Organizational overhaul prompted by signs of ‘harder times to come.’
Scripps Health failed to meet its operating budget last fiscal year for the first time in 15 years, prompting the San Diego-based health system to restructure its executive team and look to cut corporate services costs by $30 million.
Although the system remains on solid financial footing, the news came as “a sober warning of harder times to come,” Scripps president and CEO Chris Van Gorder wrote in a memo to staff and physicians last week. The memo, which Scripps released in full to HealthLeaders Media, was as much a rallying cry as it was a bulletin of somber news.
“We can sit back and fool ourselves into thinking change is not really needed, and risk the consequences,” Van Gorder wrote. “Or like our founders, we can have the courage to boldly move ahead and do what’s needed for our patients, our community and their legacy.”
The memo outlined several organizational changes coming to Scripps in the next 30-60 days, including the following:
CEOs: Rather than keeping a CEO at each Scripps hospital, the system will establish three regional CEOs.
COOs: In the absence of a CEO, COOs will take over daily operations at each hospital.
Corporate services: Scripps will look to cut costs on corporate services by $30 million. It will evaluate a shared-services model for corporate services to improve accountability.
The southern region—which will get one of the three new CEO positions—includes Scripps Mercy San Diego and Chula Vista, overseen by current CEO Tom Gammiere. The northern region will include sites in Encinitas, Green, and La Jolla, which are overseen by CEOs Carl J. Etter, Robin B. Brown Jr., and Gary G. Fybel, respectively. The third region will comprise Scripps ancillary services.
It appears Etter, Brown, and Fybel are the most likely candidates to fill the new northern-region CEO and ancillary-services CEO positions. It’s possible, though, that Scripps could bring in outside talent, promote from within, or even shift Gammiere to the northern region. This is an overhaul, after all.
Scripps Not Alone
In his memo last week, Van Gorder noted that Scripps is far from the only healthcare organization to face the kind of financial pressures that prompted these changes.
“Hospitals and health systems across the country, small and large, are being affected in similar ways,” he wrote, citing two peer institutions: Partners HealthCare and the Cleveland Clinic.
Partners HealthCare, based in Boston, reported an operating loss of $108 million last year, Van Gorder noted. Last spring, Partners offered buyouts to 1,600 workers at its Brigham and Women’s Hospital and announced plans to cut costs by more than $600 million over three years, as The Boston Globe reported.
“This is an effort fundamentally to change not our values and our culture, but how we manage ourselves, how we focus on efficiency, the patient experience, the service we deliver, and try to be reflective of the pressures of being efficient,” Partners CFO Peter K. Markell told the Globe.
Cleveland Clinic, meanwhile, saw its operating income slump 71% last year, Van Gorder noted. The clinic’s president and CEO, Toby Cosgrove, MD, said the healthcare challenges putting pressure on systems these days are “unprecedented in their size, speed, and scope.”
Harvard Business Review (HBR) and other publications have covered the problem, Van Gorder told his team, noting that declining reimbursement rates are squeezing healthcare organizations nationwide.
“For the past decade, the consensus strategy among hospital and health-system leaders has been to achieve scale in regional markets via mergers and acquisitions, to make medical staffs employees, and to assume more financial risk in insurance contracts and sponsored health plans,” HBR’s Jeff Goldsmith wrote in October. “In the past 18 months, the bill for this strategy has come due, posing serious financial challenges for many leading U.S. health systems.”
Although each chamber's bill would impose new restrictions on tax-exempt bonds, the House version would be stricter.
Nonprofit hospitals came up for air last month as the House passed its version of the tax reform bill.
One provision, in particular, pertaining to tax-exempt bonds threatened to drive up the cost of debt for capital improvement projects slated to update aging infrastructure across the country.
Scripps Health in San Diego had just announced $2.6 billion in projects planned for the next decade. About a third of those expenditures were to be financed with bonds, Scripps Corporate Vice President and Treasurer Richard McKeown told the Los Angeles Times.
The House’s plan to do away with tax exemption for private activity bonds (PABs) would make it harder to pay for such expensive undertakings.
"It'll be painful, but it won't be catastrophic for larger, financially strong organizations," McKeown told the Times. "Small community hospitals that may not be doing OK financially, the additional burden of a higher cost of debt will make it more challenging."
