HCA Healthcare will divest four of its hospitals in Georgia for about $950 million, the Nashville, Tenn.-based hospital system said May 3.
The for-profit provider will sell the four facilities to Piedmont Healthcare, a nonprofit health system based in Atlanta.
The four hospitals are the 310-bed Eastside Medical Center in Snellville; the 119-bed Cartersville Medical Center; and the two-hospital Coliseum Health System, which includes 310-bed Coliseum Medical Centers in Mason and 103-bed Coliseum Northside in Mason. Piedmont will also assume ownership of a behavioral health facility owned by the Coliseum Health System.
HCA said the transaction will provide strategic value as it increases its financial flexibility to invest in its core markets.
The two health systems expect the transaction to close in the third quarter of 2021. It still needs regulatory approvals.
Ascension Technologies, the IT subsidiary of St. Louis-based Ascension, plans to lay off an estimated 651 remote workers this year, according to an April 30 St. Louis Post-Dispatch report.
Ascension Technologies said it will begin working with a third party to take on the tech support for EHR and revenue cycle management responsibilities its employees had been performing, the company said in an April 27 notice it filed with the state.
None of the employees affected by the layoffs are based in Missouri, but all the positions report to an office in St. Louis. Ascension Technologies plans to facilitate the layoffs between Aug. 8 and Dec. 10.
Ascension Technologies employees affected by the layoffs can apply for other positions within the company or with the new vendor. Ascension will also provide severance and outplacement services to employees who are unable to get another job with the company.
The Biden administration is working to stamp out misinformation that might dissuade people from getting coronavirus shots, a crucial task as the nation shifts into the next, more difficult phase of its vaccination campaign.
The White House announced Friday that 100 million Americans are now fully vaccinated against COVID-19, but the nationwide rollout is plateauing as fewer people sign up for shots.
Administration officials and health experts know the difficulty ahead in getting vaccines into as many people as possible, and are trying to eliminate the barriers to doing so.
Authorities need to dispel the legitimate concerns that make people hesitant, while also stopping waves of misinformation.
This past week, top infectious diseases expert Anthony Fauci corrected Joe Rogan, a popular podcast host who himself later acknowledged his lack of medical knowledge, after Rogan said young healthy people don’t need to be vaccinated.
“You’re talking about yourself in a vacuum,” Fauci said of the podcast host. “You’re worried about yourself getting infected and the likelihood that you’re not going to get any symptoms. But you can get infected, and will get infected, if you put yourself at risk.”
White House communications director Kate Bedingfield also joined in the criticism.
“Did Joe Rogan become a medical doctor while we weren’t looking? I’m not sure that taking scientific and medical advice from Joe Rogan is perhaps the most productive way for people to get their information,” she told CNN.
Rogan’s comments were trending on Twitter for two days before he attempted to walk them back.
“I’m not a doctor, I’m a f—ing moron, and I’m a cage fighting commentator … I’m not a respected source of information, even for me,” he said.
Public health experts said Rogan’s comments were irresponsible, and potentially dangerous because they could perpetuate hesitancy.
“You have a responsibility as an adult, you have a responsibility as a community leader, your responsibility as a communicator to get it right,” said Georges Benjamin, executive director of the American Public Health Association.
While Rogan is not a political figure, he has one of the most popular podcasts in the world, and an enormous platform.
Rogan hosts the most popular podcast on Spotify. Rogan said in 2019 that his podcast was being downloaded 190 million times per month.
People are not getting all their information from Rogan, but when his comments clash with what public health experts say, that is problematic.
“It’s not so much that Joe Rogan’s a comedian, he’s very popular with people sort of leaning on the conservative side, especially young people. And that’s the group that we have to reach, especially young men,” said Peter Hotez, a leading coronavirus vaccinologist and dean of Baylor University’s National School of Tropical Medicine.
Hotez, who has appeared on Rogan’s show in the past, said he thinks the host was just misinformed. Hotez said he has reached out, and wants to help Rogan have a more productive discussion about why it’s so important for everyone to be vaccinated against the coronavirus.
