Patient concerns are at odds with the relatively low risk of contracting the coronavirus during in-person visits at healthcare venues.
More that two-thirds of patients in a new survey say they'd delay doctors' appointments when COVID-19 rates spike in their area, and more than half (57%) say they'd be reluctant to go to the hospital even during an emergency.
The survey, released Tuesday by Orlando Health Heart & Vascular Institute, also found that 49% of respondents will not reschedule missed in-person medical appointments until COVID-19 concerns are reduced in their area. The same number (49%) fret that their health will suffer because of the appointments.
"I understand their hesitation. But there's no question, across diagnoses, whether for chronic or acute conditions, the later in the disease process that we see people and can intervene, the worse their outcomes." said Steven Hoff, MD, a cardiothoracic surgeon at the OHHVI.
The respondents' concerns do not align with the relatively low risk of contracting the coronavirus during in-person visits at healthcare venues, which are some of the safest public spaces. At the dame time, experts note that delaying medical care can be dangerous.
"Because of the extensive protocols in place, COVID-19 transmissions in hospitals are very rare," said Joel Garcia, MD, an interventional cardiologist at the OHHVI. "There is more risk in not paying attention to symptoms or medical conditions than the benefit of staying home thinking you will not get exposed to COVID-19."
Garcia said telehealth has become an invaluable tool during the pandemic, allowing doctors to communicate with patients, explain safety protocols in place at care venues, and encourage them to come in if needed.
Telehealth can also be used in follow up care and to limit in-person visits.
"We have been fortunate that we've been able to accelerate the development of telehealth services during the COVID era because of the need that was created," Garcia said. "Being able to actually reach out to the patient in that venue allows us to educate patients better and get them in the door if we need to see them in person."
Nearly half of the people who were undergoing treatment when the pandemic shutdown began used telemedicine.
Lack of insurance was associated with lower telehealth use for new conditions.
Telehealth use for chronic care jumped 40% between mid-March and early May in the first months of the coronavirus pandemic, and more than 50% for behavioral use, a new RAND Corporation study shows.
Nearly half of the people who were undergoing treatment when the pandemic shutdown began used telemedicine, according to the study, which was published this month in Journal of General Internal Medicine.
However, the study also found that telehealth for behavioral health was lower among women, people over 60, non-Hispanic Whites relative to non-Hispanic Blacks, and those with less than a high school education.
Lack of insurance was associated with lower telehealth use for new conditions. Use of telehealth was more common in the Northeast.
"While the increased use of telehealth was widespread, some groups of Americans reported using the services less often than others," said study lead author Shira H. Fischer, MD, a physician researcher at RAND.
"If telehealth use is going to remain high, we need to ensure equity of access, particularly for behavioral health care where education, age and gender were all associated with levels of use," she said.
Among the 2,052 people surveyed most telehealth users accessed their own physicians for virtual care rather than finding a new or unfamiliar physician, the survey found.
When the pandemic began, nearly 40% of the Americans surveyed were being treated for a chronic physical health condition, while 15% were being treated for a behavioral health condition. Since the pandemic started, 16% had considered seeking care for a new or recurrent condition.
Among patients who were receiving care when the pandemic began, the study found that 11% had used video conferencing from the middle of March to early May.
A survey conducted with the same patient panel in 2019 found that fewer than 4% had ever used video conferencing with a doctor.
Among people who used telehealth services, researchers found that the use of video telehealth was less common for physical health care (14% of patients) than for behavioral health care (30% of patients).
"There is a wide expectation that telehealth will continue after the pandemic ends. Lessons from the use of telehealth during this period should inform policy for the post-COVID-19 era," Fischer said.
The sector lost 39,000 jobs in December, despite healthy gains in hospital and ambulatory care employment.
The healthcare sector, long a job-creating dynamo in the U.S. economy, shed 502,000 jobs in 2020, a casualty of the coronavirus pandemic and the ensuing shutdown of nonessential services that left providers hemorrhaging money.
In December, healthcare added 39,000 jobs, including 32,000 jobs in hospitals and 21,000 jobs in ambulatory services.
However, those gains were partially offset by declines in nursing care facilities (-6,000) and community care facilities for the elderly (-5,000.), Bureau of Labor Statistics data show.
Since February, the hospital sector has lost 70,000 jobs, and the ambulatory services sector has lost 173,000 jobs. Nursing and residential care homes lost 264,000 jobs.
The healthcare sector employed 16 million people in December, down from 16.5 million in February. Healthcare accounted for about 11% of all jobs in the overall economy in 2020.
Overall, 2020 was not kind to the U.S. labor market, which recorded 9.8 million (6.8%) nonfarm job losses since February, owing to the widespread shutdowns created by the pandemic, BLS data show.
