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Louisiana Health Officer Joseph Kanter, MD, MPH, on Saturday ordered the immediate closure of seven nursing homes that evacuated patients to a warehouse on August 27 as Hurricane Ida bore down southeast Louisiana. Conditions deteriorated in the warehouse and seven patients died; five deaths have been declared storm-related, according to a statement from the Louisiana Department of Health (LDH).

The warehouse, located in Independence, La., is located in Tangipahoa Parish, which is north of New Orleans and about 100 miles from where Hurricane Ida made landfall. The nursing homes that evacuated were in Orleans, Jefferson, Lafourche, and Terrebonne parishes, all south of Lake Pontchartrain.

All patients taken to the warehouse have since been relocated, following an inspection that was temporarily blocked by the nursing homes' owner, who also owned the warehouse. Bob Dean, the owner, has previously been cited by state officials for evacuating nursing home patients to a facility he owned that proved to be inadequate. 

LDH Secretary Courtney N. Phillips, PhD, MPA

State officials told the Associated Press that water got into the warehouse and generators failed. Meanwhile, tipsters told officials of patients being left on mattresses on the floor without food or clean clothes. Strong odors of feces permeated the building, and conditions declined rapidly as more patients arrived and owners tried to fit them into an increasingly crowded building. Trash and bags of human waste piled up, according to a nurse 

LDH has now confirmed 7 deaths of nursing home residents evacuated to the Independence facility, 5 of which have been classified as storm-related. State law enforcement officials have called for a criminal investigation, and LDH is reaching out to families of the nursing home residents.

The seven nursing homes that evacuated to the warehouse in Independence include:

River Palms Nursing and Rehab, Orleans Parish

South Lafourche Nursing and Rehab, Lafourche Parish

Maison Orleans Healthcare Center, Orleans Parish

Park Place Healthcare Nursing Home, Jefferson Parish

West Jefferson Health Care Center, Jefferson Parish

Maison DeVille Nursing Home, Terrebonne Parish

Maison DeVille Nursing Home of Harvey, Jefferson Parish

“What happened in Independence is reprehensible, and I know there are many families hurting as a result,” said LDH Secretary Courtney N. Phillips, PhD, MPA. “Today’s action against these facilities is needed. There is more to come. Our department’s mission is to advance the health and wellbeing of our residents—and that includes our vulnerable nursing home residents.”

“The lack of regard for these vulnerable residents' wellbeing is an affront to human dignity,” Kanter said. “We have lost trust in these nursing homes to provide adequate care for their residents. We are taking immediate action today to protect public health.”

Reports of the deteriorating conditions at warehouse after Hurricane Ida made landfall prompted LDH inspectors to visit the site, but they were blocked from making a full inspection August 31 and “subject to intimidation by the owner of the seven nursing facilities,” according to state officials.

LDH and other state and local agencies returned September 1 to evacuate local residents and all had been relocated by September 2.

For several days, Louisiana news outlets have covered the evacuation of the warehouse and history of issues with Dean's nursing homes. He has been described as a previously active political donor who more recently has become isolated among the state's powerful network of nursing home operators. News reports said Dean’s nursing homes received 

 from Medicare before the recent evacuation, which the website nola.com said was a part of a plan on file with the state following the deaths of fragile, elderly patients in floodwaters during Hurricane Katrina in 2005.

 at nursing homes he owned due to poor care. News outlets report attempts to reach Dean have been unsuccesful.

Articles

Bob Dean, the nursing homes' owner, has previously been cited by state officials for evacuating patients to a facility he owned that proved to be inadequate.

Louisiana Health Officer Shutters Nursing Homes That Sent Patients to Warehouse, Where 7 Died

This week, CMS offered proposals during the annual rulemaking process that it said would “address the health equity gap, ensure consumers have the information they need to make fully informed decisions regarding their healthcare, improve emergency care access in rural communities, and use lessons learned from the COVID-19 pandemic to inform patient care and quality measurements.”

In other words, the Biden team is looking to levy fines on hospitals that are skirting the pricing transparency rule that took effect during President Donald Trump’s final weeks in office. And CMS has taking the first step toward publicizing vaccination rates of staff at hospitals and surgical centers, so that consumers can make informed choices when scheduling their care.

