How New York's largest hospital system is predicting COVID-19 spikes
Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health
<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>Making machine-learning tools openly accessible
<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>Startup looks to begin pig-to-human organ transplants by 2022
Porcine gene edits may allow such transplants without rejection.
- A company called Revivicor has received clearance from the FDA to use their genetically modified pigs for medical use or as food.
- The pigs lack genes for alpha-gal sugar, which human bodies reject.
- Revivicor anticipates the first human transplant trials as early as this year.
Waiting lists
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTI2NTc2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3Mjk1Nzk2M30.4ZzZpCgUitKf03AYJeAwIbFCMoaeuEUKnbOexWuar1Q/img.jpg?width=980" id="0349f" class="rm-shortcode" data-rm-shortcode-id="ac2e62bb595a203a6ce81bb646e6e618" data-rm-shortcode-name="rebelmouse-image" data-width="1440" data-height="821" />Credit: Talaj/Adobe Stock/Big Think
<p>The U.S. Health Resources and Services Administration <a href="https://www.organdonor.gov/statistics-stories/statistics.html" target="_blank">says</a> that 109,000 Americans are currently waiting for organ transplants. Seventeen people die each day while waiting, and every nine minutes a new name goes on the waiting list.</p><p>Companies such as Revivicor are hoping to meet this need with <a href="https://web.stanford.edu/dept/HPST/transplant/html/frequently_asked_questions.html" target="_blank">xenotransplants</a>, in which organs from non-human species are transplanted into humans. Scientists have been seeking a way to perform successful xenotransplantation for decades—a newborn referred to publicly as "Baby Fae" rejected a transplanted baboon heart as far back as 1984.</p><p>Ayares says his company is "right on the cusp" of overcoming such rejection issues, anticipating their first transplants may occur in 2021 or 2022.</p><p>Animal tissue may also find use in the formulation of medications.</p>Rejection
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTI2NTg1OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzA2Mjc0OH0.pN1W_Vupa5LpYUoq9tHBTQBqRPpdZw6HneRsKmG0vD4/img.jpg?width=980" id="e2d4d" class="rm-shortcode" data-rm-shortcode-id="6675d842b366bec68fc612fbeb380930" data-rm-shortcode-name="rebelmouse-image" data-width="1440" data-height="617" />Credit: ustas /Adobe Stock
<p>The rejection problem stems from the human body's immune system expelling cells from other animals as foreign substances. (Rejection can also be an issue with human-to-human transplants.)</p><p>In 2003, Revivicor began development of GalSafe pigs by removing a gene that appears on the surface of porcine cells, and that produces a sugar called "alpha-gal." It's believed that alpha-gal sugar is the agent that causes the most acute rejections experienced with heart and kidney transplants.</p><p>Alpha-gal is also implicated in a meat food-allergy that occurs after a person is bitten by a Lone Star tick that leaves alpha-gal sugar behind in its victims' skin. Over time, the individual develops an allergy to pork, red meat, and lamb. Revivicor's Gal Pigs may one day be available to such people as non-allergenic pork.</p><p>Revivicor's manipulation of pig genes to support xenotransplantation compatibility doesn't end with eliminating alpha-gal sugar. Today's GalPig carries a total of 10 different genomic modifications—four pig genes have been turned off and six human genes have been introduced.</p>Tests so far
<p>The company, working with the National Institutes of Health, says that they managed to avoid rejection of pig hearts transplanted into baboons for six years, though these didn't replace the animals' own, original hearts. Rather, the pig hearts were transplanted into the abdomens of the baboons simply to assess rejection. Ayares also says GalPig kidneys survived in monkeys for over six months, though it's unclear if they were functioning as kidneys or simply implanted.</p><p>For human trials, Revivicor plans to begin with kidney transplants before attempting heart replacements. They expect to perform these early trials with people awaiting human transplants. XenoTherapeutics of Boston is already testing GalPig skin transplants as a temporary measure for burn victims as their own skin regenerates.</p><p>Other companies are also exploring porcine genetic modifications for xenotransplants, including eGenesis in Boston and its partner Qihan Biotech in Zhejiang, China, who are using CRISPR to perform gene edits.</p>The social determinants of health, explained
Want to tell someone's future in the US? You don't need a crystal ball, just their zip code.
- Social determinants of health, such as income and access to healthy food, affect well-being long before people may enter medical facilities.
- They're one reason neighborhoods in the same city can maintain life expectancy gaps larger than a decade.
