Cartoon – Today’s Meeting Agenda
Monthly Archives: July 2020
Cartoon – Conveying an Illusion of Concentration
Cartoon – Covid 19 Leadership
AdventHealth CEO amid Florida COVID-19 surge: ‘I wouldn’t hesitate to go to Disney’
As Florida recorded more than 15,000 new cases of COVID-19, the CEO of Altamonte Springs, Fla.-based AdventHealth said July 12 he would feel comfortable visiting Walt Disney World Resort, which has opened up two of its parks, according to CBS News.
In an interview on CBS’ “Face the Nation,” AdventHealth CEO Terry Shaw was asked about the resort’s reopening given that 48 Florida hospitals reached capacity as of July 10.
He told moderator Margaret Brennan: “So as a healthcare provider, my job is to help people do things safely. Whether it’s NASCAR or Disney, we have strategic alliances with those organizations. We work very closely with them to help them determine a way to reopen and do that safely.”
“I will tell you, based upon the way Disney is approaching this — with limiting people in, doing all the screenings that they’re doing, I’m — I personally am a Disney season ticket holder. I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” he said.
Mr. Shaw’s interview occurred the same day Florida reported 15,299 new COVID-19 cases, the largest daily case count set by any state since the beginning of the pandemic, according to NPR .
AdventHealth has about 30 hospitals in the state, and its physicians and sports medicine experts provide support to help racers who are part of runDisney races through Disney theme parks, according to the health system website. The organization has been providing this support for runDisney races for more than 25 years.
AdventHealth also confirmed health system employees are taking temperatures at the gates of the theme parks and the entrances to Disney Springs.
Access Mr. Shaw’s full interview here.
8 health systems with strong finances
Here are eight health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.
1. Baylor Scott & White Health has an “AA-” rating and stable outlook with S&P. The health system has an expansive and growing market position in Texas, healthy operating performance and robust cash flow, S&P said. The health system’s financial cushion positions it well for its COVID-19 response, according to the credit rating agency.
2. South Bend, Ind.-based Beacon Health System has an “AA-” rating and stable outlook with Fitch. Beacon is the acute care leader in its northern Indiana service area and has a track record of strong operating margins, Fitch said. The credit rating agency expects Beacon to return to strong operating margins and sustain strong liquidity, despite pressure from the COVID-19 pandemic.
3. Boston Children’s Hospital has an “Aa2” rating and stable outlook with Moody’s. The hospital has a preeminent reputation as the top children’s hospital in the U.S., robust cash reserves and strong fundraising capabilities, Moody’s said. The credit rating agency expects the hospital’s exceptional market position and robust liquidity to help it return to pre-COVID-19 levels to support proposed increases in leverage and capital investments.
4. Carle Foundation, a three-hospital system based in Urbana, Ill., has an “AA-” rating and stable outlook with Fitch. The health system has a very strong financial profile, and Fitch expects it to sustain profitable operating margins after managing through the pandemic.
5. Salt Lake City-based Intermountain Healthcare has an “AA+” rating and stable outlook with Fitch and an “Aa1” rating and stable outlook with Moody’s. The health system has a leading market position, low debt levels and strong absolute and relative cash levels, Moody’s said. The credit rating agency expects Intermountain will be able to substantially return to and sustain pre-COVID-19 volume levels and margins.
6. Oakland, Calif.-based Kaiser Permanente has an “AA-” rating and stable outlook with Fitch. The rating agency said Kaiser has a leading market share in California and other key markets, and its operational profile is arguably the most emulated model of healthcare delivery in the nation.
7. New York City-based Memorial Sloan Kettering Cancer Center has an “AA-” rating and stable outlook with S&P. The hospital has robust fundraising capabilities, an advantageous payer mix and has expanded its ambulatory footprint, providing additional revenue diversity, S&P said.
8. Tacoma, Wash.-based MultiCare Health System has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with Fitch.. The 10-hospital system has an extensive footprint, a track record of successfully executing on multiple projects and strategic ventures concurrently and good financial management, Moody’s said. The credit rating agency expects MultiCare to return to stronger operating results after recovering from disruptions related to the COVID-19 pandemic.
Trump admin seeks relaxed grandfathered ACA health plan rules that up out-of-pocket costs
Dive Brief:
- The Trump administration proposed a rule Friday to allow some group health plans grandfathered under the Affordable Care Act to raise out-of-pocket costs for enrollees but still allow them to have health savings accounts. Such plans must not discriminate against enrollees with pre-existing conditions, but are exempt from many other ACA regulations. If they violate any rules regarding costs or structure they lose their grandfathered status and are required to follow all the mandates of the landmark 2010 law.
