Paul C. Hiltz, president and CEO of Naples-based NCH discusses the health system's response to the cataclysm.
Hurricane Ian ripped into Southwestern Florida as a Category 4 buzz saw on Setember 28, bringing with it 150 mph winds, unprecendented 18-foot tidal surges, and claiming 119 lives so far, with early estimates putting the cost of the damages at $63 billion.
Naples, Florida sat about 50 miles south of the eyewall, but providers there were quick to assess the extent of the emergency for the region.
NCH Healthcare System President and CEO Paul C. Hiltz details the system's response to Ian, its role in the transfer of more than 400 patients from nearby hospitals, what worked, and what was learned, in this email exchange with HealthLeaders.
HealthLeaders: When did you start making hurricane preparations?
Paul Hiltz: NCH Healthcare System sprang into action when we first learned that we were on the edge of the long-range forecast cone, even though then, models were suggesting that the storm could perhaps make landfall 300 miles to our north.
HL: Were your facilities damaged by the storm?
Hiltz: Comparative to many other facilities closer to our coasts and just 30 miles north of us, NCH was largely spared from major damage. We did see flooding on our campuses and storm surge waters damaged some equipment chillers that are outdoors as well as some cars in our first-floor garages and parking lots at both of our hospital campuses in Naples, but water never intruded into the hospitals themselves, save for a couple of leaks in the roof that made themselves apparent during the storm.
It is hard to gage total cost imparted by the storm because we continue to assess our properties and physician group practices for damage.
HL: Did you have a disaster preparedness plan in place?
Hiltz: NCH has had a hurricane preparedness plan in place for years, and each time our plans are enacted, we learn something more and figure out better ways to refine our processes. Each storm and their effects to our region are different, however, and that’s what can make planning for these things so challenging. For example, the storm surge we saw with hurricane Ian has never-before been documented in our area. Like many, however, we plan for the worse and hope for the best.
HL: How difficult is it to prepare when the healthcare sector has so many supply issues?
Hiltz: Certainly, the supply chain issues our entire nation is facing served to make attaining needed supplies in advance of the storm challenging. However, NCH Healthcare System has strong supply chain partners who made sure we had what we needed to be as prepared as possible for whatever impacts were to come our way.
HL: What was your biggest challenge in preparing for Ian?
Hiltz: The biggest challenge for planning for any hurricane is the relative unknown of ultimately where the storm is going to end up. The forecasters do what they can with the information they have, but as we saw with Ian, the cone shifted from the west coast of Florida to the panhandle four days before appearing to swing back west to the Big Bend region, then Tampa Bay, Sarasota, and ultimately making landfall in northern Lee county – southern Charlotte county just to our north a day before landfall. But again, because we planned for the worst, NCH was as ready as it could be for whatever impacts Ian was going to throw at us.
HL: Once it was clear that the Naples area would be spared a direct hit from Ian, how did you pivot into a resource for other hospitals?
Hiltz: As the largest healthcare system in Collier County, we didn’t have to pivot much because NCH is always ready to be a resource for the patients of our region. We were happy to be able to offer some available beds to our neighboring healthcare systems to the north who suffered greater impacts than we did, and we know if the situation were reversed, they would do the same for residents of Collier County.
HL: What challenges did you face in relocating more than 400 patients into your hospital?
Hiltz: Throughout the process of receiving patients from the impacted healthcare systems to the north, we have seen a rise in emergency department usage by our own community who have sustained injuries in the wake of the clean-up. Likewise, mothers from as far away as Cape Coral are coming to NCH to give birth to their babies. In response to this, NCH reached out to the state, and they sent us 50 RNs between our two hospitals. We have asked the state for additional pediatric nurses to help us handle the influx of peds, NICU, and birthing mothers we have seen at our facilities as well.
HL: What lessons have you learned from Ian?
Hiltz: As was mentioned earlier, each storm is different, so there are different lessons to be learned from each storm. From Ian, the greatest take-away will be the power and might of the storm surge, which all Florida residents hear about with an approaching storm, but most have never experienced in our state to the degree our region did just several days ago. As a result, we will most likely be giving more attention to storm surge preventative measures as we move forward.
HL: What weaknesses did you observe in the local-state-federal preparation and response? How could they improve their prep/response?
Hiltz: State and local government response could not have been better! Florida is used to storms, so power repair trucks were already in the area before the storm hit, national guard troops were here as well. We also had NCH liaisons stationed at the county Emergency Operations Center so we could hear firsthand the information coming from our local government as it was being discussed. Additionally, the state sent us 50 nurses between our two hospitals to help us care for the influx of patients we got from our neighboring healthcare centers to the north.
