Cartoon – Importance of Likability
Category Archives: Leadership Cares
Lincoln’s Leadership Qualities
As thousands of athletes get coronavirus tests, nurses wonder: What about us?
On her day off not long ago, emergency room nurse Jane Sandoval sat with her husband and watched her favorite NFL team, the San Francisco 49ers. She’s off every other Sunday, and even during the coronavirus pandemic, this is something of a ritual. Jane and Carlos watch, cheer, yell — just one couple’s method of escape.
“It makes people feel normal,” she says.
For Sandoval, though, it has become more and more difficult to enjoy as the season — and the pandemic — wears on. Early in the season, the 49ers’ Kyle Shanahan was one of five coaches fined for violating the league’s requirement that all sideline personnel wear face coverings. Jane noticed, even as coronavirus cases surged again in California and across the United States, that Levi’s Stadium was considering admitting fans to watch games.
But the hardest thing to ignore, Sandoval says, is that when it comes to coronavirus testing, this is a nation of haves and have-nots.
Among the haves are professional and college athletes, in particular those who play football. From Nov. 8 to 14, the NFL administered 43,148 tests to 7,856 players, coaches and employees. Major college football programs supply dozens of tests each day, an attempt — futile as it has been — to maintain health and prevent schedule interruptions. Major League Soccer administered nearly 5,000 tests last week, and Major League Baseball conducted some 170,000 tests during its truncated season.
Sandoval, meanwhile, is a 58-year-old front-line worker who regularly treats patients either suspected or confirmed to have been infected by the coronavirus. In eight months, she has never been tested. She says her employer, California Pacific Medical Center, refuses to provide testing for its medical staff even after possible exposure.
Watching sports, then, no longer represents an escape from reality for Sandoval. Instead, she says, it’s a signal of what the nation prioritizes.
“There’s an endless supply in the sports world,” she says of coronavirus tests. “You’re throwing your arms up. I like sports as much as the next person. But the disparity between who gets tested and who doesn’t, it doesn’t make any sense.”
This month, registered nurses gathered in Los Angeles to protest the fact that UCLA’s athletic department conducted 1,248 tests in a single week while health-care workers at UCLA hospitals were denied testing. Last week National Nurses United, the country’s largest nursing union, released the results of a survey of more than 15,000 members. About two-thirds reported they had never been tested.
Since August, when NFL training camps opened, the nation’s most popular and powerful sports league — one that generates more than $15 billion in annual revenue — has conducted roughly 645,000 coronavirus tests.
“These athletes and teams have a stockpile of covid testing, enough to test them at will,” says Michelle Gutierrez Vo, another registered nurse and sports fan in California. “And it’s painful to watch. It seemed like nobody else mattered or their lives are more important than ours.”
Months into the pandemic, and with vaccines nearing distribution, testing in the United States remains something of a luxury. Testing sites are crowded, and some patients still report waiting days for results. Sandoval said nurses who suspect they’ve been exposed are expected to seek out a testing site on their own, at their expense, and take unpaid time while they wait for results — in effect choosing between their paycheck and their health and potentially that of others.
“The current [presidential] administration did not focus on tests and instead focused on the vaccine,” says Mara Aspinall, a professor of biomedical diagnostics at Arizona State University. “We should have focused with the same kind of ‘warp speed’ on testing. Would we still have needed a vaccine? Yes, but we would’ve saved more lives in that process and given more confidence to people to go to work.”
After a four-month shutdown amid the pandemic’s opening wave, professional sports returned in July. More than just a contest on television, it was, in a most unusual year, a symbol of comfort and routine. But as the sports calendar has advanced and dramatic adjustments have been made, it has become nearly impossible to ignore how different everything looks, sounds and feels.
Stadiums are empty, or mostly empty, while some sports have bubbles and others just pretend their spheres are impermeable. Coaches stand on the sideline with fogged-up face shields; rosters and schedules are constantly reshuffled. On Saturday, the college football game between Clemson and Florida State was called off three hours before kickoff. Dodger Stadium, home of the World Series champions, is a massive testing site, with lines of cars snaking across the parking lot.
