How The Rapid Shift To Telehealth Leaves Many Community Health Centers Behind During The COVID-19 Pandemic

https://www.healthaffairs.org/do/10.1377/hblog20200529.449762/full/

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The COVID-19 pandemic has transformed the landscape of ambulatory care with rapid shifts to telehealth. Well-resourced hospitals have quickly made the transition. Community health centers (CHCs), which serve more than 28 million low-income and disproportionately uninsured patients in rural and underserved urban areas of the United States, have not fared as well since ambulatory visits have disappearedresulting in furloughs, layoffs, and more than 1,900 temporary site closures throughout the country. Government officials have taken notice, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act infused $1.32 billion toward COVID-19 response and maintaining CHC capacity.

Many states have directed insurers to temporarily cover COVID-19-related services via telehealth while mandating parity of reimbursement for telehealth visits with in-person visits for their Medicaid program.

Preparedness Of Community Health Centers For Telehealth

Despite the changes, many health centers may not be ready to implement high-quality telehealth. study using 2016 data showed that only 38 percent of CHCs used any telehealth. In our review of 2018 Uniform Data System data—the most recent available—from a 100 percent sample of US CHCs, we found that our nation’s health centers are largely unprepared for this transformation.

Across the US, 56 percent of 1,330 CHCs did not have any telehealth use in 2018 (exhibit 1). Of those without telehealth use, only about one in five were in the process of actively implementing or exploring telehealth. Meanwhile, 47 percent of the centers using telehealth were doing so only with specialists such as those at referral centers, rather than with patients. Of those using telehealth, the majority (68 percent) used it to provide mental health services; fewer used it for primary care (30 percent) or management of chronic conditions (21 percent), suggesting that most CHCs with telehealth capabilities prior to COVID-19 were not using it for the most frequent types of services provided at CHCs.

CHCs not using telehealth reported several barriers to implementation (exhibit 2). Thirty-six percent cited lack of reimbursement, 23 percent lacked funding for equipment, and 21 percent lacked training for providing telehealth. Although most barriers were similar in both urban and rural regions, a greater proportion of rural clinics compared to urban clinics (18 percent versus 7 percent) reported inadequate broadband services as an issue.

The COVID-19 pandemic has laid bare the enormous disparities in telehealth capacity. Without adequate telehealth capacity and support, many CHCs will be left without means of providing the continuous preventive and chronic disease care that can keep communities healthy and out of the hospital. During the crisis, the Health Resources and Services Administration estimates that CHCs have seen 57 percent of the number of weekly visits compared to pre-COVID-19 visit rates, 51 percent of which have been conducted virtually, suggesting that many CHC patients have forgone care that they would have otherwise received. Given CHCs serve a disproportionate share of low-income, racial/ethnic minority, and immigrant populations—populations hardest hit by the COVID-19 pandemic—any disruption to CHC capacity may exacerbate the racial disparities that have rapidly emerged.

While an important first step, policy makers cannot simply infuse more funding to CHCs and expect them to withstand the challenges of the COVID-19 era. We recommend three targeted strategies to help CHCs adapt and perhaps even thrive beyond COVID-19: legislate permanent parity in telehealth reimbursement for all insurers; allocate sufficient funding and guidance for telehealth equipment, personnel, training, and protocols; and implement telehealth systems tailored to vulnerable populations.

Permanent All-Payer Parity For Telehealth Reimbursement

Payment parity—where telehealth is reimbursed at the same level as an in-person visit—is a crucial issue that must be addressed and instituted beyond the current public health emergency. Without commensurate reimbursement for telehealth, CHCs cannot maintain patient volume or make the long-term investments necessary to remain financially viable. A “global budget” of paying CHCs a fixed payment per patient per month would give practices flexibility in how and where to treat the patient, although this may be politically and practically challenging. Meanwhile, payment parity has already been implemented and could simply be permanently codified into existing reimbursement schemes, giving providers the option to select the best mode of treatment without making financial trade-offs.

