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With much focus on the coronavirus this year, don't forget about another viral infection that threatens your health. Each year the Influenza virus affects 5-20% of Americans. This illness puts millions at risk of lost work and sick days, medical expenses, and possible health problems. A flu shot lowers that risk. You may be wondering, should you get a flu shot?
The Center for Disease Control and Prevention (CDC) recommends that everyone over the age of six months should be vaccinated against the flu virus this year. With a few exceptions, Americans need their shots around October or in early fall.
Many people worry about just how the flu shot will affect them. If you're one of these, keep on reading to find out what you should know about getting vaccinated this year.
The American Academy of Family Physicians (AAFP) recommends a yearly flu shot for everyone over six months old. This is because the flu vaccine can safely and effectively prevent severe illness.
Flu vaccines contain dead or weakened forms of the Influenza virus. Your cells begin to build up a natural defense system when they receive these parts of the virus. Then, your body creates antibodies. These proteins help your body fight infection. Antibodies work to keep you healthy later on if you are exposed to the flu virus.
The Journal of the American Medical Association (JAMA) recently looked at the best time to get your flu shot. In their study, researchers found that the U.S. flu season usually starts in December. After a flu shot, your body takes about two weeks to build up a response to the vaccine. Therefore, flu shots give the most protection when given in the fall, around October.
Vaccination is safe. Doctors have recommended flu vaccines for over 50 years. Over this time, a lot of research has evaluated the effectiveness and safety of immunizations. Certainly, the risk of serious reactions is low. Furthermore, manufacturers demonstrate the safety of their drugs before the FDA gives their approval.
The Advisory Committee on Immunization Practices (ACIP) warns some individuals to talk to their doctor about the flu shot if they have certain contraindications. This means a specific situation, condition, or factor that could make a treatment unsafe or even harmful.
For instance, egg allergy prevents some from getting a flu shot. This is a contraindication because manufacturers use eggs to make the vaccine. Therefore, the flu shot may contain trace amounts of ovalbumin (egg protein).
In addition to contraindications, there are precautions for some individuals. For example, those with a history of Guillain-Barre Syndrome or who have an illness with fever may want to discuss vaccination with their doctor.
The flu shot may cause reactions. These are typically mild and go away within 48 – 72 hours. They may include:
In some cases, more severe reactions occur. These could be signs of a rare allergic reaction to the vaccine. If these signs or symptoms arise, you must seek medical attention right away:
The risk of not getting vaccinated is getting sick. You could miss work or school, incur medical costs, or suffer mild to moderate health complications.
Most healthy adults deal with a minor case of the flu virus by staying home and taking over the counter medication to ease symptoms. The infection generally lasts 7-14 days.
On the other hand, those considered "high-risk" could suffer much more serious cases. Some possible complications include hospitalization and even death. Here are some factors that put you in the high-risk category:
In conclusion, you and your healthcare provider will decide if a flu shot is right for you. You must talk with your physician about your past history and risk factors to decide whether or not to be vaccinated.
Talk to your physician if you still have questions about the influenza vaccine. They can help you with additional information.
If you still have questions or you would like to discuss your medical condition with a specialist, click below to schedule an appointment. MyVirtualPhysician treats conditions like the common cold, flu-like illness, and more. If you have any suggestions for additional topics you want to read about, please let us know! Don't forget to follow us on social media.
Rubin R. Is It Possible to Get a Flu Shot Too Early? JAMA. 2018;320(22):2299–2301. DOI:10.1001/jama.2018.18373
In the United States, FDA-approved generic medications account for 90% of prescriptions filled. Your doctor or pharmacy may have asked you about your preference for a generic or brand name drug. This could have left you wondering: are generic medications the same as brand names?
Generic medications are not exactly the same as brand names. This is because generic medications can have different ingredients, look dissimilar, or have individual effects. In many ways, the FDA ensures that the medications are the same. But here is what you need to know about generic vs. brand name:
A lot of money goes into research, testing, and marketing before a company can introduce a new drug to the public. Then, they can patent their new medication and own the right to make and sell their product exclusively for five years. This short time allows manufacturers to recoup some of the costs associated with getting their new brand name drug to market.
