Executive orders to fix the PPE supply chain, expedite and accelerate vaccinations, and address healthcare disparities are roundly lauded.
President Joseph R. Biden's plan to subdue the coronavirus pandemic is being greeted with cheers from the nation's largest provider organizations.
Rick Pollack, president and CEO of the American Hospital Association, said the executive orders, which the president signed on Thursday, would "help increase coordination and communication among all stakeholders involved in vaccination efforts and increase access to COVID-19 vaccines, treatments and care. Importantly, they will lead to more adherence to the public health measures we know work, especially mask wearing."
"In particular, we are pleased that the Administration will use all the tools at their disposal, including increased use of the Defense Production Act (DPA), to accelerate the availability of the supplies and equipment needed to fight COVID-19," Pollack said.
"This includes personal protective equipment for our heroic front-line caregivers and supplies needed to ramp up testing and vaccinations," Pollack said. "We know the DPA may not be able to solve all equipment shortages, but it will certainly help."
American Medical Association President Susan R. Bailey, MD, said the AMA since March has called for a coordinated federal response to the pandemic. She said the steps taken by the Biden administration "will quickly fix the supply chain issues that have plagued the U.S. for many months—providing health care professionals with the PPE they need to protect themselves, their patients, and families from illness, ramping up testing to identify COVID-19 illness more quickly, and getting the vaccines into more arms."
Bruce Siegel, MD, president and CEO of America's Essential Hospitals noted that the pandemic has disproportionately harmed "communities of color and other underserved populations."
"We are grateful for the president's pledge to create a COVID-19 Health Equity Task Force, improve access to treatment, and enhance COVID-19 data collection, as well as a renewed dedication to fill medical supply shortfalls in communities in need," Siegel said.
Federation of American Hospitals President and CEO Chip Kahn said Biden's executive orders "made it clear we are at war with COVID-19."
"President Biden aptly recognizes that to regain our nation’s health - both physical and economic - will require Americans grasp the critical importance of masking up, as well as the need for the federal government to turn to vaccine dispensing at warp speed," Kahn said."He is also rightly focused on increasing the inventory of necessary PPE, and other important supplies, through the implementation of the Defense Production Act," Kahn said. "The use of DPA must be focused on providing what has not been available, while allowing the supply chain that is working to do its job."
Sr. Mary Haddad, RSM, president and CEO, Catholic Health Association of the United States, called President Biden's executive orders "an encouraging first step for a highly coordinated federal response to bring the virus under control and stabilize our nation's healthcare delivery system, while providing necessary support to vulnerable individuals and families."
"We are pleased that this plan would offer additional support and resources for frontline workers in hospitals, nursing homes and long-term care facilities to protect patients and the communities they serve; provide for outreach and access to COVID-19 vaccines for all communities; expand coverage options for the uninsured and extend unemployment support; and provide vital funding for important social safety net programs that address food insecurity, housing and child care," Haddad said.
Jacqueline W. Fincher, MD, president, of the American College of Physicians, said the pandemic has exposed other troubling issues in the nation's care delivery system, including "racial disparities, immigration, poverty, and climate change that impact the health of our patients and our physician workforce."
"The initial announcements from President Biden are both good steps forward for the new administration to address many crucial issues, and a promising sign that he is going to make improving health for all Americans a priority," Fincher said.
The new hospital and a previously approved UCI Health Center for Advanced Care will create UCI Medical Center Irvine-Newport.
The University of California, Irvine on Thursday got the go-head from the state's board of regents to build a 144-bed acute care hospital, ambulatory care center and cancer center in southern Orange County.
The new hospital and a previously approved UCI Health Center for Advanced Care will create UCI Medical Center Irvine-Newport, an 800,000 square foot academic health complex on 202 acres, with a focus on pediatrics, oncology, neurology, neurosurgery, orthopedics, and digestive health, and it will include a 24-hour emergency department.
"With today's approval by the regents, UCI takes a giant leap toward fulfilling the visionary expansion of our campus and enhancing service to the community," said UCI Chancellor Howard Gillman said in a media release.
"Once this project is completed, the UCI healthcare system will be unparalleled in this region, with two advanced medical centers, nationally recognized research units conducting hundreds of clinical trials, and a network of community locations stretching to all corners of Orange County," he said.
The project costs are expected to exceed $1 billion and will be funded by philanthropic donations, retained earnings and revenue from UCI Health operations.
