Cartoon – Urgent Memo to All Employees
Cartoon – Importance of Employee Appreciation
Cartoon – Covid Morale Booster
Cartoon – Pandemic Employee Incentives
COVID care as a model for care redesign
https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8
We got an update from the chief medical information officer of one of our member systems about their ongoing progress in expanding telemedicine. Their rate of virtual visits peaked in late April, accounting for over half of all physician encounters. But like most systems, they’ve seen telemedicine visits drop to less than 20 percent of all appointments as physician offices have reopened.
In thinking about how the system will move telemedicine forward, she said, “We’re trying to be intentional and really design a top-notch consumer experience, with quality as the foundation.” They are going specialty-by-specialty, condition-by-condition, to redesign care pathways to optimally blend virtual and in-person care. It’s daunting, but she believes COVID-19 provided a model for how to do this quickly and effectively.
In just a few weeks, many systems stood up COVID management programs in the following way: algorithm-driven, online symptom triage triggers a virtual visit with a doctor. Testing is conducted at new, dedicated locations, to keep doctors’ offices as COVID-free as possible. Patients with concerning symptoms are monitored at home with pulse oximetry and regular check-ins; the same resources are used to ensure discharged patients are recovering well.
It’s the perfect example of how to design a safe, consumer-centered care pathway, using the whole of a health system’s resources. Now the challenge facing doctors and hospitals is: can this process be scaled across the hundreds of conditions that could benefit from a blend of virtual and traditional care?
“We’ve jumped past burnout to anger”
https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8
Last week we wrote about an observation from some physician leaders that, paradoxically, physician burnout seemed to have waned a bit during the COVID crisis. They felt that, as clinicians rallied to provide care for patients during the pandemic, many found new purpose in the work, despite great challenges. Bureaucratic hurdles yielded to the need to make critical decisions quickly, as did regulatory barriers to telemedicine.
The piece sparked a number of doctors, most from regions now experiencing surges, to share their alternative viewpoints with us.
One employed physician wrote that, across specialties, he and his colleagues are angry. They don’t feel protected, either financially, or even for their own physical safety.
A nurse practitioner working long shifts in an emergency department overloaded with COVID patients wrote, “In April, I would have never believed that we would be scrounging for PPE at the end of July. How could this happen?” And a nephrologist redeployed to a COVID ICU shared: “With the surge in New York, it felt like the entire country was behind their doctors and nurses. I drive home past restaurants and stores filled with people refusing to wear masks. It’s so demoralizing.”
Several expressed that their employers, both health systems and payers, are “counting on our goodwill that we’ll just keep showing up.” But once the crisis passes, there may be “drastic and irrational physician revolts. Someone should be watching for it.”
These comments reveal a marked difference in physician sentiment in different parts of the country, based both on the severity of the pandemic, and the nature of the local response. Regardless, we’d agree that the clinical workforce, both doctors and nurses, is working through a period of unprecedented stress, and for some, emotional trauma. Ensuring their stability and safety must be a top priority for every health system and medical group.
Increasing unemployment alters national payer mix
https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8
One in every five workers is now collecting unemployment benefits as the country struggles to get the COVID-19 outbreak under control. A recent Families USA study estimates a quarter of the 21.9M workers that were furloughed or laid off between February and May lost their health insurance. And the payer mix will continue to change as the pandemic wears on.
The graphic below highlights a study from consultancy Oliver Wyman, looking at the impact of rising unemployment (at 15, 20 and 30 percent) on insurance coverage. With each five to ten percent rise in unemployment, the commercially insured population decreases by three to five percent. Those who lose employer-sponsored insurance either remain uninsured, buy coverage on the Obamacare marketplaces, or qualify for Medicaid.
Surprisingly, Washington State and California are reporting little to no enrollment growth in Medicaid programs thus far. Experts point to lack of outreach and consumer awareness as key contributors to the slow growth—but Medicaid enrollment will likely begin to rise quickly in coming months as temporary furloughs convert to more permanent layoffs.
The right side of the graphic spotlights the growing number of uninsured individuals in those states with the highest uninsured rates. The previous record for the largest increase in uninsured adults was between 2008 and 2009, when nearly 4M lost coverage. The current pandemic-driven increase has crushed that record by 39 percent.
On average, states are seeing uninsured populations increase by two percent, with some as high as five percent. And the two states with the highest uninsured rates, Florida and Texas, are also dealing with the largest surge in COVID-19 cases and deaths. The ranks of the uninsured will continue to climb as states reimpose shutdowns, government assistance ends, and layoffs grow.
Grim statistics mount in the battle with COVID
https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8
It was a week of unhappy milestones in the nation’s battle with the coronavirus. On Thursday, the US crossed the threshold of 4M confirmed COVID cases, just 15 days after it hit the 3M cases mark. That’s three times as fast as it took to go from 2M to 3M cases, with daily new case counts now hovering near 70,000.
