White House goes quiet on coronavirus as outbreak spikes again across the U.S.

https://www.politico.com/news/2020/06/10/white-house-stops-talking-about-coronavirus-309993?utm_source=ActiveCampaign&utm_medium=email&utm_content=Mnuchin%3A+More+Stimulus++Definitely++Needed&utm_campaign=TFT+Newsletter+06102020

White House goes quiet on coronavirus as outbreak spikes again ...

The coronavirus is still killing as many as 1,000 Americans per day — but the Trump administration isn’t saying much about it.

It’s been more than a month since the White House halted its daily coronavirus task force briefings. Top officials like infectious disease expert Anthony Fauci have largely disappeared from national television — with Fauci making just four cable TV appearances in May after being a near fixture on Sunday shows across March and April — and are frequently restricted from testifying before Congress. Meanwhile, President Donald Trump is preparing to resume his campaign rallies after a three-month hiatus, an attempted signal to voters that normalcy is returning ahead of November’s election, and that he’s all but put the pandemic behind him.

“We’ve made every decision correctly,” Trump claimed in remarks in the Rose Garden Friday morning. “We may have some embers or some ashes or we may have some flames coming, but we’ll put them out. We’ll stomp them out.”

Inside the White House, top advisers like Jared Kushner privately assured colleagues last month that the outbreak was well in hand — citing data on declines in community spread — and that the long-feared “second wave” may have even been averted, according to three current and former officials.

However, new data from states like Florida and mass protests across the country are renewing concerns about the virus’s spread. Texas, for instance, has reported two straight days of record-breaking coronavirus hospitalizations — highs that come shortly after the state kicked off the third stage of its reopening plan.

Those officials also acknowledge that the Covid-19 task force has scaled back its once-daily internal meetings — the task force now meets twice per week — but insist that the pandemic response remains a priority. One official with direct knowledge of the administration’s strategy cited efforts to scale up testing, accelerate the development of treatments and vaccines and perform other behind-the-scenes work to get ready for a potential fall surge.

“We’re delivering the supplies and resources that states asked for,” said the official. “This doesn’t need to be the public ‘coronavirus show’ every day anymore.”

“You can’t win,” said a senior administration official. “Some people complained for weeks that ‘we don’t want so much White House involvement,’ and that ‘the President should stop doing daily briefings,’ and then they turn around and complain that there aren’t enough or as many briefings.”

But the White House’s apparent eagerness to change the subject comes as new coronavirus clusters — centered around meatpacking plants, prisons and other facilities — drive spikes in disparate states like Utah and Arkansas. Meanwhile, states and major cities are lifting lockdowns and reopening their economies, prompting public health experts to fret that additional outbreaks are imminent. And several Democratic governors also have defied their own states’ social distancing restrictions to join mass protests over police brutality, where hundreds of thousands of Americans have spilled into the streets, further raising public health risks.

The fear is that all the mixed signals will only confuse people, stoke public skepticism over the health threat and promote the belief the worst is over just as the outbreak enters a dangerous new phase.

“Cases are rising, including from cases in congregate settings,” said Luciana Borio, who led pandemic preparedness for the National Security Council between 2017 and 2019. “We still have a pandemic.”

Nine current and former administration officials, as well as outside experts, further detailed how the White House is steadily ramping down the urgency to fight a threat that continues to sicken more than 100,000 Americans per week and is spiking in more than 20 states.

For instance, the administration in recent days told state health officials that it planned to reorganize its pandemic response, with HHS and its agencies taking over the bulk of the day-to-day responsibilities from the Federal Emergency Management Agency.

“The acuity of the response is not what it was, so they’re trying to go back to a little more of a normal ongoing presence,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials.

The coronavirus task force, which used to send daily updates to state officials, has done so with less regularity over the last several weeks, Plescia said. And the CDC has restructured its daily conference calls with states, moving away from the practice of giving top-down briefings to encouraging state officials to offer updates on what they’re seeing in their parts of the country.

One current and one former FEMA official also said they’re keen to have HHS resume its leadership role in containing the coronavirus so FEMA can make contingencies for a summer of hurricanes, floods and other natural disasters.

“Given the likelihood that we will soon see both hurricanes and coronavirus, HHS should manage the ongoing pandemic response so FEMA can prepare for coming ‘coronacanes,’” Daniel Kaniewski, who served as the top deputy at FEMA through January, wrote last week. “But they need to act soon. Coronacanes are in the forecast.”

