A patient accused of fatally beating his roomate at Antelope Valley Hospital in Lancaster, Calif., has been arrested and charged with murder, elder abuse and a hate crime enhancement, according to the Los Angeles County Sherrif’s Department.
The victim, an 82-year-old man, was being treated for COVID-19 and sharing a room with the suspect, identified as 37-year-old Jesse Martinez. The victim, whose name has not been released, began to pray in his hospital room on Dec 17. That act upset Mr. Martinez, who allegedly struck the victim with an oxygen tank. The man died of his injuries Dec. 18, police said.
Mr. Martinez is being held at the Twin Tower Correctional Facility in Los Angeles, and his bond is set at $1 million. He’s scheduled to appear in court Dec. 28.
Police said the investigation into the incident is ongoing, and the motive is not immediately clear.
Chinese investor Tianqiao Chen and his group of companies have a 12.2 percent stake in Franklin, Tenn.-based Community Health Systems after selling nearly 13 million shares of the company in the past month, according to Securities and Exchange Commission filings.
Mr. Chen and his Shanda Group company affiliates sold 3.4 million shares of CHS on Dec. 14 for between $8.50 and $8.71 per share, bringing in a total of $28.5 million. The move comes after he sold 5 million shares of CHS from Nov. 10-12 and another 4.6 million shares Nov. 23. Those sales brought in a total of $81.2 million.
Mr. Chen, a pioneer in China’s online gaming industry, began buying up shares of CHS in 2016. The last public comment the investor made about CHS was in 2018, when Shanda Group said it had a “good relationship” with CHS and supported the company’s strategy and management team.
Hospital margins and revenues continued to fall in November, while expenses remained above 2019 levels, according to Kaufman Hall’s December Flash report, which examines metrics from the previous month.
The median hospital operating margin in November was 2.5 percent year to date with funding from the Coronavirus Aid, Relief and Economic Security Act. Without the funds, the median hospital operating margin narrowed to -1.1 percent.
Skyrocketing COVID-19 cases are already stretching hospitals’ capacity, and Kaufman Hall expects the situation to worsen in coming months as holiday gatherings and colder weather push case counts up even further.
There were several hospital mergers that, at some point in their lifetime, were called off in the past year.
Below are seven hospital mergers called off since December 2019, beginning with the most recent:
1. Sanford, Intermountain halt merger talks Sanford Health indefinitely suspended discussions in early December about a planned merger with Salt Lake City-based Intermountain Health because of the abrupt exit of Sanford’s longtime president and CEO, Kelby Krabbenhoft. Sanford and Intermountain announced in October they had signed a letter of intent to merge, with completion of the deal expected in 2021. The combination would create a $15 billion, 70-hospital system. In its statement issued Dec. 4, Sanford said it will pause current merger and acquisition activity while it addresses other organizational needs.
2. Advocate Aurora, Beaumont cancel merger Advocate Aurora Health, which has dual headquarters in Milwaukee and Downers Grove, Ill., and Southfield, Mich.-based Beaumont Health called off their merger plan Oct. 2, about five months after signing a letter of intent to combine. The proposed merger faced criticism from some Beaumont physicians, nurses and donors. In August, the Beaumont board of trustees confirmed it would delay a vote on the planned merger. The trustees decided to postpone the vote after seeing the results of a survey, completed by 1,500 of the system’s 5,000 physicians, that revealed a lack of confidence in Beaumont’s leadership and concerns about its proposed merger with Advocate Aurora. The merger of Beaumont and Advocate Aurora would have created a $17 billion system with 36 hospitals.
3. California hospital ends merger talks with Dignity Health County officials overseeing Ventura (Calif.) County Medical Center ended merger talks with San Francisco-based Dignity Health in July after leaders from both parties deemed an affiliation too risky. County Health Care Agency Director Bill Foley said Dignity officials considered it a risk to take on public hospitals, while county managers were concerned they would give up control but still face risk for buildings and finances. County officials were also concerned VCMC would lose its designation as a public hospital under either a lease or a contract with Dignity, which would put roughly $150 million in annual funding at risk.
4. Beaumont, Summa Health cancel $6.1B merger plan Southfield, Mich.-based Beaumont Health called off a proposed merger with Akron, Ohio-based Summa Health in late May. They ended talks about five months after signing a definitive agreement, under which Summa Health would have become a subsidiary of Beaumont. The proposed deal, which had already received all necessary regulatory approvals, would have created a nonprofit system with 12 hospitals and $6.1 billion in annual revenue.
