The pact looks to create "a joint undergraduate and graduate medical education program to educate and train the next generation of culturally competent health clinicians and researchers."
CommonSpirit Health and Morehouse School of Medicine on Wednesday announced a 10-year, $100 million partnership to train Black doctors.
The initiative is part of a broader plan by Chicago-based CommonSpirit and Atlanta-based Morehouse -- a historically Black medical school renowned for its primary care program -- to create "a joint undergraduate and graduate medical education program to educate and train the next generation of culturally competent health clinicians and researchers," the stakeholders said in a joint press release.
"We are laying the foundation for patients to have more access to Black clinicians and for Black medical students and graduates to gain community-based experience that they need to be successful in their work," said CommonSpirit President and CEO Lloyd H. Dean.
"Our initiative also will create a pathway for healthcare organizations across the nation to follow and share our learnings, a vital part of our work," he said.
MSM and CommonSpirit will contribute $21 million in seed money in the first two years, with a goal of spearheading a 10-year, $100 million initiative with the support of individual donors, industry partners and philanthropic organizations.
There are 155 accredited medical schools in the United States, but Morehouse and three other historically Black medical schools produce the majority of the nation's Black physicians.
"Of the 21,863 students entering medical school in 2019, only 1,626 were Black – and only 619 were Black males," said Morehouse School of Medicine President and Dean Valerie Montgomery Rice, MD.
"This statistic is alarming for many reasons, not the least of which is the impact on patient care," she said. "Studies show that Black patients have better outcomes when treated by Black doctors."
CommonSpirit, one of the nation's largest nonprofit health systems, with a footprint in 21 states, is also the largest provider of Medicaid services in the United States.
Rice called the partnership "the perfect combination of two healthcare organizations that are devoted to the creation and advancement of heath equity in underserved communities."
"Now, more than ever, we believe society needs a unique partnership like ours that can help show the way to reducing health disparities in vulnerable communities, and, in turn, make all communities stronger," she said.
The partnership will create at least 300 new residency training programs each year for Black and other underrepresented groups, recruited from communities that have a historical provider shortage.
Morehouse and CommonSpirit will also build five regional "medical 2 school" campuses and graduate medical education programs in at least 10 markets in partnership with CommonSpirit healthcare hospitals, to be announced in spring 2021.
The partnership will also address cultural competency and develop research programs to confront illnesses that disproportionately affect underserved populations.
"We're immediately leveraging our partnership to address health inequities magnified by the COVID-19 pandemic, as Black Americans are disproportionately impacted by COVID-19," Dean said.
"Together, we will foster a culturally competent system of care that includes testing, care delivery, and vaccine allocation, directed at the most vulnerable populations to reduce the impact of COVID-19 in racial and ethnic communities," he said.
Patients, not payments, are now the biggest barrier to telehealth adoption among healthcare executives responding to a survey in a new HealthLeaders Intelligence Report.
For years, providers have complained that inadequate reimbursements, particularly from Medicare and Medicaid, have given them little incentive to expand remote care.
But that paradigm shifted during the coronavirus public health emergency, when the Centers for Medicare & Medicaid Services this spring temporarily expanded reimbursements for more than 140 remote services provided by Medicare.
And earlier this month, CMS announced that it has made permanent nine telehealth services and will extend payments for another 59 services beyond the public health emergency in the ongoing effort to expand remote healthcare access in rural America.
Now, 63% of executives responding to our latest Intelligence Report,Telehealth's Road Ahead, identified, "patient ability to use technology" as the biggest barrier for telehealth adoption, compared with 44% of executives who put reimbursement at the top of their lists.
Deanna Larson, CEO of Avera eCARE, a South Dakota–based telehealth network, says technical proficiency should not be a barrier to care. She says health systems must create easy access points for patients, including telephone apps and patient portals.
"It has a lot to do with your selection of the platform being sent out to the general public," she says. "Some people say that it's the older people only, but we definitely have found that ease of use is important for all ages. Think about the apps on your phone. If they're not easy to use or frustrating, you just don't go back."
