Nursing Homes in the Wake of COVID-19

It could be that the failures of America's 15,505 nursing homes, with approximately 3 million residents, during the COVID-19 pandemic may be our teachable — our changeable– moment. Whoever said "never let a good crisis go to waste" may have been onto something.

The real question is how broad are the lessons we think we have learned.  Is it primarily a matter of improving and perfecting staff, tracking and testing alone or have we learned bigger things, like the safety and quality of life advantages of smaller facilities?


Co-Prescribing Naloxone

There is an excellent post over on The Incidental Economist outlining the rise in Naloxone co-prescribing under various state statutory regimes encouraging or even requiring it. 

This answers some questions that have been on my mind since I opened a bag of post-surgical medications this summer to find, along with antibiotics and painkillers, some Naloxone.  The discharge nurse breezed past it, not reviewing use or dosage as she had with all the other medications.  I wondered if this was because she had encountered pushback from other patients such as "I don't need that."

The post, and my experience with the implementation of the California statute requiring such prescription to accompany one for certain high dose narcotic painkillers, made we wonder if just getting Naloxone in someone's hands is enough to really make a difference on overdose prevention.  If you are barely aware you have the Naloxone prescription and are completely unaware how to use it, will you be likely to use it?

My Naloxone has been sitting on the corner of my desk for a few months– an attempt at a visual reminder to learn more about how to use it. It remains unused and unopened, just like the opioid painkillers that accompanied it.   But have I learned more about how to use it, perhaps to help someone else with it? No, I have not.

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Kayleigh McEnany: Talking About Pre-Existing Condition Exclusions at the RNC

I perked up when Kayleigh McEnany began to speak about her experience living with a positive BRACA2  gene diagnosis and her ultimate decision, in May of 2018, to  have a prophylactic double mastectomy.  "Wow, she's going to make the case that the ACA's ban on pre-existing condition exclusions may have saved her life", I thought. "Maybe she'll even give a shout out to the ACA provisions promoting such gene diagnosis and treatment." 

Nah. She really wanted people to know Donald Trump called her after her surgery and that he cared.  A little while later in her speech,  she talked about the kind of world she wants for her baby daughter: one with strong values and compassion.  But she never talked about whether her daughter, should she inherit the BRACA2 gene, would be able to get insurance coverage for her own testing and, if necessary in fear and sorrow, her own prophylactic surgery.

I want a better solution for BRACA2 gene positive women. But, at the very least,  access to testing and affordable treatment options covered by insurance for all  is what I want for you, Blake Avery Gilmartin, and for countless other American women as well. How will you obtain this if the ACA is repealed? Ask Mommy.







Where’s a Good Sanitarian When You Need One?

Some of the best writing in the world is found in the sports pages. I am reminded of this by a wonderfully headlined San Francisco Chronicle article by Ann Killion titled: Trying to Keep It Clean.  Even better, the top quote from Stan Conte, former head trainer for both the Giants and the Dodgers sums it up so well:  "The greatest epidemiologists in the world can't figure this out. Yet this is falling on an assistant trainer."

So, who's playing the role of sanitarian at your workplace/school?  Are they qualified to do so? Are they as candid as Stan Conte?





Telehealth: Is the Genie Out of the Bottle?

Telemedicine was on  an upward growth curve before this current pandemic, only experiencing explosive growth since the beginning of mass stay at home orders.  What the future holds depends on a few things: how well telemedicine substitutes for the face to face encounter; how adaptable licensed health professionals, insurers, and self-funded employers are  in embracing Telemedicine in the long run; and how economically rational the transition to Telemedicine  may prove to be.

Telemedicine's growth, pre-pandemic, was overwhelmingly in the world of large employer-sponsored health insurance. This means the urban-suburban-rural design of these systems will be quite different. This is complicated by the very high rate of uninsured individuals in rural counties.  Telemedicine or F2F encounter, providers are not equipped financially to take on a great many patients lacking insurance as out-of-pocket collection rates can be quite low, quite expensive, etc.  In addition, even in Medicaid expansion states (a group Missouri has very recently joined), Medicaid reimbursement rates are such that few providers can take more than a limited number of such individuals into their patient panels.  Many providers take none at all.

A new law in Missouri expands insurance coverage for disability therapies for children, but many won't benefit because of Missouri's "poor" Medicaid reimbursement rates.


Telemedicine – the delivery of health services by providers at remote locations, such as through video conferencing or remote monitoring – has been seen as a way to possibly improve access to care while also lowering costs.  In our 2018 Employer Health Benefit Survey (EHBS), we find that the share of large employers offering health […]

Telemedicine has, in the U.S., been for the insured.  In other countries, telemedicine is available to a much broader swath of the population :

'The genie is out of the bottle': telehealth points way for Australia post pandemic | Health | The Guardian