5. 4 Chicago hospitals call off $1.1B merger plan Chicago-based Advocate Trinity Hospital, Mercy Hospital and Medical Center, South Shore Hospital and St. Bernard Hospital signed a letter of intent in January to combine into a single health system and build at least one new hospital and several community health centers. The hospitals called off the deal in late May after government funding for the $1.1 billion plan fell through.
6. Geisinger, AtlantiCare sever merger Danville, Pa.-based Geisinger and Atlantic City, N.J.-based AtlantiCare severed their merger in March, about five years after the two systems combined. The separation of the two organizations is expected to take up to 18 months, the two organizations said in March.
7. Wisconsin health systems call off merger La Crosse, Wis.-based Gundersen Health System and Marshfield (Wis.) Clinic Health System abandoned plans in December 2019 to merge into a 13-hospital rural healthcare network. The two systems said they “mutually decided to remain independent” after several months of productive and collaborative discussions.
UMass Memorial Health Care and the Harrington HealthCare System have filed paperwork for regulatory approval for their plans for Harrington to become part of the UMass Memorial system.
Worcester-based UMass Memorial said Tuesday the two hospital systems filed the first in a series of required filings with state regulatory agencies for their proposed marriage. The review process, to include Massachusetts Health Policy Commission and Attorney General’s Office, is expected to take up to four months.
UMass Memorial and Harrington first said in January they intended on Harrington being folded into the much larger UMass Memorial system, which is the largest employer in Central Massachusetts. Harrington, whose main hospital is in Southbridge, has remained one of a small and shrinking number of independent hospitals in the state.
The two systems already collaborate through a system allowing Harrington care providers to consult remotely with UMass Memorial specialists in caring for critically ill patients. Harrington will also be brought into UMass Memorial’s electronic patient records system as part of the planned integration.
UMass Memorial has committed to operating Harrington’s hospital campuses in Southbridge and Webster as acute-care hospitals for at least five years. Upon regulatory approval, Harrington will join UMass Memorial’s Medical Center in Worcester, Marlborough Hospital and Clinton Hospital.
Two people were injured in a shooting at a medical facility near PeaceHealth Southwest Medical Center in Vancouver on Tuesday afternoon.
Both were immediately taken to the nearby PeaceHealth emergency room for treatment, according to a hospital spokesperson.
The victims’ conditions and identities were not released. But there is no longer any danger to the public, said PeaceHealth spokesperson Randy Querin.
Police were called to the shooting just before 1 p.m. at 505 NE 87th Ave. Security officers put the nearby PeaceHealth campus into modified lockdown, with most entrances closed.
“I heard shots,” said Gaye Lynn Cook who was in the building for an eye appointment. “We were told to go down the hall and hide in the rooms.”
Just after 2:30 p.m., Querin said, “The situation is now safely contained, and both the 505 building and PeaceHealth Southwest Medical Center are all clear, no longer in lockdown.”
Querin said facilities inside the 505 Building include a vision center, oncology clinic, maternal fetal medicine, family medicine and a sleep disorders clinic.
The company’s surgery centers far outnumber its hospital portfolio, and its ambulatory earnings will account for nearly half of overall earnings next year.
Tenet Health got its start as a major hospital operator in the U.S. and can trace its hospital business roots as far back as 1969. But it may be time to think of the Dallas-based company as an ambulatory surgery center operator, first, and a hospital chain, second.
Following its latest acquisition, Tenet’s ASC footprint will be nearly five times larger by the number of facilities than its hospital portfolio, and its ambulatory earnings will account for nearly half of the company’s overall earnings next year, executives recently said. That’s a significant leap from about six years ago when ambulatory represented just 4% of the company’s earnings.
“From a stock perspective, I think they’re going to get more credit now for that ownership of the surgery center business than ever just because of the size contribution,” Brian Tanquilut, an analyst with Jefferies, said.
Still he noted they will likely retain their image as a hospital provider first given that half its business (and earnings) are subject to the dynamics of the hospital space.
Tenet will now operate up to 310 ASCs in 33 states following its $1.1 billion cash deal to buy up to 45 centers from SurgCenter Development.