As the virus proliferates across the country, California has now overtaken New York as the epicenter of the outbreak, with more than 422,000 total cases reported since the beginning of the pandemic, versus New York’s 413,000.
Of greater concern, the daily US death toll from COVID stayed stubbornly above 1,000 for most of the week, the highest it’s been since late May. More Americans are currently hospitalized with COVID than at any time since the middle of April, with the Gulf Coast states showing some of the highest per-capita hospitalization rates in the country. For good reason, Secretary of Health and Human Services (HHS) Alex Azar officially renewed the Trump administration’s declaration of a public health emergency for another 90 days, clearing the way for the nation’s hospitals to receive more emergency financial assistance in battling the virus, and for continued relaxation of regulations that have allowed them to provide care virtually, and in non-traditional settings.
Meanwhile, as part of its Operation Warp Speed initiative to accelerate the development of a COVID vaccine, the Trump administration inked a $1.95B deal with pharmaceutical firm Pfizer and a German biotech company, BioNTech, to purchase 100M doses of the vaccine those companies are developing, with an option to buy an additional 500M doses. That’s in addition to contracts already in place to purchase 100M doses of a vaccine from Novavax, and 300M doses from AstraZeneca.
Americans would have free access to the Pfizer vaccine under the new arrangement, with the government subsidizing the entire cost of each dose, estimated to be about $19.50. Similar deals struck by the British government with AstraZeneca and GlaxoSmithKline carry a much lower per dose price tag—between $4 and $10—raising concerns of “profiteering” by pharmaceutical companies in the US vaccine hunt.
The forward purchasing of millions of doses, coupled with rapid progress on vaccine development (at least 25 of the 150 potential vaccines being developed are already in human trials), raises hopes that help is on the way in our battle with the virus. On Friday, however, top White House science advisor Dr. Anthony Fauci said that he doesn’t expect a vaccine to be “widely available” to the American public until the second half of next year. Until then, our hand-to-hand combat with the virus—using non-pharmaceutical interventions such as mask wearing, social distancing, hand hygiene, testing, and contact tracing—must intensify, particularly in light of increasingly worrisome data on the spread and impact of the disease.
US coronavirus update: 4.0M cases; 144K deaths; 48.8M tests conducted.
Photo of COVID-19 victim in Indonesia sparks fascination—and denial
https://www.nationalgeographic.com/photography/2020/07/covid-victim-photograph-sparks-fascination-and-denial-indonesia/?cmpid=org=ngp::mc=crm-email::src=ngp::cmp=editorial::add=SpecialEdition_20200724&rid=C1D3D2601560EDF454552B245D039020
Coronavirus victim wrapped in plastic shows what many didn’t want the populace to see.
Photojournalist Joshua Irwandi shadowed hospital workers in Indonesia, taking a striking image of a plastic-wrapped body of a COVID-19 victim while making sure not to reveal distinguishing characteristics, or even gender.
The image, taken for Nat Geo as part of a National Geographic Society grant, struck a chord in the nation of 270 million people. Indonesia had been slow to fight the global pandemic, with President Joko “Jokowi” Widodo touting an unproven herbal remedy in March. Some of the reactions to Irwandi’s image, which humanized the suffering from the virus, have been hostile.
Irwandi’s photograph has been displayed on television news and shared by the spokesperson for the nation’s coronavirus response team. The image was widely screen-grabbed and republished without Irwandi’s consent by Indonesian media. More than 340,000 people have “liked” the image on his Instagram page, which he posted after the Nat Geo story published on July 14. More than 1 million people also liked it in its first few hours on Nat Geo’s Instagram.
“It’s clear that the power of this image has galvanized discussion about coronavirus,” Irwandi said from his home in Indonesia. “We have to recognize the sacrifice, and the risk, that the doctors and nurses are making.”
There’s no question the photograph broke through, agreed Fred Ritchin, dean emeritus of the International Center of Photography: “Here we have a mummified person. It makes you look at it, feel terror.”
At the same time, there is distance, Ritchin said. “To me, the image was of someone being thrown out, discarded, wrapped in cellophane, sprayed with disinfectant, mummified, dehumanized, othered … It makes sense in a way. People have othered people with the virus because they don’t want to be anywhere near the virus.”
After Irwandi posted the photograph, a popular singer with a massive following accused the photographer of fabricating the news, said COVID-19 wasn’t so dangerous, and opined that a photojournalist shouldn’t be allowed to take a photograph in a hospital if the family could not see the victim. The singer’s followers erroneously charged Irwandi with setting up the photo with a mannequin, and called him “a slave” of the World Health Organization. The 28-year-old photographer’s ethics were questioned by the government this week, which also suggested the name of the hospital, which was not disclosed in the photograph, should be revealed, CNN Indonesia reported.
