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How America’s Hospitals Survived The First Wave Of The Pandemic

Reprinted with permission from ProPublica.

The prediction from New York Gov. Andrew Cuomo was grim.

In late March, as the number of COVID-19 cases was growing exponentially in the state, Cuomo said New York hospitals might need twice as many beds as they normally have. Otherwise there could be no space to treat patients seriously ill with the new coronavirus.

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Too Many People Still Go To The ER

On a recent Saturday morning, I drove a good friend from her health club to an emergency room at a nearby hospital. Her symptoms — not remembering what she had just done and repeating herself — spoke of a potentially serious condition. The emergency medical technicians called to the club said we had to have them checked out right away.

But “right away” turned out to be several hours later. The emergency room was jammed. The triage nurse at the front desk sorted us out according to urgency of case. My friend fell somewhere in the middle.

Why was the ER jammed on a sunny weekend morning? For starters, they are open when most doctors’ offices are not and they take all comers.

But they are also an exceedingly expensive place to deliver health care. The health care reforms were to tie the previously uninsured with doctors. That way, they would not go to ERs with minor ailments.

But many emergency departments (hospitals prefer the word “department” to “room”) are busy as ever. Something must be done about that.

Let’s first dispel one myth. Most who go to the ER do require prompt medical attention. Over half need to be seen within an hour, according to the Centers for Disease Control and Prevention.

But do they need a fully staffed hospital emergency department? A man who passes out may just require a safe place to sober up. Others clearly belong in a mental health facility. (One woman in our waiting room was hollering about discomforts large and small.)

And numerous ailments or injuries could be treated at a walk-in clinic or by a nurse in a drugstore health center. Many people go to the ER because it’s open after hours. Example: the working mother whose child has a bad sore throat.

Here are a couple of solutions, successfully tried in various communities:

Reno, Nevada, is using specially trained paramedics to assess the patients who call 911. In some cases, they treat them on the spot. If the patients need the ER, they take them there. Or they may determine that an urgent care center or mental health clinic could provide adequate care.

They also do follow-up visits to keep an eye on certain patients, especially repeat 911 dialers. For instance, a man with heart disease kept calling because he never knew whether a flutter feeling was serious or not.

Washington state is trying to discourage frequent visitors to the emergency room by enrolling them in primary care services. It’s even scheduling appointments for them and making sure the patients show up.

A number of states have tried more punitive approaches, such as charging copays to Medicaid patients who use the ER for non-emergencies. This doesn’t seem to have helped, because low- or no-income patients tend not to pay. Collecting from them costs more money than the copays generate.

And what about my friend? It seems she had experienced something called transient global amnesia, a temporary and not worrisome condition known to affect strenuous exercisers. To rule out something more serious, the ER checked her blood pressure, pulse, heart rhythm and blood sugar. This could have been done in any number of non-hospital settings.

Had we gone to an alternative, she probably would have received prompter attention and would have been told — as the ER doctor advised — to call her doctor on Monday. The cost of this treatment would have been a fraction of what it was.

Health reforms aside, unnecessary use of emergency departments continues to waste medical resources. Some communities are grappling with the problem. Successes deserve to be copied.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators Web page at www.creators.com. 

Photo: Taber Andrew Bain via Flickr

Supreme Court Case May Devastate Hospitals In 34 HealthCare.gov States

By Tony Pugh, McClatchy Washington Bureau (TNS)

WASHINGTON — As the nation’s largest private health care provider, Hospital Corporation of America owns 155 hospitals, 112 surgery centers and three psychiatric facilities across the country.

Their 37,000 affiliated staff physicians and 75,000 nurses handled 7.5 million emergency room visits, 1.8 million inpatient admissions and 1.4 million surgeries last year.

Nearly 90 percent of the corporation’s facilities are in states that use the federal health insurance marketplace at HealthCare.gov.

That puts the Nashville, Tenn.-based health care giant at the center of a potential financial catastrophe known as King v. Burwell.

The Supreme Court case will decide whether consumers in the 34 states that use the federal marketplace can continue to receive tax credits to help pay for their coverage. Plaintiffs argue that the subsidies can go only to people in the 16 states, plus Washington, D.C., that operate their own health insurance marketplaces.

If the plaintiffs prevail, an estimated 5.6 million people will lose their tax credits next year in the 15 HealthCare.gov states where Hospital Corporation of America has facilities, according to the Urban Institute, a centrist research center.

Nearly 4.9 million of these people would ultimately become uninsured, the institute predicts. Without coverage, most of these low- to moderate-income people would struggle to pay their medical bills and become prime candidates for hospital charity and uncompensated care.

That money-losing scenario after a plaintiff victory has sent a chill through HCA’s corporate coffers and the hospital industry as a whole.

“It’s kind of a perfect storm of all things bad,” said Jimmy Lewis, CEO of HomeTown Health LLC, a trade association of roughly 50 rural hospitals in Georgia and Florida. “Anything that increases the uninsured puts rural hospital providers at an even greater risk for distress or closure.”

Under the Affordable Care Act, Congress has cut hospital reimbursements for uncompensated care by $36.1 billion over 10 years. Lawmakers also cut hospitals’ Medicare payments and inflation adjustment rates by an estimated $233 billion.

Hospitals were expected to recoup the money through an influx of newly insured patients, courtesy of the marketplace tax credits, expanded Medicaid eligibility and the requirement that most Americans have health insurance.

