"Children's hospitals have pitched in to our all-of-America COVID-19 response by providing backup capacity, extra supplies of PPE, and other support," HHS Secretary Alex Azar said.
"Throughout the distribution of the Provider Relief Fund, we have sent these funds as quickly as we can to those who have been hardest hit by the virus, and this distribution recognizes the contributions of children's hospitals helping to meet the challenges of this pandemic," he said.
The money comes from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other providers.
Rick Pollack, president and CEO of the American Hospital Association, thanked HHS for the latest round of funding, but said more money will be needed.
"We continue to urge the Administration to distribute additional relief to all hospitals and health systems, as well as those in so-called 'hot spots,'" he said.
While most children's hospitals have been spared the pandemic-related surges, they've also seen their patient volumes and revenues flatten as they've suspended non-urgent surgeries offered back-up capacity for other hospitals and borne the additional costs of acquiring personal protective equipment.
HHS has already allocated about $13 billion in CARES Act and Paycheck Protection money so far this year for pediatric and adulty safety net hospitals.
Azar said the additional $1.4 billion will target free-standing children's hospitals that are not affiliated with hospital systems.
To qualify for the aid, the hospitals must either be an exempt hospital under the Centers for Medicare and Medicaid Services inpatient prospective payment system or be a Health Resources and Services Administration-defined Children's Hospital Graduate Medical Education facility.
The deal was finalized over the strong objections of healthcare unions.
Prime Healthcare this week finalized its $350 million acquisition of the bankrupt St. Francis Medical Center in Southeast Los Angeles County.
In a media release, for-profit, Ontario, California-based Prime said the acquisition signals "a new era of service excellence and award-winning healthcare for an essential medical facility in Los Angeles County."
"Prime is prepared to lead St. Francis into a bright future and we are grateful for the opportunity along with the support we have received from the community," said Sunny Bhatia, MD, CEO of Region I of Prime Healthcare.
Prime bought the 384-bed nonprofit hospital in Lynwood, California from Verity Health System of California, Inc. over the howls of protests from the Service Employees International Union-United Healthcare Workers West, which had accused Prime of a "history of bilking taxpayers and cutting services."
"Prime's shocking history of deceit, fraud and repeated elimination of health services that patients depend on is simply out of step with owning a hospital like St. Francis, which is a lifeline to the people of Lynwood and surrounding communities," said Mauricio Medina, a certified nursing assistant at St. Francis and a member of SEIU-UHW.
The union had petitioned California Attorney General Xavier Becerra to scotch the deal, which transitions the hospital to for-profit.
Instead, Becerra gave the deal his "conditional approval."
“The conditions we have attached to the proposed sale of St. Francis focus on maintaining or improving care and services at the hospital – from treatment for COVID-19 to cancer and emergency care," Becerra said. "No change in ownership, no bankruptcy filing can be allowed to diminish that priority."
Prime was the highest bidder for the hospital in the U.S. Bankruptcy Court for the Central District of California, and the acquisition was finalized after a contentious four-month review and public hearing process.
Under the terms of the acquisition, Prime committed more than $350 million to the hospital, which includes a $200 million base price and $15 million in payroll and benefits upgrades for staff.
Rich Adcock, CEO of Verity Health, said Prime was the "only bidder with the fortitude to support the hospital in its time of greatest need, despite the burden of the pandemic, the uncertain future and economic impact on hospitals."
Researchers say their findings "suggest that the mortality associated with COVID-19 during the early phase of the New York City outbreak was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic."
How does the lethality of COVID-19 compare with that of the Influenza pandemic of 1918?
In a study this week in JAMA Network, researchers at Harvard Medical School tried to find out by comparing estimated excess deaths in New York City during the first two months of the COVID-19 pandemic this spring and the peak of the Influenza 1918 pandemic.
The 1918 Influenza killed about 50 million people across the world, including 675,000 people in the United States.
The Harvard study found that, during the peak of the 1918 H1N1 influenza outbreak in New York City, between October and November 1918, a total of 31, 589 all-cause deaths occurred among 5.5 million residents, yielding an incident rate of 287.17 deaths per 100,000 population.
The incident rate ratio for all-cause mortality during the H1N1 pandemic when compared with similar two-month spans from 1914 to 1917 was 2.80.
