The Big Idea
THE PANDEMIC'S NEWEST HURDLE: Anyone who’s ever wrangled RSVPs for a potluck and tried to figure out who’s bringing what might appreciate that scheduling millions of patients for coronavirus vaccines isn’t so simple.
Compounding the problem: There are few health information networks for choreographing such an undertaking from start to finish. Some states have centralized, government-run systems for booking appointments. Others are relying on local governments and the private sector — including, perhaps most notably, the online ticketing platform Eventbrite.
Whatever the system, problems are starting to multiply as the vaccine rollout expands. Patients may not know where to look for scarce appointments. Sometimes-complex forms are dissuading people eligible for shots who aren’t fluent in English or tech-savvy. And there are myriad reports of website outages or other strange user experiences, confounding even health experts.
Time drain: “I signed up on the D.C. site for an appointment on a Sunday, and it came through on the email confirmation for the previous Thursday,” said Joanne Lynn, a geriatrician at Altarum Institute. “I don’t know how – and I had to rearrange my schedule to comply – not knowing whether, when I show up, the site will have me down for Sunday!”
The whole experience, she said, took two hours for her to manage — time she’s worried that less digitally savvy or more time-strapped patients won’t want to spend. “The planning was just atrocious.”
D.C.’s appointment system also crashed over the weekend, as did the one in Fairfax County, Va. Of course, scheduling weirdness isn’t just a Beltway phenomenon. Minnesota’s system has also been straining.
How states are reacting: As with everything coronavirus, states are taking different approaches.
POLITICO reached out to 50 states plus D.C. and heard back from 20. Of those, 11 say they’re leaving it to providers or local governments. Five plan to implement systems or are exploring their options. Four have statewide systems, with Indiana and New Mexico each registering approximately 425,000 patients for their visits.
Leaving things to providers and local health departments threatens to create an uneven campaign that could leave out hard-to-reach patients, according to experts we spoke with.
Bob Wachter, the chair of the department of medicine at University of California, San Francisco, said that he thought it would be relatively easy to schedule patients through the hospital’s electronic health record system — as long as the criteria for priority were fairly simple, and as long as they were already in the medical records’ patient portal system.
“I’m guessing that patients with no existing medical home will need to look for options in the community,” he said.
Health tech steps in: That stage concerns health experts. “I’m worried we’ll lose a lot of patients, those who aren’t connected to a health system,” said Fola May, a UCLA doctor who studies health disparities in access to cancer screening and flu vaccines. For a vaccine campaign to be successful, it needs to reach every corner of the population.
ZocDoc a few days ago launched a vaccine scheduling system. But for some startups, it can be hard to get state business. Dan Claud, an emergency physician, has been pitching some Midwestern states on a system he built, but he’s found their procurement rules are not always friendly to small firms.
Like May, he is worried that some people face higher risk of being shut out from the vaccine if they aren’t already patients in large systems. “You have to go through the equivalent of a credit check” to register at some systems, he said.
Lessons learned: CVS Chief Digital Officer Firdaus Bhathena said the company is confident its scheduling systems are patient-friendly after learning some important lessons from coronavirus testing. Among other tweaks, he said the company has restructured sign-up systems to ensure ineligible patients are weeded out quickly, rather than having to answer pages of questions before finding out they can’t yet get a shot.
The company is also letting patients sign up for first and second doses all at once. “We’re trying to be as friction-free as possible because we know people are anxious about this,” he said.
Ultimately, experts said, there are ways to ensure the underserved aren’t overlooked. That includes writing appointment sites in plain English and making them available in other languages, said UCLA’s May.
Maybe, she suggested, public health systems could rely on the most broadly available technologies of all. “Most people have a cell phone and can get a text for it,” she said.
Mohana Ravindranath contributed.
Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @ravindranize, @ali_lev, @katymurphy.
Tweet of the Week
@AndreyOstrovsky “Lots of #telehealth startups noise. Most just virtual service providers which basically just have service-provider economics (ie boring growth). Unless they have homegrown elegant tech + unique friction removal (ie networks or VBP or integration), they don't warrant venture $”
Washington Watch
WHO’S THE SOCIAL MEDIA PERSON AT CDC?: That’s a question from incoming Centers for Disease Control Director Rochelle Walensky. In a Tuesday webcast with the Journal of the American Medical Association, Walensky said she has made clear that the agency and its scientists will be unmuzzled as soon as President Donald Trump is out the door. (She takes office at 12:02 p.m. Wednesday). But she also knows that media interviews and academic journals are no longer the only way science gets communicated.
