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."
Cuomo said he will address bottlenecks to telehealth adoption, including raising reimbursements for virtual care.
New York Gov. Andrew M. Cuomo this week unveiled a sweeping plan to expand access and accelerate adoption to telehealth services across the Empire State.
The Democratic governor, in his 2021 State of the State agenda, noted that the COVID-19 pandemic exposed healthcare access inequities and demonstrated the value of telehealth.
"While New York State has been on the cutting edge of promoting telehealth for its residents, the adoption of telehealth by both patients and providers has been slow," Cuomo said in a media release.
"COVID-19 has changed not only the way we live, but the way healthcare providers support their patients, especially in regard to mental health," he said. "New Yorkers have adapted throughout 2020, but it is time to push telehealth to the next level in New York State and fully integrate it into our existing healthcare system."
Working with the Reimagine New York Commission, Cuomo said he will address bottlenecks to telehealth adoption, including raising reimbursements for virtual care, eliminating bewhiskered regulatory prohibitions, and building training programs to alleviate newbie patients' and providers' technical angst.
Specifically, Cuomo's initiative would:
Eliminate obsolete location requirements by requiring Medicaid to offer telehealth reimbursement for services rendered to patients regardless of where the patient or provider is located in a non-facility setting;
Develop interstate licensing reciprocity with other Northeast states for high-demand specialties to ensure sufficient access to medical and behavioral health;
Continue COVID-era flexibilities that allow unlicensed staff to deliver mental health and substance use services.
Eliminate in-person evaluation requirements before telehealth services can be delivered, expand staff who can deliver remote services, develop a regulatory structure for a predominantly virtual outpatient substance use disorder treatment program, and explore the expansion of behavioral health services into nursing facilities.
Require commercial payers to offer telehealth to members, and provide Medicaid coverage for services furnished telephonically when medically appropriate.
Ensure that telehealth is reimbursed at rates that incentivize use when medically appropriate.
Require providers to disclose to patients whether they provide telehealth services.
Require insurers in their provider directories to list which providers offer telehealth services.
Require insurers to offer members an e-triage or virtual ED platform that lets patients receive an assessment and a referral to providers or a nearby ED when needed.
Facilitate the use of expert consultations between providers via telehealth by encouraging insurers to reimburse providers directly for e-consults. .
Cornell University President Martha Pollack, co-chair of the Reimagine New York Commission Telehealth Working Group, said expanding telehealth services broadly to the general public "starts with comprehensive policy changes that give providers and patient's greater flexibility to use telehealth as they deem appropriate."
"We can and must ensure that those New Yorkers who are most in need have greater access to care, through new investments in telehealth infrastructure, and through the creative integration of telehealth technologies with the kinds of human support that cannot be replaced," she said.
Patient concerns are at odds with the relatively low risk of contracting the coronavirus during in-person visits at healthcare venues.
More that two-thirds of patients in a new survey say they'd delay doctors' appointments when COVID-19 rates spike in their area, and more than half (57%) say they'd be reluctant to go to the hospital even during an emergency.
The survey, released Tuesday by Orlando Health Heart & Vascular Institute, also found that 49% of respondents will not reschedule missed in-person medical appointments until COVID-19 concerns are reduced in their area. The same number (49%) fret that their health will suffer because of the appointments.
"I understand their hesitation. But there's no question, across diagnoses, whether for chronic or acute conditions, the later in the disease process that we see people and can intervene, the worse their outcomes." said Steven Hoff, MD, a cardiothoracic surgeon at the OHHVI.
The respondents' concerns do not align with the relatively low risk of contracting the coronavirus during in-person visits at healthcare venues, which are some of the safest public spaces. At the dame time, experts note that delaying medical care can be dangerous.
"Because of the extensive protocols in place, COVID-19 transmissions in hospitals are very rare," said Joel Garcia, MD, an interventional cardiologist at the OHHVI. "There is more risk in not paying attention to symptoms or medical conditions than the benefit of staying home thinking you will not get exposed to COVID-19."
Garcia said telehealth has become an invaluable tool during the pandemic, allowing doctors to communicate with patients, explain safety protocols in place at care venues, and encourage them to come in if needed.
Telehealth can also be used in follow up care and to limit in-person visits.
"We have been fortunate that we've been able to accelerate the development of telehealth services during the COVID era because of the need that was created," Garcia said. "Being able to actually reach out to the patient in that venue allows us to educate patients better and get them in the door if we need to see them in person."
Nearly half of the people who were undergoing treatment when the pandemic shutdown began used telemedicine.
Lack of insurance was associated with lower telehealth use for new conditions.
Telehealth use for chronic care jumped 40% between mid-March and early May in the first months of the coronavirus pandemic, and more than 50% for behavioral use, a new RAND Corporation study shows.