From March through May 2020 the COVID-19 outbreak in New York City saw 33,465 all-cause deaths occurred among 8.3 million residents, yielding an incident rate of 202.08 deaths per 100 000 population.
The incident rate ratio for all-cause mortality during the study period of 2020 compared with corresponding periods from 2017 through 2019 was 4.15.
In other words, the absolute increase in deaths over baseline during the peak of 1918 H1N1 influenza pandemic was higher than that observed during the first two months of the COVID-19 outbreak in New York City.
Nonetheless, the researchers said their findings "suggest that the mortality associated with COVID-19 during the early phase of the New York City outbreak was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic."
Notably, the baseline mortality rates from 2017 to 2019 were less than half that observed from 1914 to 1917, thanks to improvements in hygiene and advancements in medicine, public health, and safety.
As a result, the relative increase during early COVID-19 period was substantially greater than during the peak of the 1918 H1N1 influenza pandemic.
The study also could not directly compare the "native virulence" of the 1918 H1N1 influenza strain and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
And, it's not clear how many deaths from SARS-CoV-2 infection have been prevented because of modern interventions not widely available a century ago, including standard resuscitation, supplemental oxygen, mechanical ventilation, kidney replacement therapy, and extracorporeal membrane oxygenation.
"If insufficiently treated, SARS-CoV-2 infection may have comparable or greater mortality than 1918 H1N1 influenza virus infection," the researchers said.
The proposed reforms are now under review by the Office of Management and Budget.
Sweeping revisions of the Stark and Anti-Kickback statutes are expected to be unveiled soon as the federal government grapples with the shifting landscape of value-based care and industry consolidation.
Kathleen McDermott, a former U.S. assistant attorney, and now a partner at Washington, D.C.-based Morgan Lewis, offered some guidance on what to expect in this email exchange with HealthLeaders.
HL: When will this final rule be made public?
McDermott: Health and Human Services has suggested late August or early September 2020, though that projection may change. The regulations currently are under review by the Office of Management and Budget.
HL: Why are these revisions to Stark and Anti-Kickback needed?
McDermott: These statutes were enacted decades ago and were drafted with the older healthcare reimbursement systems in mind. The goal of these recent changes is to modernize the regulations implementing these laws to account for present risks and allow for innovation in value-based arrangements that involve clinical care coordination. Removing unnecessary regulatory barriers to clinical care coordination (in particular, by the strict liability Stark Law) should make our health system more efficient and our citizens healthier.
HL: What should we be looking for in this final rule?
McDermott: The core proposals regarding value-based arrangements should be confirmed with more regulatory details and reconciliation or harmonization of definitions that were left open in the proposed rule related to patient engagement tools and participation.
Notably, the rules introduced the concept of considering social determinants of health (nutrition, housing and transportation) for patient incentives and in the safe harbor for local transportation. This important concept could in the future open the door to a wide variety of non-medical services and arrangements to assure access to quality and coordinated care. We should also expect the implementation of several significant revisions to existing Stark Law regulations.
HL: Do you anticipate any significant changes in the final rule, compared with the proposal that was issued last fall?
McDermott: Yes, there were several areas that were left open for comment and may not result in a specific final rule.
HL: Will any of this require an act of Congress?
McDermott: Technically no, but some may argue that the regulatory changes go beyond the agency’s rule-making authority to interpret and implement a statute, such as changes to the definition of remuneration.
For example, some may argue that the anti-kickback safe harbors and Stark Law exceptions currently exceed statutory authority in some respects, but no one seems to be complaining in this regard. Nonetheless, we don’t anticipate this will impact the agency’s path to modernization.
HL: Is any significant opposition to these revisions? From whom? And what is the basis of their opposition?
McDermott: The whistleblower bar has raised concerns that modernizing the fraud and abuse laws may encourage more fraud and abuse. Whistleblowers bring cases for private gain and some of these changes may impact existing cases or cases that could have been brought under prior or superseded rules. Stark Law definitional changes to fair market value and commercial reasonableness could have a big impact on whistleblower cases based on regulatory violations.
HL: Are there any unintended consequences that could arise from this?