“Science is conveyed through Twitter, science is conveyed on social media, on podcasts, in many different ways,” she said. So one of the first questions she asked is who is the person in charge of thinking about all this for the nation’s premier public health agency.
She also said she wants the CDC to get a whole lot smarter about how to counter myths and misinformation – including about vaccines – on social media. “We have to have a social media plan for the agency,” she said.
CONGRESS’ NEXT TELEHEALTH BATTLE: BUSTING FRAUD: Most lawmakers agree that virtual appointments have been a huge lifeline for patients and doctors during the pandemic. But while there’s broad enthusiasm for telehealth, longstanding concerns that the field is prone to fraudulent billing have kept lawmakers from backing a permanent expansion of Medicare’s coverage of the technology, congressional aides tell POLITICO's Mohana Ravindranath.
To the surprise and disappointment of telehealth lobbying groups such as the American Telemedicine Association, a measure that would have extended generous pandemic-era telehealth coverage by one year was cut from last month’s major spending package. Instead, lawmakers included just a narrow expansion of behavioral health care — only for patients who had already seen their provider in-person.
Some saw the measure as a first step toward more permanent coverage, but ATA called the in-person requirement an “arbitrary restriction” that could “unnecessarily deprive Medicare beneficiaries of telemental health options. It’s now urging Congress to remove that requirement. But fraud concerns even with this limited coverage expansion, which was led by Rep. Suzan DelBene (D-Wash.) and Sen. Ron Wyden (D-Ore.), could prevent that from happening.
Overblown concerns?: A Democratic aide said supporters of the telehealth restriction felt it was necessary to prevent unscrupulous fraudsters from inappropriately billing or treating patients they connect with online. Other congressional aides who helped craft the policy warned against robocalls targeting senior citizens for therapy sessions over the phone.
The fight over behavioral health could set the stage for a broader debate over telehealth coverage that’s likely to play out in this Congress. Telehealth caucus leaders, including Sen. Brian Schatz (D-Hawaii), are considering updates to a comprehensive virtual care bill that’s stalled in Congress for several years. And Reps. Fred Upton (R-Mich.) and Diana DeGette (D-Colo.) have said the upcoming update to their 2016 medical innovation legislation, the Cures Act, will likely include telehealth measures.
What telehealth advocates are counting on this time, however, is new data from the pandemic to show that concerns about fraud and overspending are overblown.
“I think the longer a lot of these flexibilities are in place during the pandemic, and all these terrible things that everyone is so scared of actually don’t happen, hopefully that’ll provide both quantitative data and also experience to help [Congress] feel a little more comfortable,” said Faegre Drinker’s Megan Herber.
Ideas Lab
MASKS NOT OPTIONAL: The arrival of new coronavirus strains is prompting calls for stepped up infection control like wearing masks outdoors — including while exercising. But is that really necessary when the risk of coronavirus transmission is so much lower than it is in enclosed spaces, and when even leading public health officials have said there are instances when one can go without?
No doubt, says Harvard epidemiologist William Hanage, who’s making a strong pitch for precautions like running with a mask on. Doing so now can lower the public health risk of more spreadable Covid strains like the one identified in Britain that’s expected to take hold and become the prevalent variety in the U.S. by March. And it could buy time for the public health infrastructure to reset amid a sluggish national vaccination effort that’s resulted in about 12.3 million shots — well short of the Trump administration’s goal of 20 million by the end of 2020.
Hanage, who says he runs with a KF94 mask from Facefit, says masking outdoors can also have the secondary benefit of sending a message of solidarity among a crisis-fatigued population. “Seeing a person wearing a mask is a sign that they are looking out for you and not just themselves, because masks greatly reduce the risk of transmission,” he tweets.
And if the foggy eyeglasses and runny nose from the face covering are hard to bear, he suggests wearing the mask around the chin and pulling it up when approaching others.
What We're Clicking
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The Atlantic goes behind-the-scenes on HHS Protect, the government’s data system for coronavirus.
ProPublica uncovers Warp Speed’s logistical tangles.
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