Supreme Court exempts church-affiliated hospitals from federal pension law: 5 things to know

http://www.beckershospitalreview.com/legal-regulatory-issues/supreme-court-exempts-church-affiliated-hospitals-from-federal-pension-law-5-things-to-know.html

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The U.S. Supreme Court on Monday held that church-affiliated hospitals do not have to comply with the federal Employee Retirement Income Security Act, which governs employee pensions.

Here are five things to know about the case and the high court’s ruling.

1. The Supreme Court agreed in December to take up appeals filed by religiously affiliated hospital systems that were accused of underfunding their employee pension plans.

2. In three lawsuits, which were consolidated into one case, the high court was asked to decide whether the health systems can rely on their church affiliations to avoid complying with ERISA, which requires pension plans to have adequate funding to pay their promised benefits.

3. The lower courts said each of the three hospital systems — Saint Peter’s HealthCare System in New Brunswick, N.J., Dignity Health in San Francisco and Advocate Health Care in Downers Grove, Ill. — misclassified their pensions as “church plans” exempt from ERISA.

4. In an 8-0 ruling issued Monday, the Supreme Court overturned the lower court decisions that could have cost the health systems billions of dollars combined. Supreme Court Justice Neil Gorsuch did not participate in Monday’s decision, as he joined the court after arguments were presented in the case.

5. Justice Elena Kagan, writing for the court, said ERISA’s religious exemption applies to pension plans established by churches themselves and those established by organizations affiliated with churches.

“Because Congress deemed the category of plans ‘established and maintained by a church’ to ‘include’ plans ‘maintained by’ principal-purpose organizations, those plans — and all those plans — are exempt from ERISA’s requirements,” wrote Ms. Kagan.

Ascension to pay $29.5M settlement in pension lawsuit

http://www.beckershospitalreview.com/legal-regulatory-issues/ascension-to-pay-29-5m-settlement-in-pension-lawsuit.html

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St. Louis-based Ascension Health ended a class-action lawsuit filed against the system and subsidiary Wheaton Franciscan Services in Glendale, Wis., alleging Wheaton erroneously treated its pension plan as a “church plan” exempt from the federal Employee Retirement Income Security Act, Bloomberg BNA reports.

Under the settlement, Ascension will pay $29.5 million in benefit payments for Wheaton’s retirement plan and up to $2.25 million in legal fees and expenses. Court papers filed Sept. 1 show the deal mandates Ascension to guarantee payment of the $29.5 million for the benefits if the plan cannot cover the costs, the report states.

Ascension and Wheaton denied the allegations in filed court papers, St. Louis Business Journal reports. The settlement requires court approval before it is finalized.

In June, the U.S. Supreme Court held church-affiliated hospitals are not required to comply with ERISA, which governs employee pensions.

 

Irma forces 35 hospitals across 3 states to evacuate: 9 things to know

http://www.beckershospitalreview.com/patient-flow/irma-forces-35-hospitals-across-3-states-to-evacuate-9-things-to-know.html

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Hurricane Irma hit southwest Florida Sunday and continued its destructive march north, forcing at least 35 hospitals across Florida, Georgia and South Carolina to evacuate patients or shut down. Downgraded to a tropical storm Monday morning, Irma still presents a major threat to many healthcare facilities.

Here are nine things to know.

1. As of Saturday afternoon, most of Florida’s hospitals remained open, the Florida Hospital Association told STAT. In advance of the hurricane, healthcare facilities across the state evacuated nearly 1,900 patients.

2. Four hospitals in the Florida Keys — Lower Keys Medical Center in Key West, Fishermen’s Hospital in Marathon, Mariners Hospital in Tavernier and Depoo Hospital in Key West — were among the first healthcare facilities in the state to close last week ahead of the hurricane, according to STAT.

3. In Miami, Mercy Hospital, part of Nashville, Tenn.-based HCA Healthcare, closed Friday after evacuating 200 patients. The patients were transferred to other HCA facilities. The Miami Cancer Institute, part of Coral Gables-based Baptist Health South Florida, also closed.

4. Mt. Sinai Hospital in Miami opened two conference rooms to house 30 expectant couples who were unable to leave during the hurricane. The women are 36 or more weeks pregnant and unable to travel, according to WHDH.

5. Naples, Fla.-based NCH Healthcare System stayed open during the hurricane and provided shelter for hundreds of evacuees, according to the Naples Daily News.

