On April 3, the Secretary of Health and Human Services, Alex Azar, announced that the federal government would pick up the tab for testing and treating all uninsured Americans for COVID-19.
Azar specifically promised that:
a) hospitals would be paid the same prices they receive for Medicare patients; and
b) hospitals which accept the funds would be barred from sending any additional bills to patients.
Did anyone notice the last detail? This is a Republican, who is promising to protect the vulnerable.
In the coming months, thousands of COVID-19 patients will be routed through a convoluted web of providers. At various points in their treatment. they will be susceptible to receiving out-of-network care — and the staggering bills that often follow.
COVID-19 patients will rarely have the luxury to choose a network hospital, or lab, or specialist. Often, they will need to be treated at any facility that is still open.
Shortly before our
world was turned upside down by COVID-19, I visited Space Center Houston with
my family. We marveled at the collective ambition and investment it took to
move from space travel being an aspirational dream to setting foot on the moon.
I thought about my favorite scene from the movie Apollo 13, when Gene Kranz
overhears the NASA Director saying “This could be the worst disaster NASA has
ever experienced,” and candidly replies, “With all due respect, sir, I believe
this is going to be our finest hour.”
Just months later, our entire planet is on a mission to turn tragedy into triumph. Only this time, Americans have not led the way in proactively translating science into action for the benefit of humankind. Instead, we ignored scientists who warned about the inevitability of a pandemic and now lead the world in most confirmed cases (which, due to our testing debacles, underestimates actual cases). As a public health nurse, this is not a race I want to see us leading. Future outbreaks are all but certain while we wait for a vaccine. Every single one of us must start preparing now, for we will all have a role to play.
To be sure, it
is imperative that we all stay the course with current physical distancing efforts
to prevent spread, minimize death, and avoid the collapse of our healthcare
system and its ability to care for patients with COVID-19 and other life-threatening
conditions that do not pause just because of a pandemic. But social distancing
cannot be the only public health tool used to bring the pandemic under
control.
Public health experts agree we need a coordinated national public health surveillance strategy that includes widespread testing in order to identify and isolate infected people early (this is crucial given how many contagious people are asymptomatic), contact tracing to figure out who has been exposed to infected individuals, and quarantining everyone who tests positive or has come in contact with an infected person. We must leverage technology to ensure testing provides fast and accurate results, and that we are able to safely and comprehensively track exposures. Without accurate, detailed, and timely data about the epidemiology of COVID-19, we cannot make scientifically sound decisions about how to ease social distancing or ethical decisions about how to equitably allocate scarce healthcare resources to communities of greatest need.
While President Trump mulls whether to reopen the country again in May, and as Fox & Friends host Brian Kilmeade suggests that “only” 60,000 people will die from the coronavirus, there are some warning signs that the White House COVID-19 Task Force’s prediction of 100,000-240,000 deaths may be way too low.
That isn’t surprising, considering that Administration
officials said this projection depended on us doing everything right. Of
course, it appears that large sections of the country have done many things
wrong—whether it’s Florida Governor Ron DeSantis’ reluctance to close houses of
worship or the refusal of several state governors to issue stay at home orders.
That doesn’t include Trump’s own refusal to admit the seriousness of the
COVID-19 outbreak until mid-March and the continuing failure of the federal
government to ensure an adequate supply of test kits, PPE and ventilators.
So here’s what all of this may be leading up to: a minimum
of 600,000 COVID-related deaths in the U.S. over the next two years.
We’re not through the
COVID-19 pandemic. We’re probably not even near the end of the beginning
yet. That hasn’t stopped many pundits to start speculating about how our
society (and our healthcare system) are likely to be permanently changed as a result,
such as continued reliance on telecommuting and telemedicine.
OK, I’ll play too: I
believe we need to greatly expand the role of robots, and begin something that
resembles Universal Basic Income (UBI). They’re not the only changes that
may result, but they are two that should.
Robots
We’ve been seeing robots infiltrating the workforce for many decades, such as in manufacturing but also in many other industries.
Still, though, as our
economy pares down to “essential businesses” during the pandemic,
I’ve been alarmed at how many of the jobs remain done by humans. Not just
healthcare workers on the front lines but also all those people doing the
cleaning for essential businesses, all those people in the supply chain of food
and other vital materials, all those people making deliveries, all those first
responders, all those people all those people keeping the power on, the water
running, and the internet streaming, among others. And so on.
On Episode 117, we bring you the late-night edition of Health in 2 Point 00. Jess asks me about Wellthy Therapeutics raising $4 million—they’re a digital therapeutics company I’ve been working with out of the Bayer group, definitely a space to watch. Lionrock Recovery raises $7 million, lots of activity in this area of telehealth for recovery and rehabilitation. Also getting $7 million is Datos Health, an Israeli company with a remote monitoring platform. Finally, Biofourmis acquired Gaido Health, expanding into the oncology space. —Matthew Holt
We have seen and heard about the classic symptoms of
COVID-19 at UCSF Medical Center, where I work as a cardiologist. Patients keep
coming in with pulmonary distress, pneumonia, and ultimately, Acute Respiratory
Distress Syndrome (ARDS) – the life-and-death situation that requires
ventilators.
