Author Archives: henrykotula

12-hospital CHI Franciscan-Virginia Mason system would be part of CommonSpirit under new deal

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https://www.beckershospitalreview.com/hospital-transactions-and-valuation/12-hospital-chi-franciscan-virginia-mason-system-would-be-part-of-commonspirit-under-new-deal.html?utm_medium=email

CHI Franciscan and Virginia Mason moving toward merger | Tacoma ...

Washington health systems CHI Franciscan and Virginia Mason agreed to explore a combination through a joint operating company that would be part of CommonSpirit Health, the organizations said July 16. 

The proposed 12-hospital system would include more than 250 care sites and nearly 5,000 employed and affiliated providers. Combining the two systems would allow Tacoma-based CHI Franciscan and Seattle-based Virginia Mason to “shape healthcare nationally,” according to Virginia Mason CEO Gary Kaplan, MD. He told Becker’s Hospital Review in an interview that the organizations “envision creating a health system of the future.”

Ketul Patel, the CEO of CHI Franciscan and president of the Pacific Northwest division at parent system CommonSpirit Health, said in the same interview that, “Together, we’re going to not only be able to boast that we have the largest access point in the state, but we are going to be the largest and best-quality [system] in the state of Washington. We’re in a unique place to scaling and being a showcase for the entire country.” 

Dr. Kaplan and Mr. Patel would serve as co-CEOs of the organization, and the health system’s board would have equal representation from both organizations.

Quality and innovation are major focuses of the proposed deal. Virginia Mason is one of only 32 hospitals in the U.S. and the only hospital in Washington to receive an A grade in quality and patient safety from The Leapfrog Group every spring and fall since the organization started publishing grades. All but two of CHI Franciscan’s hospitals received A rankings from Leapfrog this spring, Dr. Kaplan said. Outside of that, Virginia Mason and CHI Franciscan draw patients nationally for cardiology and complex spine programs, Mr. Patel said.

Dr. Kaplan said details of the deal will be hammered out as the organizations move toward a final agreement, with hopes to finalize the process by the end of the year. The joint operating company would be in addition to the organizations’ prior relationships, which include partnerships in obstetrics and women’s health, as well as radiation oncology.

No financial information about the proposal was disclosed. Virginia Mason reported total revenues of $1.2 billion in fiscal year 2019, while Chicago-based CommonSpirit’s totaled nearly $21 billion.

 

 

 

 

Back Into the Lion’s Den: COVID-19 and Post-Acute Care

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Long-Term Complications, Coronavirus Treatment, Home Care, Home Health, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Nursing Home, Pandemic, Post-Covid Care, Public Health, Public Safety, Quarantine, Rehabilitation Care, Social Distancing, Telemedicine • Leave a comment

https://www.medpagetoday.com/infectiousdisease/covid19/87596?xid=nl_popmed_2020-07-17&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyUpdate_071720&utm_term=NL_Daily_Breaking_News_Active

Back Into the Lion's Den: COVID-19 and Post-Acute Care | MedPage Today

Returning COVID patients to unprepared facilities a “recipe for disaster”

As Florida becomes the new epicenter of the COVID-19 outbreak in the U.S., the state is trying to ensure that nursing homes and rehabilitation facilities aren’t quickly overwhelmed by patients still suffering from the disease.

So far, it has dedicated 11 facilities solely to COVID patients who need post-acute or long-term care: those who can’t be isolated at their current facilities, as well as those who’ve gotten over the worst of their illness and who can be moved to free up hospital beds for the flow of new patients.

One of those facilities is Miami Medical Center, which was shuttered in October 2017 but now transformed to care for 150 such patients. In total, the network of centers will handle some 750 patients.

“We recognize that that would be something that would be very problematic, to have COVID-positive nursing home residents be put back into a facility where you couldn’t have proper isolation,” Florida Gov. Ron DeSantis (R) said during a press briefing last week. “[That] would be a recipe for more spread, obviously more hospitalizations and more fatalities, and so we prohibited discharging COVID-positive patients back into nursing facilities.”

