Cartoon – Longing for Management Acknowledgement
Cartoon – Productivity Bonus
Cartoon – Productivity Problem
7 travel nurse pay trends for healthcare leaders to know
The COVID-19 pandemic intensified hospitals’ reliance on travel nurses to address staffing shortages and highlighted the gap between full-time workers’ pay and lucrative temporary contracts. In the third year of the pandemic, hospitals continue to rely on travel nurses and grapple with workforce shortages for a variety of reasons. However, some organizations have reduced their reliance on travel nurses, and pay overall is lower compared to certain points of the pandemic, experts told Becker’s.
Here are seven travel nurse pay trends for healthcare leaders to know, per Vivian Health, a national healthcare hiring marketplace used by about 800,000 clinicians, and AMN Healthcare, a medical staffing firm based in Coppell, Texas:
1. The average weekly travel nurse pay in July in the U.S. was $2,997, up 12 percent from $2,681 during the same time in 2021, according to a report from Vivian Health. The report, which was shared with Becker’s, is based on proprietary data of job postings on Vivian Health in July.
2. Among states, Alaska saw the largest average increase to travel nurse pay in July compared to the same time in 2021, according to the Vivian Health report. Florida saw the largest average decrease.
3. When taking a month-over-month view of 2022, average travel nurse pay is declining and coming back to last year’s levels, according to Vivian Health. The company cited several factors for this trend, such as a shift away from travel roles and toward permanent nursing roles as well as less federal money being shifted toward hospitals for large travel contracts.
4. Rishabh Parmar, head of strategy and operations at Vivian Health, told Becker’s: “Compared with July 2021, we still see that travel rates are higher [year over year] — close to around 12 percent to 15 percent — but it seems to be stabilized. Now, in terms of the demand, there’s still a lot of demand out there.”
5. Mr. Parmar estimated that available travel nurse jobs on Vivian Health’s platform doubled in July 2021 compared to pre-pandemic numbers in March 2020. As of July 2022, they were at 2.7 times the rate of March 2020 job numbers.
6. AMN Healthcare also reported lower rates. “According to a recent earnings call, AMN Healthcare expects the company will exit 2022 with travel nurse and allied healthcare professional bill rates at approximately 30 percent lower than first-quarter levels,” the company told Becker’s. “Though demand for travel nurses and allied professionals has declined from an all-time high in Q1, the company expects persistent vacancies and labor shortages to continue.”
7. Some hospitals “are saying, ‘We need to use travel nurses, we just have to use [travel contracts] at lower rates,'” Mr. Parmar said. Some organizations are also offering internal travel programs amid an opportunity to attract workers while decreasing contract labor expenses.
Kentucky nurse charged with murder in death of patient
A nurse was charged with murder Aug. 23 for allegedly causing the death of a 97-year-old patient at Baptist Health Lexington (Ky.), the Lexington Police Department said in a statement.
Eyvette Hunter, RN, was indicted in the death of James Morris. Ms. Hunter “intentionally performed actions of medical maltreatment” to Mr. Morris on April 30, and he died as a result of those actions on May 5, police said.
Ms. Hunter’s nursing license was also suspended this week, according to the Kentucky Board of Nursing.
The order suspending her license said Ms. Hunter administered lorazepam, a sedative, to Mr. Morris without a physician’s order, according to WKYT. Another nurse found the patient a short time later with labored breathing, and he died May 5. His cause of death was listed as aspirational pneumonia.
Ms. Hunter admitted to administering the drug to Mr. Morris without an order, according to WKYT.
“We have learned that a former nurse at our hospital has been arrested on criminal charges. The nurse has not worked here since April 30,” Baptist Health said in an Aug. 23 statement, according to WKYT. “The nurse was terminated and was reported to the Kentucky Board of Nursing. The hospital has fully cooperated with the police investigation. Patient care and safety are always our top priorities. Out of respect for the family and because this is a criminal matter, we are not able to talk about the investigation.”
UPMC’s operating income sinks 86% in first half of year
UPMC reported higher revenue in the first half of this year than in the same period of 2021, but the Pittsburgh-based health system’s operating income declined year over year, according to financial documents released Aug. 23.
UPMC reported revenue of $12.5 billion in the first six months of this year, up from $12.2 billion in the same period of 2021.
Expenses also increased year over year. UPMC reported operating expenses of $12.4 billion in the first half of this year, up from $11.6 billion a year earlier. Expenses increased across all categories, including supplies and salaries and benefits.
