CCM Health, a medical center based in Montevideo, Minn., shares continual COVID-19 updates from management and caregivers; daily emails to all employees about census, staffing, access and other stats; bi-weekly organizational updates from the CEO; and marketing communications that include facility updates as well as monthly department meeting recordings. tests
“We feel the key is through extensive and continuous communication,” said Kelly Johnson, CCM’s human resources manager.
Even though CereCore, which supports providers’ IT needs, initially saw its business decline, it kept more staff on than needed to help people transition to the new working environment, said Curtis Watkins, CereCore’s CEO.
They doubled down on personal check-ins, but managers had to strike a balance between checking in periodically and not overwhelming employees, he said.
“From an HR perspective, we try to treat people with grace and understanding,” Watkins said. “We were careful not to overdo it because people don’t want to feel like they always have somebody over their shoulder. So we made it personal, asking about their family or kids and had to be clear that this is about staying connected, not micromanaging.”
Ultimately, COVID-19 accelerated the Nashville-based company’s move to more remote work. Watkins expects about an 80%-to-20% ratio of remote to in-person work over the long term, up from around 60% to 40%. It will likely downsize its real estate footprint by about a third, Watkins said.
“It has been an interesting journey, and it is something we will try to figure out and get better at,” he said, adding that the biggest long-term challenge is around the void of face-to-face interaction between its senior level administrative team. “We need to find ways to build that teamwork and trust.”
Advocate Aurora launched its first ever virtual professional development initiative. To Brady’s surprise, about 40% of its leadership team tuned in to some of the 30 sessions.
“It is part of how this whole process drove more innovation,” he said.
Source: COVID-19 tests remote work capacity
Source image: Pixabay by Hilary Clark.
Care teams are asking for a safer work environment. But what does “safe” actually mean? frontline
Fall is here, and as many had feared and predicted, COVID-19 cases are on the rise again in many parts of the U.S. Just last week, 3,400 nurses at Brigham and Women’s Hospital in Boston, an area that’s been hit hard by the pandemic, urged executives to give them a safer environment with universal N95 masking, shuttle safety, communication about infections and effective quarantines.
The message was simple: To adequately care for coronavirus patients, care teams need to be able to care for themselves. That’s a tall order, given that nurses and caregivers on the front lines are more at risk of infection than the socially distanced populace. But the concern over healthcare worker safety is well-founded, and administrative teams need to ensure that equipment and processes are in place that can reduce the risk of transmission.
Enter “The Person Behind the Mask,” a campaign launched by patient safety company RLDatix. It was created to increase awareness about the importance of keeping frontline workers safe, and a key component of that effort is ensuring that caregivers remain physically and emotionally healthy in order to deliver better and safer care.
“When harm events happen in hospitals, it’s devastating for patients and families, but also for the care team,” said Dr. Tim McDonald, RLDatix’s chief patient safety and risk officer. “They feel terrible when harm events happen. Traditionally the response had been the wall of silence — don’t talk to patients and families openly, and often don’t talk to each other. It was a sign of weakness to ask for help. We needed to shatter the wall of silence.”
It’s a pressing mission for a number of reasons, not least of which is morale. Physician and nurse suicide has spiked in the past decade. McDonald works with the suicide prevention team at University of California San Diego and was distressed to learn that an emergency department physician recently committed suicide due to pandemic-related stress.
Even taking suicide out of the equation, there’s been a massive increase in burnout. Doctors and nurses are leaving the profession because of the impact, and that extends beyond their own lives to those of their families. Divorce rates are high among care teams, and also among patients and families who have lost loved ones to the coronavirus — implying some pretty troublesome collateral damage.
Yet with care teams asking for a safer work environment, it’s constructive to ask: What does “safer” mean, exactly?
A BETTER ENVIRONMENT
Broadly speaking, better safety encompasses both the physical and the psychological. Hospitals and health systems have tended to fare better on the physical side, which entails procuring the requisite personal protective equipment and getting it to the right people at the right time. Sanitation protocols also make an environment feel more physically safe.