Nearly half of the people who were undergoing treatment when the pandemic shutdown began used telemedicine, according to the study, which was published this month in Journal of General Internal Medicine.
However, the study also found that telehealth for behavioral health was lower among women, people over 60, non-Hispanic Whites relative to non-Hispanic Blacks, and those with less than a high school education.
Lack of insurance was associated with lower telehealth use for new conditions. Use of telehealth was more common in the Northeast.
"While the increased use of telehealth was widespread, some groups of Americans reported using the services less often than others," said study lead author Shira H. Fischer, MD, a physician researcher at RAND.
"If telehealth use is going to remain high, we need to ensure equity of access, particularly for behavioral health care where education, age and gender were all associated with levels of use," she said.
Among the 2,052 people surveyed most telehealth users accessed their own physicians for virtual care rather than finding a new or unfamiliar physician, the survey found.
When the pandemic began, nearly 40% of the Americans surveyed were being treated for a chronic physical health condition, while 15% were being treated for a behavioral health condition. Since the pandemic started, 16% had considered seeking care for a new or recurrent condition.
Among patients who were receiving care when the pandemic began, the study found that 11% had used video conferencing from the middle of March to early May.
A survey conducted with the same patient panel in 2019 found that fewer than 4% had ever used video conferencing with a doctor.
Among people who used telehealth services, researchers found that the use of video telehealth was less common for physical health care (14% of patients) than for behavioral health care (30% of patients).
"There is a wide expectation that telehealth will continue after the pandemic ends. Lessons from the use of telehealth during this period should inform policy for the post-COVID-19 era," Fischer said.
The sector lost 39,000 jobs in December, despite healthy gains in hospital and ambulatory care employment.
The healthcare sector, long a job-creating dynamo in the U.S. economy, shed 502,000 jobs in 2020, a casualty of the coronavirus pandemic and the ensuing shutdown of nonessential services that left providers hemorrhaging money.
In December, healthcare added 39,000 jobs, including 32,000 jobs in hospitals and 21,000 jobs in ambulatory services.
However, those gains were partially offset by declines in nursing care facilities (-6,000) and community care facilities for the elderly (-5,000.), Bureau of Labor Statistics data show.
Since February, the hospital sector has lost 70,000 jobs, and the ambulatory services sector has lost 173,000 jobs. Nursing and residential care homes lost 264,000 jobs.
The healthcare sector employed 16 million people in December, down from 16.5 million in February. Healthcare accounted for about 11% of all jobs in the overall economy in 2020.
Overall, 2020 was not kind to the U.S. labor market, which recorded 9.8 million (6.8%) nonfarm job losses since February, owing to the widespread shutdowns created by the pandemic, BLS data show.
The overall economy lost 140,000 jobs in December, with the hospitality, private education, and government sectors particularly hit. The unemployment rate remained unchanged at 6.7%.
Neil de Crescenzo, president and CEO of Change Healthcare, will be OptumInsight's CEO when the deal closes.
UnitedHealth Group tech services subsidiary OptumInsight will acquire independent software and data analytics provider Change Healthcare in a deal valued at around $8 billion.
In a joint press release Wednesday, Eden Prairie, Minnesota-based UnitedHealth, and Nashville-based Change Healthcare said the combined company "will more effectively connect and simplify core clinical, administrative and payment processes - resulting in better health outcomes and experiences for everyone, at lower cost."
Neil de Crescenzo, president and CEO of Change Healthcare, will be OptumInsight's CEO when the deal closes.
"This opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system," de Crescenzo said.
Under the deal, UnitedHealth Group will buy Change Healthcare's common stock for $25.75 per share in cash and is expected to close in the second half of 2021, subject to Change Healthcare shareholders' and regulatory approval. UnitedHealth will also take on about $5 billion in debt owed by Change Healthcare.
Change Healthcare stock was trading at $24.03 at midmorning Wednesday, up 31%.
The Blackstone Group, which controls 20% of Change Healthcare's common stock, will vote in favor of the acquisition.
The combined company is the latest step in UnitedHealth's ongoing expansion into the health services sector.
"Together we will help streamline and inform the vital clinical, administrative and payment processes on which healthcare providers and payers depend to serve patients," said Andrew Witty, president of UnitedHealth Group and CEO of Optum.
Believe it or not, there was more going on in the healthcare universe in 2020 than the response to the coronavirus pandemic and we've compiled a list of stories to prove it.
Understandably, the coronavirus pandemic dominated the headlines this year, not just with HealthLeaders, but with pretty much every media outlet on the planet.
Still, our savvy pillar editors reported on scores of healthcare stories that were not centered around that dreaded virus.
