Trump Administration Backing Off Medicaid Rule That States Warned Would Lead To Cuts

Trump administration backing off Medicaid rule that states warned would lead  to cuts | TheHill

Source: The Hill, by Jessie Hellmann

The Trump administration will not move forward with a proposed Medicaid rule that states, hospitals, insurers, patient advocates and members of both political parties warned could lead to massive cuts to the federal health care program for the poor.

“The proposed Medicaid Fiscal Accountability Rule (MFAR) was designed to increase transparency in Medicaid financing and ensure that taxpayer resources support the health care needs of our beneficiaries,” Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement Monday.

“We’ve listened closely to concerns that have been raised by our state and provider partners about potential unintended consequences of the proposed rule, which require further study,” she added.

Verma said the rule is being withdrawn from the agency’s regulatory agenda, but it’s not clear if it will be added to future agendas.

The rule was intended to overhaul the complex payment arrangements states use to raise money for their Medicaid programs — funding that is then matched by the federal government.

The administration argues some states use questionable methods of raising funds so they can leverage more money from Washington. One approach used by states consists of taxing providers that stand to benefit from more Medicaid funds flowing into the state.

But governors and state Medicaid directors argue those long-standing arrangements are both legal and necessary as states look for ways to keep up with escalating health care costs.

Dozens of states wrote public comments to Verma, urging her to withdraw the proposal, including conservative states that are typically supportive of her work.

If finalized, the rule “would have forced states to face larger Medicaid shortfalls and to make bigger cuts harming beneficiaries and providers,” tweeted Edwin Park, a research professor at Georgetown University.

What Have Pandemic-Related Job Losses Meant for Health Coverage?

What Have Pandemic-Related Job Losses Meant for Health Coverage? | KFF

Source: Kaiser Family Foundation, by Cynthia Cox and Daniel McDermott

The coronavirus pandemic has caused a sharp increase in unemployment across the country. The unemployment rate peaked at 14.7% in April and remained above 10% until very recently. In the United States, health insurance and employment often go hand-in-hand: With the majority of working age adults receiving coverage through an employer-sponsored plan, people who lose work due to the pandemic also risk losing their health coverage when they might need it most. An earlier KFF brief, based on unemployment figures through the start of May, estimated that roughly 27 million people were at risk of losing their job-based coverage when they or family members lost their jobs. However, at the time, it was unclear what decisions employers were making about whether to keep their workers covered (e.g. by keeping furloughed workers on health plans or by helping employees pay for COBRA continuation coverage).

Data has now become available that provide a glimpse into what has happened to enrollment among employer plans since the start of the pandemic. Surprisingly, in comparison to the nearly 9% drop in employment from March to June, early data suggests that employers had kept coverage rates remarkably steady, at least through mid-summer. We examined data that insurance companies submit to the National Association of Insurance Commissioners, compiled by Mark Farrah Associates, finding that enrollment in the fully-insured group market dropped by just 1.3% from the end of March through the end of June.

Part of the explanation for this apparent discrepancy could be that many of the people who lost employment were never enrolled in employer-based coverage in the first place, as lower-wage workers are less likely to be covered by their employer’s plan. Even so, there are some reasons this 1.3% drop may even overstate employer coverage losses during the early months of the pandemic. For years, the fully-insured group market has gradually shrunk: While the 1.3% is the largest drop in recent years and is likely largely driven by job losses, over the last several years we have seen enrollment drops from the first to second quarter of the year ranging from 0.3% to 0.7% in the fully-insured market. Also, though we do not have data on self-funded plan enrollment rates, there are reasons to suspect the types of companies that self-insure (which tend to be larger companies) were better able to weather the early financial hits and might have had fewer job losses or might have been in a better position to let their employees retain their health benefits.

The relatively low coverage losses through the end of June are consistent with data showing growth in Medicaid enrollment through May and relatively flat Marketplace enrollment, not yet indicative of big losses in employer coverage. If there were large coverage losses in the employer market, we previously estimated that 85% would have been eligible to move to Medicaid or the ACA Marketplaces.

