Author Archives: henrykotula

Baylor Scott & White to lay off 1,200 workers, furlough others

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Financially Distressed, Health System, Hospital, Hospital Industry, Job, Job Market, Job Search, Job Security, Pandemic, Unemployment, Unemployment Insurance • Leave a comment

https://www.beckershospitalreview.com/finance/baylor-scott-white-to-lay-off-1-200-workers-furlough-others.html?utm_medium=email

How Baylor Scott & White's quality alliance led Texas in Medicare ...

Baylor Scott & White Health, a nonprofit health system based in Dallas, is laying off about 1,200 employees, nearly 3 percent of its workforce, according to The Dallas Morning News. 

Like other health systems across the nation, Baylor Scott & White is facing financial damage caused by the COVID-19 pandemic. The health system spent $85 million to prepare and respond to the pandemic, and it also saw a significant drop in patient volumes.

“We experienced a dramatic drop in patient volumes — between 50 and 90 percent, depending upon where they sought care,” CEO Jim Hinton told employees in a video message, according to The Dallas Morning News. 

Those affected by the layoffs will be told this week and paid through June 7, a spokesperson told The Dallas Morning News.

In addition to the layoffs, Baylor Scott & White is furloughing an unspecified number of employees, leaving some open positions unfilled and cutting the pay of about 300 senior leaders, according to the report. 

Baylor Scott & White has received about $172 million in federal grants from the $175 billion in relief aid Congress has allocated to hospitals and other healthcare providers to cover expenses or lost revenues tied to the COVID-19 pandemic. The health system also received about $660 million in Medicare advance payments, which must be repaid, according to the report.

Baylor Scott & White is one of more than 260 hospitals and health systems across the nation to furlough or lay off employees in recent months. 

 

 

 

Reducing COVID-19 Deaths In Nursing Homes: Call To Action

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Medicaid, Mortality, Nursing Home, Pandemic, Personal Protective Equipment (PPE) • Leave a comment

https://www.healthaffairs.org/do/10.1377/hblog20200522.474405/full/?utm_source=Newsletter&utm_medium=email&utm_content=COVID-19%3A+Reducing+Deaths+In+Nursing+Homes%2C+Effective+Multilateralism%3B+Surprise+Out-Of-Network+Bills+For+Ambulance+Transportation+And+Ambulatory+Surgery+Centers&utm_campaign=HAT+5-27-20

Reducing COVID-19 Deaths In Nursing Homes: Call To Action | Health ...

Nursing homes are a hidden and frequently forgotten part of our health care system. They are now under attack by the COVID-19 pandemic: residents are dying, families are disconnected from their loved ones, and staff are sick and overwhelmed by work and the grief of losing so many patients in such a short time. Our state, Massachusetts, is one of the hardest-hit by COVID-19, with over 3,600 deaths and counting in nursing homes, or almost 10 percent of the nursing home population. Over 60 percent of all COVID-19-related deaths in Massachusetts are in nursing homes, one of six states where nursing home residents comprise over 50 percent of COVID-19-related deaths.  The COVID-19 pandemic is exposing years of neglect and chronic underfunding of nursing homes.  

Over 85 percent of the almost 400 nursing homes in Massachusetts currently report two or more cases of COVID-19 among residents or staff.  Emerging data make it abundantly clear that the nursing home environment is highly conducive to the rapid spread of COVID-19, and nursing home residents are among the most susceptible to severe illness and death.  Urgent and decisive action is required to reduce mortality among frail and vulnerable seniors in nursing homes. 

The New England Geriatrics Network (NEGN) is a group of geriatricians, geriatric psychiatrists, nurse practitioners, and others interested in improving care of older adults, that recently convened a Nursing Home Work Group of members interested in improving nursing home care.  We write to share our collective experiences and to reflect on some innovative and promising initiatives adopted in our state.

Success in reducing COVID-19-related morbidity and mortality in the nursing home setting requires urgent action in three areas: 1) enhancing infection control with an individualized plan for each nursing home that incorporates both regulatory guidance and current literature and is feasible to implement; 2) ensuring necessary resources to implement infection control plans, especially adequate staff, training, personal protective equipment (PPE), COVID-19 testing, creation of units for COVID-19 positive patients, and access to onsite ancillary services (labs, imaging, intravenous (IV) management); 3) mirroring the federal Coronavirus Commission for Safety and Quality in Nursing Homes by establishing state-level task forces focused on improving communication and collaboration between nursing homes and families, health care providers (hospitals, health systems, home health agencies, physician organizations), and government agencies.

Although the federal government has offered guidance on infection control in nursing homes, most efforts to manage the pandemic are initiated and managed at the state level.  As a result, there is significant variability in the response. For example, until the federal government recently mandated it, fewer than half of the states reported infection rates and deaths in nursing homes.  Massachusetts implemented several key initiatives that may serve as a model for how to limit COVID-19 epidemic in nursing homes.

Recommendation #1: Operationalizing Effective Infection Control

The only way to reduce COVID-19 deaths is to universally implement effective infection control programs in every nursing home.  The Centers for Disease Control and Prevention (CDC), state agencies like the Massachusetts Department of Public Health, and medical specialty societies have issued checklists and guidance for managing COVID-19 infections in nursing homes. The core challenge is the diversity of the nursing homes, each varying structurally in layout and room design, financially in resources and reserves, and organizationally in staffing and medical leadership. Nationally, 39 percent of nursing homes had deficiencies related to infection control in 2017, including 30 percent of Massachusetts nursing homes.  Each nursing home must create and implement a COVID-19 control plan, review it regularly with public health officials, and allow site visits to validate performance.  A truly collaborative effort will empower and support nursing homes to make required changes, maintain transparency, uphold accountability, and save lives. 

Our colleagues working in Massachusetts nursing homes continue to directly observe ongoing issues with infection control, despite the state’s best efforts to address the pandemic.  In late April, a colleague rounding at a nursing home with known COVID-19 cases found COVID-19-positive, test pending, and COVID-19-free residents sitting together in a communal area. Nurses were wearing varying levels of PPE, some in gowns and masks, and only some with face shields.

