Why Exposure to the Virus Won't Cure the Healthcare Problem-Covid-19

 It has been nearly a year since Covid-19 the deadly corona virus arrived on US shores, with the first case identified in Seattle on January 15, 2020 from a man who had visited Wuhan. (Centers for Disease Control and Prevention, 2020) Unfortunately, conflicting messages by the current presidential administration, as well as state, and local governments gave much of the public a false sense of security about their COVID-19 risk. North Dakota for example, was one of those states which remained open for business and their hospitals have since suffered a crush of patients. (Sarah Mervosh, 2020) Currently it is facing a critical shortage of hospital beds, which impacts all patients, not just Covid-19.

People who don’t think they will become ill or die from Covid-19 are missing the point, if the entire health system crashes because of an onslaught of pandemic patients, other non-COVID patients will not be able to obtain timely service. Further, there are cases, especially with cancer patients, where their treatments were disrupted and they died. Three patient groups which have experienced potentially life-threatening disruptions in care are: lymphoma patients who need CAR-T therapy, restrictions on certain coronary procedures due to Covid-19 myocarditis patient exposure, and lack of support systems for cancer patients who may be rushed into procedures to beat the Covid onslaught. (Rosenblaum, 2020)

The general public is now aware of the toll the pandemic has taken on healthcare professionals who have been taken ill by Covid-19 and died. If there aren’t enough doctors or nurses for the patients, people will die.  It takes years for healthcare professionals to become trained so losing them is a huge problem for providing adequate patient care even in non-pandemic times. The US has critical shortages in nursing due to several factors; the aging baby boomer population, a third of all current nurses are over the age of fifty and will soon be retiring, and an inadequate pipeline to produce enough nurses. (Haddad, Annamaraju, & Toney-Butler., 2020) Nurses provide the lions share of patient care in hospital settings.  There are critical shortages of nursing staff in many states, especially Texas, where ICU nurses must take care of six patients versus the normal two, this must not persist. The American Hospital Association declared in November that Texas, North and South Dakota, Minnesota, Wisconsin, and Illinois have critical shortages in staffing and even equipment, like the ultra-cold freezers to store the Covid-19 vaccine. (Goldhill, 2020)

The entire west coast from California to Washington has the most severe shortages of hospital beds in the country. This is not a state issue, it is a national issue, because the healthcare system impacts residents, visitors, and commerce. One could even argue that this is a national security issue, because prolonged absences of skilled professionals and other essential workers impacts everything from the food supply to public utilities. Though it is unconscionable the pandemic was not treated with a proven science-based protection protocol and was subject to the electoral whims of a few, this is an opportunity for America to look at its healthcare system and make critical changes for the future. The current, profit-motive system, especially in large hospitals is not working, as more and more community hospitals fail, and communities go unserved. We should not be financing venture capital funds for giant hospital corporations with our astronomical healthcare costs.

Surely the global Covid-19 Pandemic has made it clear that the nation needs to change the laissez-faire healthcare financing system and start targeting areas of shortages based on patient populations, not just “growth opportunities with the right payor mix.” Because at the end of the day, when your father can’t get timely cancer treatments, you lose your wife to COVID-19, and you are unable to find a hospital bed which is necessary for surgery, the health system is not working for us all. Let’s stop making this a political issue and start working together as a nation to resupply our critical shortages in nursing, primary healthcare, and yes, hospital beds.

This is the healthpolicymaven signing off encouraging you to have a safe and sane New Year’s Day.

Roberta Winter is an independent journalist and healthcare analyst who receives no money from any of the insurance, hospital, pharmaceutical, or medical supply sectors of US healthcare. Opinions expressed here are her own. Winter is the author of a guidebook to the US healthcare system, which was published by Rowman and Littlefield in 2013 and is still selling today.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Works Cited

Centers for Disease Control and Prevention. (2020, January 21). First Travel-related Case of 2019 Novel Coronavirus Detected in United States. Retrieved from Centers for Disease Control.com media releases: https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html

Goldhill, O. (2020, November 20). ‘People are going to die’: Hospitals in half the states are facing a massive staffing shortage as Covid-19 surges. Retrieved December 27, 2020, from Statnews.com: https://www.statnews.com/2020/11/19/covid19-hospitals-in-half-the-states-facing-massive-staffing-shortage/

Haddad, L. M., Annamaraju, P., & Toney-Butler., T. J. (2020, December 25). Nursing Shortage. Retrieved from NCBI Resources: https://www.ncbi.nlm.nih.gov/books/NBK493175/

Rosenblaum, L. (2020, June 11). The Untold Toll-The Pandemic's Affects on Patients Without Covid-19. New England Journal of Medicine. doi:DOI: 10.1056/NEJMms2009984

Sarah Mervosh, D. L. (2020, December 23). Covid-19: Lockdowns Return and North Dakota Issues Mask Mandate as Records Fall. The New York Times. Retrieved December 25, 2020, from https://www.nytimes.com/live/2020/11/13/world/covid-19-coronavirus-updates

