Physicians are set to see a 4.5 percent decrease in Medicare payment next year, in part due to the expiration of a temporary payment boost that was passed by Congress in December 2021 to avert scheduled sequester cuts. Physician groups are expected to lobby lawmakers heavily in the final months of the year, hoping to secure a reprieve, especially as inflation and labor costs continue to rise.
Other changes in the 2023 rules include advance payments to new participants in the Medicare Shared Savings Program, intended to boost participation of providers in rural and underserved areas. Some pandemic-era telehealth flexibilities that are set to expire with the end of the federal COVID public health emergency were also extended.
The Gist: We do not expect the full Medicare physician reimbursement cut to physicians to go into effect, as a bipartisan group of Senators has already asked leadership to address it in the upcoming lame-duck session. However, the cut serves the important purpose ofrebasing negotiations between physician lobbies and Congress, such that keeping rates flat or obtaining a small boost would feel like a win for both groups—even if it falls far short of the rate increases needed to meet the rising cost of running a practice.
If Congress continues to intervene to push off or mitigate Medicare’s sequestration payment reductions, we could find ourselves back in a Sustainable Growth Rate (SGR)-type situation where a payment cut constantly looms, physicians continually lobby for yet another reprieve, and the delayed cuts balloon in size.
I began to wonder if this trip to a pediatric urgent care with my son was even necessary.
Sure, he had been diagnosed with pneumonia a week ago and didn’t seem to be getting better. His cough sounded uglier. But here Ethan was in classic two-and-a-half-year-old mode: running in big circles around the waiting room chairs and causing the kind of ruckus only a toddler can.
He’d stuff some Pirate’s Booty I had hastily thrown into my purse in his mouth, before returning to his wild banshee ways and dashing around in circles again.
Our pediatrician said their office was too swamped with sick kids to see us, and referred us to this place. We had been told the wait to see a doctor would be a minimum of an hour. We struggled to find a seat in the packed waiting room as far as possible from other coughing kids.
We finally graduated from the waiting room to the doctor’s office, only for Ethan to continue his marathon by scooting a rolling chair back and forth, roaring with laughter every time it hit the examining table. When the physician walked in, I felt like I needed to defend wasting her time with this visit with my seemingly A-OK, albeit destructive, son.
But Ethan wasn’t OK.
The doctor listened to his chest with her stethoscope and didn’t like what she heard: wheezing, some crackling.
She showed me how Ethan’s Pirate’s Booty-stuffed stomach moved heavily each time he inhaled and exhaled.
They had Ethan complete a nebulizer treatment in the office, which meant slipping a device on his face that resembled an oxygen mask, while medicated air meant to open up his lungs flowed through a frightfully loud machine. I held him in my lap while the nebulizer was on, scrambling to find 100 different versions of “Wheels on the Bus” videos on YouTube to try to distract him from the vacuum-like whirring of the machine.
The doctor listened to his lungs again. His breathing still didn’t sound great, but she said the hospitals were too inundated right now.
I knew all too well what she meant. A few days before our urgent care visit, I had flagged a report for editors at The Hill that said children’s hospitals in the Washington area were at capacity, flooded with young kids suffering from RSV, a potentially life-threatening respiratory illness that has no vaccine.
After a three-hour visit, she gave Ethan a steroid and told us to follow up with his pediatrician the next day.
By the time we got to the pediatrician’s office the following morning, my happy-go-lucky, playful little guy was anything but. He curled up in my lap, as we went through a similar routine that the urgent care doctor had done just the night before. His oxygen levels were too low, and our pediatrician had him do another nebulizer treatment.
“Our goal is to keep you from going to the hospital,” our pediatrician told us.
It seemed like an unusual “goal” from a doctor, but I understood her reasoning. But after Ethan’s oxygen levels dipped lower still after the nebulizer, she said we should rush him straight to the hospital after all.
My “Blue’s Clues” and vehicle-obsessed son, usually the epitome of toddler “I can do it myself!” independence, wouldn’t let me put him down for even a moment as we waited in the emergency room lobby. Surprisingly, a separate waiting area in the ER just for children wasn’t completely full, and I wondered if maybe news reports of endless waits were overblown.
Not so.