The overall economy lost 140,000 jobs in December, with the hospitality, private education, and government sectors particularly hit. The unemployment rate remained unchanged at 6.7%.
Neil de Crescenzo, president and CEO of Change Healthcare, will be OptumInsight's CEO when the deal closes.
UnitedHealth Group tech services subsidiary OptumInsight will acquire independent software and data analytics provider Change Healthcare in a deal valued at around $8 billion.
In a joint press release Wednesday, Eden Prairie, Minnesota-based UnitedHealth, and Nashville-based Change Healthcare said the combined company "will more effectively connect and simplify core clinical, administrative and payment processes - resulting in better health outcomes and experiences for everyone, at lower cost."
Neil de Crescenzo, president and CEO of Change Healthcare, will be OptumInsight's CEO when the deal closes.
"This opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system," de Crescenzo said.
Under the deal, UnitedHealth Group will buy Change Healthcare's common stock for $25.75 per share in cash and is expected to close in the second half of 2021, subject to Change Healthcare shareholders' and regulatory approval. UnitedHealth will also take on about $5 billion in debt owed by Change Healthcare.
Change Healthcare stock was trading at $24.03 at midmorning Wednesday, up 31%.
The Blackstone Group, which controls 20% of Change Healthcare's common stock, will vote in favor of the acquisition.
The combined company is the latest step in UnitedHealth's ongoing expansion into the health services sector.
"Together we will help streamline and inform the vital clinical, administrative and payment processes on which healthcare providers and payers depend to serve patients," said Andrew Witty, president of UnitedHealth Group and CEO of Optum.
Believe it or not, there was more going on in the healthcare universe in 2020 than the response to the coronavirus pandemic and we've compiled a list of stories to prove it.
Understandably, the coronavirus pandemic dominated the headlines this year, not just with HealthLeaders, but with pretty much every media outlet on the planet.
Still, our savvy pillar editors reported on scores of healthcare stories that were not centered around that dreaded virus.
So, we thought we'd share a collection of some of non-COVID-19 content in 2020, if nothing else than to remind us all that we will get through this scourge and life will continue.
Picture a revenue cycle where employees jockey to work on their colleagues' accounts, the turnover rate is less than 5%, and staff members ask their manager not to fill a vacant position so they can work on extra accounts.
That's what's happening at Sharp HealthCare in San Diego, which has "gamified" its revenue cycle management workflow to turn employees' everyday tasks into opportunities to earn points, badges, and compete with each other.
Here are some of our other top Revenue Cycle stories of 2020:
San Francisco–based PlushCare has been providing primary care telehealth services to patients since its founding five years ago. PlushCare, which has a nationwide patient population of more than 200,000, employs more than 100 physicians. The COVID-19 pandemic has boosted demand for PlushCare's services, with a 400% increase in telehealth visit volume.
Here are some of our other top Clinical Care stories of 2020.
The Ohio State University Wexner Medical Center created Anti-Racism Initiatives to "elevate, engage, equip, and empower" the community, students, faculty, and staff to focus on improving racial inequalities in healthcare. The medical center also states that "racism is a social determinant of health."
HealthLeaders' Melanie Blackman spoke to Dr. Harold Paz, CEO of The Ohio State University Wexner Medical Center, about the medical center and university's focus on addressing social determinants of health and racial inequities in their surrounding communities through an anti-racism action plan.
Steward Health Care in June reached an agreement to buy back control of the company from Cerberus Capital Management, L.P., a New York-based private equity firm. Cerberus sold control of the Dallas-based physician-owned company to a group of Steward physicians led by CEO Dr. Ralph de la Torre.
This June, HealthLeaders convened health system executive thought leaders to discuss the "Healthcare System of the Future." In his keynote address, John Halamka, MD, MS, president of the Mayo Clinic Platform, discussed the technology stepping stones that will pave the road forward.
Other top stories from the Innovation pillar in 2020:
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
California saw nearly 20,000 more deaths from March 1 through August 22 than what would be predicted by historical trends, new research shows.
The Golden State recorded 146,557 deaths over the seven-month span between March and August, which is 19,806 more deaths than historical models suggest, according to a research letter in JAMA Internal Medicine.
Per capita excess mortality was highest among people aged 65 years and older, men, Blacks and Latinos, and those without a college degree.
"Following the statewide shelter-in-place, Latino residents and those without a high school degree/GED had the greatest increase in excess per capita mortality, with rates more than tripling after reopening," the UC San Francisco-led researchers wrote.
"We hypothesize that this pattern reflects the risk of COVID-19 death faced by low-wage, essential workers and their social networks owing to occupational exposure, crowded housing, and inadequate access to testing or treatments," they said.