In reviewing state telehealth policies during COVID-19, all states have implemented temporary executive orders or released guidance on telehealth access—although with significant variations. At least 22 states have explicitly implemented telehealth parity for Medicaid. For Medicare, the Centers for Medicare and Medicaid Services (CMS) expanded access to telehealth beyond designated rural areas, loosened HIPAA requirements around telehealth platforms, and instituted parity in reimbursement with in-person visits.

To build on these significant steps, states should mandate telehealth parity across all payers and cover all services provided at CHCs, not just COVID-19-related care. At least 12 states have mandated all-payer parity for telehealth. Meanwhile, private insurers have individually adjusted telehealth policies on a state-by-state basis if there was no statewide mandate. Nevertheless, all payers should reimburse at parity given the patchwork quilt of insurance plans that exists at CHCs.

Furthermore, state legislatures and CMS should look to extend parity beyond the current COVID-19 emergency so that CHCs can make sustainable investments that continue to benefit patients. Even as states reopen, in-person visits are unlikely to return to their previous volume as the threat of infection continues to loom. Temporary measures should be made permanent so that CHCs can make sustainable investments that continue to benefit patients.

Funding And Guidance For Equipment, Personnel, Training, And Protocols

For telehealth to function smoothly and reduce errors, proper hardware and software are critical, including telephone service, computers, broadband internet access, and electronic health records. The Federal Communications Commission (FCC) released funding to procure telehealth services and devices and some CHCs have received private funding; similar targeted funding mechanisms from states and the federal government are necessary at scale to equip hundreds of CHCs with the necessary telehealth capabilities.

However, merely having technology is not sufficient. Proper personnel with appropriate training are key to a high-functioning telehealth system along with support from information technology specialists. Additionally, CHCs need ancillary systems in place to allow for the effective use of phone and video visits. Empanelment systems to attribute patients to providers can allow for longitudinal follow-up even with telehealth. Daily huddles and team-based care can enhance the inherent complexities of coordinating care remotely. Protocols should be tailored for different specialties and services such as nutrition management and social work. Meanwhile, a robust e-consult referral network should allow primary care providers at CHCs to easily connect patients to specialty care when necessary. Adding robust protocols and systems will allow for the successful implementation and scaling of telehealth.

For example, groups of CHCs called the Health Center Controlled Networks (HCCNs), which have traditionally collaborated to leverage health information technology, are positioned to harness their economies of scale and group purchasing power to widely adopt new infrastructure while standardizing protocols. They could be a means to accelerate the adoption of telehealth technologies, trainings, and care models to optimize the use of telehealth across CHCs.

Telehealth Support For Vulnerable Patients

The patient population seen by CHCs presents unique challenges that not all ambulatory practices, particularly those in affluent neighborhoods, may face. Health centers care for many immigrant patients with limited English proficiency. Thus, clinics need financial support to contract with telehealth interpreter and translation services to provide equitable access and care. Better yet, all telehealth platforms contracting with CHCs should be required to provide multilingual support to deliver equitable access to telehealth services.

Moreover, many low-income patients lack health and digital literacy. Virtual telehealth platforms should design applications such that interfaces are intuitive and easy to navigate. They should provide specialized support to guide patients who are not familiar with telehealth systems. Additionally, insurers can reimburse CHCs that provide patient navigators, care coordinators, and shared decision-making support that bridge the health literacy divide.

Many around the US also do not have access to high-speed internet, consistent telephone services, and phones or computers with video conferencing capabilities. First, to allow for flexible access to telehealth for all patients, insurers should permanently waive geographic and originating site restrictions that limit the type and location of facilities from which patients can use telehealth. Second, insurers should waive audio-video requirements and consistently reimburse for phone-only visits to accommodate patients without video conferencing. Third, the type of services covered by telehealth should be expanded—ranging from primary care to physical therapy to nutrition counseling to behavioral health.

To address disparities in ownership of digital devices, taking a page out of the book of educators in low-income neighborhoods, local governments could loan laptops and smartphones or supply internet hotspots and phone-charging stations for these communities to enable access. Additionally, insurers could reimburse for the FCC Lifeline program to provide affordable communication services and cellular data to low-income populations to maintain their outpatient care.

