The money, a gift from the David and Lucile Packard Foundation, will pay for renovations to the hospital’s West building, which opened in 1991, and which is the only pediatric care venue in the Bay Area to offer obstetric, neonatal, and developmental medicine services in one place.
"It's vital that more mothers and babies have access to Packard Children's Hospital, in an enhanced environment that supports optimal physical and mental well-being," says Yasser El-Sayed, MD, obstetrician-in-chief at Stanford Children’s Health. "This reimagined space will also facilitate impactful scientific research studies, which will accelerate our commitment to advance maternal and infant health in California and beyond."
Nearly two-thirds of expectant mothers at Lucile Packard are high-risk, with patients coming from across the state, the nation, and the world for treatment. The renovations will expand the labor and delivery unit, adding capacity for up to 20% more births. The building will also house the hospital’s first-ever dedicated and physically separate unit for high-risk moms who need to be hospitalized for days, weeks, or months before they deliver, ensuring rapid access to a state-of-the-art obstetric delivery suite.
The neonatal intensive care units will transition from large, open rooms—which typically hold up to 10 babies, their parents and care teams, and medical equipment—to private rooms where parents can stay with their babies.
Key upgrades include:
14 private labor rooms in a new labor and delivery unit
9 private antepartum rooms in a specially designed unit
51 private postpartum rooms
64 private NICU rooms
3 new and state-of-the-art obstetric operating rooms
A streamlined, family-centered experience, starting with a welcoming lobby
The David and Lucile Packard Foundation has donated $614 million to Lucille Packard over the years, making the Bay Area foundation the single largest philanthropic supporter of Lucile Packard Children's Hospital Stanford and one of the biggest funders of children's hospitals in the nation.
Affected staff have received 60-days' notice for the lay-offs, which will take effect on July 24.
Borrego Community Health Foundation has launched "a series of strategic initiatives" – including systemwide layoffs of 218 staff -- to protect its long-term financial viability and ensure access to safety-net care Riverside and San Diego counties.
The Borrego Springs-based nonprofit Federally Qualified Health Center filed a federal Worker Adjustment and Retraining Notification Act, and the affected staff have received 60-days' notice for the lay-offs, which will take effect on July 24.
The layoffs include 11 in nursing, 14 in nursing support, 70 in clinic support, 37 in the call center, 18 phlebotomists and eight dental staff. No physicians or advanced practitioner providers will be laid off.
Borrego Health CEO Edgar Bulloch, MD, says that – like many providers across the nation – the Borrego Springs-based FQHC has been rocked by the financial ill-effects of the COVID-19 pandemic.
"Without question, the past 18 months have been significantly challenging for Borrego Health," Bulloch says. "As we work to navigate our financial and legal issues, we are driven forward by our mission to provide primary care to the underserved."
"Indeed, our patients in Riverside and San Diego counties need Borrego Health. That's why we’re doing everything we can to overcome our challenges, even though it means making difficult decisions regarding the size of our workforce and our operational structure."
Bulloch says that Borrego will work to align with industry benchmark data and best practices from other regional FQHCs to trim administrative and clinical teams.
The CEO stressed that the changes are needed to ensure Borrego Health's ability to meet the needs of patients, do not alter clinic hours or scheduled appointments.
In 2021, Borrego Health served more than 120,500 patients and had more than 463,000 visits.
Survey finds Americans will need 7x more than they expect to pay for healthcare in retirement.
A 65-year-old couple retiring this year will spend on average $315,000 for healthcare expenses throughout retirement, about seven times more than they expect to pay, according to a new study from Fidelity Workplace Consulting.
Fidelity's 21st Annual Retiree Health Care Cost Estimate for single retirees is $150,000 for men and $165,000 for women. The estimate assumes both members of the couple are enrolled in traditional Medicare and Medicare Part D.
The 2022 estimate is up 5% from 2021 ($300,000) and has nearly doubled from its original $160,000 in 2002, the first year the estimate was published.
"Even as many Americans look to turn the page on the events of the last two years, staying informed on potential future healthcare costs should remain a top factor when planning for retirement," said Hope Manion, senior vice president, Fidelity Workplace Consulting.