From discussions with employers and benefit consultants, we have heard that some employers elected to keep furloughed workers enrolled in health coverage. As the pandemic continues it’s unclear how long this can continue. Data from BLS show that temporarily laid-off workers made up the vast majority of the unemployed in the spring and early summer. However, temporary lay-offs have decreased, while the number of permanent job losses has increased through the summer. If this trend continues, we could see larger coverage losses later this year.

Are Hospitals Making Money Treating COVID-19 Patients?

Are hospitals making money treating COVID-19 patients?

Source: Modern Healthcare, by Tara Bannow

On HCA Healthcare’s second-quarter investor call, an analyst asked the for-profit chain’s chief financial officer an intriguing question: What’s the profitability of COVID-19 patients?

Posed to most other health systems, such a query would have sounded absurd. But the Nashville-based hospital giant had just posted $1.1 billion in profit, up 38% from the prior-year period, even as elective procedures were largely shut down.

Finance chief Bill Rutherford responded that coronavirus tends to prompt longer lengths of stay and higher acuity than typical hospitalized patients. “It’s too early to convert that to profitability,” he said. “Our focus is making sure we’ve got all the resources we need to care for those patients.”

Examples of wealthy health systems reporting higher 2020 profits, anecdotes of sky-high bills for COVID treatment and billions in federal grants have raised the question of whether a subset of well-performing hospitals are making money on their COVID books of business.

Most hospitals, though, appear to be losing money on COVID care, and that’s not counting the pandemic’s most detrimental effect: the plunge in profitable elective procedures. Hospitals’ divergent reimbursement experiences underscore the pandemic’s role in deepening the split between wealthy systems and their financially vulnerable peers.

Now, as the country heads into an expected second wave of the pandemic, hospital administrators need to keep trimming expenses while revenue lags and the federal government makes tough decisions about how to allocate aid with little information to go on.

Some experts are hoping HHS will consider financial need when allocating the remaining $57 billion in federal Coronavirus Aid, Relief, and Economic Security Act grants. So far, a little over half the Provider Relief Fund grants distributed have been based on prior revenue, with large, financially secure systems amassing hundreds of millions in aid.

“There is clear evidence that many hospitals that have done financially well historically, have good overall margins and hundreds of days cash on hand are getting millions in cash disbursements due to the revenue-based formula,” said William Schpero, an assistant professor of health policy and economics at Weill Cornell Medical College. “That money might be better used elsewhere, whether among hospitals that have been particularly hard-hit or that are financially vulnerable.”

A hospital’s true margin on COVID care will probably remain a mystery, experts say. That’s because the pandemic, unlike any other crisis that’s hit the industry, has come with a number of confounding factors that make it impossible to isolate the margin on treating seriously ill coronavirus patients. Most importantly, hospitals’ biggest source of revenue—nonurgent procedures—dropped out from under them, and there’s no telling when, if ever, it will completely return.

The crisis has sunk the margins of large systems like Mass General Brigham in Boston and Sutter Health in Northern California, but others, like Kaiser Permanente in Oakland, Calif., and ProMedica in Toledo, Ohio, are doing better than ever.

The 20% bonus

Aside from the grants, CMS is tacking on an additional 20% to its reimbursement for treating hospitalized Medicare patients with COVID. Medicare-age adults have seen the highest rates of COVID hospitalization. The bump has prompted conspiracy theories about hospitals wanting more COVID cases on their books to increase Medicare reimbursement.

“The COVID-specific impact is very, very difficult to quantify,” said Ge Bai, an associate professor of accounting and health policy and management at Johns Hopkins University.

One factor that makes determining margins so tricky is that so much of hospitals’ costs are tied up in fixed overhead expenses that would be difficult to allocate to a specific patient. Almost half—48%—of hospitals’ total operating expenses were overhead and capital costs in 2018, according to a recent Journal of General Internal Medicine study of about 3,500 hospitals.

Health systems prefer to discuss the pandemic’s effects in aggregate, without isolating the COVID book of business.

“They’re all unprofitable because we lost so much elective business and we have such a high fixed-cost infrastructure,” said Robin Damschroder, CFO of Detroit-based Henry Ford Health System. “You really have to look at the totality of the clinical operations of any health system.”

In normal times, there would be enough reimbursement to cover a hospital’s high overhead costs. But during the pandemic, the loss of volume and the added supply and labor costs associated with responding to the crisis has created “stranded overhead” that has nowhere to be liquidated, said Rob DeMichiei, a strategic adviser with data and analytics technology provider Health Catalyst and former CFO of UPMC.