Conclusions

As the COVID-19 pandemic sweeps through the US, health care delivery will never be the same. Health centers are struggling as many have been largely unprepared for the abrupt swing toward telehealth. COVID-19 may pose long-lasting damaging effects on CHCs and the patient populations that they serve. Nonspecific federal and state funding will allow CHCs to survive; however, deliberate action is needed to enhance telehealth capacities and ensure long-term resilience.

Similar to the Association of American Medical Colleges’ recent letter to CMS to make various telehealth changes permanent, both CMS and state governments should take immediate action by making permanent parity in reimbursement for telehealth services by all payers. State and federal policy should direct payers to lift onerous restrictions on the types of services covered via telehealth, audio/video requirements, and geographic and originating sites of telehealth services. States and payers should also explore innovative solutions to expand access to cellular data services and digital devices that allow low-income patients to digitally “get to their appointment,” similar to non-emergency medical transportation. Local governments should invest in digital infrastructure that expands broadband coverage and provides internet or cellular access points for people to engage in telehealth. Additionally, CHCs should come together under HCCNs to harness their group purchasing power to rapidly implement telehealth infrastructure that provides multilingual support and other tools that bridge gaps in digital literacy. Finally, best practices, trainings, and protocols should be standardized and disseminated across CHC networks to optimize the quality of telehealth.  

By reorienting the goals for implementing telehealth, policy makers, payers, and providers can empower health centers to thrive into the future and meet the nation’s underserved patients where they are, even during the pandemic. In the long run, telehealth can increase access and equity—but only if the right investments are made now to fill the gaps laid bare by COVID-19.

 

 

 

 

Healthcare groups call racism a ‘public health’ concern in wake of tensions over police brutality

https://www.fiercehealthcare.com/practices/healthcare-groups-denounce-systemic-racism-wake-tensions-over-police-brutality?mkt_tok=eyJpIjoiWmpobE5XVmlaRGd6T0dFdyIsInQiOiJsQmxnbVNxNVlISVNkczJIZkJXb3ZFZG9tVlpMblZ1XC9oVVB6SlRINzNhOXE4MWQzNk1cL3JTaDlcL2l0MGdhSnk0NUtqY1RzdThCN1wvZ1ZoVUxqOHJwZFJcL1wvK3FtS0o5NFwvSHA0WHhTUnhVNnY3bk5RNmhRQTdxYzYwclhYN3JTRW8ifQ%3D%3D&mrkid=959610

After days of protests across the world against police brutality toward minorities sparked by the killing of George Floyd in Minneapolis, healthcare groups are speaking out against the impact of “systemic racism” on public health.

“These ongoing protests give voice to deep-seated frustration and hurt and the very real need for systemic change. The killings of George Floyd last week, and Ahmaud Arbery and Breonna Taylor earlier this year, among others, are tragic reminders to all Americans of the inequities in our nation,” Rick Pollack, president and CEO of the American Hospital Association (AHA), said in a statement.

As places of healing, hospitals have an important role to play in the wellbeing of their communities. As we’ve seen in the pandemic, communities of color have been disproportionately affected, both in infection rates and economic impact,” Pollack said. “The AHA’s vision is of a society of healthy communities, where all individuals reach their highest potential for health … to achieve that vision, we must address racial, ethnic and cultural inequities, including those in health care, that are everyday realities for far too many individuals. While progress has been made, we have so much more work to do.”

The Society for Healthcare Epidemiology of America (SHEA) also decried the public health inequality highlighted by the dual crises.

“The violent interactions between law enforcement officers and the public, particularly people of color, combined with the disproportionate impact of COVID-19 on these same communities, puts in perspective the overall public health consequences of these actions and overall health inequity in the U.S.,” SHEA said in a statement. Association of American Medical Colleges (AAMC) executives called for health organizations to do more to address inequities. 

“Over the past three months, the coronavirus pandemic has laid bare the racial health inequities harming our black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy,” said David Skorton, M.D., AAMC president and CEO, and David Acosta, M.D., AAMC chief diversity and inclusion officer, in a statement.