Psychological safety, said McDonald, can be fostered when health leaders are transparent and report when things aren’t going the way they should be. Event reporting systems can capture unexpected events so teams can learn from them in the future, which created a psychologically safe environment for people to report and act upon the data, thereby buttressing the overall work environment.
“I’m encountering devastating things I’ve never seen before,” said McDonald. “Organizations can put in place ‘caring for the caregiver’ programs to provide support on a proactive basis. It’s analogous to what aviation does. Whenever there’s a mishap in aviation, there’s immediate outreach to the people involved in that. We need to be doing more of that in healthcare.”
Data is a big component of that approach, as it allows leaders to educate care teams about things like infection management and patient safety. Many electronic health records systems are able to analyze infection surveillance data, for example, to see whether there are pockets of infections the organization should know about, allowing the provider to take action.
It can also pick up on medication errors, which are the most common errors that occur in healthcare. EHRs and other software can analyze and collate events to look for patterns, allowing teams to take preventive action. An example of this is preventing central line and catheter infections, which are linked to ventilator-associated pneumonias.
“It changes the way we deliver care,” said McDonald. “We need to do more to identify safety scientists to help design cate that prevents events in a more rapid way.”
Executives have a challenge, but also an opportunity, to improve safety in a manner that lasts well beyond the end of the pandemic. One way is to examine the ways care has changed during the public health crisis and implement those changes permanently across all areas of care.
Change in process, said McDonald, is one of the great lessons learned during the pandemic and one of the things health leaders can begin working on immediately.
“Empathy and compassion go along with candor,” he said. “It mitigates implicit bias. One of the things we’re seeing is these issues around implicit bias and racism. We know empathy and compassion can mitigate it. That means we need to use the data that identifies things around race, ethnicity, pronoun preference, issues around LGBTQ. That’s one of the things that has reared its ugly head during this pandemic.”
McDonald sees more and more providers adopting these kinds of approaches, and in fact, it’s a mindset that’s increasingly taught at the student level, meaning those just entering the healthcare workforce will have expectations of having their health and mental well-being protected and respected. It’s a mindset that in some ways defines the future of healthcare — and the future is now.
“We’re starting to get traction,” said McDonald. “We can’t afford not to do this.”
Source: Keeping frontline healthcare workers physically and psychologically safe is paramount during the COVID-19 pandemic
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The Cleveland Clinic came under fire Friday after President Donald Trump announced that he and Melania Trump tested positive for COVID-19, days after participating in a presidential debate held on the clinic’s campus.
Numerous media reports and photos showed the Trump family not wearing masks while in attendance at the debate, which was held Sept, 29 at the Sheila and Eric Samson Pavilion at the Health Education Campus at Case Western Reserve University and the Cleveland Clinic. The president and first lady went into quarantine Oct. 1, after one of the president’s closest advisors, Hope Hicks, tested positive for COVID-19.
Ohio Gov. Mike DeWine on July 23 implemented a statewide mask mandate requiring individuals to wear masks in public if indoors and not at a residence, unless a medical condition prohibits it. Likewise, the clinic requires all caregivers, patients and visitors to its campus wear masks unless a health or behavioral issue prevents it.
Cleveland Clinic in July was chosen as a site for the first presidential debate after the University of Notre Dame withdrew over COVID-19 concerns. The clinic serves as the health security advisor for the Commission on Presidential Debates’ fall debates. Health and safety plans developed for the first debate will guide future debates, the clinic said.
During the first debate, Cleveland Clinic and Case Western Reserve University said they took many precautions, including distancing between seats, personal health screening and safety measures and disinfectant measures. Reporters at the debate said a clinic doctor tried to get the Trump family to wear masks but was rejected.
In a statement released Friday, the Cleveland Clinic said it had safety requirements in place for social distancing, hand sanitizing, temperature checks and masking and that everyone allowed inside the debate hall had a negative COVID-19 test.
“Based on what we know about the virus and the safety measures we had in place, we believe there is low risk of exposure to our guests,” the clinic said.
The health system plans to reach out to those who were in attendance out of caution.
The commission did not immediately respond to requests for comment.
