Is healthcare still recession-proof?

https://mailchi.mp/3390763e65bb/the-weekly-gist-june-24-2022?e=d1e747d2d8

A recent conversation with a health system CFO made us realize that a long-standing nugget of received healthcare wisdom might no longer be true. For as long as we can remember, economic observers have said that healthcare is “recession-proof”—one of those sectors of the economy that suffers least during a downturn. The idea was that people still get sick, and still need care, no matter how bad the economy gets. But this CFO shared that her system was beginning to see a slowdown in demand for non-emergent surgeries, and more sluggish outpatient volume generally.

Her hypothesis: rising inflation is putting increased pressure on household budgets, and is beginning to force consumers into tougher tradeoffs between paying for daily necessities and seeking care for health concerns. This is having a more pronounced effect than during past recessions, because we’ve shifted so much financial risk onto individuals via high deductibles and cost-sharing over the past decade.

There’s a double whammy for providers: because the current inflation problems are happening in the first half of year, most consumers are nowhere near hitting their deductibles, leading this CFO to forecast softer volumes for at least the next several months, until the usual “post-deductible spending spree” kicks in.

Combined with the tight labor market, which has increased operating costs between 15 and 20 percent, this inflation-driven drop in demand may have hospitals and health systems experiencing their own dose of recession—contrary to the old chestnut.

Speaking up about the unspeakable

The right to bear arms has existed since we became a nation. So, too, has the risk of violence that extensive gun ownership creates in our society. 

Unfortunately, recent mass shooting incidents, fueled by hatred or mental illness, have sparked a great deal of fear and confusion among Americans.  

As healthcare leaders, our concern centers on the treatment of those who are victims of senseless gun violence. And not just those who are shot, but the other victims as well.

Healthcare providers must care for all victims — the ones who are traumatized because a loved one has been hurt or lost, the ones who were at the chaotic scene of the violence, or who are haunted by the endless media stories they cannot seem to tune out. The emotional toll of this violence is incomprehensible.

Healthcare facilities attempt to provide refuge from violence and seek to provide healing and hope to all victims of violence. 

And yet, sadly, we are not immune to being another venue for violence

Unstable individuals with guns and other weapons of harm find their way into our buildings and hallways as well. Earlier this month, a man who blamed his physician for ongoing pain after a recent back surgery shot and killed his surgeon and three other people before fatally shooting himself in a Tulsa, Okla., medical facility. Also this month, a hospital security officer was shot and killed by a prison inmate who was receiving care in a Dayton, Ohio, emergency room.

These incidents are the latest horrifying tragedies in a wave of deadly gun violence occurring across our country, including two heart-breaking mass shootings in Buffalo, N.Y., and Uvalde, Texas. We mention these tragedies not to make a political statement, but to raise awareness of the consequences of this violence on healthcare providers and the public health. 

As healthcare workers, healers, and caregivers, we work to fix what is broken and put people back together. We bring solutions. We engage with our hearts to stand together in the fear and vulnerabilities of those who need us so that we can help them through difficult challenges. We look to bring light to dark situations. We seek to be beacons of hope. 

The escalation of recent shootings, suicides and other violent behaviors underscores the urgency for a national conversation on what has become a serious public health crisis. We believe health systems have a credible voice and can play a critical role beyond being places to physically and emotionally care for the victims of violence.

It’s easy to allow ourselves to become numb to the frequency of these unconscionable, violent acts. But we owe it to present and future generations not to let that happen. We recognize there are no easy answers to this national problem. After all, we are dealing with abnormal behavior — the decision to seriously harm or kill other people. That this behavior is increasing calls for something to be done to effect positive change.

People across our country and the communities we serve are hurting and vulnerable. Many people are weary from the pandemic that has impacted our hearts and our health. Violence and death, and particularly mass shootings, hit adults hard. Now consider what the prevalence and threat of school shootings have done to an entire generation of children, who are growing up with the fear of being shot and killed in a place they should feel safe.

