Author Archives: henrykotula

Where Europe’s Second Wave Is Filling Up Hospitals

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Treatment, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing • Leave a comment

Poland has turned its largest stadium into an emergency field hospital. The numbers of Covid-19 patients in Belgium and Britain have doubled in two weeks. And doctors and nurses in the Czech Republic are falling ill at an alarming rate.

As new cases of the virus began to increase again across Europe last month, hospitals were initially spared the mass influx of patients they weathered earlier this spring. Some suggested that the virus had become less deadly, or that older, more vulnerable people would be shielded.

But a second wave of serious illness is here, new data released on Thursday shows, making it clear that the pandemic is still dangerous and that adherence to control measures over the next few weeks will be crucial in preventing hospitals from becoming overrun for a second time this year.

The number of Covid-19 patients in hospitals across the continent is still less than half of the peak in March and April, but it is rising steadily each week, according to data from the European Centre for Disease Prevention and Control. People across much of Europe — including larger countries like France, Italy, Poland and Spain — are now more likely to be hospitalized with Covid-19 than those in the United States.

Bruno Ciancio, the head of disease surveillance at the center, said he was concerned that some of the worst-hit countries now — including the Czech Republic, Poland and Bulgaria — were not as affected this spring, and may not have expanded their hospital capacity or intensive care units.

“The signals were all there in September,” said Mr. Ciancio. “At this point it’s very important that all member states prepare their hospitals to deal with the increase in demand that is coming.”

Hospitalization rates are a key measure of the pandemic’s severity. The rates rise and fall days or weeks behind the tallies of new infections. But infection figures depend heavily on each country’s testing capacity, while seriously ill people tend to enter hospitals whether they have been tested for the virus or not.

Europe’s current wave of infection is due in part to the relative normalcy it experienced this summer. Unlike the United States, where the epidemic rose to a second peak in July and a third peak this month, travelers moved around Europe, college students returned to campus and many large gatherings resumed, all while the virus kept spreading.

Now hospitals are scrambling to prepare for an onrush of Covid-19 patients, at a time when bed and intensive care capacity will already be under strain during the winter flu season.

In Poland, the government converted the country’s largest stadium into a temporary field hospital with room for 500 patients. Hospitals in France, especially in the Paris area, have started to postpone non-emergency surgeries, while others have called back staff on leave. More than one-fifth of Spain’s intensive care beds are occupied by Covid-19 patients, and in Madrid, that figure is closer to 40 percent.

And in the Czech Republic — where the current hospitalization rate surpasses the worst period in Britain — physicians are worried about a shortage of staff. “In some regions, about 10 percent of the medical staff is either already infected or in quarantine,” said Petr Smejkal, the chief of infectious diseases and epidemiology at the Institute of Clinical and Experimental Medicine in Prague.

Mr. Smejkal said the country also lacks specialty workers like respiratory therapists, and that most nurses are not trained to operate ventilators. “I am most worried about personnel, and keeping a safe ratio of doctors to patients and nurses to patients,” he added.

There is hope that no place will experience the level of death that Bergamo, Italy, New York City and Madrid suffered this spring. How the virus spreads is better understood now, and treatments have improved, giving sick people a better chance of survival. Testing has expanded across Europe, allowing countries to identify outbreaks earlier, when they are easier to contain.

But it is unclear how successful those control measures will be, or if political resistance and collective exhaustion over new restrictions will make it harder to get the virus under control for a second time.

Deaths in most of Europe remain at a fraction of the levels seen in the spring. But they have ticked slowly upwards over the last several weeks, and they tend to lag hospitalizations by about a month. Experts say additional increases in deaths are likely over the next couple of weeks.

The COVID Tracking Project

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Data Analytics, Data Consistency, Data Control, Data Gathering, Data Management, Data Sharing, Data Transparency, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Transparency • Leave a comment

https://covidtracking.com/data/charts/us-daily-positive

The public deserves the most complete data available about COVID-19 in the US. No official source is providing it, so we are.