Chris Van Gorder, Scripps president and CEO, advocated for changes to the House’s plan during a TV interview.
“If it goes through, as of January 2018, we will no longer be allowed to sell tax-exempt bonds, so that could mean that just a half-a-percent point increase on a billion-dollar project is another $150 million in costs,” Van Gorder told KUSI. “So we’re hoping that that gets rectified before it goes forward.”
A spokesperson for Scripps told HealthLeaders Media on Wednesday that the health system would prefer the Senate’s tax reform bill—whichpassed early Saturday with a 51-49 vote—insofar as it preserves PABs for nonprofits. Congress is currently working to reconcile the two versions of the tax reform bill before it can be signed into law, so it remains unclear precisely which provisions will make it into the final version.
Even if the Senate’s language on tax-exempt bonds prevails through the reconciliation process, however, nonprofit organizations will have new restrictions on their bond financing options in 2018. Both versions of the bill would do away with advanced refunding of tax-exempt bonds—a tactic used to refinance debt at a lower interest rate.
Scripps has voiced its concerns to federal officials via the American Hospital Association, the California Hospital Association, and the San Diego congressional delegation, the system spokesperson said. The AHA, in turn, co-signed a letter sent Wednesday to majority and minority leaders in both houses.
“By eliminating or reducing PABs, the federal government will undermine vital projects in numerous public service sectors including housing, hospitals, local water systems, airports, seaports, non-profit educational facilities including universities and charter schools, and other projects, many of which are ready for or under construction,” the AHA wrote with 34 other national organizations.
The letter calls upon lawmakers to preserve the current income tax treatment of PABs and to hold off, until the end of 2018, on prohibiting advanced refunding of tax-exempt bonds.
“This would be of immense help for planning and budgeting purposes for the local communities you represent, and the constituents we all put first,” the organizations wrote.
Health system CEO cites rising costs and declining revenue growth as basis for cuts.
UW Health CEO Alan Kaplan, MD, announced Thursday that the integrated health system will eliminate an unknown number of jobs over the next 18 months as it looks to increase revenue and cut costs by $80 million.
Several factors have backed the system into this financial corner, Kaplan said in a statement, citing an increase in the proportion of UW Health patients who rely on Medicare and Medicaid. Payments from these government-funded programs and others fall short of actual costs, he said, and commercial payers are increasingly reluctant to offset those underpayments.
“We will join many of our peers across the nation in focusing on reducing waste, improving processes and always asking ourselves how we can be better,” said Kaplan, who has led the system based in Madison, Wisconsin, since May 2016.
The news comes after UW Health competitor SSM Health—which operates Madison-based Dean Medical Group and St. Mary’s Hospital—announced earlier this month that it would cut 1% of its workforce, as the Wisconsin State Journal reported. Rather than following suit with across-the-board cuts of its own, UW Health said it would pursue a targeted approach.
Precisely how many jobs will be eliminated as part of UW Health’s plan remains unclear, but system spokesperson Lisa Brunette told HealthLeaders Media that at least 25% of the reduction in expenses is expected to come from labor. That would include the elimination of unfilled positions, natural attrition, and actual job loss, she said.
The $80 million goal includes expense-reduction and revenue-increases alike, but the system could not provide an estimate Thursday of how much money would come from each category, Brunette said.
Kaplan said UW Health’s first steps to save on labor costs would include reducing its reliance on agency labor, keeping close tabs on overtime, and refraining from filling vacant positions. When jobs are eliminated, the system would help employees move within the organization when possible or to other organizations if necessary, he added.
The system will continue to recruit for positions as needed, Kaplan said.
“We have some very difficult decisions to make in the short term but are also confident in the long-term benefit for our patients and community of an efficient and stable UW Health,” Kaplan said.
Republican sees JAMA study as evidence of ACA’s ‘deadly unintended consequence,’ calls for repeal of individual mandate.
Speaking from the floor of the U.S. Senate on Wednesday during debate over a GOP tax proposal, Sen. John Barrasso (R-Wy.) cited a recent JAMA Cardiology study as evidence that the Affordable Care Act has come with unintended consequences, at least one of them fatal.
The study that Barrasso mentioned found an alarming link between lower readmissions and higher mortality among Medicare patients hospitalized with heart failure, as HealthLeaders Media reported earlier this month. Medicare made a concerted effort to reduce readmissions among these patients and succeeded, but the program might have inadvertently increased the likelihood that those patients would die, the researchers wrote.