Even with the CMS action, Ethan Booker, MD, a MedStar Health emergency physician and the medical director of the MedStar Telehealth Innovation Center and MedStar eVisit, says he was surprised by the poll findings on technical barriers.
"It's not entirely our experience. We have had the good fortune of having some very usable platforms," he says. "Certainly, while there are some folks who have struggled, and we support them in all the ways that we can, I wouldn't suggest that patients' difficulty using technology is much of a barrier."
Telehealth resource allocation
Primary care (73%) and behavioral health (51%) are the two biggest areas where survey respondents are allocating resources. Beyond that, neurology (25%), cardiology (22%), and rehabilitation (22%) lead a half-dozen subspecialties vying for resources.
Larson says she's surprised that providers aren't making an even bigger investment in behavioral health.
"We know that telemedicine is very valuable in the behavioral health space," she says. "It reduces the need to come in for the visit, and sometimes just getting past the social stigma that's associated with meeting in a behavioral health setting that's still out there."
She also questions why survey respondents are allocating relatively few resources for subspecialties such as neurology, cardiology, and ophthalmology.
"It's surprising to me that there isn't more investment for an early identification of an intervention," she says, "bringing them into a higher level of care if identified, and also follow up in all those areas when appropriate for those. It's easy to do in neurology, cardiology, and dermatology."
Booker says primary care is the clear leader in resource allocation in telehealth because the specialty stresses physician-patient communication and "lends itself extremely well to that longitudinal relationship."
"Rather than coming into the office for a handful of visits a year, there's an opportunity to check in more frequently, and perhaps with less intensity to continue to be connected to each other," he says. "It's also true that with value-based payments, population health, ACOs, etc., primary care has moved more fully into that value-based model."
The movement of behavioral health to a telehealth model predates the coronavirus pandemic, Booker says, and includes "a regulatory and reimbursement framework that began to make sense."
"There is an abundance of academic research on quality, safety, and outcomes that demonstrated that behavioral health, psychiatry, cognitive behavioral therapy—many of the core therapies that are delivered by psychiatry—can be very effectively delivered via telehealth," he says.
"There is also a critical access issue in behavioral health that there are not enough professionals to meet the needs. Telehealth has ability to spread out experts to low-density areas and to be efficient in the delivery of care," he says.
As for specialty care, Booker says MedStar Health is developing an infrastructure and a framework for "all kinds of care delivery."
"Primary care and behavioral health are right at the top of our list," he says, "but we think that it's important to build for absolutely everybody in our health system who feels like they could use telehealth to connect with a patient, whether that's fee-for-service evaluation and management, a coded encounter, or some other connection between patient and physician. We have the tools to build for them."
To download the full December 2020 HealthLeaders Intelligence Report, click here.
House and Senate leaders announced that an agreement had been reached on the "No Surprises Act," which establishes a mediation framework for providers and payers to resolve payment disputes.
The American Hospital Association is offering qualified support for bipartisan, bicameral legislation in Congress that would protect patients from surprise medical bills.
House and Senate committee leaders announced that an agreement had been reached on the "No Surprises Act," which also establishes a mediation framework for providers and payers to resolve payment disputes.
"Under this agreement, the days of patients receiving devastating surprise out-of-network medical bills will be over," House and Senate leaders said in a joint media release.
"Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility. This is a win for patients and their families that will improve America's health care system," they said.
The deal was agreed to on Friday by House Ways and Means Committee Chairman Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX), House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Greg Walden (R-OR), House Education and Labor Committee Chairman Robert C. Scott (D-VA) and Ranking Member Virginia Foxx (R-NC), and Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).
Rick Pollack, president and CEO of the American Hospital Association, said in a letter Sunday to lawmakers that the nation's hospitals "strongly support provisions to protect the patient from surprise medical bills."
"However, we have significant concerns with several of the provisions that would attempt to implement unworkable billing processes and transparency provisions that are duplicative and costly without clear added benefit for patients," Pollack said.
Among the concerns raised by the AHA:
Independent Dispute Resolution Process. If payers and providers use the IDR process, each would submit an offer to the independent arbiter. When choosing between the two offers the arbiter would consider factors such as the median in-network rate, information related to the training and experience of the provider.
