Monkeypox is in the US. Here’s what you need to know.

Amid an international string of cases, a Massachusetts man has been infected with the first case of monkeypox in the United States this year. And while the virus isn’t likely to cause a pandemic like Covid-19, experts say the outbreak is still concerning.

What is monkeypox?

Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization (WHO).

People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.

According to WHO, “There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.”

Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes, The Hill reports. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.

Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.

Monkeypox cases pop up around the world

On Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada.

According to MDPH, “The case poses no risk to the public, and the individual is hospitalized and in good condition.”

MDPH said it’s “working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus.”

Generally, monkeypox cases are very rare in the United States, however two cases were reported in the United States last year—one in Texas and one in Maryland.

Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.

British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contract.

What experts are saying

According to Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, the monkeypox virus isn’t likely to follow a similar path to Covid-19.

“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease—and we should take it seriously,” he said.

Still, experts said they are concerned by the monkeypox outbreaks. Typically, monkeypox doesn’t spread easily between humans, but the fact that multiple cases are emerging in different countries at the same time is concerning, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual happening here,” he said.

“The fact that it’s in the U.K. in multiple unrelated clusters, plus Spain, plus Portugal, is a surprise,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

According to Mateo Prochazka, an epidemiologist at the U.K. Health Security Agency, the fact that the virus appears to be spreading through sexual contact is especially strange.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” he said. “This is a novel route of transmission that will have implications for outbreak response and control.”

While experts aren’t worried about the virus being a global threat as of now, Jay Hooper, a monkeypox expert from the U.S. Army Medical Research Institute of Infectious Diseases, noted that “[e]very time there’s an outbreak—and the more people get infected—the more chances monkeypox has to adapt to people.”

“With viruses that spill over from animals, you just never know what’s going to happen,” he added.

Hospitals performed 100,000 unnecessary surgeries in the first year of COVID-19, Lown Institute says

https://www.fiercehealthcare.com/providers/hospitals-performed-100000-surgeries-elderly-2020-lown-institute

U.S. hospitals performed more than 100,000 surgeries on older patients during the first year of the pandemic, according to a new Lown Institute analysis. 

The healthcare think tank relied on Medicare claims data and analyzed eight common low-value procedures. It called the 100,000 procedures unnecessary and potentially harmful in a press release. It found that between March and December 2020, among the most-performed surgeries were coronary stents and back surgeries. 

The procedures either offered little to no clinical benefit, according to the institute, or were more likely to harm patients than help them. 

“You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures,” Vikas Saini, M.D., president of the Lown Institute, said in a statement. “The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”
 
Here is the volume of each procedure analyzed, for a total of 106,474 procedures identified:

1. Stents for stable coronary disease: 45,176
2. Vertebroplasty for osteoporosis: 16,553
3. Hysterectomy for benign disease: 14,455
4. Spinal fusion for back pain: 13,541
5. Inferior vena cava filter: 9,595
6. Carotid endarterectomy: 3,667
7. Renal stent: 1,891
8. Knee arthroscopy: 1,596

Among the “U.S. News & World Report” 20 top-ranked hospitals, all had rates of coronary stent procedures above the national average in what the Lown Institute called “overuse.” Four had at least double the national average, including the Cleveland Clinic, Houston Methodist Hospital, Mt. Sinai and Barnes Jewish Hospital. The procedures and overuse criteria were based on previous Lown research.

“We’ve known for over a decade that we shouldn’t be putting so many stents into patients with stable coronary disease, but we do it anyway,” Saini said. “As a cardiologist, it’s frustrating to see this behavior continue at such high levels, especially during the pandemic.”

In response to the Lown analysis, the American Hospital Association said in a statement Tuesday that delays or cancelations in non-emergency care may have negative outcomes on patients. “Lown may define these services as ‘low value,‘ but they can be of tremendous value to the patients who receive them,” the statement read.

It also pointed to its response to last year’s Lown analysis, which it criticized as being based “on data that are not only incomplete, but also not current.” The organization argued the services surveyed only represent a portion of the care hospitals provide. It added that procedures are determined by physicians based on an evaluation of the patient’s medical needs. 