Winter, R. (2010, September 20). The Brave New World of Accountable Care Organizations. Retrieved from Straight Talk on Healthcare.blogspot.com: https://healthpolicymaven.blogspot.com/2010/09/brave-new-world-of-accountable-care.html

 

Stopping Diabetes Before It Starts-Scientific Research

 

November 14^th is National Diabetes Day and diabetes is the number seven cause of death in the US, resulting in nearly 85,000 deaths annually. (National Center for Health Statistics, 2020) Many people globally are dying because they can’t afford their insulin, which results in diabetic ketoacidosis, when cells dehydrate and the body stops functioning. According to the World Diabetes Organization, there are over two million deaths worldwide annually, due to high glucose resulting in ketoacidosis. Children’s hospitals in the US report a rate of death of .25 out of 100,000 from Diabetic ketoacidosis (DKA) and the United Kingdom reported .21 out of 100,000 deaths of children and youths. (Denis Daneman, 2001) There are also an equal number of deaths from cerebral edema. This means that 54 people under the age of 19 died from diabetes due to hypoglycemia or DKA in the United States in 2009 and it is now estimated at 185 deaths. (US Census Bureau, 2010) One of the reasons for the increase is the escalating unaffordability of insulin, which is ten times more expensive in the US than any other country. (Rajkumar, 2020)  This article features scientific research on the cause of Type1 Diabetes and the imminent potential for a cure.

The Cure

Benaroya Research Institute is the global principal investigator in the T-1 study and has the largest bank of T-cells from which it has multiple active studies devoted to understanding the cause of diabetes and how to cure this terrible disease. Dr. Marika Bogdani leads a team of researchers studying the Hyaluronan deposits in islet cells and how that precedes insulin dependent diabetes. Her research findings were recently published in Springer Nature. (Marika Bogdani, 2020) Substantial deposits of cellular hyaluronan (HA) are characteristic of insulin dependent diabetes and her recent research investigated HA accumulation in islet cells prior to disease progress to diabetes. Her study used BioBreeding rats from 40 days of age until diabetes onset.  Pancreas tissue from 15 non-diabetic organ donors who were positive for the islet autoantibodies and 14 control donors, were analyzed for HA islet cell staining and the presence of insulitis. Here are her team’s findings:

·        1.   50% of the donors positive for islet autoantibodies showed large accumulations of HA, four times that of the control samples.

·        2.  Further, 21% of the islet cells contained the largest HA accumulations based on the HA-stained areas.

·        3.  Among those seven donor samples, 4 did not show islet immune-cell infiltrates, which means HA accumulated independently and in the absence of inflammatory cells in those which were positive for islet autoantibodies.

·         4. The accumulation of HA islets was evident up to 8 weeks prior to the onset of insulitis, which starts the pancreatic damage eventually resulting in the need for insulin. HA cells were largest in the donor rats at high risk of developing Type 1 diabetes.

·        5.  Insulitis was first detected in 9 to 10-week-old rats, where HA deposits were abundant in the islets and was associated with expansion of immune cell infiltrates, leading to an 85% loss of their beta cells.

The global T-1 study already has the ability to identify persons at risk of Type-1 Diabetes, an auto-immune disease which is prevalent in family groups. Bogdani’s research aims to identify those at risk and find a way to reprogram islet cell activity to prevent the HA mutations which result in pancreatic damage. The goal is to stop diabetes before it starts.

https://www.benaroyaresearch.org/our-research/diabetes-clinical-research/find-study

 Support for Those Living with Diabetes

I have been involved with the Lown Institute’s Right Care Alliance since 2005 and their current Affordable Insulin advocacy is an issue close to my heart. The group is hosting a nationwide Zoom program on Sunday, November 15, for those who care to participate, it is from 11:00AM to 1:00PM Pacific time. Here is a link to the program to register:

https://www.eventbrite.com/e/insulin-story-slam-tickets-124914732327

 Trouble Affording Insulin

Here are some organizations which may be able to help with insulin access.

Insulin for Life USA is a nonprofit that reclaims unused insulin and provides it to people globally.  There are 90,000 children throughout the world with Type 1 Diabetes.

https://iflusa.org/#:~:text=Insulin%20for%20Life%20USA%20is,to%20these%20life%20saving%20necessities.

Pharmaceutical makers of insulin do have patient assistance programs which can provide free insulin for a period of time, these include; Nova Nordisk, Sanofi Aventis, and Eli Lilly.

Any hospital emergency department in the US must provide insulin on an emergency basis, so if you have skipped doses and are in danger please go to an ER within 24 hours of missed doses. It doesn’t matter if you have insurance, they must provide treatment. Hospitals have medical assistance programs which provide substantial subsidies for patients who are income challenged.

If you are rationing insulin because you can’t afford your refill, call your clinic and explain your dire need and they should be able to provide a free sample.

If you use the traditional insulin which was originally derived from the pancreas of cows and pigs, but is now lab produced with E Coli bacteria, it is less expensive. The typical price in 2018 for Novolin, the needle and syringe insulin variety, was $24.88 for a vial. (Harrar, n.d.) The current list price for laboratory produced Humalog (U100-10ml) is $274.70 for 1,000 units. Perhaps Novolin won’t work as well but it will keep you alive. One hundred units of Novolin is $58 today if you buy it online. However, like everything else in healthcare, what you actually pay depends on your insurance plan.