Construction will begin this year, starting with the groundbreaking for the UCI Health Center for Advanced Care, a multicare facility that will house the Center for Children’s Health, medical offices and an urgent care operation. The first patients are expected in late 2022.
The medical center will connect with the UCI Health primary care network throughout Orange County and will serve as a feeder for flagship UCI Medical Center in Orange, a 418-bed tertiary-quaternary care center.
Tripathi, who most recently served as chief alliance officer at Arcadia, replaces Don Rucker, M.D., who has led the office since April 2017.
Healthcare technology stakeholders are hailing the news that veteran interoperability savant Micky Tripathi has been picked to lead the federal government's Office of the National Coordinator for Health Information Technology.
The announcement was made this week by the Department of Health and Human Services.
Tripathi, who most recently served as chief alliance officer at Arcadia, a Burlington, Massachusetts-based population health management company, replaces Don Rucker, M.D., who has led the office since April 2017 under former President Donald J. Trump.
Tripathi on Thursday praised his departing predecessor in a Twitter post and said the nation "owes @donrucker a debt of gratitude for so many ground-breaking contributions leading @ONC_HealthIT. And I personally thank you for assisting my transition with such generosity of spirit and sage advice. You've left us very well-prepared for the work ahead!"
"Your rich experiences in HIT will be invaluable as you start your journey to advance U.S. and global healthcare with actionable computing," he tweeted.
Farzad Mostashari, MD, who led ONC during the Obama administration, in a Twitter post offered "huge congratulations to my friend Micky Tripathi, and called him "a fantastic pick who understands technology, policy, and real world practice workflows, and has credibility with all."
Arcadia CEO Sean Carroll said he could "personally attest to Micky's industry-wide leadership on healthcare interoperability and to his vision for the value that shared, timely, and accurate data provides for improving healthcare delivery and reducing costs. No one is better suited for this absolutely critical mission."
The situation will only get worse as the epidemic drags on, and especially if multiple areas of the nation encounter simultaneous surges of infection.
The coronavirus pandemic is wearing down healthcare workers and could lead to longer-term staffing and cost pressures for the nation's not-for-profit hospitals, Fitch Ratings says.
"Hospitals and healthcare systems' ability to maintain adequate staffing and provide for employee safety and well-being during the pandemic has become more critical than ever," the bond rating agency wrote this week in an issues brief.
"Fitch believes the importance of these labor issues to a hospital's Environmental, Social and Governance (ESG) Relevance Score and credit has been heightened over the past year, indicating the potential for these considerations to have a greater bearing on a hospital's rating over time."
The brief notes widely reported morale problems at hospitals across the nation, with short-staffed clinicians overwhelmed by the coronavirus caseload, compounded by the potential for personal health risks because of an inadequate supply of personal protective equipment.
"Fitch believes these issues could negatively affect labor relations and present longer-term challenges in attracting, hiring and retaining staff at hospitals," Fitch says.
Nurses were already in short supply before the pandemic, and the surge in new cases has only made matters worse, "resulting in staff shortages and higher costs, which is expected to continue in the near term against a backdrop of lower revenues due to reduced elective surgery volumes," Fitch says.
Labor is the largest expense at most hospitals, accounting for more than 50% of total expenses. Although the pandemic has led to layoffs in hospitals, it has also forced many hospitals to ramp up staffing, pay more overtime, intensify nurse recruiting efforts, including signing bonuses, hire travel nurses, and vie with competitors to acquire expensive PPE.
"These pressures are heightened for smaller rural hospitals that must staff up for increased caseloads, as rural areas typically do not have a significant supply of nurses from which to draw," Fitch says.
The situation will only get worse as the epidemic drags on, and especially if multiple areas of the nation encounter simultaneous surges of infection.
"Under this scenario, fatigue will inevitably escalate among existing staff who could decide to retire early or leave the workforce due to fears of contracting the virus, or if they feel their health, well-being and safety have not been prioritized or are at risk," Fitch says.
The widespread availability of vaccines – expected to gain momentum in the coming months --should ease the pandemic caseload and relieve some of the pressure clinicians are experiencing, Fitch says.
"However, hospitals will have to face the longer-term challenge of attracting talent to an industry that already faces a labor shortfall and consider investing in programs that positively impact employees and reduce turnover to mitigate expense increases and improve clinical outcomes," Fitch says.