- The proposed rule, issued by the U.S. Department of Labor, would relax some of the complex inflation and pricing calculations grandfathered plans must follow. The department admitted that the change could lead to higher deductibles and other out-of-pocket costs for the estimated 23.1 million enrollees in such grandfathered plans.
- The rule stems from a 2017 executive order issued by President Donald Trump that allows regulatory changes to be made in response to perceived economic burdens imposed by the ACA. However, the Labor Department conceded in its Federal Register publication of the proposed rule that the current rules for grandfathered health plans probably weren’t that burdensome.
Dive Insight:
The administration has made no secret of its ire for the ACA and is actively trying to overturn it at the U.S. Supreme Court. A release explaining the changes notes fixed cost-sharing for high-deductible health plans would be raised, and “an alternative method of measuring permitted increases in fixed-amount cost sharing” has been introduced that “would allow plans and issuers to better account for changes in the costs of health coverage over time.”
The formal 76-page proposal, published in the Federal Register on Sunday, said premiums might go down as a result of the changes, but there were no estimates provided or circumstances where that might occur.
Moreover, the proposed rule also noted that the change could lead to more people foregoing healthcare because their out-of-pocket costs might become unaffordable.
The Labor Department also noted that there have been so few fluctuations in the state of grandfathered health plans in recent years that it was likely the current regulations were not overly burdensome in the first place.
Public comments will be solicited until mid-August before a final rule is issued.
Sen. Patty Murray, D-Wash., and ranking member of the Senate Health, Education, Labor, and Pensions Committee, wasted little time late last week blasting the proposal.
“Regardless of what the president wants to believe, we’re in the middle of a pandemic that is devastating families’ health and finances,” Murray said in a statement.
Pandemic spurs national union activity among hospital workers
https://www.healthcaredive.com/news/coronavirus-spurs-healthcare-union-activity/581397/
When COVID-19 cases swelled in New York and other northern states this spring, Erik Andrews, a rapid response nurse at Riverside Community Hospital in southern California, thought his hospital should have enough time to prepare for the worst.
Instead, he said his hospital faced staffing cuts and a lack of adequate personal protective equipment that led around 600 of its nurses to strike for 10 days starting in late June, just before negotiating a new contract with the hospital and its owner, Nashville-based HCA Healthcare.
“To feel like you were just put out there on the front lines with as minimal support necessary was incredibly disheartening,” Andrews said. Two employees at RCH have died from COVID-19, according to SEIU Local 121RN, the union representing them.
A spokesperson for HCA told Healthcare Dive the “strike has very little to do with the best interest of their members and everything to do with contract negotiations.”
Across the country, the pandemic is exacerbating labor tensions with nurses and other healthcare workers, leading to a string of disputes around what health systems are doing to keep front-line staff safe. The workers’ main concerns are adequate staffing and PPE. Ongoing or upcoming contract negotiations could boost their leverage.
But many of the systems that employ these workers are themselves stressed in a number of ways, above all financially, after months of delayed elective procedures and depleted volumes. Many have instituted furloughs and layoffs or other workforce reduction measures.
Striking a balance between doing union action at hospitals and continuing care for patients could be an ongoing challenge, Patricia Campos-Medina, co-director of New York State AFL-CIO/Cornell Union Leadership Institute.
“The nurses association has been very active since the beginning of the crisis, demanding PPE and doing internal activities in their hospitals demanding proper procedures,” Campos-Medina said. “They are front-line workers, so they have to be thoughtful in how they continue to provide care but also protect themselves and their patients.”
At Prime Healthcare’s Encino Hospital Medical Center, just outside Los Angeles, medical staff voted to unionize July 5, a week after the hospital laid off about half of its staff, including its entire clinical lab team, according to SEIU Local 121RN, which now represents those workers.
One of the first things the newly formed union will fight is “the unjust layoffs of their colleagues,” it said in a statement.
A Prime Healthcare spokesperson told Healthcare Dive 25 positions were cut. “These Encino positions were not part of front-line care and involved departments such as HR, food services, and lab services,” the system said.
Hospital service workers elsewhere who already have bargaining rights are also bringing attention to what they deem as staffing and safety issues.
In Chicago, workers at Loretto Hospital voted to authorize a strike Thursday. Those workers include patient care technicians, emergency room technicians, mental health staff and dietary and housekeeping staff, according to SEIU Healthcare Illinois, the union that represents them. They’ve been bargaining with hospital management for a new contract since December and plan to go on strike July 20.
Loretto Hospital is a safety-net facility, catering primarily to “Black and Brown West Side communities plagued with disproportionate numbers of COVID illnesses and deaths in recent months,” the union said.
The “Strike For Black Lives” is in response to “management’s failure to bargain in good faith on critical issues impacting the safety and well-being of both workers and patients — including poverty level wages and short staffing,” according to the union.
