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Tag Archives: Healthcare

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Podcast: Escaping a broken system through cash-based functional medicine

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After Dr. Morgan Camp finished his medical residency, he accepted a position in a successful, cash-based functional medicine clinic where he got to work alongside experts in the field. He found early success and soon decided to open his own concierge medical practice, which attracted a good number of high-profile clients in the Bay Area.

He built his practice over time with low risk by moonlighting in ER and urgent care as he grew his patient base. For a variety of reasons we discuss in this episode, his practice grew into something he was not satisfied with, and though it was thriving financially he eventually decided to “mostly close.”

He took a couple of years to rest, travel, and decide what would come next. When he was ready, he reopened a functional medicine concierge practice that would allow him to help patients in the way he desires while maintaining a balanced life.

In this interview, Dr. Camp explains how he got started and what he’s learned from running two different cash-based medical practices, including what worked and what he’d do differently if starting over again.

More specifically, we discuss these cash-based practice topics:

  • How he overcame his professional insecurities to be able to gain the confidence to charge what he was really worth.
  • Why he believes his early lack of marketing expertise made it harder to grow the practice.
  • Which approaches he found worked best to build strong relationships with potential referral sources.
  • Why he doesn’t feel it’s a wise investment of resources to try to convince highly skeptical patients of the value of functional medicine or the cash-based practice model.
  • How you can help educate staff to make sure they become the embodiment of your practice philosophy.
  • The characteristics he looks for when hiring help him find the best fit for the position.
  • What told him it was time to take a sabbatical and how he did things differently when he opened his concierge practice to avoid it happening again.
  • How the structure of his current practice is different from his first practice and why that helps keep life easier for him.
  • How one of Dr. Camp’s new business ventures is addressing sleep, anxiety, and neurological issues using nutritional supplements.
  • The specific approaches he uses to help make his patients’ lives better.

Resources mentioned in this episode:

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Study report: Children and the coronavirus

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Since the start of the pandemic, researchers have been puzzled at how children have been spared by the same rate of infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as adults. In fact, when the first cases of the coronavirus disease (COVID-19) were reported in Wuhan, China, children were barely infected at all. With time, researchers reported that although children could, in fact, contract the virus, they were much less likely to develop a severe infection. At that time, the importance of children in transmitting the virus was uncertain.

According to the Centers for Disease Control and Prevention (CDC) most children with COVID-19 have mild or no symptoms, but some children can get severely ill from COVID-19 and require hospitalization, intensive care, or a ventilator to help them breathe. (In rare cases, they might die.)

Although reports of children sick with COVID-19 are fewer than those of adults, the back-to-school season has been concerning for parents. Now, instead of celebrating a quiet home or buying school supplies, parents are concerned about the safety of any classroom attendance at all, even if only part-time. And, of course, if children are back at school, there is the looming question of whether they will bring the virus home.

In fact, new evidence shows that children carry high levels of the SARS-CoV-2 virus even without falling ill, which may impact the spread of the virus to others, especially those who are at high risk of developing severe COVID-19. One study, out of Northwestern University Feinberg School of Medicine, found that young children carry far more of the coronavirus than adults.

The study, conducted between March 23 and April 27, was led by Taylor Heald-Sargent of the Ann & Robert H. Lurie Children’s Hospital in Chicago. The patients (N=145) were separated into three groups according to their ages (48 adults, aged 18 to 65; 51 children aged 5 to 17 years; and 46 children under 5 years old).

The investigators carried out nasal swab tests on patients who showed an onset of mild to moderate symptoms of COVID-19 within one week. By the end, the researchers found that young children have equivalent or more viral nucleic acid in their upper respiratory tracts compared with older children and adults. The researchers also noted the differences of the material found in the tests revealed a 10-fold to 100-fold greater amount of SARS-CoV-2 in the upper respiratory tract of young children.

In children, symptoms of COVID-19 may include fever, rash, reddish eyes, swollen lymph nodes and sharp abdominal pain. However, symptoms do not usually include the two common hallmarks of Covid-19 — cough and shortness of breath. The syndrome can bear some resemblance to a rare childhood illness called Kawasaki disease, but as doctors learn more, they are emphasizing that the two conditions are not the same.

