In a letter to Apple CEO Tim Cook, the AGs say patient privacy has become a priority since the SCOTUS Dobbs decision.
A coalition of attorneys general from 10 states is urging Cupertino, CA-based Apple to vouch for the security of consumers' reproductive health information disclosed in third-party apps.
In a letter to Apple CEO Tim Cook, the AGs – nine Democrats and Vermont Republican AG Susanne R. Young – say that patient privacy has become a priority since the U.S. Supreme Court's Dobbs decision this year that overturned Roe V. Wade. Dobbs precipitated a barrage of rigorous antiabortion laws, primarily in more than a dozen Republican-controlled states.
The AGs in their letter to Cook reminded him that "Apple has long promoted privacy as one of its "core values," and that third-party apps' collecting users' search histories, location, and health data and histories could be "weaponized" by law enforcement, private entities, or individuals to target women seeking or providing abortions or other reproductive healthcare.
The AGs note that Apple has adopted rigorous privacy and security measures; for example, Apple ensures that Apple Health data — including reproductive data — is automatically encrypted. The company also has privacy controls that allow consumers to limit apps' access to certain sensitive information and requires apps to request permissions only when needed to provide service.
"Given Apple's consistent promotion of its commitment to privacy, consumers reasonably expect the same from the third-party apps that Apple allows on the App Store," the AGs say in the letter.
"However, third-party apps that sync with Apple Health, as well as apps that independently collect reproductive health data from consumers, frequently fail to meet these same standards."
Specifically, the AGs want Apple to require third-party app developers to certify that their privacy policies will:
Delete nonessential data, including location history, search history, and other data of consumers who may be seeking or helping to provide an abortion;
Provide clear and conspicuous warnings of the potential for apps to disclose to third parties user data related to reproductive healthcare, and may do so only when required by a valid subpoena, search warrant, or court order;
Implement the same or better privacy standards for App Store apps that collect consumers' reproductive health data, or that sync with user data stored on Apple devices.
In a media release accompanying the letter, California Attorney General Rob Bonta says that "in the wake of the Dobbs ruling, our fight to protect reproductive freedom has never been more crucial."
"We urge Apple to heed our call and protect their users from attempts to regulate their bodies and curtail their freedom by improving consumer protections for third-party apps in the App Store," Bonta says.
Researchers urge the transplant community not to 'squander' the opportunity to harvest organs during mass rallies.
With gallows humor, clinicians often refer to motorcycles as "donorcycles."
A new study published this week in JAMA Internal Medicine suggests that the epithet is well founded, and the authors of the study say the transplant community should not "squander" the opportunity to harvest life-saving organs during mass motorcycle rallies.
Researchers from Harvard Medical School and Massachusetts General Hospital found that regions where the nation's seven largest motorcycle rallies were held between 2005 and 2021 saw 21% more organ donors per day, on average, and 26% more transplant recipients per day, on average, during these events, compared with days just before and after the rallies.
"The spikes in organ donations and transplantations that we found in our analysis are disturbing, even if not entirely surprising, because they signal a systemic failure to avoid preventable deaths, which is a tragedy," says study first author David Cron, MD, HMS clinical fellow in surgery at Mass General. "There is a clear need for better safety protocols around such events."
Big motorcycle rallies attract hundreds of thousands of enthusiasts, and earlier studies have shown that these events are accompanied by increases in traumatic injuries and deaths from motor-vehicle crashes.
Noting that they found no difference in the quality of organs donated due to clinical or demographic differences in donors during rallies, the researchers are urging transplant stakeholders to take note.
"It is important for transplant communities in places where these events are held to be aware of the potential for increased organ donors during those periods," Cron says. "Organ donation is often called the gift of life, and we should make sure that we do not squander it and can turn any of these tragic deaths into a chance to potentially save other lives."
Using data from the Scientific Registry of Transplant Recipients, researchers analyzed records from 10,798 organ donors and 35,329 recipients in the regions where the featured motorcycle rallies take place. During the rallies, there were 406 organ donors and 1,400 transplant recipients in regions near the events. During the four weeks before and after the rallies, there were 2,332 organ donors and 7,714 transplant recipients in those locations.
