Category Archives: Health System

Philadelphia Hospital to Stay Closed After Owner Requests Nearly $1 Million a Month

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Philadelphia Hospital to Stay Closed After Owner Requests Nearly ...

Hahnemann University Hospital could hold 500 patients with the coronavirus. But city officials said the cost was too steep.

A hospital with room for nearly 500 beds has been closed for months in the center of Philadelphia, a city bracing for the spread of the coronavirus and a crush of sick patients.

But the facility will remain empty, city officials said, because they cannot accept the owner’s offer: buy the hospital or lease it for almost $1 million a month, including utilities and other costs.

“We don’t have the need to own it nor the resources to buy it. So we are done and we are moving on,” Mayor Jim Kenney told reporters on Thursday during the city’s daily briefing.

The next day, he said that Temple University would let the city use a music and sports venue for free. The city would no longer pursue the closed facility, Hahnemann University Hospital.

The abrupt end of the dispute underscored the frantic search for more hospital beds as cities try to prepare for a crisis that is overwhelming medical facilities in New York, and highlighted the tensions between government officials and businesses in responding to the pandemic. This week, the Trump administration backed away from announcing a $1 billion deal with General Motors and Ventec Life Systems to produce ventilators, after officials said they needed more time to assess the estimated cost.

In Philadelphia, coronavirus infections are quickly rising. On Friday, the city health commissioner, Dr. Thomas Farley, reported 154 new cases, for a total of 637 cases across every ZIP code of the city, and three deaths. “This virus is everywhere in Philadelphia,” he said.

The owner of the hospital, Joel Freedman of Broad Street Healthcare Properties, a real estate company, said he had offered to sell the facility to the city well below market price, or to lease it for $60 a bed a day, far less than what two other hospitals in California agreed to charge to lease their facilities.

“Anyone looking at the apples-to-apples comparison can see that Mr. Freedman not only desired to be helpful to the city of Philadelphia and its leaders, but he was very reasonable,” said Sam Singer, a spokesman for Mr. Freedman, who is based in Los Angeles. “We’re disappointed that they didn’t accept what we offered, but we stand ready to be helpful to the city or the state if they want to reopen discussions.”

Hahnemann Hospital, which once served the city’s poorest patients, closed in September 2019. The hospital had been suffering millions of dollars in losses a month, Mr. Freedman told The Philadelphia Business Journal last June.

“We relentlessly pursued numerous strategic options to keep Hahnemann in operation, and have been uncompromising in our commitment to our staff, patients and community,” Mr. Freedman said at the time. “We are faced with the heartbreaking reality that Hahnemann cannot continue to lose millions of dollars each month and remain in business.”

The decision to close the hospital last year infuriated local leaders and led Senator Bernie Sanders, the Vermont independent running to be the Democratic nominee for president, to hold a rally outside the hospital. He described the closure as a consequence of greed, and an example of the need for a better health care system.

Mr. Singer said Mr. Freedman had been unfairly maligned throughout the recent dispute, and that his obligations included maintenance, compensating his staff and paying off the loan he took out to buy the property.

“They’ve wrongly been critical of Mr. Freedman,” Mr. Singer said of his detractors. “We understand that emotions are high. We don’t want in any way to hold that against them.”

He added, “Even with those harsh words, our doors, our ears, our minds are still open. We want to help.”

Since last fall, the hospital has sat empty and fallen into disrepair, Mayor Kenney said on Thursday. “It has no beds and would require extensive work to make it usable again,” he said.

Mr. Kenney said the city had offered to lease the hospital for a “nominal” amount and pay for its maintenance and expenses, a deal that would have meant “hundreds of thousands of dollars a month” for Mr. Freedman and made the property more marketable in the future.

“Yet the owner would not agree to our offer,” he said.

Instead, Mr. Freedman wanted the city to pay $400,000 a month in rent in addition to making improvements and paying for other expenses, Mr. Kenney said. “I’ll let others decide whether that’s reasonable or not,” Mr. Kenney said.

Mr. Singer said the city contacted Mr. Freedman around March 11 about leasing the property. “We responded immediately and said, ‘Yes, we would like to help in any manner,’” he said.

Mr. Freedman offered to sell the property below market price or lease it for $27 a bed a day. The city would have to pay an additional $33 a bed a day to cover the costs of utilities and taxes, he said. The full amount came to about $910,000 a month, Mr. Singer said.

“They just decided, ‘We’re not going to pursue Hahnemann,’” he said.