Although both diseases involve a surge of inflammation in the body and can have serious effects on the heart, the new syndrome appears to affect the heart differently. While Kawasaki disease can produce coronary aneurysms when left untreated, the new syndrome seems to mostly involve inflammation of coronary arteries and other blood vessels.

The findings of this study contradict previous beliefs that children did not play a major role in transmitting the coronavirus and reveal the importance of understanding transmission potential in children, especially as schools have reopened. Behavioral habits of young children and close quarters in school and day care settings raise concern for SARS-CoV-2 amplification in this population as public health restrictions are eased or lifted.

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Will rapid COVID-19 tests help K-12 schools?

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Shortly before he was diagnosed with COVID-19, President Trump announced that the federal government would begin distributing millions of rapid coronavirus tests. The goal is to use them to urge faster reopening of K-12 schools. As virus cases continue to pile up, some school districts have announced staggered and hybrid learning modules for fall 2020 and beyond.

About Abbott Laboratories’ BinaxNOW tests

The tests are a part of the previously announced supply of 150 million ordered from Abbott Laboratories. A total of 100 million tests will be distributed to the states, according to their population. While ostensibly they are to be used as governors see fit, the Trump administration is emphasizing testing and prioritizing K-12 schools.

The reason, according to the administration, is simple. They feel regularizing learning is important to the physical, social and emotional development of students.

The Abbott tests, the size of a credit card, deliver results in about 15 minutes without the need for special computer equipment. They not only deliver rapid results but are also low-cost and come in an easy-to-use format. They cost about $5 to $6 apiece, compared to the traditional swab, which is $100 a piece.

Parents and schools will immediately know whether an asymptomatic child has COVID-19. Some states could opt for baseline surveillance and test a certain proportion of students per week or month.

Will the tests help?

Abbott’s tests will help meet the testing backlog for COVID-19, which has led to repeated delays in reporting results in the past months. High-grade medical laboratories are more accurate, but they take several days to process. Abbott reported positive cases may still have to be sent to higher-grade labs for confirmation, but the overall backlog could reduce.

There is one major cause of worry, though. State officials feel that many tests are going unreported because the tests are often performed outside the healthcare system. It could skew the government data needed to track the virus and lead to undercounts of new cases.

According to a report by the nonprofit Rockefeller Foundation, the U.S. will need roughly 200 million tests per month to reopen schools safely. Right now, we are averaging fewer than 30 million tests per month.

How are states responding?

Oklahoma announced that it had received about 77,000 rapid point-of-care COVID-19 tests. The Oklahoma State Department of Health will prioritize the distribution of these Abbott Laboratories BinaxNOW tests and equipment to K-12 schools. Next, they are deploying them to health care workers and vulnerable populations.

Arizona, which will get more than 2 million rapid COVID-19 tests from the federal government, announced that it, too, will prioritize K-12 schools. County health experts and local authorities will decide which schools and facilities will get the tests. Next, they will focus on vulnerable populations, including those with developmental disabilities and foster care.

Tennessee’s governor echoed the above statements and said that its first 133,000 of the projected 2 million tests would be deployed to reopen public K-12 schools across the state. The rapid point-of-care coronavirus test kits will also help the state in its continued approach to protect the elderly in nursing homes and long-term care facilities.

Washington state and Oregon are ready to deploy the rapid tests as well. The former expects to receive 2.3 million of the rapid tests by the end of the year. Oregon will receive 60,000 to 80,000 new rapid Abbott BinaxNOW antigen tests per week through the end of the year. The increased testing capacity will help diagnose and treat more people quickly, isolate and quarantine people, helping contain the virus. The more it is contained, the easier it will be to reopen schools and help life get back to normal.

While there are concerns about the authenticity of reporting and meeting backlog effectively, state leaders and public health officials hope that the rapid tests will make them more agile in making public health decisions related to business operations and school reopening. The administration hopes that the tests will help schools to stay open, and parents return to work.

With the renewed panic of the second wave of COVID-19, the tests will help diagnose people fast. Some states are already reporting a spike, provoking fears in the populace.

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A ‘satisfaction guaranteed’ promise holds you hostage to another’s happiness

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We recently discussed the real hazards of stamping “lifetime warranty” on your products. A close corollary to that is promising “satisfaction guaranteed” on your professional services.

You might make that offer because you are proud of the quality of your services — so confident that your work will be above reproach that you are implicitly claiming that you’ll redo the work or refund to make the customer happy.