We all can play a role. Recently, our two organizations decided to do something to reduce gun violence by sponsoring a law enforcement gun buyback program to help get guns off the street. This effort was part of the largest single-day gun buyback in New Jersey state history. It successfully removed over 2,800 guns statewide. Private organizations, companies, and individuals must think of additional creative ways beyond criticizing politicians, to bring about the change we need. 

We encourage organizations and communities to come together, to pool their minds and their resources to address gun violence in society as the urgent public health crisis that it is. We must create meaningful public health campaigns around the safe storage and handling of firearms, and sensible and innovative ways to prevent gun violence in schools, healthcare settings and public places. Individuals should educate themselves on the issues surrounding gun violence so they may contribute to the effort to bring about necessary and meaningful change.  

And yes, we need to accelerate efforts around our nation’s mental health crisis. We know from the data and what we are all experiencing that the COVID-19 pandemic has exacerbated what was already a growing nationwide mental health crisis. 

Violence against any person in any venue is unspeakable. Yet just because it is unspeakable does not mean we should not speak up about it. Let us put our anger, shock and heartbreak into positive change. With the same unstoppable resolution that we seek to cure cancer or slow heart disease, let us advocate, educate and take meaningful action to end gun violence and all senseless violence that is taking such a tragic toll on our nation and our wellbeing.  

Mr. Pullin is president and CEO of Virtua Health. Mr. O’Dowd is co-president and CEO of Cooper University Health Care.

About Virtua Health
Virtua Health is an academic health system committed to helping the people of South Jersey be well, get well, and stay well by providing the complete spectrum of advanced, accessible, and trusted healthcare services. Virtua’s 14,000 colleagues provide tertiary care, including renowned cardiology and transplant programs, complemented by a community-based care portfolio. In addition to five hospitals, two satellite emergency departments, 30 ambulatory surgery centers, and more than 300 other locations, Virtua brings health services directly into communities through Hospital at Home, physical therapy and rehabilitation, mobile screenings, and its paramedic program. Virtua has 2,850 affiliated doctors and other clinicians, and its specialties include orthopedics, advanced surgery, and maternity. Virtua is academically affiliated with Rowan University, leading research, innovation, and immersive education at the Virtua Health College of Medicine & Health Sciences of Rowan University. Virtua is also affiliated with Penn Medicine for cancer and neuroscience, and the Children’s Hospital of Philadelphia for pediatrics. As a not-for-profit, Virtua is committed to the well-being of the community and provides innovative outreach programs that address social challenges affecting health, most notably the “Eat Well” food access initiative, which includes the unparalleled Eat Well Mobile Grocery Store. A Magnet-recognized health system ranked by U.S. News and World Report, Virtua has received many awards for quality, safety, and its outstanding work environment. For more information, visit Virtua.org. To help Virtua make a difference, visit GiveToVirtua.org.

About Cooper University Health Care
Cooper University Health Care is a leading academic health system with more 8,500 employees and more than 800 employed physicians. Cooper University Hospital is the only Level 1 Trauma Center in South Jersey and the busiest in the region.  Annually, nearly two million patients are served at Cooper’s 635-bed flagship hospital, outpatient surgery center, three urgent care centers, and more than 105 ambulatory offices throughout the community. The Cooper Health Sciences campus is home to Cooper University Hospital, MD Anderson Cancer Center at Cooper, Children’s Regional Hospital at Cooper, and Cooper Medical School of Rowan University. Visit CooperHealth.org to learn more.

The Fed’s big mistake

The Federal Reserve just raised interest rates by three-quarters of a percentage point, the biggest single increase in interest rates since 1994. It’s another move in the Fed’s effort to tackle the fastest inflation in four decades.

I understand the Fed’s urgency, but it has entered dangerous territory. If the Fed continues down this path – as it has signaled it will – the economy will be plunged into a recession. Every time over the last half century the Fed has raised interest rates this much and this quickly, it has caused a recession.