Subsidized Medical Insurance

If you lack medical insurance, enroll in the Affordable Care Act, which has federal subsidies for the monthly premiums, based on your income, so this program could make your insulin more affordable. And there is no discrimination because of pre-existing conditions. Word to the wise, the Trump Administration and the Republicans have been trying to get rid of the Affordable Care Act, known as Obamacare and there is a Supreme Court case to be heard on November 10^th regarding the Commerce Clause and the validity of the act. If the Trump-packed court rules the law invalid, about 22 million people will lose their medical insurance. Further, the act mandated coverage for pre-existing conditions for all, which impact well over 100 million people, which were formerly denied access to health insurance.

This is the healthpolicymaven signing off encouraging you not to sign blanket releases when consenting to a medical procedure, do indicate that for which you consent and decline.

 Roberta Winter is an independent journalist and health policy analyst who accepts no money from anyone in the healthcare, insurance, pharmacy, or medical supply sectors. Her guidebook to the US healthcare system was published by Rowman and Littlefield in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 

Works Cited

Denis Daneman, M. B. (2001, May 24). Diabetes-Related Mortality-A Pediatrician's View. Diabetes Journals, 10(5), 801-802. doi:https://doi.org/10.2337/diacare.24.5.801

Harrar, S. (n.d.). Free Insulin: Strategies for Getting It When You Can't Afford Your Prescription. Retrieved 11 10, 2020, from Ontrack Diabetes.com: https://www.ontrackdiabetes.com/live-well/diabetes-management/free-insulin-strategies-getting-it-when-you-cant-afford-your-prescript

Marika Bogdani, C. S. (2020). Hyaluronan deposition in islets may preced and direct the location of islet immune-cell infiltrates. Springer Nature. doi:https://doi.org/10.1007/s00125-019-05066-7

National Center for Health Statistics. (2020, 11 9). Diabetes Facts. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/fastats/diabetes.htm

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States-An Urgent Call to Action. Mayo Clinic Proceedings. Mayo Foundation for Medical Education and Research.org. doi:DOI:https://doi.org/10.1016/j.mayocp.2019.11.013

US Census Bureau. (2010). US Census Brief-Population By Sex and Selected Age Groups-2010 Census. US Commerce Department-Census Bureau. Retrieved 11 9, 2020, from https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

 

 

Time to Take Action on Electoral Reforms

 

Now is the time to think about the distortion that dark money and huge corporations cause in the U.S. electoral system, which nullifies the will of the American people. Democracy can only survive if its people are informed and empowered with equal access to voting. Good health practices, clean air, and clean water are something we all desire, but the power of a few corporate oligarchs entrenched in outmoded industries seek and have been succeeding in ruining safeguards for us all under the Trump Administration.

Rolling back fuel efficiency standards for vehicles doesn’t provide new jobs, make the US more competitive, or provide any mitigation against cancer causing and planet warming gases. All of the other industrialized nations in the world have adopted higher fuel efficiency standards and will be capturing market share while the U.S. lags further behind, thanks to the current vacuum in leadership.[1] Failing to listen to Jimmy Carter in the 70’s the U.S. did not adopt more energy efficient building standards, unlike Europe, Scandinavia, and other nations. This too meant the nation fell behind in advancing greater efficiencies in energy usage. (Berkland, 2014) Due to the high price of oil and cheap Chinese solar batteries, the U.S. was finally catching up in the last decade, with rapid development of environmentally friendly energy production, such as wind and solar, but again the Trump Administration seeks to retard this process. The Koch brothers and others in the extraction industries are only interested in short term profits, but these companies could diversify into other sectors. Why not use their billions to improve how we access and deploy nature to create systems that will power our homes and businesses? Because we make it so easy for them to continue the same harmful practices, including burning natural gas which is occurring at oil wells because it is too inconvenient to contain and transport. The Trump Administration has also allowed the destruction of barrier islands on the coast, without creating mitigating artificial ones to at least allow bird estuaries a chance to survive. (Russell, 2020) We are already experiencing a massive extinction of many animal species, but no one in the Trump Administration seems to care, given the fact most of them will also be extinct based on life expectancies. Leaving an untenable planet for future generations doesn’t seem to bother them at all.  People that are working in the coal industry would welcome a chance to work in other sectors, including the creation of more efficient solar and batteries for electric vehicles. This anti-socialism rhetoric is false as the people of West Virginia and Kentucky would appreciate federal government investment in their communities.  Instead, they are assaulted with mere talk as their hospitals close, more people lose their jobs, and their health insurance.

