Is Gun Violence a Public Health Issue?

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Gun Violence, Health Policy, Public Good, Public Health, Public Safety • 1 Comment

https://mailchi.mp/burroughshealthcare/february-8-1687741?e=7d3f834d2f

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The United States population is 327 million and there are 393 million guns in this country. The issue of guns and gun control remains one of the nation’s most divisive.

As the Los Angeles Times explains in a recent editorial, “to truly address gun violence, we need to view it through a public health lens — one that reframes the issue as a preventable disease that can be cured with the help of all community members.”

The American Public Health Association (APHA) shared recently that the U.S. has the dubious distinction of “outpacing” any other country with a gun violence burden. Highly publicized statistics vary from source to source, but they do bear repeating, beginning with the fact that:

  • 82 percent of all firearm deaths in nearly two dozen populous, high-income countries—

including Australia, France, Italy, Spain and the United Kingdom — occur in the U.S.

  • 91 percent of children ages 0-14 killed by firearms in this group of nations were from the U.S.

The Gun Violence Archive stays up to date on this year’s sobering victim numbers, already standing at:

Total incidents:         36,390
Deaths:                       9,578
Injuries:                       19,102
Mass shooting:               268

Ways but No Will

Having dedicated himself to the science of gun violence, health policy professor David Hemenway, Ph.D., of the Harvard T. H. Chan School of Public Health says we’re all watching too much media where “guns are the solution to so many problems. The good guy with the gun is the big hero.”

In real life, guns are not solutions to problems. The myth is imposed early and continues to be perpetuated. Children are exposed to 90 percent of movies, 68 percent of video games and 60 percent of shows that include violence, Common Sense Media said six years ago. Current numbers are surely much higher.

Dr. Hemenway also balks at the old “we’ll be able to protect ourselves when that intruder comes into our space” argument. It takes lots of training, repetition and practicing, over and over, to do the right thing right, he says, and most don’t have time or resources to get that — right.

Although the United States is an international mega-power, it as much to learn, Dr. Hemenway says, noting that “every other country has shown us the way to vastly reduce our problems.” That means if other countries can get control of gun reasonability — as New Zealand did in a hurry following its first mass shooting — we can, too.

Repeated surveys of Americans say they favor universal background checks. As recent history has shown, whether or not that will come to fruition still remains unanswered.

Prevent Rather Than Repair

The idea of “community” as it relates to “public” means motivating responsible gun owners, says Dr. Hemenway, citing his colleague Cathy Barber, M.P.A., at T.H. Chan’s Means Matter campaign. She collaborates on a number of pertinent issues with gun owners, advocates and trainers, as well as gun shop owners.

Dr. Hemenway’s must-do list includes licensing of gun owners and all that entails, including strong background checks, and only allowing firearm sales to a licensed owner. He also recommends a federal agency to oversee the massive gun issue — a heretofore novel and yet seemingly sound idea.

The medical community has taken its stand on the public health effects of gun violence after frequently describing for the rest of us in riveting detail what it’s like to treat victims of shootings. Formally, members have established the nonprofit American Foundation for Firearm Injury Reduction in medicine (AFFIRM), with more than 40,000 healthcare colleagues.

The group seeks to inform medical protocols for their peers on the frontlines of gun violence, and to engage other first responders and stakeholders, as well as to educate and inform the public. They say they’d rather prevent than repair, and they worry about a culture of indifference and acceptance — of normalization that leads to divisiveness in this nation.

Meeting of the Minds Needed

It’s tough to solve a problem if stakeholders can’t come together to share ideas and solutions, the kind of proactive collaboration that provided results and conclusions around seat belts and smoking.

So why doesn’t the federal government jump headlong into gun violence research, specifically the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH)? The Dickey Amendment came to fruition in the early 1990s when gun violence did become a public health issue.

The National Rifle Association (NRA) said then that the CDC was biased against guns, and attracted Congressional support that basically eliminated any funding “to advocate or promote gun control”: That meant no studies related to firearms, and in 2011, the amendment reached to the NIH. After the Sandy Hook school shooting, President Obama told the CDC that the Dickey Amendment shouldn’t completely ignore funding for gun violence research, but Congress stopped it nonetheless. Currently, the amendment isn’t really in effect but there’s still no funding.