“Throughout 2022, the continued effect of COVID-19, along with conditions in the labor and supply markets have resulted in cost growth in employment, staffing and other operating expenses in excess of revenue growth,” UPMC management wrote in the financial filing.
The health system ended the first half of this year with operating income of $81.9 million, down 86 percent from $604.6 million in the same period last year. UPMC’s operating margin was 0.7 percent for the first half of this year, compared with 5 percent in the same period last year.
UPMC reported a net loss of $844.1 million in the first half of this year, compared to net income of $1.1 billion in the same period of 2021. The system’s loss from investing and financing activities totaled $865.9 million in the first two quarters of 2022, compared to a gain of $531.1 million in the same period a year earlier.
6 hospitals hit with credit downgrades
Credit rating downgrades for several hospitals and health systems were tied to capital expenditures and cash flow issues in recent months.
The following six hospital and health system credit rating downgrades occurred since June:
- Boone Hospital Center (Columbia, Mo.) — lowered in August from “Ba1” to “Ba3” (Moody’s Investors Service)
“The downgrade to ‘Ba3’ reflects the continued and material deterioration of unrestricted cash, along with simultaneous operational challenges facing BHC,” Moody’s said. “Operating headwinds, along with recent turnover in senior management, will contribute to challenges in attaining performance improvements. These headwinds will include elevated labor and supply costs, partly raised by supply chain system implementation issues, and volume disruption, which has been exacerbated by the on-going pandemic, as well as the absence of state or federal funds in 2022.” - Jackson Hospital (Montgomery, Ala.) — lowered in August from “Baa3” to “Ba3” (Moody’s Investors Service)
“The downgrade to ‘Ba3’ reflects Jackson Hospital & Clinic’s material and recent deterioration of operating performance and unrestricted cash through June 2022,” Moody’s said. “As a result, headroom to both the debt service coverage and days cash on hand covenants has been materially reduced increasing the risk of a covenant violation, which could lead to immediate acceleration of debt, a governance consideration under our ESG framework.” - Memorial Health System (Marietta, Ohio) — lowered in July from “BB-” to “B+” (Fitch Ratings)
“The downgrade of the IDR to ‘B+’ reflects MHS’s weak net leverage profile through Fitch’s forward-looking scenario analysis given stated growth and spending objectives,” Fitch said. “While operating performance has stabilized over the past three years … and reflects cost efficiency strategies and pandemic relief funding, improved cash flow funded higher levels of capital spending in fiscals 2020 and 2021.” - Doylestown (Pa.) Hospital — lowered in June from “Ba1” to “Ba3” (Moody’s Investors Service)
“The downgrade to Ba3 reflects Doylestown Hospital’s … significant and recent decline in operating performance and unrestricted cash reserves through fiscal 2022, which have materially reduced headroom to the days cash on hand covenant (100 days) and increases the risk of an event of default and immediate acceleration as soon as June 30, 2022, a governance consideration under our ESG framework,” Moody’s said. - Jupiter (Fla.) Medical Center — lowered in June from “BBB+” to “BBB” (Fitch Ratings)
“The ‘BBB’ rating reflects JMC’s increased leverage profile with the issuance of $150 million in additional debt to fund various campus expansion and improvement projects,” Fitch said. “While favorable population growth in the service area and demonstrated demand for services in an increasingly competitive market justify the overall strategic plan and project, the additional debt weakens JMC’s financial profile metrics and increases the overall risk profile.” - South Shore Hospital (South Weymouth, Mass.) — lowered in June from “BBB+” to “BBB” (Fitch Ratings)
“The downgrade to ‘BBB’ reflects SSH’s track record of very weak operating performance over the last four fiscal years, exacerbated by staffing shortages and other pandemic-related challenges, which are stymying the system’s efforts towards an operational turnaround,” Fitch said.
Advocate Aurora Health is down $601M year to date as it gears up for Atrium Health megamerger
Following a tight first quarter, Advocate Aurora Health managed to grow its operating margin but still landed negative due to $400 million in investment losses during the quarter ended June 30, according to financial filings.
The 27-hospital nonprofit—which pending regulatory review slated to merge with Atrium Health in one of the year’s biggest hospital transactions—reported a $48.7 million operating income during its second fiscal quarter of 2022 (1.7% margin).
This is up from the $2.5 million (0.3% margin) it scraped out earlier this year but well below the $213.7 million (6.5% margin) of Q2 2021.