HL: How long of a recovery time do you anticipate for NCH and other providers?
Hiltz: As of this interview, NCH Healthcare System is just about back to business-as-usual as our teams and colleagues quickly rose to the challenges and hurdles presented by this catastrophic storm. Staff came forward in droves to come to work caring for our patients, setting aside their own personal impacts endured from the storm, to focus on our patients.
It will be a long road to recovery for many of our coastal communities, and as we always do, NCH Healthcare System will continue to be there with open doors that have never closed since we took our first patient back in 1956. We continue to learn about and share new resources available for our community and our staff who are dealing with the greatest impacts from Ian, and NCH will continue to be there to support our community and our staff as we take this journey to recovery together.
The health system says the initiative demonstrates its commitment to 'building a more climate resilient infrastructure.'
UPMC says it will reduce its greenhouse gas emissions by 50% across the Pittsburgh-based mega-system over the next eight years as part of its commitment to the Health Care Sector Climate Pledge.
Sixty-one of the nation's largest health systems, including UPMC, in June signed the Biden administration initiative to cut greenhouse emissions in half.
To meet those goals laid out in the Health Care Sector Climate Pledge, UPMC has named as co-chief sustainability officers John Krolicki, vice president, Facilities and Support Services, UPMC Presbyterian Shadyside and UPMC Children's Hospital, and Michael Boninger, MD, president, UPMC Innovative Homecare Solutions.
"UPMC will lead by example to develop approaches to health care that rapidly reduce our contributions to greenhouse gas emissions," Boninger says in a media release. "We are making these pledges on behalf of the health and well-being of people today and for future generations."
The U.S. Department of Energy in a 2009 analysis found that hospitals use 836 trillion BTUs of energy annually and emit more than 2.5 times the energy intensity and carbon dioxide emissions of office buildings, producing more than 30 pounds of CO2 emissions per square foot.
"Reducing the energy intensity of this sector will decrease its carbon footprint and also alleviate stress on America's electric power infrastructure," DOE said in 2009. "Additionally, new energy efficiency strategies hold the promise of reduced costs for the sector, as U.S. hospitals spend over $5 billion annually on energy, often equaling 1% to 3% of a typical hospital's operating budget or 15% of profits."
In 2014, UPMC joined the Green Building Alliance 2030 challenge and has reduced its carbon footprint by more than 10% in the Pittsburgh area, despite significant growth by the health system.
In addition, UPMC venues have eliminated plastic foam packaging from cafeterias, and more than 40 tons of appliances and equipment have been recycled over the past five years. UPMC venues have received accolades from the Arbor Day Foundation for tree planting. The health system is also transitioning to geothermal technology and building green venues.
"As we work to continue to reduce our environmental impact, UPMC looks forward to implementing additional cutting-edge solutions that will secure our place as a healthcare leader in sustainability," Krolicki says. "We are eager to join the cause in the communities we serve to make a difference for our environment for the long term, which in the end helps the patients we serve."
HumanaChoice says it 'strongly disagreed' with the audit, which found that 76% of claims 'were not supported in the medical records.'
Federal auditors are calling for Humana Inc. to refund $34.4 million in alleged overpayments made to the payer's HumanaChoice Medicare Advantage plan in 2016 and 2017.
The Department of Health and Human Services Office of the Inspector General, in an audit release this week, examined "nine high-risk groups" billed by HumanaChoice in 2016 and 2017 and found that 207 out of 270 (76%) randomly selected diagnosis codes with charges totaling 744,438 "were not supported in the medical records and resulted in $574,430 of overpayments for the 270 enrollee-years."
"These errors occurred because the policies and procedures that HumanaChoice had to prevent, detect, and correct noncompliance with CMS's program requirements as mandated by Federal regulations could be improved," OIG says. "On the basis of our sample results, we estimated that HumanaChoice received at least $34.4 million of overpayments for these high-risk diagnosis codes in 2016 and 2017."
The nine high-risk diagnosis codes are: acute stroke; acute heart attack; embolism; vascular claudication; major depressive disorder; lung cancer; breast cancer; prostate cancer; and colon cancer.
The audit recommends that Humana refund the $34.4 million, identify similar instances of noncompliance for high-risk diagnoses before and after the audit period and refund any overpayments they find, and review existing compliance procedures to identify areas where improvements can be made.
Humana Rebuttal
Humana issued a statement saying it "strongly disagreed" with OIG's findings.
"Humana takes its compliance responsibilities seriously and remains committed to working with CMS and policymakers to find ways to preserve affordable coverage and effective healthcare services for older Americans," the payer says.
