Nearly one in four Californians (23%) know someone who has died of COVID-19.
Containing COVID-19 and making healthcare affordable and accessible for all should be the top priorities for lawmakers and stakeholders in California in 2021, a new poll finds.
"COVID-19 has definitively shaped the views of Californians over the last year and addressing the pandemic has become Californians' top policy priority by far," said Kristof Stremikis, director of Market Analysis and Insight at the California Healthcare Foundation, which commissioned The 2021 California Health Policy Survey.
"Still, ongoing issues like the high cost of healthcare, the number of healthcare providers, and access to mental healthcare remain top of mind for many," Stremikis said.
"Health equity is also a concern. Significant numbers of Californians say it is harder for Black and Latinx people to get the care they need compared to White people."
The poll of 1,541 adult Californians was conducted between November 19, 2020, and January 12, 2021 by NORC at the University of Chicago.
Among the findings:
63% of Californians say addressing the COVID-19 crisis is "extremely important" than any other priority in the three years CHCF has conducted this annual survey. 50% prioritize making healthcare more affordable.
23% of Californians say they know someone who has died of COVID-19, with larger numbers among Black (32%), Latinx (27%), and Asian Californians (26%), compared to 17% of White residents.
71% say they "definitely" or "probably" will be vaccinated once the COVID-19 vaccine becomes available to them. A total of 13% say they will "probably not" be vaccinated, and 16% say they will "definitely not" get the vaccine.
59% say ensuring state and county public health departments have the resources they need to control the spread of COVID-19 is "extremely important."
49% say making sure there are enough doctors, nurses, and other healthcare providers is "extremely important."
45% say making sure people with mental health problems can get the treatment they need is "extremely important."
52% report that they or a family member skipped or postponed healthcare in the last 12 months — mostly due to issues related to COVID-19.
51% say they took at least one action to delay or skip care because of cost in the last 12 months. Of those who cut back on care due to cost, 41% say the steps they took because of cost made their health condition worse.
51% say it is "harder" or "much harder" for Black people to get the healthcare they need when they are sick compared to White people. 49% say it is "harder" or "much harder" for Latinx people.
62% are "very" or "somewhat" worried about unexpected medical bills and out-of-pocket costs (60%).
54% are worried about affording treatment for COVID-19, 34% of Latinx, 33% Black), and 29% of Asian Californians saying they are "very worried" about affording treatment, compared to 17% of White Californians.
64% favor creating a national "public option" health plan.
60% favor lowering the age people are able to enroll in Medicare from 65 to 60.
43% favor a single-payer system. 25% strongly oppose such a policy.
64% of Californians favor increasing subsidies to make coverage more affordable for those purchasing through the ACA.
A GAO report paints a bleak picture of the state of healthcare access in rural America.
More than 100 rural hospitals in the United States closed between 2013 and 2020 and that has significantly increased the travel distance to access care for Americans living in those shuttered service areas, according to a Government Accountability Office report.
"Specifically, for residents living in these service areas, GAO's analysis shows that the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018," according to the report, Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services, which was made public this month.
It's even worse for rural patients seeking specialized care.
"For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services," GAO said.
There were more than 2,200 rural hospitals representing 48% of the nation's hospitals in 2017, providing care in 84% of the U.S. land area, and serving 18% of the U.S. population. Numerous studies have shown that rural patients tend to be older, sicker, poorer and more likely to rely on Medicaid and Medicare.
The closures also had a deep economic effect on the immediate areas they serve, because hospitals are often the largest employers in a region.
Federal data show that rural communities have lost 2,066 inpatient beds and 6,347 full-time employees because of rural hospital closures from 2013 through 2017.
Making matters worse for residents in closed service areas was the exodus of physicians when hospitals closed, further hindering access to care, GAO said.
"Specifically, counties with closures generally had fewer healthcare professionals per 100,000 residents in 2012 than did counties without closures," GAO said.
Between 2012 and 2017, "the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents," GAO said.
In the year before shuttering, hospitals that closed between 2014 and 2017 had a median of 30 inpatient beds and 96 full-time-employees. By comparison, open rural hospitals in 2017 had a median of 25 inpatient beds and 179 full-time-employees.
Stressors Grow
GAO said an analysis of data from the Department of Health and Human Services showed that many of the closed hospitals were in financial distress or operating in the red years before they shuttered.