The bond rating agency said President-elect Joseph Biden's proposal to provide $30 billion for supplies and PPE and investing $10 billion in domestic manufacturing of medical supplies will also help the hospital sector's recovery from the pandemic.
Employees say the hospital chain has donated to many GOP lawmakers implicated in last week's turmoil, including Sen. Josh Hawley, R-MO, a key instigator of Senate action to invalidate the election results.
Unionized employees at HCA Healthcare are urging the nation's largest for-profit hospital chain to suspend political donations to Republican lawmakers who attempted to invalidate the results of the 2020 presidential election.
Citing records of past political donations by HCA and its political action committees, detailed in filings from the National Institute for Money in Politics, the employees noted that the hospital chain has donated to many of the lawmakers implicated in last week's turmoil, including Sen. Josh Hawley, R-MO, a key instigator of Senate action to invalidate the election results.
"It is unconscionable that the largest hospital corporation is funding politicians whose participation in an armed insurrection in our capital led to the loss of precious human life," Shirley Caston, a GI Tech at HCA Research Medical Center in Kansas City, Missouri, said in a media release issued by the Service Employees International Union.
"Frontline healthcare workers have been risking our lives to care for our patients during a pandemic over the past year because we deeply believe in the value of human life," Caston said. "The Hospital Corporation of America is flying in the face of our values as caregivers by funding the campaigns of those who incite violence and have caused tragic bloodshed in Washington, D.C. like my Senator Josh Hawley."
HCA issued a statement Friday morning saying it was looking into the matter.
“We strongly condemn the unlawful attack against the Capitol and we are saddened by this assault on our nation and democracy. As always, we will carefully consider those that we support with our political contributions moving forward,” HCA said.
Safety Nets Suspend Donations
On Friday, the Essential Hospitals Political Action Committee said it would no longer donate to any members of Congress who supported overturning the presidential election results.
"Due to the events of Jan. 6 and discord surrounding the November elections, we have suspended contributions from our Essential Hospitals Political Action Committee to members of Congress who voted against certifying the results of a free and fair election," the PAC said.
"We will use this time to ensure our criteria for political donations align with our organizational values and commitment to social responsibility and democratic ideals."
CMS had touted MFAR as an effort to improve Medicaid accountability and transparency and to reduce spiraling program costs.
The Centers for Medicare & Medicaid Services is delivering on an earlier pledge to withdraw its proposed Medicaid Fiscal Accountability Regulation after stakeholders roundly panned the proposal.
In a notice to be published on January 19 in the Federal Registry, CMS said it has received more than 10,000 comments since MFAR was proposed in late November 2019, with the vast majority of stakeholders raising concerns about the proposed rule's effect on state and provider budgets, and the potential to disrupt access to care for Medicaid beneficiaries.
"Many commenters stated their belief that the proposed rule did not include adequate analysis of these matters," CMS said. "Numerous commenters indicated that CMS, in some instances, lacked statutory authority for its proposals and was creating regulatory provisions that were ambiguous or unclear and subject to excessive Agency discretion."
"While we continue to support the intent and purpose of the rule to increase fiscal accountability and improve transparency in the Medicaid program, based on the considerable feedback we received through the public comment process, we have determined it appropriate to withdraw the proposed provisions at this time," CMS said.
"These proposed changes would have devastating consequences for the Medicaid program," AHA said. "Nationally, the Medicaid program could face total funding reductions between $37 and $49 billion annually, or 5.8% to 7.6% of total program spending."
"Hospitals specifically could experience reductions in Medicaid payments of $23 billion to $31 billion annually, representing 12.8% to 16.9% of total hospital program payments."
Although MFAR would affect individual states differently, the AHA analysis showed that nearly all states would see cuts in Medicaid enrollment and benefits.
The news that CMS was withdrawing MFAR was cheered by hospital groups. Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, called CMS's action "the right decision."
"MFAR would have badly undermined the support essential hospitals depend on to provide access to affordable, high-quality healthcare," Feldpush said.
"We cannot afford unintended consequences that harm the safety net—especially now, as essential hospitals and other front-line providers battle the COVID-19 pandemic and the economic downturn drives rising Medicaid enrollment."
Stakeholders push CMS to make the program permanent.
Medicare's Next Generation Accountable Care Organizations saved the federal healthcare program $559 million and saw quality scores rise measurably in 2019, according to partial 2019 performance data made public this week.
