In the wake of election day, and as the COVID-19 pandemic continues to spiral uncontrolled around us, I rose to a brighter moment as my colleagues began to text me that they too were online at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Meeting with me. With our cups of coffee in hand, we were going to learn about what changes were upcoming in 2021, especially in light of the pandemic and changes in our country’s leadership. Yes, we couldn’t see each other in person this year, but we were still going to “be together.” Why was this so important to me?
The COVID-19 pandemic has evolved. Initially, there was unwavering support for health care workers. We had masks donated, face shields 3D-printed, and even thank-you meals sent to us by patients. As time has passed, the frustration with the disease was palpable among patients, staff, and clinicians alike. Patients lost their jobs and insurance. Other patients were too scared to come to the doctor and did not take advantage of the telemedicine platform. Many procedures used by allergy and immunology physicians, such as skin testing, spirometry, and FeNO testing, were shut down. We made COVID-19 protocols, only to revise them and then revise them again.
As patience is already a short commodity right now, we also are hearing about the complete change in coding for visits in 2021. In the “Presidential Plenary: The Changing Payment System – Challenge Accepted,” we heard about the holes in the current value-based payment model. How do we define value as a group? How do we tailor it to each subspecialty, including allergy and immunology? If we truly do provide value and decrease hospitalizations, why are insurance companies not picking these models up? Simply put, there is no incentive. If insurance companies are rewarded with each hospitalization, then why would they want to decrease hospitalizations? What is a physician to do? Both the answer and the path are not easy. We need to step up and get involved. But how? Cut out the middleman — insurance. We would work directly with employers and patients to show them how you would like them to save money. These substantial savings cannot come by slashing physician reimbursement yearly, delaying life-saving medications for patients in the endless prior authorizations, denials and reviews, or putting excess burdens on patients through high-cost plans and unreasonable deductibles. This can only come by us unifying as a group and leading the charge to show how we can provide excellent quality care to reduce health care costs. Physicians must be in the room where it happens, banded together, in order to create undeniable beneficial change.
Where else can allergists and immunologists make a positive difference? We can be leaders in the COVID-19 vaccine initiative. In the session, “Vaccines: The Good, the Bad and the Scary,” we saw that there are multiple unique COVID-19 vaccines in phase III trials around the world. During the past two weeks, Pfizer and BioNTech released preliminary data, which projected >90% efficacy in their mRNA vaccine trial. Moderna, another company developing an mRNA COVID-19 vaccine, has shown a 94.5% efficacy in preliminary data with their vaccine. What remains to be seen is the safety data of these new vaccines utilizing mRNA technology. As the COVID-19 vaccine race progresses, we realize our role as allergists and immunologists is to learn about the various vaccines, including their mechanisms, efficacy, and safety, and be able to effectively educate and vaccinate our patients. Together, through shared decision making with our patients and collaboration with each other, we will make forward strides to end this health care crisis.
As the first day of the ACAAI conference drew to a close, my colleagues and I cheered. We watched the sunset and offered each other a glimmer of hope of better times to come. We are all united in our goal — to provide quality, value-based, affordable health care to our patients and squash the pandemic through risk mitigation and vaccination. We, too, miss our friends and family and can’t wait to spend weekends and holidays together. Through innovation, education, and resilience, those moments are right ahead of us. We have to embrace them and forge ahead.
Illustration by Jennifer Bogartz