Think about that outrageous promise. How can you possibly guarantee another’s happiness? Why hold yourself hostage to that? Do you think it impossible that at some point — probably nearer than you think — someone will ask you to redo your work for free or demand a refund, even on the materials you purchased?

First, there are perennially dissatisfied people in this world. Nothing makes them happy because it is their personality to criticize, be disappointed, and generally find fault with everyone and everything. You have probably met at least one person like this in your lifetime. That is exactly the kind of person who will ask you to redo your work over and over and over again, dangling your promise of “satisfaction guaranteed,” while you continue to shell out more money for supplies.

Eventually, you’ll get so angry with this unhappy person that you’re willing to give a refund just to be able to walk away from this sour relationship without any guilt. Yes, those kinds of people are definitely out there — and they will find you and test your promise. Guaranteed.

What about the people who simply change their mind? “Yes, I know I picked this brown paint, but I didn’t realize it was just so dark. I am not satisfied so please repaint for free with a different color. You guaranteed satisfaction, and I am definitely not satisfied.” Believe me, that will happen.

A professional painter told me about just such an occurrence. The client picked the paint, and when the deck was completely painted, complained he didn’t like the color and demanded a complimentary repainting, blaming the painter for not overriding his color choice. Fortunately, the painter had listed in the contract that the client would choose and supply the paint; they parted ways with the customer nevertheless feeling that he’d been wronged but without legal recourse.

Then there’s another type of customer who will abuse your promise of guaranteed satisfaction. There are people who are so sensitive and malleable to others’ opinions that they transform from satisfied to dissatisfied in one day.

One handyman’s customer was absolutely delighted with the work he had performed for her, gushing about how perfect it was and that she would recommend his services to everyone she knew. Well, that was her opinion until the next day, when her family came by and told her she was stupid for being satisfied with the work and that she should have hired a friend of the family who would have done a better job.

Suddenly, this satisfied customer was anything but and demanded her money back. Instead of recommending him to her friends, she was instead going to tell everyone she knew about his lousy workmanship. What happened? Family happened.

So what is the point of promising satisfaction — to prove that you stand by your workmanship? Don’t confuse the quality of your workmanship with customers’ being satisfied with their decisions — or their lack of specificity. “Yes, I did say that I wanted a new electrical outlet by the sink, but I wanted it three inches higher and to the right; I didn’t know you were going to put it right there; I don’t like it there. I am not happy. Would you please redo it and install it higher up.”

How can you avoid these very real scenarios?

As with anything else in dealing with the volatile, fickle public, put it in writing. Specify the terms — when you’ll start, estimated time to finish, payments. Specify the materials you’ll be using, such as “customer-provided paint” or “.5 inch x2 inch x12 foot pretreated redwood.” Specify the workmanship, for example, installed per electrical code XYZ.”

The idea is to quantify observable and verifiable attributes of the finished project without depending on an ambiguous variable like a stranger’s state of being.

You can present testimonials and references for past work, but it is a costly and frustrating mistake to agree to make someone happy. You can’t make anyone happy. Sometimes you can’t even make yourself happy! So why would you give that power to a stranger?

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Workplace survivor syndrome is another consequence of COVID-19 for businesses

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COVID-19 has resulted in the loss of over 210,000 lives, but also the loss of livelihood for many Americans. According to September data from the U.S. Labor Department, 2.4 million people are experiencing long-term joblessness (defined as being out of work for at least 27 weeks). And by November, that number could more than double.

While the employees who are still employed may feel grateful or fortunate, Challenger, Gray & Christmas present another emotion that these workers may experience: guilt. The executive outplacement firm recently recommended that companies acknowledge their remaining employees may be dealing with survivor’s guilt and find a way to deal with it.

Contributing factors

Survivor’s guilt, or workplace survivor syndrome, can take more than one shape, but it’s typically related to a traumatic event. “When a person survives an event that others did not, it can lead to feelings of guilt,” says John Myers, Chicago president at Keystone Partners, which provides outplacement and leadership development services. On one hand, Myers says survivors may wonder why they escaped the “chopping block” when many of their friends and co-workers did not. “Or they may be thinking, ‘Oh great, now I will need to do this person’s job as well as my own.’”

Regardless of how the surviving employees view the situation, the results can be highly emotional. “This can lead to irritability and anger, feelings of helplessness and disconnection, fear and confusion, lack of motivation, problems sleeping, and various physical health-related problems,” Myers explains.

