Category Archives: Hospital

White House set to ask Supreme Court this week to overturn ACA: 4 things to know

Posted on by • Posted in 2020 Election Issues, ACA, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Health System, Hospital, Hospital Industry, Individual Mandate, Medicaid, Medicaid Expansion, Medical Loss Ratio (MLR), Out of Pocket Expenses, Preexisting Conditions, Supreme Court, Texas v. United States, Underinsured, Uninsured • Leave a comment

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New rules for Supreme Court justices as they plan their first-ever ...

The White House is expected to file legal briefs with the Supreme Court this week that will ask the justices to end the ACA, according to The New York Times. 

Four things to know:

1. The filings are in relation to Texas v. United States, the latest legal challenge to the ACA. Arguments around the case center on whether the ACA’s individual mandate was rendered unconstitutional when the penalty associated with it was erased by the 2017 tax law. Whether that decision invalidates the entire law or only certain parts of it is at question.

2. The White House is set to ask the Supreme Court June 25 to invalidate the law. The filings come at a time when the COVID-19 pandemic has caused millions of Americans to lose their jobs and their employer-based health coverage.

3. Republicans have said they want to “repeal and replace” the ACA, but there is no agreed upon alternative, according to The New York Times. Party strategists told the publication that Republicans will be in a tricky spot if they try to overturn the ACA ahead of the November elections and amid a pandemic. 

4. In addition to the filings, Democratic House speaker Nancy Pelosi is expected to reveal a bill this week that would boost the ACA. Proposals include more subsidies for healthcare premiums, expanding Medicaid coverage for uninsured pregnant women and offering states incentives to expand Medicaid.

Read the full report here. 

 

 

HCA nurses issue 10-day strike notice at California hospital

Posted on by • Posted in Coronavirus, Economic Stimulus, Emergency Preparedness, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, For-Profit, Health System, Hospital, Hospital Industry, Labor Spend Management, Labor Strike, Labor Union, Nurses, Nurses Union, Pandemic, Personal Protective Equipment (PPE), The CARES Act • Leave a comment

https://www.healthcaredive.com/news/hca-nurses-issue-10-day-strike-notice-at-california-hospital/580359/

UPDATE: June 23, 2020: Riverside Community Hospital on Tuesday told Healthcare Dive the motivation behind the union’s strike notice “has very little to do with the best interest of their members and everything to do with contract negotiations.” The system said it has plans to ensure appropriate staffing and continued services for any type of event, including a strike.

Dive Brief:

  • Nurses at HCA Healthcare’s Riverside Community Hospital in south-central California issued a 10-day strike notice last week, citing a breakdown in discussions over safety and staffing, the union representing them said Monday.
  • The nurses plan to strike from Friday, June 26 through July 6, prior to starting contract negotiations with HCA on July 7.  The union plans to push for better staffing and safety measures, particularly hospital preparedness during states of emergency.
  • Neither HCA nor Riverside were available for comment, but the hospital told Becker’s Hospital Review it had hoped the union “would not resort to these tactics” during the COVID-19 pandemic and said it had not laid off or furloughed any employees due to the crisis.

Dive Insight:

The strike notice follows a recent job posting from the nation’s biggest for-profit chain seeking qualified nurses in the Los Angeles area in the event of a job action or work stoppage.

Nurses at Riverside Community Hospital pushed for an improved staffing agreement last year and got it — but the hospital recently ended that agreement, resulting in fewer RNs taking care of more patients amid a pandemic, according to the union.

Insufficient personal protective equipment, inadequate safety measures and recycling of single-use PPE is also putting nurses at increased risk of COVID-19 infection, the union alleges.

Scores of RNs at the hospital have fallen ill with COVID-19, according to a release, including deaths of an environmental services worker and a lab technician, that “have not caused RCH to improve staffing or increase PPE.”

PPE shortages have been a problem at all of the 27 hospitals SEIU Local 121 RN represents, the union says. But a member survey found HCA hospitals were particularly unprepared for shortages. Only 27% of local 121 RN members at HCA hospitals reported having access to N95 respirators in their unit, significantly lower than other hospitals surveyed, according to the union.

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

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

A spokesperson with the country’s largest nurses union, National Nurses United, told Healthcare Dive the program isn’t technically a furlough because some HCA nurses participating said they must remain on call or work rotating shifts.