“He’s so cute,” a young mother in the waiting room told me, as she motioned to Ethan’s head of curls. She cradled her two-month-old in her arms, patiently rocking the baby after telling me she had waited three hours so far.
I held Ethan as my husband rushed from work to the hospital, meeting us there and with us as we were brought to an ER triage area. They ran more oxygen tests on Ethan, got some of his history, and then sent us back to the waiting room.
Finally, they called Ethan’s name and we were in the ER. My vibrant, otherwise-healthy kid was lethargic, laying on me with a glazed look in his eyes. We struggled to fit the two of us on an exam table meant for a single adult. They draped a lead apron over me and Ethan as they took X-rays of his tiny lungs. The nurse placed a cannula in Ethan’s nose for supplemental oxygen and put an IV in his arm to give him fluids, before wrapping it with a diaper so he wouldn’t try to take out the tube.
My husband and I, loopy from what was happening, laughed at the sight of a diaper being used MacGyver-style. “Hey, it works!” the nurse said, explaining that he’d done the maneuver with kid after kid in recent weeks.
The ER doctor finally came in our room and delivered a crash course in what might be to come. “Everywhere is full. The entire Eastern seaboard,” he said of hospitals.
“We’ve been airlifting kids to Pittsburgh, sometimes to Richmond,” he added. This hospital had a pediatric unit, but not an intensive care geared towards kids. So if Ethan’s condition became even more dire, they wouldn’t be able to treat him there. Our only hope was that the pediatric unit, which had just a few remaining beds, accepted him.
It was a gut punch. As the doctor left, my husband looked at Ethan, who had fallen asleep with a mask on as the nebulizer loudly buzzed away for another treatment.
“He’s just a baby. He’s not supposed to be here,” my husband said, defeated.
The pediatric unit doctor finally came into our room. She examined Ethan, and briefed us on how they’ve been dealing with case after case of the same thing: RSV.
But she offered us hope: he could head to the pediatric unit at the hospital. We wouldn’t need to travel for his care, as long as he didn’t worsen. Ten hours after we first entered the hospital, we had a bed for Ethan.
We’re among the lucky ones. We were told beyond airlifting, plenty of families had been spending multiple nights in the ER because there were no beds.
In Maryland, Gov. Larry Hogan (R) announced last week that that hospitals would receive $25 million in additional funding from the state to prioritize pediatric intensive care unit staffing. Children from birth to age two comprised 57 percent of hospitalizations last week, according to Hogan’s office.
Next to the ghost decorations for Halloween adorning the doors of the pediatric unit, room after room had the same notice taped up: isolation guidelines. The rooms were all filled with kids facing the exact same thing as Ethan. RSV was everywhere.
There’s no cure for RSV. Every two hours on the dot, the nurses would give Ethan the nebulizer treatment.
A monitor affixed to his foot would alert nurses if his oxygen dipped dangerously low, which it did several times throughout the first night. I thought at one point to ask what happens if Ethan stopped responding to the treatments, but then didn’t ask because I didn’t want to know the answer.
The goal was to get him going without the need for additional oxygen, and breathing well for at least four hours between treatments, two times in a row.
That seemingly simple goal proved elusive for two full days. I originally thought it would be a nightmare trying to get a two-year-old to stay in a hospital bed for more than five minutes, but Ethan was in such bad shape that he barely made a fuss. Then, after midnight on our second night in the hospital, Ethan suddenly perked up.
He sat up and rolled over in the hospital bed. Then, he rolled onto my head, spreading his arms and legs out as far as he could stretch, and giggled.
“Should I sleep here?” he said, cracking himself up.
It was like someone hit the power button on my kid, and suddenly he snapped back to himself. I didn’t care that it was midnight and we needed to get some extremely interrupted sleep before the next nebulizer treatment. My son was back.
A nurse later told me that she enjoyed working with kids because for as quickly as their health can deteriorate, they can just as speedily bounce back.
After that, the doctor advised us to try stretching out his time between treatments. Finally, we were told he was stable enough to go home. I somehow hadn’t shed a tear the entire time we were at the hospital, but when the doctor signed off on us leaving, I bawled.
As nightmarish an experience as it was, I realize how incredibly fortunate my family is.