Revenues for the quarter increased 1.5% year over year to more than $3.5 billion. While patient service revenue and other revenue both grew by tens of millions, capitation revenue declined slightly due to a shift in overall membership mix and a 6.1% dip in capitated lives, the system wrote in its filing.
Discharge volumes fell 7.7% year over year during the most recent quarter, as did home care visits by 7.6%. The system saw increases compared to the previous year among its observation cases (11.6%), hospital outpatient visits (2.1%) and physician visits (7.1%).
Advocate Aurora’s expenses grew at a faster rate, at 6.7% year over year during the second quarter. The increase was led by a 10.2% jump in salaries, wages and benefits payouts, which the system said was fueled by a blend of higher nurse agency costs, higher merit and premium pay for clinical care and volume-driven demand for more full-time equivalent employees.
The nonprofit saw last year’s investment gains largely upended, recording a $400 million net loss during the quarter compared to the $571.6 million gain of the prior year’s equivalent quarter.
The shortfall dragged Advocate Aurora’s net income to a $347.6 million loss for the quarter. It had logged a $545.6 million gain the previous year.
Looking at six-month numbers, the health system reported $7.1 billion in total revenue and $7 billion in total expenses for an operating income of $51.2 million. Year-to-date investment losses landed at $666 million, bringing the organization to a $600.8 million net loss.
Advocate Aurora was formed in 2018 from the merger of nonprofits Advocate Health Care and Aurora Health Care. It treats 2.6 million unique patients, employs 75,000 people and logged just under $14.1 billion in total revenue across 2021 and a net income of more than $1.8 billion.
Should its merger plans go through, Advocate Aurora and Atrium Health would control 67 hospitals and $27 billion of combined revenues across six states. The deal is anticipated to close before the end of the year, according to the earnings filing.
The system’s latest numbers will come as no surprise in light of similar quarterly reports from Advocate Aurora’s nonprofit contemporaries.
Investment struggles and increased expenses were reported across the board, although not every major system was able to keep operations in the black. Mayo Clinic, Kaiser Permanente and UPMC were among those on the stronger side of the scale while Sutter Health, Mass General Brigham and Providence each reported tens to hundreds of millions in operational losses.
Fitch Ratings warned last week that these sector-wide challenges are unlikely to vanish during the remainder of the year. As such, the agency has downgraded its outlook for the nonprofit hospital industry from “neutral” to “deteriorating.”
Amazon Care is shutting down at the end of 2022. Here’s why
Three years after it began piloting a primary care service for its employees that blended telehealth and in-person medical services, Amazon plans to cease operations of its Amazon Care service.
Amazon announced Wednesday afternoon that it would end Amazon Care operations after December 31. In an email to Amazon Health Services employees, Neil Lindsay, senior vice president of Amazon Health Services, said Amazon Care wasn’t a sustainable, long-term solution for its enterprise customers.
Amazon provided a copy of the email to Fierce Healthcare.
The decision only impacts Amazon Care and Care Medical teams and not Amazon’s other healthcare services.
While operating Amazon Care, the company “gathered and listened to extensive feedback” from its enterprise customers and their employees and evolved the service to continuously improve the experience for customers.
“However, despite these efforts, we’ve determined that Amazon Care isn’t the right long-term solution for our enterprise customers, and have decided that we will no longer offer Amazon Care after December 31, 2022,” Lindsay wrote.
“This decision wasn’t made lightly and only became clear after many months of careful consideration. Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term,” he said.
The online retail company piloted virtual urgent care and primary care service with its employees and their families in the Seattle region in 2019.
Amazon Care has since expanded rapidly with telehealth services available in all 50 states and in-person services in at least seven cities, including Dallas, D.C. and Baltimore. As part of its ambitions in healthcare, Amazon then focused on ramping up partnerships with employers and signed on other companies as clients including Silicon Labs, TrueBlue, Whole Foods Market, Precor—a Washington-based fitness equipment company that was acquired by Peloton—and Hilton.
Some industry insiders have said that Amazon Care struggled to gain a foothold with employer clients.
The company was on track to rapidly expand its hybrid care model to more than 20 additional cities in 2022, including major metropolitan areas like San Francisco, Miami, Chicago and New York City.
CEO Andy Jassy has made health care a priority, naming Amazon Care as an example of “iterative innovation” in his first letter to shareholders earlier this year. In July, the company announced plans to buy concierge primary care provider One Medical in a deal valued at approximately $3.9 billion.
If the One Medical deal goes through, it would significantly expand Amazon’s foothold in the nearly $4 trillion healthcare market, specifically in the competitive primary care market.