NNU has also recently fought with HCA over other pandemic-related labor issues. Nurses at 15 HCA hospitals protested in late May over contractually bargained wage increases the hospital says it can’t deliver due to financial strains, asking nurses to give up the increases or face layoffs.

Another dispute involves a last-minute change mandating in-person voting for nurses deciding whether to form a union at HCA’s Mission Hospital in Asheville, North Carolina, according to an NNU release.

SEIU Local 121 RN said HCA can “easily weather this storm financially, continue to provide profits for their shareholders, while at the same time support and protect nurses as they fight this disease and fight to save their community.”

 

 

 

 

In blow to hospitals, judge rules for HHS in price transparency case

Posted on by • Posted in 2020 Election Issues, ACA, American Hospital Association (AHA), Dept of Health and Human Services (HHS), District Court of Appeals, Health Policy, Health System, Hospital, Hospital Industry, Lawsuit, Price Transparency, Rev Cycle Management, Revenue Cycle, Surprise Bills • Leave a comment

https://www.healthcaredive.com/news/in-blow-to-hospitals-judge-rules-for-hhs-in-price-transparency-case/580395/

UPDATE: June 24, 2020: The American Hospital Association said it will appeal Tuesday’s ruling  that upholds the Trump administration’s mandate to force hospitals to disclose negotiated rates with insurers. The hospital lobby said it was disappointed in the ruling and will seek expedited review. AHA said the mandate “imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care.”

If AHA seeks to have the rule stayed pending an appellate ruling, the decision on such a request “is likely to be almost as significant as this ruling is, since absent a stay, the rule will likely go into effect before the appellate court rules,” James Burns, a law partner at Akerman, told Healthcare Dive.

Dive Brief:

  • A federal judge ruled against the American Hospital Association on Tuesday in its lawsuit attempting to block an HHS rule pushing for price transparency. The judge ruled in favor of the department, which requires hospitals to reveal private, negotiated rates with insurers beginning Jan. 1.
  • U.S. District Court Judge Carl Nichols, an appointee of President Donald Trump, was swayed neither by AHA’s argument that forcing hospitals to publicly disclose rates violates their First Amendment rights by forcing them to reveal proprietary information nor by the claim that it would chill negotiations between providers and payers. The judge characterized the First Amendment argument as “half-hearted.”
  • Nichols seem convinced that the requirement will empower patients, noting in Tuesday’s summary judgment in favor of the administration that “all of the information required to be published by the Final Rule can allow patients to make pricing comparisons between hospitals.”

Dive Insight:

The ruling is a blow for hospitals, which have been adamantly opposed to disclosing their privately negotiated rates since HHS first unveiled its proposal in July 2019. AHA did not immediately reply to a request for comment on whether it planned to appeal.

The legal debate hinges on the definition of “standard charges”, which is mentioned in the Affordable Care Act, though it was left largely undefined in the text. Trump issued an executive order last year that included negotiated rates as part of that definition.

Cynthia Fisher, founder of patienrightsadvocate.com, which filed an amicus brief in support of HHS, told Healthcare Dive on Tuesday the ruling could make shopping for health services more like buying groceries or retail.

“For the first time we will be able to know prices before we get care,” she said. “This court ruling rejects every claim to keep the secret hidden prices from consumers until after we get care.”

 

 

 

 

Hospitals tell court price transparency laws violate 1st Amendment

Posted on by • Posted in 2020 Election Issues, American Hospital Association (AHA), Dept of Health and Human Services (HHS), District Court of Appeals, Health Policy, Health System, Hospital, Hospital Industry, Lawsuit, Price Transparency, Rev Cycle Management, Revenue Cycle, Surprise Bills • Leave a comment

https://www.healthcaredive.com/news/AHA-HHS-price-transparency-oral-arguments/577613/

Dive Brief:

  • In the first round of oral arguments in their lawsuit against HHS over a rule requiring hospitals to reveal the secret rates they negotiate with insurers for services, hospital groups argued the requirement exceeds the government’s authority and violates the First Amendment by compelling hospitals to publicly post confidential and proprietary information​.
  • The American Hospital Association, along with other industry groups and health systems that brought the lawsuit, argued in the U.S. District Court for the District of Columbia on Thursday that medical bills aren’t considered commercial speech and don’t fall under the same regulations that traditional advertisements, flyers and other forms of commercial speech offering or promoting services do.
  • “There’s not another market that looks like the market for hospital services,” said U.S. Department of Justice Attorney Michael Baer, who was representing HHS. A majority of patients final bills’ include the negotiated rate, information that should be available to patients, acting as consumers, prior to receiving care, he said.