The actions follow President Joe Biden’s wide-ranging 

 aimed at increasing competition, which include steps to protect rural healthcare and continue the focus on transparency in hospital pricing. There had been speculation whether Biden would retain one of the Trump administration’s last major health policy moves, but Biden appears poised to expand it. Proposals announced Monday are included 

 of the CY 2022 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule.

“As President Biden made clear in his executive order promoting competition, a key to price fairness is price transparency,” HHS Secretary Xavier Becerra said as 

. “No medical entity should be able to throttle competition at the expense of patients. I have fought anti-competitive practices before, and strongly believe healthcare must be in reach for everyone.”

The proposed transparency rule, Becerra said, calls for stiffer penalties for concealing the costs of services and procedures, and shows that such practices “will not be tolerated by this administration.” The action follows reports from consumers as well as analyses, including 

®, that hospitals are not making clear, accessible pricing information available online as has been required since the rule took effect January 1, 2021.

For failing to comply with the rule, CMS proposes the following fines:

Hospitals with a bed count of 30 or less, $300 a day

For hospitals with more than 30 beds, once the bed count exceeds 30 beds, add a penalty of $10 per bed per day, with the daily fine not to exceed $5,500;

A full calendar year would have a minimum fine of $109,500 and a maximum fine of $2,007,500 per hospital.

Even with the uneven compliance, CMS has already seen wide variation in pricing, even within the same hospital or the same health system, depending on which insurer is billing the hospital.

. CMS is proposing to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.3%. According to CMS’ fact, sheet, this update is based on the projected hospital market basket increase of 2.5% reduced by 0.2 percentage point for the productivity adjustment. CMS officials note elsewhere they are using CY 2019 date to set CY 2022 rates due to the disruption caused by the COVID-19 public health emergency.

Agency officials are asking for input on ways to report health disparities based on social risk factors and race and ethnicity, to make such reporting more comprehensive and actionable. Comments could involve data collection, analysis and reporting of quality measure results by factors that include race, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status, or other factors.

CMS reports that 138rural hospitals have closed since 2010, “disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates.” The trend deprives rural Americans of key services, including access to emergency care. Congress enacted Section 125 of the Consolidated Appropriations Act of 2021 (CAA), to create a new provider type for Rural Emergency Hospitals (REHs). CMS is requesting a range of information to develop requirements that will apply to REHs, which the goal of creating the new provider designation on or after January 1, 2023.

CMS seeks comment on how hospitals are using flexibilities allowed during the public health emergency to provide mental health services remotely and whether CMS should consider permanent changes. CMS also seeks input on how to measure how many front-line healthcare workers in hospital outpatient departments and ambulatory surgical centers are vaccinated against COVID-19, and how to make this information available to the public so consumers have this information when making healthcare decisions.

CMS plans to reverse some policies that would have had Medicare pay for surgical procedures that could pose a risk to patients. The agency seeks to halt the phased elimination of the Inpatient-Only (IPO) list—procedures that Medicare will only make payment for when provided in the inpatient setting. CMS adopted a policy for 2021 to eliminate this list over a phased period and removed musculoskeletal procedures from the list in 2021. However, the current CMS leadership determined that criteria for removing items from the list were not followed and that there was not enough evidence that these services could be performed safety on Medicare patients on an outpatient basis. Some of the procedures to be removed from the IPO list included limb amputations and invasive spinal procedures. CMS seeks to return them to the list in 2022, and seeks comment on the future of the IPO list and criteria for evaluating which services should be on it.

The ongoing debate about cuts to the drug discount purchasing program 

 will reach the Supreme Court of the United States this fall. CMS notes in the Monday’s proposal that beginning January 1, 2018, Medicare adopted a policy to pay an adjusted amount of average selling price (ASP) minus 22.5% for certain separately payable drugs or biologicals acquired through the 340B Program. “In this rule, we are proposing to maintain the payment rate of ASP minus 22.5% for certain separately payable drugs or biologicals acquired through the 340B Program. Under this proposal, rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals would continue to be excepted from this policy.”