Polls show vaccine hesitancy is declining, but the holdouts are not monolithic, and experts believe trusted messengers will be needed.
“I just think they have to speak the facts. You speak the facts, and anytime you discover the facts that are incorrect, you try to correct them,” said Benjamin. “And … I don’t think you demonize the individual, nor do I think you try to pin motive to it, because you don’t know what the motive is.”
Some people are most worried about side effects, some are concerned about the safety of the vaccines and some people don’t think COVID-19 is a problem at all. There are also likely some people who will never be convinced, and try to sow confusion and distrust.
Biden administration officials are aware of the harmful impact of misinformation, but know they are walking a fine line between people who legitimately want more information and those who just want chaos.
“We know that people have questions for multiple reasons. Sometimes because there’s misinformation that they’ve encountered, sometimes because they’ve had a bad experience with the healthcare system and they’re wondering who to trust, and some people have just heard lots of different news as we continue to get updates on the vaccine, and they want to hear from someone they trust,” Surgeon General Vivek Murthy said during a White House briefing.
For the White House, using medical experts like Fauci to correct obvious misinformation is part of the strategy to boost vaccine confidence.
“Our approach is to provide, and flood the zone with accurate information,” White House press secretary Jen Psaki said Friday. “Obviously that includes combating misinformation when it comes across.”
The administration has also invested $3 billion to support local health department programs and community-based organizations intended to increase vaccine access, acceptance and uptake.
Still, experts said different messengers are needed, especially when trying to reach conservatives who may now view Fauci as a polarizing political figure.
“There needs to be a better organized effort by the administration to really understand how to reach groups that are identified in polls as saying they won’t get vaccinated,” Hotez said. “We need to figure out how to do the right kind of outreach with the conservative groups, and we’ve got to do something about” the damage caused by members of the conservative media.
In a recent CBS-YouGov poll, 30 percent of Republicans said they would not get the vaccine and another 19 percent said they only “maybe” would do so.
The underlying mistrust comes after a year in which Trump and his allies played down the severity of a virus that has killed more than half a million Americans already.
A national poll and focus group conducted by GOP pollster Frank Luntz showed Republicans who voted for President Trump will be far more influenced by their doctors and family members than any politician.
To that end, a group of Republican lawmakers who are also physicians released a video urging people to get the COVID-19 vaccine.
The video, led by Sen. Roger Marshall (R-Kan.), features some of the lawmakers wearing white coats with stethoscopes around their necks speaking into the camera.
The trope is currently abuzz in anti-vaccine circles, said Nicole Baldwin, MD, a pediatrician who has been a target of attacks by the anti-vaxxer community.
“It’s amazing, and sad, what people will believe,” Baldwin told MedPage Today.
Essentially, they believe that people who’ve had the vaccine can somehow shed the spike protein, which in turn can cause menstrual cycle irregularities, miscarriages, and sterility in other women just by being in close proximity.
“This is a new low, from the delusional wing of the anti-vaxx cult,” said Zubin Damania, MD, a.k.a. ZDoggMD, in a video he recently posted to bust vaccine shedding myths.
Damania said the misinformation originates from an earlier claim that syncytin, a protein involved in placental formation, bears some structural similarities to the spike protein, and therefore vaccination would interfere with women’s reproductive systems. Many a fact check has shown that vaccines don’t target the protein.
Once injected, the vaccines prompt cells to make the spike protein, but it’s usually cleared in 24 to 48 hours, leaving little opportunity for “shedding,” even if it could occur — which it can’t, Damania emphasized.
Another logical fallacy he pointed out: “Why, then, wouldn’t natural spike protein do the same thing? Wouldn’t you be more scared of natural coronavirus infection? Oh, but it’s ‘natural.'”
Damania noted that there are legitimate questions and research about whether the coronavirus itself and vaccines have an impact on women’s menstrual cycles. Since the beginning of the pandemic, women who’ve had COVID-19 reported changes to their menstrual cycle, and Damania said that researchers are assessing reports of changes to the menstrual cycle following vaccination.