Dive Insight:

Thursday’s hearing was the first step in what’s likely to be a drawn out legal fight. Negotiated rates between hospitals and insurers have long been private, and hospitals want to keep it that way. 

When HHS passed the final price transparency rule last year, the hospital groups filed a lawsuit in December, warning that requiring disclosure of negotiated rates will confuse patients, overwhelm hospitals and thwart competition. The rule would go into effect Jan. 1, 2021.

According to the lawsuit, the rule creates undue burden on hospitals and health systems, which can have more than 100 contracts with insurers. There can even be multiple contracts with an individual carrier to account for the various product lines, including Medicare Advantage, HMO or PPO.

The rule would require various pricing information, including gross charges, payer-specific rates, minimum and maximum negotiated charges and the amount the hospital is willing to accept in cash from a patient.

Some payers and employer groups have also protested the new rule, calling it wrong-headed.

When the rule initially passed last year, HHS argued that patients already see this pricing data when they receive their explanation of benefits, pushing back against the idea that it’s proprietary business information. They said this information needs to come before a procedure, not after.​

HHS maintains that the rule is intended to give patients better access to payment information so they can make informed decisions as consumers. 

“Patients deserve to know how much it’s going to cost when they get hospital care,” Baer said. “They deserve to know before they open a medical bill or before they choose where they want to receive care.”

 

 

 

 

This Single Factor Could Force Another Coronavirus Shutdown, Goldman Sachs Says

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.forbes.com/sites/sarahhansen/2020/06/23/this-single-factor-could-force-another-coronavirus-shutdown-goldman-sachs-says/?utm_source=newsletter&utm_medium=email&utm_campaign=news&utm_campaign=news&cdlcid=#4a09f8fb3f92

This Single Factor Could Force Another Coronavirus Shutdown ...

TOPLINE

With new coronavirus cases rising in 26 states, according to data from Johns Hopkins, and the national conversation turning to whether those states rushed to reopen their economies too quickly, new analysis from Goldman Sachs suggests that in the coming weeks, hospital capacity (rather than case numbers) is the factor most likely to prompt another lockdown.

KEY FACTS

Goldman’s experts say hospital data is a more reliable picture of the spread of the virus nationwide than positive test results, which fluctuate with changes in testing trends. 

The analysts noted, however, that “there is probably a high hurdle for states to reinstate lockdowns.”

As new cases continue to rise across the country, Goldman’s analysts also tracked which states currently meet federal reopening criteria based on four factors: symptoms, cases, testing and hospitalizations and fatalities. 

Only Arizona and Alabama fail in all four categories, the analysts say; symptoms and cases are on the rise, positive test rates are high, and hospitals are nearing their maximum capacities. 

On the other hand, 19 states meet all four criteria for reopening, including several former hot spots like New York and New Jersey, and the vast majority of states meet at least three out of the four criteria.

KEY BACKGROUND

Along with Alabama and Arizona, California, Texas, and Florida have also seen sharp upticks in infections in recent days. Florida reported a record increase in new cases on four out of the six days between June 15 and 20, for instance. The number of confirmed cases since the pandemic started has now swelled to over 100,000, and Gov. Ron DeSantis said the uptick is “clearly” the result of a failure to follow social distancing guidelines. With cases on the rise, some places—like Arizona—are forging ahead with reopening plans while others—in Maine, Oregon, and Kansas, for instance—are tightening up restrictions again. 

 

 

 

5 health systems cutting physician salaries

Posted on by • Posted in Cash, Cash Reserves, Coronavirus, Crisis, Crisis Management, Economic Crisis, Elective Procedures, Elective Surgery, Employee Benefits, Employee Pay Cuts, Health System, Hospital, Hospital Industry, Liquidity, Net Income, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Physician, Physician Compensation, Physician Employment • Leave a comment

https://www.beckershospitalreview.com/compensation-issues/5-health-systems-cutting-physician-salaries.html?utm_medium=email

Pay Cuts, Furloughs, Redeployment for Doctors and Hospital Staff ...

To help offset revenue losses attributed to the COVID-19 pandemic, many hospitals have implemented pay cuts for staff, including physicians.