Let’s create new jobs through green energy and by rebuilding our crumbling infrastructure, bring back the conservation corps that built so many of our beloved structures in national parks. Though Trump and the Republicans have controlled the Senate, for four years, they have shown no interest in rebuilding the nation. It is so much easier to offer tax breaks to huge corporations and the ultra-wealthy, who don’t need them.  Meanwhile, people like me pay higher business and personal taxes. And I don’t even mind paying my taxes, but I do mind the unfairness of our tax system, that makes the bottom 25% spend a far greater proportion of their income in taxes than the wealthy. (Picchi, 2019) And I am very concerned about the encroachment on our privacy and our liberty with the Trump Administration’s increasing militarization against its own people. This should unnerve even the most stalwart of Republicans.  When the government turns its weapons against law abiding civilians this is fascism. Yet some people still cheer because they believe they are in the right, except the unleashed militarization of our government could just as easily turn its power against them.

Denying science and criticizing those with excellent educations doesn’t make the U.S. more powerful, it makes us laughable internationally. By improving education access for all, including disenfranchised rural areas we can capture the electric brilliance of our people as we did in the 20th century. Children should not go hungry while fat cats enjoy tax breaks and the Trump Administration cuts school lunch programs. (Helen Bottemiller Evich and Juan Perez, 2020) Let’s create an incentive to go to school by offering free high-quality nutritious meals for our children and youth, because they are our future. By providing free meals for all students it would help eliminate discrimination against children from low-income households. America produces so much food that lots of it is given away, so why can’t we feed our children in public schools? Just because children don’t vote doesn’t mean we shouldn’t care.

Infants and toddlers should not be stripped from their parents, who only seek to work towards a better life. The woman who walked from Central America carrying her child 1,000 miles is exactly the kind of immigrant we need, someone with a dream, drive, and willing to put up with hardship. Yet the Trump Administration has rewritten immigration rules to make it harder for foreign students to study at our universities, for our companies to hire the best people for scientific research, and for families to reunite. Odiously the Department of Homeland Security has gone after immigrants who have lived and worked here for decades, paying taxes, with no criminal records, all because of their heritage. Trump seeks to remake this nation with the one-percenters from other countries who can buy their way in. Rich people aren’t better human beings, they may just be luckier or in many cases criminal. (McEvoy, 2020) Most of your healthcare providers are not rich, but would you seek to limit their immigration in areas of critical healthcare needs-because this is what the Trump Administration is doing.

Our nation cannot be successful if 60% of the population doesn’t embrace the administration. (Presidential Approval Ratings-Donald Trump, 2020) Bring more people to the table and we can really build something. We need to be able to tell our grandchildren and those who come after, that we did everything possible socially, emotionally, physically, and financially to assure their survival and November 3rd is the time to prove it. The survival of our democracy must be realized by liberty and opportunity for all-not just the privileged.

This is the healthpolicymaven signing off encouraging everyone to vote as our healthcare, clean air, potable water, and liberty depend on it.

Roberta Winter is an independent journalist and healthcare advocate and author of a guidebook to the US healthcare system, published by Rowman and Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

References

Berkland, S. (2014). A COMPARISON OF AMERICAN, CANADIAN, AND EUROPEAN HOME ENERGY-Performance in Heating Dominated-Moist Climates Based on Building Codes. Scholar Works. Retrieved October 21, 2020, from https://scholarworks.umass.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=2332&context=theses

Helen Bottemiller Evich and Juan Perez, J. (2020, July 21). It's Insane Millions of Kids Would Lose Access to Free Meals If This Program Expires. Politico.com. Retrieved October 21, 2020, from https://www.politico.com/news/2020/07/20/millions-of-kids-may-lose-out-on-free-meals-as-they-return-to-school-374587

McEvoy, J. (2020, August 8). Bannon Joins Long List of Trump Associates Who Have Been Charged or Imprisoned. Forbes.com. Retrieved October 21, 2020, from https://www.forbes.com/sites/jemimamcevoy/2020/08/20/bannon-joins-long-list-of-trump-associates-who-have-been-charged-or-imprisoned/#124dd8475ea4

Picchi, A. (2019, October 16). The US Tax System-New Engine of Inequality. CBS-Money Watch. Retrieved October 21, 2020, from https://www.cbsnews.com/news/u-s-tax-system-a-new-engine-of-inequality-economist-gabriel-zucman-says/

Presidential Approval Ratings-Donald Trump. (2020, October 15). Gallup Poll. Retrieved October 21, 2020, from https://news.gallup.com/poll/203198/presidential-approval-ratings-donald-trump.aspx

Russell, J. (2020, July 2). Conservation Group Sues Over Changes to Coastal Dredge Rules. Courthouse News Service. Retrieved October 21, 2020, from https://www.courthousenews.com/conservation-group-sues-over-changes-to-coastal-dredge-rules/

 

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[1] https://morningconsult.com/2019/07/31/united-states-risks-lagging-internationally-on-fuel-economy/

 

How the US Healthcare System Starves Rural Hospitals

Healthcare is the central concern in the 2020 elections in all fifty states and US territories. This article reveals more information on states with hospitals which are in danger of closing and one key finding is that most of these states (all voted Republican in 2016) chose not to expand Medicaid with the 2010 Affordable Care Act are worse off.  Of these states only Kentucky, Pennsylvania, and Arizona  have recently implemented the Medicaid expansion under the provisions of the Affordable Care Act. This provision allows low-income persons to obtain healthcare. The rest of these states are limiting federal funding for their rural hospitals even though they are required by federal law to provide care regardless of an individuals ability to pay. Here is a table which shows those states with the greatest number of hospitals likely to close: (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020)