One proposal asks hospitals for input on how to measure vaccination rates among staff with the aim of letting consumers have the information.





CMS Proposals Would Boost Price Transparency, Take Steps to Promote Safety as COVID-19 Remains a Threat

Hospital mergers are a prime target in President Joe Biden’s expansive executive order that calls on federal departments and agencies to reshape what he called a “booming” economy by putting workers first and ensuring consumer protections.

The order spans sectors from banking to transportation with 72 specific initiatives, including several that target healthcare, which is already undergoing upheaval amid the COVID-19 pandemic, which has exacerbated shortages of doctors and nurses, strained supply chains, and pushed veteran administrators into retirement.

“For decades, corporate consolidation has been accelerating,” a statement issued with the order reads. “In over 75% of U.S. industries, a smaller number of large companies now control more of the business than they did twenty years ago. This is true across healthcare, financial services, agriculture and more. That lack of competition drives up prices for consumers.”

The statement cited data claiming that mark-ups have tripled, raising costs for necessities like prescription drugs, hearing aids, and internet service—which became essential during the pandemic as telehealth became the only way to see a doctor.

Key items in Biden’s executive order include:

Empowering antitrust agencies, including the Federal Trade Commission, to address problems surrounding consolidation in certain industries, including healthcare, where mergers have left some rural areas with no hospital.

Making it easier to change jobs, including between states, by reducing occupational licensing requirements and limiting non-compete agreements.

Reducing prescription drug prices by allowing programs run by states and tribes that import drugs from Canada.

Promoting more procurement opportunities for small business with federal agencies.

The order creates a White House Competition Council the track progress on the initiatives and agencies’ response.

Consolidation in healthcare over the past decade—mergers of hospitals into larger systems, acquisition of practices, and vertical integration of health plans and pharmacy benefit managers (PBMs)—has drawn fire from consumer and antitrust advocates who say the trend works against keeping down costs, especially when one looks at some individual markets.

The order directs the Justice Department and the FTC to examine guidelines on hospital mergers to ensure that patients are not harmed.

Recent trends also work against reining in the price of prescription drugs, because powerful PBMs can dictate which drugs appear on formularies, demand rebates, or impose fees. Just this week, a study by authors at USC’s Schaeffer Center found that Medicare overspent by $2.6 billion in 2018 on commonly prescribed generic drugs compared with prices charged by Costco.

Biden’s order directs HHS to do the following:

Support hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing. This is significant, because many wondered the fact of the transparency rules imposed at the very end of the Trump administration.

Restore a rule from the Obama era that insurers selling plans under the federal marketplace, created by the Affordable Care Act, must have at least one standard design to serve as a benchmark for consumers to compare with other companies. This concept was scrapped under the Trump administration.

Directs the FDA, which is part of HHS, to work with states and tribes on safe import practices under the Medicare Modernization Act of 2003.

Increases support for generic and biosimilar drugs and allows 45 days for a comprehensive plan to combat high prescription prices.

Empowers FTC to ban “pay for delay” and similar practices that keep low cost drug or biosimilar options off the market.

Hospital Mergers Targeted in Biden Executive Order

Health systems that want to save money on a major cost of delivering care might look no further than their nearest Costco.

That’s what a health economics research team from the Leonard D. Schaeffer Center at the University of Southern California to highlight Medicare pays an extra $2.6 billion for generic drugs, thanks to layers of middlemen who negotiate prices for government—but pocket some of the savings. The study, led by Erin Trish, PhD, appeared 

When reimbursement policies eliminate cost-sharing for some prescriptions—making the “cost” invisible for some patients—those taking the drugs don’t realize that the government is spending billions for prescriptions cost less at nearby warehouse outlets, such as Costco.

The authors point out that while there’s been plenty of attention to brand name drugs with eye-popping list prices, most of the drugs that Americans take—both in the hospital or at home—are generic medications. In fact, 88% of Medicare Part D prescriptions dispensed in 2018 were generic, so any savings retained by pharmacy benefit managers (PBMs) could quickly add up.