Meanwhile, officials in at least 19 states have recorded two-week trends of increasing coronavirus cases, including spikes of more than 200 percent in Arizona and more than 180 percent in Kentucky. Two months after the White House issued so-called gating criteria that it recommended states hit before resuming business and social activities, only a handful of states — like Connecticut, New Jersey, New York and South Dakota — currently meet all of those benchmarks, according to CovidExitStrategy.org.

Officials within Trump’s health department are strategizing over how to convey the current level of risk, given data that Americans have put off emergency care and other potential medical needs, fearful of contracting Covid-19. “Our message now is that people should start returning to their health care providers to get the screenings, vaccines, care, or emergency services that they need,” Laura Trueman, the HHS official in charge of external affairs, wrote in an office-wide email to colleagues and shared with external groups on June 3, which was obtained by POLITICO.

Dan Abel, a longtime Coast Guard vice admiral, also has been installed at HHS with a small team, where he’s coordinating daily Covid-19 calls with HHS Secretary Alex Azar and the department’s division leaders, according to four officials with knowledge of the calls — an arrangement that’s raised some questions.

“Why is a Coast Guard admiral leading meetings between the HHS secretary and his senior staff?” asked one senior official, suggesting it created an unnecessary layer of management.

Meanwhile, the department is steadily turning back to its many pre-Covid-19 priorities. At the Food and Drug Administration, officials are returning to hot-button issues like tobacco and CBD regulations. Some staff in the health department’s emergency response arm are pivoting away from Covid-19 and back toward natural disasters as hurricane season begins.

At the same time, the Centers for Disease Control — traditionally the beating heart of the nation’s infectious disease response — remains largely demoralized and often sidelined in fighting what CDC director Robert Redfield last week acknowledged as the nation’s biggest health challenge in more than a century, and one he said is “moving through our social consciousness, our outward expression, and our grief.” That grim message has conflicted with Trump’s frequent vows of victory over the coronavirus.

“We were able to close our country, save millions of lives, open,” Trump said in Friday’s Rose Garden remarks. “And now the trajectory is great.”

“I fully recognize the anguish our Nation is experiencing & am deeply saddened by the many lives lost to COVID19,” Redfield tweeted just minutes later. “I call upon the American people to remain vigilant in protecting the vulnerable – protect your community, grandparents and loved ones from COVID-19.”

Redfield and other top officials also have spent the past week reckoning with the implications of widespread protests over police brutality, from meeting with staff to discuss longstanding concerns about systemic racism in health care to acknowledging the probability that those protests will spark new outbreaks.

HHS also on Monday sent members of Congress a fact sheet on its response to racial disparities in Covid-19 care — a much scrutinized issue in public health, with African Americans contracting and dying from the virus at much higher rates.

But on Capitol Hill, watchdogs say that fact sheets don’t cut it, and they’re frustrated by the lack of access to experts and insight into how the administration is handling a historic pandemic.

“Some are acting like the battle has been won when in reality it’s just beginning,” said a senior Democratic staffer. “The White House still won’t let task force members testify at hearings in June even though they have disappeared from TV and it’s not clear how often they are meeting.”

Fauci, meanwhile, has continued to issue a string of dire warnings in his lower-profile media appearances and at an industry conference on Tuesday.

We have something that turned out to be my worst nightmare,” Fauci said in virtual remarks aired at a conference of the biotech industry’s Washington trade group, recounting how quickly the virus spread around the globe, outpacing Ebola and HIV. “And it isn’t over yet.”

The White House has maintained that chief of staff Mark Meadows has needed to clear officials like Fauci to testify, so they can stay focused on other priorities, and a spokesperson insisted that Trump has still prioritized the coronavirus fight even as the White House shifts toward focusing on revitalizing the economy.

Several officials have suggested that the task force’s lower profile has been helpful for the response, especially because the daily Covid-19 press briefings were often hijacked by Trump’s meandering remarks or the day’s other political news.

“In some ways, it actually has been easier to get Covid-related work done,” said one HHS staffer who’s helped support the Covid-19 response. “The task force briefings and the prep sessions for them took up a lot of principals’ time, and staff would sometimes have to crash on putting together materials for them.”

But the white-hot spotlight on the coronavirus also brought urgency and intensity, and the increasingly scattered nature of the current response could present new challenges if there’s an uptick in cases.

“This is when a one-government approach is needed more now than ever,” said Howard Koh, who served as President Barack Obama’s HHS assistant secretary for health. “Get all those people together in one room every day at the highest level and track outcomes and address all the questions and try to maximize coordination as much as possible.”