Every day, our volunteers compile the latest numbers on tests, cases, hospitalizations, and patient outcomes from every US state and territory.

https://covidtracking.com/

How the coronavirus pandemic could end

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Research, Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Treatment, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Reinfection, Scientists, Social Distancing, Vaccine • Leave a comment

https://www.axios.com/when-will-coronavirus-pandemic-end-ecef1ae7-33b5-474c-8a02-2471742dbe99.html

It’s still the early days of the coronavirus pandemic, but history, biology and the knowledge gained from our first nine months with COVID-19 point to how the pandemic might end.

The big picture: Pandemics don’t last forever. But when they end, it usually isn’t because a virus disappears or is eliminated. Instead, they can settle into a population, becoming a constant background presence that occasionally flares up in local outbreaks.

  • Many emerging viruses become part of the viral ecology. The four coronaviruses that cause the common cold are endemic, circulating in the population, and the influenza strains that cause seasonal flu predictably surge each year.
  • The SARS outbreak in 2003 didn’t go the same way due to biology and behavior: It was much less transmissible than the virus that causes COVID-19, countries contained it quickly, and it has pretty much disappeared.
  • One virus, smallpox, was eradicated through widespread vaccination, and polio may be close, after decades of effort and billions in funding.

What’s happening: The pandemic is deepening in the U.S., Europe and elsewhere in the world.

  • Experts — from the U.K.’s chief scientific adviser to pharmaceutical CEOs to the WHO — increasingly say SARS-CoV-2 is likely to circulate in the population on a permanent basis, mainly due to the foothold the virus has already established.
  • But what damage endemic COVID-19 causes will depend on different factors, including how often people are reinfected, vaccine effectiveness and adoption, and if the virus mutates in any significant way.

“If the vaccine is really effective, like the measles vaccine or the yellow fever vaccine, it’s just going to land like a ton of bricks and suffocate this. Maybe not quite eradicate it — yellow fever and measles are not eradicated — but it’ll be an utter game changer,” UC Irvine epidemiologist Andrew Noymer says.

  • But if the vaccines are less effective — as many experts expect for at least the first generation — COVID-19 may eventually behave more like the seasonal flu, Noymer says. (Still, the death rate of COVID-19 currently well eclipses that of the seasonal flu.)

Reinfection is “the big issue,” says Columbia University’s Jeffrey Shaman, who recently described how reinfection and other factors would affect the spread of SARS-CoV-2 if it became endemic.

  • So far, there are just a handful of documented reinfection cases, but evidence about whether people retain their antibodies after infection is mixed, and a lot of unknowns remain about the likelihood of reinfection.
  • The worst-case scenario would be that there isn’t a vaccine or long-lasting immunity and people get COVID-19 repeatedly and are just as likely to end up in the hospital as with initial infections, Shaman says.

“I would say COVID-19 is already endemic,” says Larry Brilliant, an epidemiologist who worked to eradicate smallpox and now chairs the nonprofit Ending Pandemics.

  • With about 59,000 new cases per day in the U.S. alone, Brilliant says “it is already everywhere.”
  • “It doesn’t really mean very much if it is endemic,” he adds. “The real question is: How does it all end?”

Eventually, COVID-19 could end up in “the retirement village of coronaviruses,” like HIV, which today can be treated to the point of elimination, or circulate at low levels and be kept in check with a vaccine, like measles, Brilliant says, laying out a handful of possible scenarios.

  • Noymer says he suspects that after its “cataclysmic emergence,” COVID-19 may eventually fade into a common cold after a decade or so.

What’s next: “We have to work with it as a virus that we will be contending with for years possibly,” Shaman says. “It doesn’t mean an effective vaccine or treatment won’t be developed. What it means is that holding out hope that we’re going to just get a vaccine and not doing anything else is not the level of preparation we need.”