Pollack said hospitals are "concerned that the IDR process may be skewed if the arbiter is able to consider public payer reimbursement rates, which are well known to be below the cost of providing care."
"We urge that the legislation include an explicit prohibition on considering Medicare, Medicaid, and other public payer rates, especially as these programs are not implicated by the surprise medical billing provisions," he said.
Pollack also asked that payers' initial payments for out-of-network bills be considered their offer for IDR, which he said would "incentivize them to pay a fair initial reimbursement."
Clarity on enforcement of surprise medical billing violations. "We are unclear as to the oversight of this provision and, in particular, the role of states in overseeing providers," Pollack said. "It appears optional for states to conduct oversight of provider compliance, and the federal government would act as an enforcement backstop in the event a state did not take up this responsibility."
"It also is unclear if states are limited to the civil monetary penalty limits outlined in the draft legislation. This approach could potentially result in uneven enforcement of the bill's protections," he said.
Government auditing of health plan compliance. Pollack said the bill limits audits to 25 plans of all types unless there is a complaint. "This seems to be small number of maximum audits," he said. He also raised concerns that the auditing process "is sufficient to ensure ERISA plans would be audited in the same manner as other health plans."
Notice and Consent for Out-of-Network Services. Pollack asked for clarity on how the bill deals with out-of-network providers. "It appears to put the onus on the out-of-network provider to give the notice and obtain consent, but then suggests that, in the case of out-of-network providers in facilities, it is the facility's responsibility to maintain the consent forms," Pollack said. "Therefore, it is unclear as to the role of the facility versus the individual clinician in providing notice and consent. It also is unclear how the out-of-network provider will know what the in-network provider options would be for a patient, as well as whether the patient's health plan applies prior authorization or other care management requirements on items or services."
Consolidation of Professional and Facility Claims. The bill holds hospitals responsible for physician claims, even if the physician is not employed at the hospital. Pollack said hospitals would not be privy to the proprietary billing rates of providers and payers.
He also complained that the bill would require hospitals to build a framework to solicit bills from providers and issue payments.
"This would result in an unprecedented change in the relationship between independent hospitals and physicians and would require significant technology and legal resources, as well as a revamping of the billing workflow, to operationalize," Pollack said.
"This would add considerable burden and cost to the health care system and has the potential to result in a number of downstream consequences, including reducing patient access to certain specialties within a hospital or health system. And yet, this provision is not essential to resolving the issue of surprise medical bills," he said.
"We strongly urge you to clarify that independent providers, including those working in facilities, are responsible for their own contracting with and billing on health plans."
Timeline for bills. Pollack urged lawmakers to remove timeline provisions after raising concerns that providers will not control how quickly payers respond to bills. He said the bill gives payers "a mechanism to stop their clock by claiming there is a dispute between them and the provider."
"It also is unclear in the legislative text as to whether the penalties occur if any 30-day window within the 90-day timeline is breached or only if the entire 90-day window is breached," he said. "Delayed responses from plans could subject providers to penalties and prevent them from billing patients if they cannot provide patients their cost-sharing information within the required 90-day window."
President Donald J. Trump is expected to sign the resolution, which delays a government shutdown that would have taken effect at midnight Friday.
The U.S. Senate extended a stopgap delay for $4 billion in disproportionate share payments on Friday when it passed a continuing resolution to keep the government funded for at least another week.
The House passed a companion resolution on Wednesday. President Donald J. Trump is expected to sign the resolution, which delays a government shutdown that would have taken effect at midnight Friday.
The Senate action was met with applause from Bruce Siegel, MD, president and CEO of America's Essential Hospitals.
"This $4 billion cut—a third of all program funding—would destabilize hospitals and threaten access to care as the nation confronts a rapidly escalating healthcare crisis," Siegel said. "We must support essential hospitals on the front lines of the pandemic and reject funding changes that would undermine their mission."
The cuts were supposed to take effect on October 1, the start of federal fiscal 2021, and the Senate continuing resolution extends the delay for another week.
A UCLA-led study found that 30-day mortality rates are 23% higher for patients 65 and older who are treated on a surgeon's birthday.
