COVID-19 cases are on the rise. Does it matter anymore?

Posted on by • Posted in Coronavirus, Coronavirus BA.2 variant, Coronavirus BA.2.12.1 variant, Coronavirus Delta Variant, Coronavirus Long-Term Complications, Coronavirus Mutation, Coronavirus Omicron Variant, Pandemic, Public Health, Public Inaction, Public Opinion, Public Perception, Vulnerable Populations • Leave a comment
COVID-19 cases are on the rise. Does it matter anymore?

COVID-19 cases have risen in the U.S. to around 100,000 per day, and the real number could be as much as five times that, given many go unreported.  

But the situation is far different from the early months of the pandemic. There are now vaccines and booster shots, and new treatments that dramatically cut the risk of the virus. So how much do cases alone still matter?

That question has prompted debate among experts, even as much of America goes on with their lives, despite the recent surge in cases.  

How much concern high case numbers alone should prompt is “the trillion-dollar question,” said Bob Wachter, chair of the department of medicine at the University of California-San Francisco.  

In the early days of the pandemic, dying of COVID-19 was a concern for him, but now, in an era of vaccines and treatments, “it doesn’t even cross my mind anymore,” he said.  

But he noted there are other risks, including long COVID-19: symptoms like fatigue or difficulty concentrating that can linger for months.  

“I think long COVID is pretty scary,” he said.  

While cases have risen to around 100,000 reported per day, deaths have stayed flat, a testament to the power of vaccines and booster shots in preventing severe illness, as well as the Pfizer treatment pills Paxlovid, which cut the risk of hospitalization or death by around 90 percent.  

Hospitalizations have risen, but only modestly, to around 27,000, one of the lowest points of the pandemic, according to a New York Times tracker.  

Cases have now been “partially decoupled” from causing hospitalizations and deaths, said Preeti Malani, an infectious disease expert at the University of Michigan, such that hospitals are no longer overwhelmed. 

“[Cases are] not without any consequence, but in terms of pressure on the health system, so far we’re not seeing that, which is really what drove all of this,” she said.  

The behavior of much of America reflects a lessened concern about the risk of being infected. Restaurants and bars are packed. Many people do not wear masks even on airplanes or on the subway.  

An Axios-Ipsos poll in May found just 36 percent of Americans said there was significant risk in returning to their “normal pre-coronavirus life.” 

In the Biden administration, health officials are still advising people to wear masks in areas the Centers for Disease Control and Prevention classifies as at “high” risk. But President Biden himself is talking about the virus far less than he did at the start of his administration, and is not making sustained calls for people to wear masks.  

White House COVID-19 response coordinator Ashish Jha touted progress in defanging cases on Thursday.  

“We see cases rising, nearly 100,000 cases a day, and yet we’re still seeing death numbers that are substantially, about 90 percent lower, than where they were when the president first took office,” he told reporters.  

Some experts are pushing back on the deemphasis of case numbers, saying they still matter.  

“The bunk that cases are not important is preposterous,” Eric Topol, professor of molecular medicine at Scripps Research, wrote last month. “They are infections that beget more cases, they beget Long Covid, they beget sickness, hospitalizations and deaths. They are also the underpinning of new variants.” 

Even if one does not get severely ill oneself, more cases mean more chances for the virus to spread on to someone who is more vulnerable, like the elderly or immunocompromised.  

While deaths are way down from their peak earlier in the pandemic, there are still around 300 people dying from the virus every day, a number that would have proved shocking in a pre-COVID-19 world.  

Leana Wen, a public health professor at George Washington University, recommended that people take a rapid test before visiting a more vulnerable person, as a safeguard that avoids more burdensome restrictions.  

“Cases alone do not tell the whole story,” she said, adding, “As a policy matter we need to stop using the same comparisons we were in 2020 and 2021.” 

There is still much that is unknown about long COVID-19, one of the biggest risks remaining for healthy, younger people who are vaccinated.  

A recent article in the Journal of the American Medical Association estimated 10 percent to 30 percent of COVID-19 infections result in long COVID-19 symptoms, but there is no precise estimate. 