  • Until we have an effective vaccine and better contact tracing and testing, Johns Hopkins University epidemiologist Justin Lessler says public health measures should continue encouraging the use of face masks and social distancing.
  • If the disease does become endemic, Lessler says it’s likely to eventually become more like a childhood infection because adults will gradually build an immunity. And since children tend to have fewer complications, “it will no longer be the same sort of burden to health that it is now.”

The good news: Viruses can sometimes become milder with time, treatments are already becoming more effective and vaccines can be improved.

  • “Right now we are frightened, depressed and on our back heels. We will be able to conquer this disease,” Brilliant says. “It will be a matter of time and science.”

Trump claims COVID “will go away,” Biden calls his response disqualifying

Posted on by • Posted in 2020 Election Issues, ACA, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Election, Employer-Based Health Insurance, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Health Insurance Coverage Adequacy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Medicaid, Medicaid Expansion, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Supreme Court, Underinsured, Uninsured, Vaccine, Vaccine Distribution • Leave a comment

https://www.axios.com/trump-biden-debate-coronavirus-14b6e962-e968-4547-933d-6d7105df24b9.html

The Final Presidential Debate: The Moments That Mattered - WSJ

President Trump repeated baseless claims at the final presidential debate that the coronavirus “will go away” and that the U.S. is “rounding the turn,” while Joe Biden argued that any president that has allowed 220,000 Americans to die on his watch should not be re-elected.

Why it matters: The U.S. is now averaging about 59,000 new coronavirus infections a day, and added another 73,000 cases on Thursday, according to the Covid Tracking Project. The country recorded 1,038 deaths due to the virus Thursday, the highest since late September.

What they’re saying: “More and more people are getting better,” Trump said. We have a problem that’s a worldwide problem. This is a worldwide problem. But I’ve been congratulated by the heads of many countries on what we’ve been able to do … It will go away and as I say, we’re rounding the turn. We’re rounding the corner. It’s going away.”

  • Trump later disputed warnings by public health officials in his administration that the virus would see a resurgence in the winter, claiming: “We’re not going to have a dark winter at all. We’re opening up our country.”

Biden responded: “Anyone responsible for that many deaths should not remain as president of the United States of America.”

  • “What I would do is make sure we have everyone encouraged to wear a mask all the time. I would make sure we move in the direction of rapid testing, investing in rapid testing.”
  • “I would make sure that we set up national standards as to how to open up schools and open up businesses so they can be safe and give them the wherewithal, the financial resources, to be able to do that.”

The bottom line: Biden and Trump are living in two different pandemic realities, but Biden’s is the only one supported by health experts.

Go deeper: The pandemic is getting worse again

Are you ready for price transparency?

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Cost Management, Cost Reduction, Cost Shifting, Health System, Hospital, Hospital Industry, Leadership, Medicaid, Medicare, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Planning, Price Transparency, Strategy • Leave a comment

https://interimcfo.wordpress.com/2020/10/22/are-you-ready-for-price-transparency/

Exploring the Fundamentals of Medical Billing and Coding

Abstract:  This article focuses on the correct strategic response to the impending implementation of price transparency on New Year’s Day of next year.

I have stated before that I have multiple articles in process at any given time.  Some of them have been ‘in process’ for years because newer topics sometimes rise to the queue’s top.  Price transparency is an example of such a case.  I have a friend who is developing AI-enabled solutions to help organizations respond to price transparency government diktats.  Few people beyond healthcare CFOs, healthcare financial consultants, and accountants have any useful understanding of how convoluted hospital pricing has become due to decades of ill-conceived government policy for the most part.

Another problem is endless confusion over terms.  People frequently interchange the terms ‘price’, ‘cost’, ‘payment’, and ‘reimbursement’ in situations where the polar opposite is true on the other side of the issue.  In other words, ‘cost’ to a payor is price or reimbursement to a provider.

Anyway, my friend’s questions finally inspired me to go to the Federal Register, acquire the final rule, and begin the process of learning where government is headed with these regulations.  There are probably at least fifty diatribe angles I could launch into over the final rule, but I will confine my rant to only a couple of points.  