A Loretto spokesperson told Healthcare Dive the system is hopeful that continuing negotiations will bring an agreement, though it’s “planning as if a strike is eminent and considering the best options to continue to provide healthcare services to our community.”
Meanwhile in Joliet, Illinois, more than 700 nurses at Amita St. Joseph Medical Center went on strike July 4.
The Illinois Nurses Association which represents Amita nurses, cited ongoing concerns about staff and patient safety during the pandemic, namely adequate PPE, nurse-to-patient ratios and sick pay, they want addressed in the next contract. They are currently bargaining for a new one, and said negotiations stalled. The duration of the strike is still unclear.
However, a hospital spokesperson told Healthcare Dive, “Negotiations have been ongoing with proposals and counter proposals exchanged.”
The hospital’s most recent proposal “was not accepted, but negotiations will continue,” the system said.
INA is also upset with Amita’s recruitment of out-of-state nurses to replace striking ones during the COVID-19 pandemic.
It sent a letter to the Illinois Department of Financial and Professional Regulation, asserting the hospital used “emergency permits that are intended only for responding to the pandemic for purposes of aiding the hospital in a labor dispute.”
White House goes public with attacks on Fauci
Tensions between the White House and Anthony Fauci, the government’s top infectious diseases expert, are spilling into the open as officials openly attack the doctor for his public health advice during the coronavirus pandemic.
Fauci’s advice has often run contrary to President Trump’s views, and the attacks on Fauci have begun to look like a traditional negative political campaign against an opponent. Yet this time, the opponent is a public health expert and career civil servant working within the administration.
Dan Scavino, deputy chief of staff for communications, shared a cartoon on his Facebook page late Sunday that depicted Fauci as a faucet flushing the U.S. economy down the drain with overzealous health guidance to slow the spread of the pandemic.
The cartoon, which shows Fauci declaring schools should remain closed and calling for “indefinite lockdowns,” did not accurately portray what Fauci has advised in public.
Adm. Brett Giroir, the administration’s testing czar, downplayed any riff within the White House coronavirus task force before offering some criticism of Fauci.
“I respect Dr. Fauci a lot, but Dr. Fauci is not 100 percent right and he also doesn’t necessarily, and he admits that, have the whole national interest in mind,” Giroir told “Meet the Press” on Sunday. “He looks at it from a very narrow public health point of view.”
There have been tensions between Trump and Fauci throughout the pandemic. The president has repeatedly downplayed the severity of the virus, broken with the advice of his own public health experts and painted rosy but at times misleading pictures of the U.S. response. Fauci, who has served four decades in his current post, has offered blunt talk on the dangers of the pandemic that has directly contradicted the president from time to time.
But the latest criticisms mark a shift as the White House has begun publicly undermining one of the leading public health voices in the administration at a time when multiple states are struggling to get new outbreaks under control.
White House trade adviser Peter Navarro, whom the president tapped to manage the use of the Defense Production Act, said he personally proceeds with caution before heeding Fauci’s advice.
Trump said last week that Fauci is a nice man but that he’s “made a lot of mistakes.”
A White House official this weekend sent media outlets a lengthy list of “mistakes” Fauci has made since the pandemic began, like his comment in March that there is no need for people to wear masks.
That comment came before scientists knew people could spread the virus without showing symptoms, and Fauci, the Centers for Disease Control and Prevention (CDC) and other experts now urge people to use face coverings in public.
Public health experts have leaped to Fauci’s defense on Twitter, noting that Fauci is one of the most respected health experts in the world, having worked for six presidents and researched HIV/AIDS, Ebola, Zika and a variety of other infectious diseases.
“When studies show that, opposite from SARS & MERS, COVID19 is most infectious soon after infection & less infectious later, we recognize asymptomatic transmission and importance of masks,” tweeted Tom Frieden, the former director of the CDC.
“That’s called science, not a mistake. The real, deadly mistake is not listening to science.”
Ashish Jha, director of the Harvard Global Health Institute, tweeted, “His track record isn’t perfect. It’s just better than anyone else I know. Sidelining Dr. Fauci makes the federal response worse. And it’s the American people who suffer.”
Polls still show the public trusts Fauci more than Trump for accurate information on the virus, with Democrats more likely than Republicans to believe the infectious diseases expert.
White House press secretary Kayleigh McEnany during a “Fox & Friends” interview Monday insisted Fauci’s recommendations were reaching Trump, while saying he represented only “one viewpoint” among many considered by the president.
“The point of the task force is to be a whole of government look at what is best for this country,” McEnany said when asked about the status of the relationship between Trump and Fauci. “Dr. Fauci is one member of a team, but rest assured, his viewpoint is represented and the information gets to the president through the task force.”
