AMA president applauds the initiatives announced this week but calls them 'just a first step.'
President Joseph R. Biden's proposals to require serial numbers and background checks for "ghost guns" and model legislation for "red flag" laws that identify potentially dangerous gun owners are getting healthy reviews from physicians.
Susan R. Bailey, MD, president of the American Medical Association, applauded the administration for its "bold action" on a "public health crisis" that claims more than 40,000 lives each year, but stressed that the proposals "are just a first step."
"People die every day—and almost every place—in our country from firearm-related injuries. Movie theaters, grocery stores, places of worship, and elementary school classrooms have all been scenes of violence," Bailey said in prepared remarks. "Most of these deaths are preventable, and now is the time for lawmakers, policy leaders and advocates on all sides to seek common ground and save lives."
The AMA in 2016 declared firearm-related violence a public health crisis and one of the leading causes of intentional and unintentional injuries and deaths in the United States.
Biden on Thursday rolled out the initiative, which comes in the wake or shootings in Georgia and Colorado that have claimed 18 lives. The president called the nation's gun violence epidemic "a national embarrassment,"
He also conceded that his options to address the problem through executive authority are limited and that more aggressive action to curb gun violence would require action from Congress.
"We’ve got a long way to go — it seems like we always have a long way to go,” Mr. Biden said during an appearance in the Rose Garden, The New York Times reported.
Jacqueline W. Fincher, MD, president of the American College of Physicians, said the initiatives put forward this week by Biden "are consistent with the types of recommendations that ACP put forward in our 2018 policy paper Reducing Firearm-Related Injuries and Deaths in the U.S."
"In the past year, even as the US has been fighting a global pandemic, injuries and deaths from firearms increased more than any other year in the past two decades," Fincher said. "Advocating for policies, like those announced today, to reduce the toll of these injuries and deaths is in the medical profession’s lane—this is our lane —as is any issue the causes harm to our patients and could be prevented by sound public policy."
Fincher called on Congress to step up and advance other gun control measures, including universal background checks on firearms sales and a ban on assault weapons.
"Deaths and injuries from firearms are avoidable and preventable," Fincher said. "Changing the laws that surround the purchase and use of guns, in ways that are fully consistent with the second amendment, is something that must be done in order to end this crisis that America is facing."
More than half (54%) of government hospitals, 36% of nonprofits, and 43% of for-profits provided less than $1 of charity care for every $100 of expenses.
Tax-exempt nonprofit and government hospitals aren't meeting their obligations for charity care, according to a new study in Health Affairs.
Using 2018 Medicare data that compared charity care at 1,024 government, 2,709 nonprofit, and 930 for-profit hospitals, researchers from Johns Hopkins University’s Carey Business School and Bloomberg School of Public Health found that nonprofit hospitals spent $2.3 on charity care out of every $100 in total expenses, which was lower than government ($4.1) or for-profit ($3.8) hospitals.
The report also found that 54% of government hospitals, 36% of nonprofits, and 43% of for-profits provided less than $1 of charity care for every $100 of expenses.
"A large number of government and nonprofit hospitals provided little charity care," said study lead author Ge Bai, an associate professor at Carey Business School. "That seemed badly out of sync with the favorable tax treatments that these hospitals enjoy. Government and nonprofit hospitals should not have their cake and eat it, too."
"The reality is that just as other critical infrastructure, including our nation’s roads, bridges and transit systems, have aged, so too have many of our nation’s hospitals," American Hospital Association President and CEO Rick Pollack said in a March 31 letter to the president. "Many hospitals faced financial challenges prior to the pandemic, but COVID-19 has brought unprecedented financial losses."
AHA General Counsel Melinda Hatton on Wednesday challenged the Johns Hopkins findings. She cited a 2017 Ernst and Young reportshowed that for every dollar invested in non-profit hospitals and health systems through the federal tax exemption, $11 in benefits is delivered back to communities.
"The authors of this report fail to recognize that charity care is only one part of a hospital’s total community benefit," Hatton said in an email to HealthLeaders.