The findings suggest these practices, which work against Medicare, beneficiaries, and the taxpayers, deserve a closer look, Trish said in a statement released by USC.

“Our analysis shows that in systems like Costco’s, where incentives are set up to deliver value directly to the consumer at the pharmacy counter, that’s what happens,” said 

 and an assistant professor of pharmaceutical and health economics at the USC School of Pharmacy. “It’s time to fix those incentives in the Medicare Part D system to put the patient first.”

To conduct their study, the team compared what Medicare Part D plans paid for 184 commonly prescribed generic drugs, including patient out-of-pocket costs, with the cash prices that Costco members were charged for the same drugs in the years 2017 and 2018.

They found the government overpaid, and by a lot: after analyzing 1.4 billion Part D claims, they found Medicare overpaid 13% in 2017 and close to 21% in 2018, compared with the Costco customers.

For those who take regular prescriptions for a chronic condition—which many seniors do—the savings at Costco escalated. Members who took advantage of the 90-day fill option in 2018 saved whopping 53% over what Medicare plans paid. Medicare plans overspent. Medicare plans overpaid on 30-day and 90-day fills by 43%, the study found.

PBMs have been in the crosshairs from government leaders and advocacy groups alike in recent years. Vertical integration with payers has made them more powerful, and 

 many states have taken action to protect consumers and their own Medicaid budgets. Federal legislation has been introduced to limit or 

, but any effort to rein in PBM practices will have unforeseen effects. Advocacy groups in the cancer care community say efforts to stop spread pricing have resulted in the creation of new classes of fees to get revenue another way.

For those who take regular prescriptions for a chronic condition—which many seniors do—the savings at Costco escalated.

For Proof of Government Inefficiency in Drug Purchasing, They Went to Costco

The Supreme Court on Thursday tossed a lawsuit that once again threatened the Affordable Care Act (ACA), ruling 7-2 that Republican-led states who brought the case lacked legal standing to challenge the law.

For the third time, an increasingly conservative court left intact the law’s protections that require coverage for preexisting conditions, created Medicaid expansion, promote health screenings and preventive care, and launched novel, value-based payment strategies within the agency that manages Medicare and Medicaid.

The ruling comes as President Joe Biden has tried to build on the ACA and create new incentives for states that have not expanded Medicaid to do so, amid mounting evidence that having health coverage reduces mortality.

 and was joined by Justices Elana Kagan and Sonia Sotomayor, as well Chief Justice John Roberts and two appointees of President Donald Trump, Justices Brett Kavanaugh and Amy Coney Barrett. The opinion focused on the fact that individual states governed by Republicans, along with individual plaintiffs, had failed to show “a concrete, particularized injury fairly traceable to the defendants,” and thus could not challenge the law on constitutional merits.

The latest challenge, led by Texas, began after Trump’s 2017 tax law eliminated the enforcement mechanism for the ACA’s individual mandate. On those grounds, the Republican-led states tried to assert that the entire law must fall, even provisions unrelated to the requirement that all Americans have health insurance.

Today, the Supreme Court’s majority found that the states failed to make their case that the de facto end of the mandate would cause them harm, which would create grounds to challenge the entire ACA.

“Unsurprisingly, the States have not demonstrated that an unenforceable mandate will cause their residents to enroll in valuable benefits programs that they would otherwise forgo. It would require far stronger evidence than the States have offered here to support their counterintuitive theory of standing, which rests on a ‘highly attenuated chain of possibilities.’”

Justice Clarence Thomas wrote a concurring opinion, stating, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."

An estimated 20 million people had gained coverage under the law at a peak in 2017, but there was some loss of coverage during the Trump administration. More recently, more than 1 million people signed up for coverage through the ACA under a 

 authorized by the Biden administration due to the COVID-19 pandemic. The American Rescue Plan reduced premiums, and additional proposals would make those premium cuts permanent.

While many legal experts had questioned the merits of the Republican states’ challenge, the addition of Justices Neil Gorsuch, Kavanaugh, and Barrett to the court raised concerns among the law’s supporters about what would happen once the case reached the highest court. Gorsuch and Justice Samuel Alito dissented, but the other Trump appointees ruled with majority on the narrower question of standing.

