UnitedHealthcare temporarily delays a controversial policy

https://mailchi.mp/66ebbc365116/the-weekly-gist-june-11-2021?e=d1e747d2d8

UnitedHealthcare delays ED policy; ACR says 'flawed' rule may violate  patient protection laws

Facing intense criticism from hospital executives and emergency physicians, the nation’s largest health insurer, UnitedHealthcare (UHC), delayed the implementation of a controversial policy aimed at reducing what it considers to be unnecessary use of emergency services by its enrollees.

The policy, which would have gone into effect next month, would have denied payment for visits to hospital emergency departments for reasons deemed to be “non-emergent” after retrospective review. Similar to a policy implemented by insurer Anthem several years ago, which led to litigation and Congressional scrutiny, the UHC measure would have exposed patients to potentially large financial obligations if they “incorrectly” visited a hospital ED.

Critics pointed to longstanding statutory protections intended to shield patients from this kind of financial gatekeeping: the so-called “prudent layperson standard” came into effect in the 1980s following the rise of managed care, and requires insurance companies to provide coverage for emergency services based on symptoms, not final diagnosis. UHC now says it will hold off on implementing the change until after the COVID-19 national health emergency has ended, and will use the time to educate consumers and providers about the policy.

Like many critics, we’re gobsmacked by the poor timing of United’s policy change—emergency visits are still down more than 20 percent from pre-pandemic levels, and concerns still abound that consumers are foregoing care for potentially life-threatening conditions because they’re worried about coronavirus exposure. Perhaps UHC is trying to “lock in” reduced ED utilization for the post-pandemic era, or perhaps they never intended to enforce the policy, hoping that the mere threat of financial liability might discourage consumers from visiting hospital emergency rooms.

While we share the view that consumers need better education about how and when to seek care, combined with more robust options for appropriate care, this kind of draconian policy on the part of UnitedHealthcare just underscores why many simply don’t trust profit-driven insurance companies to safeguard their health.
 

Wisconsin pharmacist who intentionally damaged 570 vaccine doses sentenced to 3 years in prison

Wisconsin pharmacist arrested after allegedly deliberately ruining hundreds  of COVID-19 vaccine doses | KTLA

An Advocate Aurora Health pharmacist who intentionally damaged 570 doses of COVID-19 vaccine was sentenced to three years in prison, according to NBC affiliate WTMJ of Milwaukee.

Steven Brandenburg worked at Aurora Medical Center in Grafton, Wis., when he removed Moderna COVID-19 vaccine vials from refrigeration twice in December. He told investigators he believed the vaccine could harm patients or change their DNA. 

He was arrested Dec. 31 on charges of first-degree recklessly endangering society, adulterating a prescription drug and criminal damage to property. 

Fifty-seven people received the vaccines after they were left out, but they will likely experience no harm, according to officials with Aurora Health Care, based in both Milwaukee and Downers Grove, Ill.

After Aurora Health Care investigated the incident, Mr. Brandenburg was fired. He and the Wisconsin Pharmacy Examining Board agreed on his license suspension during a Jan. 13 meeting. 

Mr. Brandenburg on Jan. 26 agreed to plead guilty to two counts of attempting to tamper with consumer products with reckless disregard.

On June 8, Mr. Brandenburg was sentenced to three years in prison. After serving his sentence, he will face another three years of supervised release.

Mr. Brandenburg told the court he was “desperately sorry and ashamed” about tampering with the vaccines. He also said Aurora Health Care is a “pillar of the community” and “did not deserve” the incident, according to WTMJ.

Should hospitals mandate the COVID vaccine for employees?

What the COVID-19 vaccine means for your workforce

As we’ve talked to health system executives about the challenges of rolling out COVID vaccines in their communities, one topic keeps coming up: how difficult it’s been to get hospitals’ own workers fully vaccinated. One system told us recently that only 55 percent of their frontline caregivers have opted to get vaccinated, despite early and easy availability, and ongoing encouragement from the hospital’s leaders.

Healthcare workers, it turns out, are just like the general population, bringing the same diversity of perspectives and concerns about vaccination to work with them from their own communities. Vaccine hesitancy is not a new issue for hospital staffers; getting the workforce to take the flu vaccine is an annual struggle for many hospitals.

But given the risks of COVID-19, why not just mandate that hospital employees get the vaccine, as other employers have started to do? We commonly hear two concerns.