“Now, the brutal and shocking deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery have shaken our nation to its core and once again tragically demonstrated the everyday danger of being black in America,” they said. “Police brutality is a striking demonstration of the legacy racism has had in our society over decades.”

They called on health system leaders, faculty researchers and other healthcare staff to take a stronger role in speaking out against forms of racism, discrimination and bias. They also called for health leaders to educate themselves, partner with local agencies to dismantle structural racism and employ anti-racist training.

 

 

 

“All policy is health policy”

https://www.axios.com/newsletters/axios-vitals-8873028c-f37e-4712-a53a-ae324c56dbb6.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

PPT - Health in All Policies PowerPoint Presentation, free ...

The effects of racism are often inseparable from black Americans’ health and well-being, as “black communities bear the physical burdens of centuries of injustice, toxic exposures, racism, and white supremacist violence,” Rachel Hardeman, Eduardo Medina and Rhea Boyd write in the New England Journal of Medicine:

Any solution to racial health inequities must be rooted in the material conditions in which those inequities thrive. Therefore, we must insist that for the health of the black community and, in turn, the health of the nation, we address the social, economic, political, legal, educational, and health care systems that maintain structural racism. Because as the Covid-19 pandemic so expeditiously illustrated, all policy is health policy…

The response to the pandemic has made at least one thing clear: systemic change can in fact happen overnight.

 

Providers show support amid unrest: #WhiteCoatsForBlackLives

https://www.healthcaredive.com/news/providers-show-support-amid-unrest-whitecoatsforblacklives/579020/

Dive Brief:

  • The American Hospital Association on Monday condemned what they called the “senseless killing of an unarmed black man in Minneapolis,” referring to George Floyd, who died more than a week ago after a police officer held his knee on Floyd’s neck for more than eight minutes. AHA said the group’s vision is a “society of healthy communities, where ALL individuals reach their highest potential for health.”
  • Medical societies, providers and other healthcare organizations weighed in to support peaceful protests, especially as the COVID-19 pandemic shines a light on racial inequities in access to healthcare and job security in America.
  • Health officials also expressed worry that the protest gatherings could further spread of the novel coronavirus. Minnesota Gov. Tim Walz said hospitals in the state could be overwhelmed. And some COVID-19 testing sites have been shut down for safety reasons, further exacerbating concerns.

Dive Insight:

Since protests and occasionally violent police confrontations in recent days were sparked by Floyd’s death, providers have taken to social media with notes of support and pictures of themselves taking a knee in their scrubs under the hashtag #WhiteCoatsForBlackLives.

The American Medical Association responded to ongoing unrest Friday, saying the harm of police violence is “elevated amidst the remarkable stress people are facing amidst the COVID-19 pandemic.”

Board Chair Jesse Ehrenfeld and Patrice Harris, AMA’s first African American woman to be president, continued: “This violence not only contributes to the distrust of law enforcement by marginalized communities but distrust in the larger structure of government including for our critically important public health infrastructure. The disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency, and also deeply demoralizing, irrespective of race/ethnicity, age, LGBTQ or gender.”

Other organizations weighed in, including CommonSpirit Health, the American Psychiatric Association, the American College of Physicians and several medical colleges.

The nascent research and data from the pandemic in the U.S. have shown people of color are more likely to die from COVID-19 than white people. The reasons behind that are myriad and complex, but many can be traced back to systemic inequality in social services and the healthcare system.

Payers, providers and other healthcare organizations have attempted to address these issues through programs targeting social determinants of health like stable housing, food security and access to transportation.

But despite these efforts over several years to recognize and document the disparities, they have persisted and in some cases widened, Samantha Artiga, director of the Disparities Policy Project at the Kaiser Family Foundation, noted in a blog post Monday.

Health disparities, including disparities related to COVID-19, are symptoms of broader underlying social and economic inequities that reflect structural and systemic barriers and biases across sectors,” she wrote.

Providers have waded into political issues affecting them before, including gun violence. Several organizations also objected to the Trump administration’s decision to cut ties with the World Health Organization in the midst of the pandemic.

