How can hospitals weather the financial storms of 2021?

Patient volumes were uneven in 2020, and a new report shows volumes will likely remain below pre-pandemic levels in 2021. This indicates challenges for hospitals looking to stabilize their finances — but there are some key strategies that can help.

Though hospital finances recovered to some extent by the end of 2020, the industry is not out of the woods yet. However, with strategic investments, especially in outpatient care and technology, hospitals and health systems can help buoy their finances in this challenging time, industry observers said.

Patient volumes have fluctuated wildly after the Covid-19 pandemic hit as Covid-19 patients flocked to hospitals and those needing or seeking elective surgery and other care staying away. Not surprisingly, this has had a significant impact on health systems’ financial health.

But outpatient settings and digital solutions offer some revenue-generating opportunities for hospitals.

“A number of the major players and some of the bigger regional systems in the country now are in a place where they get more of their revenue from the outpatient side as opposed to the inpatient side,” said Dr. Sanjay Saxena, global healthcare leader, Payers, Providers, Health Care Systems & Services and managing director at Boston Consulting Group, in a phone interview.

In fact, outpatient care was the only healthcare setting that saw an increase in patient volumes in 2020. Though emergency department visits and inpatient volumes were down from July to December last year compared to the same period in 2019, outpatient volumes actually increased by 5%, according to a report by consumer credit reporting agency TransUnion.

Healthcare providers that have well-established and expansive outpatient and ambulatory care businesses will be able to weather patient volume trends better in 2021 than those who do not, said Saxena.

Take HCA Healthcare, for example. The Nashville, Tennessee-based healthcare giant’s revenues jumped to $14.2 billion in the fourth quarter of last year, up from $13.5 billion in the same period in 2019. HCA’s ability to move care outside of the inpatient setting to the ambulatory environment really helped their financial performance, said Saxena.

On the other hand, smaller and more rural hospitals, which depend heavily on ED and inpatient care, may face a challenging year, he added.

Another key investment for hospitals will be in digital solutions to help them manage the ups and downs of patient volume.

Resilience as a broad topic for provider executives is absolutely top of mind,” said Gurpreet Singh, health services leader at PriceWaterhouseCoopers, in a phone interview. “And resiliency can be achieved in a number of different ways. One way is [figuring out] — can you predict demand a little bit better?”

Patient demand forecasting solutions will be popular, with 74% of health executives recently surveyed by PwC’s Health Research Institute saying their organizations would invest more in predictive modeling in 2021.

Further, hospitals will see savings in some unexpected places. For example, with an increasingly remote and mobile healthcare workforce, hospitals may see cost savings on real estate and facility leases, said Singh.

They can use these savings to invest further in telehealth and at-home care programs to expand care outside of the four walls of the hospital, he added.

The industry has to come to terms with changes brought on by the Covid-19 pandemic, including the shifts in care delivery and patient preferences.

“Some of these things are structurally significant changes,” said Saxena. “Organizations ignore these things…at their peril. Some leading organizations and systems will find a way to embrace [these changes] and leapfrog others in the market coming out of 2021.”

Ruth Bader Ginsburg helped shape the modern era of women’s rights – even before she went on the Supreme Court

https://theconversation.com/ruth-bader-ginsburg-helped-shape-the-modern-era-of-womens-rights-even-before-she-went-on-the-supreme-court-95705?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20September%2018%202020%20-%201736916802&utm_content=Latest%20from%20The%20Conversation%20for%20September%2018%202020%20-%201736916802+Version+A+CID_e457010c9229c8655a12000ef21183e1&utm_source=campaign_monitor_us&utm_term=Ruth%20Bader%20Ginsburg%20helped%20shape%20the%20modern%20era%20of%20womens%20rights%20%20even%20before%20she%20went%20on%20the%20Supreme%20Court

Ruth Bader Ginsburg helped shape modern era of women's rights

Justice Ruth Bader Ginsburg died on Friday, the Supreme Court announced.

Chief Justice John Roberts said in a statement that “Our nation has lost a jurist of historic stature.”