Older patients undergoing emergency procedures on a surgeon's birthday are more likely to die within a month than are patients who go through similar procedures on other days, according to a new peer-reviewed study inBMJ.
The UCLA-led study found that 30-day mortality rates are 23% higher for patients 65 and older who are treated on a surgeon's birthday. The researchers say the evidence is quite clear, but they don't know why, beyond speculating that surgeons may be distracted.
"Our study is the first to show the association between a surgeon's birthday and patient mortality, but further research is needed before we make a conclusion that birthdays indeed have a meaningful impact on surgeons' performance," said study author Yusuke Tsugawa, MD, an assistant professor of medicine at David Geffen School of Medicine at UCLA.
"At this point, given that evidence is still limited, I don't think patients need to avoid a surgical procedure on the surgeon’s birthday," Tsugawa said.
The researchers looked at 30-day mortality for Medicare beneficiaries ages 65 to 99 who underwent one of 17 emergency surgical procedures from 2011 to 2014, and 981,000 surgeries performed by 48,000 surgeons. Of those, 2,064 procedures (0.2 %) were performed on the surgeons' birthdays.
After adjusting for patient characteristics and the comparing surgeons' performance on their birthday with other days, the study found a 6.9% mortality rate among patients who underwent surgeries on surgeons' birthdays, compared with a 5.6% rate among those whose underwent procedures on other days.
The gap represents a 23% difference in mortality rates between the two groups.
The researchers added caveats to their findings, acknowledging that they were unable to understand precisely what led to higher mortality among the patients in question and could not evaluate the causal link.
In addition, it's not clear if the findings apply to younger patients or to elective procedures.
The Notice of Proposed Rulemaking would amend provisions of the Privacy Rule that could stymie coordinated care and case management or impose other regulatory burdens.
The Department of Health and Human Services on Thursday unveiled proposed changes to the Health Insurance Portability and Accountability Act Privacy Rule that federal officials say will improve patient access to their medical records, encourage coordinated care and cut red tape.
"Our proposed changes to the HIPAA Privacy Rule will break down barriers that have stood in the way of commonsense care coordination and value-based arrangements for far too long," HHS Secretary Alex Azar said in a media release.
"As part of our broader efforts to reform regulations that impede care coordination, these proposed reforms will reduce burdens on providers and empower patients and their families to secure better health," he said.
Specifically, the proposals in the Notice of Proposed Rulemaking, drafted by HHS's Office of Civil Rights after hearing public feedback, would amend provisions of the Privacy Rule that could stymie coordinated care and case management, or impose other regulatory burdens.
"These regulatory barriers may impede the transformation of the healthcare system from a system that pays for procedures and services to a system of value-based health care that pays for quality care," the NPRM said.
Some of the major provisions of the NPRM would increase permissible disclosures of personal health information, strengthen patients' rights to access their own health information, expand the definition of electronic health records, improve information sharing for coordinated care, facilitate family and caregiver involvement in emergency care, reduce administrative burdens on HIPAA covered providers and payers, and provide for disclosures in emergency circumstances, such as the opioid or COVID-19 public health emergencies.
"Today's announcement is a continuation of our ongoing work under my Regulatory Sprint to Coordinated Care to eliminate unnecessary regulatory barriers blocking patients from getting better care," HHS Deputy Secretary Eric Hargan said.
"These proposed changes reduce burden on providers and support new ways for them to innovate and coordinate care on behalf of patients, while ensuring that we uphold HIPAA's promise of privacy and security," he said.
Randi Seigel a partner at Manatt Health, called the proposed rule "the biggest change to HIPAA in the last seven years."
"These proposed rules provide greater and quicker access by individuals to their healt care data and enable more data sharing between providers and plans and social service providers for care coordination," Seigel said. "The proposed rules also align HIPAA with the Information Blocking Rules. If the rules are enacted, covered entities will need to revise their policies and practices to ensure compliance."
HHS OCR is asking for comments from stakeholders, including patients, their families, HIPAA covered entities, consumer advocates, healthcare professional associations, health information management professionals, health information technology vendors, and government entities.
Public comments on the NPRM will be due 60 days after publication of the NPRM in the Federal Register.
