Cartoon – Questions of Ethics
Monthly Archives: June 2017
Children’s hospitals — and their patients — caught in the crosshairs with planned federal cuts
Republican plans targeting federal funding for health coverage have drawn ire from Americans in all corners of the country, but some of the loudest voices are coming from parents. They have cornered members of Congress at town halls to ask how the slashed budgets will affect some of society’s most vulnerable.
Suggested cuts to Medicaid and the Children’s Health Insurance Plans (CHIP) would throw millions of Americans off insurance and leave hospitals that are already teetering financially facing more uncompensated care. Children’s hospitals, safety net hospitals and rural hospitals will be most affected, and disabled children will face devastating cuts in coverage.
The funding decreases have been proposed in bills making their way through Congress and separately by President Donald Trump. They would shift the cost burden further onto states, many of which have seen success in expanding Medicaid, which is also on the chopping block.
“Children, the elderly, the disabled, and others from our most vulnerable populations would all be affected by these deep budget cuts,” Joanna Hiatt Kim, vice president of policy at the American Hospital Association, told Healthcare Dive. “For hospitals, this could mean more uncompensated care as millions continue to seek needed healthcare without any coverage. For the patient, this could mean delayed care or foregoing care altogether.”
Impact on children’s healthcare
More cuts to Medicaid and CHIP would reverse the trend of fewer uninsured Americans, including children.
Congress created CHIP 20 years ago when 15% of children were uninsured. CHIP, the Affordable Care Act and Medicaid expansion provided more insurance offerings and now only about 5% of children are uninsured. CHIP, which is a federal/state partnership, includes free well-child visits in many states and also provides prescription coverage, inpatient and outpatient care and emergency services.
While suggesting a two-year CHIP extension in his budget plan, Trump proposed a 20% CHIP cut over the next two years. His budget also seeks a $610 billion cut from Medicaid over 10 years, despite early promises to leave the program alone.
Studies have shown that CHIP helps reduce hospitalizations and child mortality, and improves quality of care. The program has bipartisan support. However, HHS Secretary Tom Price voted twice against expansion when he was a congressman.
CHIP is up for reauthorization by Sept. 30 and governors recently spoke out in favor of expanding it. In his budget proposal, Trump proposes a two-year extension of CHIP, but also suggests program cuts, including the matching rate for states.
Jim Kaufman, vice president of public policy at Children’s Hospital Association (CHA), told Healthcare Dive that CHIP helps children’s hospitals.
“CHIP is good for kids, and that makes it good for children’s hospitals and children’s providers.”
Jim Kaufman
Vice President of Public Policy, Children’s Hospital Association
Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, told Healthcare Dive that the cuts would shift costs to states and reduce benefits. He said Trump’s budget would eliminate a 23-percentage-point increase in each state’s federal CHIP matching rate, which is in effect until 2019. That would mean $3.5 billion cut from the program.
The budget would also cut CHIP funding for children with families that have incomes above 250% of the federal poverty line, which would affect 28 states and Washington, D.C. that provide CHIP coverage to children above the income threshold, according to Park.
This will mean states will need to pick up more of the CHIP program costs if they want to maintain the current coverage level. Park said he believes Congress will reauthorize the program, but questions remain about CHIP’s funding and benefits.
NYC Health + Hospitals cuts 476 positions amid financial pressure
Dive Brief:
- NYC Health + Hospitals on Friday cut 476 management positions, which will reduce the current six layers of managers to four and is expected to save the health system $60 million, several news outlets reported.
- The largest U.S. public health system cut 396 managers and eliminated 80 unfilled positions.
- The system expects the job cuts to lead to $60 million in savings in fiscal year 2018.
Dive Insight:
The announcement of the health system’s massive restructuring day came after a $673 million loss was posted for Q3 2017. H+H interim President and CEO Stanley Brezenoff said in a statement the restructuring will reduce “unnecessary layers of management.” The health system will now be able to “better direct resources where we need them most — at the front line of patient care.” It also cut 70 employees in February.
Revenue increased by 1.8% to $6.7 billion during the third quarter. Yet system officials said net patient service revenues dropped by 9%. The reasons behind the drop were “lower payments from the disproportionate share hospital (DSH) and upper payment limit programs,” according to the healthcare system of 11 hospitals.