Granted, people have been losing their jobs ever since Adam was fired from tending the Garden of Eden. However, the particular circumstances at play in our current environment contribute to a different range of emotions. “2020 has been described by some as an ‘emotional marathon,’ and the effects of this uniquely difficult year are being felt within multiple areas of everyday life,” says Kia Roberts, J.D., former NFL director of investigations, and founder and principal at Triangle Investigations, a group of lawyers and investigators performing misconduct investigations in workplaces, schools, and other organizations.

Not only are the remaining employees feeling guilt and dreading the extra work that going to land on their plates. “Many employees are also fearful that they will be the next employee to go,” she says. And these individuals may be dealing with additional issues. “An employee might be grieving a loved one who passed away from coronavirus, juggling at-home schooling, or feeling the drain of a year of extremely heightened racial tensions,” Roberts explains.

Preventative measures

Companies can do a lot to calm employees by handling the layoff process with a degree of grace and compassion. “Be kind and considerate towards laid-off employees during the termination process,” Roberts advises. “Impersonal and curt termination messages are painful for the employee on the receiving end of them and can be detrimental to employee morale overall.” She says it’s important to treat everyone with dignity and respect.

Myers agrees, and recommends developing a plan that minimizes the impacts of layoffs upfront.

“Such a plan starts before the layoffs by assuring their friends and co-workers who leave the company are treated in a respectful and compassionate way, with a full array of financial and career transition support.” He says it’s important to understand that layoffs affect more than just the people you’re letting go. “There’s an impact on remaining employees, the community, and your employer brand reputation.”

Compassion and communication are key

Theresa Lina, CEO of Lina Group, is a Silicon Valley business strategist who has advised executives at such companies as Apple, Amazon, Google, and Nike, and is the author of “Be the Go-To: How to Own Your Competitive Market, Charge More, and Have Customers Love You For It.” She says the three most important tools leaders can use at a time like this are compassion, perspective-taking, and communication. “It’s tempting to just keep pushing forward, but the organization has just experienced trauma.” Lina recommends putting yourself in your employee’s shoes so you can feel and show empathy.

“Use authentic, open, and consistent communication to help employees process what’s happened, taking guidance from your HR team and middle management.” And she provides a practical example of how to deliver the tough news. “Marriott President and CEO Arne Sorenson’s message to employees when it was clear that COVID-19 was having a devastating impact on the business was a masterclass in leadership,” Lina says.

Understandably, companies are likely to be financially strapped. However, Roberts recommends looking for creative ways to support the employees’ mental and emotional health. “Numerous large employers have rolled out and announced a range of brand-new offerings for supporting stressed-out employees, including offering free one-on-one therapy sessions for employees and their families, mandating weekly manager check-ins, and providing employees with free subscriptions to meditation apps.”

Right now, the remaining employees need to know that you care about their well-being and the emotions they may feel. “I recommend survivor training, health and wellness programs, work-hour flexibility, access to mental health resources such as Employee Assistance Programs (EAP), mandatory vacation and personal time, creating opportunities to connect with others through online communities and creative social events,” Myers says.

Finally, Myers recommends that companies consider how these layoffs will change how they do business. “Organizational structures need to be revisited and priorities reexamined to assure that ‘doing more with less’ is not the rallying cry.”

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Event trends designed to keep guests safe during the COVID-19 pandemic

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Due to the COVID-19 pandemic, people are now thinking of health and safety more seriously, especially when it comes to public places with large crowds — including events.

In order to keep guests safe and aid in the prevention of spreading illness or disease, there are certain new measures event coordinators must take. Let’s take a look at some creative event trends designed to keep guests safe when they return to events post-lockdown.

Health and Safety

COVID-19 prevention and the safety of your guests should be your first priority at events right now. In addition to the standard practices of taking attendees’ temperatures and asking about symptoms, increased venue cleaning, and providing stations for hand sanitizing, there are a few extra steps you can take.

Create swag bags that have all of the items guests will need to ensure personal safety: hand sanitizer, masks, cleaning wipes, and sanitizing spray. And consider visual cues to call awareness to all of the measures you have in place, including signs, floor stickers, asking staff to change to different color gloves after service changes or periods of the day, and include time in the event schedule for cleaning and room turnover.