- With growing awareness of how societal ills determine health, medical professionals and their partners are devising more holistic approaches to health.
Just 15 miles from Brownsville, Brooklyn, residents of the Upper East Side in Manhattan have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Bureau of Vital Statistics, 2006-2015
<p>Such life-expectancy gaps are common across the United States.<a href="https://www.chicagotribune.com/business/ct-biz-chicago-has-largest-life-expectancy-gap-between-neighborhoods-20190605-story.html" target="_blank"> </a><a href="https://www.chicagotribune.com/business/ct-biz-chicago-has-largest-life-expectancy-gap-between-neighborhoods-20190605-story.html" target="_blank" rel="noopener noreferrer">Residents of Chicago's Streeterville</a> neighborhood can rest easy knowing they will live to be, on average, 90 years old. Chicago's Englewood neighborhood, however, maintains a life expectancy of around 60 years. That's ten years lower than<a href="https://data.worldbank.org/indicator/SP.DYN.LE00.IN?order=wbapi_data_value_2012+wbapi_data_value&sort=asc" target="_blank"> </a><a href="https://data.worldbank.org/indicator/SP.DYN.LE00.IN?order=wbapi_data_value_2012+wbapi_data_value&sort=asc" target="_blank" rel="noopener noreferrer">the world average</a>—in the world's most affluent country. The phenomenon is not just an urban affliction. On the whole, rural community members have lower life expectancies as<a href="https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html" target="_blank"> </a>they become more likely to die from <a href="https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html" target="_blank">these five leading causes</a> than their city-dwelling peers.</p><p>While it may be tempting to write off these life gaps as the result of lifestyle choices or bad luck, they aren't. They are the consequences of a complex intersection between social, environmental, and cultural conditions that fall under 'social determinants of health.'</p>The 80/20 rule of health
<p>Social determinants of health are those conditions in a person's life and environment that can either aid or degrade their health. They include employment, education, food availability, living conditions, communal support, neighborhood quality, socioeconomic status, and the wider systems that surround these conditions. When such determinants aren't wholesome, they erode health long before someone enters a hospital—at which point, health professionals may have only minutes to turn the tide of years of eroded health.</p><p>As Udai Tambar, vice president for community health at Northwell Health, said, "You can't medicate for social issues, and that's, in a way, the system we have developed. We're trying to medicate for social risks and social factors. <a target="_blank"></a>You can have the best treatments, the best physicians, the best facilities, but unless a patient's non-clinical needs are addressed, none of it will make a difference."<a href="#_msocom_1" target="_blank" rel="noopener noreferrer"></a></p><p>Today, experts generally agree that 20 percent of health outcomes are derived from the care received at medical facilities, 80 percent from the non-clinical care attributed to one's lifestyle, environment, and social circumstances.</p><p>The data bear this out.<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/#:~:text=The%20combination%20of%20long%2Dterm,7%20percent%20of%20total%20spending." target="_blank" rel="noopener noreferrer"> </a><a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/#:~:text=The%20combination%20of%20long%2Dterm,7%20percent%20of%20total%20spending." target="_blank" rel="noopener noreferrer">U.S. health-care spending</a> has nearly quadrupled since 1980, and the country has invested that bankroll heavily in hospitals, nursing facilities, prescription drug development, and medical specialist training. Each is valuable in its own right, yet as a systematic whole, this massive, decades-long investment has not netted proportionate health dividends. In addition to country-wide life gaps, the U.S. has one of the lowest life expectancies, the highest suicide rate, the highest chronic disease burden, and the highest obesity rate when<a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019" target="_blank" rel="noopener noreferrer">compared to other major OECD nations</a>.</p><p>These other OECD countries don't spend more on health than the United States. In terms of absolute dollars, the<a href="https://data.oecd.org/healthres/health-spending.htm" target="_blank" rel="noopener noreferrer"> </a><a href="https://data.oecd.org/healthres/health-spending.htm" target="_blank" rel="noopener noreferrer">U.S. handily outspends these countries</a>. Instead, these countries spend<a href="https://www.commonwealthfund.org/sites/default/files/2018-12/Multinational%20Comparisons%20of%20Health%20Systems%20Data%202018_RTikkanen_final.pdf" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.commonwealthfund.org/sites/default/files/2018-12/Multinational%20Comparisons%20of%20Health%20Systems%20Data%202018_RTikkanen_final.pdf" target="_blank" rel="noopener noreferrer">a larger portion of their GDP</a> on social services, helping to mitigate deleterious social determinants long before a hospital visit. By<a href="https://www.brookings.edu/opinions/social-spending-not-medical-spending-is-key-to-health/" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.brookings.edu/opinions/social-spending-not-medical-spending-is-key-to-health/" target="_blank" rel="noopener noreferrer">one estimate</a>, other major OECD countries allot, on average, $1.70 for social spending for every dollar on health. The U.S. system is almost the inverse, spending .56 cents on social services for every dollar on health.</p><p>"You need social equity to get health equity," Tambar added.</p>There’s no pill to cure poverty