City officials had signaled that negotiations were breaking down earlier this week. On Tuesday, the city’s managing director, Brian Abernathy, told reporters that what Mr. Freedman wanted was “unreasonable.”

“I think he’s looking at this as a business transaction rather than providing an imminent and important aid to the city and our residents,” Mr. Abernathy said.

City Councilor Helen Gym said on Twitter that day that Philadelphia should not let “unconscionable greed to get in the way of saving lives,” and called for acquiring the property through eminent domain. Mr. Kenny said city officials had explored that option but determined it was too time-consuming and would require them to purchase the building at market price.

Mr. Kenney said in a news conference Friday that the city would use the Liacouras Center, a concert and sports venue at Temple University, for additional hospital space. The university will let the center be used for free and the space can fit up to 250 beds, officials said.

 

 

 

White House coronavirus coordinator: All governors and mayors need to ‘prepare like New York is preparing now’

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https://thehill.com/homenews/sunday-talk-shows/490052-white-house-coronavirus-coordinator-officials-are-asking-every

Deansboro, NY Coronavirus - News Break Deansboro, NY

The White House coronavirus task force coordinator said Sunday that the administration is “asking every single governor and every single mayor to prepare like New York is preparing now.”

Dr. Deborah Birx told NBC’s “Meet the Press” that state and city leaders need to know where each hospital in their jurisdiction is located, where the surgical centers are, where “every piece of equipment is in the state” and how to move equipment around the state “based on need.”

“So it’s not just what you have inside your doors today. It’s how you can surge and move things around,” she said. “We know this epidemic moves in waves. Each city will have its own epidemic curve. And so we can move between states, we can move within states, to meet the needs of everyone.”

But Birx emphasized that states and metro areas need to react because of the quickly increasing number of cases and deaths across the country.

“No state, no metro area will be spared, and the sooner we react and the sooner the states and the metro areas react and ensure that they put in full mitigation, at the same time understanding exactly what their hospitals need, then we’ll be able to move forward together and protect the most Americans,” she said.

Dr. Deborah Birx says “no metro area will be spared” of the coronavirus outbreak.

Dr. Birx: “The sooner we react and the sooner the states and the metro areas react and ensure that they have put in full mitigation … then we’ll be able to move forward.”

When NBC’s Chuck Todd questioned how states would go about obtaining new medical equipment, she said the federal government is “working very hard” to locate and place ventilators. 

“But we need states at the same time to look where all of their ventilators are, including outpatient surgical center,” she said.

New York Gov. Andrew Cuomo (D) has taken direct actions to combat the spread of the coronavirus initiating a stay-at-home order and working with the federal government to obtain more ventilators and temporary hospitals. The state has been hit hard by the pandemic with more than 52,300 cases and more than 880 deaths.

The president considered implementing a quarantine for New York’s tri-state area but ended up issuing a travel advisory for the area Saturday.

 

 

 

 

Philadelphia hospital won’t reopen to treat COVID-19 patients

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https://www.beckershospitalreview.com/patient-flow/philadelphia-hospital-won-t-reopen-to-treat-covid-19-patients.html?utm_medium=email

Closed Philadelphia Hospital Won't Be Used To Treat COVID-19 Patients

Hahnemann University Hospital, which closed last year, will not be reopened to treat COVID-19 patients, Philadelphia Mayor Jim Kenney announced March 26.

Philadelphia leaders identified Hahnemann as a possible site to quarantine patients who have tested positive for or been exposed to COVID-19. However, the mayor said the city is ending its effort to rent the shuttered hospital after negotiations with the hospital’s owner, Joel Freedman, failed to progress.

“We need to focus on the crisis at hand — including the need to develop facilities that will serve as field hospitals, as quarantine space, and as isolation space — facilities that will help save lives,” Mr. Kenney said. “We will focus our energies on working with other property owners in order to find temporary solutions to these absolutely vital needs. And I fully expect that we will find owners who are ready and willing to step up, to work with us, to do what is best for all Philadelphians.”

Talks collapsed a few days after Philadelphia Managing Director Brian Abernathy said negotiations with Mr. Freedman were not going well.

“I think he is looking at how to turn an asset that is earning no revenue into an asset that earns some revenue, and isn’t actually particularly thinking through what the impacts are on public health,” Mr. Abernathy said of Mr. Freedman at a March 24 press briefing, according to WHYY. “I think he’s looking at this as a business transaction rather than providing an imminent and important aid to the city and our residents.”

