Bundled Payments
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COVID Vaccine Side Effect - It’s Good News
COVID-19 vaccination was associated with a decrease in the prevalence of parent-reported asthma symptoms among kids, according to a cross-sectional study.
A linear regression analysis showed that with each increase of 10 percentage points in COVID vaccination coverage, parent-reported child asthma symptom prevalence decreased by 0.36 percentage points (P=0.04), reported Matthew M. Davis, MD, MAPP, of Nemours Children's Health in Wilmington, Delaware, and Lakshmi K. Halasyamani, MD, of the University of Chicago Pritzker School of Medicine. (MedPage Today)
Raw Milk? Not Recommended
I am sorry to bring politics into the discussion but right wing talking heads and legislators have been pushing a story that you should drink raw milk. I think this is a part of the “Government Can’t Tell Me What To Do” and “I Don’t Trust Experts” tantrums that have invaded our world. The Food and Drug Administration and Centers for Disease Control and Prevention still say raw milk is dangerous.
Meanwhile some Republican run state legislatures are trying to pass laws to make the sale of raw milk legal. Iowa is one. (Politico)
In March 2024, dairy cows in Texas were found to be infected with highly pathogenic avian influenza A (H5N1), in the first known case of the virus spreading to cattle. Since then, H5N1 has been found in about 200 animals—and 3 people—across 12 states, according to the Centers for Disease Control and Prevention (CDC). The virus was soon detected in raw milk, leading researchers to investigate whether dairy products pose a risk to consumers.
“How far is the virus getting through?” asked Erica Spackman, Ph.D., a virologist at the U.S. Department of Agriculture (USDA) in Athens, Ga. To find out, she and her collaborators tested nearly 300 milk products from 132 processors.
The researchers found no infectious virus in the samples, Spackman and her collaborators report this week in the Journal of Virology, a journal of the American Society for Microbiology. “Milk is safe,” she said. “Just like bacterial pathogens that occur in milk, or other viruses that could occur in milk, the sanitation processes that are in place are getting rid of the pathogens.”
The milk processing pipeline includes multiple layers of protection, Spackman said. Microbiological surveillance of milk products can identify pathogens, and milk from cows with mastitis or other disease conditions does not enter the food supply. Finally, heating during the pasteurization process can destroy H5N1 and other, more common bacterial pathogens.
Avian influenza (bird flu) primarily infects and spreads among migratory birds and can be transmitted to domestic poultry, but the virus has been detected in other animals as well. Recently, those have included cats, dogs and juvenile goats, as well as a polar bear in Alaska and elephant and fur seals in the Antarctic. However, the discovery of H5N1 on dairy farms in March was a surprise—the virus had never been found in dairy cattle before.
Soon after the discovery, diagnostic testing revealed that an infectious form of the virus was present in raw milk, suggesting the virus passes from cow to milk. That finding led the U.S. Food and Drug Administration and the USDA to investigate whether pasteurization effectively eliminated risks posed to consumers. Between April 18 and April 22, 2024, researchers used real-time PCR to analyze 297 samples of pasteurized retail milk products, including 23 types of products, collected from 17 states.
“We did a viability assay to detect live virus and went as sensitive as we could to get even the least little bit of virus, but couldn’t detect anything,” Spackman said. Using PCR, the researchers did identify viral genetic material in 20% of samples. “It looks like the virus is just totally inactivated,” she said.
Spackman said the new findings “give us reassurance that what we have been doing—pasteurization—is keeping us safe from what we don’t know about.” (American Society for Microbiology)
Bundling of Payments
A colleague of mine recently asked whether bundling of payments could result in lesser care for patients than a fee for service scenario.
Bundled payments are a payment structure in healthcare that rewards providers for coordinating care for a patient by paying them a fixed amount for a set period of time, or "episode of care". This amount covers a range of services related to a specific condition or procedure, such as hospitalization and care after discharge. In contrast to traditional fee-for-service (FFS) models, where providers are paid individually for each treatment, test, or procedure, bundled payments encourage providers to work together to improve the quality and efficiency of care.
Results are mixed. It is true that there is an incentive to withhold services and keep more of the payment. However, there is also an advantage to the doctor/hospital in that they are freed from the burden of filing a claim for each service or negotiating authorizations for services. Many doctors feel that it frees them to provide better care because they are freed from a paperwork burden.
In 2020 The Commonwealth Fund reviewed studies of bundled payments. They looked at 23 separate initiatives in 8 countries and found about 60 percent of the studies reported improved quality of care, while the other studies showed no difference in measured quality of care. Similarly, about 60 percent reported lower medical spending and/or spending growth. Their summary was that the jury is still out.
Joint Replacements in the US
Here is a link to a JAMA published paper on the subject of bundled payments and joint replacements - and it turns out that when bundled payments were involved in both Medicare Advantage and Traditional Medicare there was a statistically significant reduction in the use of post acute care facilities like a rehab facility. You can read that as lower cost and potentially lower quality care.
US Government Investigation
The Agency for Healthcare Quality and Research, a federal government office, reviewed 58 investigations into the effects of bundled payments.
Here is their conclusion:
“In summary, the introduction of bundled payment was associated with (1) reductions in health care spending and utilization, and (2) inconsistent and generally small effects on quality measures. These findings were consistent across different bundled payment programs and settings, but the strength of the body of evidence was rated as low, due mainly to concerns about bias and residual confounding.”
So there is less spending on those patients. Quality can vary some, up and some down and it is hard to determine if this is the right way to drive the healthcare system.
Personally I think a lot of this is dependent on the healthcare provider’s focus and attitude. If, they are patient centric - then they will enjoy the freedom to provide the best care they can and not have to deal with the added paperwork. If they are overly concerned with cost then there is a good risk that less care is delivered to the patient and quality and outcomes can suffer.
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Organizations to Contact
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Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
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Claims Denials and Appeals & What to Do
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Chop Wood, Carry Water by Jessica Cravens
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Speaking from a coder's perspective, I doubt this will reduce the provider's "paperwork" burden. They still have to document in detail everything they do, including the coordination of care, and then the coder has to be able to pick out the codes from the documentation to justify the payment, whatever form it takes. There would also have to be meetings or at least communications between all the care providers, all of that carefully documented of course, for each patient to make sure that everyone is on the same page. It may or may not be better care for the patient, but it's not less work for the providers and their staff.