McDermott: This modernization effort is a leap of faith that healthcare providers can be incentivized to effectively coordinate good clinical care and patients will participate meaningfully in coordinated care activities to manage their health. There will be many unintended consequences, hopefully all good ones.
HL: Will this accelerate the healthcare sector's general trend toward consolidation?
McDermott: At some level, yes, but the healthcare sector’s trend toward consolidation seems more often driven by factors other than regulatory requirements. Whatever is consolidated today will be unwound tomorrow, if history is any guide.
Of the 48,835 active emergency physicians in the United States, 92% practice in urban areas with just 8% practicing in rural communities.
Large swaths of rural America are enduring shortages of emergency physicians, and the problem is expected to worsen as a generation of rural doctors retires with no one to replace them, a new emergency medicine workforce analysis has found.
"The number of emergency physicians is increasing but there is a clear unmet need for emergency physicians in rural areas," said Christopher Bennett, MD, MA, assistant professor of emergency medicine at Stanford University School of Medicine and lead study author, which was published this week in Annals of Emergency Medicine.
"Policymakers and health leaders should prioritize opportunities to make sure that emergency departments across the country are led by appropriately trained and certified emergency physicians," he said.
Of the 48,835 clinically active emergency physicians in the United States, 92% (44,908) practice in urban areas with just 8% (3,927) practicing in rural communities, down from 10% in 2008, the study found.
"Demand for emergency care in rural areas will remain high while emergency physician shortages in these communities continues to pose significant challenges for health systems and patients," Bennett said.
The analysis also shows that the rural emergency physician workforce is closing in on mid-career or retirement, with more than 70% having completed their medical training more than 20 years ago.
The median age for urban emergency physicians is 50 years old, while the median age in large rural communities is 58 years old, and 62 years old in smaller rural communities, the study found.
Relief does not appear to be coming any time soon, as the study found that 96% of the emergency medicine residency or fellowship graduates within the past four years practiced in more urban areas.
On a brighter note, residency programs continue to expand, and that could help alleviate the shortage.
There were 4,565 residents in 145 programs in 2008, and in 2020 there are 7,940 residents in 247 programs.
"There are reasons to be optimistic about the pipeline of residents and trainees, however; we need to encourage a larger percentage of these individuals to work in rural America," Bennett said.
The study also found that women comprise 28% of emergency physicians, up from 22% in 2008.
The Community Health Access and Rural Transformation Model will pick 15 rural communities for its Community Transformation Track, which starts next summer.
The Trump Administration has unveiled a two-track pilot program that will provide $75 million in "up-front funding" for 15 rural communities to transform their care delivery models.
The volunteer Community Health Access and Rural Transformation (CHART) Model will pick 15 rural communities for its Community Transformation Track, which begins next summer.
The Centers for Medicare & Medicaid Services will also accept applications for 20 slots in a related Accountable Care Organization Transformation Track to begin in January 2022.
CMS Administrator Seema Verma said the agency was acting on an Aug. 3 executive order by President Donald J. Trump calling for a new model "to ensure that rural healthcare providers are able to provide the necessary level and quality of care."
"This new model is appropriately called CHART, or the Community Health Access and Rural Transformation Model, because it charts a course to a sustainable healthcare delivery system in rural communities," Verma said at a media teleconference Tuesday.
Verma said the model "provides three things for rural communities."
"First, it provides new upfront seed funding for rural communities to organize their efforts to transform healthcare delivery in their communities."
"Second, it allows for operational and regulatory flexibilities that enabled enhance care for fee for service beneficiaries."
"Third, it offers technical and learning support to participants to ensure the model success," she said.
CMS will detail the CHART models during a webinar on Aug. 18 at 1 p.m. ET.
Under the model, Verma said, 15 select rural community stakeholders and state Medicaid organizations could receive up to $5 million over 18 months to help transform care delivery.
The model would also provide capitated payments that de-emphasize volumes for participating hospitals, and also could waive Conditions of Participation in specific circumstances when requested to do so by applicants.
CMS believes this would allow rural hospitals to move to outpatient- and emergency department-focused models instead of relying entirely on inpatient models. It would also allow rural providers to ramp up telehealth services or develop hub-and-spoke arrangements with larger, regional providers.