The American Public Health Association in late 2018 called law enforcement violence a public health issue.

 

 

 

 

Health Equity Principles for State and Local Leaders in Responding to, Reopening and Recovering from COVID-19

https://www.rwjf.org/en/library/research/2020/05/health-equity-principles-for-state-and-local-leaders-in-responding-to-reopening-and-recovering-from-covid-19.html

Centering Health Equity in COVID-19 Response and Recovery Plans ...

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”

COVID-19 has unleashed a dual threat to health equity in the United States: a pandemic that has sickened millions and killed tens of thousands and counting, and an economic downturn that has resulted in tens of millions of people losing jobs—the highest numbers since the Great Depression. The COVID pandemic underscores that:

  • Our health is inextricably linked to that of our neighbors, family members, child- and adult-care providers, co-workers, school teachers, delivery service people, grocery store clerks, factory workers, and first responders, among others;
  • Our current health care, public health, and economic systems do not adequately or equitably protect our well-being as a nation; and
  • Every community is experiencing harm, though certain groups are suffering disproportionately, including people of color, workers with low incomes, and people living in places that were already struggling financially before the economic downturn.

For communities and their residents to recover fully and fairly, state and local leaders should consider the following health equity principles in designing and implementing their responses. These principles are not a detailed public health guide for responding to the pandemic or reopening the economy, but rather a compass that continually points leaders toward an equitable and lasting recovery.

 

Collect, analyze, and report data disaggregated by age, race, ethnicity, gender, disability, neighborhood, and other sociodemographic characteristics.

Pandemics and economic recessions exacerbate disparities that ultimately hurt us all. Therefore, state and local leaders cannot design equitable response and recovery strategies without monitoring COVID’s impacts among socially and economically marginalized groups.¹ Data disaggregation should follow best practices and extend not only to public health data on COVID cases, hospitalizations, and fatalities, but also to: measures of access to testing, treatment, personal protective equipment (PPE), and safe places to isolate when sick; receipt of social and economic supports; and the downstream consequences of COVID on well-being, ranging from housing instability to food insecurity.

Geographic identifiers would allow leaders and the public to understand the interplay between place and social factors, as counties with large black populations account for more than half of all COVID deaths, and rural communities and post-industrial cities generally fare worse in economic downturns. Legal mandates for data disaggregation are proliferating, but 11 states are still not reporting COVID deaths by race; 16 are not reporting by gender; and 26 are not reporting based on congregate living status (e.g., nursing homes, jails). Only three are reporting testing data by race and ethnicity.

While states and cities can do more, the federal government should also support data disaggregation through funding and national standards.

Include in decision-making the people most affected by health and economic challenges, and benchmark progress based on their outcomes.

Our communities are stronger, more stable, and more prosperous when every person, including the most disadvantaged residents, is healthy and financially secure. Throughout the response and recovery, state and local leaders should ask: Are we making sure that people facing the greatest risks have access to PPE, testing and treatment, stable housing, and a way to support their families? And, are we creating ways for residents—particularly those hardest hit—to meaningfully participate in and shape the government’s recovery strategy?

Accordingly, policymakers should create space for leaders from these communities to be at decision-making tables and should regularly consult with community-based organizations that can identify barriers to accessing health and social services, lift up grassroots solutions, and disseminate public health guidance in culturally and linguistically appropriate ways. For example, they could recommend trusted, accessible locations for new testing sites and advise on how to diversify the pool of contact tracers, who will be crucial to tamping down the spread of infection in reopened communities. They could also collaborate with government leaders to ensure that all people who are infected with coronavirus (or exposed to someone infected) have a safe, secure, and acceptable place to isolate or quarantine for 14 days. Key partners could include community health centers, small business associations, community organizing groups, and workers’ rights organizations, among others. Ultimately, state and local leaders should measure the success of their response based not only on total death counts and aggregate economic impacts but also on the health and social outcomes of the most marginalized.

Establish and empower teams dedicated to promoting racial equity in response and recovery efforts.

