The healthcare sector has shed 542,000 jobs since the start of the pandemic in February 2020.
Hospitals shed 5,800 jobs in April as disappointing U.S. job numbers in the larger economy for the month remained largely stagnant and the unemployment rate held at 6.1%, new federal data show.
The healthcare sector recorded a net loss of 4,000 jobs for the month. While ambulatory healthcare services saw an increase of 21,000 jobs, that was mostly offset by hospital job losses and 19,000 job losses in nursing homes, the Bureau of Labor Statistics reported on Friday.
The healthcare sector has shed 542,000 jobs since the start of the pandemic in February 2020. There are 15.9 million people attached to the healthcare sector workforce, BLS said.
The stagnant employment rates for April were reported in wide swaths of the larger economy. The U.S. gained only 266,000 jobs for the month, the unemployment rate held at 6.1%, and 9.8 million people were unemployed, all largely unchanged from March, BLS said.
"These measures are down considerably from their recent highs in April 2020 but remain well above their levels prior to the coronavirus (COVID-19) pandemic (3.5% and 5.7 million, respectively, in February 2020," BLS said in a media release.
CareCloud Health said it "admitted no wrongdoing in this matter and has accepted settlement in an effort to move forward ... and avoid costly litigation."
CloudCare Health Inc. will pay $3.8 million to settle whistleblower allegations that the Miami-based electronic health records vendor offered cash bonuses and other kickbacks to clients who recommended the vendor's software to prospective clients, the Department of Justice said.
According to federal prosecutors, violations of the False Claims Act and the Anti-Kickback Statute occurred between January 2012 and March 2017, when CloudCare launched a marketing referral initiative called the "Champion Program."
Prosecutors said that CareCloud paid existing clients cash equivalent credits, cash bonuses and percentage success payments to recommend CareCloud's EHR products to prospective clients.
"Existing clients who participated in the Champions Program ("participants") executed written agreements prohibiting them from providing negative information about CareCloud's EHR products to prospective CareCloud clients," DOJ said. "Prospective CareCloud clients were not told about this referral-kickback arrangement or about the contract that prohibited participants from sharing negative company information with them."
Prosecutors alleged that CareCloud's kickbacks rendered false the claims submitted by CareCloud for federal incentive payments under the Medicare and Medicaid Electronic Health Records Incentive Programs and the Merit-Based Incentive Payment System.
"Product functionality, reliability, and safety should drive a medical software company's success, not illegal kickbacks paid to promote its products," Acting United States Attorney Juan Antonio Gonzalez said. "There is simply no place for kickbacks in our country's healthcare system. Companies who ignore this will be held accountable."
CareCloud was acquired by publicly held MTBC, Inc., in January 2020. The Champion Program was ended as part of the DOJ settlement.
CloudCare Responds
CloudCare offered the following response on Wednesday:
"On January 8, 2020, CareCloud, Inc. acquired the company now known as CareCloud Health, Inc. (formerly CareCloud Corporation). The acquired company was, at the time of the transaction, subject to a civil investigation, which began with the filing of a sealed complaint in 2017. CareCloud Health has admitted no wrongdoing in this matter and has accepted settlement in an effort to move forward, focusing its efforts fully on the vital support and services it provides to its clients, and avoid costly litigation."
"This settlement is in response to government allegations that certain elements of CareCloud Health’s client reference program violated the Federal Anti-Kickback Statute several years prior to acquisition. The US government declined to intervene on and pursue any claims regarding CareCloud’s EHR product, Charts. The investigation was considered as an element of the acquisition, and adequate reservations were made."
The whistleblower in the settlement, identified as Ada De La Vega, will get $803,000 from the settlement.
Better-than-expected tax revenues and a tsunami of federal aid have helped states bolster Medicaid and safety net programs during the pandemic.
When the coronavirus public health emergency was declared in early 2020, public health experts feared that Medicaid and safety net programs would get pummeled.
They anticipated a huge increase in demand for public assistance colliding with an anticipated drop in state tax revenues and slashed budgets owing to the pandemic-driven recession.
That didn't happen.
"The circumstances were not as dire from a budget perspective," said Stacey Mazer, senior staff associate with the National Association of State Budget Officers, during a recent virtual round table sponsored by the Urban Institute.
"We saw the additional federal aid packages, the fact that higher-income people could work at home and pay taxes, and online sales," Mazer said. "For all those reasons, as the year progressed, the feeling was that 'huh, this is not that bad.'"