The Centers for Disease Control and Prevention recommends wearing masks in public, as do most healthcare associations, including the American Hospital Association, to prevent the spread of COVID-19.
The AHA, in partnership with the American Medical Association and the American Nurses Association, are running a Wear a Mask campaign, urging people “to follow science: continue social distancing, washing hands for at least 20 seconds, and most importantly, to wear a face covering when outside the home.”
In April, the Mayo Clinic also was criticized after Vice President Mike Pence refused to wear a mask while visiting with patents and staff. Mayo had put a mask requirement in place earlier that month for all patients and visitors. The vice president later publicly acknowledged that he should have worn a mask.
Trump has repeatedly refused to wear a mask in public, and his supporters booed Ohio Lt. Gov. Jon Husted during a campaign rally in Dayton Sept. 21 when the Republican encouraged mask usage.
In the U.S., there have been 7,213,419 cases of COVID-19 and 206,402 deaths, as of Oct. 1, according to the latest CDC data.
Source: Cleveland Clinic under the microscope after Trump tests positive for COVID-19
California Gov. Gavin Newsom Tuesday signed two bills into law requiring healthcare providers to create stockpiles of personal protective equipment or face up to $25,000 in fines per violation.
The most immediate impact will be felt on general acute-care hospitals, which must build up a three-month supply of PPE by April 1, 2021. A second bill Newsom signed, S.B. 275, requires providers, including hospitals, clinics and home health agencies, to create a 45-day supply and the California Department of Public Health to have a 90-day stockpile by June 1, 2023, or one year after the adoption of the regulations, whichever is later.
“Unfortunately, in signing both bills about personal protective equipment supply, the administration has created double jeopardy for hospitals—subjecting them to disparate requirements and penalties,” Carmela Coyle, president and CEO of the California Hospital Association said in a statement. “But, as always, California’s hospitals stand ready to work together with others on the front lines of COVID to find meaningful, long-term solutions to increase the availability of appropriate personal protective equipment to keep patients and workers safe.”
SEIU-United Healthcare Workers West and the California Nurses Association backed the legislative efforts.
“This law will make sure we will never be caught off-guard again when a pandemic or other health emergency hits our state,” Jessica Rodriguez, an emergency department technician at Kaiser Oakland, said about S.B. 275 in a SEIU press release. “Too many healthcare and other essential workers have gotten sick and needlessly died because we did not have the supplies of PPE we desperately needed to treat COVID-19 patients. Many lives will be saved because of this new law.”
Earlier this month, Jan Emerson-Shea, vice president of external affairs for CHA, told Modern Healthcare that the April 1 deadline will be “complicated by the continuing global supply shortage and the fact that we will likely still be in the midst of the pandemic.”
Source: New California laws will force providers create PPE stockpiles
SACRAMENTO, Calif. — Though COVID-19 forced California leaders to scale back their ambitious health care agenda, they still managed to enact significant new laws intended to lower consumer health care spending and expand access to health coverage.
When Democratic Gov. Gavin Newsom concluded the chaotic legislative year Wednesday — his deadline to sign or veto bills — what emerged wasn’t the sweeping platform he and state lawmakers had outlined at the beginning of the year. But the dozens of health care measures they approved included first-in-the-nation policies to require more comprehensive coverage of mental health and addiction, and thrusting the state into the generic drug-making business.
“We had less time, less money and less focus, but COVID makes the causes of expanding coverage and trying to control health care costs that much more important,” said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group.
The governor also signed into law a raft of COVID-related bills intended to address the biggest public health emergency in a century, such as measures to stockpile protective gear for health care workers.
This year’s legislative season took place against the backdrop of an unprecedented pandemic that sparked a statewide stay-at-home order, back-to-back emergency legislative recesses, the Capitol’s first foray into remote voting and a projected $54 billion budget deficit.
Among the most controversial changes Newsom signed into law was the largest expansion of the state’s family leave program since it was enacted in 2014, an upgrade opposed by the state’s business interests. The tobacco industry also took a hit when Newsom approved a measure banning retail sale of flavored tobacco products, including menthol, with exceptions made for flavored hookah products. And Newsom bucked the powerful doctors’ lobby by granting nurse practitioners the ability to practice without physician supervision.