Race or ethnicity should not determine anyone’s opportunity for good health or social well-being, but, as COVID has shown, we are far from this goal. People of color are more likely to be front-line workers, to live in dense or overcrowded housing, to lack health insurance, and to experience chronic diseases linked to unhealthy environments and structural racism. Therefore, state and local leaders should empower dedicated teams to address COVID-related racial disparities, as several leaders, Republican and Democrat, have already done.

To be effective, these entities should: include leaders of color from community, corporate, academic, and philanthropic sectors; be integrated as key members of the broader public health and economic recovery efforts; and be accountable to the public. These teams should foster collaboration between state, local, and tribal governments to assist Native communities; anticipate and mitigate negative consequences of current response strategies, such as bias in enforcement of public health guidelines; address racial discrimination within the health care system; and ensure access to tailored mental health services for people of color and immigrants who are experiencing added trauma, stigma, and fear. Ultimately, resources matter. State and local leaders must ensure that critical health and social supports are distributed fairly, proportionate to need, and free of undue restrictions to meet the needs of all groups, including black, Latino, Asian, and Indigenous communities.

 

Proactively identify and address existing policy gaps while advocating for further federal support.

The Congressional response to COVID has been historic in its scope and speed, but significant gaps remain. Additional federal resources are needed for a broad range of health and social services, along with fiscal relief for states and communities facing historically large budget deficits due to COVID. Despite these challenges, state and local leaders must still find ways to take targeted policy actions. The following questions can help guide their response.

Who is left out?Inclusion of all populations will strengthen the public health response and lessen the pandemic’s economic fallout for all of society, but federal actions to date have not included all who have been severely harmed by the pandemic. As a result, many states and communities have sought to fill gaps in eviction protections and paid sick and caregiving leave. Others are extending support to undocumented immigrants and mixed-status families through public-private partnerships, faith-based charities, and community-led mutual aid systems. Vital health care providers, including safety net hospitals and Indian Health Service facilities, have also been disadvantaged and need targeted support.

Will protections last long enough?Many programs, such as expanded Medicaid funding, are tied to the federal declaration of a public health emergency, which will likely end before the economic crisis does. Other policies, like enhanced unemployment insurance and mortgage relief, are set to expire on arbitrary dates. And still others, such as stimulus checks, were one-time payments. Instead, policy extensions should be tied to the extent of COVID infection in a state or community (or its anticipated spread) and/or to broader economic measures such as unemployment. This is particularly important as communities will likely experience re-openings and closings over the next six to 12 months as COVID reemerges.

Have programs that meet urgent needs been fully and fairly implemented?Allexisting federal resources should be used in a time of great need. For example, additional states should adopt provisions that would allow families with school-age children to receive added Supplemental Nutrition Assistance Program (SNAP) benefits, and more communities need innovative solutions to provide meals to young children who relied on schools or child care providers for breakfast and lunch. States should also revise eligibility, enrollment, and recertification processes that deter Medicaid use by children, pregnant women, and lawfully residing immigrants.

Invest in strengthening public health, health care, and social infrastructure to foster resilience.

Health, public health, and social infrastructure are critical for recovery and for our survival of the next pandemic, severe weather event, or economic downturn. A comprehensive public health system is the first line of defense for rural, tribal, and urban communities. While a sizable federal reinvestment in public health is needed, states and communities must also reverse steady cuts to the public health workforce and laboratory and data systems.

Everyone in this country should have paid sick and family leave to care for themselves and loved ones; comprehensive health insurance to ensure access to care when sick and to protect against medical debt; and jobs and social supports that enable families to meet their basic needs and invest in the future. As millions are projected to lose employer-sponsored health insurance, Medicaid expansion becomes increasingly vital for its proven ability to boost health, reduce disparities, and provide a strong return on investment. In the longer term, policies such as earned income tax credits and wage increases for low-wage workers can help secure economic opportunity and health for all. Finally, states and communities should invest in affordable, accessible high-speed internet, which is crucial to ensuring that everyone—not just the most privileged among us—is informed, connected to schools and jobs, and engaged civically.