Telehealth will have a more significant positive impact on cost trends in 2021 and beyond as its usage becomes more engrained with consumers and expands to a broader set of medical specialties.
The rising use of telehealth during the coronavirus public health emergency could help alleviate financial stressors associated with the pandemic, according to a new analysis.
CFRA, the New York-based independent investment research firm, says that telehealth will have a more significant positive impact on cost trends in 2021 and beyond, particularly for managed care insurers, as its usage becomes more engrained with consumers and expands to a broader set of medical specialties.
"We think increased use of telehealth in 2021 will help mitigate the negative impact of rising Covid-19-related costs during the first half of the year," CFRA said in a "Thematic Research" report offering predictions for the healthcare sector in 2021.
CFRA pointed to research from Arizton Advisory & Intelligence projecting that the U.S. telehealth market will hit $25 billion by 2025, growing at an annual rate of 29%.
Managed care companies, including United Healthcare, Anthem, Humana, Cigna, Centene, and Molina Healthcare, began to further embrace telemedicine space during pandemic to reduce unnecessary patient and emergency department visits, CFRA said.
"Since the onset of the Covid-19 pandemic, the use of telehealth has been growing rapidly due to stay-at-home orders and social distancing recommendations," CFRA said. "We think this trend is creating a change in the ways patients access healthcare and will continue due to its convenience and the added benefit of obtaining healthcare services at a lower cost."
CFRA is also projecting that in 2021:
Demand for Covid-19-related products and services will continue until at least 3Q 2021, creating additional opportunities for life sciences tools and services companies.
Increased use of personal protective equipment will continue, as higher standards for hygiene and infection control become the new normal.
Healthcare distributors will benefit from large-scale distribution efforts for Covid-19 vaccines and treatments in 2021.
As the Covid-19 vaccine rolls out, unless there are major issues with distribution, confidence in major vaccine makers will increase, which should positively affect valuations.
Hospitals will face continued financial stress in the first half of 2021, at least until vaccines are widely available.
The late-year deluge of COVID-19 hospitalizations does not bode well for the financial prospects of the nation's not-for-profit hospitals heading into the new year, according to Fitch Ratings, which on Wednesday revised its 2021 outlook for the sector to "stable" from "negative."
The ongoing pandemic-related public health emergency prompted a shutdown of money-making elective procedures in 2020 for hospitals, Fitch said, and the latest, soaring wave of COVID-19 cases suggest that elective procedures may continue to be restricted in 2021.
"Elective procedures, even at a reduced clip, should not hit hospitals as hard financially as the nationwide shutdown that cut top line revenues by around 40% in Spring of 2020," said Fitch Senior Director Kevin Holloran.
Holloran noted that hospitals are better prepared for this latest wave of COVID-19 hospitalizations than they were during when the first wave of cases struck last spring.
Because of that, going forward, elective procedures may again be limited in some regions, but not to the extent seen last spring, when hospitals nationwide shut down elective procedures.
"It's a case of 'been there, done that' in a sense with hospitals treating COVID-19 patients more efficiently, which is leading to shorter hospital stays," said Holloran.
However, Holloran said hospitals will face continued financial stress in the first half of 2021, until vaccines are widely available.
Hospitals also will face rising operating expenses in 2021 related to the pandemic.
"Providers will need to secure a mini-stockpile of ventilators, masks, gowns, drugs and certain types of beds, though adequate staffing will be the most critical component," Holloran said.
The president-elect is expected this week to formally announce his choices for HHS secretary, CDC director, surgeon general and "coronavirus czar."
Reports that President-elect Joe Biden will nominate California Attorney General Xavier Becerra to be secretary of the Department of Health and Human Services were met with cheers Monday from payers, providers and other stakeholders.
Rick Pollack, president and CEO of the American Hospital Association, praised Becerra for his work as a Congressman, and for in his leadership role in defending the Affordable Care Act in California v. Texas.Which was argued last month before the U.S. Supreme Court.
"We have also worked with him as a longtime former member of the U.S. House of Representatives, including as a member of the Ways and Means Committee's health subcommittee," Pollack said. "He has been a champion for affordable health access and coverage, which the AHA has supported, and he has consistently made people across America and their health a priority."
