COVID-19 impact on adults with congenital heart disease self-perceived vulnerability and coping.

The COVID-19 pandemic poses risk for worsened quality of life in patients with adult congenital heart disease. In a qualitative thematic analysis of semi-structured interviews conducted July 2020 to August 2021, we examined the pandemic's impact on participants' (N = 25) experiences with self-perception and coping. All had moderate or complex disease; median age 32 years. The pandemic altered some participants' self-perception, including increased vulnerability beyond heart-attributed risk. Restrictions frequently prevented participants from using their usual coping strategies, forcing use of alternative methods. For an already at-risk population, these findings suggest the need for increased mental health awareness, assessment, and support.

Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff.

BACKGROUND: Although collaborative care (CoCM) is an evidence-based and widely adopted model, reimbursement challenges have limited implementation efforts nationwide. In recent years, Medicare and other payers have activated CoCM-specific codes with the primary aim of facilitating financial sustainability. OBJECTIVE: To investigate and describe the experiences of early adopters and explorers of Medicare's CoCM codes. DESIGN AND PARTICIPANTS: Fifteen interviews were conducted between October 2017 and May 2018 with 25 respondents representing 12 health care organizations and 2 payers. Respondents included dually boarded medicine/psychiatry physicians, psychiatrists, primary care physicians (PCPs), psychologists, a registered nurse, administrative staff, and billing staff. APPROACH: A semi-structured interview guide was used to address health care organization characteristics, CoCM services, patient consent, CoCM operational components, and CoCM billing processes. All interviews were recorded, transcribed, coded, and analyzed using a content analysis approach conducted jointly by the research team. KEY RESULTS: Successful billing required buy-in from key, interdisciplinary stakeholders. In planning for CoCM billing implementation, several organizations hired licensed clinical social workers (LICSWs) as behavioral health care managers to maximize billing flexibility. Respondents reported a number of consent-related difficulties, but these were not primary barriers. Workflow changes required for billing the CoCM codes (e.g., tracking cumulative treatment minutes, once-monthly code entry) were described as arduous, but also stimulated creative solutions. Since CoCM codes incorporate the work of the psychiatric consultant into one payment to primary care, organizations employed strategies such as inter-departmental ledger transfers. When challenges arose from variations in the local payer mix, some organizations billed CoCM codes exclusively, while others elected to use a mixture of CoCM and traditional fee-for-service (FFS) codes. For most organizations, it was important to demonstrate financial sustainability from the CoCM codes. CONCLUSIONS: With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.

The use of complementary and alternative medical providers by insured cancer patients in Washington State.

BACKGROUND: Insurance coverage of complementary and alternative medicine (CAM) is expanding. However, to the authors' knowledge, little is know concerning CAM utilization among cancer patients under the insurance model of financing. In this study, the authors evaluated CAM provider utilization by cancer patients in a state that requires the inclusion of alternative practitioners in private, commercial insurance products. METHODS: An analysis was carried out of year 2000 claims data from two large Washington State insurance companies. RESULTS: Of 357,709 claimants, 7915 claimants (2.3%) had a cancer diagnosis. Among cancer patients, 7.1% had a claim for naturopathy, acupuncture, or massage; and 11.6% had a claim for chiropractic during the study year. The use of naturopathy (odds ratio [OR], 2.0; P<0.001) and acupuncture (OR, 1.4; P<0.001) were more common, and the use of chiropractic was less common (OR, 0.9; P<0.001) for cancer patients compared with those without cancer. No significant differences were noted in the use of massage between the two groups. Except in 2 individuals (0.03%), cancer patients also had at least 1 conventional provider claim during the year. Factors associated with nonchiropractic alternative provider use were female gender, the presence of metastatic cancer, hematologic malignancy, and the use of chemotherapy. Increased use of naturopathic physicians accounted for much of this trend. Musculoskeletal pain was the most common diagnosis at the CAM provider visit. Billed amounts for alternative services were <2% of the overall medical bills for cancer patients. CONCLUSIONS: A substantial number of insured cancer patients will use alternative providers if they are given the choice. The cost of this treatment is modest compared with conventional care charges. For individuals with cancer, CAM providers do not appear to be replacing conventional providers but instead are integrated into overall care.