These principles can guide our nation toward an equitable response and recovery and help sow the seeds of long-term, transformative change. States and cities have begun imagining and, in some cases, advancing toward this vision, putting a down payment on a fair and just future in which health equity is a reality. Returning to the ways things were is not an option.

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

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.

 

 

 

 

The rich pull up the drawbridges

https://www.axios.com/coronavirus-rich-drawbridges-7567f493-1bed-494e-926c-be897823a706.html

 Animated illustration of a drawbridge made out of a hundred dollar note being pulled up.

From hastily-chartered superyachts to fortresslike country estates, the wealthiest Americans have found places to ride out the pandemic far away from the masses.

Why it matters: The contrast between the rich vs. poor experience of coronavirus exposes class differences — in housing, access to health care, etc. — that are less obvious in normal times.

Where it stands: Even as elected officials tell us that the novel coronavirus does not discriminate — New York Gov. Andrew Cuomo called it “the great equalizer” — it’s still true that the moneyed classes are walling themselves off and, on the whole, suffering less.

  • People with second (and third) homes have stampeded from hot spots like New York City to pastoral and less-afflicted areas — like the Hamptons, Cape Cod, Hilton Head and Palm Beach.
  • Thanks to “concierge medicine,” where people pay hefty annual fees in exchange for near-unlimited access to their doctors, the rich have been getting faster access to COVID-19 tests, plus more attention when they’re sick.

Headlines that tell the story:

  • “Chic Hamptons food stores ransacked by the wealthy amid coronavirus pandemic” (NY Post)
  • Private jets ‘pour in’ to Martha’s Vineyard as rich flee coronavirus” (The Telegraph)
  • “Billionaires are chartering superyachts for months at a time to ride out the coronavirus pandemic” (Business Insider)
  • “The U.S. has a shortage of coronavirus tests, so the ultra-wealthy are paying concierge doctors to do their own,” (Business Insider)

What they’re saying: “There is an undercurrent of unequal sacrifice,” Chuck Collins, a senior scholar at the progressive Institute for Policy Studies, tells Axios.

Seasonal vacation resorts don’t have the doctors, hospital beds and other resources to care for throngs of sick people — prompting calls for the moneyed interlopers (renters and owners alike) to go home.

  • The mayor of Honolulu wants the Trump administration to suspend nonessential travel to Hawaii.
  • The governor of New Jersey is urging people not to come to the Jersey Shore — even enlisting Mike “The Situation” Sorrentino to spread the “stay home” word.
  • The chiefs of Nantucket Cottage Hospital (which has 15 beds) and Martha’s Vineyard Hospital (25 beds) are asking people to keep off the islands.
  • Angry Cape Cod residents are circulating a (probably doomed) petition to close the bridges to their area.

While the wealthy were among the first in the U.S. to contract the virus (as they’re more apt to travel abroad), the brunt of the pandemic has hurt the working poor.

  • Per the WSJ: “The new coronavirus has struck hardest in working-class neighborhoods in New York City’s outer boroughs, city data shows, underlining how the pandemic has ravaged densely packed lower-income areas where social-distancing guidelines have proved difficult to implement.”

People who live in poverty are more likely to have underlying illnesses that make them more susceptible to coronavirus — asthma, heart disease, hypertension, diabetes.

  • “Income in the United States is our pre-existing condition,” Collins said. “This infection is landing on an extremely unequal society — much more unequal than 40 years ago.”

A tale of two pandemics: As soon as NYC schools closed, real estate agents were flooded with calls from people begging to rent houses in the Hamptons — where a single summer’s lease can easily cost $100,000 — immediately and sight unseen.

  • “You have people calling in and saying, ‘We’re going to be in a car tomorrow, give me a house that I can move into,’ ” Eddie Shapiro, founder and CEO of Nest Seekers International, tells Axios. “We’ve never seen that.”

To drive there, the renters would have had to pass through Queens — the city’s hardest-hit borough — where “apocalyptic” conditions at a 545-bed public hospital in Elmhurst have turned the neighborhood into a poster child for the virus’ wrath.