Even before her appointment, she had reshaped American law. When he nominated Ginsburg to the Supreme Court, President Bill Clinton compared her legal work on behalf of women to the epochal work of Thurgood Marshall on behalf of African-Americans.

The comparison was entirely appropriate: As Marshall oversaw the legal strategy that culminated in Brown v. Board of Education, the 1954 case that outlawed segregated schools, Ginsburg coordinated a similar effort against sex discrimination.

Decades before she joined the court, Ginsburg’s work as an attorney in the 1970s fundamentally changed the Supreme Court’s approach to women’s rights, and the modern skepticism about sex-based policies stems in no small way from her lawyering. Ginsburg’s work helped to change the way we all think about women – and men, for that matter.

I’m a legal scholar who studies social reform movements and I served as a law clerk to Ginsburg when she was an appeals court judge. In my opinion – as remarkable as Marshall’s work on behalf of African-Americans was – in some ways Ginsburg faced more daunting prospects when she started.

Starting at zero

When Marshall began challenging segregation in the 1930s, the Supreme Court had rejected some forms of racial discrimination even though it had upheld segregation.

When Ginsburg started her work in the 1960s, the Supreme Court had never invalidated any type of sex-based rule. Worse, it had rejected every challenge to laws that treated women worse than men.

For instance, in 1873, the court allowed Illinois authorities to ban Myra Bradwell from becoming a lawyer because she was a woman. Justice Joseph P. Bradley, widely viewed as a progressive, wrote that women were too fragile to be lawyers: “The paramount destiny and mission of woman are to fulfil the noble and benign offices of wife and mother. This is the law of the Creator.”

And in 1908, the court upheld an Oregon law that limited the number of hours that women – but not men – could work. The opinion relied heavily on a famous brief submitted by Louis Brandeis to support the notion that women needed protection to avoid harming their reproductive function.

As late as 1961, the court upheld a Florida law that for all practical purposes kept women from serving on juries because they were “the center of the home and family life” and therefore need not incur the burden of jury service.

Challenging paternalistic notions

Ginsburg followed Marshall’s approach to promote women’s rights – despite some important differences between segregation and gender discrimination.

Segregation rested on the racist notion that Black people were less than fully human and deserved to be treated like animals. Gender discrimination reflected paternalistic notions of female frailty. Those notions placed women on a pedestal – but also denied them opportunities.

Either way, though, Black Americans and women got the short end of the stick.

Ginsburg started with a seemingly inconsequential case. Reed v. Reed challenged an Idaho law requiring probate courts to appoint men to administer estates, even if there were a qualified woman who could perform that task.

Sally and Cecil Reed, the long-divorced parents of a teenage son who committed suicide while in his father’s custody, both applied to administer the boy’s tiny estate.

The probate judge appointed the father as required by state law. Sally Reed appealed the case all the way to the Supreme Court.

Ginsburg did not argue the case, but wrote the brief that persuaded a unanimous court in 1971 to invalidate the state’s preference for males. As the court’s decision stated, that preference was “the very kind of arbitrary legislative choice forbidden by the Equal Protection Clause of the 14th Amendment.”

Two years later, Ginsburg won in her first appearance before the Supreme Court. She appeared on behalf of Air Force Lt. Sharron Frontiero. Frontiero was required by federal law to prove that her husband, Joseph, was dependent on her for at least half his economic support in order to qualify for housing, medical and dental benefits.

If Joseph Frontiero had been the soldier, the couple would have automatically qualified for those benefits. Ginsburg argued that sex-based classifications such as the one Sharron Frontiero challenged should be treated the same as the now-discredited race-based policies.

By an 8–1 vote, the court in Frontiero v. Richardson agreed that this sex-based rule was unconstitutional. But the justices could not agree on the legal test to use for evaluating the constitutionality of sex-based policies.

Strategy: Represent men

In 1974, Ginsburg suffered her only loss in the Supreme Court, in a case that she entered at the last minute.

Mel Kahn, a Florida widower, asked for the property tax exemption that state law allowed only to widows. The Florida courts ruled against him.