Even with the spike in donated organs, the researchers found that the waiting times for transplant recipients were largely unchanged whether there was a rally event or not, which they say indicates "indicates that the increase in the number of organs available was not enough to relieve the critical shortage of donor organs that the nation faces, even for a brief period."
The seven motorcycle rallies in the study each draw more than 200,000 visitors over the course of several days. Daytona Bike Week in Florida and the Sturgis Motorcycle Rally in South Dakota are 10-day events that each draw 500,000 visitors.
Cron says the data used in the research was not detailed enough to determine whether the donors died in motorcycle crashes or in passenger vehicles.
The votes are still being counted and are expected to be finalized in early December.
More than 21,000 unionized nurses at 21 Kaiser Permanente hospitals in Northern California who were poised to strike are instead voting on a four-year contract with the mega-health system.
The tentative contract, comes after months of fraught negotiations and includes pay raises of 22½% over the next four years, was brokered earlier this month, averting a November 21 two-day strike that had been authorized by rank and file.
While the votes are still being counted and are expected to be finalized in early December, leadership at KP and the California Nurses Association / National Nurses United act like it already passed, with each side declaring victory.
"We not only won the biggest annual raises in 20 years, but we have also added more than 2,000 positions across our Northern California facilities," says CNA President Cathy Kennedy, an RN in the neonatal ICU at Kaiser Permanente Roseville Medical Center. "This will ensure safe staffing and better patient care."
KP says the new agreement "is driven by the changing economy, including inflation, significant changes in the marketplace and our commitment to providing our employees with excellent pay and benefits to attract and retain the best nurses."
The contract includes:
Health and safety provisions to ensure nurses get the highest level of personal protective equipment, including the requirement to maintain a three-month stockpile of PPE, screening for infectious disease, and having the same PPE when caring for patients who are confirmed or suspected of having COVID.
Comprehensive workplace violence prevention provisions, including expanding workplace violence prevention plans to all sites; an investigation process for incidents of workplace violence, and trauma counseling for nurses.
More than 2,000 new RNs and NPs, including 1,200 graduate positions, 400 in specialty training, 300 float pool nurses, 80 acute reentry nurses, 50 NPs, and 80 outpatient positions.
Increased tuition reimbursement for education.
Pay hikes and health benefits upgrades to retain and recruit experienced nurses, including no takeaways for pensions or retiree health.
Equity and inclusion provisions, including the creation of a new regional Equity, Diversity, and Inclusion Committee to address systemic racism within the healthcare system.
Patients first language, including agreement that healthcare is a human right, promoting culturally competent care, and expanding workforce diversity.
Registered nurses at Kaiser Permanente Los Angeles Medical Center (LAMC) voted yesterday overwhelmingly in favor of ratifying a new five-year contract, announced California Nurses Association/National Nurses United (CNA/NNU). CNA/NNU represents 1,000 nurses at Kaiser Permanente LAMC.
LA Nurses Ratify New Contract
In a seperate deal, 1,000 nurses at KP Los Angeles Medical Center voted "overwhelmingly" to ratify a new five-year contract, ending more than one year of negotiations and avoiding a two-day strike, also scheduled to begin Nov. 21, CNA/NNU says.
"We fought for 14 months to get this new contract and we are happy that we won an agreement that will let us recruit and retain nurses," says Tinny Abogado, RN, KPLAMC. "This means that we can give our patients the care they deserve. It was also important that our new contract include health and safety protections for nurses and patients and a commitment to address systemic racism in healthcare."
The waiver was included in the 2020 CARES Act but will expire on December 31 if lawmakers don't act.
More than 350 stakeholders representing major employer, patient, provider, and payer groups are urging a lame-duck Congress to extend into 2023 a waiver allowing employers to cover telehealth services for their employees before they spend down their deductible.
The waiver, which loosens rules for employees’ pre-tax contributions to health savings accounts, was included in the 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act, but will expire on December 31.
Stakeholders have asked Congress to extend the waiver before the end of 2022, arguing in their letter to House and Senate leaders that the safe harbor improves care access for workers who otherwise would have avoided telehealth because of out-of-pocket expenses.