Regarding the city’s decision to end negotiations, Mr. Freedman’s Broad Street Healthcare Properties provided the following statement to Becker’s:

“We appreciate and applaud the city’s efforts to address the health crisis quickly. We understand that the city doesn’t feel that the Hahnemann building currently fits their urgent needs as a quarantine site. Should the situation change we stand ready to reengage in discussions on how the city or the state can best use the facility.”

 

 

 

What health care is getting out of the stimulus package

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Senate passes $2 Trillion coronavirus economic stimulus plan, it ...

Congress’ big stimulus package will provide more than $100 billion and several favorable payment policies to hospitals, doctors and others in the health care system as they grapple with the coronavirus outbreak.

The big picture: Hospitals, including those that treat a lot of rural and low-income patients, are getting the bailout they asked for — and then some.

The cornerstone provision is a no-strings-attached $100 billion fund for hospitals and other providers so they “continue to receive the support they need for COVID-19 related expenses and lost revenue,” according to a summary of the legislation.

  • It’s unclear how that money would be divvied up. One lobbyist speculated the funds would go to the “hardest-hit areas first and those areas that are next expected to get hit,” but that has not been clarified.

The bill provides many other incentives for the industry.

  • Hospitals that treat Medicare patients for COVID-19 will get a 20% payment increase for all services provided. That means Medicare’s payment for these types of hospital stays could go from $10,000 to $12,000, depending on the severity of the illness.
  • Employers and health insurers will be required to pay hospitals and labs whatever their charges are for COVID-19 tests if a contract is not in place. By comparison, Medicare pays $51.33 for a commercial coronavirus test.
  • Medicare’s “sequestration,” which cuts payments to providers by 2%, will be lifted until the end of this year.
  • Labs won’t face any scheduled Medicare cuts in 2021, and won delays in future payment cuts as well.

What’s missing: Patients who are hospitalized with COVID-19 could still be saddled with large, surprise bills for out-of-network care.

  • There also are no subsidies for COBRA coverage, which employers wanted for people who lost their jobs. However, people who are laid off are able to sign up for a health plan on the Affordable Care Act’s marketplaces or could qualify for Medicaid.

 

 

 

 

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Posted on by • Posted in Bioethics, Code Blue, Coronavirus, Crisis, Crisis Management, Do-Not-Resuscitate Orders, Ethics, Health Policy, Health System, Healthcare Ethics, Healthcare Providers, Hospital, Hospital Industry, Intensive Care (ICU), Leadership, Medical Ethics, Nurses, Oath to do no Harm, Pandemic, Physician, Rationing Care, Resuscitation Policy, Supply Chain, Ventilators • Leave a comment

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Image result for Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Worry that ‘all hands’ responses may expose doctors and nurses to infection prompts debate about prioritizing the survival of the many over the one.

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.

“We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment — including ventilators — that is quickly becoming a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

R. Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.”

Wunderink said all of the most critically ill patients in the 12 days since they had their first coronavirus case have experienced steady declines rather than a sudden crash. That allowed medical staff to talk with families about the risk to workers and how having to put on protective gear delays a response and decreases the chance of saving someone’s life.

A consequence of those conversations, he said, is that many family members are making the difficult choice to sign do-not-resuscitate orders.

Code blue

Health-care providers are bound by oath — and in some states, by law — to do everything they can within the bounds of modern technology to save a patient’s life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.

Some of the most anxiety-provoking minutes in a health-care worker’s day involve participating in procedures that send virus-laced droplets from a patient’s airways all over the room.

These include endoscopies, bronchoscopies and other procedures in which tubes or cameras are sent down the throat and are routine in ICUs to look for bleeds or examine the inside of the lungs.

Changing or eliminating those protocols is likely to decrease some patients’ chances for survival. But hospital administrators and doctors say the measures are necessary to save the most lives.

The most extreme of these situations is when a patient, in hospital lingo, “codes.”

When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel — usually somewhere around eight but sometimes as many as 30 people — rush into the room to begin live-saving procedures without which the person would almost certainly perish.

“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital.

Fred Wyese, an ICU nurse in Muskegon, Mich., describes it like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late.

In the process, heaps of protective equipment is used — often many dozens of gloves, gowns, masks, and more.

Bruno Petinaux, chief medical officer at George Washington University Hospital, said the hospital has had a lot of discussion about how — and whether — to resuscitate covid-19 patients who are coding.