The latest challenge was argued in November, just after Barrett joined the court, and the defense was organized by a group of officials from Democrat-led states. Their leader was former California Attorney General Xavier Becerra, recently confirmed as Biden's HHS secretary.

The ACA is now one of the most litigated pieces of legislation in history. It survived an initial challenge after its passage in 2010, although the court did reshape the law by allowing states to opt out of Medicaid expansion.

However, that decision ended up creating an environment for research comparing health outcomes between expansion and non-expansion states, and now data are pouring in that show how populations with health coverage benefit in multiple ways—those 

 who are able to manage their disease suffer fewer complications.

Veterans of the Obama administration who helped write and implement the ACA were surprised and pleased this morning, and said the decision opens the door for the Biden administration to improve the law.

“Bottom line—this is incredible,” former Obama administration policy official Kavita Patel, MD, told MSNBC. “It’s a chance for the Biden Administration to try to take back some of what the country lost when the individual mandate was taken away. … Not being a lawyer, I don’t think you could have a clearer path saying, ‘this is it.’”

“It’s not a close call in terms of the law, and not a close call in terms of who we are as a country,” said former Acting CMS Administrator Andy Slavitt.

Chiquita Brooks-LaSure, now CMS Administrator with chief responsibility for implementing the law, recalled her work on its passage during her tenure with the House Ways and Means Committee. 

"Millions of Americans can breathe a sigh of relief following today’s Supreme Court 7-2 ruling upholding the Affordable Care Act," she said. "This victory assures access to affordable and comprehensive health insurance for patients and families across the country."

She pointed to the fact that 12 states have still not expanded Medicaid, but the Biden administration hopes that will now change.  "Through the ACA, and hand-in-hand with CMS, dozens of states have expanded Medicaid – bringing quality coverage to our family and neighbors who need it most. We will continue to partner with states because we know 4 million more Americans stand to gain access to quality health coverage in the remaining states."

Other supporters of the ACA also called for working to improve the law.

"CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans,” said Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield. “CareFirst looks forward to continuing our work with federal and state policymakers to maintain and improve access to healthcare throughout our region."

Officials from the Robert Wood Johnson Foundation called for an end of “meritless attacks against a milestone law. … It is time now for our nation to resume its path toward achieving universal health care coverage.”

Supreme Court Upholds ACA, Says States Lacked Standing

A survey of reported this weekend during an annual meeting of oncologists found that almost all cancer specialists will keep using telehealth after the pandemic ends—but perhaps not for every type of visit.

The American Society of Clinical Oncology (ASCO), which held a virtual meeting for the second year, shared results commissioned by its Telehealth Survey Task Force. Chris Manz, MD, MSHP, a medical oncologist with Dana Farber Cancer Institute, said 200 physicians completed the survey; respondents offered a good geographic distribution, representing 42 states.

Respondents were evenly split between practices of 20 clinicians or fewer and those with more than 20 clinicians. Of those taking the survey, 72% were medical oncologists.

Those who responded said using telehealth for symptom management and survivorship care has clear benefits, but 68% said it fell short for first-time visit, when doctors prefer to see the patient in person. Only 8% of the respondents said they did not plan to use telehealth at all after the pandemic.

Respondents were asked how they used telehealth for different types of visits as the pandemic hit a peak in January 2021. At that time, 51% said they were using the technology for at least half of survivorship visits in the past 30 days; by contrast, only 19% said they had used telehealth for at least half of their 

 visits, when topics such as palliative care or advanced care planning may be discussed.

Manz said the appropriateness of using telehealth for a specific type of visit wasn’t the only consideration.

“Respondents reported that a number of patient, clinician, practice, and financial factors were barriers to using telehealth,” he said. Most frequently cited: patients’ access to technology, and the patients’ limited proficiency with telehealth technology. Both cited by about 80% of clinicians.

“Overall,” Manz said, “respondents in this small survey reported telehealth utilization, quality of telehealth, and preferences for post-pandemic telehealth use that often varied with the type of visit. However, clinicians highlighted a number of barriers that can inform policies around telehealth in the coming months and years.”