But 13 of the 15 HealthCare.gov states with HCA facilities haven’t expanded their Medicaid programs. This limits the number of insured patients treated at HCA hospitals and hurts the company’s ability to offset the funding cuts.

In fact, only 11 of the 34 states that use the federal marketplace have expanded coverage under Medicaid. That lost revenue stream would deepen the financial hole for hospitals in non-expansion states if tax credits are eliminated in the Burwell case.

“An ACA without subsidies would leave hospitals unable to make up the loss in their funding,” a group of hospital organizations wrote in their friend-of-the-court brief in the Burwell case. “That could imperil some hospitals, and will make it more difficult for others to carry out their missions, including effectively serving their communities.”

In its own court brief, HCA said patients with coverage through HealthCare.gov paid an average of $390 in out-of-pocket expenses when they visited an HCA facility, while 90 percent of its uninsured patients paid nothing.

HCA’s uninsured patients are also half as likely to seek cost-effective outpatient care and three times more likely to get expensive emergency room treatment than its patients with federal marketplace coverage.

Because they pay more, use the emergency room less and utilize cheaper outpatient services more frequently, patients with coverage through HealthCare.gov have helped HCA weather $600 million in federal funding cuts under the Affordable Care Act.

Last year, the company generated roughly $250 million from previously uninsured patients who obtained coverage through HealthCare.gov. That revenue is just beginning to offset the federal funding cuts that HCA has absorbed under the health care law.

“This was exactly what Congress intended when it sought to have every stakeholder in the health care system share the costs and benefits of achieving universal coverage,” HCA wrote in its brief.

HCA officials declined to discuss the Burwell case, but its corporate concerns and experiences are shared by scores of other hospitals in the 34 states where the tax credits could be eliminated.

Last year, Bothwell Regional Health Center in Sedalia, Mo., treated 589 patients who had federal marketplace insurance.

Forty-four percent — or 260 of them — were previously uninsured, a population that had paid an average of 3 cents for every dollar of care they received, said Jimmy Robertson, Bothwell’s chief financial officer.

After getting coverage through HealthCare.gov, these 260 patients generated $935,000 in additional revenue, which shaved 5.5 percent off the hospital’s $17 million uncompensated-care costs.

“That’s a huge impact,” Robertson said. “We were, quite frankly, a little amazed at what we saw, but pleasantly surprised.”

And like the HCA’s patients with marketplace insurance, Bothwell’s newly insured began to use other hospital services, relying less on emergency room care.

“A lot of the hype that we heard before the exchange opened is actually coming true,” Robertson said.

If the Burwell plaintiffs prevail and the tax credits are eliminated, Robertson said, he expects all 589 of the hospital’s marketplace plan members to drop their coverage.

Texas hospitals spend $5.5 billion each year to treat the estimated 25 percent of state residents without health insurance, said Ted Shaw, CEO of the Texas Hospital Association. Killing the tax credits would drive Texas’ uninsured rate — already the nation’s highest — even higher.

“If we add another million people to that uninsured population, you’re going to see the costs to hospitals of Texas skyrocket at least another $1 billion to ($1.5) billion dollars,” Shaw said at a recent news briefing.

In Florida, hospitals that treat high numbers of the uninsured are already facing a $1.8 billion funding loss due to the pending expiration of a state-federal program that provides medical care for low-income residents. A plaintiff victory in Burwell is projected to add more than 1 million people to Florida’s uninsured ranks next year, according to the Urban Institute.

That would “only add to the uncertainty” of hospitals that care for Medicaid and uninsured patients, said Ron Bartlett, spokesman for the Safety Net Hospital Alliance of Florida, an advocacy group for 23 hospitals that provide 41 percent of Florida’s charity care.

Lewis, of HomeTown Health, said economically distressed consumers hadn’t been following the Burwell case closely.

“I believe that they’re so consumed with the trials of living day to day that they haven’t even thought about this,” Lewis said. “There may be a large part of the population that doesn’t really get this or understand this until the day it happens. The day their insurance goes away.”

AFP Photo/Karen Bleier

Are You A Registered Organ Donor?

Are you an organ donor?  Nobody wants to think about the circumstances under which that would become an option, but upsetting as it is, it’s something that all of us should consider.

The United States has a serious shortage of organ donors. According to an article in The Atlantic, 21 people die each day in the United States for want of a donated organ, and in New York alone there are over 10,000 people on the transplant waiting list.

Organ donor registration varies by state, but the Organ Procurement and Transplantation Network tells us that 45 percent of American adults were registered as of 2012.

The big question is, why are relatively few people registered?

“It’s a touchy question, something non-donors aren’t necessarily keen to answer,” write The Atlantic’s Tiffanie Wen. “But experts say there is a large disparity between the number of people who say that they support organ donation in theory and the number of people who actually register.”

What accounts for the disparity? In a nutshell, it comes down to a question of trust.

A study by the University of Geneva (Switzerland) “cites mistrust in the medical field and lack of understanding about brain death as major barriers to donation.”  The study showed that many people would not donate the organs of a loved one even if he or she were declared brain dead.

Mistrust of the medical profession is also a factor. If you’ve ever stood watch at the bedside of a dying relativet, for example, you may think the hospital staff is not quite as attentive as they should or could be, and that would make it less likely that you would consent.  And there are plenty of people out there who believe that if your doctor or a hospital knows you’re an organ donor, they’ll be less likely to do everything they can to save your life.

Those are huge hurdles to overcome.

Photo: Wikipedia