“With that volume gone, there is all that overhead with very few cases to cover it,” he said. “There is really no amount of reimbursement on an individual case that’s going to be able to cover the direct costs, which it does cover, but also all this overhead.”

Experts are divided on the question of whether hospitals are generating a margin on their COVID patients. The point they agree on, though, is that no one can know for sure except maybe the hospital CFO, and even then, there’s a good chance he or she can’t be certain.

For Kevin Holloran, who covers not-for-profit hospitals at Fitch Ratings, the answer is an easy no. COVID is a “completely different animal” from other conditions, with some patients hospitalized for weeks or months. “I can’t see a way that anyone would say, ‘COVID patients are profitable for me’ in any way, shape or form,” he said.

When it comes to treating COVID patients who are uninsured or who rely on Medicaid, hospitals are unlikely to make money, as is their typical experience with those payers, said Dr. Ross Nelson, the head of KPMG’s healthcare strategy group.

Medicare’s 20% add-on payment for COVID patients could bump that margin into the black, Nelson said. But since Medicare pays a flat case rate per DRG, length of stay will be a big determinant of profitability. “My hypothesis is that the COVID patients that come in and stay for a week to a week and a half, at least on the Medicare and commercial side, they probably make some money on,” Nelson said. “As length of stay starts to extend beyond a week and a half or so, I think it’s too early to tell on that.”

Hospitals faced with more unknowns

Maimonides Medical Center, the largest hospital in Brooklyn, has treated north of 2,300 COVID patients. Leaders believe they broke even on commercial patients, using an estimated cost per patient, CEO Kenneth Gibbs said. Even with the 20% add-on, Medicare reimbursement covered about 90% of the cost of care. Medicaid covered about two-thirds the cost of COVID care, he said.

Gibbs said the struggle is just as much in front of providers as it is behind them. That’s because there will continue to be volume declines, and patients will still need to be isolated according to infection status. Basically, the cost per patient will be higher for the foreseeable future. “I think the challenges are unknown because the hit is ongoing,” Gibbs said. “The stress on the system may actually sort of be building, even though we’re past what feels like the core surge.”

For Henry Ford, the 20% Medicare add-on culminated in an additional $8 million on its Medicare claims related to COVID. Of the more than 10,000 COVID patients Henry Ford treated, 32% were covered by Medicare, including Medicare Advantage. But the bigger impact from Medicare was waiving the 2% sequestration, a reduction that usually happens annually, and postponing cuts to disproportionate-share hospital payments.

All told, that amounted to roughly $40 million for the health system, in addition to $328 million in federal relief grants in the first half of 2020. “Is it compensating for everything related to the cost of COVID? That’s a question yet to be answered,” Damschroder said.

Henry Ford reported $224 million in operating income in the first half of 2020, a 165% increase from the prior year and a strong 7% operating margin.

Private insurance payment rates are more than twice Medicare rates for the services most likely to be used by patients hospitalized with COVID, although Medicare’s 20% add-on payment will narrow that gap, a July analysis from the Kaiser Family Foundation found. With the 20% add-on, the average Medicare reimbursement for patients on a ventilator for more than 96 hours would have increased from $40,218—the average payment in 2017—to $48,262. Private rates would be roughly double that even with the 20% add-on, ranging from 1.8 to 2.1 times those of Medicare.

Federal aid allocations

Of the $175 billion originally allocated for Provider Relief Fund grants, a little over half has been distributed according to prior total patient revenue, suggesting HHS tried to replace revenue lost from suspending procedures. Another $22 billion went to hospitals that saw large numbers of COVID patients. Smaller amounts were targeted at safety-net hospitals, rural hospitals, skilled-nursing facilities and children’s hospitals.

Karyn Schwartz, a senior fellow with the Kaiser Family Foundation, said she agrees that knowing whether hospitals’ reimbursement for COVID treatment covers their costs could be helpful information for policymakers in determining how the remaining roughly $57 billion in Provider Relief Fund grants would be best allocated. “I think knowing how costly it is to treat these patients is important in terms of understanding how important it is to allocate the money that way versus something else,” she said.