“From a safety perspective you can make the argument that the safest thing is to do nothing,” he said. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.”

However, he said, the decision comes down to a hospital’s resources and “every hospital has to assess and evaluate for themselves.” It’s still early in the outbreak in the Washington area, and GW still has sufficient equipment and manpower. Petinaux said he cannot rule out a change in protocol if things get worse.

GW’s procedure for responding to coronavirus patients who are coding includes using a machine called a Lucas device, which looks like a bumper, to deliver chest compressions. But the hospital has only two. If the Lucas devices are not readily accessible, doctors and nurses have been told to drape plastic sheeting — the 7-mil kind available at Home Depot or Lowe’s — over the patient’s body to minimize the spread of droplets and then proceed with chest compressions. Because the patient would presumably be on a ventilator, there is no risk of suffocation.

In Washington state which had the nation’s first covid-19 cases, UW Medicine’s chief medical officer, Tim Dellit, said the decision to send in fewer doctors and nurses to help a coding patient is about “minimizing use of PPE as we go into the surge.” He said the hospital is monitoring health-care workers’ health closely. So far, the percentage of infections among those tested is less than in the general population, which, he hopes, means their precautions are working.

‘It is a nightmare’

Bioethicist Scott Halpern at the University of Pennsylvania is the author of one widely circulated model guideline being considered by many hospitals. In an interview, he said a blanket stop to resuscitations for infected patients is too “draconian” and may end up sacrificing a young person who is otherwise in good health. However, health-care workers and limited protective equipment cannot be ignored.

“If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” he said.

Halpern’s document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.

Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.

“They made us do all kinds of mandatory education and fittings and made it sound like they are prepared,” he said. “But when it hits the fan, they don’t have the supplies so the plans they had in place aren’t working.”

Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare. So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings. Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure — but it was 150 feet away.

While he said his hospital’s policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.

“By the time you get all gowned up and double-gloved the patient is going to be dead,” he said. “We are going to be coding dead people. It is a nightmare.”

 

 

 

 

America’s Wuhan: New York

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Image result for axios America's Wuhan: New York

New York’s fight against the novel coronavirus is also the nation’s fight, as the state — and the city in particular — emerges with “astronomical numbers” of cases, to quote Gov. Andrew Cuomo.

Why it matters: The Empire State has 5% of the world’s COVID-19 cases and about 50% of the nation’s. Its success — or failure — in fighting the virus, safeguarding citizens and treating the afflicted will tell us a lot about what can succeed in the rest of the U.S.

It’s a national travel hub, so it could be the catalyst for outbreaks elsewhere.

Cuomo is trying to shut the state down and stop the spread.

  • He is using his public mic as a blunt instrument to crush happy talk about quick ends or easy fixes.

A pivotal moment: Cuomo spoke passionately at a press conference Tuesday about the importance of devoting all resources to New York’s rapidly escalating caseload.

  • “We are the canary in the coal mine,” he said. “New York is going first. We have the highest and the fastest rate of infection.”

Later in the day, at a media briefing by the White House coronavirus task force, the White House advised people who had recently left New York City to self-quarantine for 14 days.

  • Asked if he had given Cuomo a “heads up” about this advice, Trump said, “We’re talking to them about it.”

By the numbers: New York has 25,000 cases of the novel coronavirus, vs. 2,800 in California, 2,200 in Washington state and 1,200 in Florida, Cuomo said.

  • The apex of the epidemic in New York isn’t expected for 14 to 21 days.
  • The state had 53,000 hospital beds pre-crisis and now expects to need 140,000.
  • New York City accounts for more than half the state’s cases: Nearly 16,000 people have been diagnosed and at least 125 people have died.
  • The first COVID-19 death in the state happened just under two weeks ago, in Brooklyn.

New York is throwing everything against the wall. Not only have residents been told to stay home whenever possible — and schools and most retail stores are closed — but the state is also trying experimental treatments and testing far more people for the virus than other places in the U.S.

  • Ventilator tubes are being split in half to accommodate two patients at once.
  • “We’re also trying all the new drug therapies — the hydroxychloroquine … we’re actually starting that today,” Cuomo said Tuesday.
  • In terms of protective gear and other relevant equipment, “We have acquired everything on the market that there is to acquire.”
  • The National Guard has been called in, and the U.S. Army Corps of Engineers is turning empty hotels and dormitories — and other huge facilities — into hospital rooms.