Below are five hospitals or health systems that have announced pay cuts for clinicians, reported by Becker’s Hospital Review in the last month.

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

2. Providence to cut salaries of 1,200 providers
Renton, Wash.-based Providence plans to reduce the salaries of 1,200 high-paid medical providers in its Oregon division to help offset losses from the COVID-19 pandemic. Providence told Becker’s Hospital Review that the decision to cut salaries was made by local leadership and is limited to Oregon-based providers.

3. Cleveland’s University Hospitals to cut all physician, clinical leader pay
University Hospitals, based in Cleveland, said it will temporarily cut pay for all physicians and clinical leaders in the organization to help offset losses driven by the pandemic.

4. Sentara executives, physicians take pay cuts
Senior leaders, executives and physicians at Norfolk, Va.-based Sentara Healthcare are taking pay cuts to help address an anticipated $778 million shortfall against projected revenue due to COVID-19, the organization confirmed to Becker’s Hospital Review.

5. Loyola Medicine CEO, physicians take pay cuts amid pandemic
Leadership and faculty physicians at Maywood, Ill.-based Loyola Medicine will take three-month pay cuts in response to the COVID-19 pandemic, CEO Shawn Vincent said in an interview with Becker’s Hospital Review.

 

 

 

 

42 hospitals closed, filed for bankruptcy this year

Posted on by • Posted in American Hospital Association (AHA), Bankruptcy, Cash, Cash Reserves, Coronavirus, Credit Quality, Credit Ratings, Health Policy, Health System, Hospital, Hospital Bankruptcy, Hospital Closure, Hospital Industry, Liquidity, Market Consolidation, Market Outlook, Market Trends • Leave a comment

https://www.beckershospitalreview.com/finance/42-hospitals-closed-filed-for-bankruptcy-this-year.html?utm_medium=email

The Local Hospital Closed. These Doctors Didn't Give Up.

From reimbursement landscape challenges to dwindling patient volumes, many factors lead hospitals to shut down or file for bankruptcy. At least 42 hospitals across the U.S. have closed or entered bankruptcy this year, and the financial challenges caused by the COVID-19 pandemic may force more hospitals to do the same in coming months. 

COVID-19 has created a cash crunch for many hospitals across the nation. They’re estimated to lose $200 billion between March 1 and June 30, according to a report from the American Hospital Association. More than $161 billion of the expected revenue losses will come from canceled services, including nonelective surgeries and outpatient treatment. Moody’s Investors Service said the sharp declines in revenue and cash flow caused by the suspension of elective procedures could cause more hospitals to default on their credit agreements this year than in 2019. 

Below are the provider organizations that have filed for bankruptcy or closed since Jan. 1, beginning with the most recent. They own and operate a combined 42 hospitals.

Our Lady of Bellefonte Hospital (Ashland, Ky.)
Bon Secours Mercy Health closed Our Lady of Bellefonte Hospital in Ashland, Ky., on April 30. The 214-bed hospital was originally slated to shut down in September of this year, but the timeline was moved up after employees began accepting new jobs or tendering resignations. Bon Secours cited local competition as one reason for the hospital closure. Despite efforts to help sustain hospital operations, Bon Secours was unable to “effectively operate in an environment that has multiple acute care facilities competing for the same patients, providers and services,” the health system said.

Williamson (W.Va.) Hospital
Williamson Hospital filed for Chapter 11 bankruptcy in October and was operating on thin margins for months before shutting down on April 21. The 76-bed hospital said a drop in patient volume due to the COVID-19 pandemic forced it to close. CEO Gene Preston said the decline in patient volume was “too sudden and severe” for the hospital to sustain operations.

Decatur County General Hospital (Parsons, Tenn.)
Decatur County General Hospital closed April 15, a few weeks after the local hospital board voted to shut it down. Decatur County Mayor Mike Creasy said the closure was attributable to a few factors, including rising costs, Tennessee’s lack of Medicaid expansion and broader financial challenges facing the rural healthcare system in the U.S.

Quorum Health (Brentwood, Tenn.)
Quorum Health and its 23 hospitals filed for Chapter 11 bankruptcy April 7. The company, a spinoff of Franklin, Tenn.-based Community Health Systems, said the bankruptcy filing is part of a plan to recapitalize the business and reduce its debt load.