Matt Hutt, an accountant who heads AAFCPAs’ healthcare division, said by his estimation, in order for Medicare’s 20% add-on payment to cover the cost of COVID care, it would have needed to be a 35% add-on. Going forward, he said it’s important to tie Provider Relief Fund grants to the losses providers are seeing on COVID care.

“That’s really what the funds should be used for: the impact that COVID had on your business,” he said.

The problem with that, however, is the numbers used to calculate margin can be “warped,” Johns Hopkins associate professor Bai said. While revenue from COVID treatment is clear-cut, the cost component is open to interpretation. Large, well-connected providers would likely hire savvy consultants to make their margins look worse than they are, she said. Instead, Bai said the decline in charges or outpatient claims would be a more objective way to distribute the money.

Even if, hypothetically, systems were making money on COVID patients but still losing money in every other aspect of their business due to lower demand, that would put the healthcare system in jeopardy, said Rick Kes, healthcare industry senior analyst with RSM. “The sustainability of our healthcare system is maybe the overriding issue.”

Opinions abound on how the remaining federal aid should be allocated. Michael Abrams, managing partner and co-founder of healthcare consultancy Numerof & Associates, said tying the disbursement to fee-for-service revenue, as has been done with much of the money so far, rewards providers who haven’t shifted toward value-based payment models. He thinks HHS should offer incentives for value-based payment with the remaining money.

“I just hate the idea of bailing out an industry that is increasingly on a course that departs from what the country needs,” Abrams said.

Does An Employer Have to Say If Coworker Has Coronavirus?

Does An Employer Have to Say If Coworker Has Coronavirus?Source: Insurance Journal

Does an employer have to say if a coworker has the virus?

Employers are generally not required to tell workers when someone in the workplace has tested positive for the coronavirus.

The U.S. Centers for Disease Control and Prevention recommends that companies monitor employees for symptoms and alert those who may have been in contact with an infected person. Some states may order businesses to follow such guidance.

Employers have the right to take employees’ temperature and ask about symptoms or if they have been exposed to or diagnosed with the virus. If an employee doesn’t respond to those questions, they can be barred from the workplace.

Businesses are required to provide a safe working environment. They also have to keep track of infections contracted on the job and report any hospitalizations or deaths related to the disease to the U.S. Occupational Safety and Health Administration.

Some workers are unsettled by the lack of information. Amazon, for example, alerted warehouse workers when someone tested positive for the virus, but didn’t disclose a tally of how many workers tested positive. So workers began trying to keep track on their own.

There are also pending lawsuits against employers filed by workers who were exposed to or diagnosed with the coronavirus. In general, there’s a high legal bar for finding an employer at fault for endangering employees and most claims are resolved via worker’s compensation settlements. There has also been some debate over whether Congress should grant businesses liability protections during the pandemic.

‘Mission Of The Century’: 8,000 Cargo Jets Needed To Transport Covid-19 Vaccines Around The World, Says IATA

8,000 cargo jets needed to transport Covid-19 vaccines, says IATA | CNN  Travel

Source: CNN, by Karla Cripps

As global pharmaceutical companies race to complete their Covid-19 vaccine trials, the logistics that will be required to deliver them to all corners of the world are coming into focus — and it will be a mission like no other.

According to the International Air Transport Association (IATA), providing a single dose of the vaccine to 7.8 billion people will require the use of 8,000 Boeing 747 cargo aircraft — and planning needs to begin now.

“Safely delivering Covid-19 vaccines will be the mission of the century for the global air cargo industry,” said IATA’s director general and CEO, Alexandre de Juniac, in a statement.

“We urge governments to take the lead in facilitating cooperation across the logistics chain so that the facilities, security arrangements and border processes are ready for the mammoth and complex task ahead.”

The air cargo industry has long played an important role in vaccine distribution, providing well-established time- and temperature-sensitive systems — which will be crucial to the quick and efficient transport of Covid-19 vaccines, notes IATA.

Dozens of research teams around the world are working to develop a vaccine for SARS-CoV-2, the virus that causes Covid-19, using a mix of established techniques and new technologies.

There are currently 29 vaccines being tested in multiple human trials, running simultaneously around the world.

Once a vaccine is approved for use, licensing and large-scale manufacturing takes place. But without proper planning, these vaccines won’t be able to fly the skies.