Awareness is important to provide a comfortable environment, so provide guests with all of the precautions you are taking in all of your event’s marketing and communications, your website, and written materials provided to attendees.

Event Schedule

Changes to your event’s schedule can help reduce capacities, enable social distancing, and minimize risk.

The first change you can make is to provide more registration time in advance of the event. Ask attendees to register in advance and assign them certain days and times pick up their materials so there are fewer people in line at your registration table at any given time.

Try staggering entry times to your event to prevent overcrowding. Or you may decide to change your program altogether. Instead of a daylong event of sessions, opt for an open house or booth-style event where attendees can enter at staggered times to learn from experts and network with peers.

Food and Beverage

Buffet service, long lines at the bar, and tables of appetizers are too much of a health risk in 2020. But the hospitality industry has come up with a lot of options for food and beverage service with safety in mind.

Staff service is a good alternative to the buffet for dine-in meals. You can also provide food to go — boxed meals, creative packaging using Mason jars or decorative boxes, and bento boxes of appetizers are contact-free ways to serve meals. Replace poured drinks with bottles or cans of beer, wine, and cocktails, or make batched cocktails in advance to speed up your bar service and avoid too many people gathering around the bar area.

Venue Setup

Most health guidelines recommend placing tables 6 feet apart and reducing the number of people seated at tables. There are some other trends that you can use to give your attendees enough space to feel safe and comfortable.

Decor, such as large plants, room dividers, designer velvet ropes, plexiglass, and oversize floral arrangements, can help to create barriers between small groups. Pillows with your logo and “This seat reserved for social distancing” placed on chairs and couches will provide appropriate space. If you have outdoor areas, encourage guests to gather there at social distanced tables, and serve food via food trucks.

Take the Time to Focus on Safety and Creativity

The pandemic has forced the hospitality industry to be more cautious and careful around safety, but it’s also allowed for creativity. Use the ideas listed to plan an event that your guests will enjoy while feeling comfortable at the same time.

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Podcast: How to cultivate physician referrals for your cash-based practice

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In this episode, I share some strategies for cultivating your network of referring physicians. I explain how to navigate the initial conversation, including discussing your billing arrangements, how to establish rapport, and things you can do to increase the chances that any referrals you receive will convert. You’ll also hear some clever follow-up techniques that create ongoing touchpoints that will help establish you as a valued resource to your referral sources.

This “highlight” is taken from Q&A calls with my Mastermind Gold group — a highly interactive, supportive group where people who have tons of questions and concerns about how to start, grow, or transition to a cash-based private practice get the answers, resources, and confidence they need to build the practice of their dreams. We have a group coaching call every week, and we occasionally use excerpts of those calls for this podcast.

More specifically, I discuss these topics related to referral sources:

  • How to know when it makes sense to talk to insurance-based practices about a referral relationship — so you don’t waste time where there’s no likely return on investment.
  • Why it’s important to make sure all your referral sources understand that your practice is out of network.
  • How to explain your practice in a way that frames the value you provide in the best light.
  • How to provide value and build rapport before diving into the “ask.”
  • Tips for the kinds of offers that can give you opportunities to directly connect with the other physician’s patients.
  • Follow-up ideas for actively nurturing relationships after the initial conversation.
  • The type of practice that is a natural fit for referring to a cash-based clinic.

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Everybody’s getting their temperature taken, but why is nobody’s actually 98.6 degrees?

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You get your temperature taken at the doctor’s office, at your hairdresser, nail salon and even before you can watch a high school football game. In the months since the outbreak of COVID-19, you’ve probably had your temperature taken more than all the years of your life before this — combined.

And you might have noticed something — you’re not normal.

When it comes to body temperature, normal temperature is 98.6 degrees Fahrenheit or 37 degrees Celsius. Chances are you aren’t, though, are you? Well, don’t worry, nobody else is either. In fact, some doctors say that finding someone who actually is 98.6 degrees is rare.

Normal for adults is now considered 97 degrees Fahrenheit (36.1 Celsius) to 99 degrees Fahrenheit (37.2 Celsius); babies’ temperatures are normal between 97.9 to 100.4 degrees Fahrenheit. Adults aren’t even considered sick until they reach 100.4 degrees Fahrenheit (38 Celsius), according to the Centers for Disease Control and Prevention.