UPMC Susquehanna Sunbury (Pa.)
UPMC Susquehanna Sunbury closed March 31. Pittsburgh-based UPMC announced plans in December to close the rural hospital, citing dwindling patient volumes. Sunbury’s population was 9,905 at the 2010 census, down more than 6 percent from 10 years earlier. Though the hospital officially closed its doors in March, it shut down its emergency department and ended inpatient services Jan. 31.

Fairmont (W.Va.) Regional Medical Center
Irvine, Calif.-based Alecto Healthcare Services closed Fairmont Regional Medical Center on March 19. Alecto announced plans in February to close the 207-bed hospital, citing financial challenges. “Our plans to reorganize some administrative functions and develop other revenue sources were insufficient to stop the financial losses at FRMC,” Fairmont Regional CEO Bob Adcock said. “Our efforts to find a buyer or new source of financing were unsuccessful.” Morgantown-based West Virginia University Medicine will open a 10-bed hospital with an emergency department at the former Fairmont Regional Medical Center by the end of June.

Sumner Community Hospital (Wellington, Kan.)
Sumner Community Hospital closed March 12 without providing notice to employees or the local community. Kansas City, Mo.-based Rural Hospital Group, which acquired the hospital in 2018, cited financial difficulties and lack of support from local physicians as reasons for the closure. “Lack of support from the local medical community was the primary reason we are having to close the hospital,” RHG said. “We regret having to make this decision; however, despite operating the hospital in the most fiscally responsible manner possible, we simply could not overcome the divide that has existed from the time we purchased the hospital until today.”

Randolph Health
Randolph Health, a single-hospital system based in Asheboro, N.C., filed for Chapter 11 bankruptcy March 6. Randolph Health leaders have taken several steps in recent years to improve the health system’s financial picture, and they’ve made progress toward that goal. Entering Chapter 11 bankruptcy will allow Randolph Health to restructure its debt, which officials said is necessary to ensure the health system continues to provide care for many more years.

Pickens County Medical Center (Carrollton, Ala.)
Pickens County Medical Center closed March 6. Hospital leaders said the closure was attributable to the hospital’s unsustainable financial position. A news release announcing the closure specifically cited reduced federal funding, lower reimbursement from commercial payers and declining patient visits.

The Medical Center at Elizabeth Place (Dayton, Ohio)
The Medical Center at Elizabeth Place, a 12-bed hospital owned by physicians in Dayton, Ohio, closed March 5. The closure came after years of financial problems. In January 2019, the Medical Center at Elizabeth Place lost its certification as a hospital, meaning it couldn’t bill Medicare or Medicaid for services. Sixty to 65 percent of the hospital’s patients were covered through the federal programs.

Mayo Clinic Health System-Springfield (Minn.)
Mayo Clinic Health System closed its hospital in Springfield, Minn., on March 1. Mayo announced plans in December to close the hospital and its clinics in Springfield and Lamberton, Minn. At that time, James Hebl, MD, regional vice president of Mayo Clinic Health System, said the facilities faced staffing challenges, dwindling patient volumes and other issues. The hospital in Springfield is one of eight hospitals within a less than 40-mile radius, which has led to declining admissions and low use of the emergency department, Dr. Hebl said.

Faith Community Health System
Faith Community Health System, a single-hospital system based in Jacksboro, Texas and part of the Jack County (Texas) Hospital District, first entered Chapter 9 bankruptcy — a bankruptcy proceeding that offers distressed municipalities protection from creditors while a repayment plan is negotiated — in February. The bankruptcy court dismissed the case May 26 at the request of the health system. The health system asked the court to dismiss the bankruptcy case to allow it to apply for a Paycheck Protection Program loan through a Small Business Association lender. On June 11, Faith Community Health System reentered Chapter 9 bankruptcy.

Pinnacle Healthcare System
Overland Park, Kan.-based Pinnacle Healthcare System and its hospitals in Missouri and Kansas filed for Chapter 11 bankruptcy on Feb. 12. Pinnacle Regional Hospital in Boonville, Mo., formerly known as Cooper County Memorial Hospital, entered bankruptcy about a month after it abruptly shut down. Pinnacle Regional Hospital in Overland Park, formerly called Blue Valley Hospital, closed about two months after entering bankruptcy.