Clif Gaus, president and CEO of the National Association of ACOs, says the savings are likely even higher because the partial results account for only 37 of the 41 Next Gen ACOs participating in 2019. Four of the Next Gen ACOs deferred financial settlements.
"For every year of the program, Next Gen ACOs yielded savings for Medicare money while also showing an improvement in quality. Very few programs CMS has developed over the years can say that," Gaus said.
Because of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services extended the Next Gen program, which was due to sunset at the end of 2020, through 2021.
Gaus urged CMS to "make the Next Gen model a permanent fixture in Medicare, either as a stand-alone program or an option within the Shared Savings Program."
He said the data show that ACOs met an average quality score of 93.7% out of a perfect score of 100, improving care for 1.2 million seniors.
After accounting for shared savings paid to ACOs for holding down costs and hitting quality targets as well as shared losses and discounts paid to the government, the Next Gen program netted $204 million to Medicare in 2019 alone.
In 2018 Next Gen ACOs saved Medicare $406 million and netted $185 million after shared savings and losses.
Researchers say the U.S. may see fewer than 1,000 flu deaths this season if safety protocols for the coronavirus pandemic remain in place.
Fewer than 1,000 cases of the flu have been documented across the United States this season, and the safety precautions taken during the coronavirus pandemic are the likely reason why those numbers are historically low, Johns Hopkins University researchers say.
So far this flu season, 925 cases of influenza have been diagnosed from lab samples submitted to the Centers for Disease Control and Prevention.
In the previous four years that number has averaged 38,280 cases, ranging from 15,026 to 63,975 cases this far into the season, says study coauthor Eili Klein, Ph.D., an associate professor of emergency medicine at Johns Hopkins University School of Medicine.
"More importantly, this gives an estimate based on testing of the percentage of samples that are flu," Klein says in an email exchange with HealthLeaders. "The average over the last four years has been 10% of samples (a range of 6% to 13%) were positive for flu; this year it is 0.2%. Thus, by either measure, flu cases are about 98% below normal."
In a typical year, the seasonal influenza runs through May and can cause about 45 million illnesses, hospitalize more than 810,000 people, and claim more than 60,000 lives, according to the CDC.
"In the last four years, there was an average of 38,750 flu-related deaths annually estimated by the CDC, though this varies widely from year to year with a low of 12,000 to a high of 61,000," Klein says. "This year the estimated number of cases is so low and measures in place to limit transmission of COVID-19 are likely to keep transmission below normal for the foreseeable future."
Although the seasonal influenza and COVID-19 viruses are different, they are both respiratory viral diseases, Klein says, which means they are spread the same way, and can be contained in the same way through physical distancing, frequent handwashing, virtual work, conferences, and school, and wearing face masks.
"Continued measures to contain spread of COVID-19 will continue to keep rates of influenza low," he says. "Unless there are significant changes in behavior over the next few months, I would expect the estimated number of deaths to be far below normal, perhaps as low as 1,000."
Klein says rising public awareness during the pandemic about the potential threats of the seasonal flu have also prompted an increase in the numbers of people getting flu shots, which will also play a big role in reducing flu deaths this season.
While the reduced number of seasonal flu deaths is a rare bright spot during the ongoing public health emergency, Klein warns that the lower number of cases could affect the severity of the next flu season.
"Because of the current restrictions and precautions everyone is taking this season, far fewer people will be infected or exposed to the flu virus, and therefore won’t become immune to certain strains of the virus," he says. "So the number of people who may have more severe infections next year is likely to be greater because immunity will be lower."
CMS says the numbers are roughly on par with individual marketplace enrollment in 2020.
More than 8.3 million people used the Affordable Care Act's Marketplaces to sign up for health insurance during the recently completed 2021 Open Enrollment Period, the federal government announced this week.
The numbers are roughly on par with individual marketplace enrollment in 2020, the Centers for Medicare & Medicaid Services said.
However, 2021 numbers no longer include enrollment from New Jersey and Pennsylvania, which transitioned this year to state-based exchange platforms.
"After removing (Pennsylvania and New Jersey) from the total plan selection totals in the 2020 Open Enrollment Period and comparing year-over-year trends shows plan selections this year increased by 7% from 2020 despite a decline in new consumers," CMS said in a media release.