"Without Congressional action, employers will be required to charge employees more to access telehealth services, creating a barrier to care, including mental health treatment," the letter states. "Unfortunately, more Americans need access to affordable mental and behavioral health services, not less."
The letter urges Congressional leaders to expedite passage of the Telehealth Expansion Act of 2021, which has bicameral, bipartisan support.
"The support for affordable telehealth and telemental health is strong. Allowing employers and health plans to continue offering these important services pre-deductible improves affordability and expands access," the letter says.
Exponential Growth
The COVID-19 pandemic resulted in massive growth for telehealth with both government- and employer-sponsored health plans.
A U.S. Department of Health and Human Services study showed a 63-fold increase in Medicare fee-for-service telehealth use, vaulting from approximately 840,000 in 2019 to 52.7 million in 2020, and a 32-fold increase in telemental health during the pandemic.
An Employee Benefit Research Institute survey found that 96% of employer respondents had adopted pre-deductible coverage for telehealth services as a result of the CARES Act waiver, with more than three-quarters of employers hoping the waiver will become permanent.
The waiver expired on January 1, 2022, but Congress re-instated and extended it in late March under the Consolidated Appropriations Act, 2022. The Alliance for Connected Care, also a signatory, noted that the lapsed waiver between January 1, 2022 – March 31, 2022 "led to confusion and uncertainty for patients and employers."
More than 67 million people have HSAs, according to the Alliance for Connected Care, a signatory of the letter, and 78% of them have annual household incomes below $100,000. America’s Health Insurance Plans, also a signatory, says that 40% of the 180 million Americans with employer-sponsored insurance are covered by an HDHP-HSA plan, with the vast majority of plans covering pre-deductible telehealth services.
The California Health Care Foundation examines new law in 2023 that creates a route for NPs to practice independently.
Public health stakeholders must rally behind nurse practitioners as a critical component of expanding healthcare access in the state, the California Health Care Foundation says.
The foundation has published an issues brief on AB 890, which goes into effect in 2023, and which creates a route for NPs to practice independently.
“AB 890 presents opportunities to increase access to healthcare for Californians, especially those served in the safety net and those who live in rural and underserved areas,” CHCF says in the brief. "Nurse practitioners can hasten the change by embracing new practice models, seizing opportunities within the changing healthcare funding and delivery systems, and sharpening their business acumen.
Promote understanding of what NPs provide and reach out to community leaders and the public about NPs role in improving care access.
Remove remaining practice barriers, that include hospital policies limiting NP privileges and leadership roles, NP practices not being allowed to apply for rural health clinic designation, NPs not being able to be lab directors offering services in their own clinics, and telehealth regulations.
Support nurse-managed health centers that are not affiliated with academic health centers but which could affiliate with federally qualified health centers for primary care.
Provide education and supports for NPs, including “business knowledge and skills to find funding and run their own businesses or expand practices within institutions. NPs need the skills to manage complex institutional, financial, billing, compliance, human resources, and marketing issues.
"NPs, clinic and healthcare system leaders, policymakers, safety-net providers, and communities must be proactive in shaping attitudes and policies that impact their practice, and addressing the resistance of some physician organizations seeking to restrict any advancement of NP practice," the brief says.
"To accomplish this, NPs will need the active involvement of supportive physicians, other healthcare leaders, and policymakers to attest to the safety and quality of NP practice. They will also need the advocacy of their patients, sharing their experience of care with families and friends in the community."
The healthcare system must find a way to provide the access to training for tens of thousands of would-be nurses.
An aging and retiring nurse workforce, burnout from the pandemic, and a rapidly greying Baby Boomer population have created a trifecta of staffing challenges across the healthcare space, but one nurse leader has some suggestions.
"We have a turnover problem," says Kenneth R. White, PhD, APRN, FACHE, FAAN, president of the American Academy of Nursing and School of Nursing Dean at the MGH Institute of Health Professions.
"To add more nurses is only part of the equation. We need to make sure we learn more about how we can support nurses, keep the bedside and make sure that they're in a safe and supportive culture," he says.