<p>This pattern of spending is one reason for the U.S. health-wealth divide, a pernicious and destructive social determinant of health. We've seen this divide's handiwork in the life expectancy differences between the Upper East Side and Brownsville, but those are samples of a whole.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer">According to a 2017 paper in </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"><em>The</em></a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"><em>Lancet</em></a>, the "life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years." And these life-gap metrics signal the end consequences of a myriad of unmet social needs.</p><p><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>Consider the health barriers common in impoverished areas, where residents lack access to healthy, affordable food. Limited funds make it impossible to update or maintain safe housing without mold or lead-contaminated<a href="https://www.epa.gov/lead/protect-your-family-sources-lead" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.epa.gov/lead/protect-your-family-sources-lead" target="_blank" rel="noopener noreferrer">paint</a> or<a href="https://www.cdc.gov/nceh/lead/prevention/sources/water.htm#:~:text=The%20most%20common%20sources%20of,1986%20may%20also%20contain%20lead." target="_blank" rel="noopener noreferrer"> </a><a href="https://www.cdc.gov/nceh/lead/prevention/sources/water.htm#:~:text=The%20most%20common%20sources%20of,1986%20may%20also%20contain%20lead." target="_blank" rel="noopener noreferrer">water pipes</a>. Narrow or nonexistent transportation options cut off residents from employment opportunities or health-care access. And being surrounded by street crime, unsafe public spaces or no greenways generates sustained high stress, which <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">research shows</a> grinds away at our physical health as fiercely as it does our mental wellbeing.<a href="#_msocom_1" target="_blank" rel="noopener noreferrer"></a></p><p>Each of these conditions is bitter in and of itself, but these social determinants often come packaged as part of a social circuit that magnifies the effects of each.</p><p>Unfortunately, dietary fads and the U.S.'s rugged individualism have loudly espoused health to be the culmination of lifestyle choices (for some, even moral rectitude). While lifestyle and choice certainly have their role, an understanding of these social determinants shows how inextricably tied our choices are to our social conditions. As Tambar points out, a person can be well-versed in nutrition, but if their neighborhood is a food desert, their choices are constrained. Social circumstances can limit or adversely influence health in inimical ways.</p><p>As Dr. Mary Travis Bassett, Director of the FXB Center for Health and Human Rights at Harvard University,<a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self"> </a><a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self">told </a><a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self"><em>Big Think</em></a>: "Nobody picks a substandard building to live in with terrible issues of rodent infestation and indoor allergens that trigger asthma. That's not a lifestyle choice. […] It's not about choice; it's about the fact that people don't have enough choice."</p>Going to the source
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTIyNDM0Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMTMwNTc3MH0.m2s2NNhfZz8Aca8H9IL3PK_B5ecVNurz82PuF8s88Js/img.jpg?width=980" id="87250" class="rm-shortcode" data-rm-shortcode-id="b2ca94d906942d55c11a83821ad79632" data-rm-shortcode-name="rebelmouse-image" data-width="6720" data-height="4480" />Credit: Getty Images
<p>Negative social determinants of health provide a massive challenge to the health-care community, but experts and medical professionals aren't powerless to meet it. As Michael Dowling, CEO of Northwell Health, writes in his book <a href="https://healthcare-reboot.com/" target="_blank">"Health Care Reboot"</a>:</p><p style="margin-left: 20px;">This trend toward greater awareness of the social determinants of health is one of the most encouraging developments in health care, for it creates greater awareness among providers of the whole patient, including all of the various elements—most of them outside what might be considered strictly medical issues—that affect an individual's overall health and wellbeing.