Cartoon – Sign of the Times
Author Archives: henrykotula
Did the CARES Act rescue hospital margins?
https://mailchi.mp/4c1ddd69e1fc/the-weekly-gist-december-4-2020?e=d1e747d2d8
Despite taking a huge volume hit in Q2, most hospitals have managed to maintain positive operating margins—largely thanks to a $100B cash infusion from the federal government via the Coronavirus Aid, Relief and Economic Security (CARES) Act.
According to Kaufman Hall’s most recent National Hospital Flash Report, based on data from over 900 hospitals of all sizes nationwide, hospitals would have been operating at a significant loss without federal aid. As the graphic above shows, the average hospital operating margin without CARES Act relief funds would have been negative eight percent in April—and would still be in the red as of October, despite much of the cancelled elective business returning across the summer and early fall.
However, with the aid, hospitals operating margins only turned negative in April and May. When compared to the same time period last year, year-to-date (YTD) gross revenue is down almost five percent, though net patient service revenue per discharge is up—the result of longer lengths of stay, the 20 percent Medicare reimbursement bump for COVID-19 patients, and suspension of the two percent sequestration adjustment on Medicare fee-for-service payments. Yet hospital expenses per discharge are also up 13.5 percent, dampening profitability.
Though the CARES Act has been a stopgap solution for the vast majority of hospitals, a handful, most notably HCA Healthcare, have proactively returned the money. While motivations for doing so are varied, we’ve been hearing that the ever-changing reporting and spending requirements associated with CARES Act funding have many hospital leaders concerned about possible future claw-backs.
With COVID-19 hospitalizations now reaching record-breaking highs, potentially forcing another round of shut-downs, and with little movement on another round of federal relief, hospitals may be on their own for the time being—and the greatest hit to health system finances may still be yet to come.
Amid a worsening pandemic, hope
https://mailchi.mp/4c1ddd69e1fc/the-weekly-gist-december-4-2020?e=d1e747d2d8
We are now in uncharted and dangerous new territory in the coronavirus pandemic, with the US recording a record-high 2,800 deaths on Thursday, along with 200,000 new cases—the second highest daily total of the pandemic so far.
More than 100,000 Americans are now hospitalized with COVID-19, occupying more than 10 percent of the nation’s hospital beds, and creating capacity constraints at hospitals around the country. With the impact of Thanksgiving travel—which was the heaviest since March—yet to be seen in the numbers, and with hospitalizations and deaths lagging new case counts by several weeks (as an epidemiological rule of thumb, 1.7 percent of new cases will result in reported deaths from COVID after 22 days), we are almost certainly headed for a grim winter holiday season.
But the light at the end of the tunnel grew brighter this week, with the United Kingdom becoming the first Western country to approve a COVID vaccine. (China and Russia both rolled out vaccines prior to Phase 3 trials being completed.)
Doctors and hospital staff in the UK will begin to administer Pfizer’s vaccine next week, and the US Food and Drug Administration (FDA) is expected to approve the same vaccine for emergency use on or shortly after an outside panel of experts convenes on December 10th.
Moderna, whose vaccine is similar to Pfizer’s, submitted an application for emergency use this week, and it will be evaluated on December 17th.
In the meantime, a group advising the Centers for Disease Control and Prevention (CDC) held a public meeting this week to craft recommendations for which populations should be prioritized to receive the new vaccines, settling on healthcare workers and residents of long-term care facilities as first in line. While state public health officials will make the final decisions about who gets vaccinated, most are expected to follow the CDC’s guidelines. The two priority groups represent about 24M people, most of whom could be immunized by the end of this month if all goes according to plan. The end of the pandemic will not come quickly, or easily, but it will come—we are near the beginning of the end.
Atlanta home healthcare owner gets 5 years in prison for Medicaid fraud
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The owner of an Atlanta-based home healthcare provider was sentenced to five years and three months in prison for defrauding Medicaid out of nearly $1 million, the U.S. Justice Department said Dec. 2.
Diandra Bankhead, owner and operator of Elite Homecare, admitted to submitting thousands of claims for services that were never provided to children in the Georgia Pediatric Program between September 2015 and April 2018. Children who are eligible for services under the program typically suffer from physical and cognitive disabilities.
Ms. Bankhead and Elite Homecare submitted more than 5,400 claims to Georgia Medicaid, receiving $1.2 million in reimbursement. About $1 million was determined to be fraudulent, prosecutors said.
Prosecutors said Ms. Bankhead defrauded Medicaid in several ways, including submitting fraudulent credentialing information to become a Georgia Pediatric Program provider, submitting claims for in-home nursing services provided to families who had not hired Elite and submitting claims in which employees provided more than 24 hours of services in a day.
“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”
Ms. Bankhead pleaded guilty in federal court to one count of healthcare fraud in August 2019. She was also ordered to pay $999,999 in restitution.
Baylor Scott & White to lay off 102 employees, outsource jobs to India
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Dallas-based Baylor Scott & White Health said it will lay off 102 employees in finance and accounting roles as part of an effort to reshape operations and reduce costs, according to The Dallas Morning News.
The duties of the affected workers will be outsourced to a third-party vendor in India. About 18 of the affected Baylor employees will be offered positions with the vendor, according to the report.
A spokesperson for Baylor Scott & White told Becker’s Hospital Review that the system will retain about two-thirds of its corporate finance department.
“Our system is continuously looking for ways to reduce costs and improve our ability to provide affordable and quality healthcare for our patients and members. As part of this, we are transforming the way we deliver our corporate finance services,” the nonprofit health system wrote in a statement obtained by Becker’s.
The cuts follow a larger round of layoffs and furloughs announced in May, which affected about 1,200 employees, or 3 percent of its workforce.
The health system said it is working to be more efficient and intentional in how resources are used. It is working to add front-line caregivers and has more than 2,000 open clinical jobs, a spokesperson told Becker’s.
“We care deeply about all our colleagues and are committed to supporting them through this process,” the statement read.
National Pearl Harbor Remembrance Day
Remembering Pearl Harbor Day
Cartoon – R.E.S.P.E.C.T
Cartoon – Importance of Transparency
Cartoon – Baseless Allegations
HENRY KOTULA 