 

 

 

 

 

Remembering King’s fight for health-care equity

Remembering King’s fight for health-care equity

Image result for martin luther king on healthcare

America celebrates a distortion of Martin Luther King Jr., void of his prophetic call to justice by any nonviolent means necessary. Particularly around the annual remembrance of his life Monday, watch for his words to be repackaged in tasty sound bites and stripped of the so-called extremism that prompted FBI Director J. Edgar Hoover to label him “the most dangerous man in America.”

Chicago was a seminal backdrop for King’s work toward justice and the place where he sounded his call for health care justice. Before a medical conference in 1966 he proclaimed, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” National criticism ensued because this activist, two years after he won the Nobel Peace Prize, dared to articulate a prophetic truism still relevant in 2020.

Researchers at New York University found that Chicago has the largest gap in life expectancy of any city in the United States (followed by Washington, D.C., and New York). Although the national trend in the gap between blacks and non-Hispanic whites continues to improve, ZIP codes can still determine life expectancy with alarming racial disparities. Like real estate, health inequality is about location, location, location.

Dallas is another city with a dubious distinction. The Urban Institute ranked it last out of 274 U.S. cities in racial equity and racial segregation. A study by Parkland Health and Hospital System and the Dallas County Health Department found that geography is deeply linked to health inequity, where a difference of 2 miles has a life expectancy gap of 26 years. Although separated by 1,000 miles, Dallas and Chicago share similar systemic inequities that perpetuate racial disparities in health.

These glaring divides are an enduring legacy of decades of isolating black Americans seeking homeownership by marking mortgage lending maps with red lines. Today, more than 50 years since the passage of the Fair Housing Act, 91% of the communities identified as “best” on the redlined maps remain middle to upper class, with 85% of these communities having majority white populations. Accordingly, 3 out of 4 redlined neighborhoods remain impoverished, and 67% of redlined neighborhoods remain populated by racial minorities. Many were intentionally located in proximity to industrial areas, municipal landfills and toxic waste sites — and the subsequent negative health impacts persist across generations.

This lengthy history of systemic inequality will take time to remedy, as will the legacy of distrust of the medical establishment from the history of experimentation without consent on black Americans. A doctor known as the “Father of Modern Gynecology” performed barbaric vaginal operations on enslaved women. They were denied anesthesia, physically restrained, repeatedly mutilated. The U.S. Public Health Service denied 600 men therapeutic penicillin from 1932 to 1972 to allow the study of the natural progression of latent syphilis in the Tuskegee syphilis experiment. Their health was compromised, as were their partners and children who were predictably exposed to the disease. Black women, many of them teenagers, were the prime target for controlled breeding through forced sterilization. This practice of eugenics did not end until the 1980s. And there was the Pentagon-funded study of nontherapeutic, whole-body irradiation from 1960 to 1971, in which 25% of the subjects died within one month of exposure. All were poor, most were black, and the Radiological Society of North America awarded the lead physician its highest honor.

Nearing his death, King was deemed “unfavorable” by two-thirds of Americans in a 1966 Gallup poll. Decades later in a 1999 Gallup poll, more than 90% of Americans had a favorable opinion and ranked him as the second most admired person of the 20th century (behind Mother Teresa). As we celebrate his legacy, we should embrace his prescient view on health care inequity and further his goal of creating a just society for all.

Perhaps King’s greatest threat was to recognize that, from Chicago to Dallas and to other cities and towns across the land, we are more alike than different. He dared to criticize health inequities embedded in communities from urban ghettos to the mountains of West Virginia. And although his life was ended while he was building bridges across racial and ethnic divides, his dream of proper health care for all should not. Because if raising his voice against persistent health inequality made King a dangerous man, add us to that list.

Health inequality remains among the greatest injustices of our time, and, as King penned in “Letter From Birmingham Jail,” “injustice anywhere is a threat to justice everywhere.” Like King, let us commit ourselves anew to eradicating these death-dealing realities “until justice rolls down like waters, and righteousness like a mighty stream” (Amos 5:24).