A March survey of 2,022 adults commissioned by Fidelity found that most are clueless about the cost of healthcare in retirement, estimating that a couple retiring this year will spend $41,000 on healthcare expenses in retirement -- $274,000 less than Fidelity's estimate. Additionally, 68% think associated costs will remain under $25,000.
Fidelity is using the survey to plug health savings accounts, which Manion said "are also a great way to cover current qualified medical expenses."
Among the misconceptions harbored by many American adults ages 58-76, the survey found that:
* 57% of respondents incorrectly think a person can elect to enroll in Medicare at age 62 and receive reduced benefits. Medicare gives people a 7-month time frame to sign up/enroll. For those who are eligible when they turn 65, that 7 months begins 3 months before the month they turn 65 and ends 3 months after the month they turn 65.
* 41% assume incorrectly that there are out-of-pocket caps for Medicare coverage. In reality, retirees must enroll in Medigap to limit their out-of-pocket expenses.
* 40% believe incorrectly that Medicare will pay for them to stay in a nursing home when they can no longer take of themselves.
A study looked at spending by Medi-Cal associated with malpractice cases from "never events."
California's cap on noneconomic losses in malpractice cases is lagging far behind current values and, perversely, could be linked to a rise in malpractice cases over the past 50 years, new research suggests.
"The lack of adjustment to reflect inflation or the growth of household incomes is inequitable, because it lowers the real value of the reward — which in current dollars, could be as much as $1.5 million – six times the 1975 value," says Prof. Jack Needleman, chair of the UCLA Fielding School of Public Health's Department of Health Policy and Management. "The second issue is that the cap, by lowering the risk of suit for malpractice, has also weakened the deterrent effect of risk of being sued on physician’s efforts to avoid malpractice."
"The best available research suggests imposing caps is associated with a 16% increase in adverse events," Needleman says. "Given this, it is likely that the repeal of a cap on noneconomic damages would increase attention to patient safety and lead to reduction of adverse patient events. These changes would be associated with cost savings to payers and patients and reduced economic and noneconomic damages that improve the life and health of patients."
Needleman's review looked at spending by Medi-Cal associated with malpractice cases from "never events," such as objects left in patients after surgery, mismatched blood transfusions, or hospital-acquired pressure ulcers. In 2018, more than 250,000 Medi-Cal patients experienced a never event and the state paid $1.5 billion on these cases.
Needleman says that many of these costs could be avoided if California’s malpractice cap was lifted or substantially raised. A 16% reduction in adverse events could mean savings to the state as much as $245 million annually.
The cap was adopted by California in the mid-1970s when state legislators believed rising malpractice premiums and risk of lawsuit would nudge some physicians into retirement or stop practicing medicine and increase care delivery costs through defensive medicine. No provision was made for indexing the cap level for inflation.
Federal statistics show that, between November 1975 and November 2021, the Consumer Price Index increased by a factor of 5.03. If the cap had been adjusted based on CPI to maintain its purchasing power, its current value would be $1.257 million.
Needleman suggests that a better measure of the value of the cap would be the ratio of the cap to household income. In 1975, the cap of $250,000 was 19.5 times the median California household income of $12,778. If the cap had been adjusted to maintain the ratio of value to household income, its current value would be $1.5 million.
"That is six times the difference," Needleman says. "In effect, someone who suffered in a malpractice case in the 1970s received much, much more in compensation, in a relative sense, than someone suffering the same injury today."
Proponents for caps on malpractice awards argue that the caps lower malpractice risk and premiums. The lower premiums and lower risk reduce practice costs, reduce the incentive for defensive medicine such as unneeded diagnostic testing — which increases overall health care costs — and reduce the incentive for physicians to leave practice.
"Imposing a cap on awards also reduces the incentive to avoid malpractice," Needleman says. "If the incentive to reduce malpractice is weakened, and malpractice rates increase, this raises the potential costs to patients and insurers, as well as increasing potential noneconomic losses for patients."
Needleman says research suggests that state adoption of caps on noneconomic damages in medical malpractice lawsuits is associated with higher rates of preventable adverse patient safety events in hospitals, estimated as a 16% increase in these adverse events.