Survivorship care and symptom management were the best uses of the technology in cancer care, according to survey results presented during this weekend's meeting of the American Society of Clinical Oncology.

Telehealth Will Stay, but Not for Every Visit, Oncologists Report

Humana has learned plenty in more than five years of running its Bold Goal program, the population health effort that now operates in 16 communities and gave the Medicare and Medicaid giant a leg up on managing the social needs that soared when COVID-19 hit.

Chief among the lessons: We can’t do it alone.

,” which are measured based on a definition developed by the CDC. This year, Humana also features information on a Basic Needs Program launched during the pandemic and screenings that doubled the original goal of 3 million to 6 million in 2020.

Bold Goal is Humana's ongoing effort to address holistic health needs in key markets, in part by working with community partners—from health systems to faith leaders—to address social determinants of health. The initiative, designed to tackle barriers such as lack of food or housing and social isolation that contribute to chronic disease, proved beneficial when the pandemic fueled a need to deliver more services in all these areas.

In 2020, Humana found that Bold Goal helped Medicare Advantage members increase the number of physically healthy days; however, perhaps to no surprise, there was a decline in healthy days on the mental health side.

Andrew Renda, MD, vice president for Bold Goal and Population Health Strategy at Humana, said in an interview with 

™ that while it’s hard to say Humana would have fared without Bold Goal in place, it is true that the program “helped position us well” when the pandemic struck.

In an interview, Renda said that partnerships for a national insurer like Humana are essential—it covers 20 million lives in commercial, Medicare and Medicaid plans—and as Bold Goal has shown, it relies on working with market-level partners, especially when managing a response to something like COVID-19.

“Partnerships are absolutely key,” he said. “Number one, we don't have all of the expertise to address all these needs, and to we don't have the resources. So, partnerships are key in a national level.

“Partnerships are really crucial on the local level as we think about building trust with people in communities in deploying interventions and getting that buy-in to participate,” Renda added. “So, partnerships are important in a number of different levels. …

Renda offered an example of building a framework to address food insecurity, which was a major focus for Humana in 2020 due to the pandemic. “If you’re going to address food insecurity, it's important that we work with key leaders in that space. So, we might work with Meals on Wheels, we might work with Feeding America, and we do work with both of them.”

On of Humana’s hallmarks: it likes to have multiple partners so that it gets different looks at how to solve a problem. If it’s testing framework, Renda said, “we want to approach that in different ways.”

Is there an ideal Humana health system partner? If so, what are the characteristics for an ideal partner for a population health initiative?

“There certainly are some characteristics,” Renda said, adding that his list might not be “as precise as you want to hear. “I look at it as creativity, willingness to partner with us openness to exploring the impact of social determinants on health and health outcomes. Because I think just that willingness to come to the table and co-create something together is really, really important. And we've done that with health systems and with providers.”

Renda offered an example of a first-of-its-kind, value-based payment innovation with a handful of providers “that were willing to jump in with us.”

“We want to incentivize primary care providers to screen for social determinants, to document a code, and to make a referral to a community based organization,” he said. “Not everybody was willing to take that leap, and certainly [not] in the middle of a pandemic.”

But some were. The inaugural participant was 

, based in the New Orleans, Louisiana metropolitan area, with operations as far north as Shreveport, La., and as far east as Pascagoula, Miss. New Orleans and Baton Rouge are both Bold Goal communities.

Does Bold Goal provide a template for health systems to be proactive in their own communities?

Renda would say yes. The toolkits, progress reports, and resources on food insecurity, which includes best practices on validated screening practices, all offer “off the shelf” help for health systems just getting started in population health.

Population health was an “aspirational goal, a little bit nebulous, frankly,” when Humana started down this path. But Renda said that didn’t matter when Humana’s CEO, Bruce Broussard charged the team with finding ways to address it—and figuring out how to measure that progress.

“We've just made such tremendous progress. I'm proud of the team and proud of our organization, how much we've learned about health-related quality of life, about social determinants, about data and interventions, partnerships.

The next step is to take what’s Humana learned and make it scalable and sustainable, Renda said. “Now we've got to move forward, I think that the new goal if there was one is to really achieve operational maturity around social determinants—it’s the proof points that these things work that justify bigger investments, so that we can scale things,” he said.