My husband and I have jobs that allowed us to drop everything when our son needed help, we have health insurance policies, and resources to get through spending days at the hospital.
Perhaps most importantly, we had access to an incredible team of doctors and nurses and the sheer fortune of being able to get a bed for our son during an unprecedented and unthinkable time for hospitals.
At the risk of repeating one of those parenting cliches that I would’ve rolled my eyes at a week ago, I’m thankful that I trusted my gut. Even when Ethan was being a wild child at urgent care, I knew something just wasn’t right. What I didn’t know was how much he had been struggling to breathe.
At the hospital after being discharged, Ethan and I waited in the lobby as my husband went to get our car from the parking lot to pick us up. Ethan spotted some empty wheelchairs in the corner of the lobby, and immediately ran over to them. He giggled as he tried to roll one of the chairs into the automatic opening and closing doors. As I looked on as he laughed and laughed at the pint-sized commotion he created, I breathed a sigh of relief.
The third quarter brought little relief to hospitals in what is shaping up to be one of their worst financial years.
Kaufman Hall’s October National Hospital Flash Report— based on data from more than 900 hospitals — found slightly lower hospital expenses in September did not outweigh lower revenue across the board, with decreases in discharges, inpatient minutes and operating minutes.
The median year-to-date operating margin index for hospitals was -0.1 percent in September, marking a ninth straight month of negative operating margins and a dimmer outlook for their climb back into the black by year’s end.
Kaufman Hall noted that expense pressures and volume and revenue declines could force hospitals to make “difficult decisions” about service reductions and cuts.
“Health systems are starting to get a clear picture of what service lines have a positive effect on their margins and which ones are weighing them down,” said Matthew Bates, managing director and Physician Enterprise service line lead with Kaufman Hall. “Without a positive margin there is no mission. Health systems must think carefully and strategically about what areas of care they invest in for the future.”
Large health systems are reporting big losses this year while insurers continue to turn billion-dollar profits.
Humanareported $1.2 billion in third quarter profits, a slight drop from the same period last year. The company has focused on regaining Medicare Advantage market share and increased quarterly revenues 10.2 percent year over year.
Cigna’s third quarter profits jumped 70 percent year over year, hitting $2.8 billion. The company reported $45.3 billion in third quarter revenues and raised its annual earnings outlook based on the results. The company now projects $179 billion for full year 2022 adjusted revenue.
CVS Health also beat investor expectations in the third quarter and raised its earnings outlook. The company’s third quarter revenue jumped almost 10 percent year over year to $81.2 billion, although it reported $3.4 billion in losses after agreeing to pay into a $5 billion global opioid lawsuit settlement over 10 years.
At the same time, health systems are reporting multimillion and even billion-dollar losses. Chicago-based CommonSpirit Health reported $1.3 billion operating loss for the 12-months end on June 30. Ascension, based in St. Louis, also reported a $1.8 billion loss for the fiscal year’s end in June.
Community Health Systemreported a $42 million net loss for the third quarter in October and both Dallas-based Tenet Healthcare and Nashville, Tenn.-based HCA Healthcare reported more than 50 percent drops in quarterly net income from 2021 to 2022.
The profitability mismatch between the nation’s largest payers and health systems of all sizes will be front and center during contract negotiations in the coming year. There have already been high profile contract impasses between insurers and large systems, with some leading to contract termination.
There are an estimated 19,000 full-time job vacancies across Massachusetts acute care hospitals, according to a survey published Oct. 31 by the Massachusetts Health & Hospital Association.
Hospitals are working to address backlogs and transfer patients to post-acute care settings while skyrocketing labor costs — including a projected $1 billion in travel labor costs this year — are compounding healthcare facilities’ financial woes, according to the report. These challenges are hampering hospital operations as well as leading to care delays and reduced access to care.
Fewer workers mean that fewer beds are available for patients, while the demand for care increases due to deferred care throughout the COVID-19 pandemic, the behavioral health crisis and reduced access to community-based services continue to challenge hospitals throughout the state. At any given time, more than 1,500 patients are in acute hospital beds awaiting placement to a specialized behavioral health bed or post-acute care, according to the MHA.