"Looking only at charity care does not account for the numerous programs and services that hospitals provide to meet the varied needs of their community, such as help accessing healthy food, educational programs and health screenings, transportation to ensure patients arrive at needed medical appointments, and assistance with housing and other efforts to address the social determinants of health, among many others," Hatton said.
Bai said hospital charity care obligations aren't a high priority for the Internal Revenue Service, which he said "doesn't specify any requirements for charity care or community benefits offered by a nonprofit hospital."
"On top of that, the IRS faces significant challenges in overseeing these activities or using them to determine tax-exempt eligibility. When charity care is a matter of little consequence, hospitals are not motivated to provide more," Bai said.
To move the needle, the study authors recommended a publicly disclosed ranking system for hospital charity care for all three ownership types.
"As a special form of the transparency approach, [ranking] has the potential to overcome the shortcomings of bright-line rules and promote competition among hospitals to provide more charity care," the researchers said.
“As a special form of the transparency approach, [ranking] has the potential to overcome the shortcomings of bright-line rules and promote competition among hospitals to provide more charity care,” the researchers write.
They also recommend revising the tax code to bring hospitals' provision of charity care more into line with their tax status.
AMA survey finds 94% of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers.
Even as COVID-19 cases were spiking in late 2020, physicians complained that health insurance companies were continuing to demand prior authorization for patient care, a new survey shows.
According to the findings, commissioned by the American Medical Association, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 said payers had either gone back to past prior authorizations policies or never relaxed these policies in the first place.
Ninety-four percent of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers, the survey found.
AMA President Susan R. Bailey, MD, said some payers had relaxed prior authorization requirements at the onset of the pandemic in early 2020, but that that changed as the public health emergency wore on.
"By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care," Bailey said.
The survey also found that 30% of physicians reported that prior authorization requirements led to serious adverse events for patients in their care, including:
Patient hospitalization – reported by 21% of physicians;
Life-threatening event or intervention to prevent permanent impairment or damage – reported by 18% of physicians;
Disability or permanent bodily damage, congenital anomaly, birth defect, or death – reported by 9% of physicians.
The survey also found that:
Only 15% of physicians reported that prior authorization criteria were often or always based on evidence-based medicine.
90% reported that prior authorizations programs have a negative impact on patient clinical outcomes.
85% said the burdens associated with prior authorization were high or extremely high.
Medical practices complete an average of 40 prior authorizations per physician, per week, which consume the equivalent of two business days (16 hours) of physician and staff time.
40% of physicians employ staff who work only on prior authorizations.
Bailey said the findings illustrate the need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery.
"Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency," she said. "This hard- learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification."
The same surveys found that public trust in the U.S. Postal Service and the FEMA bumped up significantly over the same period.
The public's trust in the Centers for Disease Control and Prevention dropped during the coronavirus pandemic, according to a new RAND study.
Surveys of more than 2,000 people in May and October 2020 show about a 10% drop in trust of the CDC over that period, with the overall population-level trust in the agency falling to the same lower level of trust long held by Black Americans about the agency.
In contrast, the same surveys found that public trust in the U.S. Postal Service and the Federal Emergency Management Agency bumped up significantly over the same period, despite those agencies facing their own challenges.
"The Biden administration will have an uphill battle in rehabilitating trust in the CDC at this critical junction in the coronavirus pandemic," said Michael Pollard, lead author of the study and a senior social scientist at nonprofit RAND.
"A key challenge in the months ahead will be to identify who will be viewed as trusted messengers regarding vaccines and public health policies," Pollard said.
The study found that non-Hispanic whites and Hispanics reported significant declines in trust in the CDC, while the changes were not statistically significant for non-Hispanic Black or "other race" respondents.
"There is remarkable consistency and convergence in reported levels of trust in the CDC across these subgroups after the declines," Pollard said. "Lack of trust among Black Americans has been a well-publicized concern regarding the COVID-19 vaccine rollout, and the convergence in lower levels of trust across race/ethnicity highlights a key challenge that the CDC now faces."
Black Americans have long held a low level of trust in healthcare institutions, widely seen as a legacy of past racism in the nation's health system, Pollard said.