In turn, the model participants would be held accountable for quality outcomes measured by total cost, admissions and ER visits, and other metrics that the community would pick.
CMS said the related ACO Transformation Track builds on the success of the ACO Investment Model, which the agency claims has saved $382 million over three years.
The ACO Transformation Track participants will enter a two-sided risk arrangements as part of the Medicare Shared Savings Program and may use all waivers available in the MSSP program.
Verma said CMS will issue a Request for Applications in the Spring of 2021 and pick 20 rural ACOs to participate starting in January 2022.
Auditors examined 150 claims and found that only three claims were properly billed and paid by Medicare.
Sloppy coding and oversight from hospitals resulted in more than $267 million in Medicare overpayments for post-acute care transfers of inpatients to home healthcare services, the Department of Health and Human Services Office of the Inspector General said in an audit released this week.
"Medicare improperly paid most inpatient claims subject to the transfer policy when beneficiaries resumed home health services within 3 days of discharge but the hospitals failed to code the inpatient claim as a discharge to home with home health services or when the hospitals applied condition codes 42 (home health not related to inpatient stay) or 43 (home health not within 3 days of discharge)," auditors said.
OIG looked at nearly 90,000 inpatient claims totaling $948 million at risk of overpayment because of the transfer policy in fiscal years 2016 and 2017. The auditors picked 150 inpatient claims and found that only three claims were properly paid by Medicare, while the remaining 147 claims received $722,288 in overpayments.
"Medicare should have paid these inpatient claims using a graduated per diem rate rather than the full payment," OIG said. "Based on our sample results, we estimated that Medicare improperly paid $267 million during a two-year period for hospital services that should have been paid a graduated per diem payment."
The auditors recommended that the Centers for Medicare & Medicaid Services and its independent contractors to reprocess the claims and attempt to recover some of the money that was paid within the four-year reopening period.
"Also, we recommend that CMS correct its related system edits, improve its provider education related to the Medicare transfer policy, and use data analytics to identify hospitals disproportionally using condition code 42," OIG said.
The auditors also recommended that CMS "reduce the need for clinical judgment" when processing claims under the post-acute-care transfer policy. This could be done, OIG said, through legislative authority to deem any home health service within three-days of discharge to be "related."
Hospitals created 27,000 new jobs, about four times as many as were created in June.
Healthcare jobs continued their steady rebound in July as the nation contends with the coronavirus pandemic, but the pace of that job growth is slowing, new data from the Bureau of Labor Statisticsshow.
Healthcare reported 126,000 "payroll additions" in July, less than half the 318,000 new jobs seen in June. However, hospitals created 27,000 new jobs, about four times as many as were created in June (6,700), BLS data show.
Most of the July's healthcare job growth came in the ambulatory sector, which had mostly shuttered this spring because of the pandemic, including dentist offices (45,000), physician offices (26,000), and home health services (16,000), BLS said.
Those gains were offset by 28,000 job losses in nursing and residential care facilities. Since February, employment in healthcare is down by 797,000 jobs, BLS said.
July marks the third consecutive month of job growth for the healthcare sector, which suffered epic job losses in April owing to the coronavirus pandemic. In May, the sector saw 312,000 payroll additions, mostly in outpatient care venues.
The July job report largely reflects the state of the economy in mid-month and are considered preliminary and subject to considerable revision.
In the overall economy, BLS reported that payroll employment grew by 1.8 million in July, and the unemployment rate fell to 10.2%.
Drug store chains are reaping the fruits of a strategy they've laid out over the past several years "to become the center of gravity for consumer healthcare."
Healthcare consumers are embracing primary care in retail pharmacies with the rising use of consultation kiosks, exam rooms, and walk-in clinics, according to the J.D. Power 2020 U.S. Pharmacy Study.
James Beem, managing director of healthcare intelligence at J.D. Power, said the major drug store chains are reaping the fruits of a strategy they've laid out over the past several years "to become the center of gravity for consumer healthcare."
"When you look at the major pharmacy business trends of the past couple of years—CVS acquiring Aetna, Walgreens partnering with Humana and Walmart moving into health insurance—it's clear that pharmacy operators are positioning themselves to become hubs of consumer healthcare, edging into the space once reserved for primary care physicians’ offices," Beem said.