Federation of American Hospitals President and CEO Chip Kahn also praised Becerra's "staunch support" of the ACA, and called the nomination "a historic choice at a historic time."
"He is a superb pick to lead the agency at the center of the fight against COVID-19," Kahn said. "As the virus continues to wreak havoc from coast to coast, he will step in with the kind of leadership that on day one will immediately impact the pandemic."
"During his time in Congress, I had opportunities to work with Attorney General Becerra on important healthcare issues and know that he brings to his new role a keen understanding of, and deep dedication to, Americans' health and healthcare," Kahn said. "He has a proven commitment to assuring all Americans affordable healthcare coverage as well as an established record of protecting and preserving Medicare for our seniors and disabled."
The Campaign for Sustainable Rx Pricing executive director Lauren Aronson praised Becerra's "demonstrated track record of standing up for consumers."
"CSRxP looks forward to working with him and the administration to advance market-based solutions to lower prescription drug prices, cut through drug companies' blame game by pulling back the misguided Rebate Rule and hold Big Pharma accountable," said CSRxP.
"It will be particularly critical for the next HHS secretary to encourage greater prescription drug pricing transparency, foster generic and biosimilar competition and crack down on Big Pharma's egregious price-gouging and anti-competitive practices," Aronson said.
Media outlets are also reporting that Rochelle Walensky, MD, the chief of infectious diseases at Massachusetts General Hospital, will lead the Centers for Disease Control; Vivek Murthy, MD, surgeon general under President Barack Obama, will return to that job under Biden; and that Jeffrey D. Zients, who led Obama's National Economic Council, will serve as Biden's "coronavirus czar."
Infectious disease expert Anthony Fauci, MD, said last week that he accepted President-elect Biden's offer to continue serving as the White House's chief medical advisor.
Matt Eyles, president and CEO of America's Health Insurance Plans, said payers "look forward to working with the entire diverse, experienced and accomplished group of leaders nominated to and announced for key positions."
"These leaders will face several critical national priorities, including overcoming the COVID-19 crisis, improving health equity, advancing healthcare affordability and access, improving quality of care, and ensuring the stability of markets," Eyles said.
"Strong public-private partnerships are essential to achieving these goals, and health insurance providers are eager to assist the Biden health team," he said.
Pollack acknowledged that Becerra will face a critical issues at HHS, but that "nothing is more critical than the COVID-19 pandemic, and making sure hospitals, health systems and our heroic frontline caregivers have the resources and support they need to care for patients and win the battle against the virus."
"We also need to make important progress on advancing the transformation of healthcare, ensuring access to coverage, making healthcare equitable to all people in America and enhancing the quality of care," Pollack said.
The largest employment gains include an additional 29,000 jobs in clinicians' offices. Hospitals created 4,000 jobs.
Healthcare added 46,000 jobs in November, the seventh consecutive month of job gains for the sector, according to the latest federal jobs report, released by the Bureau of Labor Statistics Friday.
However, the healthcare sector has 527,000 fewer jobs at the end of November than in February, BLS said.
The bulk of the new healthcare sector jobs in November (+29,000) were in physicians, dentists, and other provider offices, and home healthcare services (+13,000). Nursing homes shed 12,000 jobs. Hospitals created 4,000 jobs, BLS data show.
November's numbers mark a decrease from the 58,000 healthcare jobs created in October, and the 53,000 jobs created in September, and well below the 75,000 jobs created in August, 126,000 jobs created in July, and the 318,000 jobs created in June.
Healthcare employed nearly 16 million people in November, down from 16.5 million in February. Hospitals employed 5.1 million people in November, about 100,000 fewer than in February.
The November job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.
In the overall economy, payroll employment grew by a sluggish 245,000 in November, which BLS blamed on the coronavirus pandemic.
"These improvements in the labor market reflect the continued resumption of economic activity that had been curtailed due to the coronavirus (COVID-19) pandemic and efforts to contain it," BLS said. "However, the pace of improvement in the labor market has moderated in recent months."
The unemployment rate dropped from 6.9% to 6.7% for the month.