But several contentious health bills stalled in the legislature and never made it to Newsom’s desk, including measures that would have given the state attorney general more authority to reject hospital consolidations, expanded the state’s Medicaid program, called Medi-Cal, to unauthorized immigrants ages 65 and up, and capped consumers’ out-of-pocket costs for insulin.
Among Newsom’s vetoes were a pair of bills that sought to expand telemedicine, as well as legislation to adopt patient privacy protections for COVID-19 genetic testing.
“I think we all wish we’d had more opportunities to move more things forward,” said Assembly member Jim Wood (D-Santa Rosa), who chairs the Assembly Health Committee. “Under the circumstances, I think we did a good job.”
Here’s a look at some of the major health measures Newsom signed into law this year. Most will take effect on Jan. 1.
Lawmakers made significant changes to mental health coverage, and perhaps the most consequential is a mental health parity bill. SB-855 requires state-regulated health insurers in California to cover all treatment deemed medically necessary for mental health and substance abuse disorders, from depression to opioid addiction. Health insurers opposed the bill, arguing it would drive up health care spending.
Mental health parity is already enshrined in state and federal law, but advocates say insurers regularly don’t cover the critical care that patients need.
Julie Snyder, a lobbyist for the Sacramento-based Steinberg Institute, which advocates for mental health care policy changes, called the new law a model for the rest of the country.
“There’s no other state that has anything this comprehensive,” Snyder said.
Another bill, SB-803, will allow peer providers — people with their own histories of mental illness or substance abuse who help other Californians navigate behavioral health issues — to be certified by the state. Once certified, they can bill Medi-Cal for their services.
Scope of Practice
Newsom gave nurse practitioners, who are nurses with advanced training and degrees, the power to practice independently, after years of failed attempts and despite major opposition from the California Medical Association, which represents doctors. Supporters say AB-890 will help address health care provider shortages, especially in rural and underserved communities.
Certified nurse-midwives will also be allowed to attend low-risk pregnancies in both hospital and home settings without a physician’s supervision under SB-1237.
Cutting Health Care Costs
California will enter the highly competitive generic drug market as a result of SB-852, a first-in-the-nation law that will put the state government in direct competition with private drug manufacturers.
“The cost of health care is way too high,” Newsom said in a statement upon signing the bill.
By January, California must forge partnerships with one or more drug companies to make or distribute a broad range of generic and biosimilar drugs that are cheaper than brand-name products. The bill specifically calls for the production of the diabetes medicine insulin, because makers have hiked prices sharply in recent years.
Newsom also approved an under-the-radar health care transparency measure requiring the state to collect data on the amount state-regulated health insurers pay for specific medical services, from knee replacements to asthma treatments. The data could help policymakers identify excessive spending on certain treatments and provide fodder for proposals to control health care costs.
“While the examination of cost has slowed down, it hasn’t ended,” said state Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee.
Newsom also signed legislation cementing into state law key provisions in the Affordable Care Act, a move guaranteeing Californians will not lose coverage protections should the U.S. Supreme Court strike down the law.
SB-406 will ban health insurers in California from imposing annual or lifetime limits on coverage, and also requires health insurers to cover a range of preventive care services, from cholesterol and blood pressure screenings to immunizations, without charging patients copays or deductibles.
As California continues to grapple with the highest COVID-19 case counts in the country, lawmakers approved a suite of bills in response to the pandemic, largely intended to protect essential workers.
Employers will have to provide written notice within one business day to employees who may have been exposed to the COVID-19 virus at their worksite. They must also report the details of workplace outbreaks to local public health authorities within 48 hours. AB-685 was prompted by major outbreaks this year at food-processing plants.
Newsom also signed legislation making it easier for firefighters, health care workers and other front-line workers infected with the coronavirus to get workers’ compensation. SB-1159 took effect Sept. 17, the day the governor signed it.
State law now presumes these front-line workers were infected with the virus on the job unless their employers prove otherwise.