“Our healthcare system has never been more fragile, and its leaders have never been more concerned about what’s to come in months ahead,” Steve Walsh, president and CEO of the MHA, said in an Oct. 31 news release shared with Becker’s Hospital Review. “They are exhausting every option within their control to confront these challenges, but this is an unsustainable reality and providers are in dire need of support.”
In response to the survey, 37 hospitals — representing 70 percent of the state’s total hospital employment — reported 6,650 vacancies among 47 positions critical to hospital operations and clinical care. The positions range from direct care nurses to lab personnel and clinical support staff. Eighteen of the 47 positions have a vacancy rate greater than 20 percent.
At a 56 percent vacancy rate, licensed practical nurses is the most in-demand position, while home health aides (34 percent), mental health workers (32 percent), infection control nurses (26 percent) and CRNAs (24 percent) are also highly sought after.
Survey respondents identified 6,650 vacancies. The 47 positions included in the survey, which was conducted this summer, account for less than half of all hospital roles. The MHA said it extrapolated that across all positions and hospitals to arrive at an estimated 19,000 vacancies across the state.
Staffing shortages are driving labor costs to an unsustainable level for many hospitals already grappling with margins close to zero or in the red. Hospitals have relied on high-cost temporary staffing to fill critical positions during the pandemic, resulting in average hourly wage rates for travel nurses increasing 90 percent since 2019, according to the report. Massachusetts hospitals reported spending $445 million on temporary registered nurse staffing halfway through the fiscal year, with temporary RN staffing costs increasing 234 percent from fiscal year 2019 to March 2022.
If urgent steps are not taken to address healthcare’s staffing shortage, hospitals will continue to face capacity challenges and overpay for labor, which will lead to fiscal instability, according to Mr. Walsh.
The MHA urged providers, payers, public officials and government agencies to address the workforce crisis by investing in training and education, expanding the workforce pipeline, providing financial support to hospitals and advancing new models of care such as telehealth and at-home care.
Hospitals in the United States are on track for their worst financial year in decades. According to a recent report, median hospital operating margins were cumulatively negative through the first eight months of 2022. For context, in 2020, despite unprecedented losses during the initial months of COVID-19, hospitals still reported median eight-month operating margins of 2 percent—although these were in large part buoyed by federal aid from the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
The recent, historically poor financial performance is the result of significant pressures on multiple fronts. Labor shortages and supply-chain disruptions have fueled a dramatic rise in expenses, which, due to the annually fixed nature of payment rates, hospitals have thus far been unable to pass through to payers. At the same time, diminished patient volumes—especially in more profitable service lines—have constrained revenues, and declining markets have generated substantial investment losses.
While it’s tempting to view these challenges as transient shocks, a rapid recovery seems unlikely for a number of reasons. Thus, hospitals will be forced to take aggressive cost-cutting measures to stabilize balance sheets. For some, this will include department or service line closures; for others, closing altogether. As these scenarios unfold, ultimately, the costs will be borne by patients, in one form or another.
Hospitals Face A Difficult Road To Financial Recovery
There are several factors that suggest hospital margins will face continued headwinds in the coming years. First, the primary driver of rising hospital expenses is a shortage of labor—in particular, nursing labor—which will likely worsen in the future. Since the start of the pandemic, hospitals have lost a total of 105,000 employees, and nursing vacancieshave more than doubled. In response, hospitals have relied on expensive contract nurses and extended overtime hours, resulting in surging wage costs. While this issue was exacerbated by the pandemic, the national nursing shortage is a decades-old problem that—with a substantial portion of the labor force approaching retirement and an insufficient supply of new nurses to replace them—is projected to reach 450,000 by 2025.
Second, while payment rates will eventually adjust to rising costs, this is likely to occur slowly and unevenly. Medicare rates, which are adjusted annually based on an inflation projection, are already set to undershoot hospital costs. Given that Medicare doesn’t issue retrospective corrections, this underadjustment will become baked into Medicare prices for the foreseeable future, widening the gap between costs and payments.
This leaves commercial payers to make up the difference. Commercial rates are typically negotiated in three- to five-year contract cycles, so hospitals on the early side of a new contract may be forced to wait until renegotiation for more substantial pricing adjustments. “Negotiation” is also the operative term here, as payers are under no obligation to offset rising costs. Instead, it is likely that the speed and degree of price adjustments will be dictated by provider market share, leaving smaller hospitals at a further disadvantage. This trend was exemplified during the 2008 financial crisis, in which only the most prestigious hospitals were able to significantly adjust pricing in response to historic investment losses.