Besides, interest rate increases will not remedy the major causes of the current inflation – huge pent-up worldwide demand from two years of pandemic, shortages of goods and services responding to that demand, Putin’s war in Ukraine, and big profitable corporations with enough pricing power to use inflation as a cover for pushing up prices even further.

The Fed assumes that price increases are being driven by wage increases — so-called “wage-price inflation.” That’s incorrect. Wages are lagging behind inflation. A more accurate description of what we’re now seeing might be called “profit-price inflation” — prices driven upward by corporations seeking increased profits. (See chart below, from the Economic Policy Institute.)

A recession will be especially harmful to people who are most vulnerable to downturns in the economy — who are the first to be fired (and last to be hired again when the economy turns upward): lower-wage workers, disproportionately women and people of color.  

The Fed is making a big mistake.

Gun violence, the leading cause of death among US children, claims more victims

https://mailchi.mp/d73a73774303/the-weekly-gist-may-27-2022?e=d1e747d2d8

Only 10 days after a racially motivated mass shooting that killed 10 in a Buffalo, NY grocery store, 19 children and two teachers were murdered on Tuesday at an elementary school in Uvalde, TX. The Uvalde shooting was the 27th school shooting, and one of over 212 mass shootings, that have occurred this year alone.

Firearms recently overtook car accidents as the leading cause of childhood deaths in the US, and more than 45,000 Americans die from gun violence each year. 

The Gist: Gun violence is, and has long been, a serious public health crisis in this country. It is both important to remember, yet difficult for some to accept, that many mass shootings are preventable. 

Health systems, as stewards of health in their communities, can play a central role in preventing gun violence at its source, both by bolstering mental health services and advocating for the needed legislative actions—supported by a strong majority of American voters—to stem this public health crisis. 

As Northwell Health CEO Michael Dowling said this week, “Our job is to save lives and prevent people from illness and death. Gun violence is not an issue on the outside—it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is. If you were hesitant about getting involved the day before…May 24 should have changed your perspective. It’s time.”

5 virtues of consequential leadership

https://www.fastcompany.com/90727010/how-ukranian-president-volodymyr-zelenskyy-exhibits-the-5-virtues-of-consequential-leadership

In recent years, I’ve written and spoken a lot about consequential leadership. History has presented us with far too many examples to share here: Abraham Lincoln, Ernest Shackleton, Rosa Parks, Amelia Earhart, and John Lewis are a few names that immediately come to mind.

As we watch Russia’s unprovoked invasion of Ukraine unfold night by night, attack by attack, and tweet by tweet, the gut-wrenching and heartbreaking scenes expose an unimaginable magnitude of inhumanity. At the same time, we’re witnessing an unforeseen spirit of resilience, patriotism, and heroism emerge that reveals the best of humanity.

No one personifies the consequential leadership we are observing more than Ukrainian President Volodymyr Zelenskyy. It has been said that a crisis doesn’t build character—it reveals it. The heroic response to this crucible has demanded much of Zelenskyy and his people. But it has revealed even more about the character of this unfamiliar leader and country than any of us ever expected.

As I reflect on this past week, there are five virtues of consequential leadership Zelenskyy and his brave comrades are illuminating for us we can learn from.

Conviction: Consequential leaders know—and honor—their purpose. They recognize their responsibility to use the talent, health, education, opportunities, and influence they are blessed with to solve big problems and do really hard things. And in rare circumstances—like Zelenskyy’s— they are called to do things no person should ever have to do. While most of us devote our lives to preparing to be the leader we want to be, in moments of consequence, we must become the leaders the world needs us to be.

Courage: Consequential leaders have the fearlessness to live their purpose—even under life-threatening conditions. It’s easy for us to talk about our convictions when times are good from the comfort and safety of our corporate suites and government offices. But how many of us and our political leaders would, or could, summon the primal valor we’re seeing Zelenskyy and his lieutenants model?