Massachusetts recently enhanced its plan to manage COVID-19 in nursing homes by allocating up to $130 million in additional funding to support infection control, staffing, and PPE. Part of the plan is a 28-point audit tool to evaluate the strength of each nursing home’s plan, which will be assessed through site visits by state inspectors to every nursing home in the state either every two or four weeks (depending on initial audit results) through the end of June.  Nursing homes can qualify for up to a 50 percent increase over their baseline Medicaid (MassHealth) reimbursement by demonstrating adherence to an effective infection control plan. Facilities failing to implement effective plans can face serious penalties starting with reduced bonus funding and extending to receivership, termination from the state Medicaid program and even forced closure.

In addition to a clear and transparent approach to audits, the state is providing access to infection control expertise to enhance the ability of nursing homes to execute effective infection control plans.  A statewide infection control command center is being led by the nursing home trade organization Massachusetts Senior Care Association (MSCA), along with a senior care and housing organization, Hebrew Senior Life, and others.

Comprehensive infection control plans may require dedicated units for COVID-19-infected patients, important for preventing spread of the infection within nursing homes and for treating COVID-19-positive patients needing inpatient nursing and rehabilitation.  Massachusetts made this a focus of the first phase of its approach to managing COVID-19 in nursing homes.  As of May 1, 2020, six nursing homes have been fully converted to COVID-only facilities, and more than 80 nursing homes have dedicated in-house COVID units.  The state accelerated the creation of these facilities with increased Medicaid payment rates for the care of patients with COVID-19. This has helped offset revenue loss related to decreased post-acute care admissions due to a decrease in elective procedures.

Recommendation #2: Nursing Homes Must Have Adequate Resources For Patient Care Including Staffing, PPE, Testing, And Onsite Ancillary Services

The lack of infection control resources reflects longstanding gaps in the nursing home setting which have been greatly exacerbated by the current pandemic. The state is providing additional Medicaid payments to nursing homes, as mentioned above. These resources are needed to improve care and infection control.

Staffing

In mid-April, as the surge in COVID-19 cases accelerated in Massachusetts, 40 percent of nursing home positions were vacant in the state  As the pandemic spread, many staff became unavailable due to infection, increased risk related to underlying comorbidities, or family responsibilities.  Many nursing home staff work on a per diem basis, and often lack paid sick leave. Until recently, transportation and paid housing solutions put in place for hospital staff had not been extended to them.

The staffing shortage threatens the health of all residents on short-staffed units and reveals how human contact is fundamental to good nursing home care.  A member of our group recently visited a nursing home where staffing on a 30-resident unit was reduced to one nurse and one nurse’s aide.  Isolation is a cornerstone of fighting COVID-19, but with family and volunteers not permitted in nursing homes, he reported seeing increased dehydration, falls, and poor hygiene as staff struggled to hand-feed residents and provide personal care.  In addition, family members may wait days to hear back about their loved one from overwhelmed nursing home staff.  This lack of communication is a huge barrier to high quality care, especially for patients needing frequent symptom management, such as those in hospice care. 

Massachusetts is taking several actions to alleviate staffing shortages.  The state offered a $1,000 bonus for new nursing home staff, and an online portal was created to match nursing homes with job seekers and volunteers.  The state is making available rapid response teams including nurses, emergency medical technicians (EMTs), and others that can be temporarily deployed for a few days to assist challenged nursing homes. National Guard units are available for non-clinical support, as well as staff from temporary staffing agencies contracted by the state.  Private sector efforts include a collaboration between Massachusetts Senior Care Association, the MIT COVID-19 Policy Alliance, and Monster.com to offer free staffing listings on Monster’s recruiting website.

Personal Protective Equipment

As with all other health care settings, PPE shortages are an ongoing challenge, and states must do more to help.  In Massachusetts, as of May 19, 2020, the state has distributed almost 350,000 N95 masks, over 780,000 masks, and 708,000 pairs of gloves to nursing homes.  However, this is not enough to provide for all of the needs of the nearly 400 nursing homes in the state, which must still rely on their own supply chains, including new purchasing collaboratives, to help facilities gain PPE access. Providing PPE to family members and volunteers could help mitigate some of the impact of extreme staffing shortages.

Testing For COVID-19

Access to routine testing can improve infection control and identify patients at risk of decline.  Testing should not be limited to only those with symptoms.  In early April, a nursing home in Wilmington, MA underwent facility-wide screening.  Over 50 percent of residents without symptoms tested positive for COVID-19, and within two weeks, 25 residents had died.  Universal testing of residents and staff should be performed as quickly as possible, and routine testing must be available to evaluate symptomatic nursing home residents.  The state of Massachusetts now requires every nursing home to test all residents and staff as a prerequisite to receiving any supplemental COVID-19 funding.  If the nursing home cannot arrange testing, the state will continue to supply National Guard mobile testing teams and dispense testing kits directly to nursing homes.  For nursing homes where testing may not be readily available, or if there are already significant numbers of COVID-19 infections, it should be presumed that all residents and staff are infected, and PPE and other universal infection control measures should be implemented.

Ancillary Services

One overlooked but essential resource is access to ancillary services.  Most nursing homes rely on external companies to provide onsite services, including laboratory tests (e.g. blood tests, urinalysis), to start IVs and provide portable imaging (X-Ray, ultrasound), and to stock medications.  Many of these companies also face challenges with staff and PPE and have decreased services from daily visits to once or twice a week.  As a result, families who want their loved one diagnosed and treated in the nursing home (e.g. chest x-ray, labs for possible pneumonia, followed by IV insertion for antibiotics), or who need urgent assessments, COVID-19 related or not, must decide whether to transfer their family member to the emergency department. One solution is redeploying EMTs, now freed up from transport for elective procedures, to draw labs and start IVs in nursing homes to keep patients where they feel safe and comfortable, and to avoid further stress on over-burdened emergency departments.