Finally, economic uncertainty and the threat of recession will create continued disruptions in patient volumes, particularly with elective procedures. Although health care has historically been referred to as “recession-proof,” the growing prevalence of high-deductible health plans (HDHPs) and more aggressive cost-sharing mechanisms have left patients more exposed to health care costs and more likely to weigh these costs against other household expenditures when budgets get tight. While this consumerist response is not new—research on previous recessions has identified direct correlations between economic strength and surgical volumes—the degree of cost exposure for patients is historically high. Since 2008, enrollment in HDHPs has increased nearly four-fold, now representing 28 percent of all employer-sponsored enrollments. There’s evidence that this exposure is already impacting patient decisions. Recently, one in five adults reported delaying or forgoing treatment in response to general inflation.
Taken together, these factors suggest that the current financial pressures are unlikely to resolve in the short term. As losses mount and cash reserves dwindle, hospitals will ultimately need to cut costs to stem the bleeding—which presents both challenges and opportunities.
Direct And Indirect Consequences For Cost, Quality, And Access To Care
Inevitably, as rising costs become baked into commercial pricing, patients will face dramatic premium hikes. As discussed above, this process is likely to occur slowly over the next few years. In the meantime, the current challenges and the manner in which hospitals respond will have lasting implications on quality and access to care, particularly among the most vulnerable populations.
Likely Effects On Patient Experience And Quality Of Care
Insufficient staffing has already created substantial bottlenecks in outpatient and acute-care facilities, resulting in increased wait times, delayed procedures, and, in extreme cases, hospitals diverting patients altogether. During the Omicron surge, 52 of 62 hospitals in Los Angeles, California, were reportedly diverting patients due to insufficient beds and staffing.
The challenges with nursing labor will have direct consequences for clinical quality. Persistent nursing shortages will force hospitals to increase patient loads and expand overtime hours, measures that have been repeatedly linked to longer hospital stays, more clinical errors, and worse patient outcomes. Additionally, the wave of experienced nurses exiting the workforce will accelerate an already growing divide between average nursing experience and the complexity of care they are asked to provide. This trend, referred to as the “Experience-Complexity Gap,” will only worsen in the coming years as a significant portion of the nursing workforce reaches retirement age. In addition to the clinical quality implications, the exodus of experienced nurses—many of whom serve in crucial nurse educator and mentorship roles—also has feedback effects on the training and supply of new nurses.
Staffing impacts on quality of care are not limited to clinical staff. During the initial months of the pandemic, hospitals laid off or furloughed hundreds of thousands of nonclinical staff, a common target for short-term payroll reductions. While these staff do not directly impact patient care (or billed charges), they can have a significant impact on patient experience and satisfaction. Additionally, downsizing support staff can negatively impact physician productivity and time spent with patients, which can have downstream effects on cost and quality of care.
Disproportionate Impacts On Underserved Communities
Reduced access to care will be felt most acutely in rural regions. A recent report found that more than 30 percent of rural hospitals were at risk of closure within the next six years, placing the affected communities—statistically older, sicker, and poorer than average—at higher risk for adverse health outcomes. When rural hospitals close, local residents are forced to travel more than 20 miles further to access inpatient or emergency care. For patients with life-threatening conditions, this increased travel has been linked to a 5–10 percent increase in risk of mortality.
Rural closures also have downstream effects that further deteriorate patient use and access to care. Rural hospitals often employ the majority of local physicians, many of whom leave the community when these facilities close. Access to complex specialty care and diagnostic testing is also diminished, as many of these services are provided by vendors or provider groups within hospital facilities. Thus, when rural hospitals close, the surrounding communities lose access to the entire care continuum. As a result, individuals within these communities are more likely to forgo treatment, testing, or routine preventive services, further exacerbating existing health disparities.