White concedes that "fixing the nursing shortage is very complicated," but he believes there are pain points that can be addressed.
"One is financial incentives," he says. "Loan repayment. Loan remission, scholarships in return for work commitment once (nurses) graduate. It's difficult to give up employment for one or two years to go back to school to be a nurse and pay very high tuitions in many cases. We need to ease that financial burden."
Wannabes
The Bureau of Labor Statistics estimates that more than 275,000 new nurses will be needed by 2030. However, the American Association of Colleges of Nursing reported that last year nursing schools turned away more than 90,000 qualified applicants owing to a lack of educators or clinical placements.
White says the healthcare system must find a way to provide the access to training for tens of thousands of would-be nurses.
"Applicants are being turned away for two reasons: 1) there's a shortage in nurse educators across the country and 2) nursing programs can't place all the students in clinical learning experiences," White says. "If you can't guarantee nursing students will learn in a hospital or community setting, there's no sense in admitting them because they won't receive the hands-on experience they need to graduate and provide patient care."
White says there are two ways to alleviate that conundrum.
"One is to incentivize those who can teach nurses and mentor them. Because salaries went up during the pandemic, nurse educators oftentimes make more money as a staff nurse than they can being a nurse educator," he says. "We need to right-size that to make sure our nurse educators are rewarded for the great work they do.
"Secondly, the government can help. The Department of Labor recently announced a program calling for schools and clinical partners to attract a more diverse nursing student workforce, and more incentives for hospitals to take on students in a clinical setting," White says, adding that "the program's $80 million is a great start but I do think we need much more than that."
"We need policymakers and private funders to take a very close look at what needs to be done to fund or reimburse hospitals and health systems for nursing education," he says.
R-E-S-P-E-C-T!
In addition, White says it is imperative that hospitals and other clinical settings provide new nurses with support, resources and respect.
"Nurses graduating now - if they're not feeling respected and supported in that first year or two, they'll leave," he says. "They don't have the same commitment that our baby boom nurses had to work in one place for their entire career. For them to leave, that only exacerbates the problem."
"So, we need to understand what nurses need to feel valued and respected in order to give the very best care for their patients."
The U.S. saw 111 deaths per 100,000 population, more than double the COVID mortality rate of other wealthy nations.
The United States would have averted 266,700 deaths during the Delta and Omicron spikes of the COVID-19 pandemic if the excess all-cause mortality rate nationally matched that of the 10-most vaccinated states, a new study shows.
The data, compiled in a research letter from Brown University School of Public Health, and Penn's Perelman School of Medicine, also showed that 122,304 deaths would have been averted if COVID-19 mortality rates matched those of the 10 most-vaccinated states between June 27, 2021 and March 26, 2022, the period covering outbreaks of the Delta (June 27, 2021-Dec. 25, 2021) and Omicron variants (December 26, 2021-March 26, 2022).
The rate of COVID mortality in the nation's 10 least-vaccinated states – 145 per 100,000 population -- was nearly double the COVID mortality rate of the 10 most-vaccinated states (74.5/100,000), according to the letter which was published Friday in JAMA Network.
"The U.S. continued to experience significantly higher COVID-19 and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150,000 to 470,000 deaths," the letter states.
When compared with 20 other wealthy nations that had ready access to vaccines, the United States excess all-cause mortality – 145 deaths per 100,000 population – was the highest. However, the 10 most-vaccinated states had excess all-cause mortality (65/100,000) comparable with or lower than other wealthy countries, such as Germany (63/100,000), the Netherlands (63/100,000), and Italy (71/100,000) over the Delta and Omicron outbreaks.
Comparisons of direct COVID-19 mortality in the United States with the peer nations were even more stark, with 111 deaths per 100,000 population, more than double the rate of most wealthy nations. Austria (65/100,000) led all peer nations.
"This difference was muted in the 10 states with highest vaccination coverage; remaining gaps may be explained by greater vaccination uptake in peer countries, better vaccination targeting to older age groups, and differences in health and social infrastructure," the letter said.
The initiative is developing admissions and application criteria, with the first apprentice program to begin in 2023.