Barrasso placed blame for this increase in mortality on the 2010 healthcare law, which included a provision establishing the Medicare Hospital Readmission Reduction Program.
“There’s a program in the healthcare law that started to penalize hospitals if that Medicare patient was readmitted to the hospital within 30 days after they had been released from the hospital,” Barrasso said. “There are a number of reasons that may happen, but the goal was to penalize hospitals, and the goal—laudable goal—was to give patients better treatment, but that’s not what happened.”
Among the more than 115,000 fee-for-service Medicare beneficiaries studied, the 30-day risk-adjusted readmission rate dropped from 20% before the program was implemented to 18.4% afterward; the 30-day risk-adjusted mortality rate, meanwhile, increased from 7.2% to 8.6%, according to the study’s results.
“The hospitals succeeded in keeping people out to avoid the penalty, but people died in the process,” Barrasso said.
“There is a deadly unintended consequence here of the Obamacare healthcare law,” Barrasso added, calling upon fellow lawmakers to repeal the ACA’s individual mandate, with the eventual goal of repealing the law in its entirety.
Gregg C. Fonarow, MD, a professor of cardiovascular medicine at UCLA who coauthored the study, said his findings suggest the program could put a significant number of patients at risk.
“If we were to extrapolate this to all Medicare beneficiaries hospitalized with heart failure, we are talking about maybe 10,000 patients a year with heart failure losing their lives as a consequence of this program,” Fonarow told HLM.
The study’s findings, however, have been disputed. Kumar Dharmarajan, MD, chief science officer at Clover Health and the lead author of an earlier JAMA Cardiology study—one which reached the opposite conclusion as Fonarow’s work—said the readmissions policy worked largely as intended.
“If readmission declines are harming patients, we would expect to see that the hospitals with the greatest decrease in admissions would have the greatest increase in mortality. We found that there was no relationship,” Dharmarajan told HLM. “To the extent that there was a relationship, it was the opposite. Hospitals that were dropping readmission rates had mortality rates that were improving.”
Even so, the reported link between higher mortality and lower readmissions prompted the Wall Street Journal editorial board to accuse the ACA and its backers of putting patients at risk by foisting a Washington-centric healthcare system onto the unwilling American public.
“ObamaCare effectively enrolled Medicare patients and hospitals without their consent in a mandatory policy experiment—you’ll be better off, trust us—but then neglected to evaluate the adverse effects,” the editorial said. “A drug trial with the same results would have been shut down long ago.”
Although the House passed a tax bill that would keep the ACA’s individual mandate intact, the Senate has been considering a set of proposals that could eliminate the requirement.
Priorities include fighting the opioid crisis, protecting children, and partnering with states on Medicaid integrity.
The HHS Office of Inspector General (OIG) released its annual list Wednesday of the biggest obstacles and opportunities facing the department.
The report, Top Management and Performance Challenges Facing HHS, outlines 10 categories and makes the case that department personnel should keep these topics in mind as they seek “to reimagine HHS as part of the Federal Government’s comprehensive plan” for reform.
The list includes some familiar themes and highlights four priority areas: fighting opioid and prescription drug abuse, protecting children, preventing fraud and inappropriate payments in home-based services, and partnering with states on Medicaid.
Here are the 10 major items OIG identified, with brief summaries:
Ensuring program integrity in Medicare — The trust fund for Medicare Part A, known as hospital insurance, is on course to be depleted by 2029, according to this year’s annual report from the Medicare Board of Trustees. Spending for Medicare Part B, known as medical insurance, is expected to grow nearly 7% over the next five years, outpacing growth of the overall economy. In order to keep Medicare financially viable, the department must fight fraud, reduce improper payments, capitalize on information technology, and take other measures, the report states.
Ensuring program integrity in Medicaid — Counting federal and state programs, Medicaid spent $574 billion in Fiscal Year 2016, serving nearly 69 million enrollees, more than any other federal program. Surmounting the challenges related to Medicaid will require additional partnership and cooperation between states and the federal government; that should include fraud prevention tools, fiscal controls, and better national data management, the OIG states.