Composure: Consequential leaders thrive under fire and in times of great uncertainty. There is no blueprint for moments of consequence like the one Zelenskyy is facing. There is no playbook for responding to the unprovoked invasion of your country by a neighboring world superpower. However, leaders of consequence like Zelenskyy don’t panic. They stay calm, rational, and in control. They know that panic fuels fear and that composure catalyzes confidence.

Communication: Consequential leaders communicate frequently, authentically, and truthfully. They speak to our minds, move our hearts, and have the intuition to know when and how to deliver the hard truth as well as realistic hope. Consequential leaders like Zelenskyy are brutally blunt about the abundance of resources they are lacking, but they also remind us of the prosperity of blessings we have—things like family, friends, country, and faith.

Compassion: Finally, consequential leaders put serving others ahead of serving themselves. Zelenskyy and leaders like him put the public interest ahead of their self-interest. While most leaders measure their success in the world, consequential leaders measure their significance on the world. It is never too late for any of us to rethink how we gauge our leadership impact.

It is unclear how the battle over Ukraine will play out. But it is unambiguously clear this moment will redefine leadership for generations. As in all moments of great consequence, history will judge Zelenskyy and Putin, as well as other world leaders, by how they acted–and the consequences of their humanity and inhumanity.

As New York Times columnist David Brooks tweeted yesterday: “Would you be Zelenskyy? Would I? What a high and heroic standard that guy has set for us in the years ahead.”

US hospitals seeing different kind of COVID surge this time

https://apnews.com/article/coronavirus-pandemic-business-health-pandemics-49810a71d2ca21c4b56adb1d1092b6dd?fbclid=IwAR1KvwTCWhAHZwDlmzgzMiNL5xhBfOySbZwgzXs3IAXtWlHai_VRfni5eaQ

Registered nurse Rachel Chamberlin, of Cornish, N.H., right, steps out of an isolation room where where Fred Rutherford, of Claremont, N.H., left, recovers from COVID-19 at Dartmouth-Hitchcock Medical Center, in Lebanon, N.H., Monday, Jan. 3, 2022. Hospitals like this medical center, the largest in New Hampshire, are overflowing with severely ill, unvaccinated COVID-19 patients from northern New England. If he returns home, Rutherford said, he promises to get vaccinated and tell others to do so, too. (AP Photo/Steven Senne)

Hospitals across the U.S. are feeling the wrath of the omicron variant and getting thrown into disarray that is different from earlier COVID-19 surges.

This time, they are dealing with serious staff shortages because so many health care workers are getting sick with the fast-spreading variant. People are showing up at emergency rooms in large numbers in hopes of getting tested for COVID-19, putting more strain on the system. And a surprising share of patients — two-thirds in some places — are testing positive while in the hospital for other reasons.

At the same time, hospitals say the patients aren’t as sick as those who came in during the last surge. Intensive care units aren’t as full, and ventilators aren’t needed as much as they were before.

The pressures are nevertheless prompting hospitals to scale back non-emergency surgeries and close wards, while National Guard troops have been sent in in several states to help at medical centers and testing sites.

Nearly two years into the pandemic, frustration and exhaustion are running high among health care workers.

“This is getting very tiring, and I’m being very polite in saying that,” said Dr. Robert Glasgow of University of Utah Health, which has hundreds of workers out sick or in isolation.

About 85,000 Americans are in the hospital with COVID-19, just short of the delta-surge peak of about 94,000 in early September, according to the Centers for Disease Control and Prevention. The all-time high during the pandemic was about 125,000 in January of last year.

But the hospitalization numbers do not tell the whole story. Some cases in the official count involve COVID-19 infections that weren’t what put the patients in the hospital in the first place.

Dr. Fritz François, chief of hospital operations at NYU Langone Health in New York City, said about 65% of patients admitted to that system with COVID-19 recently were primarily hospitalized for something else and were incidentally found to have the virus.

At two large Seattle hospitals over the past two weeks, three-quarters of the 64 patients testing positive for the coronavirus were admitted with a primary diagnosis other than COVID-19.

Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco, said the rising number of cases like that is both good and bad.

The lack of symptoms shows vaccines, boosters and natural immunity from prior infections are working, she said. The bad news is that the numbers mean the coronavirus is spreading rapidly, and some percentage of those people will wind up needing hospitalization.

This week, 36% of California hospitals reported critical staffing shortages. And 40% are expecting such shortages.

Some hospitals are reporting as much as one quarter of their staff out for virus-related reasons, said Kiyomi Burchill, the California Hospital Association’s vice president for policy and leader on pandemic matters.

In response, hospitals are turning to temporary staffing agencies or transferring patients out.

University of Utah Health plans to keep more than 50 beds open because it doesn’t have enough nurses. It is also rescheduling surgeries that aren’t urgent. In Florida, a hospital temporarily closed its maternity ward because of staff shortages.

In Alabama, where most of the population is unvaccinated, UAB Health in Birmingham put out an urgent request for people to go elsewhere for COVID-19 tests or minor symptoms and stay home for all but true emergencies. Treatment rooms were so crowded that some patients had to be evaluated in hallways and closets.

As of Monday, New York state had just over 10,000 people in the hospital with COVID-19, including 5,500 in New York City. That’s the most in either the city or state since the disastrous spring of 2020.

New York City hospital officials, though, reported that things haven’t become dire. Generally, the patients aren’t as sick as they were back then. Of the patients hospitalized in New York City, around 600 were in ICU beds.

“We’re not even halfway to what we were in April 2020,” said Dr. David Battinelli, the physician-in-chief for Northwell Health, New York state’s largest hospital system.

Similarly, in Washington state, the number of COVID-19-infected people on ventilators increased over the past two weeks, but the share of patients needing such equipment dropped.

In South Carolina, which is seeing unprecedented numbers of new cases and a sharp rise in hospitalizations, Gov. Henry McMaster took note of the seemingly less-serious variant and said: “There’s no need to panic. Be calm. Be happy.”

Amid the omicron-triggered surge in demand for COVID-19 testing across the U.S., New York City’s Fire Department is asking people not to call for ambulance just because they are having trouble finding a test.

In Ohio, Gov. Mike DeWine announced new or expanded testing sites in nine cities to steer test-seekers away from ERs. About 300 National Guard members are being sent to help out at those centers.

In Connecticut, many ER patients are in beds in hallways, and nurses are often working double shifts because of staffing shortages, said Sherri Dayton, a nurse at the Backus Plainfield Emergency Care Center. Many emergency rooms have hours-long waiting times, she said.

“We are drowning. We are exhausted,” Dayton said.

Doctors and nurses are complaining about burnout and a sense their neighbors are no longer treating the pandemic as a crisis, despite day after day of record COVID-19 cases.

“In the past, we didn’t have the vaccine, so it was us all hands together, all the support. But that support has kind of dwindled from the community, and people seem to be moving on without us,” said Rachel Chamberlin, a nurse at New Hampshire’s Dartmouth-Hitchcock Medical Center.

Edward Merrens, chief clinical officer at Dartmouth-Hitchcock Health, said more than 85% of the hospitalized COVID-19 patients were unvaccinated.

Several patients in the hospital’s COVID-19 ICU unit were on ventilators, a breathing tube down their throats. In one room, staff members made preparations for what they feared would be the final family visit for a dying patient.

One of the unvaccinated was Fred Rutherford, a 55-year-old from Claremont, New Hampshire. His son carried him out of the house when he became sick and took him to the hospital, where he needed a breathing tube for a while and feared he might die.

If he returns home, he said, he promises to get vaccinated and tell others to do so too.

“I probably thought I was immortal, that I was tough,” Rutherford said, speaking from his hospital bed behind a window, his voice weak and shaky.

But he added: “I will do anything I can to be the voice of people that don’t understand you’ve got to get vaccinated. You’ve got to get it done to protect each other.”