When an adult’s temperature reaches 103 degrees, they need to see a doctor, according to the Mayo Clinic. Body temperatures lower than 95 degrees are considered hypothermia and are also a medical emergency — except for people over age 85 who may have a “normal” temperature as low as 93.5 degrees. For those seniors who are normally cool, registering 98.6 degrees could mean they’re actually running a fever.

And people’s body temperature fluctuates throughout the day and throughout their lifetime. Changes in temperature can be traced to how active they are, their age, gender (women are hotter, especially when they’re ovulating), weight, time of day (you get warmer as the day progresses), the temperature and humidity and even what they ate or drank for dinner (spicy foods can raise your body temp!).

So, who decided 98.6 degrees was normal?

In 1851, German doctor Carl Wunderlich surveyed the results from 25,000 patients and determined that the average temperature for adults was 98.6 degrees, but the U.S. National Library of Medicine has acknowledged that “normal” varies by person.

Dr. Julie Parsonnet, a professor of medicine and health research and policy at Stanford University School of Medicine, studied the evolution of humans’ body temperatures from periods in the mid-19th Century to 2017 and found that 75 percent have body temperatures lower than 98.6 degrees.

A recent study of 35,000 British residents found that their average temperature is 97.9 degrees.

So why are people so chill these days? Doctors explain that thermometers are more exact than they were 150 years ago. If you take your temperature with three different thermometers, you might get three different readings. The most accurate is liable to be an internal reading, like under your tongue, opposed to under your arm or a forehead reading, according to family physician Dr. Donald Ford.

WebMD says the cooler temps could be due to people expending less energy and having slower metabolic rates because they weigh more than they did a century ago. Slower metabolisms can also be the result of less inflammation, researchers point out, because these days people have fewer chronic infections, like tuberculosis or periodontal disease.

Parsonnet agrees and says other factors could be warmer clothing and indoor temperature controls. She also suggests that the lower metabolism and cooler body temperatures are healthier. An office worker who chills out in a 72-degree office all day is going to be cooler (and probably healthier) than a person working in an unheated and non-air-conditioned house in the 1800s, she points out.

Overall, people are just cooler than they used to be.

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CMS again expands telehealth services covered by Medicare

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The Centers for Medicare & Medicaid Services (CMS) has announced it is adding 11 new telehealth services that Medicare will reimburse. This is the first addition to the Medicare telehealth services list since May 1, 2020.

Per CMS, Medicare will begin paying eligible caregivers who furnish these newly added telehealth services — effective immediately — throughout the COVID-19 Public Health Emergency. Officials renewed the emergency declaration for another 90 days earlier this month.

These new telehealth services include some neurostimulator analyses and programming services and cardiac and pulmonary rehabilitation services.

According to CMS, additional coverages are part of a push to accelerate telehealth use by removing reimbursement barriers.

CMS also said it is providing more support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies to expand access to telehealth, building on the back of President Trump’s Executive Order on Improving Rural Health and Telehealth Access — “to improve the health of all Americans by increasing access to better care.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma in the CMS statement. “This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let the genie go back into the bottle.”

Verma said some of the changes to Medicare telehealth reimbursement might remain after the pandemic.

The additions bring coverage to a total of 144 telehealth services by Medicare.

“Between mid-March and mid-August 2020, more than 12.1 million Medicare beneficiaries — over 36% —of people with Medicare Fee-For-Service have received a telemedicine service,” CMS said in a release.

CMS also released a new toolkit (PDF) to give states more guidance on expanding the use of telehealth in Medicaid and CHIP. The toolkit provides examples to help states identify services accessible via telehealth and how telehealth is reimbursed after the public health emergency expires.

As the pandemic gained ground throughout the country, CMS loosened the reins on the types of telehealth services covered. For example, reimbursement at parity for an in-person visit has been instrumental in helping patients receive distance-based care while reimbursing caregivers the same rates as they receive for in-person visits. For patients, expanded telehealth capabilities were a blessing during the pandemic; for physicians and their practices, telemedicine allowed them to continue practicing, to some degree, while elective procedures and other care were shelved.

According to reporting, during the PHE, there have been more than 34 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June 2020. That’s an increase of about 2,600% compared to the same period last year.

Other added covered services include emergency department visits, initial inpatient and nursing facility visits, and discharge day management services.

Between mid-March and mid-August 2020, more than 12.1 million Medicare beneficiaries — more than 36% — of people with Medicare fee-for-service have received care through telemedicine.