At that time, H+H predicted that it would cut its $779 million budget gap this year and end with $185 million cash in hand. In April, the health system announced a redesign of its management structure after losing $776 million for the first half of FY 17, but said at that time that they did not expect layoffs.
Hospitals are facing financial issues across the country. Safety net hospitals like H+H may soon face even more difficulties. H+H has a large Medicaid population and potential cuts in President Donald Trump’s budget and the American Health Care Act – the GOP’s proposed bill to replace the Affordable Care Act – could send millions off of Medicaid. This would mean a system like H+H may soon face more uncompensated care.
H+H is looking for ways to improve its finances. One way is through a new Epic revenue cycle system that officials in May said will “improve efficiency and ensure that the health system is collecting the maximum amount of revenue for the services it delivers.” They expect it will improve clinical documentation, reduce claims denials and accelerate reimbursements.
States Scramble to Prevent Obamacare Exodus
Insurance commissioners are pulling out all the stops to keep insurers from leaving their states amid uncertainty over ObamaCare’s future.
They are offering insurers new, previously unheard of flexibilities to try to keep them in the market.
But the effort faces an uphill climb, given the Trump administration’s wobbling over whether it will continue federal payments that compensate insurers for subsidizing out-of-pocket costs for lower-income households. There’s also the question of whether Congress will repeal ObamaCare this year.
Insurers are skittish and pleading for certainty from Washington. They want assurances that they will continue to receive cost-sharing reduction payments from the federal government, which total about $7 billion this year.
But no such promise appears forthcoming, prompting insurance commissioners to try and hold things together with later filing deadlines for enrollment and new concessions to insurers.
“As a regulator, instead of being rigid on timelines, the type of pricing I’m going to want, I’m being more open about this,” said John Franchini, New Mexico’s insurance superintendent. “I’m trying to be more flexible to give them confidence that if things change, we as regulators will be flexible with them.”
The biggest fear of the insurance commissioners is having every carrier pull out of a market, leaving people with no ObamaCare plans to buy. It’s a situation that hasn’t happened before, but could happen this year.
In several states, such as California, companies can file two different sets of premium requests: one for the continuation of ObamaCare — such as cost-sharing reduction payments and the enforcement of the individual mandate — and one for if both are discontinued.
“Based on what we were hearing from insurers, we anticipated Trump rates would be double-digit increases over the past year,” California Insurance Commissioner Dave Jones said. “I wanted to give insurers the opportunity to file rates based on Trump.”
Insurers are facing imminent deadlines in many states to submit their preliminary premium requests and state whether they’ll stay in the market. They also face a June 21 deadline to tell the federal government whether they’ll participate in ObamaCare next year.
Can Patrick Soon-Shiong silence his many critics?
On the phone, Patrick Soon-Shiong speaks slowly and deliberately. He clearly trusts himself, but he doesn’t trust journalists anymore.
A series of scathing articles by STAT News and Politico sent stocks in his publicly-traded companies tumbling earlier this year. On Monday, he has an opportunity to change that narrative somewhat, with the unveiling of data from human trials of his cancer vaccine at a major oncology conference.
The stories allege that despite his bold claims, Soon-Shiong’s NantWorks subsidiaries are underperforming and reliant on contracts from other companies in the group. Reporters have also claimed that one of his companies, NantHealth, has received contracts from institutions that had received donations from his nonprofit foundation — a major conflict of interest. This was not adequately disclosed prior to the massive initial public offering of NantHealth, they argue, which may violate SEC laws.
For his part, Soon-Shiong, dismisses the allegations noting that part of the motivation behind those stories was political: “They had never written about me until they saw this picture of me with Trump.”
Speaking to MedCity on Wednesday after his recent appointment to a national health IT advisory committee, Soon-Shiong detailed how the various threads of his career are converging toward a pivotal moment. A solution for healthcare is almost within reach and he’s poised to unveil what he believes is a disruptive cancer therapy – the Nant vaccine – at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago on Monday.
This story clearly clashes with many other viewpoints in the industry.