"The economic and noneconomic losses for patients and their families from malpractice can be significant," he says. "Beyond these, there are substantial costs to the state in Medi-Cal and medical payment for state and local government employees that would be reduced by raising or eliminating the cap on non-economic losses in malpractice."
Burnout and need for better benefits, pay, and/or family time are adversely affecting workers' plans for the future.
More than two-thirds (64%) of California's behavioral health workforce is comprised of women, most of whom have a bachelor's degree or higher and a decade or more in the field, a new analysis from the Department of Health Care Services shows.
More than 1,600 members of the workforce responded to the Fall 2021 California Behavioral Health Workforce Assessment survey, which collected information about respondents' demographics, educational and professional backgrounds, employment, communities served and use of telehealth services.
The survey also included questions related to peer support services and providers in the context of California’s current initiative to establish Peer Specialist as a provider type under DMC-ODS and SMHS programs.
The survey found that:
64% of behavioral health workers are cisgender women.
32% of respondents are Hispanic or Latino.
76% of respondents have a college or graduate degree, and 42% of respondents have been in behavioral health for more than 10 years.
35% of respondents identify as a family or caregiver of a person with behavioral health needs, and 32% have experienced a personal mental health challenge.
Burnout and need for better benefits, pay, and/or family time are adversely affecting workers' plans for the future.
The survey assessment offers seven recommendations to support, strengthen, and expand California's behavioral health workforce:
Support data-driven decision-making and policy by collecting nuanced behavioral health workforce data.
Create, expand and strengthen career pathways for racially, ethnically, linguistically and culturally diverse behavioral health providers.
Increase pay and benefits for the behavioral health workforce. Address disparities between peer and non-peer staff.
Address provider burnout and compassion fatigue. Support parents and caregivers.
Prioritize supports for unserved, underserved and inappropriately served communities. Invest in equity-driven strategies and wraparound supports
Provide additional training and technical assistance to expand telehealth.
Invest in training initiatives and programs that support integration of peers. Include and promote peer voice and leadership.
The collaboration links Tia's expertise in retail-based primary care with UCSF's specialty and inpatient facilities.
Women's primary care provider Tia is collaborating with UCSF Health to open 10 clinically integrated clinics in the Bay Area, with the flagship venue now opening at Mission & Van Ness in San Francisco.
The collaboration links Tia's expertise in retail-based primary care with UCSF's specialty and inpatient facilities, covering services that integrate physical, mental and reproductive health for women and their families via in-person and virtual care, said Carolyn Witte, co-founder and CEO of Tia.
"Women deserve comprehensive primary care that centers on our experiences — clinically, psychosocially and experientially," Witte said. "Sadly, a 'one-size-fits-most' healthcare system leaves 50% of women without a primary care provider — depriving women of essential, preventive care and forcing them instead to bounce from specialist to specialist searching for answers, which drives up costs and worsens outcomes."
"Tia wants to change that by working with UCSF to create a women-centered healthcare system that spans outpatient to inpatient with an anchoring on prevention," she said.
A Tia-commissioned survey of 500 Bay Area women found that more than 40% of them have delayed preventive health services during the pandemic, and that 80% of women in the Bay Area say that worry or stress about the pandemic has impacted their mental health.
Amy Murtha, MD, professor and chair of the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, said the collaboration will means that more women will have access to the care they need.
"UCSF Health is a leader in women's health and renowned for its integrated specialty care, but we can’t reach every woman in the Bay Area," Murtha said. "This collaboration aims to help address that fragmentation by increasing women's access to primary care services, with seamless access to UCSF's specialty care when they need it."
Tia, with a focus on early prevention, will provide UCSF Health with new outpatient access points that reach more women for its specialty care network and inpatient services, including its pregnancy, labor and delivery program.
The providers will share clinical protocols, coordinate to improve quality metrics, and link electronic health records to enable shared clinical notes, medical records, care coordination and quality data reporting. Tia's care coordination team will oversee care transfers between the two providers.
UCSF Health is the second major health system collaboration for Tia and the collaboration follows expansions in New York, Los Angeles, and Phoenix.