"Humana's response to the Office of the Inspector General of Health and Humana Services audit of R5826 is reflected in the published report, including how we strongly disagreed with the OIG's methodology and findings and that we have repeatedly shared our concerns about the methodology with CMS. As the OIG acknowledges, its findings and recommendations do not represent final determinations."
On Monday, OIG released a similar audit of Highmark Senior Health Company, and identified $6.2 million in overpayments. Highmark also disagreed with the findings.
Illumina's partners say they believe the company will continue to improve the speed and continue to lower the price.
San Diego-based Illumina, Inc., has launched a "production scale” sequencer that it claims can process human genomes in half a day for $200.
Illumina CEO Francis deSouza says the company's new NovaSeq™ X Series (NovaSeq X and NovaSeq X Plus) have the power to more-accurately sequence more than 20,000 genomes each year – which is twice the capacity of earlier sequencers -- and will "push the limits of what is possible with genomic medicine, enabling faster, more powerful, and more sustainable sequencing.”
"Today, we are forging a new path forward to advance more breakthroughs in cancer and genetic disease treatments, precision therapies, and pandemic preparedness," deSouza says.
"Innovations like NovaSeq X are at the heart of how we will transform patient lives, and this groundbreaking technology will empower researchers, scientists, and clinicians in the fight to diagnose, treat – and eventually cure – disease while making genomics more sustainable and accessible to millions more people around the world."
Along with speed and cost, Illumina – which controls about 80% of the global genome sequencing market -- says the NovaSeq X also reduces packaging waste and weight by 90% and cuts plastic use in half when compared to NovaSeq 6000. Ambient-temperature shipping of reagents will also eliminate the need for nearly 500 tons of dry ice each year and waste for customers. Illumina will begin to distribute the NovaSeq™ X Series machines in 2023
Illumina's partners say they believe the company will continue to improve the speed and continue to lower the price.
"We're very excited to be a launching partner for NovaSeq X Series. Macrogen always strives to become the champion of personal whole genome sequencing," said Professor Jeongsun Seo, Chairman of Macrogen, a Korean international sequencing services provider that uses Illumina technology.
"I strongly believe NovaSeq X Series will accelerate our path towards the $100 genome. This will enable us to deliver a genetic blueprint to everyone in the world to unlock individual potential and increase life quality."
The payer disputes an audit finding that 70% of the diagnosis codes submitted for 'high risk groups' in 2016 and 2016 'did not comply with Federal requirements.'
Highmark Senior Health Company overcharged the federal government by an estimated $6.2 million in 2015-16, federal watchdogs say, and they want a refund.
The Department of Health and Human Services Office of the Inspector General, in an audit made public Monday, examined "six high-risk groups" billed by Highmark's Medicare Advantage plan in 2015-16 and found that 160 out of 226 randomly selected diagnosis codes with charges totaling $801,166 "were not supported in the medical records." Based on that sample, OIG estimates that "Highmark received at least $6.2 million of net overpayments for 2015 and 2016."
The six high-risk diagnosis codes are: acute stroke; acute heart attack; embolism; vascular claudication' major depressive disorder; and potentially mis-keyed diagnosis codes.
"With respect to the six high-risk groups covered by our audit, most of the selected diagnosis codes that Highmark submitted to the Centers for Medicare & Medicaid Services for use in CMS's risk adjustment program did not comply with Federal requirements," the audit says.
"These errors occurred because the policies and procedures that Highmark had to prevent, detect, and correct noncompliance with CMS's program requirements, as mandated by Federal regulations, could be improved," the audit says. "As a result, the Hierarchical Condition Categories (diagnosis code groupings based on similarity of clinical characteristics, severity, and cost implications) for these high-risk diagnosis codes were not validated."
The audit recommends that Highmark refund the $6.2 million, identify similar instances of noncompliance for high-risk diagnoses before and after the audit period and refund any overpayments they find, and review existing compliance procedures to identify areas where improvements can be made.
Highmark Rebuttal
Highmark issued a statement saying it "disagreed with OIG's findings on a number of grounds and requested that it withdraw its recommendation."
"Additionally, Highmark's review and analysis demonstrated that the audit only targeted records that supported an over payment, and that if the audit targeted records that supported underpayments as well the results would have been materially different," the statement said.
Centene allegedly used its subsidiary PBM to overcharge the Bay State's Medicaid program.
Centene Corp. will pay Massachusetts $14 million to settle allegations that managed care insurer overcharged the MassHealth Medicaid plan.
It's the latest in a series of settlements with at least 12 states for St. Louis-based Centene, the nation's largest Medicaid managed care provider, with 15.4 million enrollees nationwide. Centene agreed to pay Texas $165 million in July for overcharges in a deal that wasn't make public until earlier this month.