Sports, in other words, aren’t a distraction from a polarized nation and its response to a global pandemic. They have become a constant reminder of them. And when some nurses turn to sports for an attempt at escape, instead it’s just one more image of who gets priority for tests and, often, who does not.
“There is a disconnect when you watch sports now. It’s not the same. Covid changed everything,” says Gutierrez Vo, who works for Kaiser Permanente in Fremont, Calif. “I try not to think about it.”
Sandoval tries the same, telling herself that watching a game is among the few things that make it feel like February again. Back then, the coronavirus was a distant threat and the 49ers were in the Super Bowl.
That night, Sandoval had a shift in the ER, and between patients, she would duck into the break room or huddle next to a colleague checking the score on the phone. The 49ers were playing the Kansas City Chiefs, and Sandoval would recall that her favorite team blowing a double-digit lead represented the mightiest stress that day.
Now during shifts, Sandoval sometimes argues with patients who insist the virus that has infected them is a media-driven hoax. She masks up and wears a face shield even if a patient hasn’t been confirmed with the coronavirus, though she can’t help second-guessing herself.
“Did I wash my hands? Did I touch my glasses? Was I extra careful?” she says.
If Sandoval suspects she has been exposed, she says, she doesn’t bother requesting a test. She says the hospital will say there aren’t enough. So instead she self-monitors and loads up on vitamin C and zinc, hoping the tickle in her throat disappears. If symptoms persist, which she says hasn’t happened yet, she plans to locate a testing site on her own. But that would mean taking unpaid time, paying for costs out of pocket and staying home — and forfeiting a paycheck — until results arrive.
National Nurses United says some of its members are being told to report to work anyway as they wait for results that can take three to five days. Sutter Health, the hospital system that oversees California Pacific Medical Center, said in a statement to The Washington Post that it offers tests to employees whose exposure is deemed high-risk and to any employee experiencing symptoms. Symptomatic employees are placed on paid leave while awaiting test results, according to the statement.
“As long as an essential healthcare worker is asymptomatic,” Sutter’s statement read, “they can continue to work and self-monitor while awaiting the test result.”
Sandoval said employees have been told the hospital’s employee health division will contact anyone who has been exposed. Though she believes she’s exposed during every shift, Sandoval says employee health has never contacted her to offer a test or conduct contact tracing.
“If you feel like you need to get tested, you do that on your own,” she says. Sandoval suspects the imbalance is economic. In September, Forbes reported NFL team revenue was up 7 percent despite the pandemic. Last week Sutter Health reported a $607 million loss through the first nine months of 2020.
Sandoval tries to avoid thinking about that, so she keeps heading back to work and hoping for the best. Though she says her passion for sports is less intense now, she nonetheless likes to talk sports when a patient wears a team logo. She asks about a star player or a recent game. She says she is looking forward to the 49ers’ next contest and the 2021 baseball season.
Sometimes, Sandoval says, patients ask about her job and the ways she avoids contracting the coronavirus. She must be tested most every day, Sandoval says the patients always say.
And she just rolls her eyes and chuckles. That, she says, only happens if you’re an athlete.
Sanford Health CEO out after two decades following mask controversy
- Sanford Health’s CEO Kelby Krabbenhoft is leaving the top exec role after almost 25 years, according to a Tuesday announcement from the Sioux Falls, South Dakota-based system, following controversial statements the outgoing CEO made about mask wearing during the coronavirus pandemic.
Krabbenhoft, who has served as CEO since 1996, sent an internal memo to Sanford’s 50,000 employees on Wednesday arguing wearing a mask would defeat its purpose, as he’d already contracted COVID-19 and was therefore immune for at least seven months, as first reported by Forum News Service.
Experts dispute, however, that people previously infected with the novel coronavirus are entirely immune, as the data is not yet definitive. Other Sanford executives sent an email to employees Friday recommending mask wearing and contradicting Krabbenhoft’s claims.
