Curbside Consult with Dr. Jayne 3/4/24

A number of my physician friends still work for independent medical practices, which is a bit surprising given recent market forces that have been challenging even for the most well run of them. Now that the Change Healthcare ransomware attack is approaching the two-week point, many are concerned that they are going to be in financial straits.

The first quarter of the year can be difficult for medical practices, especially if they have a large percentage of patients that are covered by high-deductible health plans. Those patients often avoid care until they reach their deductibles, which means volumes can be down in the practice. This tends to pick up towards the end of the calendar year, when patients have met those deductibles and are trying to squeeze in visits before the new year rolls around. 

Several of my friends were chatting about the inability to send claims to insurance companies and are worried about cash flow. I asked whether their business continuity insurance policies would cover the disruption and was surprised that more than half of them didn’t know if their practices even have that kind of insurance coverage. One would think that after coming out of a pandemic that significantly disrupted practices’ ability to function, groups would have looked into that if they didn’t already have coverage. Maybe the reliance on federal pandemic funds made them think they didn’t need to worry about it, but they are now wishing they did.

For those that outsource their revenue cycle management functions, they have been surprised by the lack of communication about the situation and what the third parties are doing to try to switch to other vendors. Some are wondering how they’re going to be able to make payroll and are trying to get short term loans to cover practice expenses. I’ve heard that a couple of local banks are stepping up to help out, but it sounds like national banks are less excited to be doing so. For lack of a better description, everyone is just scrambling at this point.

My current clinical practice pays me on a per-visit basis, regardless of a patient’s ability to pay or what insurance they might or might not have. That provides me a bit of a buffer from the Change Healthcare situation, although I know that the organization I work with is nervous about the situation. They’re committed to caring for patients and have a decent financial reserve, however, and I feel reassured that I’m unlikely to be benched like I was during the pandemic.

I’m exclusively seeing patients via telehealth these days, partly due to volume demands and partly due to my computer skills. I think my employers enjoy having someone who can power through visits, understands the need to set up their own favorites and defaults, and doesn’t complain about the EHR.

Patients have grown to rely on telehealth. The fact that we don’t know for sure what will happen with telehealth reimbursement is making a lot of organizations nervous. A little more than a week ago, 200 organizations signed on to a letter that asked the US Congress to take action to ensure that virtual care payments that were modified during the pandemic remain favorable. A couple dozen of these organizations were health systems, but among the rest were professional societies, patient advocacy organizations, virtual care companies, and tech giants such as Amazon. Big names signing on included Ascension, Intermountain Health, Johns Hopkins Medicine, Mass General Brigham, Michigan Medicine, Trinity Health, and UPMC.

The signers encourage Congress to take action now so that patients and care delivery organizations can plan and budget, rather than leaving them hanging until the eleventh hour as Congress tends to do. Organizations can be confident when they make investments in virtual and hybrid care models, which will be essential in managing workforce challenges. They also note the need for employers to be able to plan ahead for their health plan offerings for the coming year, which they can’t do if decisions aren’t made well before the traditional open enrollment periods that most employers have in November. Additional points made in the letter include:

• Patients have come to rely on telehealth, and ending payments will be detrimental to established care relationships.
• Safety net organizations have used telehealth to extend care, including community health centers and rural health clinics.
• Continued provision of mental health services via virtual care is essential.

I’m now in my seventh year as a practicing telehealth clinician, which is hard to believe when you think about it like that. It’s a skill that physicians of my training generation certainly weren’t trained to do, but we adapted quickly to it when our organizations decided to roll out programs. Those of us who were already seasoned definitely had an easier time during the pandemic. I was fortunate to be able to use a mature platform that hadn’t been cobbled together with Zoom, duct tape, and leftover Cat 5 cable.

I still chafe having to wear a white coat to perform telehealth visits, as required by my organization, but the annoyance of the scratchy polyester is outweighed by the fact that patients genuinely appreciate the flexibility of care even when I’m just providing advice and not sending out prescriptions.

I can’t think of any physicians I know who still perform house calls, but in many ways telehealth visits have become the house calls of the future. Especially when you can add technology like connected blood pressure cuffs, scales, and imaging devices, it goes along way towards what you could say was almost like being there. Now we just need to break down the payment barriers, and while we’re at it, I’d love to see our federal government find a way to break down the patchwork licensing restrictions in the US that keep me from seeing patients who live a couple dozen miles away from me but who are figuratively in a different world as far as me being able to care for them. My standard of care isn’t going to be different just because of where the patients live, but state medical boards sure try to convince people that it’s a real risk. It’s time for licensure reciprocity or a federal license.

I’m realistic enough to know that probably won’t happen before I retire, but a girl can dream.

What are the biggest priorities that our legislators should be tackling where healthcare is concerned? Leave a comment or email me.

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