Certain employees who have been exposed to the virus will also have more paid sick leave time. Under AB-1867, food-processing companies with at least 500 workers must provide two weeks of paid sick leave to workers who have been exposed to COVID-19 or have been advised to quarantine.
The law also grants health care workers and emergency responders two weeks of paid sick leave, closing a loophole in a COVID-relief bill Congress approved this spring.
Two new laws will address another major challenge exposed by the coronavirus pandemic: the lack of adequate personal protective gear for health care workers. AB-2537 will require hospitals to stockpile a three-month supply of protective gear by April, while SB-275 mandates that the California Department of Public Health establish an additional stockpile for health and other essential workers to last 90 days during a pandemic.
Nursing homes, which have been at the epicenter of COVID-19 deaths, will be required to have a full-time “infection preventionist” on staff to help stem the spread of disease. The bill, AB-2644, also will require nursing homes to report deaths from a communicable disease to the state within 24 hours during an emergency related to that disease.
And California’s roughly 40,000 licensed pharmacists will be allowed to administer COVID-19 vaccines that have been approved by the Food and Drug Administration under AB-1710.
Source: New Laws Keep Pandemic-Weary California at Forefront of Health Policy Innovation
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By a narrow 214-207 margin, House Democrats passed a $2.2 trillion stimulus bill on Thursday called the HEROES Act. 2.0, essentially a slimmer version of the $3 trillion HEROES Act that was passed in May and blocked by Republicans due to the cost.
The new measure includes another $50 billion in provider relief funds and improvements to Medicaid disproportionate share hospital (DSH) funding. It aims to address hardships caused by the COVID-19 pandemic by including a second round of $1,200 stimulus checks and extended $600 weekly unemployment benefits, as well as emergency funds for state and local governments totaling $436 billion.
On top of that, it allocates $225 billion for schools and childcare and Paycheck Protection Program funding. It also includes assistance for airlines and the restaurant industry.
Also included is a $100-per-month increase in SNAP benefits in most states, rental assistance and an Affordable Care Act premium subsidy. That means those who have lost jobs during the COVID-19 pandemic would be eligible for the maximum health insurance premium subsidy under the ACA, a $1,386 benefit.
The bill passed the House despite opposition from 18 Congressional Democrats.
Ultimate passage seems unlikely, however. Newsweek reported that Senate Majority Leader Mitch McConnell has signaled doom for the new package in the Senate, with Republicans in favor of a much smaller, $500 billion package. That’s about half of the $1 trillion they had proposed for their HEALS Act legislation.
WHY THIS MATTERS
The bill matters to hospitals, especially those caring for a large share of Medicaid patients.
“With the addition of $50 billion in Provider Relief Fund aid and improvements to Medicaid disproportionate share hospital (DSH) funding, this bill would help ease the heavy financial pressures our hospitals face. We also welcome the bill’s recognition of the need to account for race, ethnicity, gender, and other demographic data to reduce persistent disparities in health, such as those amplified by the pandemic,” Beth Feldpush, senior vice president of Policy and Advocacy for America’s Essential Hospitals said.
Pelosi has spent the week trying to negotiate an agreement with Treasury Secretary Steve Mnuchin, the main GOP negotiator, and according to Politico the two are still in talks, with some hope that a deal could be reached today. Today is the final day the House is slated to be in Washington before returning home to campaign for the upcoming election, though Democratic leaders said they would keep lawmakers at the Capitol through the weekend if a deal is close to fruition.
McConnel has signaled little hope for a new deal.
THE LARGER TREND
A legislative relief package passed the House in May, but at an estimated cost of $3.5 trillion, the original HEROES Act got nowhere in the Senate. That bill also proposed providing subsidies for laid-off workers to remain on their employer-provided health insurance plans through COBRA, the Consolidated Omnibus Budget Reconciliation Act that extends benefits, and would have created an open enrollment period for plans under the Affordable Care Act.
Other relief has been in the form of regulatory measures, the biggest being the flexibility to use telehealth.