Whether 750 beds will be enough to accommodate the state’s needs remains a question, but it’s a necessary first step, given testing delays that in some cases stretch more than a week. Experts have warned that patients recovering from COVID shouldn’t be transferred to a facility without being tested first.

Without dedicated facilities, hospitals in Florida in dire need of beds for new patients might have had no other choice.

Key Role for Testing

There are no national data on the percentage of hospitalized COVID-19 patients who need rehabilitation or skilled nursing care after their hospital stay.

In general, about 44% of hospitalized patients need post-acute care, according to the American Health Care Association and its affiliate, the National Center for Assisted Living, which represent the post-acute and long-term care industries.

But COVID has “drastically changed hospital discharge patterns depending on local prevalence of COVID-19 and variations in federal and state guidance,” the groups said in an email to MedPage Today. “From a clinical standpoint, patients with COVID-19 symptoms serious enough to require hospitalization may be more likely to require facility or home-based post-acute medical treatment to manage symptoms. They also may need rehabilitation services to restore lost function as they recover post-discharge from the acute-care hospital.”

The level of post-acute care these patients need runs the spectrum from long-term acute care hospitals and inpatient rehabilitation facilities to skilled nursing facilities and home health agencies.

The variation is partly due to the heterogeneity of the disease itself. While some patients recover quickly, others suffer serious consequences such as strokes, cardiac issues, and other neurological sequelae that require extensive rehabilitation. Others simply continue to have respiratory problems long after the virus has cleared. Even those who are eventually discharged home sometimes require home oxygen therapy or breathing treatments that can require the assistance of home health aides.

Yet post-acute care systems say they haven’t been overwhelmed by a flood of COVID patients. Several groups, including AHCA, NCAL, and the American Medical Rehabilitation Providers Association (AMRPA) confirmed to MedPage Today that there’s actually been a downturn in post-acute care services during the pandemic.

That’s due to a decline in elective procedures, the societies said, adding that demand is starting to pick back up and that systems will need to be in place for preventing COVID spread in these facilities.

Testing will play a key role in being able to move patients as the need for post-acute care rises, specialists told MedPage Today.

“You shouldn’t move anyone until you know a status so that the nursing facility can appropriately receive them and care for them,” said Kathleen Unroe, MD, who studies long-term care issues at the Regenstrief Institute and Indiana University in Indianapolis.

AHCA and NCAL said they “do not support state mandates that require nursing homes to admit hospital patients who have not been tested for COVID-19 and to admit patients who have tested positive. This approach will introduce the highly contagious virus into more nursing homes. There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths.”

Earlier this week, the groups sent a letter to the National Governors Association about preventing COVID outbreaks in long-term care facilities. They pointed to a survey of their membership showing that, for the majority, it was taking 2 days or longer to get test results back; one-quarter said it took at least 5 days.

The Centers for Medicare & Medicaid Services (CMS) recently announced that it would send point-of-care COVID tests to “every single” nursing home in the U.S. starting next week. Initially, the tests will be given to 2,000 nursing homes, with tests eventually being shipped to all 15,400 facilities in the country.

Hospitals can conduct their own testing before releasing patients, and this has historically provided results faster than testing sites or clinical offices, especially if they have in-house services. However, demand can create delays, experts said.

Preparing for the Future

Jerry Gurwitz, MD, a geriatrician at the University of Massachusetts Medical School in Worcester, says now is the time to develop post-acute care strategies for any future surges.

Gurwitz authored a commentary in the Journal of the American Geriatrics Society on an incident in Massachusetts early in the pandemic where a nursing home was emptied to create a COVID-only facility, only to have residents test positive after the majority had already been moved.