40% likely to close	31-39% likely to close	26-30% likely to close	21-25% likely to close
Texas	Oklahoma	Wyoming	Nebraska
Mississippi	South Carolina	Kansas	Arizona
Missouri	Alabama	Kentucky	Pennsylvania
Florida		North Carolina
		Georgia

Of these states, only Kentucky has expanded Medicaid under the Affordable Care Act. The rest of the Methodology

The Charter Center for Rural Health used regression analysis, which is a type of statistical analysis using multiple variables to assess hospital viability and those criteria included: average age of patient, length of stay, case mix index, Medicare and Medicaid discharges, size of the facility, geographic area, and the age of the facility. In terms of financial measures, operating margins, revenue, occupancy, capital efficiency, and the state level of Medicaid expansion were also evaluated. 

Though a one percent increase in funding can reduce a hospitals chance of closure by three times that investment, this is not occurring. (The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability, 2020) One of the Charter Center’s regression models showed that states which adopted the Medicaid Expansion under the Affordable Care Act reduced the likelihood of hospital closure by 62% on average. Four hundred and fifty-three hospitals were identified as vulnerable to closure in the US.

When I researched other sources on vulnerability of US hospitals the results were similar and here are the findings from the 2020 Rural Hospital Sustainability Index by Guidehouse. (The Rural Hospital Sustainability Index, 2020)

State	Vulnerable Facilities	Proportion at risk of closure
Tennessee	19 of 28 hospitals	68% of rural hospitals are at risk
Alabama	18 of 30 hospitals	60% of rural hospitals are at risk
Oklahoma	28 of 47 hospitals	50% of rural hospitals are at risk
Arkansas	18 of 34 hospitals	53% of rural hospitals are at risk
Mississippi	25 of 50 hospitals	50% of rural hospitals are at risk
West Virginia	9 of 18 hospitals	50% of rural hospitals are at risk
South Carolina	4 of 9 hospitals	44% of rural hospitals are at risk
Georgia	14 of 34 hospitals	41% of rural hospitals are at risk
Kentucky	18 of 45 hospitals	40% of rural hospitals are at risk
Louisiana	11 of 30 hospitals	37% of rural hospitals are at risk

Larger hospital corporations are driving smaller stand-alone facilities into oblivion. Further, the US healthcare system treats the health of the nation like another product and the healthcare system like a capital enterprise, which as it turns out, doesn’t deliver the most efficacious healthcare. This means we are paying more for treatments that don’t deliver a commensurate improvement in patient health. As a society we should care about this as we would not accept a lesser quality product or outcome from any other consumer good and healthcare certainly is that.

Further, the Medicaid enrollment in rural areas is higher, so states which refuse to help their residents obtain healthcare by expansion of Medicaid under the Affordable Care Act are denying people access to care. Yet, rural people elected the current president who has vowed to gut the Affordable Care Act, an existing program for individuals to obtain medical care and to keep their hospitals afloat through improved cash flows. (Estes, 2020)

The pandemic grants from the federal government are now coming due and I think we can make a good case that rural hospitals should not have to repay the grants, as they are teetering on insolvency. Perhaps this is one issue in which Republicans and Democrats can agree, however, Senate Majority leader, McConnell has scoffed at providing further to assistance municipalities, hospitals, and individuals. The people of this diverse and hardworking nation deserve better.

And this is the healthpolicymaven signing off encouraging you not to sign blanket medical releases when you have medical procedures, do consent for which you agree and that which you decline. This article was written by Roberta E. Winter an independent healthcare analyst and journalist.

References

Estes, C. (2020, October 13). 1 of 4 Rural Hospitals Are At Risk of Closure And The Problem Is Getting Worse. Retrieved from Forbes.com: https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/#72aa1c861bc0

The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability. (2020, February 1). Retrieved from Chartis Center for Rural Health: https://www.ivantageindex.com/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf

The Rural Hospital Sustainability Index. (2020, October 13). Retrieved from Guidehouse.com: https://guidehouse.com/-/media/www/site/insights/healthcare/2020/ruralhospitalsustainabilityindex0420_rev01.pdf

Unintended Consequences of Pandemic Hospital Bailouts May Hasten Their Demise

This article was originally posted June 9, 2020 but was accidentally deleted and this is a repost as the article has been cited and comments are posted in various media.