"Not that there wasn't revenue lost and extremely expensive costs and complexities to delivering services," she said. "But that was the biggest surprise from a year ago when it looked like it was going to be a crater."
Two new reports this week by the Robert Wood Johnson Foundation found that states used better-than-expected tax revenues, and an infusion of federal aid and regulatory flexibility to increase key safety net programs such as food assistance, emergency rental assistance, moratoria on evictions and utility shut offs, direct payments to Medicaid providers, and expanded access to telehealth.
"States are now in a position to equitably and efficiently spend the large and temporary influx of federal relief funds," the studies concluded, adding that the challenge now is to determine what policy investments and innovations worked best and which to carry forward to best address racial and ethnic disparities and economic inequality that was exacerbated by the pandemic.
There are hopes that the pandemic will provide policymakers with a base from which to redesign safety net programs that are more nimble, holistic, and equitable, and which focus on prevention and preparation for the next public health emergency.
"One thing the pandemic taught us is that Medicaid, which is a $600 billion program covering one-in-five Americans, can move really quickly," said Matt Salo, executive director of the National Association of Medicaid Directors, during the Urban Institute roundtable.
"You can get things done quickly when the rules don't matter, but at some point, the rules are going to matter again, and things are going to slow down again, and the auditors are going to come in again, and we're going to have to take a breath, but we can do it," Salo said.
The survey found that the key to accessing telehealth was the ability to access broadband.
Slightly more than half (51%) of Californians went virtual for their healthcare during the pandemic, using either a telephone, smartphone or computer, a new survey finds.
And those new habits will likely continue when the coronavirus pandemic wanes and the public health emergency is lifted, according to the survey from the University of Southern California.
The survey of 1,650 Californians also found that 55% of workers with access to broadband have been working from home full- or part-time.
"The hesitancy towards remote work, learning and telehealth was swept away by necessity during the pandemic," said study lead researcher Hernán Galperin, an associate professor at the USC Annenberg School for Communication and Journalism.
"Now we’re seeing a seismic shift in the way people want to work, learn and manage health visits among those who have broadband access. Those changes give us a real opportunity to cut congestion and carbon emissions," Galperin said.
The survey found that the key to accessing telehealth was the ability to access broadband, said Sunne Wright McPeak, president and CEO of the California Emerging Technology.
"These findings call out the need for strategic broadband investments by government leaders, transportation planners and health systems to help close the digital divide, returning triple bottom-line dividends for the economy, environment and equity," McPeak said.
The survey also found that telehealth eliminates vehicle trips and reduces waiting times and time away from work. However, those benefits are not shared equally, owing largely to income, educational levels, and a lack of access to broadband in remote areas and underserved communities of color.
More than half of Hispanics (56%) said they didn’t use telehealth, compared with 44% of non-Hispanics. One-third (34%) of White respondents said they didn't use telehealth, as did 44% of Black respondents, and 54% of Asians.
Among Hispanics, 56% report no use of telehealth compared to 44% of non-Hispanics, likely reflecting both their lack of access to health care and internet. The first survey released in March reported that low-income households, and particularly low-income Spanish-speaking households, were more likely to have no or limited home internet access.
"Telehealth access is a vital component of broadband access and equity," said Dorian Traube, associate professor at the USC Suzanne Dworak-Peck School of Social Work, and a contributor to the survey.
"While the COVID-19 pandemic opened new access points for patients, disparities still exist in access related to essential social determinants of health, including race and place of residence. Closing the digital divide holds promise for increasing health equity," she said.
Although less tech-savvy and less likely to be connected to the Internet, seniors aged 65 and older also used telehealth more than any other demographic, with most seniors access services.
Within California, the Bay Area has the highest telehealth engagement in California, with 58% of respondents from the area reporting that they used telehealth, followed by Inland Empire, Orange and San Diego counties and the Central Valley.
Los Angeles County had the lowest level of telehealth participation at 46%.
The 308-bed, tertiary care hospital will be renamed St. Elizabeth's Medical Center, A Boston University Teaching Hospital.
For-profit Steward Health Care's flagship St. Elizabeth's Medical Center will become a teaching hospital for Boston University School of Medicine, the stakeholders announced Monday.
The partnership "expands medical education programs at the hospital and gives additional resources to physicians, including teaching opportunities and broader research collaboration," according to a media release.
Michael Callum, MD, president of Steward Medical Group, Executive Vice President for Physician Services, and a BU School of Medicine Graduate called the partnership with Boston University School of Medicine is "the latest example of Steward investing in our local communities."