Curbing the opioid epidemic — The OIG report identifies five things HHS should do to help fight the nation’s opioid crisis. Those include addressing apparently high rates of inappropriate opioid prescriptions among Medicare patients, cracking down on fraud and diversion, knocking down barriers to treatment when possible, holding grant recipients accountable for how their funds are used, and fighting fraud among those providing treatment for opioid use disorder.
Improving care for vulnerable populations — In addition to elderly patients in nursing homes and hospice care, HHS programs serve vulnerable groups that include children from low-income families in foster care, and others receiving home and community-based services. The department hasn’t always taken action when nursing homes, for example, have been found to be deficient, and that needs to change, the report states.
Ensuring integrity in managed care and other programs delivered through private insurers — Private insurance companies and sponsors provide coverage to millions of Americans enrolled in HHS programs. That can make it difficult for HHS to ensure that the programs are operating properly, so the department should take steps to fight fraud and waste, the OIG states.
Improving financial and administrative management and reducing improper payments — As the federal government’s largest civilian agency, HHS had about $1.1 trillion in budgetary resources in Fiscal Year 2016. Even so, the department has suffered from weaknesses in its financial management systems and problems with improper payments.
Protecting the integrity of public health and human services grants — Recently passed legislation expanded HHS grant programs by billions of dollars. Given the increase, the department should employ additional safeguards to ensure that the recipients are using the money properly and effectively, the OIG report states.
Ensuring the safety of food, drugs, and medical devices — The FDA oversees more than 13,000 drug facilities and 25,000 facilities for medical devices, according to FDA data cited in the OIG report. More should be done to better fulfill the duties of this role and to conduct oversight of the medical device and drug supply chains, the report states.
Ensuring program integrity and quality in programs serving American Indian and Alaska Native populations — Of all the federal funds that went to American Indian and Alaska Native communities last year, 45%, or $7 billion, came from HHS. Despite the large budget, HHS has a hard time ensuring that crucial services are being delivered consistently and free from fraud, waste, or abuse, the report states.
Protecting HHS data, systems, and beneficiaries from cybersecurity threats — The department deals with a large and quickly growing amount of data necessary to its work, and those data are spread across many different places and among various public and private entities with varying degrees of cybersecurity know-how and resources. This is why HHS should take steps to protect its own data and seek to foster a cybersecurity culture beyond the department, the OIG report states.
The former head of Eli Lilly’s U.S. operations has worked in public and private posts alike, a major asset in the eyes of some.
Organizations representing the healthcare industry have greeted President Trump’s pick for HHS secretary with largely positive responses. Those opposed have voiced concerns that the nominee’s allegiances could align more closely with pharmaceutical companies than consumers.
Alex Azar, JD, was president of Indianapolis-based drug giant Eli Lilly & Co.’s domestic operations from 2012 until earlier this year, when he left to launch his strategic consulting firm Seraphim Strategies LLC. When the president tweeted Monday that Azar would be nominated to replace former HHS Secretary Tom Price, the announcement prompted a slew of criticisms tying Azar to allegations involving Lilly’s drug-pricing practices.
“Choosing a top pharma executive to promote lower prices is like employing a lion to herd your sheep or cattle,” said Deborah Burger, RN, copresident of National Nurses United (NNU), in a statement condemning Azar’s nomination and denouncing Lilly’s past practices in the U.S. and abroad.
Lilly is among three companies defending themselves against a class-action lawsuit, for example, that alleges the firms drove up their own profits by exploiting the drug-pricing system, as Politico’s Sarah Karlin-Smith reported.
Even so, Azar’s boosters in the healthcare sector are numerous, with many organizations praising the former pharmaceutical executive’s previous work in public service. Azar was HHS deputy secretary during former President George W. Bush’s second term.
“He has the experience and expertise to combine the best from the private sector with the best of our public programs to make healthcare work for every American,” said Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP).
Charles “Chip” N. Kahn III, president and CEO of the Federation of American Hospitals (FAH), praised Azar as “uniquely qualified” for the job, based on his past work for both the government and private industry.
“I have worked with Mr. Azar in the past and think he is the perfect pick for the times,” Kahn said. “His steady hand of leadership will be critically important as the deliberations over health reform and the many healthcare quality and cost issues proceed.”
Douglas Hoey, MBA, a pharmacist and CEO of the National Community Pharmacists Association (NCPA), was among those who cited Azar’s history with Lilly as an asset rather than a liability.