</p><p>An outgrowth of this growing trend goes by the name "<a href="https://bigthink.com/Northwell-Health/health-care-2634148633" target="_self">upstreamism</a>." Upstreamist practitioners don't only focus on the patient's downstream symptoms; instead, they also turn their attention upstream to incorporate the patient's social determinants of health in their diagnosis. Dowling illustrates this paradigm with an example of a patient with chronic, life-interrupting headaches. Her upstreamist doctor provided her the usual medication but added the unusual prescription of a visit by a community health worker. The health worker found the patient's apartment walls to be infested with high levels of mold. The doctor and health worker told the patient to have her landlord fix the problem and provided the number for a public-interest attorney should the landlord fail to comply.</p><p>Dowling's story shows the holistic approach of upstreamism: to take into account all the determinants of health, not only those found within hospital walls. Sometimes, Dowling notes, that will require medical professionals to take the lead. But other times, when there are extra-symptomatic drivers of health, it will mean <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank">partnering with</a> or supporting social service workers, law enforcement, or legal minds to secure a combination of services to heal the whole person.</p><p>It's for these reasons that many health-care organizations are spearheading initiatives and outreach programs to directly target social determinants of health <em>before </em>they become medical issues. Examples include<a href="https://www.northwell.edu/center-for-gun-violence-prevention/news/the-latest/northwell-receives-1-4m-nih-grant-to-establish-gun-violence-prevention-screening" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.northwell.edu/center-for-gun-violence-prevention/news/the-latest/northwell-receives-1-4m-nih-grant-to-establish-gun-violence-prevention-screening" target="_blank" rel="noopener noreferrer">Northwell's first-of-its-kind gun-violence screening program</a> and<a href="https://pediatrics.aappublications.org/content/early/2015/10/20/peds.2015-3301" target="_blank" rel="noopener noreferrer"> the American Academy of Pediatrics'</a> fight for food security for U.S. children.</p><p>As Tambar points out, this holistic outlook means changing our approach to more than just medicine. It will require many aspects of our society to adopt a multi-lens approach, one that adds an interdisciplinary depth to social problems beyond a solitary profession's expertise. He concluded, "What people are realizing is to holistically serve someone, it's not about you doing it all. It's about partnering with the best person who can do something you can't do."</p>Telehealth will save lives—for as long as it has funding
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
What are the obstacles facing telehealth?
<p>One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.</p><p>States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.</p><p>Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."</p><p>But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.</p><p>"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."</p><p>Lack of internet access is also a problem. A <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771?appId=scweb" target="_blank" rel="noopener noreferrer">paper</a> published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.</p>What is the future of telehealth?
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU1NTU1Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjA1MjkxMH0.1UuR6tky1k58rOeE9Vcgt8bUfhA2vut6yaCAXik1MEY/img.jpg?width=980" id="9f55b" class="rm-shortcode" data-rm-shortcode-id="4549f30a0347a85c7145690870cf742c" data-rm-shortcode-name="rebelmouse-image" alt="Caucasian female doctor delivering telemedicine consultation to a patient" data-width="5600" data-height="3150" />Credit: Daniilvolkov via AdobeStock
<p>Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.</p><p>"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."</p><p>Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.</p><p>The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, a<a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>t parity, up and down the chain, and passing federal legislation that requires <a href="https://www.siia.org/i4a/pages/Index.cfm?pageID=4546#:~:text=What%20is%20a%20self%2Dinsured%20health%20plan%3F&text=A%20self%2Dinsured%20group%20health,care%20benefits%20to%20its%20employees." target="_blank">self-insured health care plans</a> to pay for telehealth services as they would in-person visits.</p><p>Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."</p><p>Doerfler added that, while telehealth can't replace all traditional health care services, it should be "<a href="https://www.northwell.edu/news/insights/how-to-have-an-effective-telehealth-visit" target="_blank">in the toolbox</a>" for patients and physicians.</p><p>"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.</p>Can hospitals prevent gun violence? This ‘universal screening’ study will find out.
Gun violence is a public health crisis that is notoriously difficult to study because of politics. Finally, a new research initiative has the green light to collect life-saving data.
- New York's Northwell Health system recently received a $1.4 million grant for a new study on gun violence prevention.
- The study tasks doctors with asking all patients about their access and exposure to guns, and recommending interventions and safety tips as needed.
- The goal is to destigmatize doctor-patient conversations about guns, and reframe gun violence as a public health issue.