Recommendation #3: Establishing COVID-19 Control Task Forces

COVID-19 has forced our society into isolation, but communication and collaboration are essential for successfully fighting pandemics.  We strongly recommend each state create a task force for COVID-19 pandemic control in nursing homes for a minimum of two years, to bring together relevant governmental agencies (Public Health, Elder Affairs or Aging agency, Emergency Management, Medicaid, and others) and other key stakeholders, which include nursing home clinicians, the nursing home industry, ancillary services companies, hospitals, physician groups, and nursing home residents and family members. Local and regional task forces should collaborate to support links between nursing homes and local health care systems and ensure that nursing homes have effective communications with family members and clinicians providing care.  Collaboration with state governments and nursing home leadership in other states is also essential, as many staff, clinicians, and family members travel across state lines.

Task Forces must initially focus on ensuring effective infection control and making resources available to reduce the morbidity and mortality of COVID-19 on nursing home residents and those needing post-acute care. They also should anticipate and plan for the inevitable changes and continued need for nursing home care in the wake of the COVID-19 pandemic.

In Summary

Nursing homes should receive necessary support as an integral and most vulnerable part of the continuum of care. The population is aging, and the need for high quality long-term care, especially for those who lack family or financial resources, is growing rapidly.  Now is the time to ensure the safety and continued viability of this vital health care setting.

Authors’ Note: This call to action was written by the co-authors above on behalf of The New England Geriatrics Network (NEGN) Nursing Home Work Group.

 

 

 

 

Pandemic response complicated by public health agencies’ inability to receive data from hospitals

Posted on by • Posted in American Hospital Association (AHA), Center for Medicare and Medicaid Services (CMS), Data, Data Governance, Data Management, Electronic Health Record (EHR), Health Policy, Health System, Hospital, Hospital Industry, Information Technology, Interoperability • Leave a comment

https://www.healthcaredive.com/news/pandemic-response-complicated-by-public-health-agencies-inability-to-recei/578663/

Dive Brief:

  • The biggest problem with electronic syndromic surveillance reporting isn’t that hospitals lack the capacity to send data — it’s that public health agencies lack the ability to receive it, according to a new report published in the Journal of the American Medical Informatics Association.
  • More than four in 10 U.S. hospitals say their local, state and federal public health agencies are unable to receive data electronically, reflecting a decade-long investment in health IT infrastructure on the private sector side without a concomitant investment from its federal partners, researchers found.
  • Hospitals in regions forecast to be some of the hardest hit from COVID-19 were more likely to say public health agencies were unable to receive health data electronically, implying areas of highest need were some of the least prepared to mount a coordinated, data-driven response going into the pandemic.

Dive Insight:

Effective pandemic response requires real-time, accurate data sharing between providers and public health agencies, allowing the government to track outbreaks and allocate resources as needed.

A lack of nationwide, interoperable reporting infrastructure has been one of the major criticisms of the Trump administration’s handling of the pandemic, which has infected almost 1.7 million and killed 99,000 people in the U.S. as of Wednesday.

CMS requires hospitals be able to electronically send and receive health information, including lab results and syndromic surveillance data, to and from public health agencies like their state’s department of health. For more than a decade, providers have funneled significant resources into their IT infrastructure due to a slurry of federal incentive programs, though EHR implementation remains piecemeal across the U.S. due to cost and other barriers.

The JAMIA study, one of the first looking at the state of health data reporting, analyzed 2018 American Hospital Association data to identify hospital-reported barriers to surveillance data reporting, and Harvard Global Health Institute data on the coronavirus pandemic’s projected impact on hospital capacity at the hospital referral region (HRR) level. Researchers assumed a 40% population infection rate over 12 months.

The group found 31 high-need HRRs, those in the top quartile of projected beds needed for COVID-19 patients, with more than half of the hospitals in the region saying the relevant public health agency couldn’t electronically receive data.

That suggests areas more likely to be overwhelmed by the pandemic had some of the least interoperable data-sharing capabilities going into it, hamstringing outbreak response.

Researchers found the most common barrier to data-sharing nationwide, reported by 41% of hospitals, was that public health agencies didn’t have the capacity to receive data electronically.

The next most common, reported by 32% of hospitals, was interface-related issues, such as costs or implementation complexity; followed by difficulty extracting data from the EHR (14% of hospitals reporting), different data standards (also 14%), hospitals lacking the capacity to send data (8%) and hospitals being unsure what public health agencies to send the data to (3%).

Researchers also found significant state variance in hospitals saying public health agencies couldn’t receive needed data electronically, running the gamut from 83% of hospitals saying so in Hawaii and Rhode Island to 40% in New Jersey and Virginia to none in Delaware.

Geographic variation is likely due to different funding priorities in different places, as some agencies may only be able to receive specific data elements or interface with a select number of EHRs. This spotty IT implementation results in a patchwork picture of disease progression across the U.S., though the Centers for Disease Control and Prevention is working to automate the COVID-19 reporting process.

The study does have some significant limitations. It’s a relatively one-sided portrayal of the issue, as researchers did not have access to data or survey results from public health agencies. And, since AHA survey results were from two years ago, the EHR landscape could have shifted since 2018.

However, researchers called upon policymakers to build up public health agencies’ IT capabilities, especially as states begin to reopen despite an increasingly likely resurgence of the virus in the fall.

“Policymakers should prioritize investment in public health IT infrastructure along with broader health system information technology for both long-term COVID-19 monitoring as well as future pandemic preparedness,” authors A Jay Holmgren, a doctoral candidate at Harvard Business School; Nate Apathy, a doctoral candidate at Indiana University’s Richard M. Fairbanks School of Public Health; and Julia Adler-Milstein, a professor at University of San Francisco Department of Medicine, wrote.

 

 

 

Administration Killed Rule Designed To Protect Health Workers From Pandemic Like COVID-19

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Employee Protections, Healthcare Providers, Nurses, Occupational Safety and Health Administration (OSHA), Pandemic, Personal Protective Equipment (PPE), Physician, Public Health, Public Safety • Leave a comment

https://www.npr.org/2020/05/26/862018484/trump-team-killed-rule-designed-to-protect-health-workers-from-pandemic-like-cov?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-05-27%20Healthcare%20Dive%20%5Bissue:27567%5D&utm_term=Healthcare%20Dive

Trump Team Killed Rule Designed To Protect Health Workers From ...