“His background in the pharmaceutical industry means he brings an understanding of supply chain issues and players that will be helpful to him in this role,” Hoey said.
Azar’s confirmation would deepen Vice President Mike Pence’s ties within the health department, where the former Indiana governor’s home-state allies—including CMS Administrator Seema Verma, Medicaid director Brian Neale, deputy chief of staff Brady Brookes, and top HHS spokesman Matt Lloyd—are embracing an anti-regulatory push, as Politico’s Adam Cancryn reported.
Even some who worry Azar’s allegiances could lead him to go easy on pharmaceutical companies say they’re willing to give him a chance. Ben Wakana, executive director of Patients For Affordable Drugs, said drug corporations already exercise “undue influence over health policy in America.”
“But actions speak louder than words. Mr. Azar is well-qualified and has the chance to stand up for patients because he knows exactly how our drug pricing system is broken,” Wakana said. “If he wants to take meaningful action to lower drug prices, we want to help him.”
More statements from healthcare organizations:
Rick Pollack, president and CEO of the American Hospital Association (AHA), said the AHA welcomes Azar’s nomination.
“We are confident that his extensive background in business, healthcare and medicine distinguishes him as a uniquely qualified candidate for the vacancy. The expertise garnered from his career in the private sector and prior public service at HHS as Deputy Secretary will prove to be particularly valuable in addressing the serious challenges facing our nation's healthcare system today,” Pollack said.
“We look forward to working side-by-side with him to achieve our mission of advancing the health of the patients and communities we are privileged to serve,” he added.
“In our view, Alex Azar brings superior credentials for this job, based on his extensive management experiences and deep understanding of our healthcare system. He understands the needs of the patient community and particularly the challenges of the rare disease community and the urgency of orphan drug development,” Saltonstall said.
“While we inevitably will discuss and debate policies that affect the rare disease community, what we value most is a Secretary who will listen carefully and decide thoughtfully,” Saltonstall added. “Alex Azar meets this test. We look forward to the opportunity to work with him if he is confirmed by the Senate.”
“In this position, he will oversee many of the federal agencies that play a crucial role in how the nation’s medical schools and teaching hospitals are able to educate and train the next generation of doctors, care for the nation’s most vulnerable and complex patients, and conduct medical research that brings hope to countless Americans,” Kirch said.
“Upon his confirmation, we look forward to working with Mr. Azar on improving the health of all through high-quality clinical care, groundbreaking medical research, and a robust, diverse physician workforce.”
Susan DeVore, CEO of Premier Inc., commended President Trump’s for his selection.
“Premier has worked with Mr. Azar when he served in the Bush administration on some of the early value-based payment models pioneered by that administration, including the Hospital Quality Improvement Demonstration project. We know from that work he understands the need to move away from the perverse incentives in the Medicare fee-for-service payment system and to do so in a fashion that incents high-quality care,” DeVore said. “He also appreciates the need to have access to healthcare data and interoperability of health information systems. We are looking forward to working with Mr. Azar once confirmed.”
“Prescription drug costs are the top driver behind high medical costs in this country, hurting retirees and all consumers. By nominating a drug corporation insider to lead the Department of Health and Human Services, President Trump appears to be putting a fox in charge of the henhouse,” Fiesta said.
“Congress must ask tough questions of this nominee during the confirmation process. In particular, Mr. Azar should be asked whether he supports giving Medicare the ability to negotiate drug prices, the way that Medicaid and the Veterans Administration do today,” Fiesta added.
“This is an ironic choice for a President who has pledged to lower prescription drug prices,” Richtman said of Azar’s nomination. “As President of Eli Lilly, Azar presided over frequent price hikes on medications that seniors on fixed incomes depend upon. In fact, the company is currently being sued for fixing the price of insulin. Equally discouraging is Azar’s support of reckless legislation to repeal-and-replace the Affordable Care Act. Like his predecessor, Azar would be an unreliable steward of Medicare and Medicaid, which the GOP-led Congress has proposed to cut despite the President’s promise to protect both programs.”
“This appointment is yet another example of President Trump restocking the pond with corporate chieftains instead of draining the swamp,” Richtman added. “Seniors and their families should vigorously oppose it."