Among the major concerns cited by IATA is the availability of temperature-controlled facilities and equipment, along with trained staff. Robust monitoring capabilities will need to be in place too.

And then there are the current border restrictions, which will need to be eased. Permits for operators carrying the vaccine will need to be fast tracked, and the flight crew members exempted from quarantine requirements to ensure cargo supply chains are maintained, says IATA.

Security is another concern, with IATA noting that vaccines will be highly valuable commodities. Shipments will need to be secured and protected from tampering and theft.

Cargo capacity impacted by pandemic

The aviation industry has already been playing a critical role throughout the pandemic, delivering essential supplies to first responders, with the Boeing 747 in particular key to these efforts.

The newest version of the cargo 747 is based on the passenger model, the 747-8. At just over 250 feet, it’s the longest of all the jumbos, with new engines and enhanced aerodynamics.

Cargo operators such as Silk Way Airlines, Atlas Air, Air Bridge Cargo (ABC) and Cargolux have been leading logistical efforts to support first responders and will likely continue to do so when vaccine deliveries ramp up.

Moscow-based ABC, for instance, has 17 747Fs — four 747-400Fs and 13 newer 747-8Fs. (The “F” stands for Freighter.)

“Air cargo solutions have never been more important than they are now to global health services. Currently, our international teams dispatch multiple flights daily to ensure that vital medical supplies protect those in need,” said Tatyana Arslanova, executive operating officer for ABC, in July.

She pointed to the 747-8F’s climate-controlled cargo holds as one of the big plane’s assets.

“Its three compartments can have different temperature settings from 4 degrees Celsius to 29 degrees (39 F to 84 F), giving us extra opportunities to transport perishable cargo, such as temperature-sensitive pharmaceuticals and life-saving medical equipment.”

In spite of the presence of established operators, IATA warned that the global air transport industry’s cargo capacity has been severely impacted by the pandemic, with airlines downsizing their networks and putting aircraft into long-term storage due to diminished demand.

About half of the world’s air cargo is transported by passenger planes, with shipments placed in the belly of the plane with luggage.

IATA acknowledged that land transport will also play an important role in vaccine distribution — especially in developed economies with local manufacturing capacity, “but vaccines cannot be delivered globally without the significant use of air cargo.”

Californians Are Testing Positive For COVID-19 At The Lowest Rate On Record

California has record low COVID-19 positivity rate - Los Angeles Times

Source: Los Angeles Times, by Laura J. Nelson

As the Golden State faces a triple threat of respiratory risks — destructive wildfirestoxic air quality and a deadly pandemic — there is a faint glimmer of hope.

Over the last seven days, just 3.5% of COVID-19 tests in California came back positive, the lowest rate since the state began reporting the data in late March. A month ago, the positive test rate was nearly twice as high.

The number of new confirmed cases has fallen to the lowest level since mid-June, according to a Times analysis of state data. Hospitalizations for COVID-19 have fallen to the lowest levels since the start of April, with 2,869 patients in hospital beds Saturday.

These positive signs come as California reduces the turnaround time for coronavirus tests. Dr. Erica Pan, the acting state public health officer, said last week that laboratories are now producing test results in an average of 1.3 days.

The data have left officials feeling cautiously optimistic about California’s progress against the pandemic as the state nears the end of the sixth month of stay-at-home orders. They urged residents to stay vigilant and to keep taking the precautions that are working: wearing face coverings in public, observing social distancing with anyone outside the immediate household and staying home whenever possible.

Officials said there are two factors that could mar the rate of positive tests: a decline in testing during the wildfires and lingering questions about whether Labor Day gatherings caused a surge in transmissions.

It can take up to two weeks for the coronavirus to incubate in the human body. California saw a surge in cases, hospitalizations and deaths after the Memorial Day weekend, which included holiday gatherings, graduation parties, massive protests over police brutality and the reopening of bars, which were later closed again.

Health officials are “very anxious to figure out” whether gatherings, parties and other activities over the latest three-day weekend, which ended a week ago, will lead to another spike in cases, “which then leads to more hospitalizations and even more deaths,” said Barbara Ferrer, director of Los Angeles County’s Department of Public Health.