On the heels of the news, Sanford’s board of trustees and Krabbenhoft have now “mutually agreed to part ways,” according to the release. The turnover comes at an acutely crucial time for the major Midwest health system, as it signed a letter of intent last month to merge with Salt Lake City-based Intermountain Healthcare.
If the deal closes, the two would operate 70 hospitals and 435 clinics — many of which will be located in rural communities across the country — and insure 1.1 million people. The merger would form one of the nation’s largest nonprofit health systems with more than $13 billion in combined annual revenue. It’s expected to close in 2021, pending regulatory approvals.
While Intermountain CEO Marc Harrison is slated to lead the combined organization, Krabbenhoft was poised to serve as president emeritus. It’s unclear what the plans are now after Krabbenhoft’s exit.
Sanford, which operates 46 hospitals in 26 states, did not reply to requests for comment by time of publication.
What healthcare executives can expect under Biden presidency
https://www.pwc.com/us/Biden2020healthagenda
President-elect Joe Biden’s healthcare agenda: building on the ACA, value-based care, and bringing down drug prices.
In many ways, Joe Biden is promising a return to the Obama administration’s approach to healthcare:
- Building on the Affordable Care Act (ACA) through incremental expansions in government-subsidized coverage
- Continuing CMS’ progress toward value-based care
- Bringing down drug prices
- Supporting modernization of the FDA
Bolder ideas, such as developing a public option, resolving “surprise billing,” allowing for negotiation of drug prices by Medicare, handing power to a third party to help set prices for some life sciences products, and raising the corporate tax rate, could be more challenging to achieve without overwhelming majorities in both the House and the Senate.
Biden is likely to mount an intensified federal response to the COVID-19 pandemic, enlisting the Defense Production Act to compel companies to produce large quantities of tests and personal protective equipment as well as supporting ongoing deregulation around telehealth. The Biden administration also will likely return to global partnerships and groups such as the World Health Organization, especially in the area of vaccine development, production and distribution.
What can health industry executives expect from Biden’s healthcare proposals?
Broadly, healthcare executives can expect an administration with an expansionary agenda, looking to patch gaps in coverage for Americans, scrutinize proposed healthcare mergers and acquisitions more aggressively and use more of the government’s power to address the pandemic. Executives also can expect, in the event the ACA is struck down, moves by the Biden administration and Democratic lawmakers to develop a replacement. Healthcare executives should scenario plan for this unlikely yet potentially highly disruptive event, and plan for an administration marked by more certainty and continuity with the Obama years.
All healthcare organizations should prepare for the possibility that millions more Americans could gain insurance under Biden. His proposals, if enacted, would mean coverage for 97% of Americans, according to his campaign website. This could mean millions of new ACA customers for payers selling plans on the exchanges, millions of new Medicaid beneficiaries for managed care organizations, millions of newly insured patients for providers, and millions of covered customers for pharmaceutical and life sciences companies. The surge in insured consumers could mirror the swift uptake in the years following the passage of the ACA.
Biden’s plan to address the COVID-19 pandemic
Biden is expected to draw on his experience from H1N1 and the Ebola outbreaks to address the COVID-19 pandemic with a more active role for the federal government, which many Americans support. These actions could shore up the nation’s response in which the federal government largely served in a support role to local, state and private efforts.
Three notable exceptions have been the substantial federal funding for development of vaccines against the SARS-CoV-2 virus, Congress’ aid packages and the rapid deregulatory actions taken by the FDA and CMS to clear a path for medical products to be enlisted for the pandemic and for providers, in particular, to be able to respond to it.
Implications of Biden’s 2020 health agenda on healthcare payers, providers and pharmaceutical and life sciences companies
The US health system has been slowly transforming for years into a New Health Economy that is more consumer-oriented, digital, virtual, open to new players from outside the industry and focused on wellness and prevention. The COVID-19 pandemic has accelerated some of those trends. Once the dust from the election settles, companies that have invested in capabilities for growth and are moving forcefully toward the New Health Economy stand to gain disproportionately.