To that end, early this year, Rep. Carolyn Maloney (D-NY) introduced H.R. 674 and Sen. Edward Markey (D-MA) introduced S.184, the Gun Violence Prevention Research Act of 2019, which was referred to the Subcommittee on Health, where it’s been languishing. It would provide CDC funding to study gun violence for the next five fiscal years.

Random Attacks Are Few
 
If the United States is unable to tackle more research into gun violence, that hasn’t stopped smaller, independent studies, like one from the state of Utah. It published a report in 2018 with the T.H. Chan School, looking at suicide and firearm injury. It was supported by both parties, and by gun rights champions.

The results showed that 87 percent of those who died by suicide could have passed a background check and that Utahns with mental health or drinking issues weren’t properly storing or locking up guns. The most surprising fact: Those random attacks that people are warned about as reasons to carry guns occurred only three or four times a year.

So with all we know and all that’s yet to be known if more scientific research is conducted, the following have been suggested as remedies to the gun violence epidemic. The solutions run the gamut from more basic to creative:

  • Universal background checks
  • An assault weapons ban, along with a ban on high-capacity magazines
  • Mandatory license needed to buy a gun
  • Mandatory gun registration
  • Mandatory training for owners
  • Waiting periods for firearm purchase
  • More taxes on gun manufacturers
  • Safe and secure gun storage
  • No sales to anyone on a terrorist watch list
  • No sales to anyone convicted of a felony
  • Red-flag law: Families can ask a judge to temporarily prohibit an individual from possessing a firearm if those parties believe that individual might commit violence.

Also mentioned as possible solutions:

  • The federal government could buy the domestic handgun manufacturing industry.
  • It could ban the import of all handguns.
  • It could offer cash buybacks for all handguns in circulation.
  • A person buying a gun would have to enlist for military reserve service.

Scientific American sees it this way, opining that we just don’t know enough about gun violence perpetrators and we should.

Did they get firearms legally, or how did they get them?

Are our current laws being used to disarm dangerous people?

What do we do about the proliferation of underground gun markets?

How can we better evaluate violence prevention policies and programs, as in “Do they work?”
 
As the editorial board notes, research doesn’t infringe on Second Amendment rights, but it does support those other, unalienable rights we are all due, thanks to the Declaration of Independence. Don’t forget “Life, Liberty and the pursuit of Happiness.”

NorthBay Medical Center in Solano County to open $225 million expansion

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https://www.dotmed.com/news/story/48531?s=newsreg

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NorthBay Healthcare is set to unveil its five-year, three-phase $225 million expansion and rehab of the NorthBay Medical Center.

The 77,000-square-foot North Wing level II trauma center, located in Fairfield, California, will be open for business in October, according to the North Bay Business Journal.

The ED has been enlarged and a new welcome pavilion has also been added, as well as the final phase, which adds 22 beds, eight surgical suites, a 16-bed post-anesthesia care unit, diagnostic imaging services, and a new 6,000-square-foot kitchen and café, according to the journal.

“The North Wing perfectly illustrates dedication to offering advanced medicine right here for our community,” said B. Konard Jones, president and CEO, in a statement. “We’ve never been content to be just another community hospital. Instead, generations of NorthBay leaders vigorously pursued a path to clinical excellence, without sacrificing community service and compassionate care for every patient, every visit, every day.”

After the board of directors of NorthBay Healthcare approved a $205 million bond in 2016, work began on the North Wing project.

In its first phase, came the pavilion, which began operations in 2016. The second phase, which was finished in February, included redoing and enlarging the ED to add a CT scanner and 10 new treatment bays.

“We can (now) deliver modern medicine close to where patients live,” Jones told the journal, adding, “people should not have to cross a bridge or travel hours to get complex medical care.”

The project architects are Ratcliff Architects of Emeryville and the general contractor is DRP Construction.

NorthBay Healthcare was in the news in August when it earned Magnet status from the American Nurses Credentialing Center, according to regional publication The Reporter.

“It is my honor and privilege to officially notify you that the Commission on Magnet has voted unanimously to credential NorthBay Healthcare Group as a Magnet Organization,” Sharon Pappas, RN, Magnet Recognition Program Commission executive committee member told those on the conference call hearing the news at the time.