Regarding the potential relationship to vaccination, “we don’t understand, first, if it’s true, and if it were true, what is the mechanism?” he said. “Anything that causes stress, inflammation, and an immune response may have an effect on the menstrual cycle. … Could it be that the vaccine causes a temporary change in menses? Sure, it’s possible, and it’s being looked at.”
Leila Centner, co-founder and CEO of Centner Academy, the Miami school that has banned vaccinated employees, told NBC News in a statement that “tens of thousands of women all over the world” have reported reproductive issues from being around someone who has been vaccinated.
Baldwin pointed out an Instagram video, now marked as misinformation, in which a nurse, Maureen McDonnell, RN, and a physician, Lawrence Palevsky, MD, discuss the effect of vaccines on women’s menstrual cycles.
“This isn’t just a trivial thing,” Damania said. “It’s quite harmful.”
We’ve closely tracked Colorado’s pursuit of its own public option insurance plan, which seems now to have reached a compromise that will allow a bill to move forward, according to reporting from Colorado Public Radio. The saga began two years ago when state legislators passed a law requiring Democratic Governor Jared Polis’ administration to develop a public option proposal. Amid the pandemic and broad industry opposition, progress stalled last year on the proposal. Lawmakers picked up the proposal this session, and have made progress on a compromise bill now poised to pass the state’s Democratic legislature.
Unlike the earlier version, the new legislation would not lay the groundwork for a government-run insurance option, but rather would force insurers to offer a plan in which the benefits and premiums are defined and regulated by the state. The bill would also allow the state to regulate how much hospitals and doctors are paid.
In the current version,hospital reimbursement is set at a minimum of 155 percent of Medicare rates, and premiums are expected to be 18 percent lower than the current average. While state Republicans and some progressive Democrats are still opposed, the Colorado Hospital Association and State Association of Health Plans are neutral on the bill, largely eliminating industry opposition.
The role hospitals played in fighting the pandemic surely paved the way toward the compromise bill, which is viewed as much more friendly to providers than the previous proposal.With the Biden administration unlikely to pursue Medicare expansion or a national public option, we expect more Democratic-run states to pursue these sorts of state-level efforts to expand coverage.
In the wake of the pandemic, providers are well-positioned to negotiate—and should use the goodwill they’ve generated to explore more favorable terms, rather than resorting to their usual knee-jerk opposition to these kinds of proposals.
A recently retired health system CEO pointed us to a working paper from the National Bureau of Economic Research, which indicates that leading an organization through an industry downturn takes a year and a half off a CEO’s lifespan.
It’s not surprising, he said, thatgiven the stress of the past year, we will face a big wave of retirements of tenured health system CEOs as their organizations exit the COVID crisis. Part of the turnover is generational, with many Baby Boomers nearing retirement age, and some having delayed their exits to mitigate disruption during the pandemic.
As they look toward the next few years and decide when to exit, many are also contemplating their legacies. One shared, “COVID was enormously challenging, but we are coming out of it with great pride, and a sense of accomplishment that we did things we never thought possible.
Do I want to leave on that note, or after three more years of cost cutting?” All agreed that a different skill set will be required for the next generation of leaders. The next-generation CEOs must build diverse teams capable of succeeding in a disruptive marketplace, and think differently about the role of the health system.
“I’m glad I’m retiring soon,” one executive noted. “I’m not sure I have the experience to face what’s coming. You won’t succeed by just being better at running the old playbook.” Compelling candidates exist in many systems, and assessing who performed best under the “stress test” of COVID should prove a helpful way to identify them.
The American public’s attitude toward COVID-19 vaccination has evolved rapidly since the end of last year. The share of adults who report they have either already been vaccinated or intend to get the vaccine as soon as possible continues to rise (currently about 62 percent), while the share who say they will “wait and see” continues to shrink (now 17 percent). Importantly, however, the share who say they will either “definitely not” get vaccinated or only do so “if required” (currently 20 percent) has remained stubbornly consistent since December.