When President Trump took office in 2017, his team stopped work on new federal regulations that would have forced the health care industry to prepare for an airborne infectious disease pandemic such as COVID-19. That decision is documented in federal records reviewed by NPR.

“If that rule had gone into effect, then every hospital, every nursing home would essentially have to have a plan where they made sure they had enough respirators and they were prepared for this sort of pandemic,” said David Michaels, who was head of the Occupational Safety and Health Administration until January 2017.

There are still no specific federal regulations protecting health care workers from deadly airborne pathogens such as influenza, tuberculosis or the coronavirus. This fact hit home during the last respiratory pandemic, the H1N1 outbreak in 2009. Thousands of Americans died and dozens of health care workers got sick. At least four nurses died.

Studies conducted after the H1N1 crisis found voluntary federal safety guidelines designed to limit the spread of airborne pathogens in medical facilities often weren’t being followed. There were also shortages of personal protective equipment.

“H1N1 made it very clear OSHA did not have adequate standards for airborne transmission and contact transmission, and so we began writing a standard to do that,” Michaels said.

HIV/AIDS rule set the standard for protecting workers

OSHA experts were confident new airborne infectious disease regulations would make hospitals and nursing homes safer when future pandemics hit. That’s because similar rules had already been created for bloodborne pathogens such as Ebola and hepatitis.

Those rules, implemented during the HIV/AIDS epidemic, forced the health care industry to adopt safety plans and buy more equipment designed to protect staff and patients.

But making a new infectious disease regulation, affecting much of the American health care system, is time-consuming and contentious. It requires lengthy consultation with scientists, doctors and other state and federal regulatory agencies as well as the nursing home and hospital industries that would be forced to implement the standard.

Federal records reviewed by NPR show OSHA went step by step through that process for six years, and by early 2016 the new infectious disease rule was ready. The Obama White House formally added it to a list of regulations scheduled to be implemented in 2017.

Then came the presidential election.

An emphasis on deregulation

In the spring of 2017, the Trump team formally stripped OSHA’s airborne infectious disease rule from the regulatory agenda. NPR could find no indication the new administration had specific policy concerns about the infectious disease rules.

Instead, the decision appeared to be part of a wider effort to cut regulations and bureaucratic oversight.

“Earlier this year we set a target of adding zero new regulatory costs onto the American economy,” Trump said in December 2017. “As a result, the never-ending growth of red tape in America has come to a sudden, screeching and beautiful halt.”

The impact on the federal effort to protect health care workers from diseases such as COVID-19 was immediate.

“The infectious disease standard was put on the back burner. Work stopped,” said Michaels, now a professor at George Washington University.

A medical worker is assisted into personal protective equipment on May 8 before stepping into a patient’s room in the COVID-19 intensive care unit at Harborview Medical Center in Seattle.

Elaine Thompson/AP

A deadly escalation of the H1N1 crisis

This spring, hospitals and nursing homes found themselves facing much of the same crisis they experienced during the H1N1 outbreak, with many facilities unprepared and unequipped. Only this time the scale was larger and deadlier.

The federal government reports that at least 43,000 front-line health care workers have gotten sick, many infected, while caring for COVID-19 patients in facilities where personal protective equipment was being rationed.

“Even just a few months ago, I couldn’t have imagined that I would have been on a Zoom call reading out the names of registered nurses who have died on the front lines of a pandemic,” said Bonnie Castillo, who heads the National Nurses United union.

“The memorial was not only about grief. It was also about anger.”

OSHA’s infectious disease rule debated in Washington

Castillo said Congress should immediately implement the infectious disease regulations shelved by the Trump administration as an emergency rule before a second wave of the coronavirus hits.

“Which obviously would mandate that employers have the highest level of PPE, not the lowest,” she said.

Democrats in the House of Representatives passed a bill in mid-May that would do so, but the Republican-controlled Senate has blocked the measure, and the White House still opposes the rules.

The Trump administration hasn’t responded to NPR’s repeated inquiries about the infectious disease rule. But in a briefing call with lawmakers this month, the current head of OSHA, Loren Sweatt, argued enough rules are already in place to protect workers.

“We have mandatory standards related to personal protective equipment and bloodborne pathogens and sanitation standards,” Sweatt said in a recording provided to NPR. “We have existing standards that can address this area.”

The hospital industry also opposes the new safety rules. Nancy Foster with the American Hospital Association said voluntary guidelines for airborne pandemics are adequate.

“You’re right; they’re not regulations, but they are the guidance that we want to follow,” Foster said. “They set forth the expectation for infection control, so in a sense they’re just like regulations.”

But the infectious disease standard would have required the health care industry to do far more. It sets out specific standards for planning and training. It would also have forced facilities to stockpile personal protective equipment to handle “surges” of sick patients such as the ones seen with COVID-19.

NPR also found the lack of fixed regulations allowed the Trump administration to relax worker safety guidelines. Federal agencies did so repeatedly this spring as COVID-19 spread and shortages of personal protective equipment worsened.

As a consequence, hospitals could say they were meeting federal guidelines while requiring doctors and nurses to reuse masks and protective gowns after exposure to sick patients.

 

 

 

Chicago hospitals blame 11th-hour legislation shakeup for ending $1B South Side project

Posted on by • Posted in Health Inequity, Health Policy, Health System, Hospital, Hospital Industry, Mergers & Acquisitions, Vulnerable Populations • Leave a comment

https://www.healthcaredive.com/news/chicago-hospitals-end-plans-for-new-south-side-system/578673/

Chicago hospitals blame 11th-hour legislation shakeup for ending ...

Dive Brief:

  • Four Chicago hospitals were on track to create a new health system designed to expand access to care to reduce health inequities on the city’s South Side, but the effort was derailed after state funding plans changed. The hospitals planned on receiving $520 million over five years from the state to offset any losses as they stood up the new system.
  • The hospitals are blaming an “eleventh-hour shift in the legislation” that they say forces them to abandon plans to form the new system, according to a letter sent to the director of the Illinois Department of Healthcare and Family Services. They contend a broad health bill as approved did not provide the requested funding.
  • The quartet warned that the move by the legislators would only continue to perpetuate health disparities among the African American community, also laid bare by the novel coronavirus claiming more African American lives in Chicago than whites.