This marks the second time since 2014 that the organization has won this recognition, according to the news site.

“The depth and breadth of engagement and support is exemplary,” Pappas told the audience during the call, adding, “this organization is unique. It goes above and beyond in its message to celebrate the value of nursing. You are a national role model for nursing excellence.”

“I’m so proud of our nursing team members for their ongoing commitment to nursing excellence, as well as the entire organization for participation and commitment in achieving this wonderful honor,” said vice president and chief nursing officer Traci Duncan, according to The Reporter. “Our nursing staff and nurse leaders helped create our Magnet environment using relationship-based care and our professional practice model. I’m honored to be a part of this team and this organization.”

 

New Hampshire AG rebuffs Partners acquisition

Posted on by • Posted in Antitrust, Attorney General, Competition, Health System, High Deductible Health Plans, High Premiums, High Prices, Hospital, Hospital Industry, Market Consolidation, Market Power, Mergers & Acquisitions • Leave a comment

https://www.modernhealthcare.com/mergers-acquisitions/new-hampshire-ag-rebuffs-partners-acquisition?utm_source=modern-healthcare-daily-dose-tuesday&utm_medium=email&utm_campaign=20190924&utm_content=article6-readmore

New Hampshire officials opposed Partners HealthCare‘s continued expansion into the state, claiming that the health system’s proposed acquisition of Exeter Health Resources would diminish competition.

Partners’ Massachusetts General Hospital’s plans to acquire Exeter (N.H.) Health Resources, an independent system that includes a hospital, a physician group, home health and hospice agency, and a real estate management subsidiary. Exeter would merge with Dover, N.H.-based Wentworth-Douglass Hospital, which Mass General acquired in 2017, to create NewCo, a New Hampshire not-for-profit entity. NewCo was also the name used for the first iteration of what is now Beth Israel Lahey Health.

After a year-long review by the Consumer Protection and Antitrust Bureau, Attorney General Gordon MacDonald said the combination would violate state law requiring free and fair competition.

“New Hampshire patients already pay some of the highest prices for health care in the country,” he said in prepared remarks. “Based on our investigation, we have concluded that this transaction implicates our laws protecting free and fair competition and therefore threatens even higher health care costs to be borne by New Hampshire consumers.”

The AG’s Charitable Trusts Unit report followed a notice of intent to take civil enforcement action issued on Sept. 13 by the Consumer Protection and Antitrust Bureau.

Partners officials said they look to continue talks with the attorney general to allay antitrust concerns.

“We remain fully committed to seeing this transaction through and are confident that the Attorney General’s Office will ultimately determine that our affiliation will pass antitrust review based on the thorough review that the expert economists have completed on this proposal,” Dr. Peter Slavin, Massachusetts General Hospital president, said in prepared remarks.

In a public forum last year, Exeter officials said that the new regional health system would bolster their electronic health record capabilities and streamline care, offer scale to grow services, and enhance care quality.

Economists counter that hospital consolidation often inflates prices thanks to reduced competition and that so-called efficiencies don’t often reach expectations.

Under the deal, NewCo would be substituted as the sole member of Exeter Health Resources and Wentworth-Douglass Hospital. Mass General would become the sole member of NewCo, giving it significant control over the governance and operations, which is a matter of “considerable interest to this state,” the report said.

Exeter Hospital, a 100-bed hospital with outpatient programs in surgery, radiation, oncology and cardiac catheterization, and Wentworth-Douglass Hospital are within 18 miles of each other and provide similar inpatient and outpatient services, according to the report. Both Exeter and Wentworth-Douglass own a significant number of physician practices, such as Exeter’s 140-doctor group that offers primary care, pediatrics, orthopedics, gastroenterology and other specialties. Within the seacoast region, there are a limited number of healthcare entities of size and breadth similar to Exeter and Wentworth-Douglass that also own physician practices, the report said.

“Should EHR, WDH and MGH take further steps to consummate the transaction despite the objection set forth in this report, the Charitable Trusts Unit will bring judicial proceedings and seek injunctive relief,” New Hampshire authorities said in the report.