If the decades-old restriction on federal Medicaid dollars going to mental health institutions were to be abolished, it could change the patient population seeking care at general hospitals as well.
In declaring the opioid epidemic a national public health emergency on Thursday, President Trump committed to charting a path forward that will “unlock treatment for people in need.” He took aim specifically at a longstanding policy that prohibits states from using federal Medicaid funding on certain mental health facilities.
“As part of this emergency response,” he said, “we will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction.”
Since its enactment in 1965, Medicaid has barred states from using federal dollars to pay institutions for mental disease (IMD) in most cases. This so-called “IMD exclusion” sought to phase out use of older psychiatric wards, but there have been incremental changes to the policy since, as population needs and the healthcare landscape have evolved.
Due to the IMD exclusion, many Medicaid enrollees with behavioral health needs find their way to emergency departments in general hospitals, where clinicians are often less prepared to address matters of mental health and substance abuse, the Centers for Medicare & Medicaid Services (CMS) has said. Abolishing the exclusion could therefore affect the patient population seeking care at non-IMD facilities.
Rep. Brian Fitzpatrick (R-PA) in June introduced a bill, the Road to Recovery Act, that aims to permit Medicaid funding for patients to use IMDs for “residential substance use disorder treatment services.” Earlier this month, attorneys general from 38 states and the District of Columbia signed onto a letter backing Fitzpatrick’s bill.
“This change has been called for by providers, the medical establishment, governors of both parties and the President’s Commission on Combating Drug Addiction and the Opioid Crisis because it will make treatment affordable for those who need it, and create market incentives for new treatment resources,” the letter stated.
At the request of Sen. Dianne Feinstein (D-CA), the Government Accountability Office (GAO) published a report on the topic in August. The number of inpatient mental health hospital beds for adults decreased from more than 290,000 in 1990 to less than 189,000 in 2008, according to the GAO report. That’s a 35% decline.
“As the number of beds has decreased, questions have been raised as to whether sufficient capacity for inpatient and residential services exists,” the report notes, adding that the rising number of opioid-overdose deaths has driven calls for more treatment options, as some states have secured waivers from the exclusion.
President Trump’s public health emergency declaration stopped short of declaring a full-fledged national emergency, which could make additional funding available. Andrew Kolodny, MD, codirector of the Opioid Policy Research Collaboration at Brandeis University’s Heller School, said he finds the declaration disappointing.
“This is not a plan,” Kolodny told NPR. “The administration still has no plan” to address opioids.
As the White House seeks to specify and implement a plan, it suffers from a few key vacancies. There’s no permanent secretary leading the Department of Health and Human Services (HHS) and no permanent director at the Drug Enforcement Agency (DEA), and the top candidate for drug czar, Rep. Tom Marino (R-PA), withdraw his name from consideration.
Despite the challenges, President Trump said his declaration Thursday is an obligatory step in the long-term but winnable fight.
“It will take many years and even decades to address this scourge in our society,” he said, “but we must start in earnest now.”
A psychiatric treatment center in Massachusetts faces more than $207,000 in proposed penalties after the Occupational Safety and Health Administration (OSHA) accused the facility of failing to adequately protect employees from workplace violence, despite having promised specifically to do so.
Notice of the proposed action against Lowell Treatment Center, which is operated by UHS of Westwood Pembroke Inc., comes as OSHA has grown significantly quieter about its enforcement activity under President Donald Trump’s administration than it had been under former President Barack Obama. There have been fewer enforcement-related OSHA press releases issued in the seven months since Trump took office than there were in just the final month of 2016.
It remains unclear how OSHA decides which enforcement actions warrant a press release. An agency spokesperson was not available Wednesday to answer questions about this threshold. But we know that this case entails allegations that the facility failed to keep specific promises it made last year in a formal settlement agreement stemming from an unfavorable 2015 evaluation by federal inspectors.
“Our inspectors found that employees throughout the Lowell Treatment Center continued to be exposed to incidents of workplace violence that could have been greatly reduced had the employer fully implemented the settlement agreement,” OSHA’s Boston-based regional administrator, Galen Blanton, said last week in a written statement.
The management company, which operates 350 facilities throughout the United States and United Kingdom, notified OSHA that it intends to contest the findings, according to the press release.
