Looking Back at 2020
This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of December and a look back at the 2020
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
We take a look back at the Year 2020, the SARS-CoV-2 virus and the COVID19 pandemic, where we are with vaccine roll out and talk about the ongoing challenge for healthcare that leave patients struggling with Surprise bills and drugs that cost more in the US than anywhere else in the world
The good news is there has been much learnt in 2020 and capitalizing on the crisis to effect real change will be our task for 2021. Listen in to hear how home hospital’s are moving
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, as I am each month, I’m delighted to be joined by Dr. Craig Joseph. He is the chief medical officer for Nordic consulting partners. Craig, thanks for joining me today. It is a pleasure as it is every month. So we normally sort of review the past month of activity. And since we’re at the end of 2020, which has been just like every other year, we thought we would actually review the whole of the year versus just last month and take a little bit of a peek into the future. And, and obviously, the major topic that we’ve had for the majority of the past several months, has been COVID-19. First off, any thoughts, anything that, you know, has really stood out to you over the last several months, rounds, saws, COBie, two and COVID-19.
Craig Joseph
You know, I’ve just starting to hear about this thing. Is this that pandemic that you’ve been talking about? I don’t really pay attention when we do these. So I’m not really sure what you’ve been saying about it. But well, we’ve got some vaccines. A couple.
Nick van Terheyden
And isn’t that great news? I mean, would you be honest with yourself back in January, February, March, whenever you really started paying attention? Would you have predicted that we would have vaccines for something that we had never seen? or certainly had not seen? Prior to December of 2019?
Craig Joseph
Absolutely not. Not only did we not have a vaccine, but we didn’t, you know, we’re not really have a lot of experience with making vaccines successfully making vaccines for Coronavirus, specifically. So no, it’s a it’s a monumental task and, and a new kind of vaccine, at least new to me, since I am not a vaccine expert, and mRNA vaccine. And that’s the reason that they were able to so quickly take research that has been, you know, been done for decades and put it into into the real world with something so quickly,
Nick van Terheyden
what it speaks to for 2020. And the thing that stands out for me is that we’ve built so much on the shoulders of all the other efforts and work of other people. I mean, your point about messenger RNA vaccines is exactly right. We’ve not produced them, but we’ve been working on it. And it all came together at the right time, quite frankly, to allow us to produce a vaccine in record time. I mean, I don’t think there’s any instance where we’ve managed to do that. That sort of case, which is just incredible to me, and it’s a testament to all the people pulling together. And it was all triggered in that instance triggered by one scientist in China, who published the sequence of the virus online so that it was accessible to everybody.
Craig Joseph
Yep, it’s a it’s it you know, if you would have written a screenplay, I don’t think we would have those in the know would have believed any of it.
Nick van Terheyden
No, I’m the screenplays that have been written didn’t they? Absolutely not. They had what’s his name running around the country in orange suit and shooting gun helicopters and all sorts of things. Well,
Craig Joseph
we do I you know, we still might need to shoot down helicopters, you know, in order to get the No I’m just making that up trying to come up with some
Nick van Terheyden
kind of to get the vaccine out.
Craig Joseph
It since we’ve got the vaccines already available. You know, I don’t I don’t foresee any need for helicopters. At this point. It’s really just UPS and FedEx trucks,
Nick van Terheyden
right and UPS and FedEx trucks with special refrigeration, which brings us to the point of the distribution which has been Raising the eyebrow too. How are we doing on that?