First, the final draft of the rule is ‘only’ 331 pages long. The three-column final rule in the Federal Register is ‘only’ 83 pages long.  That pales compared to Obamacare that is over 1,200 pages long, so by government standards, this is but a trifle of regulation.  

Secondly, some parts of the final rule are actually funny.  For example, CMS estimates that the average hospital will spend only 150 staff hours in the first and 46 staff hours in subsequent years complying with price transparency requirements.  Is it constitutional for government to compel private enterprises to disclose the terms of what they thought were private contracts?  Apparently so.  Once government breaks this ice, will any agreement of any type ever be private?

As I have discussed price transparency with healthcare leaders, I sense that leaders are currently focused on technical compliance with the regulations.  With COVID on their plate simultaneously, they have little capacity to take on strategic financial planning.

The final rule lays out in excruciating detail what providers face complying with the regulation.  Reading the comments and responses is equally entertaining.  CMS repeatedly says something to the effect; we heard your concern, and we’re proceeding as planned anyway.  Litigation brought by the AHA and others has to date been unsuccessful in slowing stopping the price transparency snowball that is now most of the way down the mountain.

So, what are you supposed to do?  The CFO and CIO will work, possibly with consultants’ assistance, to prepare the organization’s data release.  Soon after the release occurs, expect the defecation to hit the rotary oscillator.  The press will call out organizations with high prices, and the rancor over learning what some systems have been able to get from third-party payors will be entertaining, to say the least.  Many people believe that one of the primary motivators of the massive consolidation occurring in the healthcare industry is the market leverage exerted by growing systems on third-party payors to obtain otherwise unachievable reimbursement rates.

Regardless of the course of action following price releases in January, the intended and most likely result of this initiative is to drive prices to a lower common denominator.  A lot of people think Medicare rates will become that benchmark.  There are two significant issues that I did not see addressed in the pricing rule that will have the effect of transferring substantial risk to providers.  

The first is that there will be little if any provision for recognition of complications, comorbidities, and hospital-acquired conditions that can dramatically impact the cost of care in a given diagnosis.  

The second is the elephant in the room. The current pricing system has developed over time to facilitate cross-subsidization among payors.  There is a reason that commercial rates are so high that has nothing to do with the cost of providing care.  I have stated before that, government has turned the entire healthcare industry into a taxing authority to extract tax from commercial payors for the benefit of government payors that routinely reimburse providers below the cost of providing care.  It has been entertaining to watch the reaction of Boards of Directors when they first realize that the healthcare system has been forced by government into a wealth redistribution mechanism.

So, what happens as providers lose the ability to cross-subsidize the cost of care?  Very few hospitals (<10%) are profitable on Medicare, and it is doubtful that any hospital is breaking even on services provided to Medicaid patients.  In my experience, hospital reimbursement for self-pay patients is less than 5% of charges.  If the prices hospitals realize for services start falling and they lose the current ability to cross-subsidize the cost of care . . . . . well, you don’t need an MBA to understand the likely outcome.

What to do?  If (when) prices start falling and providers lose pricing leverage, the only place to turn is operating expense.  Hospitals that have failed to undertake serious, highly focused, and robust operating cost reduction programs that yield quantifiable results may not have a very bright future.  If your organization is not in the bottom quartile of operating cost compared to its peer group and part of your mission is to remain independent, you must be losing sleep.  In a recent article related to COVID Response, I argued that the time has come to get after clinical process variance that is the source of most of the high cost, waste, and abuse in the healthcare system. For most organizations, the days of sourcing cheaper supplies and sending nurses home early are, for the most part, over as there is little if any juice remaining in that lemon.

If, as a leader, you do not have a plan that gets you to break-even on Medicare within the next 12-18 months, you had better have a plan B, something like tuning up your CV.  I can help you with your response to price transparency, working on your CV, or helping manage your next career transition as the case may turn out.  I am as close as your phone.  Best of luck.

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https://interimcfo.wordpress.com/