The survey respondents, all members of RAND's American Life Panel, were asked in May to rate their trust in the CDC, USPS and FEMA on a scale of 0 to 10, and again in October.
Trust in the CDC fell from 7.6 in May to 7 in October. Conversely, trust in the Postal Service rose from 6.9 in May to 7.7 in October; trust in FEMA rose from 6.4 in May to 6.7 in October.
Drop in trust of the CDC was notable among people who intended to vote for Donald Trump or another candidate other than Joe Biden in the 2020 presidential election or did not intend to vote at all. Pollard said that finding suggests that views of the CDC are now strongly politicized, although similar politicization was not observed for FEMA or the USPS.
"The public trust in federal government agencies has never been as important as during the current COVID-19 pandemic, yet public suspicions of scientific experts and distrust of government institutions are increasing for a variety of reasons," said Lois Davis, co-author of the report and a senior policy researcher at RAND.
"Reasons for this include a blurring of the line between opinion and fact, and access to more sources of conflicting information," Davis said.
Davis said the CDC could rebuild trust and depoliticize public's views of the agency by ensuring that the public understands the scientific rationale for policy changes and guidance during the COVID-19 pandemic.
HHS said four out of five consumers now enrolled in a plan through HealthCare.gov will be able to find a plan for $10 or less per month with additional ARP assistance.
Many beneficiaries enrolled in Marketplace health plans will see their premiums decrease, on average, by $50 per person per month and $85 per policy per month thanks to expanded financial assistance under the American Rescue Plan, the Department of Health and Human Services announced Thursday.
HHS said four out of five consumers now enrolled in a plan through HealthCare.gov will be able to find a plan for $10 or less per month with additional ARP assistance.
Additionally, with advanced payments of premium tax credits, an average of three out of five uninsured adults eligible for coverage on HealthCare.gov may be able to access a zero-premium plan and nearly three out of four may find a plan for $50 or less per month on HealthCare.gov, HHS said.
"Today help is here and millions of Americans can start saving money on their health insurance premiums thanks to the American Rescue Plan," HHS Secretary Xavier Becerra said in a media release. "The Biden Administration is committed to bringing down healthcare costs for families."
To spread the word on the new plan options during the special enrollment period, Becerra said HHS has launched a $50 million public awareness campaign.
Consumers who want to enroll in coverage and see if they qualify for more affordable premiums can visit HealthCare.gov or CuidadoDeSalud.gov to view 2021 plans and prices and, if eligible, enroll in a plan that best meets their needs.
Additionally, consumers can call the Marketplace Call Center at 1-800-318-2596, which helps in more than 150 languages.
Consumers in states that operate their own Marketplace platforms should visit those state websites or call centers.
AHA President and CEO Rick J. Pollack tells President Biden that the COVID-19 pandemic has crippled the nation's hospitals.
The nation's hospitals want a share of the $2 trillion infrastructure plan put forward on Wednesday by President Joseph R. Biden.
In a letter Wednesday to the president, American Hospital Association President and CEO Rick J. Pollack noted that healthcare is one of the 16 critical infrastructure sectors designated by the Department of Homeland Security, and that the ongoing COVID-19 public health emergency has left hospitals badly strained.
"As your Administration works with Congress to develop policies aimed at rebuilding our nation's critical infrastructure, as reflected in today's announcement, we urge you to prioritize support for healthcare and its vital role in addressing critical challenges including health equity, emergency preparedness, access to care and more," Pollack said.
"The reality is that just as other critical infrastructure, including our nation’s roads, bridges and transit systems, have aged, so too have many of our nation’s hospitals," Pollack said. "Many hospitals faced financial challenges prior to the pandemic, but COVID-19 has brought unprecedented financial losses."
Pollack pointed to AHA estimates that the nation's hospitals lost more than $320 billion in 2020 and would lose as much as $120 billion in 2021 because of the pandemic and the ensuing shutdown of nonessential healthcare services.
"These compounding financial pressures have resulted in delays in necessary capital spending, including for needed maintenance and physical plant upgrades," he said. "In addition, some hospitals that are in the greatest need of repair have the greatest barriers to accessing capital."