Central Hospital of Bowie (Texas)
Central Hospital of Bowie abruptly closed Feb. 4. Hospital officials said the facility was shut down to enable them to restructure the business. Hospital leaders voluntarily surrendered the license for Central Hospital of Bowie.

Ellwood City (Pa.) Medical Center
Ellwood City Medical Center officially closed Jan. 31. The hospital was operating under a provisional license in November when the Pennsylvania Department of Health ordered it to suspend inpatient and emergency services due to serious violations, including failure to pay employees and the inability to offer surgical services. The hospital’s owner, Americore Health, suspended all clinical services at Ellwood City Medical Center Dec. 10. At that time, hospital officials said they hoped to reopen the facility in January. Plans to reopen were halted Jan. 3 after the health department conducted an onsite inspection and determined the hospital “had not shown its suitability to resume providing any health care services.”

Thomas Health (South Charleston, W.Va.)
Thomas Health and its two hospitals filed for Chapter 11 bankruptcy on Jan. 10. In an affidavit filed in the bankruptcy case, Thomas Health President and CEO Daniel J. Lauffer cited several reasons the health system is facing financial challenges, including reduced reimbursement rates and patient outmigration. The health system announced June 18 that it reached an agreement in principle with a new capital partner that would allow it to emerge from bankruptcy.

St. Vincent Medical Center (Los Angeles)
St. Vincent Medical Center closed in January, roughly three weeks after El Segundo, Calif.-based Verity Health announced plans to shut down the 366-bed hospital. Verity, a nonprofit health system that entered Chapter 11 bankruptcy in 2018, shut down St. Vincent after a deal to sell four of its hospitals fell through. In April, Patrick Soon-Shiong, MD, the billionaire owner of the Los Angeles Times, purchased St. Vincent out of bankruptcy for $135 million.

Astria Regional Medical Center (Yakima, Wash.)
Astria Regional Medical Center filed for Chapter 11 bankruptcy in May 2019 and closed in January. When the hospital closed, 463 employees lost their jobs. Attorneys representing Astria Health said the closure of Astria Regional Medical Center, which has lost $40 million since 2017, puts Astria Health in a better financial position. “As a result of the closure … the rest of the system’s cash flows will be sufficient to safely operate patient care operations and facilities and maintain administrative solvency of the estate,” states a status report filed Jan. 20 with the bankruptcy court.

 

 

 

Moody’s: Patient volume recovered a bit in May, but providers face long road to recovery

Posted on by • Posted in ACA, Bad Debt Expense, Cash, Cash Reserves, Coronavirus, Credit Quality, Credit Ratings, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Elective Procedures, Elective Surgery, Emergency Care, Federation of American Hospitals, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Liquidity, Market Outlook, Market Trends, Market Uncertainty, Medicaid, Medicare Advance Payments, Mortality, Office Visit, Pandemic, Payor Mix, Personal Protective Equipment (PPE), Physician, Public Health, Public Safety, Quarantine, Rev Cycle Management, Revenue Cycle, Social Distancing, Supply Chain, The CARES Act • Leave a comment

https://www.fiercehealthcare.com/hospitals/moody-s-patient-volume-recovering-may-but-providers-face-long-road-to-recovery?mkt_tok=eyJpIjoiWmpjeVlXVTRZV0l5T1RndyIsInQiOiJLWWxjamNKK2lkZmNjcXV4dm0rdjZNS2lOanZtYTFoenViQjMzWnF0RGNlY1pkcjVGcFwvZFY4VjFaUUlZaFRBT1NRMGE5eWhGK1ZmR01ZSWVZWGMxOHRzTkptZVZXZmc5UnNvM3pVM2VIWDh6VllldFc3OGNZTTMxTDJrXC8wbzN1In0%3D&mrkid=959610

Moody's: Patient volume recovered a bit in May, but providers face ...

Patient volumes at hospitals, doctors’ and dentists’ offices recovered slightly in May but lagged well behind pre-pandemic levels, according to a new analysis from Moody’s Investors Service.

In all, the ratings agency estimated total surgeries at rated for-profit hospitals declined by 55% to 70% in April compared with the same period in 2019. States required hospitals to cancel or delay elective procedures, which are vital to hospitals’ bottom lines.

“Patients that had been under the care of physicians before the pandemic will return first in order to address known health needs,” officials from the ratings agency said in a statement. “Physicians and surgeons will be motivated to extend office or surgical hours in order to accommodate these patients.”