 

 

 

 

Dow Falls 250 Points After Federal Reserve’s Grim Economic Outlook

https://www.forbes.com/sites/sergeiklebnikov/2020/06/10/dow-falls-250-points-after-federal-reserves-grim-economic-outlook/?utm_source=newsletter&utm_medium=email&utm_campaign=news&utm_campaign=news&cdlcid=#50eb6c4f56be

Dow Falls 250 Points After Federal Reserve's Grim Economic Outlook

TOPLINE

The market finished slightly lower on Wednesday after the Federal Reserve indicated that it would leave interest rates unchanged until 2022, while also warning of a long economic recovery from the coronavirus recession.

KEY FACTS

The Dow Jones Industrial Average fell 0.9%, over 250 points, on Wednesday, while the S&P 500 was down 0.5% and the tech-heavy Nasdaq Composite gained 0.7%.

The Federal Reserve concluded its two-day meeting on Wednesday by leaving interest rates unchanged near zero and indicating that they will stay there until 2022.

It also gave a grim update on the economy: The Central Bank forecasts a long recovery, with unemployment likely to remain high for many years.

The Fed, which has injected nearly $3 trillion into financial markets since late February, pledged to continue its unprecedented stimulus plan until the economy has weathered the coronavirus recession.

The Nasdaq climbed to a new record high on Wednesday, however, closing above 10,000 for the first time ever thanks to continued strength in tech stocks. Investors continued to rotate back into names like Amazon and Apple, which both hit new record highs again.

“A large shift is occurring as investors cycle out of value/cyclical stocks for a second day and pour money into growth,” according to Vital Knowledge founder Adam Crisafulli.

Stocks that would benefit from a reopening—including airlines, retailers and cruise operators—have all been moving lower recently, after having led the market rally in the past few weeks.

Bank stocks were especially hard-hit on Wednesday, plunging on the news that the Fed will keep interest rates low for a long time.

CRUCIAL QUOTE

“We are not even thinking about thinking about raising rates,” Federal Reserve chairman Jerome Powell confirmed at his press conference. He added that while “there is great uncertainty about the future,” the central bank is strongly committed to doing “whatever we can, for as long as it takes” to help support the economy. 

BIG NUMBER: 10,000.

With tech stocks making a comeback in recent days, the Nasdaq hit a new record high on Wednesday, closing above 10,000 for the first time ever. Shares of Amazon, Apple, Netflix, Microsoft and Google-parent Alphabet have all been soaring recently, boosting the index higher.

KEY BACKGROUND

Stocks have continued to rally on optimism about reopening the economy and a faster than expected recovery from the coronavirus pandemic. The market has so far had a strong start to June, building on back-to-back monthly gains. The S&P 500 on Monday turned positive for 2020, fully recouping its losses from the coronavirus sell-off earlier this year. The index is now up more than 45% from its low point on March 23.

 

 

 

 

HCA seeks nurse backup ahead of potential strike

https://www.healthcaredive.com/news/hca-seeks-nurse-backup-ahead-of-potential-strike/579502/

Dive Brief:

  • HCA is looking for qualified nurses in the event of a job action against its facilities in Los Angeles, such as a strike, according to a job posting from May 29. The giant hospital chain did not respond to multiple requests for comment.
  • The country’s largest nurses union, National Nurses United, has recently disputed with the system over other pandemic-related labor issues. Nurses at 15 HCA hospitals protested in late May over contractually bargained wage increases the hospital says it can’t deliver due to financial strains, asking nurses to give up the increases or face layoffs.
  • Another dispute involves a last-minute change mandating in-person voting for nurses deciding whether to form a union at HCA’s Mission Hospital in Asheville, North Carolina, according to an NNU release.

Dive Insight:

Nashville-based HCA Healthcare, the largest among for-profit hospital operators, has received the most among for-profits in Coronavirus Aid, Relief and Economic Security Act funding so far, about $1 billion. The amount is about 2% of HCA’s total 2019 revenue.

The 184-hospital system said it has not had to furlough any employees like other systems have, though some employees have been redeployed or seen their hours and pay decrease. HCA implemented a program providing seven weeks paid time off at 70% of base pay that was scheduled to expire May 16, but extended through June 27.

An NNU spokesperson told Healthcare Dive the program isn’t technically a furlough because some HCA nurses participating said they must remain on call or work rotating shifts.

The union spokesperson also confirmed that an email was sent to HCA nurses referring them to the strike-nurse job posting, which would offer more pay than their current roles.

“This really is a threat to nurses, and particularly insulting when you already have layoffs or cuts, if you don’t accept further concessions,” a union spokesperson told Healthcare Dive.

Nurses in California joined those in five other states at the end of May to protest HCA’s proposal to cut wage increases or impose layoffs.