Without providing a specific cost estimate, Pollack offered recommendations for healthcare infrastructure improvements that included:
Investing in hospital physical infrastructure, including physical plant upgrades, mechanical systems, IT, medical equipment, and supplies. "In addition, hospitals face the added challenge of needing to reconfigure care delivery and “right-size” so that they can continue to transform to meet the needs of the healthcare system for the future in an effort to make care more accessible and convenient for patients," Pollack said.
Building emergency preparedness and response capacity through continued funding and structural improvements for the Hospital Preparedness Program. "The COVID-19 experience reinforces the need for sustained federal investment to support increased capacity for emergency preparedness and response," Pollack said.
Expanding healthcare digital and data infrastructure, including access to adequate, affordable broadband to enable telehealth and increase access to care, particularly for remote and underserved areas, hardening cyber defenses to protect patient privacy, and modernizing data systems that support identifying issues that affect health equity, racial and ethnic disparities, care quality, and public health responses.
Strengthening the healthcare workforce by increasing the number of residency slots eligible for Medicare funding; funding educational loan pay-downs and vouchers for clinicians and other front-line workers; providing visa relief during emergency response; funding research and demonstration programs related to clinician wellbeing; establishing grants for cultural competency training in medical residency programs and in-service training for healthcare professionals; providing grants to expand, modernize and support schools of medicine and schools of nursing in rural, underserved areas or minority-serving organizations; and rejecting reductions to Medicare funding for direct and indirect graduate medical education.
Securing the supply chain by increasing domestic production capacity and manufacturing redundancy; and reinforcing the strategic national stockpile through continuous investment so that the equipment is available in adequate amounts when it's needed for public health emergencies.
Supporting behavioral health access with funding for new behavioral care sites; renovations to improve safety at psychiatric facilities; end-user devices to upgrade audio-video technology to support behavioral telehealth; therapeutics for children and adolescents, including mobile applications, text messaging, and remote biometrics that can assist in screenings and treatment for behavioral health conditions; and interoperable electronic health records for behavioral health providers.
Blue Cross Board Trustee Kathleen Blatz will serve as interim CEO starting on April 1.
After nearly three years at the helm, Blue Cross and Blue Shield of Minnesota President and CEO Craig Samitt, MD, will retire on May 3, the company announced Wednesday.
Kathleen Blatz, a former Minnesota Supreme Court Chief Justice and a Blue Cross Board of Trustees member for more than a decade, will serve as interim CEO starting on April 1, while the board looks for Samitt's replacement.
Blatz also served as interim president and CEO for Blue Cross before Samitt's appointment in July 2018.
In an interview with HealthLeaders in January, Samitt said he had "mixed emotions about the future" as the healthcare sector emerges from the pandemic.
"My greatest worry is that we go back to the way things were," he said. "We've been calling it the 'Day After Tomorrow' strategy; that what happens in June can't be what it looked like a year ago. It just can't. We have to leapfrog over tomorrow and go to the day after tomorrow and be somewhat insistent and brave. It's not a 'new normal,' I hate that expression. A 'better future' is the way that I would describe it."
"I've long predicted that something would disrupt healthcare; COVID didn't break our system because so much was already broken in our industry," he said. "We either didn't recognize it or we weren't rewarded to fix it."
As one of the first healthcare executives to identify racism as a public health crisis, Samitt made racial and health equity the cornerstone of Blue Cross’ initiative to make healthcare more equitable.
"The impact of racism on health is expansive, and frankly, much greater than we have historically recognized or, frankly, been willing to admit," Samitt said in a March 25 interview with HealthLeaders.
"The mission of Blue Cross is to focus on high quality, sustainable, affordable, and equitable healthcare, [but] we are missing a huge driver of poor health and inequities if we ignore the impact that racism has on the health," he said.
Blue Cross Board Chairman Michael Robinson said the insurer would continue to push for racial and health equity, while working with providers to keep healthcare affordable, sustainable, and accessible.
"Our talented executive leadership team at Blue Cross will stay true to our nonprofit mission and will remain focused on the important work of accelerating the change that will make healthcare more accessible, more affordable, and more effective for everyone," Robinson said in a media release.