In an effort to address Michigan's dire rural nursing shortage, the state has launched its first registered nurse apprentice program in a partnership with Corwell Health Ludington Hospital and West Shore Community College.
Stakeholders say the new program combine classroom instruction and practical experience with a nurse mentor for full-time apprentices at Corewell Health Ludington Hospital (formerly Spectrum Health Ludington Hospital) for a faster, less cumbersome path to RN licensure.
"The rural health workforce faces many challenges, including nursing shortages," Meleah Mariani, DNP, RN, NEA-BC, FACHE, CNO, at Corewell Health Ludington said at the launching ceremony this month in the city, located about 100 miles north of Grand Rapids on Lake Michigan.
Under the partnership, Corewell Health Ludington Hospital apprentices will enroll in the West Shore Community College nursing program for classroom instruction, lab, and clinical education. The apprentices also will be employed by Corewell Ludington with on-the-job training provided, which will expedite the time it takes to become practice-ready.
"The registered nurse apprenticeship can open doors for those who otherwise might not pursue a career in nursing," Mariani says. "So many times, I have heard someone say 'I always wanted to be a nurse,' but the need to work full-time, the demands of childcare, and other associated expenses create roadblocks.
"It is my hope that our RN apprenticeship and partnership with West Shore Community College and Michigan Works! West Central means that Corewell Health can inspire hope for those caring individuals who envision themselves as future nurses. We are incredibly grateful for this opportunity."
The partnership is developing admissions and application criteria, with the first apprentice program to begin in 2023.
"We are thrilled with this opportunity to allow working people a chance to take their skills and education to the next level," says Shelley Boes, MSN, RN, director of nursing and allied health at West Shore. "The nurse apprenticeship program will help nurses understand the role and job while they continue to learn and gain experience."
Not-for-profit Corewell Health West, formerly Spectrum Health, serves 13 counties in West Michigan. Corewell Health West is a region of Corewell Health, a 22-hospital system formerly known as Beaumont Health and Spectrum Health system.
The CNA/NNU issued a 10-day notice on Nov. 10 following a near-unanimous strike authorization vote from rank and file.
More than 21,000 registered nurses and nurse practitioners at 21 Kaiser Permanente Hospitals in Northern California are planning a two-day strike on November 21 and 22 to protest what they say is the health system's "refusal to address ongoing concerns about workplace health and safety and chronic short staffing."
The California Nurses Association/National Nurses United issued a 10-day notice on Nov. 10 following a near-unanimous strike authorization vote from rank and file this month.
Nurses at Kaiser Permanente Los Angeles Medical Center will also join the two-day strike in what the union is calling the biggest private-sector nurses strike in U.S. history.
"We always want to give our patients the best care, but Kaiser refuses to provide the resources we need to do our jobs safely," says CNA President Cathy Kennedy, RN, in the neonatal ICU unit at Kaiser Permanente Roseville Medical Center. "We are chronically short-staffed, which means patients are waiting longer for care. This is unacceptable and unconscionable when Kaiser made more than $14 billion during the first two years of the pandemic."
The union and Kaiser have been negotiating a new contract since June but have made little headway. Among its demands, the union is calling for minimum staffing guidelines, increased hiring and training, and job protections against subcontractors and outsourcing.
The nurses' strike would come just one month after Kaiser Permanente in NorCal came to terms with more than 2,000 mental healthcare care workers following a 10-week walkout over chronic staffing shortages and long wait times for mental health services.
Kaiser Permanente calls the strike "counterproductive and distracts everyone from reaching agreement."
At its most-recent bargaining session last week, KP says it offered NorCal nurses "higher annual raises for our nurses than we have been able to offer for decades – 21.25% in wage increases over 4 years of the contract."
"Our proposal is driven by the changing economy, including inflation, significant changes in the marketplace and our commitment to providing our employees with excellent pay and benefits," KP says.
"In bargaining in Southern California, we are actively bargaining today. We hope to reach a mutually agreeable solution that recognizes the nursing wage rates in the Los Angeles market, our current economic realities, and the inflationary environment of today."