One is a labor relations worry: will mandating vaccination cause workers to quit, or make it harder to hire staff in an already difficult market for talent? And given growing concerns about unionization of healthcare workers, will mandatory vaccination become a flashpoint issue?

The second concern is medical liability: can we force workers to get a vaccine that hasn’t been fully approved by the FDA? Would that expose the hospital to legal challenges down the road, if there turn out to be long-term complications from the vaccine?

Our own view is that the first concern is overblown—we suspect vaccine mandates are going to become more and more common as the economy reopens. As to the second, we’re more sympathetic. But once the FDA does grant full approval for the vaccines, we’d hope hospitals will get tougher about vaccine mandates (with the necessary exemptions for health, religious, and other concerns).

At the end of the day, hospitals are in the patient care business, and they should view vaccine mandates—whether for COVID or for influenza—as a patient safety issue, not a workforce engagement issue.

COVID-19 patient killed by hospital roommate in California, police say

COVID-19 patient charged with murder in deadly beating of fellow patient at California  hospital - ABC13 Houston

A patient accused of fatally beating his roomate at Antelope Valley Hospital in Lancaster, Calif., has been arrested and charged with murder, elder abuse and a hate crime enhancement, according to the Los Angeles County Sherrif’s Department

The victim, an 82-year-old man, was being treated for COVID-19 and sharing a room with the suspect, identified as 37-year-old Jesse Martinez. The victim, whose name has not been released, began to pray in his hospital room on Dec 17. That act upset Mr. Martinez, who allegedly struck the victim with an oxygen tank. The man died of his injuries Dec. 18, police said.

Mr. Martinez is being held at the Twin Tower Correctional Facility in Los Angeles, and his bond is set at $1 million. He’s scheduled to appear in court Dec. 28.  

Police said the investigation into the incident is ongoing, and the motive is not immediately clear. 

University of Chicago Medical Center closes level 1 trauma center ahead of strike

https://www.beckershospitalreview.com/human-resources/university-of-chicago-medical-center-closes-level-1-trauma-center-ahead-of-strike.html

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University of Chicago Medical Center has closed its level 1 trauma center for adult and pediatric patients as it prepares for about 2,200 nurses to go on strike next week, medical center leaders announced.

Medical center leaders said UCMC closed its pediatric level 1 trauma program Nov. 18 and its adult trauma program Nov. 20. Its adult and pediatric emergency rooms continue to take walk-in patients.

Nurses are scheduled to strike Nov. 26, two days before Thanksgiving. The nurses also walked off the job Sept. 20 in a strike organized by National Nurses Organizing Committee/National Nurses United. They were allowed to return to work Sept. 25, after the medical center said it fulfilled its contract with temporary nurses to replace the striking ones for five days.

In preparation for the strike, UCMC announced earlier this week that it is moving about 50 babies and 20 children in its neonatal and pediatric intensive care units to other facilities.

UCMC President Sharon O’Keefe is also recruiting about 900 replacement nurses.

However, “it’s exceptionally difficult to hire people who are willing to leave their families during Thanksgiving,” she said in a news release. “At the same time, other hospitals in the city are already at or near capacity, which means they will not be able accept transfers of current inpatients if that need arises when nurses walk out. The combination of the two led us to take the step of temporarily closing our trauma program ahead of the strike.”

UCMC said the hospital was required to offer replacement nurses five days of work “to best recruit qualified and experienced replacement nurses.” Therefore, the nurses on strike will not be able to return to work until 7 a.m. Dec. 1.

Negotiations between UCMC and National Nurses Organizing Committee/National Nurses United began earlier this year. Medical center leaders say incentive pay — and whether the hospital should end the pay for newly hired nurses — is a sticking point in negotiations, according to the Chicago Tribune. The union has continued to express concerns about staffing levels.

The nurses said they plan to strike unless an agreement is reached.

 

 

 

 

The plight of America’s rural health care

https://www.axios.com/the-plight-of-americas-rural-health-care-a34b6c66-7674-4f78-abdc-33f8e711a601.html

Illustration of a tractor plowing a field in the shape of a heart monitor that is petering out

Rural America is stuck in a cycle of increasingly vulnerable patients with declining access to health care.

Why it matters: Rural patients often can’t afford care, are being hounded by hospitals and collection agencies over their unpaid bills, and are facing the reality of life in communities where the last hospital has closed.

Rural Americans tend to be older, sicker and lower-income than urban Americans. They suffer from higher rates of obesity, mental health issues, diabetes, cancer and opioid addiction, as my colleagues Stef Kight and Juliet Bartz reported.