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Algorithm could help keep consumers safe from illegal online pharmacies

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It might be tempting to purchase your medicines from an online pharmacy to save money, but beware. Some online pharmacies are selling ineffective and even dangerous products.

The National Association of Boards of Pharmacy (NABP) reported this year that it identified dozens of illicit online pharmacies (IOPs) selling drugs marketed as treatments for COVID-19, drugs that would normally require a prescription.

“Rogue internet pharmacy networks are run by criminal opportunists, and the coronavirus disease 2019 (COVID-19) pandemic has provided the perfect opportunity for illegal online drug sellers to prey on fearful consumers,” the NABP says in its “Rogue Rx Activity Report.”

But now, researchers at Penn State University have developed an algorithm that may be able to identify which online pharmacies are legitimate and which ones are not. They wrote about their findings in the Journal of Medical Internet Research.

IOPs are a serious problem, says Soundar Kumara, Ph.D., the Allen E. Pearce and Allen M. Pearce Professor of Industrial Engineering. Illegal pharmacies can, for example, sell unwitting customers drugs mixed with ineffective ingredients like corn starch.

“If they’re adulterated,” says Kumara, “you cannot get the right dosage. So the effectiveness of the drug could be wrong, and, people could die.”

“In addition, some expensive drugs can be counterfeited,” he says. “So, for example, if someone wants to buy a drug for an immune-compromised disease that costs $3,000, and they go online and the online pharmacy says, ‘We can give you the drug for $1,000,’ that person may feel that it’s great and get it, but it might not have the potency that is needed.”

Moreover, some IOPs sell highly addictive drugs such as oxycodone and other opioids without the required prescription from a physician, Kumara says.

“So, there are so many problems associated with having IOPs,” he says.

In a warning letter from the Food and Drug Administration (FDA) in September, the agency notified a number of rogue online pharmacies that they were in violation of the U.S. Food, Drug and Cosmetic Act by:

“Offering for sale unapproved prescription drugs of unknown origin, safety, and effectiveness; offering prescription drugs without a prescription; offering prescription drugs without adequate directions for safe use; and offering prescription drugs without FDA-required warnings to consumers about the serious health risks associated with the prescription drug.”

In its BeSafeRx campaign, the FDA says, “A safe, legal internet pharmacy always requires a doctor’s prescription, has a physical address and phone number in the United States, is licensed by the state where they are doing business and has a state-licensed pharmacist on staff to answer questions by the patient.”

But catching and stopping IOPs is difficult for several reasons, says Hui Zhao, Ph.D., a Penn State associate professor of supply chain and information systems and the Charles and Lilian Binder Faculty Fellow in the Smeal College of Business.

“Nobody really knows how many are out there,” she says. “But there are at least 30,000 to 35,000.”

“But we don’t really know because of the dynamic nature of online pharmacies,” she says. “Online markets come and go easily. They disappear here and pop us somewhere else with a different URL.”

So Kumara, Zhao and Sowmyasri Muthupandi, a former research assistant, developed an algorithm to distinguish IOPs from the legal online pharmacies.

Using a dataset of 763 online pharmacy websites, the researchers examined web traffic and engagement data to observe the different ways consumers find and engaged with the online pharmacies. In particular, they focused on referral links between websites.

If customers consistently come upon an online pharmacy through referral links that regularly link to illicit pharmacies, chances are the online pharmacy is also illicit, Zhao says.

“On the other hand,” says Zhao, “if I find that website X has been referenced by a site that mostly refers to the legal ones, then I would say there’s a higher likelihood that X is a legal one.”

“Think about your social network,” she says. “If a person hangs out with bad guys, then likely, if he hangs out with another person, that person likely belongs to this similar group.”

Their prediction models achieved an accuracy rate of more than 95%in identifying IOPs, she says. The prediction models could have many applications, Kumara and Zhao say.

In their journal article, they write that search engines, online retailers as well as credit card and other payment companies could someday use the models to either filter out IOPs or consider the status of an online pharmacy when ranking search results.

The tool could also be used to fashion a warning system that could notify consumers as to which pharmacies are legal and which ones are not, they say.

“Policy makers, government agencies, patient advocacy groups and drug manufacturers may also use such a system to identify, monitor, curb IOPs, and educate consumers.”

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