"Also, for the fourth straight year in a row, the consumer satisfaction rate at the Call Center remained high – averaging over 90% – throughout the entire Open Enrollment Period."
CMS Administrator Seema Verma credited the stable enrollment to her agency's ongoing improvements to the HealthCare.gov platform, which she said allowed more consumers to enroll or re-enroll this year without the need for waiting rooms.
"CMS has layered year upon year of improvements on HealthCare.gov, a sterling record of success that puts the lie to baseless accusations of sabotage," Verma said.
"Our policies have lowered premiums, brought issuers back to the market, stabilized a law that had been in a tailspin for years and improved the customer experience," she said.
Compared to 2020, and removing New Jersey and Pennsylvania, the number of new enrollees fell 3.6%, the number of renewing enrollees with active plan selections increased by 13.2% and the number of renewing consumers who were automatically re-enrolled increased by 4.4%. Total plan selections increased by 7%, CMS said.
Verma said the 2021 enrollment period continued a three-year decline in the average benchmark silver plan premiums, which have fallen by an 8% since 2018.
In addition, the percentage of HealthCare.gov enrollees with access to only one plan dropped from 29% in 2018 to 4% in 2021 and more than three quarters of HealthCare.gov enrollees had access to at least three issuers in 2021.
Wausau, Wisconsin-based Aspirus is a community directed health system that operates four hospitals in Michigan, six hospitals in Wisconsin, and more than 50 clinics.
Ascension will sell its seven hospitals, 21 physician clinics, and air and ground medical transport services in north and central Wisconsin to Aspirus Health, the two nonprofit health systems announced jointly on Tuesday.
Financial terms of the deal were not disclosed.
"Aspirus is committed to creating thriving, healthy rural communities," Matthew Heywood, president and CEO of Aspirus Health, said in a media release.
Wausau, Wisconsin-based Aspirus is a community directed health system that operates four hospitals in Michigan, six hospitals in Wisconsin, more than 50 clinics, and ancillary services.
"We are looking forward to welcoming these new team members into the Aspirus family and to expanding access to local primary care and specialty services to create a more seamless health care experience for thousands of rural Wisconsin residents," Heywood said.
The seven hospitals to be sold by Ascension had a combined $336 million in net patient revenues in 2019, with St. Michael's accounting for $130 million of that total.
Ascension operates 24 hospitals in Wisconsin, with more than 100 care venues.
Allan Baumgarten, a veteran observer of the hospital sector in several states, tells HealthLeaders that Ascension looks to be "reducing its footprint in rural parts of Wisconsin while making investments in expanded and new facilities in southeast Wisconsin."
"Ascension was a close second to Aurora for largest hospital system in Wisconsin until 2016," Baumgarten says. "Since then it has been dealing away a lot of its small, rural Wisconsin facilities, most of which were part of the old Ministry Health network."
"In the last 2-3 years, they sold hospitals in Park Falls and Weston to Marshfield Clinic (after selling St. Joseph hospital in Marshfield to Marshfield Clinic a few years earlier.) It also sold St. Elizabeth in Wabasha, MN (the only Ascension hospital in MN) to Gundersen Health," Baumgarten says.
At the same time, Baumgarten says, Ascension has eight projects underway in southeast Wisconsin, "including three micro-hospitals, some joint venture urgent care, some renovations of hospitals in Milwaukee, mostly around labor and delivery."
Aspirus has also been making acquisitions (Divine Savior in Portage) and in 2020 opened an 8-bed inpatient unit next to its clinic in Stevens Point, where it is now acquiring the Ascension hospital, he says.
The sale will include:
Eagle River Hospital in Eagle River
Good Samaritan Hospital in Merrill
Howard Young Medical Center in Woodruff
Our Lady of Victory Hospital in Stanley
Sacred Heart Hospital in Tomahawk
St. Mary’s Hospital in Rhinelander
St. Michael’s Hospital in Stevens Point
Ascension Wisconsin Spirit Medical Transport, and 21 physician clinics.
"Ascension Wisconsin remains committed to putting our communities first, which means being responsive to the changing needs of those we serve," said Bernie Sherry, senior vice president of Ascension and ministry market executive for Ascension Wisconsin.
"We look forward to finalizing this transition with Aspirus as a way of honoring that commitment," Sherry said. "We are confident that this transition will enable these facilities and their dedicated caregivers to be in a better position to serve the communities' health needs going forward."