The projections in the research letter are consistent with state and national tracking of COVID-19 deaths. As of December 21, the pandemic had claimed 22,820 lives in California with about 1.9 million cases reported. Nationally, the virus has claimed more than 311,000 lives, with more than 18 million cases reported, according to data compiled by The New York Times.
The research also compared deaths in March through April against deaths in May through August and found that Latinos and those without a high school degree or the equivalent had the greatest increase in excess deaths.
Latino deaths tripled from 16 to 51 excess deaths per 1 million, and deaths in those without a high school degree grew by a factor of 3.4, from 21 to 72 excess deaths per 1 million.
Younger adults had the biggest increases in excess deaths, more than doubling the rate between shutdown and reopening. Ages 25-54 increased from 4 to 11 excess deaths per million, and ages 55-64 grew from 12 to 30 excess deaths per million.
Black people had higher per capita excess mortality than other racial/ethnic group throughout most of the pandemic. However, later in the shelter-in-place period, White, Asian, and Black residents had a decline in excess per capita deaths.
Latinos and those without a high school diploma saw a large and sustained increase in per capita deaths.
While noting that the research is not designed to determine the effect of policies undertaken during the pandemic, the researchers said their findings "suggest that the policies adopted to date have had disparate outcomes across population subgroups.":
"Our findings underscore the importance of examining the inequitable effects of policies during the pandemic, reexamining the effects over time, and investing in strategies to mitigate the excess mortality in affected communities," the said.
Methodology
Using California Department of Public Health, the researchers evaluated deaths for the entire state and for specific groups by age, sex, race/ethnicity, and educational level, ages 25 or older.
The researchers estimated excess deaths for each week by subtracting the number of forecast deaths from the number of observed deaths.
"For each time period, we obtained 95% prediction intervals by simulating the forecast 10,000 times, selecting the 97.5% and 2.5% quantiles and subtracting the total number of observed deaths," the research letter said.
"We obtained per capita estimates by dividing the excess deaths and corresponding 95% prediction intervals by population size, using estimates from the U.S. Census Bureau."
The latest annual List of Measures under Consideration is part of a broader "Meaningful Metrics" initiative launched in 2017 to reduce red tape for providers.
Most of the 2020 quality and efficiency metrics proposed by the federal government would be collected digitally, cutting the hassle for providers to retrieve the data manually, the Centers for Medicare & Medicaid Services said Tuesday.
CMS Administrator Seema Verma said theList of Measures under Consideration is part of a broader "Meaningful Metrics" initiative launched in 2017 to reduce red tape for providers.
"We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty," Verma said.
"Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same," she said. "They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients."
The proposed list of metrics will be sent for stakeholder review to the independent National Quality Forum's Measure Applications Partnership, which is expected to provide feedback by February 1, 2021.
The 2020 list – which includes new measures and updates – features:
Five outcome measures, such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;
Five process measures, such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes;
Three process measures for the coronavirus vaccine, including vaccination coverage among healthcare personnel, vaccination by clinicians, and vaccination coverage for patients in End-Stage Renal Disease venues;
Five cost/resource use measures – including episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;
Three composite measures, which summarize overall quality of care across multiple measures using one piece of information;
Two patient reported outcomes measures.
Only three measures under consideration rely "pen-and-paper" data collection.
Of the non-digital measures, two assess COVID-19 vaccinations among healthcare workers and patients in ESRD facilities. The other acts on patient-reported health outcomes.
CMS says enrollment growth is driven largely by the Public Health Emergency and the Families First Coronavirus Response Act's continuous enrollment mandate.
Medicaid and Children's Health Insurance Program enrollment grew by a combined 5.8 million people, or 8.3%, from February to August, a data "snapshot" from the Centers for Medicare & Medicaid Services shows.
Following months of decline in applications early in the public health emergency, the new data released Monday show an increase in applications starting in June, with a big leap in applications between July and August.
A further breakdown of the data shows that Medicaid enrollment grew by more than 5.8 million people, or 9.1%, over the seven-month span, and that CHIP enrollment grew by 33,000 children, or 0.5%.
CMS Administrator Seema Verma said the enrollment growth is driven largely by the COVID-19 Public Health Emergency, and by the Families First Coronavirus Response Act's continuous enrollment mandate.
"In the midst of a pandemic of generational scope and fury, it has never been more important to understand the underlying drivers of enrollment trends and the impact of new congressional requirements," Verma said.
The mandate provides a temporary 6.2% increase in matching funds through Federal Medical Assistance Percentages for states but requires states to maintain Medicaid enrollment for beneficiaries except in a few circumstances.
However, CMS noted that -- while the data on applications suggest that new enrollment has affected the overall increases in Medicaid and CHIP enrollment during the PHE -- it has not been "the key driver," because enrollment growth is outpacing applications.
