Insights on the Homefront

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.

As a result of managed care, patients missed the close relationships they previously had with their doctors. Many felt that office visits were too short and that their doctors were too busy with documentation. From this dissatisfaction grew two new models of care: concierge care and direct care. There are similarities between the two, but important differences as well.

Described as the biggest Medicare reimbursement overhaul in 20 years, the recent changes to the Centers for Medicare and Medicaid’s (CMS) payment models have caused a lot of buzz. The reason for all the hype is the transition towards a more value-based system and away from the fee-for-service status quo. The intent behind these administrative changes, commonly known as the Patient-Driven Payments Model (PDPM) for skilled nursing facilities (SNFs) and the Patient-Driven Groupings Model (PDGM) for home health care, is to improve the quality of patient care, promote the overall health and wellbeing of the Medicare Advantage population, and lower healthcare costs.