“We should be thinking, okay, what are the steps, what’s the alternative to emptying out nursing homes? Can we make a convention center, or part of it, amenable to post-acute care patients?” Gurwitz said. “Not just a bed to lie in, but possibly providing rehabilitation and additional services? That could all be thought through right now in a way that would be logical and lead to the best possible outcomes.”

Organizations can take the lead from centers that have lived through a surge, like those in New York City. Rusk Rehabilitation at NYU Langone Health created a dedicated rehabilitation unit for COVID-positive patients.

“We were able to bring patients out from the acute care hospital to our rehabilitation unit and continue their COVID treatment but also give them the rehabilitation they needed” — physical and occupational therapy (PT/OT) — “and the medical oversight that enhanced their recovery and got them out of the hospital quicker and in better shape,” Steven Flanagan, MD, chair of rehabilitation medicine at NYU Langone, said during an AMRPA teleconference.

Flanagan noted that even COVID patients who can be discharged home will have long-term issues, so preparing a home-based or outpatient rehabilitation program will be essential.

Jasen Gundersen, MD, chief medical officer of CareCentrix, which specializes in post-acute home care, said there’s been more concern from families and patients about going into a facility, leading to increased interest in home-based services.

“We should be doing everything we can to support patients in the home,” Gundersen said. “Many of these patients are elderly and were on a lot of medications before COVID, so we’re trying to manage those along with additive medications like breathing treatments and inhalers.”

Telemedicine has played an increasing role in home care, to protect both patients and home health aides, he added.

Long-term care societies have said that emergency waivers implemented by CMS have been critical for getting COVID patients appropriate levels of post-acute care, and they hope these remain in place as the pandemic continues.

For instance, CMS relaxed the 3-hour therapy rule and the 60% diagnostic rule, Flanagan said. Under those policies, in order to admit a patient to an acute rehabilitation unit, facilities must provide 3 hours of PT/OT every day, 5 days per week.

“Not every COVID patient could tolerate that level of care, but they still needed the benefit of rehabilitation that allowed them to get better quicker and go home faster,” he said.

Additionally, not every COVID patient fits into one of the 13 diagnostic categories that dictate who can be admitted to a rehab facility under the 60% rule, he said, so centers “could take COVID patients who didn’t fit into one of those diagnoses and treat them and get them better.”

AHCA and NCAL said further waivers or policy changes would be helpful, particularly regarding basic medical necessity requirements for coverage within each type of post-acute setting.

But chief among priorities for COVID discharges to post-acute care remains safety, the groups said.

“The solution is for hospital patients to be discharged to nursing homes that can create segregated COVID-19 units and have the vital personal protective equipment needed to keep the staff safe,” they said. “Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept COVID-19 patients is a recipe for disaster.”

 

 

 

 

Nearly one-third of children tested for COVID in Florida are positive.

Posted on by • Posted in Asymptomatic Transmission, Chronic Care Management, Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Long-Term Complications, Coronavirus Treatment, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.sun-sentinel.com/coronavirus/fl-ne-pbc-health-director-covid-children-20200714-xcdall2tsrd4riim2nwokvmsxm-story.html

Nearly One-Third Of Children Tested For COVID In Florida Are ...

Palm Beach County’s health director warns of risk of long-term damage.

Nearly one-in-three children tested for the new coronavirus in Florida has been positive, and a South Florida health official is concerned the disease could cause lifelong damage even for children with mild illness.

Dr. Alina Alonso, Palm Beach County’s health department director, warned county commissioners Tuesday that much is unknown about the long-term health consequences for children who catch COVID-19.

X-rays have revealed the virus can cause lung damage even in people without severe symptoms, she said.

“They are seeing there is damage to the lungs in these asymptomatic children. … We don’t know how that is going to manifest a year from now or two years from now,” Alonso said. “Is that child going to have chronic pulmonary problems or not?”