“What happens in New York, we can expect to see in other cities around the world, but maybe not at the same scale,” Denis Nash, an epidemiologist at City University of New York’s school of public health, told Axios.

Be smart: Population density, which a New York Times headline called a “trait defining New York life,” is the reason the Big Apple has become the U.S. focal point.

  • On the NYC subway — where 23 employees have tested positive — reduced service (due to budget constraints and workers calling in sick) has straphangers riding cheek-by-jowl.
  • Of the 5 boroughs, Queens — a magnet for immigrants, with lots of packed apartment buildings — has the highest number of cases.

As the densest city in the country, “New York is really a testing ground” for ways to fight the coronavirus, Tomas Hoyos, co-founder of Voro, an online social network where people share recommendations for doctors, told Axios.

  • “To the extent that you can apply elsewhere the lessons you learn from the most difficult place to contain COVID-19, you’re going to be in a good spot,” he said.
  • The flip side? New York also has more resources and commands more attention than other places that haven’t (yet) been hit as hard.

My thought bubble: As a born-and-bred New Yorker who watched from my office window as the second plane hit the Twin Towers on 9/11, I find eerie similarities between the empty streets I see this week — and the constant wail of emergency sirens — and the days after the terror attacks.

  • A key difference: Social distancing has us pulling away from one another, not coming together for comfort.

 

 

 

 

We keep underestimating the coronavirus

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Image result for axios We keep underestimating the coronavirus

The U.S. keeps reacting too late to the novel coronavirus, prolonging its economic pain and multiplying its toll on Americans’ health.

Why it matters: The spread and impact of the coronavirus may be unfathomable, but it’s not unpredictable. And yet the U.S. has failed to respond accordingly over and over again.

First, it happened with testing — a delay that allowed the virus to spread undetected.

  • Then we were caught flat-footed by the surge in demand for medical supplies in emerging hotspots.
  • And the Trump administration declined to issue a national shelter-in-place order. The resulting patchwork across the country left enough economic hubs closed to crash the economy, but enough places up and running to allow the virus to continue to spread rampantly.

Between the lines: Proactive containment and mitigation steps would have required extraordinary political and economic capital, especially if they had come early in the process, when many Americans didn’t grasp the full weight of this challenge.

  • But making decisions based on today’s information — without an understanding of how much worse tomorrow will be — is also politically and economically risky, and carries the extra cost of more deaths.

Now, even as testing and hospital capacity remain limited, President Trump is eager for an economic recovery — even though, by all estimates, the outbreak is only going to get worse.

The bottom line: When I asked one senior Health and Human Services official how all of this keeps happening, the official said it’s at least partially due to disconnects — between Trump and his administration; between the government and the private sector, and between the U.S. and the rest of the world.

  • “At the end of the day, the virus has slipped through all those cracks that exist between all of these entities,” the official said.

 

 

 

 

 

Everybody wants a piece of the stimulus

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Image result for axios vitals Everybody wants a piece of the stimulus

Lobbyists are racing to grab a piece of the stimulus package lawmakers are still trying to hammer out on Capitol Hill, Bob writes.

Driving the news: Hospitals and physicians want at least $100 billion and significant Medicare payment hikes, partially because they’ve had to cancel lucrative elective procedures.

  • Hotels, airlines, restaurants, casinos, manufacturers and other service industries that have been battered by the coronavirus spread are angling to get hundreds of billions in loans and other funding.
  • A coalition of major employers is lobbying Congress for payroll tax credits and coverage subsidies for people who lose their jobs.

The intrigue: The chance for federal bailouts has motivated small players to make bigger investments, and some nontraditional parties are spending their first lobbying dollars.

 

 

 

 

“We’re looking at a tsunami”

Posted on by • Posted in Childcare, Coronavirus, Crisis, Crisis Management, Cybersecurity, Health System, Healthcare Providers, Home Care, Home Health, Hospital, Hospital Industry, Infection Control, Infectious Virus, Intensive Care (ICU), Leadership, Nurses, Paid Time Off (PTO), Pandemic, Talent Management • Leave a comment

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Yesterday we spoke with a senior healthcare executive leading the COVID-19 response for a regional health system on the West Coast. Their area is now experiencing exponential growth of new cases, with the number of local diagnoses doubling every couple of days. In all likelihood, they’re less than two weeks from having the number of cases seen in harder-hit areas like San Francisco, Seattle and New York City. She said the “anticipation of what is about to happen” is the scariest part of the around-the-clock work they are doing to prepare.