Micah Smith, an OSHA attorney with Conn Maciel Carey in Washington, D.C., said during a webinar Tuesday that any Republican administration would be expected to back off the level of enforcement seen under the Obama administration, which engaged in “regulation by shaming.”
“We’re expecting to see this change, and that press-heavy enforcement model to be rolled back,” Smith said. “We haven’t seen any official actions, but in the early days of the administration, most agencies across the government have been encouraged or required to reduce their press activity.”
Smith said there were two or three OSHA enforcement press releases in June and July this year, compared to 25-40 for each of the same months last year. Even so, it’s important to note that OSHA’s priorities are just as unsettled as its staffing.
“As with all things, without the permanent OSHA team in place, we’re still reading the tea leaves a little bit,” Smith said.
The press release in this case comes two months after OSHA endured criticism for backing off an allegation that Bergen Regional Medical Center (BRMC) in Paramus, New Jersey, had an inadequate workplace violence prevention plan. Jordan Barab, a former OSHA official under Obama, drafted a lengthy blog post critical of the move, and he clashed on Twitter with Eric Conn, another attorney with Conn Maciel Carey, who was hired to represent BRMC’s defense against the citation.
Barab, who has also been critical of the marked decrease in the issuance of OSHA enforcement press releases, hasn’t blogged on the topic since OSHA issued its press release last week.
Chillicothe-based Adena Health System held a special meeting to ensure its facilities are ready to handle a potential influx in opioid overdoses over the holiday weekend.
A hospital system in south-central Ohio is bracing for the possibility of a rough holiday weekend after a local law enforcement official’s startling warning that criminal gangs could be planning to target the area with violence and extra-lethal drugs.
Pike County Sheriff Charles Reader issued an alert Monday on Facebook stating that members of the criminal gangs MS-13 or Konvicted Family could make their way into the region, about an hour’s drive south of Columbus, this weekend with plans to wreak havoc.
“Possibly planning on ‘taking out’ believed snitches and spread ‘HOTSHOTS’ of heavily laced Heroin into the area that could cause an extremely large amount of overdoses in Pike County and surrounding counties,” Reader wrote in an alert reported by The Columbus Dispatch and other local media. “This is according to very limited intelligence deputies have gathered in recent drug related investigations across the area in the past weeks.”
When news of the sheriff’s warning broke, leaders within Chillicothe-based Adena Health System convened a special planning meeting to ensure that its facilities in and around Pike County would be prepared in case an influx in opioid overdoses, or any other incident, did materialize, says Jason Gilham, Adena’s communications manager.
“We operate a daily patient safety huddle every single morning at 9:30, which brings together one individual, one representative from across the health system in, I think, about 18 different departments, from surgical, our emergency department, communications security, housekeeping, all across the board,” Gilham says.
The sheriff’s warning came up during the 15-minute huddle, and the group decided to schedule a follow-up meeting Tuesday with key players to discuss the matter in greater detail.
“That gave our security team a chance to touch base again with the local law enforcement, whether that be in Ross County and in Pike County, with a little bit more detail, just to kind of get a greater feel for where they stood and the latest information,” Gilham says. (Chillicothe is in Ross County.)
The leaders revisited the system’s emergency response plans and asked whether workers could use a refresher on what to do, for instance, in the event of a lockdown, Gilham says. They also decided to add an off-duty officer for the July 4 weekend at Adena Pike Medical Center, the system’s 25-bed critical access hospital in Waverly, which is the Pike County seat.
Furthermore, the system’s pharmacy department checked with all Adena facilities in the area to ensure that each had a sufficient supply of the opioid overdose-reversing drug Narcan® (naloxone).
“It was just kind of bringing everybody up to speed and having that comfort level going into the weekend,” Gilham says.
The Ohio Attorney General’s Office distanced itself from Reader’s warning. “We are not involved with this,” spokeswoman Jill Del Greco said, as Dayton Daily News reported. And the alert has been greeted with skepticism from law enforcement in at least one neighboring county.
Scioto County Sheriff Marty V. Donini said there is “absolutely” no credible evidence that the gangs are present in the county he oversees, which lies just south of Pike County.
“The public is urged to be responsible and to refrain from circulating ‘unverified’ facts,” Donini said in a press release Tuesday, as reported by Columbus-based NBC4. “[T]o do so simply fuels hysteria and pandemonium within our community.”