Partners has continued to try to expand into neighboring states, with varying success. The Boston-based integrated health system was targeting an entry point into the Rhode Island market through a deal with Care New England, adding Lifespan to the proposed talks early last year. It later dropped Lifespan and ultimately nixed the entire deal in June.

Establishing a presence in Rhode Island was an emphasis of Dr. David Torchiana, former president and CEO of Partners. Torchiana retired in April, making way for Dr. Anne Klibanski, who took on the interim CEO role in February and officially became the system’s first female chief executive in June.

Partners has been criticized for its high prices stemming from higher than average inpatient and academic medical center utilization. Beth Israel Deaconess Medical Center and Lahey Health said that a significant driver behind their merger late last year was to keep Partners in check.

Partners reported operating income of $309.9 million on operating revenue of $13.31 billion in 2018, up from $52.6 million in operating income on $13.37 billion of operating revenue in 2017, according to Modern Healthcare’s Health System Financials database.

Through three quarters of its fiscal 2019, Partners reported operating income of $450 million on total operating revenue of to $10.4 billion. That was up from $275 million of operating income on $10 billion of total operating revenue over the same period the year prior.

 

 

 

Trinity Health may issue $1.7 billion in debt

Posted on by • Posted in Debt Refinancing, Health System, Hospital Industry, Tax Exempt Debt, Taxable Bonds • Leave a comment

https://www.modernhealthcare.com/finance/trinity-health-may-issue-17-billion-debt?utm_source=modern-healthcare-daily-dose-tuesday&utm_medium=email&utm_campaign=20190924&utm_content=article3-readmore

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Trinity Health, based in Livonia, Mich., is considering the refinancing of $1.7 billion in debt, with $1.4 billion of that amount likely to take the form of taxable bonds.

The debt under consideration for refinancing represents about 22% of the system’s $6.3 billion in total long-term debt.

The remaining $300 million in debt may or may not be issued as a tax-exempt security, but would be issued to cover the cost of the acquisition, construction, renovation and equipping of new and existing Trinity Health facilities or the refinancing of such expenditures, according to a municipal bond filing.

Not-for-profit hospitals typically borrow in the tax-exempt market but because of new refunding restrictions or depending on market conditions, they may elect to borrow in what is typically a higher cost environment.

In February, Trinity issued $383 million worth of tax-exempt fixed-rate hospital revenue with $78.9 million of that used for refunding of bonds. During the first nine months of fiscal 2019, which ended March 31, Trinity reported $14.3 billion in operating revenue and profit of $457.9 million, according to Modern Healthcare’s financial database.

Earlier this month, Trinity and an anesthesia group reached a settlement following a contract dispute, reported Crain’s Detroit Business.

In August, the system named Cassandra Willis-Abner as senior vice president of diversity and inclusion and chief experience officer; Marcus Shipley as Trinity’s chief information officer and senior vice president of innovation; and Dr. Mouhanad Hammami its senior vice president of safety net transformation, community benefit, and community health and well-being.

 

Kaiser strike called off as company, unions reach tentative agreement

Posted on by • Posted in Collective Bargaining, Health System, Hospital Industry, Labor Union, National Labor Relations Board, Strike • Leave a comment

https://www.healthcaredive.com/news/kaiser-strike-called-off-as-company-unions-reach-tentative-agreement/563523/

UPDATE: Sept. 25, 2019: Following two days of discussion, Kaiser Permanente has come to an agreement with the Coalition of Kaiser Permanente Unions, which has called off the strike. Under the terms of the four-year tentative agreement, some 85,000 unionized Kaiser employees will receive guaranteed annual wage increases through 2023, additional education, training and advancement opportunities, a defined benefit pension plan, higher travel reimbursement and incentives for using Kaiser’s mail-order prescription service.

The coalition of unions and Kaiser reached a consensus Tuesday following roughly five months of bargaining. The agreement still needs to be ratified by coalition union members. Voting is expected to be completed by the end of October and, if approved, the contract will have an effective date of Oct. 1.

Arlene Peasnall, Kaiser’s interim chief human resources officer, said the company and its workforce “may disagree at times, but we have always been able to work through our challenges to align on common goals,” she said.