"Specifically, for hospitals that closed from 2014 through 2017, the median margin declined from -3.3% in 2012 (the year prior to our closure study period) to -13.8% in the year prior to closure—a reduction of 10.5 percentage points," GAO said.
"Consistent with our findings, NC RHRP's research found that the margins for rural hospitals have declined from 2016 through 2018, putting these hospitals at higher risk of financial distress," GAO said.
"Moreover, the percentage of rural hospitals classified as high or mid-high risk of financial distress has increased over the past 5 years—from 24% in 2015 to 26.2% in 2019," GAO said, with a particularly large increase in financial distress for rural hospitals in the South, which also saw the highest numbers of hospital closures.
The GAO report was requested by U.S. Sen. Gary Peters, D-Mich., the new chairman of the Committee on Homeland Security and Governmental Affairs.
The coronavirus pandemic wreaked bottom line havoc on the nation's healthcare delivery system in 2020 and that trend is expected to continue well into 2021.
Kaufman Hall's latest National Hospital Flash Report finds that the elevated COVID-19 inpatient volumes, coupled with spooked consumers unwilling to visit care venues for non-urgent services, completed 2020's months-long trend of declining operating margins for physicians and hospitals.
"The remaining winter months will be critically challenging for our hospitals and health systems as COVID-19 hospitalizations climb and new, more contagious variants of the virus spread nationwide," said Jim Blake, a managing director at Kaufman Hall and publisher of the National Hospital Flash Report.
"COVID-19 will continue to create a volatile environment well into 2021," he said.
The report notes that, for hospitals, "escalating expenses coupled with declining volumes and outpatient revenues continued to stress limited resources."
"The median Operating Margin dropped 55.6% (4.9 percentage points) throughout 2020 without Coronavirus Aid, Relief, and Economic Security (CARES) Act funding and was down 16.6% (1.2% percentage points) with CARES," the report said.
"In December, Operating Margin declined 18% (2.4 percentage points) year-over-year but increased 21.2% (2.2 percentage points) from November without CARES," KH said.
KH's quarterly Physician Flash Report reported similarly that performance metrics remained below 2019 levels on most measures.
"The increasing size of employed physician groups and the level of investment needed to support them continue to strain health system operating margins," said Cynthia Arnold, senior vice president at Kaufman Hall.
"While inpatient care and procedures offset those subsidies somewhat, long-term success will require joint system-physician leadership representation and robust data and analytics to address physician productivity issues," Arnold said.
The median investment to subsidize inadequate physician revenues fell 9.5% in Q4 but was up 0.5% year-over-year in October at $194,632 per physician.
Physician work Relative Value Units per Full-Time Equivalent —was 4.9% below 2019 levels in October, because of fewer patient visits and lower hospital diagnostic and procedural volumes.
New patient visits also fell year-over-year owing to a bad economy, competition from telemedicine, and the ongoing dread of some patients to visit physician offices. The lower productivity drove Net Revenue per Physician FTE down 4.5% year-over-year compared to 2019, KH said.
The KH analyses also found that:
The median hospital Operating Margin Index closed a tumultuous 2020 at 0.3%, not including federal CARES Act funding, according to the January. With the CARES funding, it was 2.7%.
The median 2020 Operating Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin was 5.1% without CARES and 7.6% with CARES.
Patient Days rose 4.5% compared to December 2019, thanks to Covid. Discharges were down 4.3% year-over-year and down 7.3% year-to-date, signaling an increase in higher acuity patients.
The Average Length of Stay rose 11% year-over-year and 6.6% from January through December 2020.
Emergency Department Visits volumes fell 16.2% for January through December and 22.6% year-over-year.
Operating Room Minutes fell 10.5% over the calendar year as many patients delayed non-urgent procedures due to COVID-19 concerns.
Lower volumes pushed revenue declines, particularly for outpatient services. Gross Operating Revenue (not including CARES aid) dropped 3.1% in 2020, while Outpatient Revenue fell nearly 6%. Inpatient Revenue was essentially flat, rising just 0.3% for the year.
Total Expense per Adjusted Discharge and Labor Expense per Adjusted Discharge both increased 14.4% throughout 2020, and Non-Labor Expense per Adjusted Discharge was up 14.2%.
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.