6. On Florida’s west coast, at least five hospitals have closed. Tampa General Hospital, the region’s only Level 1 trauma center, stayed open. As of Sunday, about 650 patients were in the hospital. A group of physicians, nurses and other staff will care for patients throughout the remainder of the storm, according to the Tampa Bay Times.

7. In central Florida, Cape Canaveral Hospital closed after evacuating patients last week, according to STAT.

8. In Georgia, Candler Hospital in Savannah transferred patients to St. Joseph’s Hospital in Savannah. Officials said St. Joseph’s Hospital “is better equipped to handle the long-term needs of our caregivers, medical staff and any patients who are too sick to be discharged or evacuated.”

9. In South Carolina, Hilton Head Hospital evacuated all patients and suspended services.

The unfortunate truth about most health care jobs

https://www.cbsnews.com/news/health-care-jobs-salary-the-unfortunate-truth/

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For Americans seeking career advice, experts often point to health care as an occupation ripe with opportunities. If only the pay were better.

Employment data do, in fact, show the health care industry to be the fastest growing sector in the U.S. A recent analysis by the National Employment Law Project estimates that the number of jobs, mostly tied to hospitals, will rise 21 percent in the decade ending 2024. That contrasts with a projected 7 percent decline in manufacturing.

About 1.4 million manufacturing jobs evaporated during a 16-year period, while health care added 1.3 million, according to the analysis, which focused on 11 industrial states. By 2016, health care had a net 780,000 more workers versus manufacturing in the region, concluded NELP, a labor rights advocacy group. The figures are based on U.S. Labor Department data from its quarterly census of employment and wages.

“There’s been a lot of focus on the industrial Midwest in general because there is so much anxiety,” said Rajesh Nayak, NELP’s director of research and author of the analysis, in an interview. “Contrast that with the growing health care industry, and you start to see opportunities for folks.”

Yet for every higher-paying job held by workers like nurses and doctors, more than six workers such as orderlies, phlebotomists and cooks make less than $15 an hour. Nationwide, 70 percent of hospital service workers make less than $15 an hour, NELP found. In the Midwest, it’s 71 percent.

The NELP study defined Midwest industrial states as Minnesota, Indiana, Missouri, Illinois, Wisconsin, Michigan, Indiana, Ohio, Kentucky, West Virginia and Pennsylvania.

By contrast, unionized hospital workers in Seattle, New York and Oakland had wages higher than $15. Higher wages can help with quality of care, the group said, citing collective bargaining agreement data.

“We can take some of the lessons from factories — folks had decent labor standards. They had a collective bargaining agreement, or just more of a voice in general,” Nayak said. By raising wages, “You start to get to a place where people can pay for a family that looks like the kind of wages that folks were getting in the factory jobs.”

It’s not just hospitals that pay lower hourly wages, a study released this week by the Center for Economic Policy and Research shows hourly wages in outpatient centers either fell or stayed stagnant in the decade ending in 2015. Median hourly wages after inflation is factored in rose 75 cents over the decade, from $23.79 to $24.54, the think tank found. That amounts to a rise of only 3.2 percent over 10 years.

“A hospital’s workforce is its most vital asset,” said Marie Watteau, vice president of media relations with the American Hospital Association, in an e-mailed statement. “From the clinicians to environmental services professionals, all play a role in ensuring that patients receive high quality care.”

The top three fastest-growing health care occupations from 2014 to 2024 are personal care aides, registered nurses and home health aides, according to projections from the Bureau of Labor Statistics. Health care will drive all five of the five fastest growing industries, the NELB analysis found.

In 2015, spending tied to health care made up 17.8 percent of U.S. gross domestic product, a figure that is projected to rise to 19.9 percent by 2025, according to the Centers for Medicare and Medicaid Services.

Women made up 68 percent of hospital workers in Midwest industrial metro areas, while 49 percent were non-white, the NALP analysis found.

On Monday, thousands workers rallied in Chicago, including hospital support workers, focusing on issues including raising the minimum wage to $15 an hour by 2022 from the current $8.25. Illinois Gov. Bruce Rauner vetoed such an increase last month, contending the cost may be too high for some employers.

Even as some cities like Seattle require higher wages, some states, like Missouri, are rolling them back as employers generally complain they can’t afford to pay. Conflicting studies earlier this year differed on how well Seattle’s shift  to a higher minimum wage affected the city’s economy.