Reframing conversations on gun violence
<p>One major goal of the study is to reframe how health professionals and patients discuss gun violence—an issue that's often couched only in political terms.</p><p>"Our big push is to consider <a href="https://www.northwell.edu/news/gun-violence-is-a-public-health-issue" target="_blank">gun violence as a public health issue</a>," said Dr. Sathya. "For decades, we've tried to get doctors to try to ask [patients about firearms access and exposure]. They won't, because it's not considered part of the usual care."</p><p>Dr. Megan Ranney, an emergency physician and Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, said talking about guns from a different angle can lead to meaningful reductions in injuries and deaths. </p><p>"When we reframe [gun violence] as a public health issue, then we're able to use the same strategies that we've used to decrease car-crash deaths, decrease infections and deaths from HIV, and reduce injuries and deaths from a host of other problems," said Dr. Ranney. "We don't waste our time arguing while death rates go up. Instead, we actually do something that we as individual Americans can take on."</p>Moving forward on gun violence research
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk0MTM0Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMDAxMTIwMX0.Urx2J0MFe2lW2WAt9T1dwuo6ZubtKMisdtaQ_R4AZxg/img.jpg?width=980" id="f35eb" class="rm-shortcode" data-rm-shortcode-id="2db88a0c7cac7228bf26e73da87c1b20" data-rm-shortcode-name="rebelmouse-image" data-width="1426" data-height="934" />Mortality rate vs funding for 30 leading causes of death in the United States.
Credit: Stark et. al. / JAMA
<p>Over the past couple of decades, researchers have conducted many studies on gun violence. But hardly any received federal funding. To put it in perspective, a <a href="https://jamanetwork.com/journals/jama/fullarticle/2595514" target="_blank">2017 study</a> found that the federal government spends about $63 on firearms research for every life lost to gun violence in the U.S. Compare that to $182,668 in funding for every life lost to HIV.</p> <p>The funding freeze stems largely from the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993413/" target="_blank" rel="noopener noreferrer">Dickey Amendment, which Congress passed in 1996</a> to ensure that "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control."</p> <p>"It comes from a perception that research was done with an agenda of legislative change, which it isn't," said Dr. Ranney. "Research is done in order to advance health, and it ideally happens from a perspective that is independent of personal belief." </p><p>Focused on public health instead of politics, the new study aims to broaden the scope of firearms research.</p> <p>"The studies that have been conducted with respect to firearms have been so limited," said Dr. Sathya, noting as an example how doctors might ask about firearms only if a patient is suicidal. "Because there has been no funding, we're starting from scratch in many ways."</p>Hospitals and gun violence prevention
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk0MTY4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MjI5NDA1NX0.VawFYH1HlHUb_5PGFgG5H-XcsPexTYN-OEChswldgVU/img.jpg?width=980" id="17c92" class="rm-shortcode" data-rm-shortcode-id="fdcb8f981260299213e4c90d450277ad" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />Dr. Sathya and Mr. Dowling are spearheading Northwell's gun-violence prevention efforts, including the "We Ask Everyone. Firearm Safety is a Health Issue" research study.
Credit: Northwell Health
<p>One reason health professionals are uniquely suited to play a lead role in preventing gun violence is that they're often the first point of institutional contact for at-risk people. By normalizing doctor-patient conversations about guns, health professionals would be able to intervene early.</p><p>For example, they could connect at-risk patients with violence-prevention resources like the <a href="https://criminaljustice.cityofnewyork.us/programs/office-to-prevent-gun-violence/" target="_blank" rel="noopener noreferrer">New York City Mayor's Office to Prevent Gun Violence</a>, which curbs gun violence through strategies like "<a href="https://www.ny1.com/nyc/all-boroughs/in-focus-shows/2020/11/15/interrupting-gun-violence" target="_blank" rel="noopener noreferrer">violence interrupters</a>," liaisons between communities and public officials, and funding for community-based activities to make neighborhoods safer.</p><p>Northwell Health president and CEO Michael Dowling also noted that about 40,000 people die from guns every year in the U.S., while thousands more are injured. For the health professionals that treat the victims, these statistics aren't abstract.</p><p>"Gun violence is a public health problem, period," said Dowling. "As guardians of public health, <a href="https://www.northwell.edu/news/insights/where-are-health-care-ceos-in-the-fight-against-gun-violence" target="_blank">it is our responsibility</a> to address this scourge on our communities, and the clinicians who are knee-deep in the carnage."</p><p>In 2021, Northwell Health plans to begin sharing and discussing the results of its multi-year study with other health systems as part of its Gun Violence Prevention Learning Collaborative. </p><p>"We hope that it serves as a blueprint for other hospitals and health systems as to how to institute this universal approach so that doctors can start asking the question more and more, and so it isn't an awkward topic to talk about," said Dr. Sathya.</p>