Dive Brief:

  • An overwhelming majority of Kaiser Permanente workers voted to authorize a strike in October over the not-for-profit integrated health system’s labor practices. It will be one of the largest strikes in the last two decades if the system and the union coalition fail to come to an understanding.
  • The final unions voted over the weekend, bringing the total of U.S. Kaiser employees in support of the strike to almost 51,000 (97% of all Kaiser coalition union members). Three percent, or 1,348 workers, voted ‘no’ on the strike.
  • The Coalition of Kaiser Permanente Unions are meeting with Kaiser leadership Monday and Tuesday for a two-day bargaining session. If no agreement is reached, the strike is scheduled to begin Oct. 14 and run for seven days.

Dive Insight:

The final votes on a Kaiser Permanente strike trickled in over the weekend. The last three unions located in Washington, D.C. and Southern California finished voting on Friday, though a Coalition representative declined to break down votes by individual union.

Union leaders counted 50,884 ‘yes’ votes in support of the strike and 1,348 ‘no’ votes, accounting for 97% and 3% of workers represented by unions under the coalition, respectively.

Kaiser, which has previously blamed worker support for the strike on “misleading” ballot questions, said it would continue to work with the union coalition toward a mutually beneficial outcome. For example, the not-for-profit giant’s most recent contract proposal for its Colorado workers offers guaranteed wage increases and no changes to pension benefits.

“We are offering a proposal that’s fair, equitable, and aligned with our other union agreements,” Arlene Peasnall, Senior Vice President for Human Resources at Kaiser told Healthcare Dive. “We hope the Coalition will not call a strike on October 14. However, we are preparing to deal with all scenarios.”

Support for the strike has continued to mount over the past few months, with labor interests across the country skewering the Oakland, California-based nonprofit provider for soaring profits and what they see as unfair labor practices.

Along with sitting on more than $37 billion in reserves, Kaiser took in more than $5.2 billion in income in the first half of the year alone, heightening scrutiny of the system.

California Governor Gavin Newsom, a Democrat, signed a bill into law earlier this month mandating Kaiser be more transparent within its financial disclosures, including breaking down expenses and revenue on a per-facility basis, revenue by type of payer and rate increases by type of medical service provided starting in 2020.

It’s been almost a full year since the Kaiser workforce’s national contract expired. Kaiser was charged by the National Labor Relations Board for failing to bargain in good faith in December, and union employees have been working without a national contract ever since.

However, it appears matters have come to a head, with the strike garnering support from California community leaders, religious figures and influential politicians, including House Speaker Nancy Pelosi, presidential hopeful Senator Kamala Harris, D-Calif., Sens. Ron Wyden, D-Ore. and Jeff Merkley, D-Ore., and Rep. Maxine Waters, D-Calif.

 

 

 

Sutter Antitrust Class Action Could Upend Industry Consolidation

Posted on by • Posted in Antitrust, Federal Trade Commission (FTC), Health Policy, Health System, High Deductible Health Plans, High Premiums, High Prices, Hospital, Hospital Industry, Lawsuit, Market Consolidation, Market Power, Monopoly, Monopoly Behavior, Out of Pocket Expenses, Out-of-Network • Leave a comment

https://news.bloomberglaw.com/health-law-and-business/sutter-antitrust-class-action-could-upend-industry-consolidation

Health-care consolidation and antitrust allegations are the focus of litigation that alleges Sutter Health Systems uses its Northern California dominance to force higher fees out of employer-funded health plans and consumers.

Jury selection begins Sept. 23 in San Francisco in a case that could translate into more than a billion-dollar liability for California’s third-largest hospital system. Sutter denies the allegations.

Employers, payors, and the health-care industry are closely watching the case. Success in California could spill into other states and undermine consolidation efforts by other health-care providers, observers said.

“If I’m a system somewhere else and these guys lose, these class-action lawyers I assume are going to start putting pins in the map around the country and say, ‘OK let’s go look at Utah, Florida, other parts of California’” that have dominant players, said Glenn Melnick, a health-care economist at the University of Southern California. “They have a template now.”

Total Revenue Hit $13 Billion in 2018

Sutter Health is a California behemoth, consisting of 24 acute care hospital facilities, 36 ambulatory surgery centers, nine cancer centers, six specialty care centers, nine major physician organizations, with 12,000 physicians and 53,000 employees located in 19 counties in Northern California. The system reported $13 billion in revenue in 2018.

