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California’s Health Care Workforce
http://www.chcf.org/publications/2017/08/california-workforce
California’s health care industry employed more than 1.4 million people in 2015. Five Almanac guides provide data on wages, education, and workplaces for selected health professions.
California’s health care industry employed more than 1.4 million people in 2015. Among these workers, nearly 55% were employed in ambulatory settings, about 25% in hospitals, and 20% in nursing or residential care facilities. An aging population, population growth, and federal health reform will likely contribute to increased demand.
This series of Quick Reference Guides from the CHCF California Health Care Almanac examines specific segments of the state’s health care workforce, focusing on pharmacists and pharmacy technicians, physician assistants, health diagnostic and treatment therapists, clinical laboratory scientists and technicians, and imaging professionals.
Among the trends:
- California’s supply of pharmacists grew 17% between 2012 and 2015, while the supply of pharmacy technicians increased by 8%. About half of the state’s pharmacists were trained in California.
- The number of physician assistants (PAs) in California grew 37% between 2012 and 2015. The Northern and Sierra region had more licensed PAs per capita than the rest of the state.
- The supply of occupational and physical therapists increased between 2012 and 2015, while the supply of speech-language pathologists decreased slightly.
- Between 2012 and 2015, California’s supply of clinical laboratory scientists remained stable while the number of medical/clinical lab technicians rose 11%.
The complete guides, as well as the 2014 editions, are available as Document Downloads.
California Nurses: Taking the Pulse
http://www.chcf.org/publications/2017/08/california-nurses
In 2015, 330,000 registered nurses made up the largest health profession in California. This overview of the nursing workforce looks at supply, demographics, education, distribution, and pay.
California is home to more than 330,000 actively licensed registered nurses (RNs), making nursing the single largest health profession in the state.
Key findings include:
- The nursing workforce has grown more diverse. Non-white RNs accounted for almost half (48%) of employed nurses in 2015. However, compared to the state’s population, Latinos were significantly underrepresented in the RN workforce, while Filipinos and whites were significantly overrepresented.
- The pre-licensure programs for RNs produced 11,119 graduates in 2015, slightly down from a high of 11,512 in 2010.
- California’s RN workforce relies on foreign-educated nurses. In 2015, about one in five employed RNs were trained outside the US.
- 64% of employed RNs worked in a hospital in 2014. Another 15% were in ambulatory care.
- Nurses’ average income was $100,000 in 2015.
- In 2015, more than two-thirds (71%) of LVN graduates came from for-profit schools.
Quick reference guides, as well as a full report from 2010, are available under Document Downloads.
Judge weighs in on whether Jahi McMath is brain dead
Jahi McMath, the Oakland teenager whose brain death case has sparked national debate, may not currently fit the criteria of death as defined by a state law written in conjunction with the medical establishment, a judge wrote in an order Tuesday.
In his ruling, Alameda County Superior Court Judge Stephen Pulido wrote that while the brain death determination in 2013 was made in accordance with medical standards, there remains a question of whether the teenager “satisfies the statutory definition of ‘dead’ under the Uniform Determination of Death Act.”
His ruling comes in the years-long medical malpractice suit against UCSF Benioff Children’s Hospital Oakland and its doctors, which also challenges the hospital’s 2013 brain death diagnosis of the Oakland teenager following a complex nose, throat and mouth surgery.
The judge’s order pertains to the personal injury claim in the lawsuit, which the hospital sought to dismiss, and could result in a trial on whether Jahi is alive. An attorney for the family is arguing Jahi is alive and therefore entitled to more than the cap of $250,000 on medical malpractice lawsuits involving children who die as a result of surgery.
Pulido heavily cited Dr. Alan Shewmon, who concluded in a court declaration that Jahi doesn’t currently fit the criteria for brain death after reviewing 49 videos of her moving specific fingers and other extremities when given commands to do so. Shewmon, a professor emeritus of pediatrics and neurology at UCLA, wrote that Jahi “is a living, severely disabled young lady, who currently fulfills neither the standard diagnostic guidelines for brain death nor California’s statutory definition of death.” Shewmon also reviewed an MRI.
The girl’s family released some of the videos in 2014.
Reached Wednesday, hospital spokeswoman Melinda Krigel referred to a statement issued in July in which Children’s Hospital stood by its position that Jahi “fulfills the legal diagnostic criteria for brain death.” After her December 2013 surgery ended tragically, two doctors declared the teenager dead. An independent and court-appointed doctor from Stanford University later affirmed the diagnosis.