Most counties in the U.S. have a cost of living across industries that isn’t covered by minimum wage incomes, according to a recent blog post  from Amy Glasmeier, a professor and co-chair at the Massachusetts Institute of Technology’s economic geography and regional planning Ph. D program.

For instance, in Chicago, a single parent of one child needs to earn $24.67 an hour to meet a definition of living wage, while a person living alone there needs at least $12.33, based on a living-wage calculator  developed by Glasmeier in conjunction with MIT.

And the Survey Says: We Want a Positive Clinical AND Financial Experience

Click to access Connance_SurveySays_PositiveClinicalandFinancial_Experience.pdf

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California’s Health Care Workforce

http://www.chcf.org/publications/2017/08/california-workforce

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California’s health care industry employed more than 1.4 million people in 2015. Five Almanac guides provide data on wages, education, and workplaces for selected health professions.

California’s health care industry employed more than 1.4 million people in 2015. Among these workers, nearly 55% were employed in ambulatory settings, about 25% in hospitals, and 20% in nursing or residential care facilities. An aging population, population growth, and federal health reform will likely contribute to increased demand.

This series of Quick Reference Guides from the CHCF California Health Care Almanac examines specific segments of the state’s health care workforce, focusing on pharmacists and pharmacy technicians, physician assistants, health diagnostic and treatment therapists, clinical laboratory scientists and technicians, and imaging professionals.

Among the trends:

  • California’s supply of pharmacists grew 17% between 2012 and 2015, while the supply of pharmacy technicians increased by 8%. About half of the state’s pharmacists were trained in California.
  • The number of physician assistants (PAs) in California grew 37% between 2012 and 2015. The Northern and Sierra region had more licensed PAs per capita than the rest of the state.
  • The supply of occupational and physical therapists increased between 2012 and 2015, while the supply of speech-language pathologists decreased slightly.
  • Between 2012 and 2015, California’s supply of clinical laboratory scientists remained stable while the number of medical/clinical lab technicians rose 11%.

The complete guides, as well as the 2014 editions, are available as Document Downloads.

California Nurses: Taking the Pulse

http://www.chcf.org/publications/2017/08/california-nurses

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In 2015, 330,000 registered nurses made up the largest health profession in California. This overview of the nursing workforce looks at supply, demographics, education, distribution, and pay.

California is home to more than 330,000 actively licensed registered nurses (RNs), making nursing the single largest health profession in the state.

Key findings include:

  • The nursing workforce has grown more diverse. Non-white RNs accounted for almost half (48%) of employed nurses in 2015. However, compared to the state’s population, Latinos were significantly underrepresented in the RN workforce, while Filipinos and whites were significantly overrepresented.
  • The pre-licensure programs for RNs produced 11,119 graduates in 2015, slightly down from a high of 11,512 in 2010.
  • California’s RN workforce relies on foreign-educated nurses. In 2015, about one in five employed RNs were trained outside the US.
  • 64% of employed RNs worked in a hospital in 2014. Another 15% were in ambulatory care.
  • Nurses’ average income was $100,000 in 2015.
  • In 2015, more than two-thirds (71%) of LVN graduates came from for-profit schools.

Quick reference guides, as well as a full report from 2010, are available under Document Downloads.

Judge weighs in on whether Jahi McMath is brain dead

Judge weighs in on whether Jahi McMath is brain dead

In this Oct. 2, 2014 file photo Sandra Chatman, left, and Nailah Winkfield look on as a photo of their granddaughter and daughter, respectively, Jahi McMath, 13, is shown during a press conference at Dolan Law Firm in San Francisco, Calif. Christopher Dolan, attorney for Jahi McMath’s family, showed photos and a pair of videos where McMath moves her foot and arm in response to the voice of her mother Nailah Winkfield in a home in New Jersey. She was declared brain-dead in California after tonsil, throat and nose surgeries to relieve her sleep apnea. (Ray Chavez/Bay Area News Group)

Jahi McMath, the Oakland teenager whose brain death case has sparked national debate, may not currently fit the criteria of death as defined by a state law written in conjunction with the medical establishment, a judge wrote in an order Tuesday.

In his ruling, Alameda County Superior Court Judge Stephen Pulido wrote that while the brain death determination in 2013 was made in accordance with medical standards, there remains a question of whether the teenager “satisfies the statutory definition of ‘dead’ under the Uniform Determination of Death Act.”