ON THE RECORD
“In a family of four, this is a lifeline for workers and families who are facing this coronavirus disaster,” said House Speaker Nancy Pelosi in a floor speech on Thursday. “For a family of four earning $24,000, Heroes 2 would mean direct payments, a $3,400 direct payment; unemployment benefits, $600 per week enhanced UI benefits; tax credits, up to $5,920 through the EITC and a fully refundable $4,000 (Child) Tax Credit, equaling additional $1,200 in refunds.”
Source: House passes $2.2 trillion HEROES Act 2.0, including $50 billion in provider relief funds
Hospitals will be able to purchase remdesivir, Gilead Sciences’ antiviral drug used to treat hospitalized COVID-19 patients, directly from distributor AmerisourceBergen, federal authorities announced Thursday.
Supplies of remdesivir, which is the only antiviral drug with emergency use authorization to treat hospitalized COVID-19 patients, have increased over the past several weeks as demand has waned and production has expanded. As a result, HHS will no longer oversee distribution via state health departments as planned.
“There is enough supply on hand to treat every existing COVID hospitalization in the U.S. and ample supply even if incidence surges,” Johanna Mercier, Gilead’s chief commercial officer, said during a press call with reporters.
Hospitals have not been purchasing the full available amounts of the drug over the past several weeks, which is a good sign, said Dr. John Redd, a captain in the U.S. Public Health Service and chief medical officer of the HHS Assistant Secretary for Preparedness and Response.
Of the 500,000 treatment courses made available in the U.S. between July and September, state and territorial health departments accepted 84% of their allocations, ASPR data show. However, only 32% of the total allocation was actually purchased by hospitals.
“That is a key indicator that the supply exceeds the demand and that there is no need for the federal government to oversee allocations of the drug,” Redd said during the call.
AmerisourceBergen will continue to be the sole distributor of remdesivir. If hospitals hadn’t secured allocations of the drug with the distributor prior, they should not have trouble getting supplies, Matt Sample, vice president of manufacturer operations at AmerisourceBergen, said during the call. There will be no minimum order threshold, he added.
Preliminary data from a government-sponsored trial showed remdesivir reduced recovery times by about four days, which could save hospitals $12,000 per patient, Gilead estimates, although health policy experts have cautioned that hospital costs vary widely and that the outcomes aren’t yet clear.
“There are now 3 (randomized clinical trials) of remdesivir in hospitalized patients with differing results, raising the question of whether the discrepancies are artifacts of study design choices, including patient populations, or whether the drug is less efficacious than hoped,” Erin McCreary, infectious disease pharmacist at the University of Pittsburgh Medical Center, and Derek Angus, chair of UPMC’s critical care medicine department, wrote in a JAMA editorial.
Remdesivir costs $3,120 for a five-day treatment cycle. Gilead had donated 150,000 treatment courses for the drug, but that supply ran out in late June. Since then, the cost has been incorporated into the DRG payments hospitals receive for treating COVID-19 patients.
Mercier said full FDA approval of the drug is “imminent,” which would likely expand its use.
Source: Hospitals can purchase remdesivir directly from distributor
A group of California lawmakers recently sent letters to Aetna and UnitedHealthcare urging them to fully cover non-invasive prenatal testing for all pregnant women in the state.
The two insurance companies temporarily covered non-invasive prenatal testing, or NIPT, for younger women during the pandemic, but the letters implore them to broaden the coverage beyond COVID-19.
Instead of offering coverage for NIPT like other insurers including Cigna, Blue Shield of California and Optima Health, Aetna and UnitedHealthcare only cover screening tests that can cause pregnant women and their families additional costs, and referrals to specialists for further testing, according to the letters.
WHY THIS MATTERS
NIPT is used to determine the risk that a fetus will be born with certain abnormalities, such as Down’s syndrome.
It has been found to be the most accurate prenatal screening test and has a detection rate for Down’s syndrome of more than 99%, with a false positive rate as low as 0.1%, according to a study from The New England Journal of Medicine. The same study found that traditional screening tests miss up to 21% of Down’s syndrome cases.