Massachusetts Attorney General Maura Healey says her office looked into Centene's operations in her state, including its pharmacy benefits manager, Envolve Pharmacy Solutions, Inc., after other states discovered irregularities in pricing and reporting to MassHealth by Centene subsidiaries.
Healey's office alleges that Envolve and Centene failed to disclose or pass on some retail discount fees to MassHealth, which inflated fees and drug costs reported to the Commonwealth.
"This settlement is a significant result in our work to protect taxpayer dollars and the integrity of our MassHealth program," Healey says. "We are pleased to secure these funds to help control Medicaid costs and ensure that state resources are directed to the best possible uses in our health care system."
Centene issued a statement admitting no wrong-doing and suggesting that the overcharges were unintentional.
"We respect the deep and critically important relationships we have with our state partners," the insurer says. "This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members."
More than two-thirds (67%) of respondents say they've used telehealth in the past year, up from 37% in 2019.
Consumers are embracing the convenience and accessibility of telehealth for "routine" medical care and mental health services in nearly twice the numbers seen in pre-pandemic 2019, a new survey shows.
The J.D. Power 2022 U.S. Telehealth Satisfaction Study, released Thursday, found that 67% of 4,306 consumers surveyed in June and July reported using telehealth within the past year, up from 37% in 2019.
And the vast majority (94%) of consumers who used telehealth in the past 12 months say they "definitely will" or "probably will" use telehealth to receive medical services in the future.
"Telehealth and digital technologies are transforming how patients seek and receive healthcare," says Christopher Lis, Troy, MI-based J.D. Power's managing director of global healthcare intelligence.
"Telehealth has the potential to increase access, convenience, care coordination and continuity, improve outcomes, and fill in gaps in provider coverage, particularly in underserved areas," Lis says.
"As technology adoption and consumer demand continue to increase, it will be important to keep evaluating what's working well and which areas need improvement, with the aim being to improve equitable access, quality of care and patient outcomes that complement in-person care."
A strong majority of consumers say they prefer telehealth for "routine care", such as prescription refills (80%), medication review (72%), test result consultations (71%), and mental health visits (57%).
Nearly two-thirds of consumers (61%) say that convenience is the top reason why they use telehealth, along with faster access to care (49%) and ease of access to health information (28%).
While the use of telehealth is gaining ground, the survey found that consumers still demand digital face time with clinicians, both to ensure care quality and to resolve medical concerns.
Among telehealth providers, LiveHealth Online ranks highest in telehealth satisfaction among direct-to-consumer brands, with a score of 869, followed by Doctor on Demand (864) ranks and eVisit (862). Among payers that provide telehealth services, Humana ranks highest with a score of
862, followed by Aetna (855). The segment average is 852.
The J.D. Power survey, now in its fourth year, measures customer satisfaction with telehealth service experience based on customer service (42%); consultation (28%); enrollment (19%); and billing and payment (11%).
'When compared with non–safety net hospitals, safety-net hospitals were confronted with more concentrated financial losses,' report says.
California's 348 hospitals booked "highly variable” financials during the first 18 months of the COVID-19 pandemic, with many maintaining positive margins despite a virtual shutdown of profitable elective surgeries and procedures.
However, the state's safety net hospitals (SNH) did not fare well and lost more than $3.2 billion between January 2020 and June 2021, a new study in JAMA Health Forum shows.
"When compared with non–safety net hospitals, safety-net hospitals were confronted with more concentrated financial losses,” the report says.
For all hospitals, the operating margin decreased from 2.8% in 2019 to 0.4% in 2020 then rebounded to 1.3% in the first 6 months of 2021. However, safety net hospital margins did not recover in 2021 and were negative in 2020 and 2021. A similar pattern was found for total margin.
"For non-SNHs, operating margin was negative only in the first and second quarters of 2020 and quickly returned to positive levels comparable to pre–COVID-19 quarters,” the report says. "In comparison, operating margin for SNHs decreased substantially from the first quarter of 2020 to the second quarter of 2020 and remained lower than pre–COVID-19 quarters for the sample periods.”
Using state-compiled Hospital Quarterly Financial and Utilization Data, researchers from Cal State Fullerton and UNC-Wilmington focused on operating income and net income and found that non-SNHs saw reduced profits at the onset of the pandemic but were able to "mitigate more detrimental fiscal consequences” thanks largely to federal COVID-19 relief funding and strong equities market investments.
The early months of the pandemic saw a virtual lock-down in care delivery nationwide as hospitals cancelled or postponed elective surgeries and other acute and non-emergency care, which generally account for nearly two-thirds of revenues.