"This trend suggests that enrollment increases are likely attributed to existing enrollees remaining eligible due to the maintenance of effort requirements," CMS said, adding that it will "continue to monitor these trends."
The rate of growth in 2019 was down slightly from the 4.7% rate in 2018 and consistent with the average annual spending growth rate of 4.5% since 2016.
Healthcare spending in the United States grew 4.6% in 2019, hitting $3.8 trillion, or $11,582 per person, federal actuaries announced on Wednesday.
The rate of growth in 2019 was down slightly from the 4.7% rate in 2018 but consistent with the average annual spending growth rate of 4.5% since 2016, according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services.
The report, which was published online Wednesday afternoon in Health Affairs, notes that faster growth in personal healthcare spending was offset by a drop in the net cost of health insurance, mostly because of the suspension of the individual mandate.
The report covers 2019 and does not include the effects of the coronavirus pandemic on healthcare spending.
Healthcare spending grew somewhat faster than the 4% growth in the gross domestic product, and healthcare spending as a share of the overall economy nudged up slightly to 17.7% from 17.6% in 2018, the analysis shows.
"Healthcare spending in 2019 increased at about the same rate as it had in 2018 and was similar to the average annual growth since 2016," said study first author Anne Martin, an economist in the CMS Office of the Actuary.
"This relative stability in healthcare spending growth over the last four years preceded the COVID-19 pandemic in 2020," Martin said. "The full impact of the pandemic on the healthcare sector is still not known, but it will certainly have profound consequences on the provision and consumption of healthcare in 2020 and perhaps beyond."
Personal healthcare spending accounted for 84% of total healthcare spending in 2019 and grew 5.2 %—compared with 4.1% growth in 2018. Martin said the increase was driven mostly by accelerated spending growth for hospital care, retail prescription drugs, and physician services.
National health spending grew 4.1% per capita in 2019, similar to the 4.2% increase in 2018, reflecting faster growth in the residual use of healthcare goods and services and slower growth in medical prices.
Medical prices increased 1.1% in 2019, half the rate of 2.3% growth seen in 2018. However, residual use and intensity of services increased 2.5% in 2019, which is faster than the 1.4% growth seen in 2018.
The rate of growth linked with changing demographics held steady at 0.5% in 2019.
A detailed breakdown of major spending growth in 2019 found that:
Hospital spending grew 6.2% and reached $1.2 trillion in 2019, representing 31% of overall healthcare spending, compared with 4.2% in 2018. However, hospital prices rose 2% compared with 2.4% in 2018, while nonprice factors such as the use and intensity of goods and services grew 4.2%, compared with 1.8 % in 2018.
Physician and clinical services grew 4.6% and reached $772.1 billion, or 20% of total healthcare expenditures. Spending grew 4.6%, up from 4% in 2018. Nonprice factors, such as the use and intensity of services, were the largest contributor to the acceleration in expenditure growth, as price growth remained steady in 2019 at about 0.8%. The 5.8% pending growth for clinical services outpaced spending growth for physician services 4.2%.
Private health insurance grew 3.7% and reached $1.2 trillion and accounted for 31% of total national health spending. Private health insurance spending increased 3.7% in, which was slower than the 5.6% growth rate seen in 2018, and driven largely by the suspension of the Affordable Care Act's Individual Mandate.
Private health insurance enrollment grew 0.5%. Per enrollee spending increased 3.2%, half the 6.4% growth of 2018.
Medicare spending grew 6.7% and reached $799.4 billion in 2019, representing 21% of total national healthcare expenditures. Medicare's 6.7% spending growth was up slightly from the 6.3% growth in 2018.
Medicare enrollment grew 2.6% in 2018 and 2019. Per enrollee Medicare expenditures grew 4% in 2019 compared with 3.6% in 2018. Fee-for-service procedures accounted for 61% of Medicare spending in 2019, down from 67% in 2016, which Martin said reflects the shrinking FFS share of total Medicare enrollment over the past four years.
FFS Medicare spending grew 2.2%, down from 3% in 2018. Medicare Advantage spending accounted for 39% spending in 2019 and increased 14.5%, up from 12.6% growth in 2018.
Per capita enrollee spending in Medicare Advantage grew 6.3%% in 2019, almost three times the 2.4% per capita growth rate of Medicare FFS.
Medicaid spending grew 2.9% and reached $613.5 billion, accounting for 16% of national health spending, and down slightly from the 3.1% growth in 2018.
Martin said the steady growth in 2019 was owing to faster spending growth for most goods and services and an offsetting drop in the net cost of insurance, thanks largely to the suspension of penalties associated with the Affordable Care Act's individual mandate.
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.