Shortages of clinicians and foreign medical students may continue to be an issue for a while
The Trump administration made limiting the flow of immigrants to the US a priority. The associated policy changes have the potential to exacerbate shortages of physicians, nurses and other healthcare workers, including medical students. These consequences have been aggravated by the pandemic, which dramatically curtailed travel into the US.
- Healthcare organizations, especially rural ones heavily dependent on foreign-born employees, may find themselves competing fiercely for workers, paying higher salaries and having to rethink the structure of their workforces.
- Providers should consider reengineering primary care teams to reflect the patients’ health status and preferences, along with the realities of the workforce on the ground and new opportunities in remote care.
Focus on modernizing the supply chain
Biden and lawmakers from both parties have been raising questions about life sciences’ supply chains. This focus has only intensified because of the pandemic and resulting shortages of personal protective equipment (PPE), pharmaceuticals, diagnostic tests and other medical products.
- Investment in advanced analytics and cybersecurity could allow manufacturers to avoid disruptive stockouts and shortages, and deliver on the promise of the right treatment to the right patient at the right time in the right place.
Drug pricing needs a long-term strategy
Presidents and lawmakers have been talking about drug prices for decades; few truly meaningful actions have been implemented. Biden has made drug pricing reform a priority.
- Drug manufacturers may need to start looking past the next quarter to create a new pricing strategy that maximizes access in local markets through the use of data and analytics to engage in more value-based pricing arrangements.
- New financing models may help patients get access to drugs, such as subscription models that provide unlimited access to a therapy at a flat rate.
- Companies that prepare now to establish performance metrics and data analytics tools to track patient outcomes will be well prepared to offer payers more sustainable payment models, such as mortgage or payment over time contracts, avoiding the sticker shock that comes with these treatments and improving uptake at launch.
- Pharmaceutical and life sciences companies will likely have to continue to offer tools for consumers like co-pay calculators and use the contracting process where possible to minimize out-of-pocket costs, which can improve adherence rates and health outcomes.
View interoperability as an opportunity to embrace, not a threat to avoid or ignore
While the pandemic delayed many of the federal interoperability rule deadlines, payers and providers should use the extra time to plan strategically for an interoperable future.
- Payers should review business partnerships in this new regulatory environment.
- Digital health companies and new entrants may help organizations take advantage of the opportunities that achieving interoperability may present.
- Companies should consider the legal risks and take steps to protect their reputations and relationships with customers by thinking through issues of consent and data privacy.
Health organizations should review their policies and consider whether they offer protections for customers under the new processes and what data security risks may emerge. They should also consider whether business associate agreements are due in more situations.
Plan for revitalized ACA exchanges and a booming Medicare Advantage market
The pandemic has thrown millions out of work, generating many new customers for ACA plans just as the incoming Biden administration plans to enrich subsidies, making more generous plans within reach of more Americans.
- Payers in this market should consider how and where to expand their membership and appeal to those newly eligible for Medicare. Payers not in this market should consider partnerships or acquisitions as a quick way to enter the market, with the creation of a new Medicare Advantage plan as a slower but possibly less capital-intensive entry into this market.
- Payers and health systems should use this opportunity to design more tailored plan options and consumer experiences to enhance margins and improve health outcomes.
- Payers with cash from deferred care and low utilization due to the pandemic could turn to vertical integration with providers as a means of investing that cash in a manner that helps struggling providers in the short term while positioning payers to improve care and reduce its cost in the long term.
- Under the Trump administration, the FDA has approved historic numbers of generic drugs, with the aim of making more affordable pharmaceuticals available to consumers. Despite increased FDA generics approvals, generics dispensed remain high but flat, according to HRI analysis of FDA data.
- Pharmaceutical company stocks, on average, have climbed under the Trump administration, with a few notable dips due to presidential speeches criticizing the industry and the pandemic.
- Providers have faced some revenue cuts, particularly in the 340B program, and many entered the pandemic in a relatively weak liquidity position. The pandemic has led to layoffs, pay cuts and even closures. HRI expects consolidation as the pandemic continues to curb the flow of patients seeking care in emergency departments, orthopedic surgeons’ offices, dermatology suites and more.