Her comments stand in contrast to Gov. Ron DeSantis’ messaging that children are at low risk, and classrooms need to be reopened in the fall. DeSantis has said he would be comfortable sending his children to school if they were old enough to attend.

Some studies suggest that children are less likely to catch COVID-19 than adults. Children are also far less likely to die of the disease. About 17,000 of Florida’s roughly 287,800 cases have been people younger than 18. Of the 4,514 COVID-19 deaths reported by Florida as of Tuesday, four have been younger than 18.

Still, it’s possible COVID-19 could have long-term consequences that will take time to understand, Alonso said.

“This is not the virus you bring everybody together to make sure you catch it and get it over with,” she said. “This is something serious, and we are learning new information about this virus every day.”

State statistics also show the percentage of children testing positive is much higher than the population as a whole. Statewide, about 31% of 54,022 children tested have been positive. The state’s positivity rate for the entire population is about 11%.

Researchers have linked a serious and potentially deadly inflammatory condition with COVID-19 in children. The condition, called pediatric multisystem inflammatory syndrome, doesn’t appear to be widespread. The Florida Department of Health lists 13 confirmed cases of the syndrome.

Dr. Jorge Perez, co-founder of Kidz Medical Services, said it’s too early to say how common and severe long-term damage could be from COVID-19, but early evidence suggests some children infected with the virus could have lasting damage.

“We are learning something every day,” said Perez, who operates pediatric offices throughout South Florida. “We have to be knowledgeable about this and continue to monitor to see what effects it has in children.”

DeSantis told talk radio host Rush Limbaugh last week that the risk to children is “very low.”

“I’ve got a 3-year-old daughter, 2-year-old son, and a newborn daughter,” DeSantis said in the radio interview. “And I can tell you if they were school age, I would have zero concern sending them.”

 

 

Doctors have gotten better at treating coronavirus patients

Posted on by • Posted in Blood Clots, Coronavirus, Coronavirus Treatment, Health System, Hospital, Hospital Industry, Inflammation, Intensive Care (ICU), Mortality, Pandemic, Public Health, Public Safety, Quarantine, Remdesivir, Social Distancing, Steriods • Leave a comment

https://www.axios.com/coronavirus-treatment-better-drugs-hospitals-6f92cf31-4fa1-4181-ba21-a5a8c778ec9e.html

Doctors and hospitals have gotten better at treating coronavirus ...

Doctors and hospitals have learned a lot about how best to treat people infected with the coronavirus in the months since the pandemic began.

Why it matters: Better treatment means fewer deaths and less pain for people who are infected, and research into pharmaceutical treatments is advancing at the same time as hospital care.

The big picture: Some of the simplest changes have been the most effective. For example, doctors have learned that flipping patients onto their stomachs instead of their backs can help increase airflow to the lungs.

  • Providers also now prefer high-flow oxygen over ventilators, despite the early focus on ventilator supply.
  • “If you can avoid ventilation, it is preferred if someone is able to breathe on their own and you just help them out by giving them more oxygenated air to breathe,” said Janis Orlowski, chief health care officer of the Association of American Medical Colleges.

Researchers have also discovered new utility in old drugs.

  • Dexamethasone, a cheap steroid used to treat inflammation, has been found to reduce deaths by one-third among patients on ventilators and one-fifth among those on oxygen.
  • Preliminary data has shown that remdesivir, an antiviral, probably doesn’t save seriously ill patients’ lives, but can help others get out of the hospital a few days earlier. “Anyone who has evidence of lung injury or needing oxygen, we give it,” said Armond Esmaili, a hospitalist at the University of California San Francisco Medical Center.
  • Doctors have also learned to put all COVID patients on drugs to prevent blood clots, Esmaili said.

What they’re saying: There’s still a lot doctors and scientists don’t know about the virus, but they say they’ve come along way since February and March, when they were essentially flying blind.