Donini said he had investigated the matter and consulted the Southern Ohio Drug Task Force after several Scioto County residents inquired with his office with concerns about social media posts and news reports.
Reader shot back with another Facebook post, arguing that Donini’s office was not involved in executing the search warrants and conducting the interviews that led to the alert being issued.
“Scioto County would NOT have the information that we obtained in aggressively attacking the drug epidemic in Pike County,” Reader wrote Tuesday. “I’m sure they stay busy enough in Scioto County.”
Opioid-related trips to the emergency department (ED) have risen dramatically over the past decade in Ohio, according to data from the Agency for Healthcare Research and Quality (AHRQ). While rates of opioid-related ED visits have approximately doubled nationwide since 2007, they have nearly quadrupled in Ohio, where rates have held consistently above the national average, according to AHRQ’s Healthcare Cost and Utilization Project.
Deputies in Pike County have been cracking down on heroin dealers recently, with one recent raid garnering nearly $10,000 and 42 grams of fentanyl-laced heroin, as Cincinnati-based Fox19 reported. Reader noted in his Facebook post that one person arrested in the course of executing drug-related warrants was confirmed to be a Konvicted Family gang member with other Pike County ties.
Regardless of whether the gang members show up for Independence Day weekend, Adena is prepared to handle the fallout, Gilham says, noting Wednesday that the health system is “very confident with where we stand currently.”
Brigham and Women’s Hospital (BWH) in Boston is well-acquainted with the dangers an unauthorized person can pose when granted access to restricted areas. The facility suffered unflattering headlines earlier this year when the public learned that 42-year-old Cheryl Wang had bluffed her way into five ORs and other patient care areas late last year by posing as a doctor-in-training, despite having been dismissed from her surgical residency program.
Wang’s case—which brought an unsettling reminder of the 2015 security lapse that enabled a disgruntled man to corner and kill a BWH doctor in an exam room—drew attention to an extremely common security vulnerability known as “tailgating” or “piggybacking.” When walking through a doorway, it’s common courtesy to hold the door for whoever is behind you. That’s a problem, however, if the person behind you doesn’t have permission to go where you’re going.
To reinforce the lesson that every hospital employee has a responsibility to help keep unauthorized people out of restricted areas, BWH produced instructional videos that depict disturbingly mundane security lapses. The two dramatizations, titled “Be Aware” and “Don’t Hold The Door,” will be shown to all 18,000 of BWH’s employees.
“We intended for the videos to be provocative, to invoke a strong reaction, so that they would be memorable,” said Erin McDonough, BWH’s chief communication officer, in a statement.
One video depicts two workers chatting as they return to their stations from a coffee break, unaware that an unknown woman has followed them onto a restricted elevator. From there, the woman gains access to a maternity ward to abduct a newborn. The other shows a worker in scrubs politely holding the door for an unknown man.
“Closing a door to someone feels uncomfortable and impolite, and it contradicts what many of us have been taught from a young age,” McDonough said. “We need our staff to know the potentially dangerous consequences of enabling people who do not have permission to access restricted areas—whether consciously or unconsciously—and give them tools that empower them to take action.”
The two videos are the centerpiece of BWH’s safety campaign, but they are buttressed by a multi-pronged approach that includes the following:
Signage. The points where unauthorized access is most likely to occur, including some 1,200 card scanners throughout BWH’s facilities, will be labeled with signs to remind workers to be aware of who’s coming with them.
Reminder cards. Workers will be issued additional cards that bear the slogan “Stop, Challenge, Assist,” with a phone number for hospital security, as a reminder to use their privileged access with caution and care.
Policies. Employees who are followed by an unauthorized person are now required to abide by two updated policies: Either question the person directly, or contact security to do so. There’s no option to merely dismiss the unauthorized access as nonthreatening.
Training. After hospital employees screen the two videos, they will role-play related scenarios with a security team, then follow-up to session with a Q-and-A to discuss what they learned.
In addition to training its own staff, BWH has opted to share the components of this campaign far and wide—a helpful gesture, considering that tailgating and piggybacking are a safety consideration in every healthcare facility.
“People who work in the healthcare setting have a natural inclination to help others,” said Dave Corbin, BWH’s director of security and parking, in the statement. “Our campaign emphasizes that being aware is one of the best ways for them to ensure the wellbeing of patients, their families and each other.”