“There is no evidence that Sutter has hurt competition, as demonstrated by the fact that new hospitals continue to open and existing facilities continue to expand in markets that Sutter Health serves, including in the San Francisco Bay Area and the greater Sacramento region,” Sutter said in a statement.

Northern California has experienced more rapid consolidation of hospital, physician, and insurance markets from 2010 to 2016 than Southern California, University of California Berkeley researchers found. And inpatient prices were 70% higher, outpatient prices 17%-55% higher depending on physician specialty, and Affordable Care Act premiums 35% higher in the northern part of the state.

Sutter inflated prices by an average 15.5% between 2003 and 2016, a United Food & Commercial Workers & Employers Benefit Trust expert analysis said. The UFCW trust sued Sutter first, followed by the state. For trial purposes, the court joined California’s lawsuit with the UFCW class action.

The inflated prices translated into $756 million in overcharges, the state and class members allege. More than 90% of class members for which measurements were available paid higher average prices at Sutter than class members paid for services at other California hospitals, they said.

Patients Protected, Sutter Says

The hospital system says its offerings shield patients from unforeseen expenses.

“Our broad provider network gives patients greater choice and predictability and protects patients from surprise billing. It also prevents patients from paying more in co-pays and deductibles for out-of-network doctor and hospital visits,” Sutter’s statement said.

Treble damages and attorneys’ fees are available if the UFCW and state win under the Cartwright Act, California’s antitrust law. The union trust fund, representing a class of large California employers who self insure their health-care costs, seeks damages from the jury while the California Attorney General wants to stop the practices alleged.

Jury selection is set for Sept. 23-24 with a two-week break while the parties argue over issues including sealing contracts negotiated with third parties including Anthem Inc., Blue Shield of California Inc., United Healthcare Services Inc., Teamsters Benefit Trust, Apple Inc., and HealthNet of California Inc. The trial is expected to last 60-90 days.

Consolidation Concerns

Health-care costs are one of the most important concerns in the U.S., said Jaime King, associate dean of the University of California Hastings School of Law and director of the Concentration on Law and Health Sciences.

“I know that attorneys general in other states are paying very close attention to what’s happening because concentration is not something that is just happening in California—it’s happening all over the country. If successful we will start to see a rollout of lots of similar cases across country,” King said.

“I think we will see ripple effects that go well into the future,” she said.

The case has implications especially in Northern California and could have legs elsewhere, Attorney General Xavier Becerra (D) said.

“Does this have an impact outside California? I would say that most everything that California does has an impact on this country and dare say the world. We hope that in our effort to pursue lower costs and higher quality of care in health care that the beneficiaries are not just Californians but people throughout the country,” Becerra said.

 

 

 

6 hospitals planning upgrades, expansions

Posted on by • Posted in Health System, Hospital, Hospital Construction, Hospital Expansion • Leave a comment

https://www.beckershospitalreview.com/facilities-management/6-hospitals-planning-upgrades-expansions-9-24-19.html?origin=cfoe&utm_source=cfoe

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Six hospitals or health systems announced, started or completed construction projects in the last two weeks:

1. Cape Cod Healthcare breaks ground on $180M tower 
Hyannis, Mass.-based Cape Cod Healthcare broke ground Sept. 23 on a six-story, $180 million patient tower.

2. Sutter Santa Rosa breaks ground on $158M expansion
Sutter Santa Rosa (Calif.) Regional Hospital broke ground Sept. 20 on its $158 million expansion.

3. Mercy Health to open $133M Arkansas hospital tower Oct. 21
Rogers-based Mercy Health System of Northwest Arkansas plans to open its $133 million, seven-story patient tower Oct. 21.

4. Michigan Medicine to build $920M hospital
University of Michigan in Ann Arbor plans to spend $920 million to build a new hospital, which is expected to take five years to complete.

5. Orlando Health opens 6th freestanding ER, keeping pace with rivals
Orlando (Fla.) Health opened its sixth freestanding emergency room in Central Florida., Sept. 16.

6. Hackensack Meridian Health breaks ground on $714M expansion
Hackensack (N.J.) Meridian Health broke ground Sept. 13 on its nine-story, $714 million pavilion.