The patent expires after that time. This means other companies can come along and produce the same medication under a different name. This “copy-cat” is considered a generic medication.
So you may be asking… what is the difference anyway? Well, in many ways a generic medication is like the brand name version. To be approved as a generic drug, the pharmacologic characteristics must be the same as the brand name. This means that generic medicines are the same when it comes to:
By contrast, generic medications can be approved with different inactive ingredients. So colors, additives, and fillers used to help with binding, flavoring, coloring, or preserving may not be the same. That means that your generic medication will likely look different. Trademark laws in the U.S. prevent drug makers from creating a version that looks exactly like the brand name.
The Federal Drug Administration (FDA) regulates generic drugs that are approved for sale in the United States. It provides a process that ensures the medications are safe, effective, and of sufficient quality. Keep in mind that the FDA also investigates complaints about all medications including side effects. They can issue a recall any time there is a concern for safety.
There are always risks and benefits associated with any medication. Everybody is different, and some are more sensitive to differences in the drugs.
Because the inactive ingredients are not the same, some individuals may notice differences when taking a generic medication vs. a brand name, but this is not always the case.
There have been reports of medications affecting patients differently.
For example, when the onset of effects is felt, how long the medication effects last, and even the side effects can vary when comparing drugs made by different companies or labs.
Keep in mind that some pharmaceutical companies produce both brand and generic forms of medication, so even some of the generics are very close to the original.
It is important to talk to your physician if you are concerned about a generic medication affecting you differently.
The FDA requires drug companies to prove generics are effective for treatment in the same way brand name medications are. Some generic medications have been on the market for years and shown to be as effective and a solid choice for some consumers.
Some individuals choose generic versions because they work just as well but cost much less than the brand name. Again, the company making the generic did not have to pass along the cost associated with getting a new drug to market.
So when a patient is going to be on a drug long-term or even for a lifetime, choosing a generic medication can save thousands of dollars a year in medical expenses. Lower costs may mean better compliance for some patients.
The savings to the individual are important, but it doesn’t stop there. When multiple manufacturers are able to make and sell a medication the competition can drive the cost down and makes healthcare more affordable for the public. Generic medicines save our healthcare system millions of dollars every year.
This answer may be different for each person. As with many choices in your health and medical care, you have to weigh the risks and benefits.
Is it worth it for you to spend more on a brand name medication? Cost is an important factor when deciding what is best. For example, when a person is on medication for a lifetime, opting for a generic version may save thousands of dollars in healthcare costs. On the contrary, generic medication for an acute illness that will resolve quickly could mean a different decision.
Today, many pharmacies routinely fill the generic versions for cost savings to the insurance companies and the customers. The FDA says that increasing the availability of generic drugs in the marketplace encourages competition in the pharmaceutical market which improves access to healthcare.
Although generic medications are not identical to their brand name counterparts, the FDA ensures that customers are getting safe, effective, quality options when they chose an approved generic. Although they may have different ingredients, appearances, and effects, the pharmacologic effects are the same. As with all medications, there are risks and benefits that should be weighed when making a personal choice.
If you would like to know more or have questions about your medications, our doctors are available for a virtual consultation. MyVirtualPhysician is a multi-specialty provider with physicians available for a consultation now. Click below to schedule an appointment. If you have any suggestions for additional topics you want to read about please let us know! Don’t forget to follow us on social media.
The Centers for Medicare and Medicaid Services (CMS) have issued the advance copy of its proposed 2021 Physician Fee Schedule rule on August 3 of this year. It contains the new telehealth services which will be covered under Medicare, which has changed immensely since the previous year. Unlike last year, where CMS made only minor additions to telehealth services, the proposed changes for 2021 are substantial. The addition of enhanced telemedicine services is designed to more deliberately expand the use of telehealth technologies among Medicare beneficiaries, making healthcare more accessible to Americans.
The most notable change is to allow physicians to fulfill direct supervision requirements while remote, provided the physician is immediately available to engage via audio-video technology if needed. This change can greatly increase physician leverage and virtual oversight, including more incident-to billing options. Another notable change is CMS’ proposal to remove frequency limitations for facility inpatient-type telehealth services. Essentially, these proposed changes are intended to expand the type of services for which doctors can perform and be reimbursed for through telemedicine.