The letter cites one reason that insurers should cover NIPT is to avoid “wrongful birth lawsuits,” where parents claim negligence in informing the parents of the risk of having a genetically impaired child. The letter suggests that by offering more accurate tests, like NIPT, these lawsuits could be avoided because the likelihood of discovering the baby’s genetic disorder is higher.
Although California’s overall maternal mortality rate is less than the national average, significant racial and ethnic disparities exist across a variety of maternal quality measures, including prenatal visits, preterm births, and maternal and infant mortality rates, according to the 2019 California maternity care report.
The lawmakers who sent the letter believe providing equitable access to prenatal screening options regardless of insurance plan, socioeconomic level, race or ethnicity is crucial in reducing the state’s maternal health disparities.
THE LARGER TREND
The American College of Obstetricians and Gynecologists recently updated its policy recommendations to say all patients should be offered NIPT regardless of age or risk factors.
Previously, the organization only recommended the use of NIPT in “high-risk” pregnancies, such as in individuals 35 years or older.
Besides offering NIPT to pregnant women, telehealth may be a strategy to close the maternal health gap. It can bring pregnant women the prenatal care they need even when they don’t have access to a physician.
ON THE RECORD
“Healthcare coverage decisions are often determined by a variety of factors including cost, medical necessity, standard of care, and availability of service,” the lawmakers said in their letter. “An essential area of healthcare coverage for many, particularly young women, is maternity benefits and testing available to determine a healthy pregnancy. Poor insurance coverage for early genetic maternity testing can have devastating consequences on women and their pregnancies. Unlike several insurers like Cigna, Blue Shield of California, Optima Health and others, Aetna [and UnitedHealthcare have] still not fully endorsed non-invasive prenatal testing (NIPT) coverage for all pregnant women.”
Source: California lawmakers push insurers to universally cover prenatal screening tests
The Association of Credit and Collection Professionals and the Healthcare Financial Management Association’s Accounts Receivable Resolution Task Force reconvened this year to update best practices for resolving patient medical bills. HFMA
The updates, created in response to the COVID-19 pandemic, focus on patient education and communication.
“This year was a critical time to revisit and update these best practices on behalf of healthcare providers and accounts receivable management companies with the goal to help consumers resolve and understand their medical bills,” said Mark Neeb, CEO of the ACA.
WHAT’S THE IMPACT?
The first aspect of the updated framework is patient-friendly billing. HFMA has a set of principles that help guide this idea, including clear and understandable language, concise bills with only the necessary information, accurate information regarding the patient’s financial responsibility, and processes focused around the patient’s needs.
Next is effective communication between providers and patients at every stage of the process. This helps patients become more engaged in their healthcare and gives them a better understanding of how to resolve their outstanding accounts, according to the report.
HFMA recommends that providers assume responsibility for engaging in these conversations long before the post-discharge account resolution process. For nonemergency services the conversations should begin before the procedure, and for emergency services they should occur before discharge, according to the framework.
Within their communications with patients, providers should educate patients on the account resolution process, the report said. This can look like a discussion about how patients can qualify for third-party-payer coverage or different ways that patients can pay their bills.
Beyond traditional modes of communication, the task force encourages the use of alternative strategies such as informational signage and pamphlets in the registration area, explanatory YouTube videos, and chatbots on facility websites.
Above all else, giving patients price estimates of the medical procedure is crucial in facilitating a discussion about the patient’s financial obligation, the report said.
For insured patients, the estimate should include the member’s expected out-of-pocket expenses, based on their current deductible status, along with copayment and coinsurance information, which can be provided by their health plan.
Uninsured patients should be provided price information resources from the hospital, as well as alternatives for sharing their healthcare expenses such as insurance options and financial assistance, according to the report.
In addition to following the best practices shared in the report, HFMA suggests that providers regularly survey their patients to assess their performance in assisting the resolution of medical accounts.
THE LARGER TREND
The task force was originally created in 2014 to establish best practices for the fair resolution of patients’ medical bills. Members of the task force included providers, patient advocates, collections agencies and credit bureaus.