Still, Fauci’s public appearances became few and far between as his dire warnings about the state of the pandemic in the U.S. increasingly clashed from more hopeful messages coming from the White House.
Fauci also told the Financial Times last week that he hadn’t briefed Trump in two months, in which time a growing number of states have experienced significant surges in cases.
Fauci was not present at the White House coronavirus task force media briefing last week, events that have become rarer even as the COVID crisis grows worse.
And while he was a regular on cable news in the early days of the pandemic, his appearances have dwindled, a fact he said last week could be because of his “honesty.”
While Fauci has warned that the U.S. could hit 100,000 new COVID-19 cases per day if steps aren’t taken to alter the trajectory of the outbreaks, Trump has tied the rise in cases to increased testing.
While Fauci attributed outbreaks in some states to reopening too quickly after the spring lockdowns, Trump and his top allies have mostly stood by their decision to push governors to jump over checkpoints set by the White House.
Fauci has refuted the president’s claims that the rise in cases is solely tied to increased testing and that 99 percent of cases are “totally harmless.”
And as Trump touted a falling COVID-19 death rate, which is actually now increasing, Fauci has said the U.S. shouldn’t take comfort in the “false narrative,” noting the disease can cause other severe health outcomes.
Fauci’s warnings grew more urgent last week when he warned that the U.S. is “facing a serious problem” and the pandemic has become politicized.
“And you know from experience historically that when you don’t have unanimity in an approach to something, you’re not as effective in how you handle it,” Fauci said in an interview with FiveThirtyEight. “So I think you’d have to make the assumption that if there wasn’t such divisiveness, that we would have a more coordinated approach.”
Democrats align around a health policy platform
https://mailchi.mp/86e2f0f0290d/the-weekly-gist-july-10-2020?e=d1e747d2d8
Promising that “we are going to at last build the health care system the American people have always deserved”, a joint task force of health policy advisors from the Biden and Sanders campaigns this week released a unified set of proposals that will serve as part of the former Vice President’s campaign platform for the November election.
While the document does not include Sanders’ signature “Medicare for All” proposal, it does support a government-run public insurance option that would be available to all Americans, at income-adjusted, subsidized rates—including free coverage for those with low incomes. It also promises to expand Medicare benefits to include dental, vision, and hearing coverage, and to extend Medicare eligibility to those age 60 and above.
For those who lose their health coverage due to the COVID pandemic, the unity document endorses having the government pick up the tab for COBRA benefits and shifting enrollees into premium-free coverage on the Obamacare exchanges when their COBRA eligibility expires.
It also promises greater investment in public health resources, including increased funding for the CDC, and funding to recruit 100,000 contact tracers nationwide.
Other key components of the proposal include eliminating “surprise billing”, reducing drug costs, addressing racial and gender-based health inequities, and bolstering investment in scientific research.
This week’s document represents an important step in unifying the progressive and moderate wings of the Democratic party around key health policy principles. Should Biden win in November, and if Democrats gain control of the Senate, we’d expect quick action on many of these proposals.
Clearly the most difficult would be the public option and Medicare expansion, which would require lengthy negotiation with various industry groups to garner sufficient political support. Similar to the 2009 process that led to the Affordable Care Act, we would likely see a year’s worth of political horse-trading, leading to passage of some compromise legislation before the midterm elections in 2022.
All of that in the midst of an ongoing pandemic and likely prolonged economic downturn—both of which will probably allow for the passage of more far-reaching legislation than might otherwise be possible.
Consumer confidence declines as COVID surges
https://mailchi.mp/86e2f0f0290d/the-weekly-gist-july-10-2020?e=d1e747d2d8
Just as consumer confidence was approaching pre-COVID levels in early June, cases began surging in many parts of the country. The graphic below shares highlights from a recent Morning Consult poll, which found reduced consumer confidence in participating in a range of activities, like dining out or going to a mall.
The poll also showed a significant consumer divide based on political affiliation, with Republicans’ confidence levels for many activities being twice that of Democrats. It remains to be seen whether the current surge will result in consumers pulling back on healthcare utilization the way they are beginning to for other activities.
A coalition of healthcare organizations is urging consumers to continue social distancing but “stop medical distancing”—in hopes that the new surge will not lead patients to avoid needed medical care. While cell tower data at thousands of hospital facilities suggest volumes may be stalling again, we anxiously await the latest national data on outpatient visit and elective procedure volumes.
We’d predict the surge will exacerbate consumer discomfort with “waiting” in healthcare settings—urgent care clinics, emergency departments and the like—though we’d expect the reduction in utilization to be less severe and more regionally varied this time around.
Let us know what you’re seeing!
HENRY KOTULA 