What has not been clear until now, Beem says, is how consumers would react to the shift.
"Simply put, they're embracing it, and it's driving higher overall satisfaction and increased spending as they use more health and wellness-oriented services," he said.
According to the J.D. Power study:
Use of health and wellness services is growing and driving higher customer satisfaction. Nearly half (48%) of retail pharmacy customers have used at least one health and wellness service provided by their pharmacy this year, up 5 percentage points from 2019.
Overall customer satisfaction is 26 points higher (on a 1,000-point scale) among customers who use health and wellness services compared with those who haven't.
Penetration into primary care drives satisfaction and spending: Customers who use at least one health and wellness service provided by their pharmacy spend an average of $11 more per customer than those who do not use these services ($35 vs. $24, respectively).
When customers use two or more health and wellness-oriented services, that average spend climbs to $58. Among customers who use two or more health and wellness services, overall satisfaction jumps to 907 vs. 861 for those who don’t use any service.
Digital ordering drives high levels of satisfaction, but use remains low: Only 9% of brick-and-mortar pharmacy customers order their prescriptions via digital channels. Despite the low utilization rate, satisfaction among those customers who order digitally through a brick-and-mortar pharmacy is 859, which is 5 points higher than among those who only visit the store in person.
Mail-order pharmacy customers are far more frequent users of digital ordering, with 32% ordering prescriptions via digital channels. These mail-order digital customers have an overall satisfaction score of 867.
Physician recommendations are key to health services use: Physician-recommended, pharmacy-delivered health and wellness services saw an 80% use rate and recommendations from friends and family have a 75% use rate.
Only 8% of customers say they've a recommendation from their doctor and 9% have received a recommendation from friends and family. The most common means of hearing about these services is in-store advertising, which drives a 45% utilization rate.
Study Rankings
The study also ranked the top performers among consumers for brick-and-mortar and mail order pharmacy services.
And the winners are:
Good Neighbor Pharmacy ranks highest among brick-and-mortar chain drug store pharmacies for a fourth straight year, with a score of 915. Health Mart (905) ranks second and Rite Aid Pharmacy ranks third (861).
Sam's Club ranks highest among brick-and-mortar mass merchandiser pharmacies for a fifth consecutive year, with a score of 885. Costco and CVS/pharmacy inside Target (870 each) rank second in a tie.
Wegmans ranks highest among brick-and-mortar supermarket pharmacies for a third consecutive year, with a score of 904. Publix (889) ranks second and Winn-Dixie ranks third (883).
Humana Pharmacy ranks highest in the mail order segment for a third consecutive year, with a score of 904. OptumRx (886) ranks second and Kaiser Permanente Pharmacy (883) ranks third.
J.D. Power's 12th U.S. Pharmacy Study is based on responses from 13,378 pharmacy customers who filled a prescription during the three months prior to the survey period of September 2019-May 2020.
With more than 25 years of experience, Hofheins currently is executive vice president and CFO of HealthPartners.
Veteran healthcare finance executive Todd Hofheins has been named CFO at Adventist Health, the Roseville, California-based nonprofit health system announced Thursday.
"I'm excited to welcome Todd to Adventist Health," Adventist CEO Scott Reiner said in a media release. "His extensive success with system finance strategies, health plans and wellness programs make him an ideal fit for Adventist Health's vision of bringing health and well-being into reach for everyone."
With more than 25 years of experience, Hofheins currently is executive vice president and CFO of HealthPartners, the largest nonprofit consumer-governed healthcare organization in the nation. Before that, he was executive vice president and CFO at Providence St. Joseph Health / Providence Health & Services.
Hoffheins, who will join Adventist in September, said he was attracted by the health system's faith-based mission, innovation, and wellness culture.
"The U.S. is spending significantly more on healthcare than other countries without that investment translating to better health outcomes," he said. "Adventist Health's focus on well-being to improve the health of individuals and communities holds the promise to make care more affordable, and I look forward to working with the team to support this vision."
Adventist Health has a footprint in California, Hawaii, Oregon, and Washington, with 20 hospitals, 280 clinics, nearly 5,000 staff physicians, and 32,900 employees.