As the US reaches a vaccine tipping point, with more COVID vaccines available than people willing to be vaccinated, it will be important to understand this vaccine-hesitant population more clearly. A recent consumer segmentation analysis found that this group falls into four major behavioral profiles, shown on the right side of the graphic above.
The next phase of vaccine rollout must specifically address the key concerns of individuals in each of these different segments. For example, the “watchful” group, the easiest to persuade, will likely respond to a more transparent vaccination process and the amplification of positive vaccination testimonials. On the other hand, “system distrusters,” generally comprised of younger, lower-income minorities, would benefit most from hearing community leaders discuss vaccine safety. Unfortunately, the largest segment of vaccine-hesitant Americans, the “misinformation believers”, will also be the most difficult to turn. These individuals are more likely to hold rigid, politically driven beliefs.
While countering misinformation by leveraging trusted influencers may help convince some, this group may be the hardest to persuade—although their participation will be crucial to hitting any goal of “herd immunity” by this fall.
The Centers for Medicare & Medicaid Services (CMS) released its 2022 Inpatient Prospective Payment System (IPPS) proposed rule this week. Overall, the rule brings good news for hospitals: Medicare reimbursement rates are slated to increase by 2.8 percent,resulting in a $2.5B payment boost to the industry.
In another win, hospitals will no longer be required to disclose their contract terms with Medicare Advantage (MA) insurers. Hospitals had previously been mandated by the 2021 rule to report median, payer-specific, negotiated charges for MA insurers on their Medicare cost reports. Medicare’s goal was to use this data to create a new, market-based, inpatient reimbursement methodology—an effort which has also been tabled, at least for now.
Led by the American Hospital Association, hospitals have been embroiled in lengthy legal challenges over a variety of CMS price transparency requirements, maintaining they are neither beneficial for consumers, nor helpful in lowering healthcare costs.
It’s too early to tell whether this step back from price transparency, which was a key goal of the Trump administration, signals anything about the Biden administration’s priorities; it’s possible CMS may just be slowing down the effort in the wake of the pandemic.
Other highlights of the proposed rule includefunding 1,000 more residency slots over the next five years, and extending payments for COVID-19 treatments to the end of 2022, as CMS expects COVID patients will need care beyond the duration of public health emergency. The agency also proposed several changes to its readmissions and other value-based purchasing programs, to ensure hospitals aren’t penalized by COVID-related impacts on quality measures.
Comments on the proposed rule are due by June 28th.
In his first address to a joint session of Congress, delivered on the eve of his 100th day in office, President Biden laid out his vision for two major legislative proposals to follow the $1.9T stimulus package he signed into law last month.
The first, described as an “infrastructure” bill, focuses largely on investing in transportation-related improvements, building projects, and “green” upgrades to the nation’s energy grid, along with a $400B investment in home-based care for the elderly and people with disabilities—which amounts to over 17 percent of the package’s $2.3T price tag.
The second, which he unveiled in Wednesday’s speech, is a $1.8T “families” bill, is largely aimed at expanding childcare subsidies, early childhood education, paid family and medical leave, and educational investments. Included in that package is $200B to extend the temporary subsidies—approved as part of last month’s stimulus law—for those seeking health insurance coverage on the individual marketplaces created by the Affordable Care Act (ACA).
Notably absent from either proposal were two categories of healthcare reform that received much focus and airtime during last year’s election campaign: reducing the cost of prescription drugs and lowering the eligibility age for Medicare to 60 or below. Given the closely divided makeup of the new Congress, and the relatively moderate position staked out by the Biden administration on healthcare issues (with a bias toward bolstering the ACA rather than pursuing sweeping changes), we’re not surprised to see the Medicare expansion go unmentioned.
But the bipartisan popularity of lowering prescription drug costs seems like a missed opportunity for Biden, who encouraged the Congress to return to it separately, later in the year. We’ll see. For now, with even some Democrats expressing concern about the $4.1T price tag of Biden’s proposals, we would be surprised if all $600B of the healthcare-related spending makes it to the final legislation. In particular, our guess is that some portion of the home-care spending will get traded away in favor of other components of the package. Expect negotiations to be intense.
HENRY KOTULA 