Dive Insight:

The four hospitals — Advocate Trinity Hospital, Mercy Hospital and Medical Center (a member of Trinity Health), South Shore Hospital and St. Bernard Hospital — had ambitious plans for the underserved area of the city, in which nearly 60% of residents leave the area for care, leaders have claimed.

The group had planned to invest at least $1.1 billion to erect a new hospital and community health centers, targeted at reducing the health disparities. Average life expectancy is 30 years shorter for residents on the South Side compared to other parts of the city.

But forming a new health system would create financial challenges of its own, which is why the four hospitals were leaning on the state to help with funding.

The system “moved closer to reality in recent weeks, as the agreements for the complex legal transaction as well as the financial and operational models — have been refined and finalized,” the letter to the Illinois health official said.

The system even held virtual town hall meetings, convening more than 700 community leaders and residents across 11 ZIP codes to assess their needs and wants from the new provider.

But leaders blamed the failed plans due to changes in legislation that they expected to help fund the effort. The bill was approved by both the state Senate and House on Friday.

“You can imagine our profound disappointment that our project is not identified in the final form of the legislation and that, in fact, HFS cannot allocate funds associated with the hospital and health care transformation pool without further action,” according to the letter. ​

The group hopes that its business plan will serve as a resource for the state should a similar plan be developed in the future.

 

 

 

 

Providence, 1st to treat COVID-19 patient, posts $1.1B loss

Posted on by • Posted in Coronavirus, Economic Crisis, Economic Stimulus, Elective Procedures, Elective Surgery, Health System, Hospital, Hospital Industry, Net Income, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Telemedicine • Leave a comment

https://www.healthcaredive.com/news/providence-1st-to-treat-covid-19-patient-posts-11b-loss/578585/

Dr. Ryan Keay: Medicaid Plays a Crucial Role in Alleviating the ...

Dive Brief:

  • Providence posted a net loss of $1.1 billion and operating loss of $276 million for the first quarter of 2020, drastically down from a net gain of $543 million and operating loss of $4 million in the first quarter of 2019 as the COVID-19 pandemic has slashed financial operations for providers across the country.
  • The Catholic nonprofit system saw investment losses of $763 million as stock market volatility followed stay-at-home orders in March and April for much of the United States. That compared to a $582 million investment gain in the prior-year period.
  • Patient volumes dropped as Providence suspended non-emergency procedures amid the pandemic. Surgeries declined 8%, total outpatient visits dropped 3% and acute patient days were down 5%, according to a financial report filed late last week.

Dive Insight:

Providence Regional Medical Center in Everett, Washington, was the first to knowingly treat a COVID-19 patient in the United States — on Jan. 20. Since then, cases have plateaued, with the rate becoming “more manageable” throughout the communities Providence serves.

The system suspended elective procedures the week of March 16 and saw telehealth appointments skyrocket from an average of 50 visits per day to more than 12,000. “Now, the critical path forward is reopening services safely so that we can get back to patients who have delayed their care,” Providence CFO Venkat Bhamidipati said in a statement.

Providence reported receiving $509 million from the Coronavirus Aid, Relief, and Economic Security Act and $1.6 billion in accelerated Medicare payments. The system tapped $800 million in private credit lines as well. As of the end of the first quarter, Providence had 182 days cash on hand, down slightly from the prior-year period.

The hospital operator is far from alone in reporting steep first-quarter losses, and ratings agencies predict the second quarter will not be kind to nonprofits either.

So far, the system has not imposed layoffs but has cut overtime and seen voluntary furloughs and executive pay cuts. “If patient census and revenue does not return to anticipated levels, we would also consider involuntary options,” according to the filing.

Providence’s operating EBIDTA margin was down to 0.9% in the first quarter of this year from 5.5% in the first quarter of 2019.

Operating expenses increased 10% to $6.6 billion, driven by increases in labor costs and supplies. The system noted paying “significantly higher” premiums to obtain personal protective equipment and increased costs for ICU medications amid the pandemic.

The filing discloses a complaint under the California Corporations Code from earlier this month. It was filed by two of the three corporate members of Hoag Hospital, seeking to dissolve the third member and remove Hoag as an obligated group member. Providence states it “believes that the complaint is without merit, and believes the legal process will vindicate this position.”

The 51-hospital system created by the 2016 merger of Washington-based Providence and California-based St. Joseph is coming off a 2019 surplus of $1.36 billion, swinging to the black from 2018’s deficit of $445 million.

 

 

 

 

Why We Should Be Reading Albert Camus During the Pandemic

Posted on by • Posted in 2020 Election Issues, Blame, Clinical Testing, Conspiracy Theories, Contact Tracing, Coronavirus, Crisis, Crisis Management, Denial, Economic Crisis, Infection Control, Infection Control Plan, Infectious Virus, Leadership, Mortality, Pandemic, Public Health, Public Safety, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.governing.com/context/Why-We-Should-Be-Reading-Albert-Camus-During-the-Pandemic.html?utm_term=READ%20MORE&utm_campaign=Why%20We%20Should%20Be%20Reading%20Albert%20Camus%20During%20a%20Pandemic&utm_content=email&utm_source=Act-On+Software&utm_medium=email

Looking at Albert Camus's “The Plague” - The New York Times

The author’s masterpiece, The Plague, will make you think, ask all sorts of Socratic questions of yourself and form resolutions about how you intend to measure your life after getting through this global catastrophe.

It’s amazing how many pandemic books there are, and how thoroughly the idea of a global pandemic had crept into our popular culture well before the current situation. My daughter and I watched the Tom Hanks movie Inferno over the weekend, mostly because we wanted to gaze at the city of Florence. It’s not a great movie, but it is visually stunning in several ways. The plot is not something I gave much attention to when I first saw the film a couple of years ago: a rich Ted-talking eccentric decides to kill off most of the people of the world to save the Earth from over-population and the ravages 16 billion people would mean for other species and the health of the biosphere.

When I first saw the film in 2016, I regarded the plotline (will the vial of lethal germs be released or not?) as nothing but the usual “James Bond” setup for whatever else happened in the film. This time I watched it with greater alertness.