Lawmakers and politicians often use bold language, and propose bold solutions to problems, but the government and the industry itself resists sudden, dramatic change, even in the face of sudden, dramatic events such as a global pandemic. One notable exception to this would be a decision by the US Supreme Court to strike down the ACA, an event that would generate a great deal of uncertainty and disruption for Americans, the US health industry and employers.
What Do You Want?
Talk vs. Action
Experts Slam The White House’s ‘Herd Immunity’ Plan
The White House is reportedly embracing a herd-immunity approach focused on “protecting the elderly and the vulnerable” but experts are calling the plan dangerous, “unethical”, and equivalent to “mass murder”.
The news comes following a petition titled The Great Barrington Declaration, which argued against lockdowns and school and business closures and got almost 500,000 signatures – although some of them were fake.
“Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states, adding, “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”
Essentially, herd immunity is when enough people are immune to a disease, like Covid-19, that the disease can’t be transmitted as easily and thus provides indirect protection.
It’s been rumoured that the government has been leaning towards this plan of action for some time now, although this is the first real admission.
In response to today’s news, experts around the world have been voicing their concerns.
And this isn’t the first time we’ve heard experts say herd immunity is not a good idea.
For example, the head of the World Health Organization said Monday that allowing the novel coronavirus to spread in an attempt to reach herd immunity was “simply unethical.”
Similarly, the National Institutes of Health (NIH) director Francis Collins also denounced herd immunity as a viable plan.
“What I worry about with this is it’s being presented as if it’s a major alternative view that’s held by large numbers of experts in the scientific community. That is not true. This is a fringe component of epidemiology. This is not mainstream science. It fits into the political views of certain parts of our confused political establishment,” he said in an interview.
Not to mention studies continue to show that Sweden’s attempts at herd immunity have failed and have resulted in a higher Covid-19 death toll than expected.
As more research comes out, scientists are starting to learn that Covid-19 immunity, even in those who were severely infected, can fade after a few weeks.
This is why we’ve seen cases of reinfection and why many experts are advising against a herd immunity plan.
Currently less than 10% of the population in the U.S. are immune to Covid-19 but for herd immunity to be achieved most experts estimate between 40% to 80% of the population would need to be infected.
To put that into context, that means around 197 million people would need to be infected in America. And assuming that the Covid-19 fatality rate is somewhere between 0.5% and 1%, based on numbers from the World Health Organization (WHO), more than 1 million people would die – at minimum.
William Haseltine, Chair and President of ACCESS Health International, told CNN “herd immunity is another word for mass murder. We are looking at two to six million Americans dead – not just this year but every year.”
“This is an unmitigated disaster for our country – to have people at the highest levels of our government countermanding our best public health officials. We know this epidemic can be put under control. Other countries have done it. We are doing the opposite.”
Cartoon – Thoughtful Gift
America’s most prestigious medical journal makes a political statement
https://mailchi.mp/45f15de483b9/the-weekly-gist-october-9-2020?e=d1e747d2d8
For its first 208 years, the New England Journal of Medicine has never endorsed a political candidate. But this week the journal published an editorial outlining its political position in the upcoming Presidential election, signed unanimously by all editors who are US citizens.
The editors did not explicitly endorse former Vice President Biden, but rather offered a scathing condemnation of the current administration’s performance during the COVID pandemic: “Reasonable people will certainly disagree about the many political positions taken by candidates.
But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.” (Formally endorsing Biden last month, Scientific American also made the first political endorsement in its 175-year history.)
Much of the media coverage of the NEJM statement has centered on the question of whether medicine should involve itself in politics, or “live above it”.
Medicine has been drawn into political disputes before, but now the nature of the involvement has changed. In the past, debates largely centered around regulation, payment or policy—but now the science itself has become a fundamentally political issue.
The very nature of the coronavirus has become a matter of political belief, not just an indisputable scientific fact.
Public trust in both scientific institutions and the government, and their ability to work together, has been damaged. We fear this will lead to poorer health outcomes regardless of who wins the upcoming election.