Researchers note the disturbing trend runs contrary to the increased emphasis of many medical schools on health equity and building a more diverse physician workforce.
A new UCLA report finds that states that have eliminated affirmative action admissions at public medical schools also saw enrollment of racial and ethnic minority students fall by 37%.
In a study published this week in Annals of Internal Medicine, researchers at the David Geffen School of Medicine said the disturbing trend runs contrary to the increased emphasis of many medical schools on health equity and building a more diverse physician workforce.
"We know that a more diverse physician workforce leads to better care for racial and ethnic minority patients," said lead author Dan Ly, MD, an assistant professor of medicine at Geffen. "But we have made such poor progress in diversifying our physician workforce. Our research shows that bans on affirmative action, like the one California passed a quarter-century ago in 1996, has had a devastating impact on the diversity of our medical student body and physician pipeline."
The study looked at enrollment data from 1985 through 2019 for 21 public medical schools in California and seven other states with bans on affirmative action and 32 public medical schools in 24 states without such bans.
The year before the eight states adopted their bans, underrepresented students in public medical schools in these states represented 14.8% of total enrollment. Five years after imposing the bans, however, enrollment of minority students at these public medical schools fell 5.5 percentage points compared to public medical schools in states without the bans. The 5.5 percentage point drop represents a 37% reduction relative to the 14.8% enrollment of underrepresented students in the year before ban implementation.
"As our country has spent the last two years weaving through the twin pandemics of racial health disparities amplified by COVID-19 and structural racism at large, our findings are critically important," said co-author Utibe Essien, MD, an assistant professor of medicine at the University of Pittsburgh.
"As we observed, affirmative action bans have resulted in a loss of underrepresented physicians, who could have been at the frontlines of caring for vulnerable populations throughout the pandemic and helping to alleviate disparities in care," Essien said. "My hope is that our findings will help provide policymakers with the tools to push back against affirmative action bans, not just for the diversity of the physician workforce, but for the equal and just health of our society."
Primary care spending, as a percentage of overall spending, varied widely among the eight health plan products examined in the report, from a low of 4.9% to a high of 11.4%.
Investing in primary care is associated with better quality medical care, fewer hospital visits, and savings of $2.4 billion annually in California, according to a new study.
The report -- Investing in Primary Care: Why It Matters for Californians with Commercial Coverage -- looked at eight health plans covering 80% of commercially insured adults in California, almost 14 million people. The report finds that primary care spending, as a percentage of overall spending, varied widely among the health plan products, from a low of 4.9% to a high of 11.4%.
The researchers speculated that if lower-spending providers matched the highest-spending providers, California could see 25,000 fewer acute hospital stays, 89,000 fewer emergency room visits, and a $2.4 billion reduction in overall healthcare spending in one year. As an added bonus, providers would see higher patient satisfaction and quality improvement scores.
"This study is the first analysis of health plan-level primary care investment in California and also the first to delve into primary care spending at the provider organization level, allowing for more granular analysis on the impact of primary care on quality and cost,” said study coauthor Dolores Yanagihara, MPH, with Integrated Healthcare Association. "Our analysis adds to the growing body of evidence that investing in primary care produces higher value and better outcomes for patients and purchasers."
The report comes as a new California Health Care Foundation / NORC Health Policy Survey reveals big differences between insured Californians who have a primary care provider and those who don't. Insured Latinos were the least likely to have a primary care provider compared to other insured Californians.
Californians who have a primary care provider have fewer language, distance, and affordability barriers to care and are less likely to delay care and are less likely to report negative provider experiences.
Kathryn E. Phillips, senior program officer at CHCF, said despite decades of research showing the cost-effectiveness of investing in primary care, "America, on average, spends only about five cents of every health care dollar on primary care."
The Primary Care Investment Coordinating Group of California, led by CHCF, Covered California, CalPERS, and other state agencies and business associations, are joining more than a dozen other states that are pushing for an increased share of healthcare dollars devoted to primary care.
"The shared, sweeping commitment of PICG members signals a major shift in priorities for healthcare in California and is intended to spur new investment in primary care throughout the state and the nation," Phillips said.