That's really the objective now—to scale that work to get those proof points, to infuse it into a variety of aspects of our business.”

Humana's 2021 Bold Goal Report, released last week, highlights the importance of health system partnerships.

Humana’s Bold Goal Effort Shows Value of Health System Partnerships 

Burnout among healthcare workers during the COVID-19 pandemic has been well-documented, but cardiovascular clinicians appear to be particularly hard hit, according to a survey presented during the recent American College of Cardiology Scientific Sessions.

Burnout rose from 20% prior to the pandemic to 38% at the peak. All cardiology team members experienced burnout, which researchers said is not a surprise, said they were more likely to be with patients as they were near death.

Survey findings show some health systems have fallen short in meeting cardiologists’ basic needs, with 41% of participants saying they might cut back hours, change jobs or retire due to lack of health system support. They cited inadequate food, lodging, transportation, childcare and emotional support while caring for COVID-19 patients. As the pandemic hit the one-year mark in the United States, Kaiser Health News reported that more than 

 had died from complications, and more than 4,100 safety complaints had been filed with the U.S. Department of Labor.

And at the same time, 41% reported financial stress, often due to pay cuts.

Half of the cardiovascular team members surveyed provided direct care to patients with COVID-19 but one in five said they lacked adequate personal protective equipment, or PPE. The team members surveyed included cardiologists, physician assistants, nurse practitioners, nurses, pharmacists, and imaging technologists.

To no surprise, burnout was highest among those who provided direct care.

“We know from previous studies that burnout is pervasive in cardiology and medicine in general, but we felt it was important to take the temperature of our colleagues amid the COVID-19 pandemic,” said Laxmi Mehta, MD, vice chair of wellness for the Department of Internal Medicine at the Ohio State University Wexner Medical Center and the study’s lead author.

“The prevalence of burnout among cardiovascular professionals nearly doubled when comparing pre- to peak COVID-19 levels. It clearly shows that there are lots of opportunities to improve the work environment; COVID-19 has really put a magnifying glass on the fact that things were bad and now have significantly worsened.”

The findings portend upcoming shortages in cardiovascular care, with some of this driven by COVID-19. Some plan to cut back on work hours (23%), retire early (13%), or leave their current practice (13%). The sentiments were highest among those feeling burnt out.

COVID-19 is driving force in the decision for some, with 17% of clinicians planning to reduce their clinical work hours, 12% planning to leave their current practice and 11% planning to retire due to COVID-19.

Unprecedented stress, long hours, less pay, and uncertainty are proving a toxic mix, the survey found.

“Health systems need to take steps to help ensure basic safety, financial and personal needs of cardiology clinicians especially in the wake of COVID-19,” Mehta said. “There are also still many unknowns with emerging variants and as our communities open more, some people are choosing not to get vaccinated, not to mention on top of the already taxed health systems, there are additional burdens of caring for patients with cardiovascular disease who delayed care and are now sicker than they would have been if they presented earlier.”

The mini-Z survey on burnout emailed to participants in November 2020 to 10,019 cardiologists, fellows-in-training and cardiovascular team members. A total of 1,288 people responded to the survey (456 U.S. and 436 international cardiologists, 128 trainees and 268 cardiovascular team members). Because peaks in COVID-19 disease activity differed by region, participants were asked to ask about feelings of burnout before COVID-19 and during the peak of COVID-19 where they lived and worked.

Of note, burnout was less severe among international professionals compared with cardiovascular team members in the United States.

“Burnout is a metric, but well-being is the goal and what we are striving for,” Mehta said. “While we are resilient, these results show that we really need to be focusing on fixing the work environment, including ensuring that we have enough PPE, feeling valued and safe at work, improving team dynamics and efficiencies, which are all essential whether there is COVID-19 or not. Organizations need to focus on improving workforce care not just patient care.”

One limitation of the survey is that it asked respondents to use their own definition of burnout. Mehta said the research team will dig into the data to gain insights of differences by gender and career stage.