Relief funding helped hospitals stay in the green during COVID-19’s initial barrage, study finds

https://www.fiercehealthcare.com/providers/relief-funding-helped-hospitals-stay-green-during-covid-19s-initial-barrage-researchers

Despite substantial operating margin declines during the first year of COVID-19, U.S. hospitals were able to keep their finances on track thanks to billions in government relief funds, Johns Hopkins researchers wrote in a new study published Friday in JAMA Health Forum.

Per their analysis of Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports data, researchers found that thousands of hospitals broadly maintained their overall profit margins thanks to a boost in “other nonoperating income,” the category under which hospitals recorded the collective $175 billion in subsidies Congress allocated to support healthcare facilities and clinicians.

This was particularly the case for government, rural and smaller hospitals that typically run on tighter margins, the researchers wrote. Because they, by design, received more targeted relief than other types of hospitals, these facilities were able to record higher overall profit margins in 2020 than in prior years.

“Hospital operations were really hit hard during the pandemic,” Ge Bai, professor in the Bloomberg School’s Department of Health Policy and Management, a professor of accounting at the Johns Hopkins Carey Business School and an author of the study, said in a statement.

“Our study shows that the relief funds provided an important lifeline to keep financially weak hospitals up and running.”

Among the study’s sample of 1,378 hospitals, mean operating margin declined from –1.0% in 2019 to –7.4% in 2020, representing the hit facilities took to their operations prior to the relief funding.

Those hospitals’ mean overall profit margin during the first year of the pandemic was 6.7%, which the researchers wrote was stable in light of the preceding four years and across all ownership types, geographic locations and hospital sizes.

The difference-maker, they wrote, was an increase in other nonoperating income as a share of a hospital’s total revenue. While that mean share was 4.4% in 2019, it jumped to 10.3% in 2020 thanks to the government relief funds.

Additionally, certain types of hospitals with traditionally lower overall profit margins saw significant improvements in 2020. These included government hospitals (3.7% to 7.2%), rural hospitals (1.9% to 7.5%) and hospitals with fewer admissions (3.5% to 6.7%).  

“Hospitals that tend to serve socioeconomically disadvantaged patients and more who are uninsured are the most vulnerable to financial losses,” Yang Wang, a doctoral student in the Bloomberg School’s Department of Health Policy and Management and the study’s first author, said in a statement. “But the extra federal funding helped them stay operational.”

The researchers’ study included hospitals with fiscal years beginning in January whose financial data were compiled and processed as part of RAND Hospital Data, which in turn pulls its data from CMS’ Medicare Cost Reports. The findings persisted among a second sample of 785 hospitals from the database with fiscal years beginning in July.

The government’s distribution of COVID-19 relief funds to providers has faced some critique from healthcare policy researchers, some of whom suggested that the methodology led to funding skewed toward hospitals serving well-insured communities.

Much of the relief set aside for hospitals has since run dry or is on its last legs as of early 2022. With COVID hospitalizations again ticking upward and earlier surges still unaccounted for, industry groups and the Biden administration alike are pushing Congress for more relief support.

RWJBarnabas Health, Saint Peter’s integration deal wins NJ approval, awaits FTC signoff

https://www.fiercehealthcare.com/providers/rwjbarnabas-health-saint-peters-integration-deal-wins-nj-approval-awaits-ftc-sign

RWJBarnabas Health (RWJBH) and Saint Peter’s Healthcare System’s proposed integration has received the blessing of New Jersey regulators, a key step forward as the systems look to form what they describe as the state’s “first premier academic medical center,” according to a Monday announcement.

The organizations are now awaiting a final approval from the Federal Trade Commission (FTC) before moving ahead with the deal.

“State approval now puts us on the cusp of being able to create New Jersey’s first multi-campus premier academic medical center that will draw top talent, increased research funding and more opportunities for groundbreaking clinical trials, while also enhancing specialized services and improving overall patient care,” Saint Peter’s President and CEO Leslie Hirsch said in a statement.

“New Jersey deserves to have a premier academic medical center of national distinction like many other states that will serve as a destination for patients from all walks of life to get lifesaving treatment for complex illnesses and as an anchor for medical innovation, educational opportunity and economic development,” Hirsch said.

The two health systems had signed a definitive agreement declaring their “intention to integrate” in late 2020.

The organizations said that in addition to increasing services and strengthening patient access, the premier academic medical center’s location in New Brunswick, New Jersey, would play a role in attracting more academic talent and research to nearby Rutgers University.