Medicare is making a big push to expand access to telemedicine among medicare beneficiaries. Below is an article written by Foley and Lardner LLP which discusses the new changes and proposed telehealth codes and explains how to submit public comments on the proposed rule.
CMS proposed changing the definition of direct supervision to allow the supervising physician to be remote and use real-time, interactive audio-video technology. This is a big change because the current definition of direct supervision requires the physician to be physically present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. (It does not require the physician to be physically present in the actual room when the service or procedure is performed.) If finalized, the change would be in effect through December 31, 2021 or the end of the Public Health Emergency (PHE), whichever is later.
Under this new definition, direct supervision requirements could be met if the supervising physician was immediately available to engage via audio-video technology. It does not require the physician’s real-time presence or observation of the service via interactive audio-video technology throughout the performance of the procedure. Audio-only technology is not sufficient to fulfill direct supervision requirements.
The new definition opens opportunities for telehealth and incident-to billing. CMS acknowledged there are no Medicare regulations that explicitly prohibit eligible distant site practitioners from billing for telehealth services provided incident-to their services. But because the current definition of direct supervision requires on-site presence of the billing clinician when the service is provided, it is difficult for a billing clinician to fulfill direct supervision of services provided via telehealth incident-to their professional services by auxiliary personnel. Under the new definition, CMS believes services provided incident to the professional services of an eligible distant site physician or practitioner could be reported when they meet direct supervision requirements at both the originating and distant site through the virtual presence of the billing physician or practitioner.
The duration of this change is time-limited because CMS has concerns that widespread direct supervision through virtual presence may not be safe for some clinical situations. For instance, virtual direct supervision might not be appropriate in complex, high-risk, surgical, interventional, or endoscopic procedures, or for patients with dementia, or patients where an in-person physical examination is necessary and important. CMS is seeking comments as to whether there should be any additional “guardrails” or limitations to ensure patient safety/clinical appropriateness, beyond typical clinical standards, as well as restrictions to prevent fraud or inappropriate use if this new definition were to become permanent beyond December 31, 2021. CMS also seeks information on what risks this policy might introduce to beneficiaries as they receive care from practitioners that would supervise care virtually in this way. Commenters are invited to provide data and information about their implementation experience with direct supervision using virtual presence during the PHE, including comments on the degree of aging and disability competency training that is required for effective use of audio/video real-time communications technology.
CMS proposed changing the frequency limitation to cover subsequent nursing facility care services furnished via telehealth to once every 3 days (the current rule covers it only once every 30 days). The original 30 day restriction was due to concerns on the acuity and complexity of nursing facility residents, and to ensure nursing facility residents have frequent encounters with their admitting practitioner. However, CMS has been persuaded that the use of telehealth is crucial to maintaining a continuum of care in nursing facilities, and to honor the independent medical judgment of treating clinicians to decide whether telehealth vs in-person care should be used depending on the needs of each specific resident.
CMS did not propose changing the frequency limitations for subsequent inpatient hospital telehealth services (once every 3 days). But CMS is seeking comments if it would enhance patient access to care if frequency limitations were removed altogether (and, if so, how best to ensure that patients receive in-person care when necessary).
To facilitate billing of CTBS by therapists, CMS proposed to designate HCPCS codes G20X0, G20X2, G2061, G2062, and G2063 as “sometimes therapy” services. When billed by a private practice PT, OT, or SLP, the codes would need to include the corresponding GO, GP, or GN therapy modifier to signify that the CTB are furnished as therapy services furnished under an OT, PT, or SLP plan of care.