At HCA’s Regional Medical Center in San Jose, California, NNU filed a suit to block the closure of the maternal-child care center, which it said is in violation of laws to protect the health and safety of the community. The closure proceeded anyway on May 30, followed by an announcement from Santa Clara County that the move may be jeopardizing the facility’s Level II Trauma designation agreement.

Across the country, frontline caregivers continue noting a lack of adequate personal protective equipment. The union’s executive director, Bonnie Castillo, will testify before Congress on Wednesday on protecting nurses during the pandemic and the dire need for optimal PPE.

 

 

 

After criticism, HHS directs $25B in CARES funding to Medicaid providers, safety net hospitals

https://www.healthcaredive.com/news/after-criticism-hhs-directs-25b-in-cares-funding-to-medicaid-providers-s/579496/

Dive Brief:

  • HHS announced Tuesday it will deliver $25 billion to providers and hospitals that serve the nation’s most vulnerable patients, or those with Medicaid and Children’s Health Insurance Program coverage. Of that, $15 billion will go to providers that primarily serve Medicaid and CHIP patients while the other $10 billion is reserved for safety net hospitals that usually operate on razor-thin margins. A total of 758 safety net hospitals will receive direct deposits, and the administration noted that many of these facilities are operating in the red with an average profit margin of -7%.
  • Not all Medicaid providers received Coronavirus Aid, Relief, and Economic Security funding from the initial general distribution. This targeted allocation is designed to make up for that by distributing money to the remaining 38% of Medicaid and CHIP providers who were left out of the first tranche.
  • These Medicaid providers will receive at least 2% of reported gross patient revenue, but could receive more depending on how many patients they serve. HHS will make a final determination once providers start submitting data to the relief portal.

Dive Insight:

The industry has been clamoring for HHS to target funding to Medicaid providers amid the COVID-19 pandemic and the downturn in business, noting these organizations are already on fragile ground.

Last week the American Hospital Association pleaded for the administration to release $50 billion more for all hospitals, with $10 billion reserved for providers with a heavy caseload of Medicaid patients.

HHS answered the hospital lobby’s call — in part. HHS will distribute funds to safety net providers — more than AHA asked for — but disclosed no plans Tuesday to broaden that funding to all hospitals. America’s Essential Hospitals, which represents safety net providers, had also called for the quick release of targeted funding.

“Our goal for all these distributions has been to get the money to the providers who need it most as soon as possible,” Eric Hargan, HHS deputy secretary, said Tuesday during a call with reporters.

However, some have been critical of how the administration decided to allocate the first few waves of funding.

Congress has earmarked a total of $175 billion in funding for providers through two pieces of legislation, including the CARES Act.

To get the money out the door quickly, the first tranche was sent to providers based on the Medicare fee-for-service business, and later on the net patient service revenue.

These formulas put certain providers at an advantage, which tend to be for-profit hospitals with higher-margins, or those who were already well off heading into the pandemic, according to a recent Kaiser Family Foundation analysis.

This targeted funding was not swift, one reason for the delay was the challenge in getting a list of Medicaid providers from the states to validate and authenticate those who came to the portal to apply for funds, according to a senior HHS official.​

Still, providers that have already received funds have noted that it comes with its own set of headaches. Some have decided to return the funds as navigating the legal and compliance issues may not be worth the hassle.

Though, that’s likely not the case for these safety net hospitals and providers.

 

 

 

 

ThedaCare physicians, advanced practice clinicians take pay cuts

https://www.beckershospitalreview.com/compensation-issues/thedacare-physicians-advanced-practice-clinicians-take-pay-cuts.html?utm_medium=email

ThedaCare pay cuts: Doctors, advanced practice clinicians affected

ThedaCare physicians and advanced practice clinicians will take a 10 percent pay cut to help reduce the Appleton, Wis.-based health system’s financial hit due to the COVID-19 pandemic, the organization confirmed to The Post-Crescent.

The physicians and advanced practice clinicians — which include physician assistants and nurse practitioners — will see their pay reduced beginning in June, Cassandra Wallace, a ThedaCare spokesperson, told the newspaper.

ThedaCare is projecting a $70 million loss this year after temporarily postponing revenue-generating elective surgeries and nonurgent clinic visits due to the COVID-19 pandemic. The health system began a phased approach to reinstate services last month, but the recommended suspension and the costs associated with COVID-19 preparation resulted in net revenue dropping 40 percent in April, ThedaCare said in a June 4 news release.

The salary reductions are part of the health system’s plan to narrow its projected loss to $30 million, said Imran A. Andrabi, MD, ThedaCare president and CEO.

Dr. Andrabi has also agreed to take a 50 percent pay cut, and other executive leaders will take a 40 percent cut to improve the health system’s financial picture.

