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Clinical economics: Cough, cold, and flu


How to better manage-and get reimbursed-for treating cough, cold and flu patients.

Approximately 1 billion cases of the common cold occur annually in the United States, according to population research estimates. Each year, between 5% and 20% of patients will be diagnosed with influenza. Cold and flu season-which typically peaks between December and February when high levels of viruses circulate-is often associated with increased patient traffic for primary care offices.

Colds may be common, but viral infections can have serious implications: on average 200,000 Americans are hospitalized annually due to influenza, and flu-related deaths in the United States have been estimated to range from 3,000 to 49,000 over the past 30 years.

Cold and flu are also associated with significant burdens for patients and physicians. Approximately 28% of all annual over-the-counter medication expenditures are for cold and flu treatments. Viruses are easily spread and many patients experience multiple colds per year, which may result in frequent office visits. Symptoms can linger for up to 2 to 3 weeks, translating into lost work time.

Seasonal flu outbreaks result in an average of $10.4 billion in direct costs of hospitalization and outpatient visits, according to the Centers for Disease Control and Prevention (CDC). That total does not include indirect costs associated with lost productivity and worker absenteeism. According to the Bureau of Labor Statistics, employee absences on average are up an estimated 32% during the winter flu season compared with the rest of the year.

Primary care physicians play a key role in patient education, because patients may not know how to protect themselves and their families during cold and flu season, or may misunderstand the role of vaccinations and medications. By teaching patients how to identify influenza versus the common cold, which over-the-counter medications are appropriate, and when vaccination is recommended, primary care physicians can ease the burden of cold and flu season for their patients and staff.


NEXT: Patient management tips


Patient management tips

Educate on prevention. The common cold and influenza are caused by viruses, which can be airborne or spread through close personal contact.

Although winter and early spring are typically considered cold and flu season, physicians can help patients protect themselves and their loved ones year-round by offering simple, yet effective, educational tips:

  • Hand washing
    Scrubbing with soap and water for at least 20 seconds, especially after coughing or sneezing; using alcohol-based hand sanitizer when soap and water are not available.

  • Avoidance of the eye, nose, and mouth
    Patients should be reminded that viruses live on the hands, and these are common entry points to the body.

  • Minimizing contact when sick
    Avoid close personal contact with people who are sick, and patients should stay at home while they are sick whenever possible.

  • Disinfecting
    Clean items that are frequently handled, such as phones, toys, and doorknobs, when someone in the household has a cold or the flu.

Recommend vaccination. Although there is no vaccination that can protect against the common cold, the best way for patients to avoid the flu is to get vaccinated every year. Since 2010 the CDC has recommended that everyone older than 6 months get a flu shot as soon as one becomes available for the season. However, vaccination may be preventative even if patients have waited until the flu season is underway. Those vaccinated miss fewer days of work or school and have reduced rates of hospitalization.

Vaccination is especially important for patients at increased risk of developing flu-related complications, including young patients, elderly patients, and those with compromised immune system function.

For families, vaccination of all members may decrease the risk of infection for those at high risk. Getting a flu shot annually results in significantly higher rates of protection compared with that experienced in the initial year, especially against the complications of flu, such as pneumonia, cardiac events, and death.

Patients should be reminded that there is still a chance they can contract the flu even if they have been vaccinated. Vaccination in such cases leads to cases being milder, however.

Educate patients on the differences between colds and the flu. It can be challenging for patients to distinguish between the common cold and a case of the flu, especially because the symptoms of a severe cold can seem flu-like. Patients should understand the difference between the two and the treatment options for each, as well as when an office follow-up may be needed.

Preach the power of patience. Cold and flu symptoms can be frustrating for patients. Most patients recover within seven to 10 days, but symptoms such as fatigue can last beyond 2 weeks and it can take up to 3 weeks for a persistent cough to completely disappear.

Patients can be reminded that medication may ease symptoms but may not speed healing, and that they will likely only need to make additional appointments if symptoms become severe or will not resolve. If a patient experiences worsening of symptoms after 7-10 days, this may signal that s/he is developing a bacterial complication such as sinusitis or pneumonia.


NEXT: Key coding considerations


Key coding considerations

Getting paid for treating the common cold or influenza requires understanding the possible diagnosis codes. See the table at right for a selection of available codes in both International Classification of Diseases-9th Revision (ICD-9) and ICD-10.

Patient Education Resources

  • American College of Chest Physicians: Cough
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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
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© National Institute for Occupational Safety and Health