Increased admissions for COVID patients might have partially offset lost revenue from other procedures, but the American Hospital Association estimated a total loss of $202.6 billion by U.S. hospitals between March and June 2020.
To soften the blow, the federal Provider Relief Fund in April 2020 advanced hospitals serving Medicare 2% of their previous year's patient revenue and targeted $10 billion for safety-net hospitals and providers serving a high proportion of Medicaid patients.
The Feds also provided a 20% increase in Medicare payments for patients with COVID-19, loans through the Medicare Accelerated and Advance Payment Programs and the Paycheck Protection Program, state-funded increases in Medicaid payments in many states, and reimbursements to health care organizations for testing, treatment, and vaccination of uninsured patients.
Auditors say the increase coincided with an overall increase in Medicaid enrollment during the first year of the pandemic.
The value of improper Medicaid capitation payments made by states to managed care providers for beneficiaries who were already enrolled in Medicaid programs in other states increased by 60% between 2019 and 2020, the first year of the coronavirus pandemic, federal auditors say.
The Department of Health and Human Services Office of the Inspector General found that 47 state Medicaid agencies made improper capitation payments for beneficiaries enrolled in Medicare and living in other states totaling $117 million in August 2020, compared with $73 million in August 2019.
Volume-wise, OIG says capitation payments to MCOs were made for 208,254 concurrently enrolled beneficiaries in August 2019 and 327,497 concurrently enrolled beneficiaries in August 2020.
"The significant increase in these payments from August 2019 to August 2020 coincided with an overall increase in Medicaid enrollment during that time, and new federal requirements and flexibilities that were available to states during the COVID-19 public health emergency," OIG says.
Auditors compared Centers for Medicare and Medicaid Services' Transformed Medicaid Statistical Information System (T MSIS) data from 45 States, the District of Columbia, and Puerto Rico and identified all August 2019 and August 2020 capitation payments made by two states for the same beneficiary. The audit covered $145.7 million and $234.2 million in Medicaid capitation payments for August 2019 and August 2020, respectively, made by states for beneficiaries who were concurrently enrolled in Medicaid managed care in two states during July through September 2019 and July through September 2020.
"Two states often made capitation payments for the same Medicaid beneficiary in part because states did not have full access to data they needed to identify beneficiaries who were concurrently enrolled in another state," the audit says. "Therefore, CMS does not take all available steps, either directly or through the states, to identify and prevent state capitation payments for non-resident beneficiaries."
Auditors recommend that CMS monitor beneficiaries' concurrent Medicaid MCO enrollments, rather than rely upon individual states to do so and provide states with T-MSIS national enrollment data to help them check their rolls for redundancies.
CMS acknowledge the problem with the double payments, but did not concur with the recommendations and says that T-MSIS monitoring could prove "redundant, inefficient, and confusing to states." Instead, the agency said it will continue to rely on states and provide guidance and technical help as needed.
The soon-to-be shuttered hospitals in southeastern Pennsylvania, owned by Prospect Medical Holdings, Inc., will reopen as outpatient and behavioral health venues by the end of 2022.
Citing "post-pandemic operational realities," Crozer Health on Wednesday said it will close two acute-care hospitals – including emergency departments -- in southeastern Pennsylvania within 60 days and transition the venues into new care roles.
Delaware County Memorial Hospital in Drexel Hill, PA, will transition into a behavioral health hospital with more than 100 inpatient beds. Springfield Memorial Hospital in Springfield, PA, will transition to outpatient only services, including imaging, urgent care, and minor surgeries, and will house physician offices. Those transitions are expected to be completed sometime in 2023.
Taylor Hospital in Ridley Park and Crozer-Chester Medical Center in Upland will remain acute-care hospitals.
"What we've done is assess what those needs are in partnership with physicians, the community, and local leaders," Crozer Health CEO Anthony Esposito said in a media release. "Through this engagement, we determined that access to community-based, high-quality, safe, and effective services are key to being responsive to the community while also addressing the changing nature of healthcare today."
Wednesday's announcement comes one month after Crozer, a for-profit system owned by LA-based Prospect Medical Holdings, Inc., cancelled merger talks with Wilmington, DE-based ChristianaCare Health System, Inc. The two systems at the time blamed a shifting "economic landscape" for healthcare services.
Crozer says it will also continue its previously announced systemwide transition to not-for-profit status.
"We've looked at how we can provide better access to care for our patients, especially the most vulnerable, while not ignoring the pressures hospitals are facing in this post-pandemic world," said Crozer CMO Dina Capalongo, DO. "We will refine alternate care models and technology to enhance this access."