Why this time of the year often presents the greatest risk to public health and the greatest opportunities to showcase our skills and abilities as consultants.
By Jim Poggi, Principal, Tested Insights
By this time each year we have already been involved in multiple activities intended to help our customers effectively prepare for the late fall and early winter patient visits and to provide effective preventive services to their patients.
As temperatures drop, this typically signals an annual increase in cardiac illnesses and the rise of an increasing variety of respiratory diseases. Most of us have already been providing our customers with flu and COVID vaccines and helping them prepare for the rise in annual school physical exams. It is also likely that your customers have asked you about your respiratory testing portfolio this year and your recommendations to help them prepare for respiratory testing for their patients. Make sure to have comprehensive discussions with your trusted respiratory testing manufacturers to understand available platforms, tests, current reimbursement and testing trends.
This year, I am seeing more interest in RSV testing for older adults than in previous years. This trend mirrors an increased level of RSV vaccination utilization for older adults. As the pharmaceutical companies that offer RSV vaccines create awareness of the incidence of RSV in older adults and the seriousness of RSV in this patient group, they create opportunities for us to expand our discussion of respiratory testing. If you need a refresher on overall respiratory testing options, please refer back to my August 2024 Repertoire column which describes typical respiratory tests, their CPT codes, reimbursement, waived status and available lateral flow and molecular testing platforms.
Hopefully we have the foresight to plan for these annual experiences, but if we have not so far, it is not too late to prepare to be an active and well-informed consultant for the balance of the fall prevention season. What do I mean by this? In this column I plan to help you think about late fall and early winter the way your customers do. We need to go beyond talking about the patient conditions and concerns they will face. Not all their patient visits will involve specific clinical conditions. Some will involve questions about which vaccines are appropriate for them. Others will involve questions about health insurance, including which plans the practice will cover in the coming year.
This year there are changes in Medicare Advantage program coverage by many commercial insurance companies that your customers’ patients may ask about. Many Medicare Advantage (Part C) plans will increase in cost and some will offer reduced benefits or increases in deductibles. As we approach the end of the calendar year, a number of patients will schedule appointments and request tests to make sure they take advantage of all their current year benefits, before annual deductibles go into effect in January.
Looking more broadly than just the clinical side of your customers’ businesses will pay dividends at this time of year. Understanding the types of questions and patient visits your customers will encounter this time of year will allow you to consult more effectively. Let’s take a look at some of these scenarios together.
Preparing for end-of-year patient visits
As the calendar year comes to a close, many patients schedule physical exams to make sure they obtain these benefits before the start of the new benefit year when deductibles will need to be satisfied all over again. Some may be changing plans, which adds urgency to their desire to schedule their physical.
While we know this trend typically increases end-of-year patient visits and daily use office consumables like gloves, masks and table paper, are you thinking about increased testing? If not, you should be. Patients with a history of diabetes, hypertension, heart disease and other conditions should have testing conducted to ascertain any key changes in their lab test values. Lipid testing, glucose and hemoglobin A1c, CBC, urinalysis and metabolic testing panels are all likely to increase at this time of year.
At the same time, patients previously diagnosed with cancer, or having a family history of it, should be tested for tumor markers including PSA and fecal occult blood or FIT. Comparing current values for all these tests to baselines is sound and sensible preventive medicine and can discover trends important to the patient and care giver. This can be good news, or result in more intensive follow up, depending on the results of the trends. Knowing the patient’s lab result status means knowing how their current values stack up against their values over time and how well their treatment program is working.
From your perspective, knowing which lab tests your customer frequently performs should lead you to ask about their end-of-year testing needs. If they have thought about a seasonal spike, you are on the same page and can easily help. If not, it is likely you have created a valuable reminder that can help them to be prepared and have the test kits and reagents on hand to make sure they are ready for anticipated patient visits. Either way, your consulting skills can be a benefit that sets you apart from others.
What about end-of-year Medicare visits?
This year, in particular, there is a lot going on here. Medicare annual enrollment is coming to a close in early December. But annual Medicare wellness visits are a year long activity. While they are mostly comprised of “vital signs” measurements and an optional questionnaire regarding physical and emotional safety issues, they can also lead to preventive measures which are also covered by Medicare. Knowing more about both the annual Medicare wellness exam and the covered preventive services will help you expand your knowledge and provide useful information with your customers. I am providing links to both home pages. Note that most Medicare preventive services, which are typically based on patient history or an assessment of patient risk, are covered at no cost to the patient.