We can thank the Covid pandemic for revealing the fissures in America’s healthcare system, especially how large hospital corporations continue to be focused on earnings over community healthcare. This article examines how the federal pandemic money (CARES Act) for hospitals exacerbated the problem, through distribution to the wealthiest hospital systems and not the struggling rural ones. A similar phenomenon was observed for the farm bailouts when giant agricultural corporations ended up with the money and not the small farmers. The continual winnowing of our nation’s food suppliers and healthcare resources weakens national health. Doling out money without restrictions and lacking a needs-profile for the hospitals resulted in the federal government giving billions based on how much money the hospitals already billed for services. This is like providing a sewage treatment plant to a city that already has one and leaving the neighboring community to treat its own effluent. Further, no other country spends wildly in healthcare, with fewer community health benefits. All funding for healthcare, which is largely paid for by the government through tax subsidies and government financed programs, as well as steep individual contributions in the private sector should be needs-based. We can’t expect the Trump Administration to understand these criteria since it has given billions to the wealthiest while stripping school lunch money from children. This article analyzes the fraying network of urban trauma centers and rural hospitals, with suggestions to abate the hemorrhaging.

Hospitals at Risk

Becker’s Hospital Report found that 20% of US hospitals are at risk of closure as of April 20, 2020. (Ellison, State By State Breakdown of 354 Hospitals At Risk of Closing, 2020) In real terms that means 354 hospitals are potentially unsustainable and 81% of those are considered critical to the community. In my home state, Washington, 18% of rural hospitals are in danger of failure and this isn’t as dire as many states where 50% of theirs could fail. Hospitals provide jobs, help economic development, and offer critical healthcare. Here is a list of the states where the greatest percentage of their hospitals are threatened with closure due to inadequate cash on hand:

1.       Tennessee-68%

2.       Alabama-60%

3.       Oklahoma-60%

4.       Arkansas-53%

5.       Mississippi-50%

6.       West Virginia-50%

7.       South Carolina-44%

8.       Georgia-41%

9.       Kentucky-40%

10.   Louisianna-37%

Hospitals at risk of failure in Washington State (Ellison, 2020)

Columbia County Health System in Dayton is a farming community which serves a county-wide population of 4,058. The nearest hospital is in Walla Walla which is a half-hour drive by car.

Mid-Valley Hospital in Omak (4,806) is a mountainous community in the Okanogan and serves a countywide population of 41,000

Three Rivers Hospital in Brewster is also in the Okanogan region and is in a town of 2,364 people. Seems like Mid-Valley and this one should combine forces.

Grays Harbor Community Hospital in Aberdeen is a fishing and logging community which serves a countywide population of 75,000. The next nearest hospitals would be Olympia or Shelton, both about and hours drive.

Whidbey Health Medical Center in Coupeville, the Whidbey Island County Seat has a population of 1,959 people. Since there is another hospital on the island in Oak Harbor, this wouldn’t be as critical if it succumbs.

To See How Your State Hospitals Fair

Here is the link to the statewide list: https://www.beckershospitalreview.com/finance/state-by-state-breakdown-of-354-rural-hospitals-at-high-risk-of-closing

Covid-19 Hospital Bail-out Impact

In this latest government give-a-way most of the money went to the elite health care organizations, including local, Providence Healthcare, which is technically a nonprofit by statute, but makes so much money it has its own venture capital fund (12 billion in cash reserves), generating a billion dollars annually. (Jesse Drucker, 2020) And not to be outdone, lush Cleveland and Mayo Clinics also received millions. My former employer, Ascension Health, which is a Catholic hospital chain, makes so much money it has its own venture capital fund (15.5 billion in cash reserves) and it too received federal bail-out money. This table shows cash reserves and CARES fund distribution: (Liss, 2020)

Hospital Group	Cash in Reserves	Government Bailout
Ascension Health	15,500,000,000	211,000,000
Cleveland Clinic	7,000,000,000	199,000,000
Mayo Clinic	10,600,000,000	150,000,000
Providence Health	12,000,000,000	509,000,000
HCA (for profit)	51,300,000,000	1,000,000,000
Tenet (for profit)	731,000,000	517,000,000

This government largess was despite the fact all of these mega corporations have plenty of cash in reserves, so the government funding was to ensure their profits. Worse yet, the money they were given starves small rural hospitals which may be forced to close. I can’t think of a better example of the American “winner-take-all philosophy, but is this really how we should be running our critical healthcare system? It is impossible to research this and not feel the US government is cannibalizing its own health system.  This demonstrates another systemic failure in US healthcare, which puts profits ahead of patient health. I knew it was time to leave healthcare when the hospitals preferred hiring people without a healthcare background, the easier it is to put patients out of the equation if you think of them as widgets.

This article was written by Roberta Winter, an independent journalist and health policy analyst, who has published under the healthpolicymaven trademark since 2007. Please feel free to share this article virally.