Additionally, ThedaCare leaders will not be eligible for incentive compensation for 2020, the health system said.

The health system’s plan does not include mass layoffs.

 

 

 

 

8 nonprofit health systems got $1.7B bailout, furloughed more than 30,000 workers

https://www.beckershospitalreview.com/finance/8-nonprofit-health-systems-got-1-7b-bailout-furloughed-more-than-30-000-workers.html?utm_medium=email

Sixty of the largest hospital chains in the U.S., including publicly traded and nonprofit systems, have received more than $15 billion in emergency funds through the Coronavirus Aid, Relief and Economic Security Act, according to an analysis by The New York Times

Congress has allocated $175 billion in relief aid to hospitals and other healthcare providers to cover expenses or lost revenues tied to the COVID-19 pandemic. The first $50 billion in funding from the CARES Act was distributed in April. Of that pool, HHS allocated $30 billion based on Medicare fee-for-service revenue and another $20 billion based on hospitals’ share of net patient revenue. HHS also sent $12 billion to hospitals that provided inpatient care to large numbers of COVID-19 patients and $10 billion to hospitals and other providers in rural areas.

Though one of the goals of the CARES Act was to avoid job losses, at least 36 of the largest  hospital systems that received emergency aid have furloughed, laid off or reduced pay for workers, according to the report.

Approximately $1.7 billion in bailout funds went to eight large nonprofit health systems: Mayo Clinic in Rochester, Minn.; Trinity Health in Livonia, Mich.; Beaumont Health in Southfield, Mich.; Henry Ford Health System in Detroit; SSM Health in St. Louis; Mercy in St. Louis; Fairview Health in Minneapolis; and Prisma Health in Greenville, S.C. Mayo Clinic furloughed or cut hours of about 23,000 workers, and the other seven health systems furloughed or laid off a total of more than 30,000 employees in recent months, according to The New York Times.

The pandemic has taken a financial toll on hospitals across the U.S. They’re losing more than $50 billion per month, according to a report from the American Hospital Association. Of the eight nonprofit systems that collected $1.7 billion in relief aid, several have reported losses for the first quarter of this year, which ended March 31. For instance, Mayo Clinic posted a $623 million net loss, SSM Health’s loss totaled $471 million, and Beaumont and Henry Ford Health System reported losses of $278 million and $235 million, respectively.

Since CARES Act payments were automatically sent to hospitals, some health systems have decided to return the funds. Kaiser Permanente, a nonprofit system, is returning more than $500 million it received through the CARES Act. The Oakland, Calif.-based health system ended the first quarter with a $1.1 billion net loss.

Access the full article from The New York Times here

 

 

 

South Asia emerges as a new coronavirus hotspot

https://www.axios.com/india-coronavirus-cases-south-asia-pakistan-5447da22-7418-43f7-a17a-d247b92e4205.html

Featured image

India opened up restaurants, shopping malls and places of worship today even as it recorded a record-high 9,971 new coronavirus cases, the third-most worldwide behind Brazil and the U.S.

Why it matters: Lockdowns are being lifted in South Asia — home to one-quarter of the world’s population — not because countries are winning the battle against COVID-19, but because they simply can’t sustain them any longer.

Flashback: For a time, South Asia was cited as a source of optimism because relatively few cases and deaths were being recorded despite large, dense populations.

  • Lockdowns came relatively early, with varying severity (India’s was considerably stricter than Pakistan’s, for example).
  • Outbreaks have continued to accelerate, however. Pakistan’s daily case count is now on par with the U.K.’s and six times Germany’s, adjusted for population.
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios

Limited testing means South Asia’s outbreaks could actually be far more severe. India, for example, is testing at one-twentieth the rate of the U.S.

  • John Clemens, an epidemiologist at ICDDR,B (formerly the International Centre for Diarrheal Disease Research, Bangladesh), estimates that Bangladesh’s capital, Dhaka, may have up to 750,000 cases — 12 times the official tally, per the Economist.
  • The official numbers still show India, Pakistan and Bangladesh with the third-, seventh- and tenth-most new cases in the world over the past three days, respectively.

Bhramar Mukherjee, a professor at the University of Michigan who has been modeling India’s outbreak, tells Axios that while some states have hit initial peaks, she doesn’t expect a national peak until late July or August.

  • While the transmission rate has slowed, “you see this steady rise in cases because the population is so large.” She expects the numbers to fall slowly after the peak, unlike the trajectory in Europe.
  • The numbers can be unreliable, Mukherjee says, with some states fearing that testing symptomatic people will cause them to “look bad” as cases rise.
  • She also worries that India didn’t use the lockdown period to build up testing and hospital capacity.
  • “It’s really chaos unfolding in Mumbai and Delhi, and I think unfortunately India is going to be at the top of the list in terms of cases,” she says.