“We are, in fact, somewhat challenged about getting good data because we’ve had both extreme heat and we’ve had the fires that have created unhealthy air conditions,” Ferrer continued. “What that’s led to, unfortunately, is a lot less testing.”

Ash and smoke from the Bobcat fire were so strong that L.A. County was forced to temporarily close some testing sites in the San Gabriel Valley. But, Ferrer said, the vast majority of testing centers are open. She urged residents to get tested if they have experienced COVID-19 symptoms or have associated with anyone who has, including in a workplace or at home.

Meanwhile, Southern California officials are watching with interest and caution as San Diego and Orange counties have begun to slowly reopen indoor businesses. Both counties have received approval from the state to reopen restaurant dining rooms, museums, movie theaters and places of worship at 25% capacity.

Last week, Los Angeles County reported 9.6 transmissions per 100,000 residents. That rate must fall below seven per 100,000 for two consecutive weeks before Newsom would allow restaurants, theaters and other nonessential businesses to reopen.

For now, no L.A. County school campuses will be allowed to reopen to all K-12 students until at least November. However, schools will be allowed to offer in-person classes for children with special needs, provided occupancy on campus does not exceed 10% of the student body.

Public health officials have received 59 applications from individual schools to reopen for “students who cannot be served virtually,” Ferrer said.

Health Care Prices Rising

Healthcare Costs for Americans Projected to Grow at an Alarmingly High Rate

Source: Morning Consult, by Gaby Galvin

High prices, widening gaps in insurance coverage and racial disparities in outcomes are tied to wide state-level variation in health care performance that will likely be exacerbated by the coronavirus pandemic, according to a sweeping new report from The Commonwealth Fund.

The analysis, which assessed all 50 states and the District of Columbia on dozens of measures tracking health care quality and costs, health outcomes and disparities, indicates Americans’ health care burden and risk of poor health varies widely based on where they live. While the data predates the COVID-19 crisis, researchers said the pandemic could worsen these state-level disparities, “leaving people in poorly performing states even further behind.”

The report notes a few key issues: Because most Americans get their health insurance through an employer, recent job losses are estimated to leave 3.5 million people uninsured by the end of the year, according to an Urban Institute analysis, widening existing coverage gaps. Rising provider prices have led to higher costs for people with private insurance because employers tend to pass premium increases on to employees. And U.S. life expectancy, which has fallen in recent years, is closely tied at the state level to premature deaths from treatable conditions like appendicitis, certain cancers, heart disease and diabetes — which Black Americans have twice the risk of dying from as whites.

“There’s little doubt that the pandemic has exacerbated these and other weaknesses in our health care system,” Dr. David Blumenthal, president of The Commonwealth Fund, said during a call with reporters.

Despite health insurance gains in the years following the Affordable Care Act’s passage — which is also credited with shrinking racial and economic disparities in health coverage — access to care remains a critical problem, the report shows. From 2016-18, 22 states saw increases in the share of adults without health insurance, and uninsured rates in the 12 states that have not expanded Medicaid eligibility were among the highest in the country in 2018.

People who have insurance can face steep health care costs, as well. Commercial insurance prices for hospital inpatient care were at least twice as high as Medicare rates in 22 states, the report said, while people reported delaying care due to costs in 15 states.

“These higher prices have consequences,” said Dr. David Radley, a senior scientist for The Commonwealth Fund and one of the report’s authors. Higher health care prices essentially burden “working families with higher premium contributions and unaffordable out-of-pocket costs.”

Investment in primary care — one way to improve health care performance, researchers said — is also lower in the United States than in other wealthy countries. For example, just under 6 percent of spending on Medicare patients went to primary care in 2017 — amounting to about $712 per beneficiary annually — with rates ranging from less than 5 percent in Rhode Island and New Hampshire to more than 7 percent in Tennessee.

Overall, Hawaii, Massachusetts, Minnesota, Iowa and Connecticut performed best in The Commonwealth Fund’s state ranking, while West Virginia, Missouri, Nevada, Oklahoma and Mississippi scored worst, and Florida, Kentucky, Louisiana and Virginia improved the most between 2014 and 2018.

If all states’ metrics matched the highest-performing state for each of the report’s 49 measures, researchers estimated it would lead to 91,000 fewer deaths before the age of 75 from treatable conditions, 10 million fewer emergency room visits for health issues that could have been treated in non-emergency care and 18 million more adults and children with health insurance in addition to those who already have ACA coverage.