"St. Elizabeth's programs of excellence rival the quality of other academic medical centers – but at a better value to patients, payors and employers," Callum said.
The 308-bed, tertiary care hospital will be renamed St. Elizabeth's Medical Center, A Boston University Teaching Hospital.
Karen Antman, MD, BU Medical Campus provost and dean of the School of Medicine, said the agreement will expand the numbers of medical students, physician assistants, mental health and genetics counselors who will do clinical rotations at St. Elizabeth's.
"The education of future clinicians requires hands-on patient care experiences, small-group or even one-on-one teaching. Ideally each student is part of the team that cares for a number of patients, with increasing levels of responsibility under close supervision," Antman said. "This new arrangement with St. Elizabeth's will help us achieve that objective."
St. Elizabeth's Medical Center recently opened a 10-bed intensive care unit and a "hybrid operating room" and has committed to investing $100 million in capital improvements for the hospital, which opened in 1868.
Physician-owned Steward, based in Dallas, operates 34 hospitals in nine states, 11 of which are teaching hospitals, and in Colombia, and Malta.
C-section rates varied widely between hospitals in California before the initiative with no particular reason.
A four-year, Stanford-led initiative to reduce C-sections for low-risk, first-time mother in California is paying dividends, a new study finds.
The study, published in the Journal of the American Medical Association, found that the initiative slightly exceeded national goals and led California to become the first state in the nation to reach a sustained reduction in C-sections.
C-section rates varied widely between hospitals in California before the initiative with no particular reason, said study senior author Elliott Main, MD, clinical professor of obstetrics and gynecology at Stanford Medicine.
"We had pregnant women going to different hospitals in California and, through one door, the cesarean delivery rate was 15%, while through another it was 60%," Main said. "That wasn't right."
The study examined several coordinated initiatives in California to reduce C-sections between 2015 and 2019, including annual public reporting of hospital C-section rates, messaging to the state's 238 hospitals, as well as state agencies and payers, and quality improvement programs targeting hospitals with the highest C-section rates.
As a result of those efforts, the study found that the initiative reduced the percentage of first-time California mothers with low-risk pregnancies who underwent C-sections from 26% in 2014 -- a rate equal to the current national average – to 22.8% in 2019, putting the Golden State below the 23.9% target put forward by the Centers for Disease Control and Prevention in its Healthy People 202 initiative.
"It's a big change from the U.S. average, and our collective efforts have not only significantly lowered the average rate for the state but also narrowed the variation between hospitals in California," Main said. "This is great news for California women, especially because we have preserved and even improved on babies’ outcomes at the same time."
When appropriate, Main said, C-sections can be lifesavers for babies and their mothers, but they also carry risks. C-sections are considered major surgery and thus create potential complications, longer recovery periods, and endanger future pregnancies than vaginal births.
The study identified several factors that have nothing to do with the health or safety of the patients as factors driving C-section rates, including hospital policies, the culture of the labor delivery unit, and the attitudes of individual doctors and nurses.
"Getting healthcare providers to change their behaviors is difficult, but this was a concerted effort with many layers of support for our hospital teams," said the study lead author, Melissa Rosenstein, MD, associate director for implementation science at the California Maternal Quality Care Collaborative and an assistant professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
"After we shared multiple strategies and provided every hospital with an analysis of its own data, each hospital chose the approach, or approaches, it wanted to work on," Rosenstein said.
The sweeping proposed rule also calls for a 2.8% IPPS rate increase for FY22, and creates 1,000 new residency slots to bolster the healthcare workforce in rural and underserved areas.
The Centers for Medicare & Medicare Services on Tuesday unveiled a sweeping proposed rule that would nullify the mandated public disclosure of negotiated rates between payers and providers and increase by 2.8% Medicare's inpatient prospective payment in fiscal year 2022.
"The rule's provisions seek to sustain hospital readiness to respond to future public health threats, enhance the health care workforce in rural and underserved communities, and revise scoring, payment and public quality data reporting methods to lessen the adverse impacts of the pandemic and future unplanned events," CMS said in a media release, adding that the proposed repeal of "collection of market-based rate information on the Medicare cost report and the market-based MS-DRG relative weight methodology… will avoid imposing additional unnecessary burden on hospitals."
Not surprisingly, provider groups were elated.
"Based on our initial review, we are very pleased CMS is proposing to repeal the requirement that hospitals and health systems disclose privately negotiated contract terms with payers on the Medicare cost report," Tom Nickels, executive vice president of the American Hospital Association said in a media release.