Survey findings show some health systems have fallen short in meeting cardiologists’ basic needs, with 41% saying they might cut back hours, change jobs or retire due to lack of health system support.

High Burnout Seen Among Cardiologists in COVID-19; Health Systems Fall Short 

The COVID-19 pandemic provides an opportunity for organizations to think about how they can be proactive and monitor new regulatory changes in real time, said Ogi Kwon, a manager in the regulatory team at 

Kwon explains how he feels price transparency as a whole while be something that continues to be iterated upon going forward and how requirements could take different forms. 

R1 RCM is a revenue cycle management company that offers technology-driven solutions to transform health care providers' patient experience and financial performance.

Videos

Ogi Kwon, of R1 Revenue Cycle Management (RCM) offers insights on lessons learned from the COVID-19 pandemic and the future of price transparency. 

The Effects of COVID-19 on Patient Experience and Price Transparency 

More than 1 million tests and procedures that Medicare patients received in hospitals over a three-year period were likely not needed, according to an analysis released today.

The Lown Institute, named for Bernard Lown, MD, a Nobel Laureate who died earlier this year at age 99, released its 

 that measures how well they do in avoiding low-value care, based on established criteria for overuse.

Most of the top performing hospitals in the Lown Institute Hospital Index are not from large, well-known health systems that appear on the annual rankings of U.S. News and World Report—in fact, only Cleveland Clinic, which ranked 58th on the Lown list, is on the U.S. News honor roll, according to the a statement on findings.

But there were some patterns: of the 50 top performers, nine are in the Northeast and 10 were in the Pacific Northwest. By contrast, the South is home to highest number of poor performers—41 out of 50—and five of the 10 worst performers are found in Florida. The Lown Institute noted that 47% of Florida’s hospitals are for-profit enterprises.

The 2021 Lown Institute Hospital Index measured overuse at 3,100 hospitals from 2016-2018, using data from 100% of Medicare claims between January 1, 2016, and December 31, 2018. The analysis focuses on 12 low-value services, including four tests and eight procedures, with the index giving added weight to services that account for higher shares of overuse.

 at the University of Michigan, low-value care includes services “that provide little or no benefit to patients, have potential to cause harm, incur necessary costs to patients, and waste limited healthcare resources.” The Center estimates that low-value care costs the country more than $345 billion a year, and notes that there have been several initiatives to squeeze low-value care from the system.

“Overuse in American hospitals is a pervasive problem that needs to be addressed,” said Vikas Saini, MD, president of the Lown Institute. “Hospitals want to do better and these objective measures of performance can help them move forward.”

Services measured in the Lown Index are: 

 when patients have not had a meniscal tear; 

, which maps plaque buildup, if done on female patients who have no stroke symptoms or history; 

when performed on patients with stable heart disease; 

electroencephalography (EEG) for fainting

 if patients have not had epilepsy or seizures; 

 if patients have not had pulmonary embolism; 

 for patients without a diagnosis of fibromuscular dysplasia of the renal artery; 

The top 10 high-performing hospitals are as follows:

Scott County Hospital in Scott City, Kansas

Beth Israel Deaconess Medical Center in Boston, Massachusetts

West River Regional Medical Center in Hettinger, North Dakota

Mayo Clinic Health System in Lake City, Minnesota

Sidney Regional Medical Center in Sidney, Nebraska

Mary Hitchcock Memorial Hospital in Lebanon, New Hampshire

Healdsburg District Hospital in Healdsburg, California

Contra Costa Regional Medical Center in Martinez, California

CMS has tried to target low-value care in recent years through the use of alternative payment models (APMs), and efforts to eliminate wasteful hip- and knee replacements have been deemed largely successful. Other hospital safety organizations have zeroed in on unnecessary hysterectomies, which the 2021 Lown analysis found were unnecessary in 64% of the cases. In North Dakota and Wyoming, hysterectomy overuse was 90% and 94%, respectively.

The analysis also ranked states based on the overall record of its hospitals and found that Vermont did the best job of avoiding unnecessary procedures, while Alabama fared the worst.

The analysis by the Lown Institute measures hospitals based on their performance of 12 services performed over a three-year period.