The fact is, of course, that COVID-19 is a serious global nuisance that has disrupted the lives of all Americans in a way that almost nobody could have predicted (well, there is Bill Gates, of course), but it is not the Black Plague, which swept away somewhere between one-fourth and one-half of all Europeans between 1348-1352, or the Yellow Fever epidemic in Philadelphia, which killed one in 10 inhabitants of America’s largest city in 1793, or the Spanish Flu, which killed somewhere between 57 and 100 million people worldwide in 1918.

If the coronavirus eventually kills 5 million people worldwide, and a couple of hundred thousand Americans before the vaccines gallop in to save the day a year or 18 months hence, it will have been a comparatively minor event in the history of global pandemics. The moment when it appeared that the hospital and medical infrastructure of New York might collapse has now passed. And though the death toll continues to climb towards perhaps 150,000 American dead by Aug. 1, 2020, the national dread that created a sustained will-we-survive and how-will-we-cope conversation in virtually every household in the United States is mostly over. The question now is when and how (and if) the country can return to what the late John McCain called regular order.

In the past two months I have read more than a dozen pandemic books, from Daniel Defoe’s A Journal of the Plague Year (1721), to Stephen King’s endless The Stand (1978). They are all interesting. If you outline the takeaway insights from these books, written over the span of many hundreds of years, they all make essentially the same points:

  1. Every government starts in denial, moves through some form of coverup, and eventually has to come to terms with the facts on the ground. 
  2. The rich flee to their country estates (or the Hamptons) and whine about all the inconvenience.
  3. The poor (as always) do most of the suffering, not merely because they are poor and have less access to the Maslovian necessities of life, but because they wind up putting themselves into harm’s way to help other people and even help the undeserving rich.
  4. The only sure methods of dealing with the epidemic (before the coming of vaccines) are social distancing, masks and the avoidance of direct body contact, and quarantining — and these do work.
  5. Economic activity grinds to a halt, but new forms of employment emerge, such as enforcing quarantines or monitoring the spread of the disease through contact tracing.
  6. People who have contracted the disease but who do not yet exhibit symptoms are the principal transmitters of the disease to others.
  7. Government has no choice but to subsidize the lives of people who have no savings and cannot work, because the alternative is food riots, looting, and perhaps revolution.
  8. Quacks, charlatans, and mountebanks abound, as always, to exploit exploitable people.
  9. Bad leaders and some portions of the population spend their time embracing and spreading conspiracy theories and searching for some group, some nation, some tribe to blame for the catastrophe.
  10. Social mores, including sexual codes, begin to break down as people slowly adopt an “eat, drink, and be merry, for tomorrow you shall certainly die” attitude.
  11. The natural sociability of humanity is such that we invariably rush back into the public square too soon, before the disease has been mastered, thus causing a second or a third wave of infection and death.

 

 

 

 

How Jefferson and Franklin Helped End Smallpox in America

Posted on by • Posted in 2020 Election Issues, Clinical Research, Clinical Trials, Leadership, Physician, Smallpox, Vaccination, Vaccine • Leave a comment

https://www.governing.com/context/How-Jefferson-and-Franklin-Helped-End-Smallpox-in-America.html

Drawing Lessons from a Government Protest in North Dakota

As the world eagerly awaits a vaccine for the coronavirus, 200 years ago a smallpox cure struggled to gain acceptance. This is how our founding fathers helped promote the medical breakthrough that saved countless lives.

The great scourge of Thomas Jefferson’s era (1743-1826) was smallpox. Historians have estimated that perhaps as many as 2 billion people have died of smallpox in recorded history. That’s a pretty arbitrary figure, but it certainly indicates how serious the problem was. Modern epidemiology has not only eliminated smallpox as a threat to civilization but has been engaged in a protracted debate about whether to snuff it out altogether once and for all, or to keep a tiny bit of it alive in a handful of tightly secured vials in case we need to study it in the face of other disease epidemics. It was officially declared eradicated in 1980.

For most of human history, you either got it or you didn’t and then you either survived it or you didn’t. George Washington was infected by smallpox in Barbados in 1751. He survived, and though he was slightly disfigured, he was thereafter immune to the disease. It is possible that this early brush with smallpox saved the American Revolution 20 years later. In 18th-century Europe, 400,000 people died annually of smallpox.

By the time Jefferson was born in 1743, there was an experimental inoculation procedure, but it was quite dangerous and therefore highly controversial. The idea was to give healthy individuals a very tiny amount of actual smallpox under quarantine and very carefully controlled conditions and simply hope that the person’s immune system would be able to fight it off. Survival would immunize that individual for life. The procedure required many weeks of quarantine, fasting, puking, and rest, followed by a very light diet through convalescence. John Adams wrote a fascinating account of his own inoculation in 1764. He was 28 years old.

Young Thomas Jefferson’s first journey out of his native Virginia was to Philadelphia in 1766 to be inoculated. He would have undertaken the procedure in Williamsburg or Norfolk had it been available. He made the long journey (eight to 10 days in either direction) because he wanted to protect himself from the disease and study the procedure at the same time for possible incorporation into his own community at Monticello. With his characteristic taciturnity about personal things, Jefferson did not leave us a detailed account of the medical procedure, which required prolonged isolation, personal discipline and a great deal of patience.

Inoculation was first introduced in Europe 40 years earlier. Lady Mary Wortley Montague (1689-1762) had spent time in Turkey as the wife of the British ambassador to the Ottoman Empire. There she had witnessed inoculation in the zenanas (segregated women’s quarters) she visited. She called the procedure “engrafting,” which she described in an important “Letter to a Friend” on April 1, 1717. Mrs. Montagu’s brother had died of smallpox four years earlier and she herself had survived a bout of smallpox in 1715, but with her famous beauty disfigured. She had her five-year-old son Edward inoculated in the British Embassy in Turkey.

Lady Mary Wortley Montagu in Ottoman Travel Dress. She was the first to introduce smallpox inoculation in Europe.