His ruling comes in the years-long medical malpractice suit against UCSF Benioff Children’s Hospital Oakland and its doctors, which also challenges the hospital’s 2013 brain death diagnosis of the Oakland teenager following a complex nose, throat and mouth surgery.

The judge’s order pertains to the personal injury claim in the lawsuit, which the hospital sought to dismiss, and could result in a trial on whether Jahi is alive. An attorney for the family is arguing Jahi is alive and therefore entitled to more than the cap of $250,000 on medical malpractice lawsuits involving children who die as a result of surgery.

Pulido heavily cited Dr. Alan Shewmon, who concluded in a court declaration that Jahi doesn’t currently fit the criteria for brain death after reviewing 49 videos of her moving specific fingers and other extremities when given commands to do so. Shewmon, a professor emeritus of pediatrics and neurology at UCLA, wrote that Jahi “is a living, severely disabled young lady, who currently fulfills neither the standard diagnostic guidelines for brain death nor California’s statutory definition of death.” Shewmon also reviewed an MRI.

The girl’s family released some of the videos in 2014.

Reached Wednesday, hospital spokeswoman Melinda Krigel referred to a statement issued in July in which Children’s Hospital stood by its position that Jahi “fulfills the legal diagnostic criteria for brain death.” After her December 2013 surgery ended tragically, two doctors declared the teenager dead. An independent and court-appointed doctor from Stanford University later affirmed the diagnosis.

“The videotapes do not meet the criteria set forth in the guidelines” for determining brain death, the hospital said in the statement.

Bruce Brusavich, an attorney for Jahi’s family, did not return a call for comment Wednesday. The family has also filed a federal lawsuit.

Jahi’s story and her family’s fight to remove her from Children’s Hospital captured worldwide attention and inspired other families to question brain death determination of their loved ones.

In late December 2013, then-family attorney Christopher Dolan was successful in convincing a judge to order Jahi released from the Oakland facility, allowing the family to take her cross-country to a hospital in New Jersey. Unlike California, the Garden State has a law allowing guardians to reject a brain death diagnosis on religious grounds.

After leaving the New Jersey hospital, Jahi has been hooked up to breathing and feeding machines in a nearby apartment she shares with her mother, Nailah Winkfield, and other family members. She has used the machines to breathe and eat for nearly four years, a duration that is believed to be longer than any other U.S. patient declared brain dead.

Talk over Coffee into a Data Revolution for northern Nevada’s largest hospital system

http://www.beckershospitalreview.com/hospital-management-administration/steal-this-idea-how-renown-ceo-dr-tony-slonim-turned-a-talk-over-coffee-into-a-data-revolution-for-northern-nevada-s-largest-hospital-system.html

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In May 2016, Tony Slonim, MD, DrPH, met fellow New Jersey native Joe Grzymski, PhD, at a Starbucks for coffee. Dr. Slonim, CEO of Reno, Nev.-based Renown Health, said he expected to trade stories about their home state, but they soon found their professional interests as compatible as their personal ones.

“Like all good things, it started at Starbucks over a coffee on a Saturday morning,” Dr. Slonim said, “As we let our minds expand and started thinking about complementary ways we could collaborate, this idea came up.”

This idea is a partnership between Renown and the Desert Research Institute, where Dr. Grzymski is senior director of applied research.

The duo began to think of ways they could combine the clinical data 946-bed Renown had on hand with the DRI’s environmental data to better understand the ways outside factors affect health outcomes in their community.

But the idea didn’t stop there. The pair also recognized that social determinants play an equally influential role in shaping a person’s health, so they made sure to include social data from the Governor’s Office of Economic Development in their new project, which did not yet have a name, but more importantly had a purpose.

“If we believe in population health, and the vision for population health, we’ve got to do a better job of understanding the health and the wellbeing of the people we’re serving,” said Dr. Slonim. “As an organization that’s got a large market share, it’s incumbent upon me as the CEO to think about how to use the most efficient resources for the most benefit for people that need it.”

At first, the collaboration was seen as a data-sharing project that would connect skilled researchers and analysts at the DRI with a wealth of combined information that had been inaccessible to a single provider in the past. However, it was only once Dr. Slonim and Dr. Grzymski took their idea to the 2016 BIO International Convention in San Francisco that they were able to find a third partner to provide them with yet another data set that would help them fully see the big picture of a person’s health.