Planning for the typical respiratory season patient visit spike
In days gone by, this was simply a reminder to order flu and strep tests NOW in anticipation on the coming surge of patients ill with respiratory disorders. We also presented our usual “stock up and save” promotions offered by our trusted respiratory test manufacturers.
But as times change, so has the complexity of preparing for respiratory season. Is the customer using a lateral flow testing reader or a molecular testing reader? If not, are they thinking about one or should they be? If they have expressed questions about test results not matching patient symptoms, mentioned possible false negatives, challenged the skill of their staff to properly collect the specimen or perform the test or are looking to expand their respiratory testing portfolio, NOW is the time to discuss the testing platform BEFORE discussing the individual tests. Having the right testing platform can mean increased confidence in results, reduced concerns about staff skills, the ability to perform all the respiratory tests they need and even the possibility of increases in revenue.
If I were preparing to discuss respiratory testing with my key customers, my first question might well be “How satisfied are you with your current respiratory testing platform? Do you have specific concerns? Are you looking for options?”
It’s worth probing for concerns about result quality, especially for both strep and RSV where a false negative can have serious adverse results. For customers with these concerns, introducing a molecular platform can provide a valuable solution and assure they feel prepared to confidently test and treat their patients this season. Be sure to enlist the help of your trusted respiratory test manufacturers to provide the best solutions.
Respiratory season makes all comorbidities worse
No matter where we are in the annual progression of respiratory season or how severe any specific respiratory season is, all co-morbidities associated with respiratory illnesses make the patient situation and prognosis more dangerous. What this means is that any patient with any pre-existing condition has a higher risk of more severe outcomes if they develop a respiratory illness. This can include serious complications including pneumonia. Typical co-morbidities your customers are concerned about include pre-existing respiratory conditions including asthma and COPD, diabetes, hypertension and osteoarthritis. As always, both the very young and the elderly have a higher risk profile when they develop a respiratory illness and need to be monitored closely.
Respiratory season CDC information
While your trusted respiratory test kit manufacturer is an outstanding resource, the CDC also provides a large range of information for you. It ranges from an overview of the respiratory season to date to an analysis of the incidence of specific seasonal pathogens to community specific incidence data on the respiratory season. Each of these resources helps you to stay well informed and is also likely to make sure you are viewing the same information source many of your customers use to stay informed. This helps you and your customers to “speak a common language” about respiratory season. (See sidebar for CDC respiratory illnesses data channel.)
It is also well established that heart disease incidence has a seasonal spike associated with late fall and winter weather. Reduced activity levels in combination with other seasonal factors cause an increase in heart attacks at this time of year. For a more detailed summary of the cardiac risks at this time of year, you may want to re-read my January 2024 column “Home is Where the Heart Disease is”. It discusses age, nutritional, lifestyle and other factors that are implicated in the development of cardiac illnesses at this time of year. There is no doubt your customers are intimately familiar with this information, but it pays you to be well informed. A little research here can add to your reputation as a well-informed consultant.
Wrapping it all up
The pathway to better health in the fall and winter is prevention. While being well informed and able to “speak a common language” with our customers is critical, we must never forget to continue to ask specific and appropriate questions to continue to know them and their concerns as well as possible.
The example of respiratory testing platforms mentioned earlier should be part of your customer dialogue at this time of year. Other conversation starters I am thinking about include:
- “There is a lot of discussion about continuous glucose monitoring currently. What is your current viewpoint on CGM? Which patients could have the most benefit? Are you actively using it or waiting for more information?”
- “I heard very little about RSV in adults until the past few years. Now it seems that availability of RSV vaccines has caused concern about RSV in older adults. How are you managing your elder adults regarding RSV vaccination and testing? Are you recommending vaccination? Is testing for RSV in adults part of your current respiratory practice? My company offers multiple options. How can I help you?”
It’s not just how much you know but more often how much you know about your customers that makes all the difference in your success. Be well informed on the issues but be better informed about your customers’ concerns.