Zoom in: Mumbai has launched an app to help people locate hospitals with empty beds, but such is the scarcity that they’re often full by the time patients arrive, WSJ reports. Some die without ever receiving treatment.

  • Morgues are overfull t00. There are reports of patients being treated in rooms that also contain dead bodies.
  • Public hospitals in Delhi, home to 26 million people, are also reportedly full and turning people away.

The coronavirus likely arrived in Mumbai with wealthy people returning from abroad, before spreading among poorer people and to slums where social distancing is hardly an option.

  • That pattern has been seen elsewhere in the developing world, including in cities like Rio de Janeiro.
  • There’s an additional complication in India’s case, though. After initially failing to account for migrant workers when implementing the lockdown, the government started to transport them to their home villages on special busses and trains.
  • The virus traveled too. 71% of cases recorded in Bihar, a state in eastern India, have been linked to returning workers, Foreign Policy reports.

The bottom line: South Asian governments attempted to balance health and hunger, knowing they could only shut down their largely informal economies for so long.

  • But with health care systems already stretched and case counts continuing to rise, they’re opening up with more hope than confidence.

 

Hospitals Got Bailouts and Furloughed Thousands While Paying C.E.O.s Millions

Hospitals Got Bailouts and Furloughed Thousands While Paying ...

Dozens of top recipients of government aid have laid off, furloughed or cut the pay of tens of thousands of employees.

HCA Healthcare is one of the world’s wealthiest hospital chains. It earned more than $7 billion in profits over the past two years. It is worth $36 billion. It paid its chief executive $26 million in 2019.

But as the coronavirus swept the country, employees at HCA repeatedly complained that the company was not providing adequate protective gear to nurses, medical technicians and cleaning staff. Last month, HCA executives warned that they would lay off thousands of nurses if they didn’t agree to wage freezes and other concessions.

A few weeks earlier, HCA had received about $1 billion in bailout funds from the federal government, part of an effort to stabilize hospitals during the pandemic.

HCA is among a long list of deep-pocketed health care companies that have received billions of dollars in taxpayer funds but are laying off or cutting the pay of tens of thousands of doctors, nurses and lower-paid workers. Many have continued to pay their top executives millions, although some executives have taken modest pay cuts.

The New York Times analyzed tax and securities filings by 60 of the country’s largest hospital chains, which have received a total of more than $15 billion in emergency funds through the economic stimulus package in the federal CARES Act.

The hospitals — including publicly traded juggernauts like HCA and Tenet Healthcare, elite nonprofits like the Mayo Clinic, and regional chains with thousands of beds and billions in cash — are collectively sitting on tens of billions of dollars of cash reserves that are supposed to help them weather an unanticipated storm. And together, they awarded the five highest-paid officials at each chain about $874 million in the most recent year for which they have disclosed their finances.

At least 36 of those hospital chains have laid off, furloughed or reduced the pay of employees as they try to save money during the pandemic.

Industry officials argue that furloughs and pay reductions allow hospitals to keep providing essential services at a time when the pandemic has gutted their revenue.

But more than a dozen workers at the wealthy hospitals said in interviews that their employers had put the heaviest financial burdens on front-line staff, including low-paid cafeteria workers, janitors and nursing assistants. They said pay cuts and furloughs made it even harder for members of the medical staff to do their jobs, forcing them to treat more patients in less time.

Even before the coronavirus swept America, forcing hospitals to stop providing lucrative nonessential surgery and other services, many smaller hospitals were on the financial brink. In March, lawmakers sought to address that with a vast federal economic stimulus package that included $175 billion for the Department of Health and Human Services to hand out in grants to hospitals.

But the formulas to determine how much money hospitals receive were based largely on their revenue, not their financial needs. As a result, hospitals serving wealthier patients have received far more funding than those that treat low-income patients, according to a study by the Kaiser Family Foundation.

One of the bailout’s goals was to avoid job losses in health care, said Zack Cooper, an associate professor of health policy and economics at Yale University who is a critic of the formulas used to determine the payouts. “However, when you see hospitals laying off or furloughing staff, it’s pretty good evidence the way they designed the policy is not optimal,” he added.

The Mayo Clinic, with more than eight months of cash in reserve, received about $170 million in bailout funds, according to data compiled by Good Jobs First, which researches government subsidies of companies. The Mayo Clinic is furloughing or reducing the working hours of about 23,000 employees, according to a spokeswoman, who was among those who went on furlough. A second spokeswoman said that Mayo Clinic executives have had their pay cut.