The projected savings work under the assumption that state and federal funding would be the same as under the current fragmented financing system.
A final report from California Gov. Gavin Newsom's Healthy California for All Commission claims that that the Golden State could save 40,000 lives and more than $500 billion over the next decade if it adopts single-payer.
"The commission found that, absent a shift to unified financing, California will spend $158 billion more annually on healthcare in 2031, approximately 30% more than baseline spending," the report said. "By contrast, residents, businesses, and government agencies would save money within the first year of the new system — and those benefits would increase over time."
The projected savings work under the assumption that state and federal funding would be the same as under the current fragmented financing system, and that that savings would funnel down to employers and families. The commission suggested that a portion of the projected $500 billion in savings generated by single-payer could be used to fund long-term care services for every resident of California.
Under the commission's framework a "unified financing system" would:
Provide universal entitlements for all Californians for a standard package of healthcare services that could include long-term care support and services, which would relieve the growing burdens on millions of families;
Allow no variance for entitlements based on age, employment status, disability status, income, immigration status, or other characteristics; and
Eliminate distinctions among Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage.
The report said the next big step for single-payer would be to engage the federal government to set the parameters for funding and undertake steps for legislative approval in California. However, the most-recent attempt to advance a single-payer bill in the California Assembly stalled in January after the bill's sponsor -- Assemblymember Ash Kalra (D-San Jose) -- conceded he didn’t have the votes.
As for the fate of commercial health plans, the report offers no firm recommendations, but suggests that huge savings would be generated by the reduction in administrative costs if payers are still around after the transition to single-payer, they could be relegated to administrative roles.
California hospital margins — a measure of financial performance — were 26% lower on average than before the pandemic.
The COVID-19 pandemic may be waning, but California's hospitals are still reeling from the economic fallout that has cost them $20 billion in the past two years and put more than half of hospitals in the red.
According to a Kaufman Hall study commissioned by the California Hospital Association, Golden State hospitals in 2021 lost nearly $6 billion, roughly three times the $2.2 billion that had been projected. In 2020, California hospitals lost $14 billion.
Federal CARES Act relief softened the blow somewhat, but California hospitals still took a $12 billion hit, the report says.
"The pandemic has taken a devastating financial toll on the majority of hospitals in California," CHA President and CEO Carmela Coyle said at a media event detailing the report. "In communities throughout our state, many hospitals are struggling to provide services for all who need care. It is going to take years for hospitals to recover from these losses, and the truth is some hospitals may not survive."
The report shows that 51% of the state's hospitals are operating in the red, compared to 40% before the pandemic, with higher expenses such as labor costs largely to blame. Total costs for California hospitals rose 15% in 2021, outpacing the 11% national average. These cost increases were largely driven by higher labor costs and medical supply chain shortages. Overall, California hospital margins — a measure of financial performance — were 26% lower on average than before the pandemic.
The report also shows that while hospitals took care of fewer patients in 2021 than pre-pandemic, those patients who were hospitalized were sicker and required longer hospital stays, which the report says likely is the result of hospitals caring for both extremely ill COVID-19 patients, and those patients who delayed non-COVID-19 care earlier in the pandemic.
Because hospitals are commonly paid a fixed amount per admission, fewer admissions and longer lengths of stay create additional financial pressures for hospitals.
Roger Sharma, president and CEO of Emanate Health, says his non-profit, three-hospital system serving the East San Gabriel Valley was dealt a devastating blow by the pandemic.
The system, which serves a largely Hispanic community, gets 80% of its reimbursement from Medicare or Medi-Cal, lost $30 million in FY 2020 and an additional $16.6 million in the first two months of 2022. To stay afloat, Emanate Health has had to dip into reserves to make payroll and pay utility bills, mandate 20% payment cuts for managers, and suspend pension plan contributions from mid-2020 to mid-2021, with only a 50% restoration from mid-2021 to now.
"In the last decade, we have never been in the red before," Sharma says. "The pandemic might have clinically ended, but the economic disaster is continuing — even more severely today. If the current economic burden continues, we are worried about running out of funds to keep the hospital operational and expanding much-needed services for our community."