“The videotapes do not meet the criteria set forth in the guidelines” for determining brain death, the hospital said in the statement.
Bruce Brusavich, an attorney for Jahi’s family, did not return a call for comment Wednesday. The family has also filed a federal lawsuit.
Jahi’s story and her family’s fight to remove her from Children’s Hospital captured worldwide attention and inspired other families to question brain death determination of their loved ones.
In late December 2013, then-family attorney Christopher Dolan was successful in convincing a judge to order Jahi released from the Oakland facility, allowing the family to take her cross-country to a hospital in New Jersey. Unlike California, the Garden State has a law allowing guardians to reject a brain death diagnosis on religious grounds.
After leaving the New Jersey hospital, Jahi has been hooked up to breathing and feeding machines in a nearby apartment she shares with her mother, Nailah Winkfield, and other family members. She has used the machines to breathe and eat for nearly four years, a duration that is believed to be longer than any other U.S. patient declared brain dead.
Talk over Coffee into a Data Revolution for northern Nevada’s largest hospital system
In May 2016, Tony Slonim, MD, DrPH, met fellow New Jersey native Joe Grzymski, PhD, at a Starbucks for coffee. Dr. Slonim, CEO of Reno, Nev.-based Renown Health, said he expected to trade stories about their home state, but they soon found their professional interests as compatible as their personal ones.
“Like all good things, it started at Starbucks over a coffee on a Saturday morning,” Dr. Slonim said, “As we let our minds expand and started thinking about complementary ways we could collaborate, this idea came up.”
This idea is a partnership between Renown and the Desert Research Institute, where Dr. Grzymski is senior director of applied research.
The duo began to think of ways they could combine the clinical data 946-bed Renown had on hand with the DRI’s environmental data to better understand the ways outside factors affect health outcomes in their community.
But the idea didn’t stop there. The pair also recognized that social determinants play an equally influential role in shaping a person’s health, so they made sure to include social data from the Governor’s Office of Economic Development in their new project, which did not yet have a name, but more importantly had a purpose.
“If we believe in population health, and the vision for population health, we’ve got to do a better job of understanding the health and the wellbeing of the people we’re serving,” said Dr. Slonim. “As an organization that’s got a large market share, it’s incumbent upon me as the CEO to think about how to use the most efficient resources for the most benefit for people that need it.”
At first, the collaboration was seen as a data-sharing project that would connect skilled researchers and analysts at the DRI with a wealth of combined information that had been inaccessible to a single provider in the past. However, it was only once Dr. Slonim and Dr. Grzymski took their idea to the 2016 BIO International Convention in San Francisco that they were able to find a third partner to provide them with yet another data set that would help them fully see the big picture of a person’s health.
Representatives from retail genetics firm 23andMe approached Dr. Grzymski following his talk at BIO. The company offered to provide genetic testing and sequencing for the project. Dr. Grzymski jumped at the opportunity, which would enrich the already robust data collection he and Dr. Slonim had begun to compile.
With genetic information as a fourth pillar of their potential data set, Renown and the DRI founded the Renown Institute for Health Innovation. The IHI’s most important initiative would go on to be named the Healthy Nevada Project.
At a September 2016 press conference, Dr. Slonim and other IHI leaders teamed up with Nevada Gov. Brian Sandoval to announce that the first 5,000 Reno residents who signed up to submit genetic samples would receive free access to the test results. Dr. Slonim believes offering this access to community members is what encouraged 5,000 people to sign up in only the first 24 hours of the enrollment period. With such an enthusiastic response, the leaders at the IHI decided to open up 5,000 more slots, which took one more day to fill. In only 48 hours, the Healthy Nevada Project had succeeded in enrolling 10,000 local residents to submit samples for genetic testing.
The project was off and running — quickly. And Dr. Slonim’s work was only just beginning.
Once 23andMe completed genetic sequencing of all 10,000 study participants in December, the Healthy Nevada Project still faced a looming question: What to do with all the data they’d collected?
“One-hundred more people per 100,000 die of cardiovascular disease in northern Nevada than national estimates. Our cancer rates are significantly higher and nobody knows why. So [we’re] trying to understand what the backdrop and the context is,” Dr, Slonim said. “Is it the mines that we have here? Is it the weather patterns that change because we’re in a valley? Our air pollution is higher, our particulate matter is higher — is that what causes lung cancer? We’re trying to figure this out, but you can’t do anything without data, so we started there.”
Dr. Slonim understands epidemiologists and analysts will have to spend many careful hours with the data to come to any concrete conclusions, but he believes the Healthy Nevada Project represents an essential first step for the future of the healthcare industry. If he and his colleagues could begin to harness the power of data in EHRs, then he sees a world of untapped potential that can help his community improve their health while also improving Renown’s organizational efficiency.