However, I’m beginning to learn about other symptoms that some
doctors are noticing. There are numerous reports of other complications, especially
in advanced disease.
Elevation in D-Dimer, (a biomarker of coagulation system activation) has been associated with dramatically increased risk of death from COVID-19. This has led some to speculate that empiric treatment with anticoagulants might improve outcomes in these critically ill patients. Indeed, there was this recent publication of a retrospective analysis of anticoagulation with heparin or low molecular weight heparin showing an association with improved outcomes in COVID-19 patients in China.
“I never anticipated — and no one did — the level of uptake and the level of scale.”
It says a lot that Joe DeVivo, CEO of Intouch Health, who’s worked with hospitals and health systems on standing up B2B-focused telehealth programs for years (and whose company was acquired by Teladoc Health for $600-million dollars in January) is surprised about the uptake of virtual care during the COVID-19 pandemic.
“Historically, I look at virtual care as a bell curve,” says Joe. “On one side of that small tail of the bell curve are the virtual care companies. Teladoc dominates that space for D2C. There’s millions of consultations a year, and we’re seeing a subset of that. On the opposite side of the bell curve is high-acuity, and what InTouch has been doing for critical care.”
“This crisis, and the changes in reimbursement, have opened up the middle of that bell curve. The core, everyday transaction of healthcare is now being impacted by virtual care. And the big question that everyone has is, “is this going to stick? Is this a crisis management tool and we’re going to go back to the ways of the past, or is that genie out of the bottle?”
We put Joe on-the-spot with his own question, find out what he thinks it will take to enable the permanent shift to virtual care at-scale, and dig in on how demand for telehealth within hospitals has changed as a result of the pandemic, where its not only being used to expand access to specialists, but has also been adapted into a PPE-hack to help frontline hospital workers distance themselves from infected patients.
And what of working with Teladoc? While waiting for the paperwork to finalize (all on-schedule for the end of Q2 as originally announced), the two have organized a co-selling agreement to be able to “hit the market fast” and bring their “hospital-to-home” end-to-end virtual care offering to those who need it now.
As Christians experienced Holy Week 2020, the week commemorating the trial, suffering, and death of Jesus, the somber tone such remembrances evoke took on new meaning in the midst of the COVID-19 epidemic with the catastrophic loss of life and livelihoods. Many churches remained physically closed, some already outfitted with sophisticated systems for live streaming and others scrambled, along with their congregants, to create meaningful virtual worship and fellowship opportunities. Finding ways to maintain physical distancing while still providing social and spiritual connections.
These challenges face people of other faiths as well since the current guidance regarding social distancing affected those observing Passover, April 8-16 and will likely affect Orthodox Easter, April 19 and Ramadan, which will start April 23.
Maintaining social and spiritual connections in the midst of COVID-19 are not the only challenges facing our communities of faith. For centuries if not longer, religious congregations have played critical roles in providing and supporting social services within communities. There are over 345,000 religious congregations in the US of various faiths and denominations and, despite declining rates of religious affiliation and attendance, national surveys still find a sizeable proportion – about 45% – of all adults report attending religious services at least monthly. Religious congregations play even more important roles in particular subgroups, such as low-income communities and among certain racial-ethnic minority groups and immigrants, the elderly, and other vulnerable groups, making faith-based organizations critical to the COVID-19 response in the short and long terms.
Episode 5 of “The THCB Gang” was live-streamed Thursday, April 16 at 1pm PT- 4pm ET! 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the sh*t about health care business, politics, practice, and tech. It tries to be fun but serious and informative! If you miss it, it will also be preserved as a weekly podcast available on our iTunes & Spotify channels.
Deven McGraw (@healthprivacy), Kim Bellard (@kimbbellard), Grace Cordovano (@gracecordovano), Michael Millenson (@MLMillenson), and Dave deBronkhart (@ePatientDave) all discussed the recent news surrounding COVID-19, and their guesses on how it will impact the landscape of health care; from policy to practice — Matthew Holt
COVID-19 testing in grocery store parking lots. Clinicians crossing state lines to practice in hard-hit hospitals miles away from their health system. ICU doctors made to shore up shortages of ventilators by adapting medical equipment from its intended purpose. Are these just medical malpractice suits waiting to happen?
Margaret Nekic, CEO of Inspirien, a hospital-and-physician-owned medical malpractice and worker’s comp insurance company, reveals what’s happening behind-the-scenes as professional liability carriers hurry to adapt to the changing circumstances of a healthcare system thrown into crisis-mode.
While new legislation is emerging to somewhat safeguard healthcare workers from bearing the risk of some of the pandemic’s unprecedented circumstances, what happens when the immediate surge has passed? Will costs for medmal insurance go up? And, what happens from a worker’s comp standpoint if a healthcare worker becomes infected with COVID-19?
As healthcare delivery in hospitals continues to change — and, at the same time, more and more care extends outside the traditional doctor’s office by way of an uptick in use of digital health and telehealth options among non-COVID patients — it seems the pandemic might ultimately also accelerate changes in the way healthcare organizations think about risk management and their insurance coverage for it.