”Details of my private life have been published without my permission,“ Irwandi said. ”We’ve gone really astray from the photojournalistic intent of my photograph.“
However, he has gotten support from the nation’s association of photojournalists. They countered that the image met journalistic standards—and demanded the singer apologize, which he subsequently did.
Irwandi says some government officials have said the nation should take COVID-19 more seriously. As of Tuesday, the Johns Hopkins University Coronavirus Tracker had reported 4,320 COVID-19 deaths and 89,869 cases from Indonesia, although the count is believed to be vastly underreported. Many people aren’t practicing social distancing, and hordes have not been wearing masks. Large-scale social restrictions began fading last month.
His hope is that the image encourages Indonesians to take precautions—and save lives. He cited a challenge to photojournalists given in May by Harvard professor Sarah Elizabeth Lewis: to move beyond statistics and show how COVID-19 is affecting people. Other photographers, such as Lynsey Addario, have been motivated to do the same thing. (Addario also has been supported by a National Geographic Society fund for COVID-19 reporting.)
So, what are Irwandi’s next steps?
He paused a moment.
“I think I’m going to stay low for a time,” he said.
America has to be ready for mail voting to avert an election crisis
America has to be ready for mail voting to avert an election crisis
Valid concerns have been raised about mail voting. In New York, the local election boards have taken weeks to count primary ballots received in the mail as a result of the coronavirus, leaving several races for Congress still unresolved. The problems have been blamed on the late decision to send out the absentee ballot applications, outdated ballot counting machines, and the sheer number of mail ballots. The New York case raises a serious alarm with the 2020 election approaching and many states considering more reliance on mail voting in the midst of the pandemic.
Adding to this sense of urgency, President Trump has declared, without evidence, that mail voting is an open invitation to fraud and will be used unfairly against him this fall. He has tweeted that mail voting would make this the “most rigged” election in history. Setting aside the fact that states have relied on absentee and mail voting to hold secure elections for many years, the stumbles in New York and the irresponsible fear mongering by Trump raise the potential of a very real crisis come this fall.
Consider the national disruption surrounding the 2000 election, which was decided for George Bush after a recount in Florida, a month of legal battles, and a controversial split Supreme Court decision. After you add the factor of a second wave of coronavirus cases in the fall and a sitting president shouting “rigged!” to the rafters, and you can understand why some analysts worry that the period following the 2020 election may be one of the most disruptive contests in our modern history.
A crisis foretold, however, can be a crisis averted. Instead of wringing our hands over the recent problems with mail voting in New York, we have to learn from them and from the multiple states that have implemented mail voting systems without problems or fraud. Then states can make common sense preparations to ensure the process goes as quickly and smoothly as possible to prevent a potential election crisis in November.
The fact that election boards were overwhelmed by an influx of absentee ballots in New York must be the rallying cry for dedicating more resources to efficiently implement mail voting systems. Reducing funds available for mail voting initiatives, as some Trump supporters have advocated, in this era when many people have to rely on these ballots or literally risk death, will only serve to suppress voting, which may be the point.
Consider the case of Ohio for a glimpse of what a proactive mail voting initiative looks like. At the urging of Governor Mike DeWine, Republican and Democratic lawmakers unanimously approved their all mail voting primary that was successfully concluded in April. Governors and state legislatures across the country have to learn from Ohio, and additional federal funds have to be made available to assist the efforts.
All those claims that mail ballots are subject to rampant tampering is not evidence that they are, and it suggests the need to educate voters on the issue. Members of the Armed Forces have relied on absentee voting with mail ballots since the Civil War. Trump himself has voted absentee by mail. Meanwhile, three states allow ounties to conduct elections completely by mail if they choose, five other states conduct elections almost entirely by mail, and more than two dozen other states permit their residents to cast absentee ballots by mail without having to provide a reason.
Over 250 million votes have been cast using mailed ballots since 2000, according to the Vote at Home Institute, and yet exhaustive analysis has identified only a tiny fraction of cases of fraud. None of those states that hold their elections almost entirely by mail has seen voter fraud scandals. The bipartisan group Vote Safe, chaired by former Governor Tom Ridge of Pennsylvania and former Governor Jennifer Granholm of Michigan, notes that several studies have consistently proven that mail ballots are secure and do not advantage one political party over the other. The team rightly emphasizes that the goal of ensuring the safety of voters as they exercise their rights during a raging pandemic is not a partisan issue.
Whether we improve our voting systems or defund them, the use of mail ballots will inevitably be much greater in the 2020 election than in years past. We can prepare for this eventuality and find innovative ways to deal with the challenges that arise, or we can shift our gaze from another crisis foretold and suffer the major consequences come November.
Winston Churchill noted that democracy is the worst form of government, except for all other forms that have been tried. In the midst of a pandemic across the country that has already claimed the lives of tens of thousands of Americans, exercising our right to vote by mail instead of in person may also seem like the worst solution, except for all other options.
HENRY KOTULA 