HOW LEADERS CHANGE PEOPLE BY SIMPLY SEEING THEM
Who’s watching:
Have you seen leaders walk around without looking at people? Ignoring people is an act of power that makes others feel less powerful.
People need to be seen. Leaders make people feel they matter by seeing and acknowledging them.
Gratitude is a way of seeing that changes people. You get what you honor.
5 ways to see people:
See with your eyes and your mouth.
#1. Honor development. Let people know that you see them working to develop skills. “I can see that you’ve turned team meetings into energizing experiences. What are you learning?”
#2. Elevate status when results exceed expectation. Give titles to acknowledge great results, not to elevate poor performance. Providing titles to people who haven’t performed invites entitlement.
#3. Give public acknowledgement. Let people hear you bragging about them to others. Tell higher ups about someone’s great performance.
Enjoy someone’s performance publicly.
#4. Praise character and strength. Gratitude is about behaviors. Praise is about character. You might say, “I notice that you’re very kind with people.”
#5. Show gratitude for effort and energy, even if performance falls short. If you want people to pour energy into work, notice their effort, even if the numbers fall short. “I could tell that you worked really hard, even though we fell short of our goal.”
Disappointing performance:
See disappointing performance with forward facing optimism.
- “What are you going to do differently next time?”
- “What are you learning about yourself or your team?”
- “What strengths can you bring to the next challenge?”
How might you see people today?
Cartoon – Some of us are part of the problem
Senate returns more pessimistic than ever on healthcare
Senators went into a recess skeptical over whether they could agree to legislation repealing and replacing ObamaCare.
They will return on Monday more doubtful than ever.
Sen. Richard Burr (R-N.C.), one of Senate Majority Leader Mitch McConnell’s (R-Ky.) most loyal allies, said Thursday that it’s “unlikely” the GOP will get a healthcare deal.
“I don’t see a comprehensive healthcare plan this year,” he told a local news station.
Senate Republicans hoped to have a draft bill this week, but it now looks like there will at best be an outline.
A Senate Republican aide said it’s too early to begin drafting legislation that can come to the floor in the next few weeks.
“Parameters are more likely,” said the aide, who explained that McConnell wants to keep the details held closely so the legislation doesn’t get picked apart before lawmakers have a chance to consider it carefully.
“The last thing we want to do is litigate this in the press,” the aide said. “We want to discuss parameters and concepts without releasing a draft.”
“Maybe they can start talking to members about a specific product next week, but I would not be surprised if we don’t,” said another Senate GOP aide.
More unhelpful news came in the form of a Kaiser Family Foundation poll underscoring how unpopular the bill approved by the House is.
It found that three-quarters of Americans surveyed think the House bill does not fulfill President Trump’s promises on healthcare.
A full 82 percent said federal funding for ObamaCare’s expansion of Medicaid should be continued, an issue that deeply divides the Senate GOP. The House bill ends the ObamaCare funds in 2020.
Yet another factor for Republicans is Trump’s approval rating, which has fallen to its lowest point with Republicans since he took office in the latest Reuters/Ipsos tracking poll.
Republicans already had sought to lower expectations.
McConnell conceded last week that, “I don’t know how we get to 50 [votes] at the moment.”
He sounded more optimistic about passing major tax reform legislation, rating its chances as “pretty good.”
Republicans control 52 seats and can afford only two defections from their ranks. Vice President Pence could cast the deciding vote in case of a 50-50 tie.
The Senate GOP hasn’t given up hope on healthcare and faces tremendous pressure from the White House and House Republicans to hold a vote.
Republicans for years have promised to repeal ObamaCare, so failure would be a major blow. They also face pressure to finish their work on healthcare because of the tax reform push.
The GOP is using special budgetary rules to prevent Democrats from filibustering legislation on tax reform and healthcare.
Republicans can’t move to tax reform until the healthcare debate is finished because once they pass a new budget resolution that would allow them to move tax legislation with 51 votes, they will lose the vehicle set up to enable a healthcare bill that would circumvent a Democratic filibuster.
Those on a special 13-member working group have heard very little about the drafting efforts that were supposed to take place over the recess.
The Truth is like a Lion
Cartoon – Food Science
HENRY KOTULA 