Craig Joseph
We’re not doing well. And some epidemiologists are calling out the federal government for really not taking the lead, in terms of, actually, hey, we’ve got it, we’re going to get it to someone in the state, and then we kind of wash our hands of it. And so every state’s left to their own with very, at this point, hardly any money given to them to figure it out. And so it’s not been as of the day we speak today. It’s not been very well done. And so my understanding is that about 20 million doses were were were given out to the states and about 2 million have been actually put into arms. And so that’s a much smaller number, we were kind of expecting 20 million doses to be administered by the end of the year. We’re not going to come anywhere, anywhere close to that. So we do have to figure this thing out. I think the one one thing though, to comment from the some of the anti vaxxers are vaccine naysayers. You know, some of whom will never be convinced, but when you have news stories of physicians almost coming to blows with one another about who gets the vaccine first, I suspect that the rest of hopefully the rest of society will see that that the the doctors are arguing over who can get it. I want it. Do you know anyone that has any on the side? Yeah, I
Nick van Terheyden
and, you know, you bring up a couple of interesting points there that, you know, both the the sort of resistance, but equally this side or back child distribution that is causing I, you know, certainly some resistance from, you know, the ethical considerations. We’ve seen people trying to jump in front of the line, you’re right about it, you know, there’s pushing and shoving. It’s interesting, one of the things that I heard, in fact, close to home, for me was, you know, the desire by the clinical folks to put it on social media to say I’m receiving it, but actually now not wanting to do so for fear of a backlash, because people are judging them and saying, Well, why do you have it before I have? So maybe you’re right. I mean, we might see a rollout because I heard that one of the suggested levels of herd immunity was cited as high as 90%, which when you think about that, and the challenges of getting to that point is going to be very, very significant. So I just my sort of sense of this is, or at least my hope is not only that the government steps in but the people that I really want to step in, because I’ve seen them do it, I saw them do it at a client of mine is the military who go in and they do logistics, they can get things to any point in a location, geography time with all of the limitations. And I have to say, that’s what I thought was going to happen. Obviously, I was somewhat confused. And we’re still struggling. And the fact that there’s 18 million doses available or not, is just or actually no 19, you said 22,
Craig Joseph
as of as of this morning, about two and there’s probably a little bit of a lag in the reporting. So that might, that number might be higher. But however, the goal and I think what was was stated as what was going to happen, for sure would be 20 million vaccines were going to be in arms by the end of this year. And that’s, that’s clearly not going to happen, even though those 20 million doses are available. So yeah, I agree with you. You know, if you want to look to find someone who’s good at military precision, it might be the military. I think there are also third party so you know, CVS, Walgreens, some of those groups that are, can can ramp up very quickly and are are omnipresent in the United States are set, you know, that have the ability to do that. To give it I know that some of them are looking to hire 1000s of people to actually give give immunizations. So we’ll get there I’m pretty confident we’ll get there but it is something that we’ve been talking about for months and months that we’re going to have these vaccines or we’re gonna have to get them out. And now we have them and and the actual administration, the thing that we could have been planning for four months doesn’t seem dead as advanced or matures, as one would want.
Nick van Terheyden
It does bring out one of my little bees that lives in my bonnet occasionally. And that’s the, the the requirements to be able to do some of these things and it You know, I agree with you, you know, most people live within 15 minutes of a pharmacy around the US even in fairly remote parts. I’m sure that I know, there’s exceptions to that. But you know, there’s a distribution mechanism. But, you know, hiring folks to give vaccines, I can tell you, as a qualified physician, I am precluded from doing testing for a period of time, I was able to volunteer to do testing in my state. So I volunteered, I dressed up in PPV. And, you know, was in car parks and in, you know, venues, carrying out testing, but they changed the rules. And now you have to be a licensed practitioner to be able to carry out testing. So the idea that you’re not a licensed practitioner to be able to give a vaccine here represents a little bit of a challenge that I’m not sure I see a pathway to unless they start to relax some of these regulations and tap into resources. And do I feel like I could give vaccinations? Yeah, pretty much. I I’m, I don’t know about you. I know you’re not practicing clinically, but I feel like you ought to be on if you needed to write?
Craig Joseph
I think I could, I think I could. And that, you know, I think a lot of it, obviously, every state has different rules. And then within the state different groups interpret the, you know, the rules. When I was in practice, we had medical assistants who gave all of our vaccines, and those are folks who are trained by us they have no, they didn’t at that time at least have a license or anything else. And that that was okay. But, you know,
Nick van Terheyden
did you know this? I actually know this, you know, that’s one of the surprising areas. There’s some reasons why I do. But now you have to go to school, you’ve got to go to some diploma place and get a diploma and you can’t just take the exam. So you can’t just know the knowledge, you have to actually go pay the fee, and sit in coursework for a period of time to become a medical assistant.
Craig Joseph
Yeah, things are different. And I’m not saying necessarily for the better, I agree with you. The other thing is the corporatization of medicine. And we’re, we can, you know, veer off that way. But, you know, when I practice with one other physician, and that was it, and we own the practice, we got to make a lot of rules that physicians now who work for large, large companies or large groups, have a, you know, have lawyers and regulatory experts and compliance experts that we didn’t have. So there was no one to tell us that we couldn’t do something. Now, I think we were able to do it. And I’m not saying that we didn’t practice safely. But yeah, even things that I think are allowed. larger organizations are very risk averse, and will tell you no, even though there’s there’s no good reason that they’re telling you No. So.