Those declines narrowed to 20% to 40% in May when compared to 2019.

Emergency room and urgent care volumes were still down 35% to 50% in May.

“This could reflect the prevalence of working-from-home arrangements and people generally staying home, which is leading to a decrease in automobile and other accidents outside the home,” the analysis said. “Weak ER volumes also suggest that many people remain apprehensive to enter a hospital, particularly for lower acuity care.”

The good news:  The analysis estimated it is unlikely there will be a return to the nationwide decline of volume experienced in late March and April because healthcare facilities are more prepared for COVID-19.

For instance, hospitals have enough personal protective equipment for staff and have expanded testing, the analysis said.

For-profit hospitals also have “unusually strong liquidity to help them weather the effects of the revenue loss associated with canceled or postponed procedures,” Moody’s added. “That is largely due to the CARES Act and other government financial relief programs that have caused hospital cash balances to swell.”

However, the bill for one of those sources of relief is coming due soon.

Hospitals and other providers will have to start repaying Medicare for advance payments starting this summer. The Centers for Medicare & Medicaid Services doled out more than $100 billion in advance payments to providers before suspending the program in late April.

Hospital group Federation of American Hospitals asked Congress to change the repayment terms for such advance payments, including giving providers at least a year to start repaying the loans.

Another risk for providers is the change in payer mix as people lose jobs and commercial coverage, shifting them onto Medicaid or the Affordable Care Act’s (ACA’s) insurance exchanges.

“This will lead to rising bad debt expense and a higher percentage of revenue generated from Medicaid or [ACA] insurance exchange products, which typically pay considerably lower rates than commercial insurance,” Moody’s said.

 

 

 

Coronavirus Doesn’t Recognize Man-Made Borders

Posted on by • Posted in 2020 Election Issues, Access, Access & Quality of Healthcare, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Economic Crisis, Economic Stimulus, Economy Reopening, Essential Health Benefits, Essential Workers, Health Policy, Health System, Hospital, Hospital Bed Shortage, Infection Control, Infection Control Plan, Infectious Virus, Intensive Care (ICU), Mortality, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing, Supply Chain • Leave a comment

Coronavirus Doesn’t Recognize Man-Made Borders

Coronavirus Doesn't Recognize Man-Made Borders - California Health ...

From El Centro Regional Medical Center, the largest hospital in California’s Imperial County, it takes just 30 minutes to drive to Mexicali, the capital of the Mexican state of Baja California. The international boundary that separates Mexicali from Imperial County is a bridge between nations. Every day, thousands of people cross that border for work or school. An estimated 275,000 US citizens and green card holders live in Baja California. El Centro Regional Medical Center has 60 employees who reside in Mexicali and commute across the border, CEO Adolphe Edward told Julie Small of KQED.

Now these inextricably linked places have become two of the most concerning COVID-19 hot spots in the US and Mexico. While Imperial County is one of California’s most sparsely populated counties, it has the state’s highest per capita infection rate — 836 per 100,000, according to the California Department of Public Health. This rate is more than four times greater than Los Angeles County’s, which is second-highest on that list. Imperial County has 4,800 confirmed positive cases and 64 deaths, and its southern neighbor Mexicali has 4,245 infections and 717 deaths.

The COVID-19 crisis on the border is straining the local health care system. El Centro Regional Medical Center has 161 beds, including 20 in its intensive care unit (ICU). About half of all its inpatients have COVID-19, Gustavo Solis reported in the Los Angeles Times, and the facility no longer has any available ventilators.

When Mexicali’s hospitals reached capacity in late May, administrators alerted El Centro that they would be diverting American patients to the medical center. “They said, ‘Hey, our hospitals are full, you’re about to get the surge,’” Judy Cruz, director of El Centro’s emergency department, recounted to Rebecca Plevin in the Palm Springs Desert Sun.

By the first week of June, El Centro was so overburdened that “a patient was being transferred from the hospital in El Centro every two to three hours, compared to 17 in an entire month before the COVID-19 pandemic,” Miriam Jordan reported in the New York Times.

Border Hospitals Filled to Capacity

Since April, hospitals in neighboring San Diego and Riverside Counties have been accepting patient transfers to alleviate the caseload at the lone hospital in El Centro, but the health emergency has escalated and now those counties need relief. “We froze all transfers from Imperial County [on June 9] just to make sure that we have enough room if we do have more cases here in San Diego County,” Chris Van Gorder, CEO of Scripps Health, told Paul Sisson in the San Diego Union-Tribune. El Centro patients are now being airlifted as far as San Francisco and Sacramento.