When she returned with her family to Britain, she became an outspoken advocate for the procedure. The English medical establishment decried inoculation and denounced Mary Montagu. Still, in 1721 when a smallpox epidemic broke out in England, she had her daughter inoculated in London. This was the first recorded use of the procedure in England. The medical establishment was slow to accept the efficacy of inoculation, which it regarded as an “oriental folk remedy.” It seemed counter-intuitive and just wrong-headed to give a healthy person a dose of smallpox to try to prevent her or him from getting it by accident. 

Franklin Learns About Inoculation the Hard Way

New England Puritan minister Cotton Mather (1663-1728) first promoted inoculation in America. In 1706, Reverend Mather purchased a black slave he named Onesimus (from the Epistle to Philemon). Ten years later, Onesimus told Mather he had been made immune to smallpox in Africa by having the pus of an infected person rubbed on an open wound on his arm. This is known as the variolation method. Mather interrogated other slaves to learn more, confirmed the story, and became an advocate for inoculation. He was subjected to the usual criticism and pushback. An explosive device was thrown through the window of his home. In this instance, racism joined fear as a means of discrediting the medical procedure. What possible wisdom could come from a slave?

The smallpox plague that disturbed Britain in 1721 found its way that same year to Boston. Now Mather and Dr. Zabdiel Boylston, the only physician in Boston who supported the technique, offered their inoculation services to anyone who would trust them. Of the 242 people Boylston inoculated, only six died, or one in 40. Of those who did not undergo the procedure, one in seven died.

America’s greatest exemplar of the Enlightenment, Benjamin Franklin, became a passionate advocate of the procedure after his first son Franky died of smallpox on Nov. 21, 1736, at the age of four. Because Franklin was known to be a friend to inoculation, rumors spread in Philadelphia that Franky had died from the procedure. To set the record straight, the grieving father wrote an article in the Pennsylvania Gazette on Dec. 30, 1736: He had “intended to get [Francis] inoculated as soon as he should have recovered sufficient strength from a flux with which he had been long afflicted.” Franklin assured the public that his son “received the distemper in the common way of infection.”

In 1774, Franklin, who was an indefatigable creator of associations, societies, clubs and public institutions, including volunteer fire departments and lending libraries, established the Society for Inoculating the Poor Gratis to help the poor people of Philadelphia have access to inoculation. In his famous autobiography, Franklin wrote: “In 1736 I lost one of my sons, a fine boy of four years old, by the smallpox taken in the common way. I long regretted bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of the parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it.”

Edward Jenner and the Fight to Vaccinate

As a young man, the future English physician Edward Jenner (1749-1823) overheard an English milkmaid say, “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” Many years later, remembering the incident, Jenner, now a doctor, interrogated other milkmaids and then experienced one of the most important “eureka” moments in history. Without understanding how germs work, with no knowledge of anything called a virus, Dr. Jenner realized that cowpox (also known as kinepox) must be closely related to smallpox, and that surviving it seemed to make individuals immune to the more deadly disease. He reckoned that cowpox and smallpox must share some essential epidemiological element and since cowpox was neither lethal nor usually disfiguring, careful use of cowpox material would represent a superior protection against smallpox than variolation, which was a more dangerous procedure.

On May 14, 1796, Jenner inoculated an eight-year-old boy named James Phipps with kinepox pus. Phipps developed mild fever and discomfort. Ten days later he felt fine. Two months after that, Dr. Jenner inoculated the boy again, but this time with serum from a fresh smallpox sore. No disease developed. The smallpox vaccine had been born. Our term “vaccination” dates from this episode. Vaccination comes from the Latin word for cow, “vacca.” Jenner called the cowpox serum “vaccinia.” The terminology reminds us that all western vaccination stems from this moment in 1796.

No good deed goes unpunished, apparently, not even one that changes the history of the planet. In Britain, Edward Jenner was subjected to the usual harassment and ridicule. The paper he submitted to the Royal Society of England was rejected by none other than Sir Joseph Banks, one of Britain’s premier naturalists, botanists, and patrons of science. It took many years and the vaccination experiments of other physicians and scientists before Jenner’s work was vindicated.

Eventually, Jenner received worldwide recognition for his discovery. Devoted like Jefferson to the philanthropic principles of the Enlightenment, Dr. Jenner not only made no effort to enrich himself but devoted so much of his time and energy to promoting vaccination that he endured periods of real poverty. Finally, in 1802, the British Parliament voted him a reward of £10,000. Five years later he received £20,000 more from Parliament.

The true vaccine found its way to America thanks to Dr. John Haygarth of Bath. He sent some of Jenner’s material to Benjamin Waterhouse, a professor of physics at Harvard University. Waterhouse, in turn sent serum and reports of the vaccine’s efficacy to Thomas Jefferson, now the third president of the United States.

Dr. Edward Jenner discovered the true smallpox vaccine in 1796.

Jefferson’s Scientific Approach to Vaccines

In the new world, inoculation had a very rough reception. When John Dalgleish and Archibald Campbell began inoculating individuals in Norfolk, Virginia, an angry mob burned down Campbell’s house. Similar incidents occurred in Salem and Marblehead, Mass. In Charleston, S.C., an inoculation control law of 1738 imposed a fine of £500 on anyone providing or receiving inoculation within two miles of the city. A similar law was passed in New York City in 1747.

The measures in New England were so draconian that Benjamin Waterhouse noted the paradox: “New England, the most democratical region on the face of the earth voluntarily submitted to more restrictions and abridgements of liberty, to secure themselves against that terrific scourge, than any absolute monarch could have enforced.” (This, strangely prescient, anticipates the current debate about liberty versus public health). It was in the middle colonies — Maryland, Pennsylvania, New Jersey — that inoculation was most tolerated in the second half of the 18th century. That’s why Jefferson made the long journey to Philadelphia to be inoculated in 1766.