Ginsburg, working with the national ACLU, stepped in after the local affiliate brought the case to the Supreme Court. But a closely divided court upheld the exemption as compensation for women who had suffered economic discrimination over the years.

Despite the unfavorable result, the Kahn case showed an important aspect of Ginsburg’s approach: her willingness to work on behalf of men challenging gender discrimination. She reasoned that rigid attitudes about sex roles could harm everyone and that the all-male Supreme Court might more easily get the point in cases involving male plaintiffs.

She turned out to be correct, just not in the Kahn case.

Ginsburg represented widower Stephen Wiesenfeld in challenging a Social Security Act provision that provided parental benefits only to widows with minor children.

Wiesenfeld’s wife had died in childbirth, so he was denied benefits even though he faced all of the challenges of single parenthood that a mother would have faced. The Supreme Court gave Wiesenfeld and Ginsburg a win in 1975, unanimously ruling that sex-based distinction unconstitutional.

And two years later, Ginsburg successfully represented Leon Goldfarb in his challenge to another sex-based provision of the Social Security Act: Widows automatically received survivor’s benefits on the death of their husbands. But widowers could receive such benefits only if the men could prove that they were financially dependent on their wives’ earnings.

Ginsburg also wrote an influential brief in Craig v. Boren, the 1976 case that established the current standard for evaluating the constitutionality of sex-based laws.

Like Wiesenfeld and Goldfarb, the challengers in the Craig case were men. Their claim seemed trivial: They objected to an Oklahoma law that allowed women to buy low-alcohol beer at age 18 but required men to be 21 to buy the same product.

But this deceptively simple case illustrated the vices of sex stereotypes: Aggressive men (and boys) drink and drive, women (and girls) are demure passengers. And those stereotypes affected everyone’s behavior, including the enforcement decisions of police officers.

Under the standard delineated by the justices in the Boren case, such a law can be justified only if it is substantially related to an important governmental interest.

Among the few laws that satisfied this test was a California law that punished sex with an underage female but not with an underage male as a way to reduce the risk of teen pregnancy.

These are only some of the Supreme Court cases in which Ginsburg played a prominent part as a lawyer. She handled many lower-court cases as well. She had plenty of help along the way, but everyone recognized her as the key strategist.

In the century before Ginsburg won the Reed case, the Supreme Court never met a gender classification that it didn’t like. Since then, sex-based policies usually have been struck down.

I believe President Clinton was absolutely right in comparing Ruth Bader Ginsburg’s efforts to those of Thurgood Marshall, and in appointing her to the Supreme Court.

 

 

 

 

Recovery Through Resilience: Considerations of Top CFOs

Recovery Through Resilience: Considerations of Top CFOs

Recovery Through Resilience: Considerations of Top CFOs - CFO

As the pandemic continues to cause global economic disparity, experts scramble to forecast economic recovery. While no one can predict with precision what lies ahead for the economy, CFOs’ expectations and actions can be a helpful barometer. On a recent Resilient Podcast episode, Mike Kearney, Deloitte Risk & Financial Advisory CMO, and I discussed CFOs’ expectations for the economy, how they are handling hiring and retention, and how they can position their companies for growth. Here are the top takeaways.

1. CFOs Remain on the Defensive

CFOs’ economic expectations have plummeted. Our Q2 CFO Signals Survey marked the lowest readings on business expectation metrics since the first survey 41 quarters ago. Just 1% of CFOs rated conditions in North America as good, compared with 80% in the first quarter. A separate poll of 118 Fortune 500 CFOs conducted at the end of June echoed the sentiments of our Q2 Signals Survey and found that most respondents expect slow to moderate recovery. Over half expect they will not reach pre-crisis operating levels until 2021 and with 17% expecting 2022 or later.

Right now, a foremost priority for resilient CFOs is to ensure enough cash and liquidity for their company to operate. The focus on cost reduction outweighed revenue growth for the first time in the history of the Signals survey. As such, CFOs are doubling down on investing cash rather than returning it to shareholders, staying in existing geographies rather than moving to new ones, and focusing on organic growth as opposed to inorganic growth like mergers and acquisitions.