Before joining Blue Cross of Minnesota in mid-2018, Sammit worked at Anthem, Inc., where he was president of Anthem's Diversified Business Group, and chief clinical officer.
Blatz was Chief Justice of the Minnesota Supreme Court from 1998 to 2006. She joined the Blue Cross Board of Trustees in 2009.
In 2017, Blatz spent five months as interim chair of the Metropolitan Sports Facilities Authority, which oversees the operations of U.S. Bank Stadium in Minneapolis.
At issue is the so-called 'competitive impact' conditions attached to the affiliation by the AG's office that state regulators said would ensure that the consolidation does not raise prices for consumers in the affected service areas.
Cedars-Sinai and Huntington Hospital have filed a lawsuit against the California Attorney General's Office, claiming that state regulators have slapped burdensome and unprecedented conditions on their proposed affiliation.
At issue is the so-called "competitive impact" conditions attached to the affiliation by the AG's office that state regulators said would ensure that the consolidation does not raise prices for consumers in the affected service areas.
Notably, the deal would require price caps on Huntington's negotiated rates with insurance companies for at least 10 years, without any requirement that the insurance companies pass their savings on to consumers, the suit alleges.
Huntington and Cedars-Sinai would also be required to submit to insurance companies' demands for "winner-take-all" arbitration in contract negotiations any time that a payer wanted to do so. No other hospital in California is subject to such conditions, the hospitals claim.
"We are shocked at the unprecedented over-reach of the conditions being imposed," Lori J. Morgan, MD, MBA, president and CEO of the not-for-profit Huntington Hospital, said in a media release.
"Rather than benefitting our community, the conditions primarily benefit health insurance companies," Morgan said.
The California AG's office issued a statement defending the requirements.
"The priority of the California Department of Justice is to ensure the proposed affiliation of Huntington Memorial Hospital with Cedars-Sinai Health System safeguards the availability and accessibility of healthcare for the people of Greater Los Angeles, and protects public funds," the AG's office said. "The conditions we attached to this affiliation will keep the healthcare market competitive for the consumers served by these hospitals."
Under the proposed deal, which was announced in March 2020, the 619-bed, Pasadena-based Huntington Hospital would continue to operate independently from the three-hospital Los Angeles-based Cedars-Sinai. As part of the affiliation, the Cedar-Sinai would invest in the Huntington's information technology infrastructure, along with its "ambulatory services and physician development."
The suit, filed in Los Angeles County Superior Court, claims the two hospitals worked in good faith with state regulators to resolve issues around provisions of care for their respective patient communities that included maintenance of operations and services and capital improvements, maintaining access to reproductive health services, and ensuring there is no discrimination against LGBTQ patients.
"However, the Attorney General added the unprecedented "competitive impact" conditions, despite the fact that the Federal Trade Commission's analysis of the proposed affiliation did not find any concern that the affiliation would lessen competition," the suit alleges. "The Attorney General's office has never imposed such conditions on any previous nonprofit hospital affiliation."
Cedar-Sinai President and CEO Thomas M. Priselac said the common measure of market competition used by the Federal Trade Commission shows that the Huntington affiliation would not lessen competition, because there is little overlap between Huntington's service area and Cedars-Sinai's.
Instead, the suit alleges that the AG's office used an "unvalidated academic theory" called "cross-market effects" that assumes that Huntington and Cedars-Sinai would engage in "all-or-nothing" negotiations with health insurers to accept the same terms for both Cedars-Sinai and Huntington.
The two health systems said they had agreed to not engage in such negotiations with payers for 10 years, but the AG rejected the proposal "even though its own expert's 'cross-market effect' analysis confirmed that such a commitment would remove any concerns regarding competition," the suit alleges.
Atrium Health Virtual Edge will partner with other hospitals, employers and commercial payers to deliver clinically appropriate, consumer-oriented care.
Atrium Health this week announced the launch of an expansive telehealth platform that will give patients a wide range of virtual primary and specialty care options.
"Virtual health is no longer a nice-to-have or an augmentation of care," said Scott Rissmiller, MD, executive vice president and chief physician executive for Atrium Health. "It is an essential and necessary way of clinical care delivery and customer service for any healthcare system. It allows us to deliver affordable, accessible care for all."