As is, the report concludes that the U.S. health care system is “highly unequal in its care of people of color and those with low and moderate incomes,” and says national averages mask the fact that some parts of the country lag behind not only other states, but other developed countries.

Independent, Smaller Hospitals Will Need To Make Tough Choices To Survive COVID-19 Financial Crisis: Analysis

Independent, smaller hospitals will need to make tough choices to survive  COVID-19 financial crisis: analysis | FierceHealthcare

Source: Fierce Healthcare, by Robert King

Independent hospitals could need to make drastic decisions such as reducing service lines or workforces to survive the cash crisis caused by the COVID-19 pandemic, a new analysis finds.

The analysis, published Thursday from consulting firm Kaufman Hall and the law firm Waller, projects an increased number of independent hospitals and smaller systems partnering up due to massive financial damage caused by COVID-19. Kaufman Hall also finds that more integrated and larger systems with more access to capital are better positioned.

“While the desire to remain independent is understandably important to many community hospital boards, independence may no longer be realistic in the current environment,” the analysis said.

COVID-19 has caused massive financial upheaval for hospitals that were forced back in March to cancel or postpone elective procedures. Patient volumes at outpatient clinics have also plummeted as patients have been afraid to head back to the doctor’s office.

At the same time, hospitals have faced higher costs for personal protective equipment and other price hikes for drugs and adding more staff to handle surges.

The analysis finds that larger systems are more able to weather these challenges because they have more purchasing power, additional borrowing capacity to get more money and greater integration of healthcare services.

“The COVID-19 pandemic has revealed that hospital systems that are able to deliver services in post-acute settings and through telemedicine, home health agencies and other outside services are better positioned,” the analysis said. “This sort of vertical integration enables hospital systems to diversify risk, as well as create significant efficiencies and cost savings.”

But smaller and independent hospitals need to start thinking now about what their facility will look like in the near future.

“In some cases they may have been operating on razor thin margins prior to COVID-19, but now are bleeding into the red,” Kaufman Hall said. “Finding a strategic partner may be imperative, and failure to engage in a thorough analysis of strategic alternatives now may come at the risk of losing potential partners down the road.”

Hospitals may have to take a number of actions to continue to be viable, including:

  • * Reducing service lines that don’t have a lot of patient demand
  • * Reducing workforces and cuting more expenses
  • * Cutting capital investments in plant and equipment

“For nearly every organization, some element or facet of the ‘core business’ is changing and the failure to diagnose and act with purpose to this fact may be the first step in a downward cycle of performance,” Kaufman Hall said.

The analysis also expects a surge of hospital mergers and acquisitions in 2021 as the impact of the pandemic lessens. So far, the pandemic has reduced deal volume as hospitals shift toward strategic growth.

Distressed hospital systems, though, could already be looking for new partners to get through the financial crisis.

“Rural hospitals in particular are likely to pursue ‘hurry-up mergers’ to enable them to address supply and staffing shortages, as well as fund increased expenses, during the pandemic,” the report said.

Top Adviser To Operation Warp Speed Calls An October Vaccine ‘Extremely Unlikely’

Top Adviser To Operation Warp Speed Calls An October Vaccine 'Extremely  Unlikely' : Coronavirus Live Updates : NPR

Source: NPR, by Christianna Silva

The Centers for Disease Control and Prevention is asking states to have a plan in place to distribute a COVID-19 vaccine as soon as late October — but that doesn’t mean an effective treatment will be ready quite so soon.

In separate interviews Thursday with NPR, the chief scientific adviser to the Trump administration’s vaccine development effort and the former director of the CDC’s office of public health preparedness cautioned that an effective vaccine is likely still months away.

Dr. Moncef Slaoui is one of two men that President Trump has put in charge of Operation Warp Speed, which has a goal of developing a COVID-19 vaccine by January. The former GlaxoSmithKline executive said having states prepared is “the right thing to do” in case a vaccine does become ready, but he acknowledged that having one by October or November was “extremely unlikely.”

“There is a very, very low chance that the trials that are running as we speak” could be ready before the end of October, Slaoui said.