In areas not affected by hospital closures, access will be more selectively impacted. After the 2008 financial crisis, the most common cost-shifting response from hospitals was to reduce unprofitable service offerings. Historically, these measures have disproportionately impacted minority and low-income patients, as they tend to include services with high Medicaid populations (for example, psychiatric and addiction care) and crucial services such as obstetrics and trauma care, which are already underprovided in these communities. Since 2020, dozens of hospitals, both urban and rural, have closed or suspended maternity care. Similar to closure of rural hospitals, these closures have downstream effects on local access to physicians or other health services.
Potential For Productive Cost Reduction And The Need For A Measured Policy Response
Despite the doom-and-gloom scenario presented above, the focus on hospital costs is not entirely negative. Cost-cutting measures will inevitably yield efficiencies in a notoriously inefficient industry. Additionally, not all facility closures negatively impact care. While rural facility closures can have dire consequences in health emergencies, studies have found that outcomes for non-urgent conditions remained similar or actually improved.
Historically, attempts to rein in health care spending have focused on the demand side (that is, use) or on negotiated prices. These measures ignore the impact of hospital costs, which have historically outpaced inflation and contributed directly to rising prices. Thus, the current situation presents a brief window of opportunity in which hospital incentives are aligned with the broader policy goals of lowering costs. Capitalizing on this opportunity will require a careful balancing act from policy makers.
In response to the current challenges, the American Hospital Association has already appealed to Congress to extend federal aid programs created in the CARES Act. While this would help to mitigate losses in the short term, it would also undermine any positive gains in cost efficiency. Instead of a broad-spectrum bailout, policy makers should consider a more targeted approach that supports crucial community and rural services without continuing to fund broader health system inefficiencies.
The establishment of Rural Emergency Hospitals beginning in 2023 represents one such approach to eliminating excess costs while preventing negative patient consequences. This rule provides financial incentives for struggling critical access and rural hospitals to convert to standalone emergency departments instead of outright closing. If effective, this policy would ensure that affected communities maintain crucial access to emergency care while reducing overall costs attributed to low-volume, financially unviable services.
Policies can also help promote efficiencies by improving coverage for digital and telehealth services—long touted as potential solutions to rural health care deserts—or easing regulations to encourage more effective use of mid-level providers.
Conclusion
The financial challenges facing hospitals are substantial and likely to persist in the coming years. As a result, health systems will be forced to take drastic measures to reduce costs and stabilize profit margins. The existing challenges and the manner in which hospitals respond will have long-term implications for cost, quality, and access to care, especially within historically underserved communities. As with any crisis, though, they also present an opportunity to address industrywide inefficiencies. By relying on targeted, evidence-based policies, policy makers can mitigate the negative consequences and allow for a more efficient and effective system to emerge.
Several hospitals and health systems are trimming their workforces or jobs due to financial and operational challenges.
Below are workforce reduction efforts or job eliminations that were announced within the past month and/or take effect over the next month.
1. Fayetteville, N.C.-based Cape Fear Valley Health is eliminating 200 positions. The decision affects 42 employees in non-direct patient care positions. The other 158 positions were unfilled positions. Employees were informed of the changes Oct. 27.
2. Sioux Falls, S.D.-based Sanford Healthannounced layoffs affecting an undisclosed number of staff on Oct. 19, a decision its CEO said was made “to streamline leadership structure and simplify operations” in certain areas. The layoffs primarily affect nonclinical areas.
3. University Hospitalsannounced efforts to reduce system expenses by $100 million Oct. 12, including the elimination of 326 vacant jobs and layoffs affecting 117 administrative employees. None of the employees affected by job cuts or layoffs provide direct patient care. The workforce reduction comes as the 21-hospital system faces a net operating loss of $184.6 million from the first eight months of 2022.
4. Ascension is closingAscension St. Vincent Dunn, a critical access hospital in Bedford, Ind., and nine medical practices in December, a move that will affect 133 employees. Affected employees who do not secure another position within the health system will be offered severance and outplacement services.
5. Quincy, Ill.-based Blessing Health Systemclosed its hospital in Keokuk, Iowa, Sept. 30. The closure affected 151 workers. The layoffs take effect Nov. 4. The employees will do on-site work or be placed on administrative leave until the layoff date, Blessing Health said.
6. St. Vincent Charity Medical Center in Cleveland will lay off 978 workers when it ends many services in November. The hospital, part of Sisters of Charity Health System, is ending inpatient care and most other services in November. After the transition, the facility will offer outpatient behavioral health, urgent care and primary care.