But that two-week lead time has given them precious time to organize, and she generously shared key elements of their action plan. Their preparation work—surely similar to what hundreds of health systems around the country are doing—impressed us not only with its breadth, depth and comprehensiveness, but also the level of energy and confidence conveyed by the hundreds of actions and decisions, large and small, the system is making every day. Here are some of their important learnings so far:

  1. Even though the surge of patients has yet to begin, staff are “worried and scared”. They are concerned about PPE shortages and personal safety and stressed at home with schools and daycare closed. Detailed and regular communication is more critical than ever—and they’re trying to answer every inbound concern or question from associates directly. They are funding and expanding childcare options for staff, through partnerships with community organizations and daily stipends for home-based care.
  2. As the system works through worst-case scenario planning, they anticipate the need for critical care nurses, respiratory therapists, and emergency physicians will be the worst bottlenecks, and they are working to cross-train adjacent clinicians and build new staffing models to increase capacity. While most providers are deeply dedicated to providing care for COVID-19 patients, a small number have already “called off” and refused to report—creating unanticipated questions around how to manage these difficult situations.
  1. As they prepare to implement new surge staffing models, the system is now navigating through a period of downtime. With elective procedures cancelled and some ambulatory sites closed, they currently need fewer nurses and clinical staff than a month ago, and are creating policies, like allowing staff to go negative into PTO, to maintain income while they wait for the surge. Staff who must work in-person are working variable shifts to reduce crowding. They are also working to credential nurses and staff furloughed from local ambulatory surgery centers, so they have them ready to deploy when needed.
  1. IT staff are working nonstop to quickly make it possible for all eligible employees to work remotely, and to enable staff to safely gain access to the system’s intranet while guarding against new cybersecurity threats. The system is training and enabling hundreds of doctors to deliver care virtually, including affiliated independents.
  1. Guidelines for coronavirus patient management and recommended PPE practices change daily; it’s a full-time job for clinical leaders to keep up. Doctors are eager to try novel and creative treatments for very sick patients. (For instance, one doctor is developing a 3-D printed device that will allow one ventilator to be used for four patients simultaneously.) This eagerness to “do something” is understandable but creates a bit of chaos as leaders work to create policies around how to best manage patients.
  1. While leaders communicate with other health systems and local and state authorities daily, the vast majority of decisions are made internally, on the fly. For instance, the system is connecting with now-empty local hotels and universities to provide options for low-acuity patient capacity, but leaders hope that parallel efforts at other organizations can be brought together into a more unified regional response. For now, however, coordination would likely create unacceptable delays.
  1. Long-term health and stamina of staff is top among the system’s concerns. “If I borrow worry from the future”, this leader said, “I am worried that we are facing years-long trauma, both emotional and financial, and I’m not sure how we will sort it out”. For now, efforts to support staff and provide moments of relief and joy, are critical, and very appreciated by front-line team members.

We left this conversation emotionally overwhelmed ourselves, and with a huge sense of gratitude for clinicians and health system leaders. Americans can take comfort in the amount of work that is taking place even before critical patients begin to appear—and that doctors, nurses and hospitals are truly dedicated to providing us the best possible care under circumstances they have never faced before. If you know about creative approaches or new ideas organizations are putting in place to contend with the current situation, please let us know. We’re eager to share great ideas!

 

 

 

We may need retired doctors and nurses

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Health System, Healthcare Providers, Hospital, Hospital Industry, Nurses, Physician, Recruiting • Leave a comment

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Image result for axios We may need retired doctors and nurses

Hospitals are asking retired doctors and nurses to come back and help with operations as they prepare for a rush of severe coronavirus cases, Axios’ Bob Herman reports.

The bottom line: Retired clinicians likely won’t be placed in intensive care units or coronavirus testing stations, because older adults are at higher risk of falling ill and dying from the virus. But they could help stabilize hospitals that will need as many hands on deck as possible over the coming months.

Where it stands: The Association of American Medical Colleges floated this idea last week with hospitals and federal agencies.

  • “The question is: How can we bring people up to speed and bring them in?” said Janis Orlowski, a physician and executive at the AAMC. “They will … [likely] backfill in areas where it’s not direct patient care.”

What they’re saying: Some retired clinicians are willing to take on other necessary care, while residents and other doctors funnel into coronavirus cases.

By the numbers: 41% of doctors are 55 or older, according to American Medical Association data provided to Axios, and 38% of nurses are 55 or older.