Homefront Insights

Telemedicine, defined as the practice of medicine using electronic communication, has been around for a number of years; however, the COVID-19 crisis has thrust telemedicine into the spotlight. The lockdowns and shelter-in-place orders has led to nationwide shut-downs of physicians’ offices and the emptying out of hospital wards and emergency rooms, even as intensive care units remained busy tending to severely ill COVID-19 patients. Telemedicine entered to fill the gaps left by empty examination rooms.

For over 20 years, CareCentrix has been focused on this trend by taking an uncommon approach:  creating more healthy days at home. In many cases, care too often defaults to an acute setting due to an inability to control not only clinical but also non-clinical needs, better known as Social Determinants of Health (SDoH).

During COVID-19 outbreak in early 2020, hospitals and clinics began shutting their doors to patients who required routine care. Administrators scrambled to find ways to deliver services while avoiding clustering groups of patients in one location. For patients who required regular treatment with intravenous medications, a location already existed: their home.

The population of the US is aging fast. This has been accompanied by a rapid increase in the incidence of chronic diseases such as type II diabetes mellitus and end-stage kidney disease. These conditions are expensive to treat, and are largely preventable. They place patients at increased risk of other potentially life-threatening conditions, including respiratory viruses such as COVID-19.

Our Quick Guide to Treating Dyspnea with Opioids provides a concise evidence review of how opioids relieve dyspnea, includes recommendations for starting doses and titration, describes the role of anxiolytics such as lorazepam and answers the question “do opioids hasten death?” (the answer is no).

Because of the COVID-19 pandemic, by mid-March 2020, most hospitals in the US were restricting entry and allowing access only through an extra layer of triage at their emergency rooms. Many institutions sternly warned people to stay away unless there was a true emergency. Hospitals, doctor’s offices, and civic organizations asked individuals to check on the well-being of chronically ill and elderly family and neighbors.

In November 2019, the Centers for Medicaid and Medicare Services (CMS) withdrew guidelines directing states regarding how to implement Medicaid block grants and per capita cap programs. The political wrangling over the plan has obscured the details of the current administration’s Medicaid block grant proposal in general, and Tennessee’s plans in particular. To understand block grants, one needs to understand Medicaid’s current funding structure.