to “How can I help my patient?” The difference may seem subtle at first, but knowing how to get patients to share their stories can be transformative in improving patient care, say proponents of this approach called “narrative medicine.”

Another classification for this is Social Determinants of Health (SDOH)

Social determinants of health

These include underlying communitywide social, economic, political, cultural, and physical conditions people experience when they are born and as they grow, live, work and age. These experiences shape individual material and psychosocial circumstances as well as biological and behavioral factors. The term commonly refers to defined communities or regions, which are typically defined by geography. All patients experience social determinants of health.  

Structural determinants

These include the climate, socioeconomic-political context—for example, societal norms and macroeconomic, social, and health policies—and the structural mechanisms that shape social hierarchy and gradients, including economics income, access to food, power, class, racism, sexism, and exclusion. It commonly refers to cities, states, nations, or the world and typically is defined by political jurisdictions, cultural boundaries, or economic relationships. 

Community Health

A multisector, multidisciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities in a culturally appropriate manner to optimize the health, quality of life, and social determinants of health for all people who live, work or are otherwise active in defined communities.

Public Health

Public Health is often determined by factors outside the health care system and is committed to addressing the social determinants of health to improve health outcomes for all Americans.

Narrative Medicine: Every Patient Has a Story | AAMC

    

Prior Authorization Angst, Another Reason for Doctor burnout.

Consult this handy glossary to better grasp the frustrating cost-control practice and learn how the AMA is leading the charge to fix prior auth.

Listen to this Article

Any patient who has been to their physician in the past decade has heard, (We'll have to get authorization for a referral, treatment, or medical equipment.  The time involved or this is not insignificant and adds expense for additional personnel. Some medical practices may employ one or two full-time employees to perform this task.

Amongst other tasks contributing to physician burnout is the electronic health record.   

What is the leading cause of physician burnout?

The healthcare environment—with its packed work days, demanding pace, time pressures, and emotional intensity—can put physicians and other clinicians at high risk for burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.

8 prior authorization terms that drive every doctor crazy | American Medical Association:  

Among physician specialties, the biggest declines were seen within internal medicine, family practice, and emergency medicine fields. (Getty)

Nearly 334,000 physicians, nurse practitioners, physician assistants, and other clinicians left the workforce in 2021 due to retirement, burnout, and pandemic-related stressors, according to new data.

Physicians experienced the largest loss, with 117,000 professionals leaving the workforce in 2021, followed by nurse practitioners, with 53,295 departures, and physician assistants, with 22,704 departures. About 22,000 physical therapists also left the healthcare workforce and 15,500 licensed clinical social workers, according to a report from commercial intelligence company Definitive Healthcare.

Among physician specialties, the biggest declines were seen within internal medicine, family practice, and emergency medicine fields. "Like clinicians and registered nurses, providers in these three specialties frequently worked on the frontlines during the pandemic, risking exposure and facing many of the same pressures and stressors as described earlier," the report authors wrote.

In 2021, 15,000 internal medicine doctors left the workforce, followed by 13,015 providers who left family practice and 10,874 who left clinical psychology.

Definitive Healthcare's report leverages data from more than 2 million physicians and nurses, 9,200 hospitals and IDNs, and 128,000 physician groups.

Among high levels of burnout, many healthcare providers are nearing retirement age, the report noted.

 According to Definitive Healthcare data, many physicians across several healthcare specialties are on the verge of retirement or will be near that age soon. Research from the American Association of Medical Colleges (AAMC) found that nearly 45% of doctors are older than age 55, and more than 40% of active physicians will be 65 or older in the next ten years. The average age of a nurse is 57, the report said.

Physicians leaving the workforce of patient care

Retirement age, disability, burnout, including pandemic stress, new non-clinical role, loss of license due to malfeasance, malpractice.

Plan B

Plan B is about mixing boxes, not stacking them. Instead of a sequence of education, work and retirement, the approach means blending the three during your life and creating a portfolio career. In addition, if your interest is some kind of alternative career using your skills as an experienced physician, then you need to plan sufficiently ahead of time, with areas of overlap and transition, instead of just jumping off the cliff once you decide to shove the white coat.

Truveta releases live dashboard with healthcare data from 25 health system partners

The age of AI is here,  and how it will improve your health.  The data is collected after personal information is removed from it.

Health data startup Truveta has released a real-time searchable dashboard featuring deidentified medical records from more than 70 million patients from its 25 health system partners.

Truveta Studio has data covering 16 percent of the healthcare system that researchers can use to study patient care and outcomes by condition, drug or medical device. The data, integrated via artificial intelligence-powered natural language processing, is updated daily.

"For researchers, this is really exciting," said Ari Robicsek, MD, chief medical analytics officer and senior vice president of research at Renton, Wash.-based Providence, in a Nov. 2 Truveta news release.

The data spans a patient's longitudinal history, covering diagnoses, vital signs, lab tests, clinical notes, procedures, medications and vaccinations. Gaps are filled with insurance claim information, while daily mortality and social drivers of health data is imported from LexisNexis.

"Researchers often spend countless hours attempting to stratify and define the patient populations they are seeking to study before they can even begin their analysis," stated Eric Eskioglu, MD, executive vice president and chief medical and scientific officer at Winston-Salem, N.C.-based Novant Health. "Truveta not only ensures consistency and transparency across different clinical concepts and outcomes, but also fundamentally lower the cost and increase the speed of research, enabling scientists to get to insights faster for saving more lives."

Truveta's health system partners include:

• Advocate Aurora Health (Downers Grove, Ill., and Milwaukee)
• AdventHealth (Altamonte Springs, Fla.)
• Baptist Health (Jacksonville, Fla.)
• Baylor Scott & White Health (Dallas)
• Bon Secours Mercy Health (Cincinnati)
• Centura Health (Centennial, Colo.)
• CommonSpirit Health (Chicago)
• Hawaii Pacific Health (Honolulu)
• Henry Ford Health (Detroit)
• HonorHealth (Scottsdale, Ariz.)
• MedStar Health (Columbia, Md.)
• Memorial Hermann Health System (Houston)
• MetroHealth (Cleveland)
• Novant Health (Winston-Salem, N.C.)
• Northwell Health (New Hyde Park, N.Y.)
• Ochsner Health (New Orleans)
• Providence (Renton, Wash.)
• Saint Luke’s Health System (Kansas City, Mo.) 
• Sentara Healthcare (Norfolk, Va.)
• Tenet Healthcare (Dallas)
• Texas Health Resources (Arlington)
• Trinity Health (Livonia, Mich.)
• UnityPoint Health (Des Moines, Iowa)
• Virtua Health (Marlton, N.J.)
• WellSpan Health (York, Pa.)

Truveta releases live dashboard with healthcare data from 25 health system partners