Experts also urge people who have not gotten their booster shots, or not been vaccinated at all, to do so, given that many are more vulnerable to the virus if they are not up-to-date on their shots.  

A new variant also always holds the risk of upending the current risk-benefit calculations. The virus has continued to evolve to spread more easily, and a future mutation could cause more severe illness or more greatly evade vaccines.  

Pfizer and Moderna are working on updated vaccines to better target the omicron variant, but the Biden administration warns it will not have enough money to purchase those new vaccines for all Americans this fall unless Congress provides more funding. The funding request has been stalled for months, though, itself a sign of the reduced sense of urgency around the virus fight. 

At least for now, though, while many people are getting COVID-19, fewer are getting extremely sick.  

“It’s a very risky time if you don’t want to get COVID [at all],” Wachter said. “But a relatively less risky time if your goal is to not get severe COVID or die.” 

How other industry players are expanding their healthcare platforms  

Posted on by • Posted in Access, Accessible Care, Care Ecosystem, Care Supplier, Consumer Engagement, Consumer Loyalty, Consumer Needs, Consumer Preferences, Consumer-Centric, Consumerism, Healthcare Platform, Managing Health Spending, Managing the Total Cost of Care, Platform of Choice, Population Management Platform, Population Manager, Premium Owner, Promote Health, Strategic High Ground, Strategy, Strategy Framework, Value Creation, Value Proposition, Value-Based Healthcare • Leave a comment

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Last week, we introduced our framework for value delivery as a “healthcare platform”, in which an organization’s proximity to both the consumer and to the premium dollar determines how it competes as a “care supplier,” a “care ecosystem,” a “premium owner,” or a “population manager.” Traditionally, different healthcare companies have operated primarily in one of these four domains. However, as shown in the graphic below, we’ve recently seen many shift their business into one or more additional quadrants, as they seek to expand their value propositions. UnitedHealth Group is an obvious example: it has moved well beyond the traditional insurance business, via numerous provider and care delivery acquisitions across the continuum.

Other players have shifted from their own “pure play” positions toward more comprehensive “platform” strategies as well: One Medical adding Iora Health to enhance population health capabilities; Walmart moving beyond retail and pharmacy services, partnering with Oak Street Health to expand its ability to manage Medicare patients; Amazon getting into the employer health business. 

There’s a clear pattern emerging—value propositions are converging on a “strategic high ground” that encompasses all four dimensions of platform value, creating a comprehensive set of solutions to deliver accessible care, promote health, and grow consumer loyalty, with an aligned financial model centered on managing the total cost of care. Health systems looking to build platform strategies will find many of these competitors also vying for pride of place as the “platform of choice” for healthcare consumers and purchasers.

Eyeing a rebound in emergency department volumes

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This week we heard from three healthcare executives that they’ve seen a recent uptick in emergency department (ED) volumes. As we’ve discussed before, ED visits plummeted at the beginning of the pandemic, and were the slowest class of care volume to rebound. Over the past year, many systems reported that ED volume had remained persistently stuck at 10 to 15 percent lower than pre-COVID levels, leading us to question whether there had been a secular shift in patient demand, with consumers choosing alternative options like telemedicine or urgent care as a first stop for minor acute care needs. 
 
An uptick in ED volume would be welcome news to many hospital executives, as the emergency department is the source of half or more of inpatient admissions for many hospitals. But according to what we’re hearing, the recent rise in emergency department patient volume has not resulted in an expected bump in inpatient volume.

“We’ve dug into it, and it seems like the jump in ED visits is a function of COVID,” one leader shared. “There’s just so much COVID out there now…even though the disease is milder, there are still a lot of patients coming to the ED. But unlike last year, most aren’t sick enough to be admitted.”

And ED visits for other causes have not rebounded in the same way: “We’re hoping patients aren’t still staying away because they’re afraid of catching the virus.” We’ll be watching closely across the summer to see how volumes trend as the pandemic waxes and wanes across the country—we’d still bet that many consumers have changed their thinking on where and how they will seek care when the need arises.   