“This is the ultimate in strategic planning. If I figure out that our community is more at risk for cardiovascular disease 10 years from now, I can be thoughtful about how I go about recruiting cardiologists. If I know that the population is growing in pediatrics, I can start a program for pediatric residents at the medical school and grow my own pediatricians,” Dr. Slonim says. “The horizon for planning can be kept in view because we’re learning about our population’s health and disease. The second reason why I did this is because it’s the best way to engage consumers in their own healthcare to modify their behaviors.”
Dr. Slonim’s advice to hospital leaders looking to improve their capacity for innovative data concepts is simple: Take the first step. For the most part, the benefits of the Healthy Nevada project still lay ahead, as it has been only 15 months since that coffee meeting, but the game-changing potential cannot be understated. Dr. Slonim is confident that putting in the work to collect and analyze this comprehensive data will revolutionize the way Renown cares for its patients, and he believes other providers can follow suit.
“If you’re a large contributor to your market in healthcare with full range of integrated services across the continuum, get the environmental data. Get partnerships with the social data,” Dr. Slonim says. “Figure out how you can exercise your clinical EMRs and the great repository of data that are in there and put them in a big data warehouse and figure out how to analyze them. We’re not using predictive analytics in healthcare the way that other industries are, and we need to be better at that.”
Review finds 5 in 20 Washington hospitals violate state charity care law
Twelve hospitals across the state of Washington received charity care deficiency letters after a recent report by Columbia Legal Services revealed significant problems.
Washington law requires all hospitals to only demand one form of an income-related document, determine if patients qualify for charity care and notify patients of their options. Columbia Legal Services found five hospitals violated this law. The legal organization also found seven more hospitals deficient in their charity care offerings, but not in violation of state or federal laws.
The study cited instances where hospitals were not doing enough to overcome language barriers to charity care, patients were not adequately informed about their charity care rights and hospitals were not informing patients of eligibility or screening them for eligibility.
To investigate the efficacy of charity care policies in Washington hospitals, Columbia Legal Services reviewed state and national charity care reports, hospital data, state laws and uninsured rates. The report tested 20 hospitals in the state.
Read the full report here.
Click to access 170824CharityCareReportFINAL-DIGITAL.pdf
Novant Health sees operating income drop 32.3%
http://www.beckershospitalreview.com/finance/novant-health-sees-operating-income-drop-32-3.html
Winston-Salem, N.C.-based Novant Health saw operating income drop 32.3 percent year-over-year in the second quarter of fiscal year 2017 to $39.7 million, according to unaudited financial documents.
The health system recorded a 2.2 percent year-over-year increase in operating revenue in the second quarter of this year, to $1.11 billion. However, the system saw operating expenses increase 5 percent year-over-year to $994 million.
Including expenses, Novant saw net income drop 2.8 percent year-over-year for the second quarter ended June 30 to $83.9 million.
Becker’s Hospital Review reached out to Novant Health for further explanation of its second quarter financial performance. The system did not provide any additional information.
Exposure Draft: U.S. Not-For-Profit Hospitals andHealth Systems Rating Criteria
https://www.fitchratings.com/site/re/895646
Fitch Ratings has proposed rating criteria changes for nonprofit hospitals and health systems.
Here are five things to know.
1. Fitch said the proposed criteria changes include introduction of revenue defensibility, operating risk and financial profile rating factors as well as individual assessments for each of those factors.
2. Other proposed criteria changes from Fitch include “financial profile alignment with business profile in rating assessment; forward looking consideration of the impact of existing or needed capital investments that may increase financial leverage; and introduction of FAST, an issuer specific scenario analysis tool measuring investment portfolio stress linked to asset allocation, stress on revenue and cost growth rates.”
3. The overall goal with the proposed criteria changes is “to communicate Fitch’s credit ratings more clearly and better express the characteristics that affect a credit’s relative resilience in changing economic conditions,” said Fitch Senior Director Kevin Holloran.
He added, “Fitch believes that this will facilitate a more forward-looking approach to ratings and will better highlight differences among credits within the same rating category.”
4. The agency said it anticipates “fewer than 15 percent of ratings will be affected, with a roughly equal mix of upgrades and downgrades” as a result of the proposed criteria changes.
5. Fitch is accepting comments on the proposed criteria changes via email until Oct. 20. The full Fitch report on the proposed criteria changes is available here.