Jefferson first became aware of the discovery of a true smallpox vaccine from the newspapers he read in Philadelphia and the new capitol in Washington, D.C. Then, on Dec. 1, 1800, just after Jefferson’s election to the presidency, Benjamin Waterhouse sent him his pamphlet on the vaccine with a lovely cover letter saying that he regarded Jefferson as “one of our most distinguished patriots and philosophers.” Jefferson responded immediately, thanking Waterhouse for the publication and declaring, with his usual grace, that “every friend of humanity must look with pleasure on this discovery, by which one evil the [more] is withdrawn from the condition of man: and contemplating the possibility that future improvements & discoveries, may still more & more lessen the catalogue of evils. in this line of proceeding you deserve well of your [country?] and I pray you to accept my portion of the tribute due you.”

The following June, Waterhouse sent Jefferson a long letter explaining how the vaccine must be administered, how the serum could be preserved over time, and how much the controversial procedure needed the public support of a man of Jefferson’s stature in the “republic of letters.” President Jefferson became known as a defender and promoter of vaccination. In fact, he even arranged for his protégé Meriwether Lewis to carry some of the serum with him up the Missouri River in 1804-05, instructing him to “carry with you some matter of the kine pox, inform those of them with whom you may be, of its efficacy as a preservative from the small pox; and instruct & encourage them in the use of it. This may be especially done wherever you may winter.” Unfortunately, by the time the Lewis and Clark Expedition reached their winter encampment in today’s North Dakota, the serum had become inert. Thus Jefferson’s philanthropic initiative to vaccinate the Native Americans of the American West was stillborn.

Then, on May 14, 1806, now in his second term, Jefferson wrote perhaps the greatest presidential fan letter of all time. He took time from his duties as president to write the following letter to Edward Jenner. I quote it in its entirety:

SIR,— I have received a copy of the evidence at large respecting the discovery of the vaccine inoculation which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts, in this part of the globe, to its efficiency, I took an early part in recommending it to my countrymen. I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey’s discovery of the circulation of the blood was a beautiful addition to our knowledge of the animal economy, but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated. Accept my fervent wishes for your health and happiness and assurances of the greatest respect and consideration.

Who would not have wished to receive this magnificent, selfless, public-spirited, and enlightened letter? Unfortunately, we do not know how or even if Dr. Jenner responded. Except in medical circles, Edward Jenner has been largely forgotten.

 

 

 

 

 

McLaren Health Care’s too secretive about finances, PPE, Michigan nurse union says

Posted on by • Posted in Coronavirus, Economic Stimulus, Elective Procedures, Elective Surgery, Employee Benefits, Employee Hazard Pay, Employee Layoffs, Employee Pay Cuts, Executive Compensation, Health System, Healthcare Providers, Hospital, Hospital Industry, Labor Union, National Labor Relations Board, Pandemic, Personal Protective Equipment (PPE), Sick Leave, Transparency, Unfair Labor Practices • Leave a comment

https://www.beckershospitalreview.com/workforce/mclaren-health-care-s-too-secretive-about-finances-ppe-michigan-nurse-union-says.html?utm_medium=email

About McLaren Health Care

Ten nurse unions in Michigan are accusing McLaren Health Care of not being transparent about its finances and personal protective equipment supply during the COVID-19 pandemic, but the health system said it has shared some of that information.

Many of the nurse unions have filed unfair labor practice charges with the National Labor Relations Board, alleging that by not sharing information with front-line healthcare workers the Grand Blanc, Mich.-based health system is violating federal labor law, a media release from the Michigan Nurses Association states.

According to the association, each of its 10 unions received a letter from the health system May 15, in which the system refused to divulge how much funding it received in federal COVID-19 grants. The health system also has refused to provide details about its protective gear inventory, the unions allege.

“The fact that they won’t share basic financial information with those of us working on the front lines makes you wonder if they have something to hide,” said Christie Serniak, a nurse at McLaren Central Michigan hospital in Mount Pleasant and president of the Michigan Nurses Association affiliate.

But the health system maintains it has been transparent and has worked with labor unions and bargaining units across the system since the beginning of the coronavirus pandemic.

“We’ve openly shared information about our operations, the challenges of restrictions on elective procedures, our plans for managing influxes of patients and our supplies of personal protective equipment,” Shela Khan Monroe, vice president of labor and employment relations at McLaren Health Care told Becker’s Hospital Review.

Ms. Khan Monroe said that the information has been shared through weekly meetings, departmental meetings and several union negotiation sessions over the last two months.

The unions also say that the health system has not offered its workers hazard pay or COVID-19 paid leave that is on par with other systems. They say that only workers who test positive for COVID-19 can take additional paid time off.

In a written statement, McLaren disputed the union’s claims about employee leave, saying that employees “dealing with child care and other COVID-related family matters” can take time off to care for loved ones.

McLaren did not specify if this time off is paid. Becker’s has reached out for clarification and will update the article once more information is available.

“We have negotiations pending with several of the unions involved in the coalition, and while we are deeply disappointed in these recent tactics, we will continue to work towards productive outcomes for all concerned,” said Ms. Khan Monroe.

Recently, a coalition of unions urged McLaren Health Care executives to reduce their own salaries before laying off employees.

 

 

 

UW Medicine to furlough 4,000 union employees

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https://www.beckershospitalreview.com/finance/uw-medicine-to-furlough-4-000-union-employees.html?utm_medium=email

UW Medicine furloughing 1,500 staffers | News | dailyuw.com

UW Medicine will furlough approximately 4,000 unionized employees due to financial challenges related to COVID-19 response, the Seattle-based organization said May 25.

The furloughs will last at least one week and as many as eight weeks. Affected employees will maintain their healthcare benefits, including insurance, during the furlough.

“This has been a very difficult, but necessary, decision to address the financial challenges facing UW Medicine and all healthcare organizations responding to the COVID-19 pandemic,” Lisa Brandenburg, president of UW Medicine Hospitals & Clinics, said in a news release. “We have taken deliberate steps to ensure patient care is not impacted by aligning staff levels with current and predicted patient volumes including the return of elective procedures, expanded in-person clinical services and continued expansion of telehealth, while ensuring UW Medicine is prepared to respond to future surges of patients with COVID-19.”

The decision comes one week after UW Medicine announced furloughs of 1,500 professional and nonunion staff members. UW Medicine said executive leaders, directors and managers are also participating in furloughs.

The actions are intended to help the organization address an anticipated $500 million loss from the pandemic.