Representatives from retail genetics firm 23andMe approached Dr. Grzymski following his talk at BIO. The company offered to provide genetic testing and sequencing for the project. Dr. Grzymski jumped at the opportunity, which would enrich the already robust data collection he and Dr. Slonim had begun to compile.

With genetic information as a fourth pillar of their potential data set, Renown and the DRI founded the Renown Institute for Health Innovation. The IHI’s most important initiative would go on to be named the Healthy Nevada Project.

At a September 2016 press conference, Dr. Slonim and other IHI leaders teamed up with Nevada Gov. Brian Sandoval to announce that the first 5,000 Reno residents who signed up to submit genetic samples would receive free access to the test results. Dr. Slonim believes offering this access to community members is what encouraged 5,000 people to sign up in only the first 24 hours of the enrollment period. With such an enthusiastic response, the leaders at the IHI decided to open up 5,000 more slots, which took one more day to fill. In only 48 hours, the Healthy Nevada Project had succeeded in enrolling 10,000 local residents to submit samples for genetic testing.

The project was off and running — quickly. And Dr. Slonim’s work was only just beginning.

Once 23andMe completed genetic sequencing of all 10,000 study participants in December, the Healthy Nevada Project still faced a looming question: What to do with all the data they’d collected?

“One-hundred more people per 100,000 die of cardiovascular disease in northern Nevada than national estimates. Our cancer rates are significantly higher and nobody knows why. So [we’re] trying to understand what the backdrop and the context is,” Dr, Slonim said. “Is it the mines that we have here? Is it the weather patterns that change because we’re in a valley? Our air pollution is higher, our particulate matter is higher — is that what causes lung cancer? We’re trying to figure this out, but you can’t do anything without data, so we started there.”

Dr. Slonim understands epidemiologists and analysts will have to spend many careful hours with the data to come to any concrete conclusions, but he believes the Healthy Nevada Project represents an essential first step for the future of the healthcare industry. If he and his colleagues could begin to harness the power of data in EHRs, then he sees a world of untapped potential that can help his community improve their health while also improving Renown’s organizational efficiency.

“This is the ultimate in strategic planning. If I figure out that our community is more at risk for cardiovascular disease 10 years from now, I can be thoughtful about how I go about recruiting cardiologists. If I know that the population is growing in pediatrics, I can start a program for pediatric residents at the medical school and grow my own pediatricians,” Dr. Slonim says. “The horizon for planning can be kept in view because we’re learning about our population’s health and disease. The second reason why I did this is because it’s the best way to engage consumers in their own healthcare to modify their behaviors.”

Dr. Slonim’s advice to hospital leaders looking to improve their capacity for innovative data concepts is simple: Take the first step. For the most part, the benefits of the Healthy Nevada project still lay ahead, as it has been only 15 months since that coffee meeting, but the game-changing potential cannot be understated. Dr. Slonim is confident that putting in the work to collect and analyze this comprehensive data will revolutionize the way Renown cares for its patients, and he believes other providers can follow suit.

“If you’re a large contributor to your market in healthcare with full range of integrated services across the continuum, get the environmental data. Get partnerships with the social data,” Dr. Slonim says. “Figure out how you can exercise your clinical EMRs and the great repository of data that are in there and put them in a big data warehouse and figure out how to analyze them. We’re not using predictive analytics in healthcare the way that other industries are, and we need to be better at that.”

Review finds 5 in 20 Washington hospitals violate state charity care law

http://www.beckershospitalreview.com/legal-regulatory-issues/review-finds-5-in-20-washington-hospitals-violate-state-charity-care-law.html

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Twelve hospitals across the state of Washington received charity care deficiency letters after a recent report by Columbia Legal Services revealed significant problems.

Washington law requires all hospitals to only demand one form of an income-related document, determine if patients qualify for charity care and notify patients of their options. Columbia Legal Services found five hospitals violated this law. The legal organization also found seven more hospitals deficient in their charity care offerings, but not in violation of state or federal laws.

The study cited instances where hospitals were not doing enough to overcome language barriers to charity care, patients were not adequately informed about their charity care rights and hospitals were not informing patients of eligibility or screening them for eligibility.

To investigate the efficacy of charity care policies in Washington hospitals, Columbia Legal Services reviewed state and national charity care reports, hospital data, state laws and uninsured rates. The report tested 20 hospitals in the state.

Read the full report here.

Click to access 170824CharityCareReportFINAL-DIGITAL.pdf