Surprise billing ban leads to cuts at PE-backed staffing firms

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 When Congress passed the “No Surprises Act” in 2021, credit rating agencies like Moody’s warned that the bill would hurt physician staffing firms, especially those that provide emergency department (ED) services, which result in a surprise bill in roughly one in five visits. A piece from investigative outlet The Lever highlights how one private equity-backed physician staffing firm, Nashville-based American Physician Partners, is responding to the resultant cash flow challenges by cutting ED physician pay, after already reducing staffing levels. As the article describes, this is possible in an otherwise tight labor market because, unlike many other specialties, there’s an oversupply of ED physicians, due to the rapid growth in emergency medicine residency programs over the last decade.  

The Gist: With two-thirds of hospitals outsourcing at least some ED physician labor, the potential insolvency of large physician staffing firms could bring a crisis in access and coverage. 

In addition to revenue cuts tied to the surprise billing ban, rising interest rates also mean that PE firms may soon find it more difficult to fund their aggressive growth strategies. 

Health systems should proactively evaluate their partnerships with PE-backed physician staffing groups, with an eye toward anticipating potential staffing problems and service quality shortfalls.

Steward Health Care sells its Medicare value-based care business to CareMax

Posted on by • Posted in Accountable Care Organization (ACO), Health System, Hospital Industry, Management Service Organization (MSO), Market Consolidation, Market Trends, Medicare Advantage, Medicare Risk, Mergers & Acquisitions, Outsourced Care Management, Outsourced Patient Engagement Functions, Private Equity, Value-Based Care Functions, Value-Based Healthcare • Leave a comment

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The for-profit, 39-hospital Steward system manages 171K lives across the Medicare Advantage, Medicare shared savings, and Medicare direct contracting programs. This deal will allow Miami-based CareMax, a publicly-traded, value-based care company with 42 senior centers (mostly in Florida) and 34K lives under management, to expand across Steward’s footprint, which includes Texas and Arizona, states with rapidly growing Medicare populations.

The Gist: This deal is an example of the rise of venture-funded MSO (medical services organization) services that aim to subsume and scale value-based care functions from hospitals and medical groups. Steward wagers it can find greater success in managing risk in partnership with CareMax, moving a greater share of its Medicare population into risk, and outsourcing care management and patient engagement functions.

Many health systems have spent substantial resources building out accountable care organizations and risk-based Medicare businesses over the last decade. While selling these assets to a company like CareMax may be one way to generate a return, particularly for those frustrated by lower-than-anticipated gains from moving to value-based care, it also requires relinquishing control of functions likely central to the future health system business model.

CVS Health to launch a virtual-first primary care platform

Posted on by • Posted in Chronic Condition Management, Competition, Consumer Care Consumption Patterns, Consumer Engagement, Consumer Needs, Consumer Preferences, Consumer-Centered Care Pathway, Consumer-Centric, Coordinated Care, Digital Access, Digital Channels, Digital Health, Disruption, Disruptive Technology, Integrated Delivery System, Medication Management, Mental Health, On Demand Care, Primary Care, Primary Care Delivery Model, Primary Care Strategy, Virtual Care Strategy, Virtual Healthcare, Virtual Visit, Virtual-First Care Platform • Leave a comment

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The digital platform is designed to provide consumers with a coordinated healthcare experience across care settings. It’s being sold to Aetna’s fully insured and self-insured plan sponsors, as well as CVS Caremark clients, and is due to go live next year. According to CVS Health, the new offering “enables consumers to choose care when and where they want,” whether that’s virtually, in a retail setting (including at a MinuteClinic or HealthHUB), or through at-home services.

Patients will have access to primary care, on-demand care, medication management, chronic condition management, and mental health services, as well as help in identifying other in-network care providers. 

The Gist: CVS Health has been working to integrate its retail clinics, care delivery assets, and health insurance business. This new virtual-first care platform is aimed at coordinating care and experience across the portfolio, and streamlining how individuals access the range of services available to them.