Seven chains that together received more than $1.5 billion in bailout funds — Trinity Health, Beaumont Health and the Henry Ford Health System in Michigan; SSM Health and Mercy in St. Louis; Fairview Health in Minneapolis; and Prisma Health in South Carolina — have furloughed or laid off more than 30,000 workers, according to company officials and local news reports.

The bailout money, which hospitals received from the Health and Human Services Department without having to apply for it, came with few strings attached.

Katherine McKeogh, a department spokeswoman, said it “encourages providers to use these funds to maintain delivery capacity by paying and protecting doctors, nurses and other health care workers.” The legislation restricts hospitals’ ability to use the bailout funds to pay top executives, although it doesn’t stop recipients from continuing to award large bonuses.

The hospitals generally declined to comment on how much they are paying their top executives this year, although they have reported previous years’ compensation in public filings. But some hospitals furloughing front-line staff or cutting their salaries have trumpeted their top executives’ decisions to take voluntary pay cuts or to contribute portions of their salary to help their employees.

The for-profit hospital giant Tenet Healthcare, which has received $345 million in taxpayer assistance since April, has furloughed roughly 11,000 workers, citing the financial pressures from the pandemic. The company’s chief executive, Ron Rittenmeyer, told analysts in May that he would donate half of his salary for six months to a fund set up to assist those furloughed workers.

But Mr. Rittenmeyer’s salary last year was a small fraction of his $24 million pay package, which consists largely of stock options and bonuses, securities filings show. In total, he will wind up donating roughly $375,000 to the fund — equivalent to about 1.5 percent of his total pay last year.

A Tenet spokeswoman declined to comment on the precise figures.

The chief executive at HCA, Samuel Hazen, has donated two months of his salary to a fund to help HCA’s workers. Based on his pay last year, that donation would amount to about $237,000 — or less than 1 percent — of his $26 million compensation.

“The leadership cadre of these organizations are going to need to make sacrifices that are commensurate with the sacrifices of their work force, not token sacrifices,” said Jeff Goldsmith, the president of Health Futures, an industry consulting firm.

Many large nonprofit hospital chains also pay their senior executives well into the millions of dollars a year.

Dr. Rod Hochman, the chief executive of the Providence Health System, for instance, was paid more than $10 million in 2018, the most recent year for which records are available. Providence received at least $509 million in federal bailout funds.

A spokeswoman, Melissa Tizon, said Dr. Hochman would take a voluntary pay cut of 50 percent for the rest of 2020. But that applies only to his base salary, which in 2018 was less than 20 percent of his total compensation.

Some of Providence’s physicians and nurses have been told to prepare for pay cuts of at least 10 percent beginning in July. That includes employees treating coronavirus patients.

Stanford University’s health system collected more than $100 million in federal bailout grants, adding to its pile of $2.4 billion of cash that it can use for any purpose.

Stanford is temporarily cutting the hours of nursing staff, nursing assistants, janitorial workers and others at its two hospitals. Julie Greicius, a spokeswoman for Stanford, said the reduction in hours was intended “to keep everyone employed and our staff at full wages with benefits intact.”

Ms. Greicius said David Entwistle, the chief executive of Stanford’s health system, had the choice of reducing his pay by 20 percent or taking time off, and chose to reduce his working hours but “is maintaining his earning level by using paid time off.” In 2018, the latest year for which Stanford has disclosed his compensation, Mr. Entwistle earned about $2.8 million. Ms. Greicius said the majority of employees made the same choice as Mr. Entwistle.

HCA’s $1 billion in federal grants appears to make it the largest beneficiary of health care bailout funds. But its medical workers have a long list of complaints about what they see as penny-pinching practices.

Since the pandemic began, medical workers at 19 HCA hospitals have filed complaints with the Occupational Safety and Health Administration about the lack of respirator masks and being forced to reuse medical gowns, according to copies of the complaints reviewed by The Times.

Ed Fishbough, an HCA spokesman, said that despite a global shortage of masks and other protective gear, the company had “provided appropriate P.P.E., including a universal masking policy implemented in March requiring all staff in all areas to wear masks, including N95s, in line with C.D.C. guidance.”

Celia Yap-Banago, a nurse at an HCA hospital in Kansas City, Mo., died from the virus in April, a month after her colleagues complained to OSHA that she had to treat a patient without wearing protective gear. The next month, Rosa Luna, who cleaned patient rooms at HCA’s hospital in Riverside, Calif., also died of the virus; her colleagues had warned executives in emails that workers, especially those cleaning hospital rooms, weren’t provided proper masks.