  • “It was very scary, just to give you the subjective feeling, of caring for patients and talking with patients and their families and a lot of the time saying, ‘We don’t know a lot about this disease. We don’t know how you’re going to do,’” Esmaili said.

Between the lines: Hospitals are also able to provide better care when they’re not overwhelmed with patients.

  • New York’s hospitals were so overwhelmed in the spring that they brought in employees to work well outside of their specialties. In some hospitals’ emergency rooms, patient-to-nurse ratios rose to more than 20 to 1, the NYT reports — five times the recommended ratio.
  • “Really attentive-level care is important,” Esmaili said.“It’s not that hard to imagine that when you have the resources and you’re not overburdened with a massive amount of patients that patients are going to get better care.”

What we’re watching: These advances in treatment protocols will only go so far, especially if hospitals in states like Florida, Arizona and Texas become too full to put them into practice.

  • In states with rising case counts, “I think you’re going to see mortality rates increase there because of that phenomenon of hospitals being unable to deliver optimal care, because they don’t have the staffing,” said James Lawler, an infectious disease specialist at the University of Nebraska Medical Center.
  • “You don’t want your ICU nurse to have to take care of five or six patients at the same time,” he said.

 

 

 

 

Disappearance of covid-19 data from CDC website spurs outcry

Posted on by • Posted in 2020 Election Issues, American Medical Association (AMA), Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Data Governance, Data Integrity, Data Interpretation, Data Management, Data Ownership, Data Privacy, Health System, Hospital, Hospital Industry, Transparency, Trust • Leave a comment

https://www.washingtonpost.com/health/2020/07/16/coronavirus-hospitalization-data-outcry/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR2ONMOtMxy2LFUw0qKhDZwb1n5yFRv2oCTZlrr49_YpdO8WTzkSC90JjY0

Disappearance of covid-19 data from CDC website spurs outcry ...

Governors join calls for delay of administration plan to shift control from the CDC as Trump administration pledges to make data available to the public.

On the eve of a new coronavirus reporting system this week, data disappeared from a Centers for Disease Control and Prevention website as hospitals began filing information to a private contractor or their states instead. A day later, an outcry — including from other federal health officials — prompted the Trump administration to reinstate that dashboard and another daily CDC report on the pandemic.

And on Thursday, the nation’s governors joined the chorus of objections over the abruptness of the change to the reporting protocols for hospitals, asking the administration to delay the shift for 30 days. In a statement, the National Governors Association said hospitals need the time to learn a new system, as they continue to deal with this pandemic.

The governors also urged the administration to keep the information publicly available.

The disappearance of the real-time data from the CDC dashboard, which was taken down Tuesday night before resurfacing Thursday morning, was a ripple effect of the administration’s new hospital reporting protocol that took effect Wednesday, according to a federal health official who spoke on the condition of anonymity to discuss internal deliberations.

Without receiving the data firsthand, CDC officials were reluctant to maintain the dashboard — which shows the number of patients with covid-19, the disease caused by the virus, and hospital bed capacity — and took it down, the federal health official said. The CDC dashboard states that its information comes directly from hospitals and does not include data submitted to “other entities contracted by or within the federal government.” It also says the dashboard will not be updated after July 14.

The dashboard “was taken down in a fit of pique,” said Michael R. Caputo, the assistant secretary for public affairs at the Department of Health and Human Services. “The idea CDC scientists cannot rely upon their colleagues in the same department for data collection, or any other scientific work, is preposterous.”

This week, the CDC, the government’s premier public health agency whose medical epidemiologists analyze the hospital data, also stopped producing reports about trends in the pandemic that had gone twice a week to states, and six days a week to officials at multiple federal agencies. Adm. Brett Giroir, an assistant secretary in the HHS who oversees coronavirus testing, was unhappy that the CDC hospital report stopped Wednesday and Thursday mornings, according to the federal health official.