Our nurses’ dedication to providing expert, compassionate care, especially throughout the COVID-19 pandemic, has been nothing short of inspiring. We are committed to continuing to provide excellent compensation and a work environment committed to well-being, safety, and professional opportunities for our nurses.
KP's Statement
Kaiser Permanente issued the following statement in response to the strike threat.
"We have been in bargaining with the California Nurses Association (CNA) for months, and have been making steady progress towards these goals, including in a session Thursday (Nov. 10). We have already reached important agreements in bargaining on safety, diversity, and other important matters.
In Thursday's bargaining session in Northern California, we put an offer on the table, which includes higher annual raises for our nurses than we have been able to offer for decades – 21.25% in wage increases over 4 years of the contract. Our proposal is driven by the changing economy, including inflation, significant changes in the marketplace and our commitment to providing our employees with excellent pay and benefits. In bargaining in Southern California, we are actively bargaining today (Nov. 11). We hope to reach a mutually agreeable solution that recognizes the nursing wage rates in the Los Angeles market, our current economic realities, and the inflationary environment of today.
It is disappointing to receive a strike notice from CNA for a 2-day strike Nov. 21 and 22, as this tactic is counterproductive and distracts everyone from reaching agreement. Further, our nurses would prefer to be at the side of our patients as we once again manage through a time when flu and RSV illness are affecting so many patients and COVID-19 is still very real and sickening thousands every day.
We are committed to reaching an agreement, and do not believe there is any reason for a strike, given the many agreements we have already reached in bargaining, and the generous economic proposal we are putting on the table.
Right now, every health care provider in the nation is facing staffing shortages and fighting burnout, and Kaiser Permanente is not immune. In spite of the acute shortage of nurses in the state, our commitment to being the best place for nurses to work has enabled Kaiser Permanente Northern California to hire about 3,300 additional nurses since 2021 of which 650 were new graduates hired through our nurse residency program.
We are committed to hiring hundreds more additional nurses, in addition to the hundreds we are already bringing on board through aggressive recruitment and hiring, to provide relief for our nurses and address staffing shortages. As a result of all this work, we are proud that Kaiser Permanente has one of the lower turnover rates for nurses in health care, and we don’t take that achievement for granted. The union’s claims of unsafe staffing levels are not correct. Kaiser Permanente meets or exceeds state-mandated staffing ratios.
Our first priority is always the care and safety of our members and patients. We have contingency plans in place to ensure patients receive the care they need in the event CNA carries out a strike.
Kaiser Permanente has a long and productive history with organized labor and we are proud of our ability to successfully reach agreements with our unions, which represent 160,000 Kaiser Permanente employees – more than any other health care organization in the nation. Labor unions have always played an important role in our efforts to give more people access to high-quality care and make care more affordable."
Ninety percent of the Californians in the plan receive financial assistance.
Gov. Gavin Newsom says that one million uninsured Californians could gain coverage in 2023 for as little as $10 a month through Covered California, the state's Affordable Care Act marketplace.
Two-thirds of the 1.7 million enrollees already are eligible for the low-cost coverage and some can get free coverage. Ninety percent of the Californians in the plan receive financial assistance.
"Millions of Californians now have access to affordable health coverage and now is the time to go sign up for health insurance to keep yourself and your family healthy," Newsom says. "We won't stop until every Californian – regardless of income or immigration status – has the health insurance they need and deserve."
According to Newsom, California leads the nation in lowering healthcare costs and improving access.
Other cost-reduction actions claimed by Newsom include:
Working with an outside partner to manufacture low-cost insulin, to reduce the cost of this life-saving medication, particularly for those who lack coverage for prescription drugs or who have a high level of cost sharing.
Expanding Medi-Cal to all income-eligible, undocumented Californians. By January 2024, all low-income Californians will be eligible for no-cost comprehensive healthcare coverage.
Eliminating Medi-Cal premiums for hundreds of thousands of Californians while improving quality and access. That includes reducing to zero the financial burden for approximately 500,000 pregnant women, children, and disabled working adult Medi-Cal enrollees.
Transforming Medi-Cal through CalAIM to provide better outcomes, expand access to services, and reduce disparities.