References

Ellison, A. (2020, March 6). Five Hospitals Face Imminent Closure As Covid-19 Wreaks Havoc. Beckers Hospital Review. Retrieved June 8, 2020, from https://www.beckershospitalreview.com/finance/5-washington-hospitals-face-imminent-closure-as-covid-19-wreaks-havoc.html

Ellison, A. (2020, April 9). State By State Breakdown of 354 Hospitals At Risk of Closing. Becker Hospital Report. Retrieved June 8, 2020, from https://www.beckershospitalreview.com/finance/state-by-state-breakdown-of-354-rural-hospitals-at-high-risk-of-closing.html

Jesse Drucker, J. S.-G. (2020, May 25). Wealthiest Hospitals Get Billions in Bailbouts for Struggling Providers. The New York Times. Retrieved June 8, 2020, from https://www.nytimes.com/2020/05/25/business/coronavirus-hospitals-bailout.html

Liss, S. (2020, May 26). Here's How Much For Profit Hospitals Have Received In Bailout Money So Far. Healthcare Dive.com. Retrieved June 8, 2020, from https://www.healthcaredive.com/news/heres-how-much-for-profit-hospitals-have-received-in-covid-19-bailout-fund/578378/

 

Nationwide Data on Hospital Price and Comparability-Are You Getting Ripped Off By Your Hospital?

 

Hospital Price and Comparability-What Private Employers Pay VS Medicare

One of the crucial elements for making informed decisions on any product is understanding price and comparability for services and this is also true for healthcare. The recent Rand Report (Christopher M. Whaley, 2020) illuminated huge pricing disparities for hospitals across the country by evaluating what private employers pay versus government reimbursements. The State of Maryland has state-controlled hospital prices (and some of the lowest hospital costs in the nation) and is therefore not included in the survey. I previously published an article on how Maryland’s state hospital pricing works. (Winter R. , 2014) The Rand Report analyzed 3000 hospitals in 49 states to assess relative value for similar services paid by private employer plans versus Medicare, which is the largest government funded plan in the US. Quality rankings were based on findings from the Centers for Medicare and Medicaid Hospital-Compare data, Leapfrog Hospital Survey, and HRIS patient mix data then scaled on a 1-5, with 1 being the lowest ranking.

Using data from 2016 to 2018 for private employers, the Centers for Medicare and Medicaid (CMS), and state agency data on hospital claims, here are the key findings from the report: (Christopher M. Whaley, 2020)

ü     Rand found little relationship between hospital quality rankings and price disparity. In other words, hospitals that charge less can also deliver high quality results and these are referred to as high value hospitals. Conversely hospitals that charge more don’t necessarily have better quality.

ü      There is a huge variance in hospital prices by state, with Arkansas, Michigan, and Rhode Island boasting relative value prices within 200% of Medicare reimbursement levels. Meanwhile, Florida, West Virginia, and South Carolina had relative value prices nearly 350% of Medicare reimbursement levels. So private employer plans in the latter could be paying 150% more for the same services compared to those in AK, MI, or RI.

Using the recently published Rand Report of hospital pricing for private payments versus government funded CMS payments, I extracted the zip file and analyzed data for the combined cost for inpatient and outpatient services by state, health system, and individual hospital. Here are the results for the most expensive and least expensive hospitals both in Washington and nationwide.

Washington

These tables show the relationship between the combined price for inpatient and outpatient services charged to private insurers (and self-insured plans), versus what the Centers for Medicare and Medicaid paid. Yakima Valley Memorial Hospital is one of the best deals in the state with a combined price for inpatient and outpatient services of 170% for private insurance compared to what Medicare/Medicare (CMS) pays.

Least Expensive Hospitals

Facility Name	Location	Quality Ranking 5 is highest	Health System	Combined Price vs CMS
Yakima Valley Memorial Hospital	Yakima	4	Virginia Mason Health System	170% of CMS
Swedish Hospital Issaquah	Issaquah	4	Providence St. Joseph	176% of CMS
Evergreen Hospital	Kirkland	5	Peace Health	189% of CMS
UW Medicine-Northwest Hospital	Seattle	4	UW Medicine	207% of CMS
Overlake Hospital	Bellevue	4	Peace Health	215% of CMS

Most Expensive Hospitals

The most expensive hospital in the state is Tacoma General Hospital-Allenmore, part of the Multicare  System charging 330% of the CMS rate of reimbursement for privately insured plans. Though Harborview Medical Center scored a 312% combined price vs CMS, since it is a critical access hospital and trauma center for multiple states and therefor has more intensive patient needs, I have removed it from the list.

Facility Name	Location	Quality Ranking 5 is highest	Health System	Combined Price vs CMS Reimbursement
Tacoma General-Allenmore	Tacoma	2	Multicare	334% of CMS
Good Samaritan Puyallup	Puyallup	2	Multicare	330% of CMS
Swedish Providence	Seattle	5	Providence St. Joseph	307% of CMS
Harrison Medical Center	Bremerton	3	Catholic Health Initiatives	304% of CMS
St. Joseph Medical Center-Bellingham	Bellingham	4	Peace Health	303% of CMS

 Nationwide Data

10 Best Value Hospitals Rand Report 2020

Here are the 10 least expensive hospitals in the country, based on the relationship of what they charge private employers and what they are paid by CMS for similar services. Kudos to Maine for boasting multiple hospitals on this list of low price and high-quality rankings. This trend was also proven true when I ranked nationwide hospitals in 2011 and found only 1 hospital in the country had a perfect safety score, Penobscot Bay Medical Center in Maine. (Winter R. E., 2012) Of these highly affordable hospitals 90% are nonprofits and 40% are independent community based hospitals.