"We have long said that privately negotiated rates take into account any number of unique circumstances between a private payer and a hospital and their disclosure will not further CMS's goal of paying market rates that reflect the cost of delivering care," he said. "We once again urge the agency to focus on transparency efforts that help patients access their specific financial information based on their coverage and care."
CMS said the IPPS 2.8% net rate increase would apply to hospitals "that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users."
"This reflects the projected hospital market basket update of 2.5% reduced by a 0.2 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by legislation," CMS said.
With the aim of bolstering the nation's badly understaffed healthcare workforce in rural and underserved areas, the proposed rule also would distribute 1,000 new physician residency slots over five years to hospitals in healthcare deserts, phasing in 200 slots per year over five years, at a Medicare-funded cost of about $300 million a year.
"Hospitals are often the backbone of rural communities – but the COVID-19 pandemic has hit rural hospitals hard, and too many are struggling to stay afloat," Health and Human Services Secretary Xavier Becerra said in a media release. "This rule will give hospitals more relief and additional tools to care for COVID-19 patients and it will also bolster the healthcare workforce in rural and underserved communities."
Nickels said the additional slots will "help ease current physician shortages and bolster the foundation of our healthcare system."
CMS said it also wants to hear suggestions from stakeholders about policy changes that could facilitate healthcare equity.
"This includes enhancing hospital-specific reports that stratify measure results by Medicare/Medicaid dual eligibility and other social risk factors, ways to improve demographic data collection, and the potential creation of a hospital equity score to synthesize results across multiple measures and social risk factors," CMS said.
The proposed rule also would: extend new COVID-19 treatments and add-on payments through the end of the fiscal year, when the public health emergency is supposed to end; "suppress" most hospital value-based purchasing metrics, resulting in neutral payment adjustments for hospitals; exclude 2020 pandemic-tainted data when measuring hospital-acquired conditions in fiscal years 2022 and 2023; discount pneumonia readmissions to FY 2023 hospital readmission penalties, and exclude COVID-19 patients from the other five readmissions measures.
CMS is accepting comments on the proposed rule through the end of June.
Molina said it will fund the purchase with cash on hand, and the deal is expected to be finalized by the end of 2021.
Molina Healthcare, Inc. will spend $60 million to buy Cigna Corp.'s Texas Medicaid and Medicare-Medicaid Plan, the two companies announced Thursday.
Cigna's Texas Medicaid and MMP health plan serves 48,000 Medicaid beneficiaries in the Hidalgo, Tarrant, and Northeast service areas, and 2,000 MMP members in the Hidalgo service area, with full year 2020 premium revenues of $1 billion.
Long Beach, California-based Molina said it will fund the purchase with cash on hand, and the deal is expected to be finalized by the end of the 2021, pending regulatory approval.
"Acquiring Cigna's Texas Medicaid business provides us with a stable base of membership and revenue that will deepen Molina’s service offerings in Texas, allowing us to meet the needs of thousands of additional Medicaid and MMP members," Molina said in a media release. "The transaction demonstrates continued execution and is nicely representative of our growth strategy."
Bloomfield, Connecticut-based Cigna said in a statement: "We are proud of the positive impact we have made on customer lives through our Texas Medicaid business, and are confident that Molina will build on our work to improve their health, well-being, and peace of mind. We remain fully committed to the state of Texas, and look forward to continuing to bring affordable, predictable, and simple health care solutions to the millions of Texans we serve through our Medicare, Commercial, and Health Services businesses."
Median net patient revenue for not-for-profit health systems was $1 billion in fiscal 2020, nearly double the $568 million in 2010.
Hospital partnerships, affiliations, and mergers and acquisitions "will continue at a robust pace in the healthcare sector in 2021," extending a decade-long consolidation trend in both the not-for-profit and for-profit sectors, Moody's Investors Service said in a new report.
"Larger health systems will pursue M&A to increase market share through geographic and service line diversification," Moody's said in its April Healthcare Quarterly report. "As COVID-19 takes a toll on financial performance, smaller providers will look to partner to gain access to clinical, strategic, and financial resources and reduce labor, supply and information technology expenses."
The report noted that median net patient revenue for not-for-profit health systems was $1 billion in fiscal 2020,1 nearly double the $568 million in 2010.
Moody's credited the steady increase of revenues for not-for-profit health systems over the past decade to provider consolidation, because bigger systems have greater leverage with payers. In addition, larger systems offer better access to pricey clinical resources for complex money-making procedures.
