Hospital finances are stressed, care access is threatened, and staff are burned out.

The nation's hospitals are reporting that the year-long battle with the coronavirus pandemic has put them in "survival mode," contending with stressed margins, burned-out staff, and exacerbated concerns about care access for vulnerable communities, a federal report said.

"Hospitals described difficulty balancing the complex and resource-intensive care needed for COVID-19 patients with efforts to resume routine hospital care," the Department of Health and Human Services' Office of the Inspector General said in a report made public Wednesday.

"(Hospitals) reported that staffing shortages have affected patient care, and that exhaustion and trauma have taken a toll on staff's mental health," the report said. "Administrators detailed challenges associated with vaccine distribution efforts and concerns about vaccine hesitancy among staff and members of their communities."

The report is based on a February 22–26 survey of hospital administrators from 320 hospitals across 45 States, the District of Columbia, and Puerto Rico. They were asked three questions: 

1. What are your most difficult challenges in responding to the COVID-19 pandemic right now, and what strategies have you been using to address the challenges?
    
2. What are your organization's greatest concerns going forward?
    
3. How can government best support hospitals?
    

"Hospitals also raised concerns that the pandemic has exacerbated existing disparities in access to care and health outcomes," the report said. "Additionally, many hospitals reported experiencing financial instability because of increased expenses associated with responding to a pandemic and lower revenues from decreased use of other hospital services."

The report noted that many of the challenges posed by the pandemic are even more severe for rural hospitals.

Beyond providing more money, especially for hospitals in rural and underserved areas -- the hospitals said government could best help them by offering guidance on COVID-19 treatment and prevention, including safe discharges of COVID-19 patients, help to reduce depleted staff, especially nurses and specialists, and continuing to encourage the public to get vaccinated.

In the long-term, the hospitals said the pandemic has exposed existing gaps in the nation's care delivery system. The recommend that the federal and state governments and healthcare stakeholders use the public health emergency to address issues that predate the pandemic, such as healthcare disparities and access.

"These improvements include reducing disparities in access to healthcare and in health outcomes, building and maintaining a more robust health care workforce, and strengthening the resiliency of our health care system to respond to pandemics and other public health emergencies and disasters," the report said.

The hospital association says the deal would squash competition and raise costs for consumers and providers.

The American Hospital Association has asked the Department of Justice to launch an anti-trust investigation of United Health Group's proposed $8 billion acquisition of software and data analytics provider Change Healthcare.

In a seven-page letter Thursday to Richard Powers, acting assistant attorney general at DOJ's Antitrust Division, AHA General Counsel Melinda Reid Hatton raised concerns that the deal "threatens to reduce competition for the sale of healthcare information technology services to hospitals and other health care providers, which could negatively impact consumers and health care providers."

Reid Hatton said UHG and Change are aware that the deal "presents substantial antitrust concerns because the transaction agreement provides that the Parties will divest assets that generate hundreds of millions of dollars in revenue in order to obtain DOJ approval."

Under the proposed acquisition, announced in January, UnitedHealth Group's tech services subsidiary OptumInsight would buy Change Healthcare in a deal valued at around $8 billion.

In a joint press release at the time of the announcement, Eden Prairie, Minnesota-based UnitedHealth, and Nashville-based Change Healthcare said the combined company "will more effectively connect and simplify core clinical, administrative and payment processes - resulting in better health outcomes and experiences for everyone, at lower cost."

Optum issued a statement Thursday night that skirted the issues raised in the AHA letter.

“Optum and Change Healthcare share a vision for better health outcomes and experiences for everyone, at lower cost. With distinct and complementary capabilities, this combination will help healthcare providers and payers better serve patients by more effectively connecting and simplifying key clinical, administrative and payment processes to the benefit of the health system and the people we serve,” the company said.

Reid Hatton said the deal would consolidate and shift away competitively sensitive healthcare data from Change Healthcare, now a neutral third-party, to UGH subsidiary Optum.

"Because Optum's parent, UHG, also owns the largest health insurance company – UnitedHealthcare – in the United States, the combination of the Parties' data sets would impact (and likely distort) decisions about patient care and claims processing and denials to the detriment of consumers and health care providers, and further increase UHG’s already massive market power," Reid Hatton said.

The letter noted that UHG generated more than $242 billion in 2019, and that subsidiary UnitedHealthcare is the largest health insurance company in the nation, with more than 70 million members, and commercial, Medicare and Medicaid insurance plans.

Reid Hatton said UnitedHealthcare also has the largest or second largest market share in 20 states, with a network that includes 1.4 million physicians and other clinicians, and more than 6,500 hospitals.

Optum and its OptumHealth, OptumRx, and OptumInsight businesses generate about 50% of UHG's earnings, Reid Hatton said, and are expected to continue to drive UHGs revenues over the next three years.

Reid Hatton cited UHG's company reports boasting that OptumInsight provider health care IT services to more than 5,000 (9 out of 10) hospitals and 100,000 physicians, and processes more than 5 billion pages of clinical documents and processes data covering 240 million people each year.

Change Healthcare reported a net loss of nearly $59 million in Q1 2021, attributed largely to the negative impact of the coronavirus disease 2019 (COVID-19) pandemic on the business model, according to the company's latest earnings results released Wednesday afternoon.

Change Healthcare LLC, a joint venture previously held by McKesson that Change purchased in early March, delivered a net income of nearly $72 million and an adjusted net income of $141.5 million.

Medicare payments will increase from $28 to $40 for one-dose vaccines, and from $45 to $80 for two-dose vaccines, effective immediately.

In a bid to accelerate vaccinations for COVID-19, the federal government is offering Medicare providers a big bump in the reimbursements it pays for the single- and two-dose vaccinations.

The new payments -- which go into effect immediately -- will increase from $28 to $40 for one-dose vaccines, and from $45 to $80 for two-dose vaccines, increases of 43% and 78%, respectively, the Centers for Medicare & Medicaid Services announced Monday.

The exact payment rate will depend on the provider venue that administers the vaccination, and on the geographic location of the providers.

"These updates to the Medicare payment rate for COVID-19 vaccine administration reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately," CMS said in a media release.

CMS said the higher payments will incentivize providers to increase the daily volume of vaccines they can administer,  expand vaccination sites, conduct community outreach and education, and hire additional staff.

Providers receive the coronavirus vaccines for free from the federal government and cannot charge Medicare, Medicare Advantage or Medicaid patients. Most private health insurers are required to provide the vaccination to their beneficiaries with no out-of-pocket costs.

AMA Cheers

American Medical Association President Susan R. Bailey, M.D. said her group has been pushing for more money since President Joseph R. Biden took office in January.

"The additional resources will increase the number of clinicians who can administer the vaccine," she said. "This has been a trying time for physician practices, and we thank the administration for acknowledging the challenges of practicing medicine during a pandemic."