Tenet has billed its purchase from SurgCenter Development as a transformative deal, crowning itself the leading musculoskeletal surgical platform.
SurgCenter Development is one of the larger ASC operators in the country. The Towson, Maryland-based firm has developed more than 200 centers since the company was officially established in 2002. SCD’s business model calls for its physician partners to maintain majority ownership while SCD provides consulting and capital.
In fact, Tenet will pull ahead of the pack and will operate the most ASCs compared to its competitors, according to various public data.
Amsurg, an ASC operator under private equity-owned Envision, controls more than 250 surgery centers, according to its website, followed by Optum’s 230 centers under its Surgical Care Affiliates brand.
Owner
Number of ASCs (fully or partially owned)
Tenet Health
310
Amsurg (Envision)
250
Surgical Care Affiliates (Optum)
230
SurgCenter Development
122
HCA
121
Surgery Partners
111
Total Medicare-certified ASCs in U.S.
5,700
Still, those large players only control a sliver of the overall market. There are more than 5,700 Medicare-certified ASCs operating in the U.S., according to MedPac’s latest March report.
The market is so fragmented because, historically, a handful of doctors could come together and open up a small surgery center with a few operating rooms, Todd Johnson, a partner at Bain and Company, said. Johnson noted there are not that many deals like this out there, which is why it’s significant that Tenet was able to gobble up 45 centers in one swoop.
“We’re a long way from this being a market where any individual operator’s got 30% of market share. There’s just so many of these out there,” Johnson said.
What’s so attractive?
Regulatory and reimbursement changes and patient preference continues to fuel certain procedure migration away from hospitals.
“For payers, typically, the surgery rates are 30 to 40% less than the same procedure that’s done in a hospital outpatient department. So, payers certainly value the economic value proposition of ASCs,” Johnson said.
Just recently, regulators cleared the way for more procedures to be done in ASCs. CMS is eliminating the list of procedures that must be performed in a hospital, drawing ire from the hospital lobby. The inpatient-only list will be completely phased out by 2024, creating even more growth potential for surgery centers. Come Jan. 1, total hip replacements will be covered if performed in an ASC, a huge win for ASC operators.
It’s why hospital operators like Tenet have been keen to expand their surgery center footprint. The centers attract relatively healthy patients for quick procedures — eating into hospitals’ revenue and margin.
“This further move only solidifies the fact that they are trying to diversify their revenue streams, and, frankly move into a more attractive economic profile of procedure types — not trauma and COVID but rather scheduled surgeries they can run in and out like a factory but with really good clinical outcomes,” Johnson said.
To this point, Tenet leaders said the new SurgCenter Development centers generate higher margins and have minimal debt.
Patients also tend to prefer ASCs, Johnson said. Plus, as a lower cost option it can be persuasive for patients, especially those with high-deductible health plans.
Long-term strategy
Tenet has continued to bet on the shift from inpatient to outpatient services following its purchase of USPI in 2015.
The purchase set Tenet up to be a serious competitor in the space, establishing a portfolio of 244 surgery centers when the deal was announced. It illustrated Tenet’s intent to build a broader portfolio.
At the same time, it has whittled down its hospital portfolio, divesting in markets where it isn’t the No. 1 or No. 2 player as it seeks to hone its most competitive segments and markets.
Just last year, it announced plans to largely exit the Memphis, Tennessee, market with the sale of a number of assets including two hospitals, urgent care centers and the associated physician practices.
In 2018, Tenet shed all of its operations in the U.K. and eight hospitals across the U.S.
That long-term strategy was made clearer last week when Tenet announced its sale of its urgent care business to FastMed. By selling off its 87 CareSpot and MedPost centers, Tenet said it will allow the company to further focus on its surgery center business.
Tenet has been keen to tout its position of musculosketel procedures — a high growth area compared to other procedure types such as gastroenterology. A 2019 report from Bain and Company expects that orthopaedic and spine procedure volumes will increase the fastest over the next few years.
With the SCD centers in the mix, CEO Ron Rittenmeyer said, “this transaction ensures Tenet will essentially double down and further deepen our concentration in these high growth areas of the future.”
It turns out it’s not just the kids who aren’t getting snow days this year. This week, we spoke with an executive at a health system hit hard by Wednesday’s Nor’easter, and asked how the system was faring with the expected 18 inches of snowfall. He replied that the medical group was as busy as usual.