So, we thought we'd share a collection of some of non-COVID-19 content in 2020, if nothing else than to remind us all that we will get through this scourge and life will continue.
Picture a revenue cycle where employees jockey to work on their colleagues' accounts, the turnover rate is less than 5%, and staff members ask their manager not to fill a vacant position so they can work on extra accounts.
That's what's happening at Sharp HealthCare in San Diego, which has "gamified" its revenue cycle management workflow to turn employees' everyday tasks into opportunities to earn points, badges, and compete with each other.
Here are some of our other top Revenue Cycle stories of 2020:
San Francisco–based PlushCare has been providing primary care telehealth services to patients since its founding five years ago. PlushCare, which has a nationwide patient population of more than 200,000, employs more than 100 physicians. The COVID-19 pandemic has boosted demand for PlushCare's services, with a 400% increase in telehealth visit volume.
Here are some of our other top Clinical Care stories of 2020.
The Ohio State University Wexner Medical Center created Anti-Racism Initiatives to "elevate, engage, equip, and empower" the community, students, faculty, and staff to focus on improving racial inequalities in healthcare. The medical center also states that "racism is a social determinant of health."
HealthLeaders' Melanie Blackman spoke to Dr. Harold Paz, CEO of The Ohio State University Wexner Medical Center, about the medical center and university's focus on addressing social determinants of health and racial inequities in their surrounding communities through an anti-racism action plan.
Steward Health Care in June reached an agreement to buy back control of the company from Cerberus Capital Management, L.P., a New York-based private equity firm. Cerberus sold control of the Dallas-based physician-owned company to a group of Steward physicians led by CEO Dr. Ralph de la Torre.
This June, HealthLeaders convened health system executive thought leaders to discuss the "Healthcare System of the Future." In his keynote address, John Halamka, MD, MS, president of the Mayo Clinic Platform, discussed the technology stepping stones that will pave the road forward.
Other top stories from the Innovation pillar in 2020:
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
California saw nearly 20,000 more deaths from March 1 through August 22 than what would be predicted by historical trends, new research shows.
The Golden State recorded 146,557 deaths over the seven-month span between March and August, which is 19,806 more deaths than historical models suggest, according to a research letter in JAMA Internal Medicine.
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
"Following the statewide shelter-in-place, Latino residents and those without a high school degree/GED had the greatest increase in excess per capita mortality, with rates more than tripling after reopening," the UC San Francisco-led researchers wrote.
"We hypothesize that this pattern reflects the risk of COVID-19 death faced by low-wage, essential workers and their social networks owing to occupational exposure, crowded housing, and inadequate access to testing or treatments," they said.
The projections in the research letter are consistent with state and national tracking of COVID-19 deaths. As of December 21, the pandemic had claimed 22,820 lives in California with about 1.9 million cases reported. Nationally, the virus has claimed more than 311,000 lives, with more than 18 million cases reported, according to data compiled by The New York Times.
The research also compared deaths in March through April against deaths in May through August and found that Latinos and those without a high school degree or the equivalent had the greatest increase in excess deaths.
Latino deaths tripled from 16 to 51 excess deaths per 1 million, and deaths in those without a high school degree grew by a factor of 3.4, from 21 to 72 excess deaths per 1 million.
Younger adults had the biggest increases in excess deaths, more than doubling the rate between shutdown and reopening. Ages 25-54 increased from 4 to 11 excess deaths per million, and ages 55-64 grew from 12 to 30 excess deaths per million.
Black people had higher per capita excess mortality than other racial/ethnic group throughout most of the pandemic. However, later in the shelter-in-place period, White, Asian, and Black residents had a decline in excess per capita deaths.
Latinos and those without a high school diploma saw a large and sustained increase in per capita deaths.
While noting that the research is not designed to determine the effect of policies undertaken during the pandemic, the researchers said their findings "suggest that the policies adopted to date have had disparate outcomes across population subgroups.":
"Our findings underscore the importance of examining the inequitable effects of policies during the pandemic, reexamining the effects over time, and investing in strategies to mitigate the excess mortality in affected communities," the said.
Methodology
Using California Department of Public Health, the researchers evaluated deaths for the entire state and for specific groups by age, sex, race/ethnicity, and educational level, ages 25 or older.
The researchers estimated excess deaths for each week by subtracting the number of forecast deaths from the number of observed deaths.
"For each time period, we obtained 95% prediction intervals by simulating the forecast 10,000 times, selecting the 97.5% and 2.5% quantiles and subtracting the total number of observed deaths," the research letter said.
"We obtained per capita estimates by dividing the excess deaths and corresponding 95% prediction intervals by population size, using estimates from the U.S. Census Bureau."