“And therefore, there could be — if all other conditions required for an Emergency Use Authorization are met — an approval. I think it’s extremely unlikely but not impossible. And therefore, it’s the right thing to do, to be prepared in case.”

Slaoui said that he “firmly” believed a vaccine could be ready by the end of the year and that “we may have enough vaccine by the end of the year to immunize probably I would say between 20 [million] and 25 million people.” He said immunizing the U.S. population as a whole would take until “the middle of 2021.”

His assessment follows new CDC guidance, first reported by The New York Times on Wednesday, for states to prepare to distribute a vaccine to health care workers and other high-risk groups within a matter of weeks. In another letter, CDC Director Robert Redfield asked governors to fast-track permits and licenses in an attempt to make vaccine sites operational by Nov. 1, just two days before the presidential election.

Dr. Ali Khan, former director of the Office of Public Health Preparedness and Response at the CDC, called that timetable unlikely.

“I do not believe that this is going to be ready in a matter of weeks,” he said.

Khan, now dean of the College of Public Health at the University of Nebraska Medical Center, said the CDC’s guidance was less a prediction, and more a typical action the agency takes to ensure that once a vaccine is ready, states can use it.

“This is something that the CDC is appropriately doing, which is making sure that the states are prepared,” Khan said. “It’s a complex process that involves, how do you allocate vaccines, how do you distribute the vaccine, how do you administer the vaccine, how do you ensure equitable access for the vaccine. So the CDC and the states do this all the time.”

There are currently three different COVID-19 vaccines in phase 3 trials in the U.S., during which the vaccine is given to thousands of people to test its safety and efficacy. If a vaccine were made available as early as next month, it would shatter what is typically a years-long process to develop a new vaccine.

“I’m very optimistic about a vaccine and potentially more than one vaccine,” Khan said. But the notion that one may be ready in October was “super optimistic,” he said.

The CDC is facing backlash for the timing of its guidance, with critics charging that the development of a vaccine has been politicized ahead of the November election.

Khan said for his part, he was confident “that we will have good science to finally make a decision on an efficacious vaccine with a good side effect profile,” but he said that “the most important thing we need right now for vaccines is trust.”

Trust, however, is something with which many Americans appear to be struggling. An NPR/PBS NewsHour/Marist poll last month found that more than a third of Americans said they would not get vaccinated when a vaccine comes available.

“Trying to propose that there is going to be a vaccine available before the election actually may undermine people’s trust in the process to develop an efficacious and safe vaccine,” Khan said.

Slaoui said he understands why the date might concern people but added that the people working on Operation Warp Speed aren’t interested in the politicization of the vaccine. He said vaccines would not be introduced before clinical trials are completed.

“For us there is absolutely nothing to do with politics, and many of us may or may not be supportive of this administration,” he said. “It’s irrelevant frankly.”

CMS Unveils Redesigned Medicare Provider Comparison Website For Consumers

CMS Launches 'Streamlined Redesign' of Medicare Compare Tools |  HealthLeaders MediaSource: Modern Healthcare, by Maria Castellucci

CMS launched a remodeled website Thursday that consolidates its eight online consumer tools to one platform.

The redesigned site is an attempt by CMS to give users a more streamlined experience using its platform, called Compare tools.

CMS has published information online about healthcare providers and care settings for Medicare beneficiaries and their caregivers for more than 15 years. One of the elements for the hospital version to convey quality, the star ratings, has come under fire for producing inconsistent results and CMS recently proposed changes to the methodology as a result.

The eight different interfaces representing each care setting was confusing and cumbersome for users, according to CMS Administrator Seema Verma during a press call Wednesday. “The information will now be displayed in a modern streamlined design to make it as helpful as possible to users,” Verma said.

The remodeled site, available on, can now access users’ location and a drop-down menu allows the consumer to select what type of provider they are looking for. Options are hospitals, nursing homes, home health, dialysis centers, long-term care hospitals, inpatient rehabilitation, physicians and hospice groups. A user can compare up to three providers using information about costs, location and quality data. The site is also compatible for use on smartphone and tablets.

CMS is seeking feedback from users about the upgraded platform. There is an online survey available on for users. CMS will also seek feedback from provider stakeholders who treat Medicare beneficiaries.

Last Updated 09/16/2020

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