Around the time of Ms. Luna’s death, HCA executives delivered a warning to officials at the Service Employees International Union and National Nurses United, which represent many HCA employees. The company would lay off up to 10 percent of their members, unless the unionized workers amended their contracts to incorporate wage freezes and the elimination of company contributions to workers’ retirement plans, among other concessions.

Nurses responded by staging protests in front of more than a dozen HCA hospitals.

“We don’t work in a jelly bean factory, where it’s OK if we make a blue jelly bean instead of a red one,” said Kathy Montanino, a nurse treating Covid-19 patients at HCA’s Riverside hospital. “We are dealing with people’s lives, and this company puts their profits over patients and their staff.”

Mr. Fishbough, the spokesman, said HCA “has not laid off or furloughed a single caregiver due to the pandemic.” He said the company had been paying medical workers 70 percent of their base pay, even if they were not working. Mr. Fishbough said that executives had taken pay cuts, but that the unions had refused to take similar steps.

“While we hope to continue to avoid layoffs, the unions’ decisions have made that more difficult for our facilities that are unionized,” he said. The dispute continues.

Apparently anticipating a strike, a unit of HCA recently created “a new line of business focused on staffing strike-related labor shortages,” according to an email that an HCA recruiter sent to nurses.

The email, reviewed by The Times, said nurses who joined the venture would earn more than they did in their current jobs: up to $980 per shift, plus a $150 “Show Up” bonus and a continental breakfast.

 

 

 

 

Providence to cut salaries of 1,200 providers

https://www.beckershospitalreview.com/compensation-issues/providence-to-cut-salaries-of-1-200-providers.html?utm_medium=email

CareOregon and Providence to join forces in Medicaid - Portland ...

In a second round of cuts, Renton, Wash.-based Providence plans reduce the salaries of 1,200 high-paid medical providers to help offset losses from the COVID-19 pandemic, according to OregonLive.

The health system said the pay cuts will begin July 5 and will last three months. The salaries will be restored after that three-month period.

The 1,200 providers will see their salaries reduced based on their current compensation level. Providence said that providers will see 10 percent to 17.5 percent reductions, or will have the amount cut to what they were paid in 2019, according to The Lund Report.

Providence told The Lund Report that reductions will be 10 percent for those earning under $150,000; 12.5 percent for those earning $150,000 to $300,000; 15 percent for those earning $300,000 to $500,000; and 17.5 percent for those earning more than $500,000.

It is unclear how the system will decide whether pay will be cut by percentage or 2019 salary level.

The latest round of belt-tightening comes after Providence announced in May mandatory furloughs and pay cuts for 600 high-earning employees, including executives. 

 

 

An optimistic view from health system workforce leaders

https://mailchi.mp/9f24c0f1da9a/the-weekly-gist-june-5-2020?e=d1e747d2d8

Aldous Huxley and Brave New World: The Dark Side of Pleasure

Continuing our series of Gist member convenings to discuss the “Brave New World” that awaits in the post-pandemic era, we brought together a group of senior human resources and nursing executives this week for a Zoom roundtable.

Several themes emerged from the discussion. First, there was general consensus that the COVID crisis exposed a workforce that had become over-specialized and inflexible. Said one chief nursing officer, “Our workforce is much more brittle than we thought.” A key lesson learned is the need for increased cross-training—especially for nurses, and especially in critical care. Systems should work now to increase the supply of nurses comfortable in an ICU environment to enable hospitals to flex staff across settings and roles to deal with future waves of the virus.

Not surprisingly, layoffs were top-of-mind for many. Executives were of one mind on the need to safeguard clinical staff as much as possible, and many systems are now considering deep cuts to management and administrative ranks: “It’s easier to stand in front of your clinical staff and be able to say you’ve stripped millions from administration before turning to clinical cuts.”

There was broad consensus for the potential for artificial intelligence and robotic process automation to enable greater reliability and productivity at lower cost in areas such as billing, coding, and even some clinical functions—and that the pandemic will accelerate plans to implement these solutions.

On a more optimistic note, one executive shared that “relationships between clinicians and administrators have never been stronger. The pandemic has forced us to have difficult and constructive conversations we would have never had the courage to have before.”

Another noted the pandemic has spotlighted new leadership talent who might otherwise have been overlooked, and plans are now in place to formally recognize and retain newly crisis-tested talent for the work of restructuring the system.

On the whole, the discussion was far more upbeat that we had expected—as difficult as the crisis has been for many teams, the opportunity to rethink old ways of doing business seems to have created renewed enthusiasm even in the face of daunting financial and operational challenges ahead.