CVS is not alone in focusing here: UnitedHealth Group, Cigna, and others have announced virtual-first health plans with a similar value proposition. Any payer or provider who aims to own the consumer relationship must field a similar digital care platform that streamlines and coordinates service offerings, lest they find themselves in a market where many patients turn first to CVS and other disruptors for their care needs. 

Former patient kills his surgeon and three others at a Tulsa hospital

Posted on by • Posted in Employee Safety, Gun Control, Gun Related Deaths, Gun Violence, Health System, Hospital, Hospital Industry, Leadership, Leadership Cares, Leadership Commitment, Leadership Culture, Leadership Values, Leadership Will, Patient Safety • Leave a comment

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On Wednesday afternoon, an aggrieved patient shot and killed four people, including his orthopedic surgeon and another doctor, at a Saint Francis Hospital outpatient clinic, before killing himself. The gunman, who blamed his surgeon for ongoing pain after a recent back surgery, reportedly purchased his AR-15-style rifle only hours before the mass shooting, which also injured 10 others. The same day as this horrific attack, an inmate receiving care at Miami Valley Hospital in Dayton, OH shot and killed a security guard, and then himself.

The Gist: On the heels of the horrendous mass shootings in Buffalo and Uvalde, we find ourselves grappling with yet more senseless gun violence. Last week, we called on health system leaders to play a greater role in calling for gun law reforms. This week’s events show they must also ensure that their providers, team members, and patients are safe. 

Of course, that’s a tall order, as hospital campuses are open for public access, and strive to be convenient and welcoming to patients. Most health systems already staff armed security guards or police officers, have a limited number of unlocked entrances, and provide active shooter training for staff.

This week’s events remind us that our healthcare workers are not just on the front lines of dealing with the horrific outcomes of gun violence, but may find themselves in the crosshairs—adding to already rising levels of workplace violence sparked by the pandemic.

Something must change.

COVID-fatigued health workers are mobilizing

Posted on by • Posted in Collective Bargaining, Employee Complaint, Employee Satisfaction, Employee Staffing, Employee Staffing Shortage, Health Policy, Health System, Hospital, Hospital Industry, Labor Activism, Labor Organizing, Labor Union, Nurse Staffing Ratios • Leave a comment

https://www.axios.com/2022/06/02/health-care-workers-unions-covid-fatigue

Health care workers nationwide are organizing and pushing for workplace changes like better pay or more favorable staffing ratios after waves of pandemic-fueled burnout and frustration.

Why it matters: COVID-19 and its aftereffects triggered an exodus of health care workers. Those who stayed are demanding more from health systems that claim to be reaching their own breaking points.

  • “The pandemic exacerbated a crisis that was already there,” Michelle Boyle, a Pittsburgh nurse told Axios. “It went from being a crisis to being a catastrophic freefall in staffing.”

Driving the news: About 1,400 resident physicians in public Los Angeles County hospitals have authorized a strike if their demands for pay parity with other local facilities aren’t met in contract negotiations this week.

  • Nurses demonstrated across Pennsylvania in early May, protesting one state lawmaker’s inaction on legislation that would have set nurse-to-patient ratios.
  • A fight is brewing in Minnesota as contracts covering 15,000 nurses in several hospital systems are expiring.
  • Some 2,000 resident physicians and interns at Stanford University and the University of Vermont Medical Center joined an affiliate of the SEIU for medical workers that claims more than 20,000 members nationwide.
  • In North Carolina, where union membership is low, staff at Mission Health in Asheville voted to unionize largely over staffing concerns.

Less than half of the of nearly 12,000 nurses polled by the American Nurses Association last year believe their employer cares about their concerns, and 52% of those surveyed said they intend to leave their jobs or are considering doing so.

The other side: Hospital operators generally oppose unionization efforts, as well as mandated staffing ratios.