One Medical markets itself as a membership-based, tech-integrated, consumer-focused primary care platform. The company operates 188 offices in 29 markets. At the end of March, One Medical had 767,000 members.
The deal also gives Amazon rapid access to the lucrative employer market as One Medical works with 8,000 companies.
The One Medical acquisition has not yet closed.
Lindsay said the company’s work building Amazon Care has deepened its understanding of “what’s needed long-term to deliver meaningful health care solutions for enterprise and individual customers.“
“I believe the health care space is ripe for reinvention, and our efforts to help improve the health care experience can have an immensely positive impact on our quality of life and health outcomes. However, none of these reasons make this decision any easier for the teams that have helped to build Amazon Care, or for the customers our Care team serves,” he wrote.
The decision to cease Amazon Care’s operations will likely mean some employees will be laid off. Lindsay said in his email to employees that many Amazon Care employees will have an opportunity to join other parts of the Health Services organization or other teams at Amazon. “Well also support employees looking for roles outside of the company,” he said.
How Medicare Advantage Enrollment Has Grown, Diversified in 10 Years
Medicare Advantage enrollment has grown in the last decade largely due to an influx of Black, Hispanic, and low-income beneficiaries, a research letter published in the JAMA Health Forum found.
Before 2011, Medicare Advantage health plans absorbed a greater share of Medicare enrollment because traditional Medicare enrollees were transitioning to Medicare Advantage plans. From 2011 to 2019, Medicare Advantage enrollment continued to increase but the source changed.
The researchers used the Master Beneficiary Summary File from 2011 to 2019 to inform their study of the source of Medicare Advantage enrollment during that timeframe. These files provided over 524.4 million person-years.
Medicare Advantage still drew enrollees from traditional Medicare from 2012 to 2019, with the share of those who came from Medicare Advantage growing from 65.9 percent to 71.1 percent.
The number of enrollees that were new to Medicare who chose Medicare Advantage coverage also grew. A little over 18 percent of enrollees who did not have Medicare coverage previously transitioned into Medicare Advantage in 2012. But by 2019, that share had swelled to 24.7 percent.
Beneficiaries who switched to Medicare Advantage from traditional Medicare tended to be older. Fewer of them identified as Hispanic individuals but more of them identified as Black individuals. Additionally, they were more likely to be dually eligible and more likely to have a disability. Finally, they were more likely to die within two years of enrolling in Medicare Advantage.
“Our study is limited in that it was not designed to examine these mechanisms,” the researchers acknowledged. “As MA continues to grow, understanding the reasons for switching from TM to MA will become more important.”
Although the study did not explicitly explore the causes behind these enrollment shifts, the researchers cited three factors that might contribute to the growth and diversity of the Medicare Advantage population.
First, they noted that Medicare Advantage plans offer supplemental benefits and dental and vision coverage, which traditional Medicare does not cover.
In 2022, more Medicare Advantage plans offered more supplemental benefits, including special supplemental benefits for the chronically ill (SSBCI), expanded supplemental benefits, and traditional supplemental benefits, according to a Better Medicare Alliance brief.
Second, Medicare Advantage plans offer lower out-of-pocket healthcare spending compared to traditional Medicare.
On average, Medicare Advantage beneficiaries spend nearly $2,000 less than traditional Medicare beneficiaries in out-of-pocket healthcare spending and premium costs, according to Better Medicare Alliance’s 2022 State of Medicare Advantage report.
Finally, Medicare Advantage might be more attractive due to the lower premiums.
In 2022, costs were particularly low since Medicare Advantage premiums dropped to the lowest level in 15 years, 10 percent lower than in 2021, the Better Medicare Alliance report shared.
The results corroborate separate studies that show that the Medicare Advantage population is growing and becoming more diverse.
In more than 100 congressional districts, Medicare Advantage coverage represents half or more of enrollment, according to Better Medicare Alliance research. Medicare Advantage coverage is particularly strong in Alabama, Michigan, and Florida.
As the Medicare Advantage population grows, it has also diversified, according to data from the Alliance of Community Health Plans (ACHP).
Medicare Advantage plans grew 60 percent from 2013 to 2020. By 2020, Medicare Advantage plans served 25 million seniors, of which six out of ten were women. Also, more than half of all Hispanic American seniors (52 percent), 49 percent of African American seniors, and 35 percent of Asian Americans selected Medicare Advantage plans for their coverage.
HENRY KOTULA 