With all the work this spring to expand telemedicine capabilities, clinic staff were able to reach out to patients the day before the storm, and proactively convert a majority of scheduled in-person clinic visits to telemedicine. “Normally we would’ve been closed, and most appointments rescheduled for weeks down the road,” he told us. Instead, they were able to keep most of those visits in their scheduled time slot.
“Now that we have a systemwide process for telemedicine, I don’t think we’ll have a reason for the clinic to take a snow day again.” It’s a clear win-win for the system and patients: patient care seamlessly goes on. It’s easy to see the many use cases for the ability to toggle between in-person and virtual visits. A parent is stuck at home with a sick kid, and can’t make her endocrinologist appointment? Moved to virtual! A patient has an unexpected business trip taking him out of town? Don’t cancel, let’s do that follow-up visit via telemedicine.
We’ve been worried about the slowdown in progress made on telemedicine as patients switched back to in-person visits across the summer and fall. The ability to continue patient care during a record-breaking snowstorm is a perfect illustration of why it’s critical not to “backslide” with virtual care: meeting patients where they are, regardless of circumstances, is an essential part of building long-term loyalty and care continuity.
Several hospitals in Los Angeles County are preparing for the possibility of restrategizing care delivery in the coming weeks amid growing COVID-19 hospitalizations, according to the Los Angeles Times.
Los Angeles County reported 6,018 COVID-19 hospitalizations Dec. 20 — a 2.5 percent increase from the day prior — with 1,198 patients in ICUs, according to the state’s data dashboard. Statewide, 17,750 patients are hospitalized with COVID-19, 3,710 of them in ICUs.
The LA Times obtained a document recently circulated among physicians at the four county-run hospitals that outlines resource allocation in crisis situations. The guidelines call for physicians to save as many patients as possible versus trying everything to save a patient, meaning those less likely to survive will not receive the level of care they would have otherwise. L.A. County Health Services Director Christina Ghaly, MD, told the LA Times that the guidelines were not in place as of Friday night.
California activated its “mass fatality” program last week, which coordinates mutual aid across several government agencies when more deaths take place in a period of time than can be handled by local coroner or medical emergency personnel, NPR reports.
Nearly all of the state is under stay-at-home orders, with residents prohibited from gathering with anyone outside their immediate household.
“I have yet to see any clear signals that things are slowing down, and I’m very concerned about the next two months,” Timothy Brewer, MD, an epidemiologist with UCLA Health, told the LA Times. He said UCLA Health is scheduling several infectious disease specialists to be on call at any time, and the biggest issue is that hospitals may quickly run out of providers who can administer ICU-level care.
Congressional leaders have reached an agreement on a $900 billion COVID-19 relief package and $1.4 trillion government funding deal with several healthcare provisions, according to Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Chuck Schumer, D-N.Y.
Here are seven things to know about the relief aid and funding deal:
1. Congressional leaders have yet to release text of the COVID-19 legislation, but have shared a few key details on the measure, according to CNBC.Becker’s breaks down the information that has been released thus far.
2. The COVID-19 package includes $20 billion for the purchase of vaccines, about $9 billion for vaccine distribution and about $22 billion to help states with testing, tracing and other COVID-19 mitigation programs, according to Politico.
3. Lawmakers are also expected to include a provision changing how providers can use their relief grants. In particular, the bill is expected to allow hospitals to calculate lost revenue by comparing budgeted revenue for 2020. Hospitals have said this tweak will allow them to keep more funding.
4. The agreement also allocates $284 billion for a new round of Paycheck Protection Program loans.
5. The COVID-19 relief bill also provides$600 stimulus checks to Americans earning up to $75,000 per year and $600 for their children, according to NBC. It also provides a supplemental $300 per week in unemployment benefits.
6. The year-end spending bill includes a measure to ban surprise billing. Under the measure, hospitals and physicians would be banned from charging patients out-of-network costs their insurers would not cover. Instead, patients would only be required to pay their in-network cost-sharing amount when they see an out-of-network provider, according to The Hill.The agreement gives insurers 30 days to negotiate a payment on the outstanding bill. After that period, they can enter into arbitration to gain higher reimbursement.
7. Lawmakers plan to pass the relief bill and federal spending bill Dec. 21.
HENRY KOTULA 