 2. Navigating New Frontiers

Rest assured that the news isn’t all bad. The Q2 Signals Survey did find that 585 of CFOs see the North American economy rebounding a year from now. Notably, when asked whether they felt their company was in response or recovery mode, or already in a position to thrive, only about a quarter of CFOs said they were still responding to the pandemic. In fact, 37% of CFOs believe their companies are already in “thrive” mode. In the meantime, CFOs are reimagining company configurations, diversifying supply chains, and accelerating automation.

One obvious example of how CFOs are taking a resilient approach to navigate uncertainties is the widespread adoption of virtual work.

According to the Q2 Signals Survey, while just under half say they will resume on-site work as soon as governments allow it, about 70% of CFOs say those who can continue to work remotely will have the option of doing so. This will likely become a critical component to retaining top talent—a longtime concern for CFOs—particularly in a challenging economy. Resilient CFOs will continue to shift underlying business processes to accommodate routine remote work, including investing in new technologies for an efficient and effective virtual workforce, moving platforms to the cloud, and even adjusting internal control mechanisms to allow for off-site collaboration, budgeting, and financial planning.

3. The Role the CFO Can Play

Over the past decade or so, CFOs have evolved to become business strategists, but never has their role as stewards been more important as they grapple with how to navigate a business landscape that changes by the hour. In the coming months, CFOs should consider focusing on:

  • Revisiting their financing and liquidity strategies, centralizing cash release decisions with the treasurer, and leveraging tax planning to reduce cash outlays and preserve budget. Deliver a balance sheet with headroom, flexibility, and liquidity to take advantage of once-in-a-lifetime market opportunities that could present themselves.
  • Exploring different recovery scenarios, keeping an eye on important risk metrics that may signal a time to innovate. Evolve business models, processes, and technologies to maximize current performance and position companies to be able to seize new opportunities.
  • Keeping top talent by embracing a company’s best people, whether it is offering work-from-home capabilities, or nurturing followership through trust. Organizations that can retain their top people may be best positioned in recovery.

During recovery, a critical benchmark to track will be CFOs’ risk appetite. In the Q2 Signals Survey, the proportion of CFOs saying it is a good time to be taking greater risk plummeted to 27%. An upward tick of this finding may signal a greater focus on revenue growth, a willingness to expand into new markets, and an appetite for deal-making. Until then, by taking a resilient approach in the coming months, CFOs can position their companies for strong performance, future growth, and market-moving success as the economy starts to recover.

 

 

 

Resilience, dedication, conviction: Hospital CEOs write thank-you notes to staff

https://www.beckershospitalreview.com/hospital-management-administration/resilience-dedication-conviction-hospital-ceos-write-thank-you-notes-to-staff.html?utm_medium=email

Words of appreciation: Thank-you notes from 15 health system CEOs ...

Healthcare workers have been on the front lines of the COVID-19 pandemic, providing care to ill patients and battling the public health crisis from various angles. In honor of these workers, Becker’s asked hospital and health system CEOs to share notes to their staff and team members.

Michael Apkon, MD, PhD
President and CEO
Tufts Medical Center & Floating Hospital for Children (Boston)

At Tufts Medical Center, we see some of the sickest people in Boston. Our teams routinely surround each of these patients with the extraordinary care and services they need to get well.

This pandemic is unprecedented.  I know our staff are balancing the concerns that we all have for our families and friends, our own health, as well as the changes to our lives outside of work at the same time they do everything they can to provide the level of care people have come to trust from our organization. I can tell you that over my 30 years in this industry, I have not seen more dedication, innovation and willingness to help than I have during these past few months, as we fight a largely unknown enemy.

I could not be more proud of our doctors, nurses, technologists, transporters, housekeepers, cooks, public safety officers and all others who have been vital to the care of all of our patients, including those with a COVID-19 diagnosis. I know that people are coming together across our industry in nearly every city and town. Many thanks to each of our team members and to the healthcare workers around our country as well as to their families, who have had to worry day after day about their loved one on the front lines. Please know your partners, mothers, fathers, sister, brother, sons or daughters have played a critical role in saving lives, and we are doing everything we can to keep them safe.