Caputo said that the administration’s goal is to maintain transparency, adding that conversations were still taking place between HHS officials and the CDC on a plan to keep producing the dashboard updates and the reports. “We expect a resolution,” he said.

Another HHS spokesperson said the CDC might create a new dashboard, based on a wider set of information.

During a conference call for journalists Thursday on coronavirus testing, Giroir did not acknowledge his displeasure with the reports’ discontinuation. But he said: “Those data are really critical to all of us. … I wake up in the morning and first thing I do, I look at the data. I look at midday. I look at it at night before I go to bed. … We drive the response based on that.”

The CDC site had been one of the few public sources of granular information about hospitalizations and ICU bed capacity. About 3,000 hospitals, or about 60 percent of U.S. hospitals, reported their data to the CDC’s system.

The president of the American Medical Association, Susan R. Bailey, spoke out Thursday on the uncertainties about access to data. “[W]e urge and expect that the scientists at the CDC will continue to have timely, comprehensive access to data critical to inform response efforts,” she said.

Governors, hospital officials and state health officers were given scant notice of the change in the reporting system. Two top administration health officials said in a letter to governors early this week that some hospitals were not complying with the previous protocols, suggesting that states might want to consider bringing in the National Guard to help gather the information. Hospital industry leaders vehemently protested that characterization, as well as the idea that they should be assisted by the National Guard in the midst of a pandemic.

HHS and CDC officials have said the protocol was changed to streamline reporting of data that is used, among other things, to determine the federal allocation of therapeutics, testing supplies and protective gear. Instead of reporting to the long-standing CDC system, hospitals must send data about covid-19 patients and other metrics to a recently hired federal contractor, called TeleTracking, or to their state health departments.

At least some state health departments that have been collecting data for their hospitals and sending it to Washington have already said the switch will make it impossible for them to continue, at least for now. The changed protocol includes a requirement that hospitals send several additional types of data that some state systems are not equipped to handle, state health officials said.

The Pennsylvania Department of Health sent a notice to hospitals Tuesday night saying that its platform was not ready to accommodate the new federal requirements, so that hospitals needed to report every day to both the state and to TeleTracking.

Charles L. Gischlar, spokesman for the Maryland Department of Health, said the reporting change “is a heavy lift for hospitals.”

The new system “exceeds the capacity of the current statewide system” to which hospitals had been reporting, he said, so the state no longer can send consolidated information to the federal government. As a result, he said in a statement, hospitals must provide data individually to the government.

 

 

 

 

Unpublished White House Coronavirus Task Force Report – 18 States in Red Zone

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Coronavirus, Crisis, Crisis Management, Data Control, Data Interpretation, Data Management, Data Ownership, Economic Crisis, Economy Reopening, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Leadership Decentralized, Leadership Intent, Leadership Trust, Mislead, Misleading, Mixed Message, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Transparency, Trust, Truth • Leave a comment

https://mailchi.mp/publicintegrity/exclusive-white-house-docs-shows-18-states-in-coronavirus-red-zone?e=4539e77864

An unpublished document prepared for the White House Coronavirus Task Force and obtained by the Center for Public Integrity suggests more than a dozen states should revert to more stringent protective measures, limiting social gatherings to 10 people or fewer, closing bars and gyms and asking residents to wear masks at all times.

The document, dated July 14, says 18 states are in the “red zone” for COVID-19 cases, meaning they had more than 100 new cases per 100,000 population last week. Eleven states are in the “red zone” for test positivity, meaning more than 10 percent of diagnostic test results came back positive. 

It includes county-level data and reflects the insistence of the Trump administration that states and counties should take the lead in responding to the coronavirus. The document has been shared within the federal government but does not appear to be posted publicly.

It’s clear some states are not following the task force’s advice. For instance, the document recommends that Georgia, in the red zone for both cases and test positivity, “mandate statewide wearing of cloth face coverings outside the home.” But Gov. Brian Kemp signed an order Wednesday banning localities from requiring masks.