State officials plead for bipartisan ObamaCare fix
State insurance officials pleaded with senators on Wednesday to quickly act to stabilize the ObamaCare markets, calling for a multiyear extension of key payments to help fund premiums for low-income customers.
Congress must pass a fix by the end of September to shore up the wobbly individual markets, several officials said, in particular funding for key ObamaCare insurer payments known as cost-sharing reductions (CSR).
“The CSR funding issue is the single most critical issue that you can address to help stabilize insurance markets for 2018 and potentially bring down costs,” Tennessee’s insurance commissioner Julie Mix McPeak told the Senate Health Committee.
The panel kicked off a series of hearings Wednesday on stabilizing the markets. If Congress can pass a bill, it would represent the biggest bipartisan update since President Obama signed the law in 2010.
Health committee Chairman Lamar Alexander (R-Tenn.) wants to find consensus by the end of next week. To sell the fix, he and ranking member Patty Murray (D-Wash.) held a private meeting with senators not on the committee and the witnesses who testified as Wednesday’s hearing.
“If we can do two things, that would be two more things that we have agreed on in a bipartisan way in the last seven years in health insurance,” Alexander told reporters.
“And then let the leaders see if we can pass it, and hope the House does and that the president signs it.”
Despite some pushback that could still come from conservatives calling the payments an “insurer bailout,” Alexander and Murray hope to cobble together a bipartisan group that agree some continuation of the payments is necessary.
The cost sharing subsidies, which reimburse insurers for giving discounted deductibles and co-pays to low-income customers, have been made by the Trump administration on a month-to-month basis.
Republicans had sued the Obama administration over the payments, calling them unconstitutional, but many have since acknowledged they need to continue at least in the near term to prevent steep premium hikes.
Insurers have asked for long-term certainty on the payments, threatening to hike premiums and leave the ObamaCare markets altogether if they don’t get it.
Democrats, and some Republicans like Alexander, agree Congress should fund the payments, but there’s disagreement on the time frame.
Alexander wants to fund the payments through 2018 while Murray has pushed for multiple years.
“It is critical that we work toward a multiyear solution in order to provide the kind of certainty that will have the most impact on families’ premiums and choices in the marketplaces,” Murray said.
America’s Health Insurance Plans, the nation’s largest insurer trade association, and other stakeholder groups urged Congress to fund the payments through at least 2019.
“Without two years of CSR funding, uncertainty will persist and the Congress will need to address these same issues early next year,” the groups wrote in a letter to the committee Tuesday.
Meanwhile, Republicans say a bipartisan health bill must include changes to ObamaCare’s state waivers so states have more control over what their insurance plans look like.
Alexander said ObamaCare’s waivers should be amended so “states can have more flexibility to devise ways to provide more coverage with more choices and lower costs.”
“It just hasn’t been very appealing to states because it is a difficult tool to use,” he said.
This point was echoed by Pennsylvania’s insurance commissioner Theresa Miller, who called the process to get approved cumbersome.
“Baseline coverage requirements should be kept intact as much as possible … but make it easier for states to respond to market issues,” she said.
For example, it takes at least six months to get a waiver approved with the federal government, which the commissioners said made it difficult to quickly respond to market issues.
But Democrats have been wary of anything they say could result in coverage losses and the availability of less comprehensive insurance plans.
The Senate GOP’s ObamaCare repeal plan, which failed in a dramatic vote with Sen. John McCain (R-Ariz.) joining two other Republicans in opposition, contained language intended to make it easier for states to approve less comprehensive plans.
However, Democrats say that is going in the wrong direction.
We should be “moving forward not backward on affordability, coverage and quality of care,” Murray said.
“We’re all well aware threading this needle won’t be easy,” she said, “but I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current health care system, is possible.”
Several commissioners also recommended setting up a temporary reinsurance program to help insurers with high cost patients with the intent of lowering premiums for healthier ones.
“Congress should enact a federal reinsurance program with a minimum duration of three years,” said Washington state insurance commissioner Mike Kreidler, adding that it would “significantly help stabilize the individual health insurance market.”
But Alexander indicated it’s unlikely for the bill to include reinsurance funding, noting that the U.S. is already trillions in debt.
“If a reinsurance program is such a good idea … why don’t states do it?” he asked, suggesting states impose small fees on every insurance plan sold to help fund it.
Democrats are also pushing for a bill to restore ObamaCare outreach funding after the Trump administration announced drastic cuts to the program.
Alaska’s insurance director Lori Wing-Heier said the cuts concern her because “these programs reduce the number of uninsured citizens and maximize public participation.”
