Sunday, August 30, 2009

H1N1: The Obama Administration's Coming Katrina?

In a prior post, the Disease Management Care Blog noted that the Obama Administration’s health care chops would depend on its response to the H1N1 (Swine Flu) virus. So far, it’s been lucky: a serious pandemic has yet to land on U.S. shores. With the coming arrival of fall, however, luck may be running out.

According to this New England Journal of Medicine article, planning is furiously underway. It looks like the patchwork of emergency rooms, public health clinics and primary care providers are being geared up to give the vaccine. Individual clinics are anticipating the coming demand based on the Centers for Disease Control's (CDC's) emerging two shot vaccine recommendations that assign priority to the pregnant, children, young adults and adults up to age 50 years with a chronic illness.

This may look good on paper, but the DMCB worries that this public health campaign is vulnerable to one of two extremes. One is high numbers of persons refusing to be vaccinated because of the fear of side effects. The other is high numbers of persons demanding the two shots and over-running our decaying primary care network. Over the last decade, most primary care sites have reduced overhead to a minimum and have neither the personnel or the resources to take on a new crush of persons demanding the two Swine Flu shots.

For more insight on this, the DMCB turned to one of its primary care colleagues, who, unlike the apparent healthcare experts writing in the New England of Journal, has a real grip on the reality of what could happen this fall:

'I hear rumors that the government is going to pay for the vaccine but the cost of administering the shot (including storing the vaccine and covering the cost of the nurses to administer it) is supposed to be covered by private insurance. We haven’t heard if the insurance payers we deal with will provide first dollar coverage or if they’ll transfer some of that cost through a co-pay or other forms of co-insurance. We also still have no idea about the distribution channels and we don’t know how the vaccine supply will be shared with physicians’ offices, Department of Health clinics or pharmacies. Our small primary care office is terrified of the burden that will be imposed by having giving two more shots to our population with a short lead time. We already have full schedules for the fall season and will have difficulty processing the 1200+ extra contacts and associated paperwork. We are a tiny office that normaly gives 600-700 flu shots a year.'

By the way, the primary care physician had a particularly novel idea. It’s built on the common sense observation that lay people can be trained to give shots.

'My solution: Train census takers to give shots or better yet, put a shot giver on every Fed Ex and UPS truck. Those guys are the best logistical wizards on the planet. You could even get a tracking number and find out where your flu shot is!! They know where everyone lives. My UPS guy knows that if I am not a work to drop by my house. Talk about a neural network.

Readers may think this is naive, but the DMCB points out that the circumstances of the coming H1N1 pandemic may warrant out-of-the-box thinking. This is the Obama Administration's chance to show that it is different - that it is able to come up with non-FEMAoid approaches. Are there plans to involve the public schools? Why can't Visiting Nurse Associations be contracted to set up vaccine stations in our nation's post offices? Or maybe when the Administration isn't pillorying the insurance industry, it is working with it to reduce the out of pocket financial barriers that patients may be facing?

And, in case sizable numbers of persons refuse to be vaccinated for H1N1, check out this thought:

How about a variation of the Cash for Clunkers Program. I call it Shekels for Shots program. At first glance, this may sound silly, but if a voucher not only provides first dollar coverage of the shot for particularly vulnerable persons, but gives them a meaningful cash rewards, the population will be vaccinated and we’ll have another stimulus!!

The DMCB says the traditional response to H1N1 so far does not bode well for the Administration. If the story being told above is typical of many other primary care providers, H1N1 could turn out to be the Obama Presidency’s Katrina.

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