The biggest barrier to a positive patient financial experience is a lack of understanding around pricing, insurance coverage and the complexity of medical bills, according to a study by WayStar. The research found that a quarter of patients find pricing too complicated to understand.
This is especially true among Medicare beneficiaries, with more than two-thirds saying their insurance is confusing and difficult to understand in a survey conducted by MedicareAdvantage.com. The same survey found that a majority of beneficiaries couldn’t correctly define basic insurance terms such as “deductible” and “coinsurance.”
ON THE RECORD
“We know medical debt sometimes comes with added challenges and uncertainty, and it is the mission of the accounts receivable management industry and its health care provider partners through these best practices to work together to offer solutions, education and guidance,” ACA’s CEO Mark Neeb said.
Source: HFMA task force releases best practices for resolving patient medical bills
At Texas Children’s Hospital, some patients are trying new web-based tools to stay connected with physicians between psychology appointments—a program that’s taken on newfound importance while providers care for patients amid the COVID-19 pandemic. Mental
Typically, providers give pen-and-paper questionnaires to patients during appointments to assess and track symptoms related to mental health over time. But the Houston hospital earlier this year began rolling out a software program from Owl Insights to screen and monitor patients remotely.
Texas Children’s psychology service treats kids with such mental health concerns as anxiety, obsessive compulsive disorder and, more recently, distress related to COVID-19.
By implementing a program that lets children and their parents respond to questionnaires online, Texas Children’s not only aimed to provide more touch points between appointments, but also to make the process more efficient for physicians, cutting down the time they spend documenting that information as well as automatically graphing symptoms over time.
The program has been particularly helpful as telehealth usage has spiked during the pandemic. That’s by chance, said Karin Price, chief of psychology at Texas Children’s, since the hospital had already been planning to go live on the program.
Tracking a patient’s symptoms is key to noting their progress and informing treatment options; for example, flagging if a patient’s depression isn’t improving as expected, Price said. But she stressed “more information is not always better;” it’s important for physicians to select appropriate questions based on a patient’s specific concerns.
Just a handful of providers have been tasked with using the platform to figure out the best way to integrate it into workflows.
Mental health is a growing segment within digital health, capturing significant attention from investors. While overall funding into wellness startups dipped 24% in the first half of 2020—dropping from $6.1 billion in the first half of last year to $4.6 billion this year—mental health startups raised more than $1 billion, up 43% year-over-year, according to a report from CB Insights, a firm that analyzes data on venture capital and startups.
Earlier this month, Owl Insights said it raised $15 million in an investment co-led by Ascension Ventures, the investment arm of hospital giant Ascension.
While other areas of medicine frequently use metrics like blood pressure, blood sugar levels and weight when treating diseases, using standard measures to track patients is newer in psychology, said Nancy Ruddy, a professor of clinical psychology at Antioch University New England and a consultant who works with organizations on integrating behavioral health and primary-care programs.
She hasn’t used similar software with her patients, but said she thinks they have potential to support a broader push to add more “measurement-based care” to behavioral health programs.
“Whether we’re using a paper-
and-pencil kind of thing or something via an app, it’s just a way of having a sense of is the treatment working and is this person improving, or do we need to change course,” Ruddy said.
Jefferson Health in Philadelphia began rolling out a program to help monitor patients’ behavioral health symptoms between appointments from another company, NeuroFlow, about two years ago. Since then the system has created the app, which lets providers assign surveys and set care reminders for patients, available for behavioral health, primary care and OB-GYN treatment.
To really help patients, it’s important that the programs are “anchored with clinicians” and integrated into patient care, said Dr. Michael Vergare, chair emeritus of Jefferson’s psychiatry and human behavior department.
One of the areas where the program’s had strong uptake, even before the pandemic, is screening and monitoring new mothers for postpartum depression. Providers can offer patients the option to enroll in the program to receive reminders about wellness and mental health between visits, as well as to track symptoms related to depression and anxiety.
If a patient’s symptoms unexpectedly change between appointments, providers can use the information to intervene more quickly and to adjust their care plan, Vergare said.
Source: Mental health startups help providers monitor patient symptoms at home