The systems’ announcement also cited affirmation from Superior Court Judge Lisa Vignuolo, who said when authorizing the transaction that the deal “will serve in the public interest and the public good.”

RWJBH is the larger of the pair, providing care to more than 3 million patients annually across 11 hospitals, four children’s hospitals and dozens of other centers. It’s already the largest academic health system in New Jersey thanks to a collaboration with Rutgers Robert Wood Johnson Medical Schools to train over 1,000 medical residents and interns across RWJBH hospitals yearly.

Formed in 2007, Saint Peter’s Healthcare System is a Catholic organization headlined by the 478-bed Saint Peter’s University Hospital in New Brunswick. It also operates a children’s hospital, primary and specialty care networks and a surgical center.

Under the previously announced terms of the agreement, Saint Peter’s would remain a full-service acute healthcare provider in New Jersey and continue to adhere to its Catholic healthcare mission. RWJBH would make significant strategic capital investments in St. Peter’s facilities, technology and innovation.

“This is a tremendous milestone in a years-long journey towards fulfilling our shared vision to bring transformative care to New Jersey,” RWJBH CEO Barry Ostrowsky said in a statement.

The beginning of the year already saw RWJBH officially acquire Trinitas Regional Medical Center, an Elizabeth, New Jersey-based Catholic teaching medical center.

Regulators’ green light for RWJBH’s moves contrasts with the recent opposition to Hackensack Meridian Health and Englewood Health’s now-nixed merger plans. The FTC and half of the country’s state attorneys general fought the proposal due to concerns that it would remove competition and harm residents in New Jersey’s Bergen County.

RAND: Private plans paid hospitals 224% more than Medicare rates

https://www.fiercehealthcare.com/payers/rand-study-finds-private-plans-paid-hospitals-224-more-compared-medicare-rates

Private insurance plans paid hospitals on average 224% more compared with Medicare rates for both inpatient and outpatient services in 2020, a new study found. 

Researchers at RAND Corporation looked at data from 4,000 hospitals in 49 states from 2018 to 2020. While the 224% increase in rates is high, it is a slight reduction from the 247% reported in 2018 in the last study RAND performed. 

“This reduction is a result of a substantial increase in the volume of claims in the analysis from states with prices below the previous average price,” the study said. 

The report showed that plans in certain states wound up paying hospitals more than others. It found that Florida, West Virginia and South Carolina had prices that were at or even higher than 310% of Medicare

But other states like Hawaii, Arkansas and Washington paid less than 175% of Medicare rates. 

“Employers can use this report to become better-informed purchasers of health benefits,” study lead author Christopher Waley said in a statement. “The work also highlights the levels and variation in hospital prices paid by employers and private insurers, and thus may help policymakers who may be looking for strategies to curb healthcare spending.”

The data come as the federal government has explored ways to lower healthcare costs, including going toe-to-toe with the hospital industry. The Centers for Medicare & Medicaid Services (CMS) has in recent years sought to cut payments to off-campus outpatient clinics in order to bring Medicare payments in line with payments paid to physicians’ offices but has met with stiff legal and lobbying opposition from the hospital industry that argues the extra payments are needed.

CMS has also published regulations that call on hospitals to increase transparency of prices, including a rule that mandates hospitals publish online the prices for roughly 300 shoppable services.

The hospital industry pushed back against RAND’s findings, arguing that the study is based on incomplete data. The industry group American Hospital Association said researchers only looked at 2.2% of overall hospital spending, a small portion of overall expenses.

“Researchers should expect variation in the cost of delivering services across the wide range of U.S. hospitals – from rural critical access hospitals to large academic medical centers,” said AHA CEO Rick Pollack in a statement to Fierce Healthcare. “Tellingly, when RAND added more claims as compared to previous versions of this report, the average price for hospital services declined.”

‘We have turned to AI to disrupt the future,’ Michael Dowling says

Hospital systems can employ artificial intelligence to reduce the types of health inequities that have made communities of color more vulnerable to COVID-19, the leader of one of the nation’s largest health systems says.

“At Northwell Health, New York’s largest health system, we know health disparities will only grow worse if we don’t move more quickly to identify and correct them,” Michael Dowling, president and CEO of New Hyde Park-based Northwell Health, wrote in a May 11 news release with Tom Manning, chair of Ascertain, an AI venture between Northwell and Aegis Ventures. “To do that, we have turned to AI to disrupt this future.”