Marna Borgstrom
CEO Yale New Haven (Conn.) Health

During these unprecedented times I welcome the opportunity to reflect on all that our staff at Yale New Haven Health are doing for each other and for our communities. We have a team of more than 27,000 hardworking and talented people to care for communities in Connecticut, New York and Rhode Island. I am truly humbled and honored to work alongside these amazing individuals.

Our staff, like healthcare workers everywhere, are being tasked in seemingly conflicting ways during this pandemic. Not only are they continuing to do their jobs by caring for the sickest patients, but they are also managing extremely challenging issues at home. Children of all ages are home from school, some need to be home-schooled. Businesses are closed, impacting many spouses and other family members. Staff worry that they may not have an adequate amount of protective equipment and supplies while at work.

But Yale New Haven Health staff are strong, they are resilient and most of all they are caring. As we do everything in our power to keep our staff safe, they are doing everything in their power to care for very ill patients in a world where new information is coming in real time and changing rapidly. We all hope and pray that this pandemic will end soon, but until it does, we are all in this together. I have never been more proud to work with this this wonderful Yale New Haven Health team.

Audrey Gregory, PhD, RN
CEO of the Detroit Medical Center

We know that the current situation around COVID-19 is unnerving, and as things continue to change rapidly every day, it can also be overwhelming.

I want to take this opportunity to thank all the front-line staff at every level in our organization and at healthcare facilities all across the country.

I also would like to say thank you to all of the providers, including residents, fellows and advanced practice providers. I recognize the commitment that you have to provide care to our patients. Not only do I want to acknowledge that, I never want to take that for granted. As healthcare workers, this is the time that we courageously stay on the front lines.

Please be safe and do your part to protect each other. If you have any flu-like symptoms such as fever, cough, sore throat, body aches or shortness of breath, please stay home. I know that as healthcare workers we have a tendency to ignore symptoms, and work through them, so that we do not let the team down. This is the time that I implore you not to do so.

Thank you for your commitment and dedication to the patients and families that depend on us during this challenging time.

R. Guy Hudson, MD
CEO of Swedish Health Services (Seattle)

As we come together to fight this unprecedented pandemic, I am continually impressed by the resilience, professionalism and dedication of our community’s healthcare workers, first responders and other providers of essential services. Without their selfless commitment to serving others, we would not be able to weather this crisis.

Though we have yet to see the full costs that COVID-19 will exact on our region, I am confident that our community will continue to come together, support each other and manage through this situation with resolve.

I am grateful to the community’s outpouring of support for healthcare providers on the front lines, including the 13,000 dedicated caregivers at Swedish. It is often in times of crisis that our humanity, resilience and compassion shine brightest.

The pandemic poses the greatest risk to the most vulnerable members of our community. There are hundreds of nonprofits and other organizations that are doing heroic work to help our neighbors who struggle with mental illness, housing instability, food insecurity and other challenges. Their efforts are more critical than ever and need our support.

In this unchartered territory, I find strength in the dedication and conviction of the caregivers I have the privilege to work alongside. Providing care to our community in a time like this is exactly why we chose careers in healthcare. In the face of this pandemic, we will continue to serve the needs of our community, and we will not waver in our commitment to our patients.

To all our Swedish caregivers: I am proud to work with you.

Alan Kaplan, MD
CEO of UW Health (Madison, Wis.)

We find ourselves in an unprecedented time. We are preparing for a global pandemic, an insidious virus, that is already at our doorstep. To do this, the physicians and staff at UW Health are adjusting every aspect of our standard service to care for those who need us now, to prevent the spread of COVID-19 and to save as many lives as possible.