Nick van Terheyden
So, for those of you just joining, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Craig Joseph, he is the chief medical officer of the Nordic consulting partners when reviewing 2020, we were just talking about some of the challenges around COVID-19 distribution, looking back and obviously looking forward hoping logistics get sorted out. And, you know, from a crisis standpoint, perhaps the crisis might remove some of the nuclear arms race have certifications that I personally, at least fall foul of as I tried to sort of help out and contribute. Perhaps we’ll see some of that in in 2021. I don’t know. But looking at some other things. So COVID-19 Obviously, we’ve learned a lot. You know, and I think it’s going to impact us for a long period of time. But there were other things that took place in 2020 surprise billing. Suddenly, there was a focus and new activity What’s your thoughts around that?
Craig Joseph
Well, so just to kind of clarify these that surprise billing happens when you walk into the emergency department with with insurance and then get billed a lot of money even though the hospital might be in network also happens when you have picked out a hospital that’s again, in your network, your your, your insurance company says you can go to the hospital a and then you get very large bills that are rejected from your surgeon potentially or from your anesthesiologist or radiologist or pathologist doctors that you didn’t know that you you had any interactions with. And they may not be in network and there was no way for you to know that. And obviously, if it’s emergency, there’s no way for you to deal with that. And so people would get these very large bills that will be rejected by their insurance. company, because the doctors didn’t want to take the money that the insurance company was offering. And so now there are people have been complaining about that for a long time. Me among them that it’s it’s not fair and there’s there needs to be a middle ground. And so hopefully that’s coming. So that was passed recently, at least the initial steps of requiring physicians to come to some agreement with the with the payers, that’s reasonable, somewhere between what the doctor wants to receive and what the the insurance company wants to get. And so I wholeheartedly think it’s overdue and very excited that we’re actually making concrete steps towards it will make a big difference in people’s lives.
Nick van Terheyden
Yeah. And I think I saw some regulations that were being pushed through around that that talked about, you know, if you go, particularly in emergency circumstances, I think that’s the one, you know, but it’s not confined to that. To be clear, you can still get surprise bills when you think you’re in network. But there’s this procession of people that show up in your room who, for one reason or another, and not in network, but you know, in the case of emergency circumstances, you know, you’re doing, you make best efforts to do follow the rules, but somebody falls out of network. And you end up with that surprise, Bill. I mean, that just seems reasonable. And, you know, as I think about the sort of reforms around healthcare, one of the things that seems to be a central tenant, and I don’t know if this is just 2020, I feel like it’s not, it’s a lot to do with money and price. You know, and drugs is another one, we’ve had this huge sort of focus, there were some attempts at trying to create some pricing transparency, I can tell you with 100% certainty that you pay an awful lot more for your drugs in the US than you do in other countries. I’ve yet to hear a cogent explanation of why that is, is there anything that you imagine would allow for a difference in pricing that we see?
Craig Joseph
Well, maybe you’re not familiar with our ways. Have you ever heard of lobbyists? Ah, that’s the reason that’s the answer to your potentially rhetorical question. Dr. Nick lobbyists. Yes, sir. So big pharma. Which, you know, I don’t want to I don’t want to say that all pharmaceutical companies are evil. That’s absolutely not the case. However, yeah, there, you know, CMS is not able to do certain things, even though there are a huge purchaser of medications, they’re not able to, because the government won’t allow them to make demands and, and require that they they pay reasonable amounts of money. And so you know, you have lobbyists who are saying to Congress, people, hey, the reason we need to make all this money is because of our research. And without research and development, which we don’t get paid for. We can’t if we don’t, you know, get the big money for the few drugs that make it through, then we’re not going to be able to continue to do research and development and come up with ad now I sound like one of the lobbyists. And hey, you know, you like that mRNA vaccine you got for COVID? Well, come on. We haven’t we’ve been working on that for a long, long time. And we’ve not found any commercial success until now. But the reason we were able to there’s some truth here, the reason we were able to quickly find that get that vaccine for COVID. Out the door in less than a year was because of all this r&d we’d been doing for free.
Nick van Terheyden
Yeah, well, to be clear, nothing is free. He paid
Craig Joseph
for it somewhere. And while I’m saying that they drove the r&d, I react
Nick van Terheyden
to that just because people always call the NHS free. It’s not free. Oh, no wait of service. Um, you know, and things have to be painful there is somebody needing to? It’s interesting, because I was on a webinar recently, and you know, talking about some of these issues. And there was somebody there who said that the most important thing we could do to fix some of these issues was campaign finance reform, which would change the way that some of this lobbyist whole process works. I don’t know. So I’m not a political pundit. I have to say that I continue to be surprised as I learn and understand the US political system. But however we do it, we have to because it just it’s having such a huge impact. In fact, there was a paper published today. I don’t know if you saw it, that talked about it compared the best access to health care, and that was defined as people that were in the top one percent or 5%, income brackets living in the best areas and compare their outcomes health outcomes to other countries with, you know, just their regular health care. And across the board, even at that level, they’re not getting as good health care as people around the rest of the world. So even with the discrepancies we have, we have this huge failure to deliver on all of this money that we’re paying. So we sure have a big hill to climb to fix that.