  • They’re also more likely to be uninsured or covered by Medicare or Medicaid, which pay doctors and hospitals less than private insurance does.
  • A small and shrinking population, mostly covered by insurance plans that don’t pay very much, many of whom need a lot of care, puts more financial pressure on providers, especially hospitals. Physician shortages are common.

What they’re saying: “Rural hospitals have long been right there on the edge on average, and we’re seeing more and more of them flip over to red,” said Mark Holmes, a professor at UNC-Chapel Hill and director of the Cecil G. Sheps Center for Health Services Research.

And hospital closures often exacerbate the problems communities were already facing.

  • Hospitals are often the largest or second-largest employer in a rural community.
  • 113 rural hospitals have closed since 2010, according to the Sheps Center.
  • These are disproportionately located in the South — the region with the nation’s worst health outcomes, and where most states haven’t expanded Medicaid — leaving hospitals with more uninsured patients.
  • A 2018 study in Health Affairs found that Medicaid expansion is “associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets.”

The bottom line: “What we have here is not one root cause; there’s multiple things going on here,” Holmes said. “All these sort of modest kind of trends are adding up to something that’s quite considerable.”

Go deeper:

  • Bloomberg Businessweek reported on eastern Montana’s sole psychiatrist, despite being the state with the nation’s highest suicide rate.
  • The Washington Post detailed a hospital in Missouri’s practice of suing its patients for payment — money that the hospital needed but patients generally don’t have.
  • Kaiser Health News and NPR have profiled the fallout in a rural community in Kansas after its sole remaining hospital closed, which included a 2-week lapse in nearby emergency care.

 

 

 

 

Government to start posting list of troubled nursing homes

https://www.apnews.com/c8e1e70253fb405e8fe13cd7b2eda70f

In this Oct. 26, 2018, file photo, Sen.Bob Casey, D-Pa., speaks to reporters in the studio of KDKA-TV in Pittsburgh. For years the federal government for years has kept under wraps the names of hundreds of nursing homes around the country found to have serious health, safety or sanitary problems. Lawmakers say the silence calls into question the government’s commitment to families going through the difficult process of finding a nursing home for a loved one. The secrecy began to crack Monday when two U.S. senators from Pennsylvania released the government’s list.

In a turnabout, the government said Wednesday it will start posting a list of some 400 troubled nursing homes , days after senators released the “secret” document along with a report questioning oversight of poor-quality facilities.

Dr. Kate Goodrich, chief medical officer with the Centers for Medicare and Medicaid Services, said the agency soon will post the list and update it regularly. She didn’t set a date.

“We are working actively to get the list posted,” Goodrich told reporters, saying that attention focused on the issue “has amplified a very important national dialogue on nursing home quality.”

The Associated Press reported Monday that Sens. Bob Casey, D-Pa., and Pat Toomey, R-Pa., had found that conditions at the 400 facilities were “indistinguishable” from those at about 80 poor-performing nursing homes that are publicly identified by the government and undergo an additional level of inspections.

In a statement, Casey welcomed the commitment to post the list, but said more work is needed to make sure the government’s program to improve poor-performing nursing homes is running properly and has enough financing.

About 1.3 million Americans live in nursing homes, with more than 15,700 such facilities nationwide. The troubled nursing homes that Casey and Toomey identified are part of the government’s Special Focus Facility program, representing about 3 percent of all homes.

Budget cuts appear to be contributing to the problem by reducing money available for focused inspections, according to documents and interviews.

Agency officials say they currently only have enough money for 88 slots in the special focus program. Those facilities are publicly identified. Consumers can spot them on the government’s Nursing Home Compare website by looking for an icon that resembles a traffic “caution” sign.

But a larger group of some 400 nursing homes are designated as “candidates” for the program, and their names have not been publicly disclosed. The agency says that’s now about to change.

It pushed back against the suggestion it was keeping secrets, saying its nursing home website uses starred ratings that allow consumers to readily identify troubled facilities. Nursing homes with five stars have much better than average quality and nursing homes with a single star are considered to be much below average. Nationwide, there are about 2,900 of the latter.

Goodrich said starred ratings are the best way for consumers to get a sense of quality, but the senators’ report concluded that the ratings can be misleading. For example, nearly 3 in 10 of the 400 “candidate” nursing homes with problems had two stars out of five overall.

The government spends about $400 million a year on all Medicare-related inspections, and Goodrich said most of that goes for nursing home checks. The Trump administration has asked Congress for nearly $45 million more.