During the pandemic, the Atrium Health Hospital at Home program allowed tens of thousands of COVID-19 patients to be treated virtually, freeing bedspace and conserving staff time and personal protective equipment.
The virtual program has since been extended to cardiac patients, a process that Rissmiller said is the product of a decade of telehealth innovation at Atrium Health, a 42-hospital health system based in Charlotte, NC.
"Since the beginning, our goal has been crystal clear; to make virtual health an everyday part of how we care for patients," Rissmiller said. "We realized years ago that there were cost factors, convenience factors and access issues that could be improved upon through advancements in virtual care delivery. With dozens of rural hospitals closing their doors, we recognized that we could extend the reach of our renowned clinicians to help more people through virtual care."
The new remote care platform, Atrium Health Virtual Edge, will partner with other hospitals, employers and commercial payers to deliver clinically appropriate, consumer-oriented care that could also extend to patients living in remote and underserved areas, said Katie Kriener, senior vice president of Medical Group Operations for Atrium.
"Within Atrium Health Virtual Edge, our critical care, neurology, stroke, psychiatry, infectious disease and hospitalist programs all offer virtual hospital-based services, providing access to specialty care, while also helping balance provider supply," Kriener said.
Atrium has seen substantial, tangible results from its virtual offerings, Kriener said.
"We've achieved significant improvement in mental health and cost, including greater than 40% remission rates, 27% reduction in avoidable inpatient visits and 7% reduction in avoidable emergency department visits," she said.
Atrium also uses virtual, school-based clinics, providing students with increased access to care during school hours, which Kriener said has yielded 55% fewer avoidable emergency department visits and a 33% reduction in school absences.
An AMA analysis shows the highest prevalence of medical liability premium increases since 2005.
Nearly one-third (31%) of liability insurers increased their premiums at the height of the COVID-19 pandemic in 2020, the highest percentage in 15 years, an American Medical Association analysis shows.
The analysis found that, for a second straight year, there was a big surge in the percentage of premiums with a year-to-year increase. Between 2010 and 2018, the share of premiums that increased maintained a somewhat stable pattern, ranging from 12% to 17%. In 2019, that proportion almost doubled to 26.5% and went up again in 2020 to 31.1%, the analysis found.
However, the analysis noted that it's not clear if the pandemic was to blame for the premium increases, or if they were already in the works when the public health emergency was declared.
"The responsiveness of premiums to changes in their determinants and external factors takes considerable time in the medical liability insurance market," the analysis said. "Therefore, although some 2020 premiums may have been set after the onset of the [COVID-19] pandemic, it was still too early for them to be affected by it."
AMA President Susan R. Bailey, MD, said the premium hikes came at a difficult time for physicians.
"Increases in medical liability premiums compound the economic stress on medical practices as the COVID-19 pandemic resulted in significant reductions to patient volume and revenue, and higher expenses for scarce medical supplies," she said.
"Practice revenue has not fully recovered as the pandemic has stretched on and a protracted upward trend in medical liability premiums will threaten the viability of many practices that already face a difficult road to recovery.
The analysis identified the 14 states that had premium increases of 10% or more. Those states are: Kentucky (29.6%), South Carolina (27.8%), Maryland (18.8%), Nebraska (16.7%), Oregon (16.7%), Montana (16.7%), Georgia (14.8%), Missouri (14.8%), New Hampshire (13.3%), Illinois (11.9%), Michigan (11.6%), Texas (9.2%), North Carolina (6.7%), and Virginia (1.3%).
There was also a striking difference in premiums by geography. For example, in 2020 physicians in OB/GYN faced base premiums ranging from $49,804 in Los Angeles County, California to $205,380 in Miami-Dade County, Florida.
"Keeping medical liability premium growth in-check is imperative to ensure patient access to care is not jeopardized by unaffordable liability insurance costs that make it impossible for physicians to remain in practice," Bailey said. "This concern is particularly pressing given the negative impact that the COVID-19 pandemic has had on access and practice viability, as many physicians have had to suspend patient visits or elective procedures, and some have had to close their practices."