Craig Joseph
Are you saying sometimes our perceptions don’t meet reality that the data show a different picture? So what you’re saying,
Nick van Terheyden
Yes, I tend to focus on the data, although I know that’s, you know, somewhat Harris heretic in some circles. But
Craig Joseph
yeah, that’s crazy talk.
Nick van Terheyden
I know. Absolutely. Um, so a couple of other things. Before we run out of time, I know you have mentioned home hospitals, that’s one of the areas of sort of trying to reduce costs, or get people out of hospitals, both from a cost perspective, but also outcomes, I think, you know, they tend to do better and people don’t like being in hospitals. Seems like there’s some move towards
Craig Joseph
that. There, there is actually so a hospital at home. And they there’s been research done on this to show that their their quality is about the same, if not maybe even a little bit better. So obviously, we’re not talking about taking very, very sick patients and putting them back at home. But for some patients who might be able to be discharged a few days earlier, or patients who could go into a virtual observation unit. That was something that was never paid for by any of the big payers big insurers, but now because of the pandemic, and because a lot of hospitals are just filled with patients, they do need to find other ways. And so yeah, the CMS has now started a program by which certain hospitals can apply for and then receive payment, which I believe is the same payment, as if the patient were in in their, in their, in their walls. But but but it would be at home. Obviously, if you’ve got to have a pretty good IT system, you’ve got to have a great electronic health record, you’ve got to have the the monitoring systems at home. So you can get the patient to take their blood pressure and their Pulse ox to make sure their oxygen is good, do those kinds of things. And also, they they need to be seen fairly frequently. So at least once a day, someone from the hospital, typically, paramedic or a nurse goes out and visits with them. So
Nick van Terheyden
if you need what was that
Craig Joseph
physically seen, as opposed to some sometimes physically seen, so it’s not just observation, actually. So some hospitals now they have acute care units that are remote are at home. And so patients will actually be physically seen every day, not typically by a physician, there’ll be overseen by a physician but yes, a human will go and see them every day and to keep them out of those, those precious rooms. So not so much about money anymore. But really about just lack of space, you see patients especially in like Southern California now, and they’re there, they’ve taken every every spot that they can to try to put patients in I’ve seen the gift store that that’s when I knew it was bad. The gift store has been repurposed with gurneys now, in some hospitals in Los Angeles County, so you need to get these patients out, who don’t absolutely positively need to be in the hospital. This is one way. And I think it’s gonna, once it’s again, as you know, I like to say don’t don’t waste a perfectly good crisis. So we’re going to be learning tons. And I think, hopefully, we won’t be able to go back to the days where we we make these fairly crazy rules that well, it’s okay, if you’re physically located over here, but if you’re across the street, it’s not okay. And so hopefully those will continue to to crumble and not be rebuilt unnecessarily in the future.
Nick van Terheyden
Wow. So I, you know, another benefit of the crisis as usual. We’ve run out of time, but I think, you know, in general, yeah. 2020 has been a challenging year, but we’ve learned a lot, we’ve come a tremendous way. And there’s a bunch of changes, you know, in that home hospital to me is quite exciting. I think, you know, most people would say they’d rather not be in hospital if we can start to deliver and push that out. That’s exciting news, and all the progress that we’re building on. You know, I agree with you. I think we’re going to solve the distribution problem. I just thought we’d get on and do it and do it as quickly as possible. This is an exciting time. I mean, I’m looking forward to 2021 I think a lot of people have said you know, good riddance to 2020 but you know, Let’s celebrate the positive all the things that we’ve learned so all been a good thing in general.
Craig Joseph
Yeah, well, I like your optimistic attitude. It’s cute. It’s cute.
Nick van Terheyden
If if somewhat foolish I sat
Craig Joseph
with you and hoping 2021 is a better year.
Nick van Terheyden
Well, just remains for me to thank you. It’s always a great pleasure to connect, talk about what’s going on in healthcare and look forward to continued episodes in 2021. So, thanks again for joining me, Craig.
Craig Joseph
Thank you. I’ll see you next year.