While Coronavirus Aid, Relief and Economic Security (CARES) Act money, Medicare accelerated payments and expense reductions have offset pandemic-related losses, Moody's said that relief "will be temporary as hospitals will need to repay Medicare for the payment advances while volumes will likely remain at lower-than-historical levels."
"Smaller systems may find it more difficult to repay the Medicare funds, given lower liquidity and less financial flexibility than larger health systems," Moody's said. "And partnerships provide an opportunity to lessen financial challenges, such as an increasingly more expensive workforce."
Moody's said M&A will allow larger health systems to diversify revenue streams, which will become more important with a weakening payer mix, particularly in areas where Medicare, Medicaid, and other government insurers are the dominant payers.
"An aging population will exacerbate the trend as an increasing number of older Americans shift to Medicare and, at least during the economic downturn, if people out of work move to Medicaid coverage," Moody's said. "Additionally, organic growth will be constrained by an increasing level of patient care moving to lower-cost, non-hospital settings, including those operated by nontraditional providers, which drives down potential reimbursement revenue."
Moody's also anticipates that independent physicians will affiliate with larger health systems offering financial incentives. "Physician burnout and the financial impact of the pandemic-related shutdown in elective services also stands to drive hospital/physician partnerships or acquisitions," Moody's said.
For-profits Flush with Cash
For-profit health systems are flush with cash thanks to CARES Act money and rapid cost reductions because of the pandemic, Moody's said, and that will push M&A activity in the for-profit sector for the next 12-to-18 months.
"Consolidation will be focused on enhancing services provided outside the hospital as consumers seek more access points and flexibility," Moody's said. "Flush with liquidity, for-profit hospitals will focus M&A efforts on building capabilities in non-hospital settings to meet consumer demand."
Some for-profit systems refused CARES Act funds or returned it, which Moody's said illustrates their continued financial health during the pandemic. "HCA Healthcare, Inc. (Ba1 stable), for example, returned its funds, but liquidity improved substantially in fiscal 2020," Moody's said.
U.S. Chamber of Commerce, Harvard Pilgrim, Ascension, and others back audio-only Medicare Advantage bill.
A group of 33 business leaders and healthcare stakeholders have signed on to a letter urging Congress to support legislation allowing the use of audio-only telehealth for Medicare Advantage risk adjustments.
The bipartisan Ensuring Parity in Medicare Advantage for Audio-Only Telehealth Act of 2021, sponsored by Senators Catherine Cortez Masto (D-NV) and Tim Scott (R-SC) and Representatives Terri Sewell (D-AL) and Gus Bilirakis (R-FL), would protect continuity of care for Medicare Advantage beneficiaries during the COVID-19 pandemic by allowing the use of audio-only telehealth for risk adjustment purposes.
The House bill would also allow audio-only telehealth visits for Programs of All-Inclusive Care for the Elderly (PACE) organizations.
"It is essential that the collection of diagnoses required for risk adjustment be as complete and as accurate as possible," the letter said. "Action by Congress now will … provide relief necessary for Medicare Advantage and PACE organizations, allowing them to continue to provide high quality, affordable care to millions of Medicare beneficiaries."
A study published last August in JAMA Internal Medicine found that 41% of Medicare beneficiaries lacked access to a computer with a highspeed internet connection in their home, and that 41% didn't have a smartphone with a wireless data plan. More than one in four (26.3%) of beneficiaries had neither form of digital access.
Those numbers worsened depending upon the beneficiaries' socioeconomic groups, with half (50.9%) of beneficiaries with an income of 100% below federal poverty level lacking digital access, compared with 11.5% of beneficiaries with income 400% or more above the federal poverty level.
Led by the Better Medicare Alliance, the letter's cosigners include the U.S. Chamber of Commerce, Ascension, Harvard Pilgrim Health Care, Northwell Health, SummaCare, UPMC Health Plan, the American Physical Therapy Association, LeadingAge, and the Visiting Nurse Associations of America.
Better Medicare Alliance President and CEO Allyson Y. Schwartz noted that "telehealth has been a lifeline for older Americans amid COVID-19, but challenges persist."
"Limited access to broadband internet, financial constraints, and functional limitations are real barriers for many vulnerable Medicare Advantage beneficiaries," she said. "Use of audio-only telehealth brings greater equity during the COVID-19 response, as it ensures all seniors have the opportunity to use virtual care options that meet their needs."