  • “The last thing we need is requirements set by somebody in Washington as to exactly how many nurses ought to be providing service at any given time,” said Chip Kahn, CEO of the Federation of American Hospitals. “That ought to be a local decision based on the need in the hospital at the time.”
  • The American Organization for Nursing Leadership, an affiliate of the American Hospital Association, also opposes staffing ratios.
  • The industry says decisions on staffing and workplace rules are best left to local executives who need to be flexible to meet shifting demand for care.
  • “You’re basically taking away the flexibility of those on the scene to determine what it takes to provide the needed patient care,” Kahn said.

Go deeper: The pandemic drove up labor costs significantly for hospitals that were forced to pay travel nurses to fill workforce gaps during COVID surges.

  • April marked the fourth month in a row this year that major hospitals and health care systems reported negative margins, a Kaufman Hall report found. And executives say things could worsen amid inflation and stubborn supply chain woes.

And yet, some big hospital chains like Tenet reported strong earnings in the first quarter.

Between the lines: California is the only state to have set staffing ratios for nurses, but hospital unions in other states have fought for similar requirements in their contracts.

  • In California, every nurse on a general hospital floor has no more than five patients to care for at a time; nurses in ICUs should care for no more than two patients.
  • Nurses want look-alike standards in states like Pennsylvania, where only some hospitals have staffing ratios, saying short-staffing threatens patients’ well-being.

What we’re watching: While many legislative proposals failed this year, unions representing health care workers say their message is getting across.

  • Unions in Illinois, Pennsylvania and Washington state are redoubling efforts for staffing ratio legislation modeled on California’s.
  • In New York, nurses passed a law that took effect in January mandating staffing committees at hospitals.

The bottom line: The labor tension is a sobering coda to a health crisis that’s stretched health systems and workers alike in unprecedented ways.

“What you’re seeing is nurses finally saying enough is enough and this system is broken and we need it to be fixed,” said Denelle Korin, a nurse alliance coordinator with Nurses of Pennsylvania.

Cleveland Clinic reports $282M quarterly loss

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Cleveland Clinic ended the first three months of this year with higher revenue, but rising expenses offset those gains, according to financial documents released May 26. 

The health system’s revenue climbed to $3.03 billion in the first quarter of this year, which ended March 31, up from $2.81 billion in the same period of 2021. The system’s net patient service revenue increased from $2.53 billion in the first quarter of 2021 to $2.73 billion in the same period this year. 

“Operating revenues in the first quarter of 2022 were impacted by lower patients served, partially due to the postponement of nonessential surgeries and procedures during the month of January,” the system said in an earnings release. 

In the first quarter of this year, Cleveland Clinic facilities had 57,864 inpatient admissions and 61,103 surgical cases. In the same period a year earlier, the system reported 60,338 inpatient admissions and 63,051 surgical cases. 

Cleveland Clinic reported expenses of $2.96 billion in the first quarter of this year, up from $2.56 billion in the same quarter of 2021. The system saw expenses rise across all categories, including supplies and salaries, wages and benefits. 

The hospital system ended the first quarter of 2022 with an operating loss of $104.5 million, compared to operating income of $61.7 million in the same period of 2021. 

Cleveland Clinic posted a net loss of $282.46 million in the first quarter of this year, compared to net income of $350.26 million in the same period a year earlier.

Early pandemic loans adding to hospital financial woes

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The bill is coming due for federal loans given to hospitals early in the COVID-19 pandemic, adding to their financial woes, Oregon Public Broadcasting reported May 28. 

The Medicare Accelerated and Advance Payment program offered hospitals short-term interest- free loans, according to the report. These loans are coming due as hospitals’ costs are rising quickly and revenue from patient stays and surgeries is growing more slowly. 

The idea behind the program was that hospitals would be able to pay back the advance once the pandemic passed and operations returned to normal, according to the report. Hospitals are still dealing with the effects of the pandemic, but the federal government wants to recoup the money to keep Medicare funded.  

In March 2021, HHS began recovering those cash advances by paying hospitals 25 percent less for Medicare reimbursement claims, according to the report. Earlier this year, HHS began paying hospitals 50 percent less for reimbursement claims. 

Hospitals lobbied for the loans to be forgiven, but were unsuccessful, according to the report.