CMS received several requests to add new telehealth services. After review of the submissions, CMS proposed adding nine new codes to the list, set forth in the table below.
| Service Type | HCPCS Code | Service Descriptor |
| Visit Complexity Associated with Certain Office/Outpatient E/Ms | GPC1X | Visit complexity inherent to evaluation and management associated with primary medical care services that serve as the continuing focal point for all needed health care services (Add-on code, list separately in addition to an evaluation and management visit) |
| Prolonged Services | 99XXX | Prolonged office or other outpatient evaluation and management service(s) (beyond the
total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services) |
| Group Psychotherapy | 90853 | Group psychotherapy (other than of a multiple-family group) |
| Neurobehavioral Status Exam | 96121 | Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure) |
| Care Planning for Patients with Cognitive Impairment | 99483 | Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver. |
| Domiciliary, Rest Home, or Custodial Care services | 99334 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. |
| 99335 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. | |
| Home Visits | 99347 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99348 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
These nine services are sufficiently similar to services already on the list of Medicare telehealth services, so CMS classified them as Category 1 under a streamlined review process. Subject to public comment, these services are expected to be added to the list of Medicare telehealth services when the final rule is published, and would go into effect January 1, 2021. Note: for HCPCS 99437-99438, CMS the patient’s home can serve as a qualifying originating site when the patient is being treated for a substance use disorder or a co-occurring mental health disorder (in accordance with the SUPPORT Act).CMS rejected a request to add CPT 96040 (genetic counseling services) to the list. Genetic counselors are not allowed to bill Medicare directly for their professional services. Nor are genetic counselors eligible distant site practitioners for telehealth under the Social Security Act.
For 2021, CMS proposed creating a temporary Category 3 for those services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends. CMS proposed adding thirteen codes to the list of Medicare telehealth services. We will discuss those Category 3 services, as well as the approximately 50 other codes CMS has temporarily added as telehealth services during the pendency of the PHE, in a companion article.
Providers, technology companies, and entrepreneurs interested in telehealth should consider submitting comments to the proposed rule anonymously or otherwise – via electronic submission at this link. Alternatively, commenters may submit comments by mail to:
If submitting via mail, please be sure to allow time for comments to be received before the closing date. CMS is soliciting comments on the proposed rule until 5:00 p.m. through the end of September.
Continued expansions in Medicare reimbursement mean providers should make enhancements to telehealth programs now, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of clinical quality and patient satisfaction. Though providers should be mindful of any sunset provisions on these expansions and be prepared to adjust operations in accordance with those timelines. We will continue to monitor CMS for any rule changes or guidance that affect or improve telehealth opportunities.
Connect with Virtual Gynecology For additional background information, you can learn about the basics of Medicare telehealth services and CMS’ annual review process here. And for more information regarding telehealth, telemedicine, or virtual care, then connect with the team at Virtual Gynecology. Together, we’ll make healthcare more accessible to those who need it most.
The journal, Female Pelvic Medicine & Reconstructive Surgery, published a study comparing video visits to in-person office visits for postoperative care. To read the study, click the link below!
Researchers at the University of California, San Francisco have been evaluating hundreds of pregnant women who tested positive for coronavirus, and the impact it has had on themselves and their babies during pregnancy. The study aims to better understand the correlation between pregnancy and coronavirus. They also want to evaluate a diverse population for a more thorough grasp of the findings. The study is open for women 14 years or older who have tested positive for coronavirus or are experiencing symptoms. In addition, it will examine the impact of the virus on African American and underprivileged women who are more susceptible due to a lack of health care.
As of May 15th, 2020 The Pregnancy Coronavirus Outcomes Registry, or PRIORITY, has registered 706 women to participate in the study. The year long evaluation includes how the virus impacts maternal health, fetal development, early delivery, newborn health, transmission between mother and child, and the correlation between underprivileged women and the risk of higher mortality. Participants are asked to answer questions about their health and pregnancy, permission to review their medical records related to their coronavirus diagnosis and treatment, and contacted up to 7 times within the next year for routine checkups. The PRIORITY website states that they will continuously update their data so all of the information is available to the public eye. For more information about PRIORITY, click here to navigate to their homepage, and click here if you’re a healthcare provider who wants to refer someone, or if you are personally interested in joining the study.
Everyday Health released an article about the importance of making and keeping your appointment to see your gynecologist during the pandemic. If you are interested in learning more, click here to read the article! Make sure to book your appointment with our virtual gynecologist today.
