Monday Morning Update 2/27/23

Top News

The White House proposes a crackdown on telehealth-related prescribing of some medications when the COVID public health emergency ends on May 11.

Providers would be required to conduct at least one in-person visit before prescribing or refilling Schedule II drugs such as Adderall and opioids.

The DEA says the rule change was prompted by online telehealth companies that took advantage of pandemic-relaxed restrictions to overprescribe drugs such as Adderall, OxyContin,  and ketamine.

The proposed rule would allow prescribing a 30-day supply of Schedule II, IV, and V controlled substances after an initial telemedicine visit, but refills would require the patient to be seen in person. Patients who have seen their practitioner in person or were referred by them to a new practitioner can have all of their prescriptions issued via telehealth visits. 

Reader Comments

From Suzette Crepes: “Re: Teladoc Health. Interesting that it is framing its nearly $14 billion FY22 loss as irrelevant to future success. We use their software and it still is missing features that are in Zoom, Teams, and other software. Reliability is erratic – if a patient receives a phone call during a session, it switches the screen’s focus and disconnects Teladoc. I know some behavioral health clinicians who have left the company and are looking for other opportunities, which are ample, and that may be a worrisome sign.” Unverified. If I were investor in TDOC, I would not find it easy to forgive its executives for satiating their lust for diversified growth by wildly overpaying for Livongo and its skimpy six-year track record. Especially when they failed to make executive retention part of the terms, allowing 11 of the 12 Livongo suits to bail (all but the HR VP). The investor saying to “bet on the jockey, not on the horse” works both ways, and this particular TDOC jockey – who wasn’t a founder and had never been a CEO — was occupying the other end of the steed than Zane Burke. Zane was given the best gift of his life by being disliked by Neal Patterson enough to be passed over for the Cerner CEO job in favor of a far less qualified outsider who had also never been a CEO, allowing Teladoc to make Zane a billionaire in return for his big chair occupancy of less than two years. I don’t know what the TDOC board was thinking, although that of LVGO was surely high-fiving and ka-chinging.

From Benny: “Re: re-imposition of rules requiring an initial in-person visit for prescribing. This is unfortunate, since while a few highly publicized startups were engaging in cavalier practices, most clinicians used this flexibility appropriately. It’s already a challenge to get ADHD care, and stimulants if needed, due to limited availability of professionals, many of whom switched their practices away from in-person healthcare to focus on telehealth. In-person visits are challenging for patients because of transportation and time off from work. Evidence is clear that appropriate treatment ADHD with stimulants improves educational or other outcomes, so this imposed constraint will reduce treatment, worsen outcomes, and increase patient hassle. This will be superimposed on the existing adverse effects of stimulant drug shortages due to regularly constraints placed on manufacturing capacity, of which no evidence exists that it will reduce misuse.” I’m still surprised that DEA is blaming companies rather than individual prescribers, the same as it did with opioid mills where drug distributors paid billions to settle charges for having their products dispensed via the prescriptions of ethically challenged prescribers who were mostly left to keep practicing. ChatGPT could probably spit out a list of shady doctors given only the prescription records of Walgreens or CVS.

HIStalk Announcements and Requests

Nearly 80% of poll respondents who park at work do so for free, and of those who pay, it’s a 50-50 split between employer-controlled and public parking.

New poll to your right or here: Should physicians be allowed to open and operate hospitals? They can’t for the most part due to Medicare restrictions that were intended to prevent self-referral.

Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

People

Optimum Healthcare IT hires Jennifer Mahoney, MS (AdventHealth IT) as VP of HR.

Announcements and Implementations

NHS is testing the use of AI-powered software from Deep Medical to predict the likelihood that a patient will miss their scheduled appointment so that they can be rescheduled in advance. I was briefly entertained by the original version of the announcement (above).

Wolters Kluwer Health launches Lippincott Medical Procedures, a point-of-care guide for performing core procedures, and a new medical and healthcare learning solution called Lippincott Connect.

Government and Politics

An employee health plan sues its health insurance administrator for refusing to turn over claims data that would allow the employer to verify the accuracy of charges against its self-funded health insurance plan. Medical supply vendor Owens & Minor says Anthem Blue Cross and Blue Shield has refused to provide it with claims data since 2021 as required by federal law. Anthem says its claims data involves proprietary arrangements that it doesn’t want to make public. Several similar lawsuits have been settled out of court, with details hidden behind non-disclosure agreements.

Other

American healthcare in a nutshell: sign-waving protesters demand a change in leadership at struggling Brooklyn hospital Maimonides Medical Center, recruited from Craigslist for $600 per week as part of a $1 million campaign by a group called Save Maimonides that refuses to name its donors. Hospital leaders say the effort is being funded by Eliezer Scheiner, a wealthy operator of a chain of bottom-rated nursing homes who proposed installing 16 new board members of his choosing who would donate $2 million each in holding a majority of the 30 board seats. The hospital says Scheiner wants to gain control over the hospital’s purchasing to steer business to his many supply and services companies. He denies any involvement in the campaign, saying he gave up trying to help the hospital months ago. The money-losing safety net hospital paid its CEO $3.2 million in 2020.

ProPublica reviews the sprawling family empire that was created by the non-profit Liberty HealthShare, whose healthcare sharing ministry heavily markets its medical insurance alternative to people who didn’t like the political ideology or cost involved with Affordable Care Act policies. The ministry took in $300 million in annually, steering much of it to dozens of businesses that were operated by the same Beers family, who bought an airline, a wedding venue, a marijuana farm, a wholesale carpet chain, a hunting lodge in Canada, and a bank that is now selling services to other healthcare sharing ministries. Healthcare ministries pool customer premiums and pay their bills under their own rules, allowing them to avoid regulation as insurers and to claim religious persecution when investigated. ProPublica found that the ministry collected $1.9 billion in revenue in six years while failing to report $1 billion of that to tax authorities, using self-developed software to make it look as though members controlled their own payments to avoid being regulated as an insurer. The company started rejecting claims and lowballing providers in late 2016, causing at least 50 hospitals – including Intermountain Healthcare – to refuse to negotiate with the ministry.

Sponsor Updates

• Healing Hands Ministries uses the PRISMA health information search tool of EClinicalWorks.

Blog Posts

• Tips for Payer Reviews: How to handle Pre-payment, Post-payment, and Probe (Experity)
• OptimizeRx’s EHR Network: Insights from Therapy Brands’ Danny Shipman (OptimizeRx)
• 5 Keys to Unlock Metrics That Matter for Process Improvement (Pivot Point Consulting)
• How to Combat Physician Burnout in Cardiology (PerfectServe)
• Healthcare Supply Chain 2.0: Tapping Actionable Data for Resiliency (Premier)
• Go beyond appointment reminders with optimized appointment-related messaging (Relatient)
• Moving Interoperability Mountains to Improve Patient Care (Surescripts)
• A primer on ChatGPT, large language models, and generative AI (Talkdesk)
• Communication Silos: What Clinicians Need to Know About EHRs (TigerConnect)
• First, Gradually, and Then All at Once: Amazon Puts a Premium on Patient Experience (Upfront Healthcare)
• MIPS Quality Measures vs. Improvement Activities (WebPT)
• Adopting Digital Mindsets: Where Healthcare Stakeholders Are Succeeding and Where They’re Falling Short (West Monroe)
• How Are Care Plans Created? (Zynx Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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