According to the US Census Bureau, nearly 85% of Imperial County residents are Latino, and statewide, Latinos bear a disproportionate burden of COVID-19. The California Department of Public Health reports that Latinos make up 39% of California’s population but 57% of confirmed COVID-19 cases.

Nonessential travel between the US and Mexico has been restricted since March 21, with the measure recently extended until July 21. However, jobs in Southern California, such as in agricultural fields and packing houses, require regular movement between the two countries. “I’m always afraid that people are imagining this rush on the border,” Andrea Bowers, a spokesperson for the Imperial County Public Health Department, told Small. “It’s just folks living their everyday life.”

These jobs, some of which are considered essential because of their role in the food supply chain, may have contributed to the COVID-19 crisis on the border. Agricultural workers often lack access to adequate personal protective equipment and are unable to practice physical distancing. They also are exposed to air pollution, pesticides, heat, and more — long-term exposures that can cause the underlying health conditions that raise the risk of death for COVID-19 patients.

Comite Civico del Valle, a nonprofit focused on environmental health and civic engagement in Imperial Valley, set up 40 air pollution monitors throughout the county and found that levels of tiny, dangerous particulates violated federal limits, Solis reported.

“I can tell you there’s hypertension, there’s poor air pollution, there’s cancers, there’s asthma, there’s diabetes, there’s countless things people here are exposed to,” David Olmedo, an environmental health activist with Comite Civico del Valle, told Solis.

Fear of New Surges

With summer socializing in full swing, health experts worry that COVID-19 spikes will follow. Imperial County saw surges after Mother’s Day and Memorial Day, probably because of lapsed physical distancing and mask use at social events.

Latinos in California are adhering to recommended public health behaviors to slow the spread of the virus. CHCF’s recent COVID-19 tracking poll with Ipsos asked Californians about their compliance with recommended behaviors. Eighty-four percent of Californians, including 87% of Latinos, say they routinely wear a mask in public spaces all or most of the time. Seventy-two percent of Californians, including 73% of Latinos, say they avoid unnecessary trips out of the home most or all of the time, and 90% of Californians, including 91% of Latinos, say they stay at least six feet away from others in public spaces all or most of the time.

A Push to Reopen Anyway

Most counties in California have met the state’s readiness criteria for entering the “Expanded Stage 2” phase of reopening. Imperial County has not. In the past two weeks, more than 20% of all COVID-19 tests in the county came back positive, the Sacramento Bee reported. The state requires counties to have a seven-day testing positivity rate of no more than 8% to enter Expanded Stage 2.

Still, the Imperial County Board of Supervisors is pushing Governor Gavin Newsom for local control over its reopening timetable. The county has a high poverty rate — 24% compared with the statewide average of 13% — and “bills are stacking up,” Luis Pancarte, chairman of the board, said on a recent press call.

He worries that because neighboring areas like Riverside and San Diego have opened some businesses with physical distancing measures in place, Imperial County residents will travel to patronize restaurants and stores. This movement could increase transmission of the new coronavirus, just as reopening Imperial County too soon could as well.

More than 1,350 residents have signed a petition asking Newsom to ignore the Board of Supervisor’s request, Solis reported. The residents called on the supervisors to focus instead on getting the infection rate down and expanding economic relief for workers and businesses.

Cruz, who has been working around the clock to handle the county’s COVID-19 crisis, agrees with the petitioners. The surges after Mother’s Day and Memorial Day made her “really concerned about unlocking and letting people go back to normal,” she told Plevin. “It’s going to be just like those little gatherings that happened [on holidays], but on a bigger scale.”

 

 

 

 

Navigating a Post-Covid Path to the New Normal with Gist Healthcare CEO, Chas Roades

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Covid-19, Regulatory Changes and Election Implications: An Inside ...Chas Roades (@ChasRoades) | Twitter

Healthcare is Hard: A Podcast for Insiders; June 11, 2020

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.

As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.

“Almost overnight, Chas went from in-depth sessions about long-term five-year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:

  • Corporate Governance. The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for the making these difficult choices.
  • Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.
  • The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.
  • The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.”