Facility Name	City	Quality Ranking 5 is highest	Health System	Combined Price vs CMS
Texas Women’s Hospital	Houston, TX	3	HCA Healthcare	48% of CMS
Redington Fairview Hospital	Skowhegan, ME	4	Independent	61% of CMS
Good Samaritan Hospital	Bakersfield, CA	2	Independent	62% of CMS
Women’s Hospital	Baton Rouge, LA	3	Independent	67% of CMS
Sebasticook Valley Hospital	Pittsfield, ME	4	Eastern Maine Healthcare Systems	71% of CMS
Deaconess Women’s Hospital	Newburgh, IN	5	Deaconess Health Systems	75% of CMS
Patients Hospital of Redding	Redding, CA	NA	Adventist Health	80% of CMS
Blue Hill Memorial Hospital	Blue Hill, ME	4	Eastern Maine Health Systems	82% of CMS
Physicians Medical Center	New Albany, IN	5	Independent	83% of CMS
Mount Desert Island Hospital	Bar Harbor, ME	4	Eastern Maine Healthcare Systems	89% of CMS

 10 Worst Value Hospitals Rand Report 2020

Of the most expensive hospitals with the greatest disparity in price charged to private employers versus the CMS reimbursement 70% were for profit companies, with 50% of those run by the behemoth HCA Health. HCA is the company that received the largest fine for healthcare fraud (at the time) for up-charging CMS and bilking government tax payers for billions. (Justice Department-US Government, 2003) Rick Scott, former Governor of Florida and now Senator of Florida was running HCA at that time. (Schultz, 2018) 

Most interesting is Face Book founder and guy-still-trying-to-make-friends, Mark Zuckerberg’s hospital in San Francisco, had the worst quality ranking in the Rand 2020 survey and still managed to charge private employers nearly six times the CMS reimbursement for the same services. These hospital price disparities place a great strain on employers in California, especially with the pressures of the Covid-19 pandemic. It is no wonder that California is exploring establishing its own state-run healthcare plan.

Facility Name	City	Quality Ranking  5 is highest	Health System	Combined Price vs CMS
North Bay Regional Hospital	Fairfield, CA	2	North Bay Healthcare Group	815% of CMS
Fort Walton Beach Medical Center	Fort Walton Beach, FL	2	HCA Healthcare	575% of CMS
Memorial Hospital Modesto	Modesto, CA	2	Sutter Health	572% of CMS
Zuckerberg Memorial Hospital	San Francisco, CA	1	San Francisco Health Network	565% of CMS
Westside Regional Medical Center	Plantation, FL	1	HCA Healthcare	514% of CMS
Colorado Plains Medical Center	Fort Morgan, CO	2	LifePoint Health	508% of CMS
Parkridge Medical Center	Chattanooga, TN	2	HCA Healthcare	505% of CMS
Springs Memorial Hospital	Lancaster, SC	2	Community Health Systems	499% of CMS
Summit Medical Center	Hermitage, TN	2	HCA Healthcare	493% of CMS
Alaska Regional Hospital	Anchorage, AK	5	HCA Healthcare	493% of CMS

 Conclusion

It is obvious that small independent hospitals frequently offer better value with good hospital quality rankings, which reflects on hospital leadership and the fact they are focused exclusively on delivering healthcare to their communities as opposed to creating giant venture capital funds. I personally suggest we have someone from Maine lead US healthcare reform for they have surely figured that out in their home state.

And this is the healthpolicymaven signing off encouraging you not to sign blanket waivers when submitting to healthcare procedures, do indicate that for which you agree and also what you choose to decline.  Healthpolicymaven is a trademark of Roberta E. Winter, in continuous use since 2007. All opinions expressed in this column are independent journalism without industry sponsorship from the healthcare sector.

 References

Christopher M. Whaley, B. B. (2020). Nationwide Evaluation of Health Care Prices Paid by Private Health Plans-Findings From Round 3 of Employer-led Transparency Initiative. Rand Corporation, Santa Monica. doi: https://doi.org/10.7249/RR4394

Justice Department-US Government. (2003, June 26). Largest Healthcare Fraud Case In US History Settled-HCA Investigation Nets 1.7 Billion. US Government Department of Justice. Retrieved September 18, 2020, from ustice.gov/archive/opa/pr/2003/June/03_civ_386.htm#:~:text=(formerly%20known%20as%20Columbia%2FHCA,the%20Justice%20Department%20announced%20today.

Schultz, R. (2018, October 2). Gov. Rick Scott Took Responsibility-No He Took 300 Million. Retrieved September 18, 2020, from https://www.sun-sentinel.com/opinion/fl-op-col-rick-scott-medicare-fraud-20181002-story.html

Winter, R. (2014, May 20). State Laws Which Inform the Consumer of Price and Quality. Retrieved September 18, 2020, from https://healthpolicymaven.blogspot.com/2014/05/state-laws-which-inform-consumer-of.html

Winter, R. E. (2012). Unraveling US Healthcare-A Personal Guide. Rowman & Littlefield. Retrieved from https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972