Despite these dire circumstances, I remain optimistic and proud. The faculty and staff at UW Health, from our diligent technicians to our expert physicians and nurses, are all working incredibly hard to ensure we are doing everything in our power to care for the communities we serve. Your early actions and quick flexibility gave our health system the best chance to manage this crisis. I am especially impressed by the ongoing collaboration, because it shows how much we are capable of accomplishing together. This work is highly valued and deeply appreciated, both within our walls and beyond.

I know this is a trying time for everyone in our organization and so many others around the world. Much of our specialty care has been put on hold, clinics have closed, and regular schedules are nonexistent. I appreciate the long hours and commitment it takes to serve patients and the public good in a time like this. For those on the frontlines of COVID-19, know that our entire organization and our community are proud of the work you are doing.

Finally, I hope you all do what you can to stay healthy, refresh and take time for yourself and to be with loved ones however possible during this new and challenging time. Thank you for everything you do. You are a daily inspiration.

Sarah Krevans
President and CEO of Sutter Health (Sacramento, Calif.)

The healthcare profession attracts those who want to make a difference in the lives of others. They all have a higher calling and always rise to the challenges in front of them. This happens every day, but it’s very apparent during this time in our history. There is no part of our organization that is untouched by this public health emergency. And yet, our teams stand tall. They don’t back down. From front-line health workers, to food and nutrition services staff, to information services personnel — they are committed to keeping our communities safe. Words will never be able to adequately thank them for their dedication, their perseverance and their heart, but all of us across our organization are forever grateful.

Jody Lomeo
President and CEO of Kaleida Health (Buffalo, N.Y.)

As we face these historic and challenging times, it is vitally important that we come together and stick together as a community. It’s just as important that we remain unified as the Kaleida Health family.

That said, let me thank everyone for their incredible dedication and teamwork this past week.

This is an unprecedented issue for healthcare providers to have to deal with; yet the response by the organization as a whole is what we have come to expect: nothing short of remarkable and solely focused on taking care of our community.

On behalf of a grateful community, the board of directors and the Kaleida Health leadership team, we thank you all for your incredible dedication these past few weeks. I have said it numerous times this week: You are the true heroes of this pandemic. And while our way of life has been forever changed, one constant that remains the same: the outstanding work that is done by the Kaleida Health team!

A special note of gratitude goes out to all of those who have volunteered to care for COVID-19 patients within their respective hospitals and across the Kaleida Health system. We could not do this without you!

In closing, thanks again. Stay healthy, stay safe.

We remain #KaleidaStrong.

Elizabeth Nabel, MD
President of Brigham Health (Boston)

We face an unprecedented challenge — possibly the greatest we will ever experience in our careers, maybe even our lifetimes. I am inspired by the indomitable dedication, courage and innovative spirit of our medical and scientific community as we navigate through these most trying events. From providers working on the front lines of patient care to investigators racing to discover an effective treatment for COVID-19, we are surrounded by countless demonstrations of commitment, collaboration and compassion. We will get through this together and come out on the other side stronger than ever.

 

 

 

 

Leading with Honor – Adverse Situation

Lee Ellis FAQ – Lessons Learned?

Leading with Honor Frequently Asked Question –

“During the Vietnam War, after 53 missions in enemy territory, your plane was hit. You managed to parachute to safety but landed in a field of Vietnamese snipers and were captured, subsequently being held prisoner for more than five years.

What lessons did you learn from such an adverse situation?”

Lee’s Answer –

“Because we had a lot of time to reflect and think about things in the POW camps, I really got to know myself. What are my strengths and struggles? What are my fears? Am I authentic, or do I hide behind a persona or façade—I wanted to be real, authentic in every situation.

I learned to be positive and expect a good outcome, even in difficult circumstances. Communication is so important. We had to work hard to communicate, because the enemy tried to keep us from communicating. Another important lesson learned is being resilient and bouncing back. We got knocked down and tortured, and what we learned was resilience.

Our senior POW leaders suffered first and most often and the most torture and hardship. They were committed to doing their duty in spite of the heavy costs. They leaned into their doubts and fears to do the right thing and that was a powerful example. We wanted to be like them, so they raised our level of courage and commitment by their example. My goal became to do the right thing regardless of my fears or the risks associated with the situation.”