For instance, health systems can utilize AI to forecast which expectant mothers could benefit from early intervention and specialized care to treat preeclampsia, a pregnancy complication characterized by high blood pressure that affects Black women at three times the rate of white women, the executives wrote.

Organizations can also use health screenings and predictive models to determine which patients are most likely to develop chronic health conditions such as obesity, diabetes and hypertension, the men wrote. In addition, systems should diligently research AI health care applications, such as the National Institutes of Health’s All of Us initiative, which seeks to obtain health data from a representative sample of the U.S. population.

Dowling and Manning noted that health systems must also commit to high standards of data integrity outlined by the U.S. Food and Drug Administration and apply the Hippocratic oath to AI to make sure it does not widen health inequities.

NYC Nears High Covid-Alert Level, May Consider Requiring Masks

https://www.bloomberg.com/news/articles/2022-05-16/nyc-may-reach-high-covid-alert-level-consider-requiring-masks

  • City strongly recommends masks in public indoor places for now
  • About 8% of people tested for Covid in city have been positive

New York City is preparing to hit a high Covid-transmission level in the coming days that would have it reconsidering mask requirements in public places.

“If NYC’s Alert Level is raised to High, the City will consider requiring face masks in all public indoor settings,” according to guidance on the city health department’s website.

New cases per 100,000 people over the last seven days surpassed 300 citywide, with Staten Island the highest at 390, followed by Manhattan at about 366. A month ago, the citywide rate was less than 200 per 100,000. About 8% of people tested for Covid-19 over the last seven days have been positive. 

Earlier in May the city moved to a medium alert from low.

“New York City is preparing to potentially enter a high COVID-19 alert level in the coming days and strongly recommends that all New Yorkers mask up in public indoor settings to protect themselves and others,” according to a statement Monday from Mayor Eric Adams’s office.

A high level is reached when new Covid hospital admissions over seven days surpass 10 per 100,000 and the percentage of staffed inpatient beds occupied by Covid-19 patients is greater than 10%, according to guidance from the US Centers for Disease Control and Prevention.

Masks Indoors

New York City’s new admissions are at 9.2 per 100,000 and increasing, while 3.85% of inpatients beds were occupied by Covid-19 patients as of May 10.

Under a high alert level, in addition to masking indoors, New Yorkers are recommended to limit gatherings to small numbers and get tested if they have symptoms, were exposed, traveled or were at a large event. 

The city is distributing 16.5 million at-home Covid tests over the next month in an effort to prepare for another wave. The increase in tests will bring the total amount distributed to more than 36 million.

Most of the US remained at a low Covid community transmission-level as of May 12, with medium and high alerts mostly concentrated in the northeast, CDC data show. The nationwide case rate is 185 per 100,000 in the past seven days, up from 66 a month earlier. The rate surged to more than 1,700 per 100,000 during the omicron surge in January. 

Providence’s operating loss hits $510M in Q1

Citing inflation and labor cost pressures, Renton, Wash.-based Providence recorded an operating loss of $510.16 million in the first quarter of 2022, according to financial documents released May 13. In the same quarter one year prior, Providence posted an operating loss of $221.91 million.

In the quarter ended March 31, the 51-hospital health system saw its operating revenue hit $6.29 billion. In the same quarter one year prior, Providence recorded operating revenue of $6.44 billion. 

Providence’s expenses grew about 2 percent year over year to $6.8 billion. In the comparable quarter in 2021, Providence recorded expenses of $6.67 billion. Providence attributed the expense increase to added costs of agency staff, overtime, retention and wage increases, as well as supply cost boosts. 

Providence also said that excluding from the 2021 comparison the assets of Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. — which split from Providence in January — the health system’s expenses grew 9 percent year over year. 

After factoring in nonoperating items, including investment losses of $359 million and a $3.41 billion disaffiliation cost tied to the Hoag Memorial split, Providence recorded a net loss of $4.25 billion in the first quarter of 2022. 

“With the pandemic, the last two years were challenging for many in healthcare. However, 2022 may be the biggest challenge yet,” Providence CFO Greg Hoffman said. “Rising costs due to inflation and the health care labor crisis are putting significant pressure on major U.S. health systems, some of whom have reported significant operating losses this quarter.”