7. Commonwealth Health, part of Franklin, Tenn.-based Community Health Systems, will lay off 245 employees when it closes facilities at the end of October. The health system is closing First Hospital, a psychiatric hospital in Kingston, Pa., and its various outpatient centers on Oct. 30. Affected workers are encouraged to apply for open positions they’re qualified for at other Commonwealth Health facilities, a system spokesperson told Becker’s.
8. Yale New Haven (Conn.) Healtheliminated 155 management positions from its nearly 30,000-person workforce. The health system laid off 72 employees and eliminated 83 vacant positions, a spokesperson told Becker’s Hospital Review in September. The cuts were attributed to financial pressures.
9. Citing financial pressures, BHSH System — now named Corewell Health — cut about 400 positions from its 64,000-member workforce in September. The 22-hospital organization was formed by the February merger of Grand Rapids, Mich.-based Spectrum Health with Southfield, Mich.-based Beaumont Health.
10. Bakersfield (Calif.) Heart Hospital is laying off 114 employees. Affected employees were told in September that they no longer had to report to work, but they will continue to receive full pay and benefits through Nov. 5. The layoffs are an effort to optimize operations and to free up resources for patient care and specialized surgery, the hospital said.
Early into flu season, nationwide flu activity is ten times higher than at the same point last year. Meanwhile, cases of respiratory syncytial virus (RSV), a virus most severe in young children and the elderly, have tripled in the past two months, with some children’s hospitals reporting “unprecedented” admissions for the virus. And most experts expect at least some winter COVID surge, possibly involving several different variants. The combined threat of these viruses circulating together has been labeled a potential “tripledemic.”
The Gist: Across the past two winters, the widespread adoption of COVID prevention measures, including masking and social distancing, kept the spread of other viruses at bay. But with return to normal life for most Americans, other viruses have returned to circulation—and with a vengeance, as population immunity toward flu and RSV has weakened.
While it’s hard to predict when and where local surges will occur, hospitals struggling with staffing shortages may be forced to hire more contract labor to care for an influx of patients—making this a potentially challenging winter for already stretched facilities.
Drawing on a report published by the North Carolina State Health Plan for Teachers and State Employees, a recent Kaiser Health News article shines a light on the lack of transparency in financial reporting of not-for-profit hospitals’ community benefit obligations.
The report claims many North Carolina hospitals—including the state’s largest system, Atrium Health—show profits on Medicare patients in their cost report filings, while at the same time claiming sizable unrecouped losses on Medicare patients as a part of their overall community benefit analyses.
The Gist: These kind of reporting discrepancies draw attention to the controversial issue of whether not-for-profit hospitals provide sufficient community benefit to compensate for their tax-exempt status, which was worth nearly $2 billion in 2020 for North Carolina hospitals alone.
Greater transparency around charity care, community benefit, and losses sustained from public payerscould go a long way toward shoring up stakeholder support for not-for-profit institutions at a time when their political goodwill has deteriorated. Hospitals should be proactive on this front, as political leaders increasingly train their sites on high hospital spending in the current tight economic environment.
As the nation continues to grapple with the fallout from COVID, one of the greatest unknowns is “long COVID”, the broad range of health problems experienced by a significant number of individuals after contracting the virus. The Centers for Disease Control and Prevention defines long COVID as any post-COVID condition lasting three months or longer.
In the graphic above, we aim to quantify the prevalence of long COVID and its ongoing impact on the US workforce. While estimates for thesenumbers vary, data compiled by Brookings show that COVID infections in roughly one in four working age adults have resulted in long COVID, and up to one in four individuals with long COVID are unable to work due to their lingering health problems. Long COVID is also more prevalent in middle-aged adults, who are often at the peak of their working years. Dealing with symptoms like chronic fatigue and brain fog, long COVID patients are more likely to be unemployed or working reduced hours, compared to a pre-COVID baseline of the general adult population.
While it’s difficult to assess the precise impact on the nation’s current labor shortage, the estimate that 4M working age adults are no longer working because of long COVID equals about 40 percent of the 10M total job openings in August of this year, undoubtedly exacerbating ongoing economic challenges.
HENRY KOTULA 