On top of the mental and emotional pressures of being a healthcare worker during a global pandemic, caregivers also are feeling financially stressed, according to a new report. Healthcare
The TIAA Institute’s 2020 Healthcare Sector Financial Wellness Survey found that the financial condition of 45% of the workers surveyed had worsened since the COVID-19 pandemic began. And 27% of those workers expected to see their finances get worse in the next year.
“The impact of COVID-19 on healthcare institutions and their workforce has been extreme,” said Paul Yakoboski, TIAA Institute senior economist and author of the report. “Some segments have experienced major increases in work hours, while others have experienced furloughs, layoffs and salary reductions. While much attention has been paid to the mental and emotional toll on our frontline medical workers, we must also pay attention to the financial toll on this obviously critical industry and its employees.”
Of those surveyed, 45% now expect to work past 67 and 38% are less confident about their retirement savings, according to the report. The expected retirement age has risen for 29% of workers 50 and older.
Of the 75% of workers who emergency savings before the pandemic, about 33% have tapped into it.
According to Bureau of Labor Statistics, employment was down 3.2% in September compared to a year ago, but numbers have been climbing throughout the end of the year.
In response, national organizations like the American Nurses Foundation, set up pandemic response funds for nurses and other workers in need.
The 2020 Healthcare Sector Financial Wellness Survey was conducted online from May 21 to June 11 and included responses from 1,203 healthcare workers, including registered nurses, physicians and surgeons, other medical professionals, office and administrative staff and non-medical professionals.
Source: Healthcare workers could delay retirement over COVID-19 financial concerns
The available supply of medical-grade exam gloves may not meet the projected demand over the next 12 months, which will likely translate to price hikes for health systems and other providers, according to data from the group purchasing organization Vizient. spike
Personal protective equipment supply levels have been dropping for several product types as COVID-19 cases rebound in some states. While many health systems and other providers have been able to source alternatives for PPE like face shields and gowns, exam gloves may be more complicated.
Global demand for medical-grade exam gloves may reach 560 billion individual gloves over the next 12 months, but total production is estimated to fall short by about 260 billion units, according to Vizient. The annualized utilization rate of exam gloves across Vizient’s membership, which represents 50% of the U.S. acute care market, has jumped about 22% from the first half of 2019 to the same period in 2020.
“That is significant for a commodity product,” said Cathy Denning, who lead’s Vizient’s sourcing operations.
About 90% of the raw materials used to make exam gloves as well as the finished products are sourced from Malaysia, which has been hamstrung by labor issues, the pandemic and the limited supply of butadiene that’s used to make nitrile gloves, Denning said.
Although an acute shortage is unlikely, prices have already increased between 25% and 130% across six of of Vizient’s suppliers in the first round of price hikes. A second price increase across the same suppliers ranged from 13% to 210%.
“We don’t think it will equilibrate anytime soon, and it is important for hospitals to prepare from a cost perspective,” Denning said.
About 900 million tons of butadiene are produced globally. But output needs to be 1.5 billion tons to meet the current demand for nitrile gloves, according to Vizient. Onshoring is an option, but it will take more than a year to build a production line with a max output of 10 billion gloves, Denning noted.
In the meantime, hospitals will need to budget for price increases, while trying to extend the shelf life of their existing inventory or find alternative materials like synthetic nitrile, she said.
“Unit-of-measure and just-in-time inventory are great in times of plenty, but they are terrible in times of shortage,” said Denning, adding that some of its large health system members are purchasing their own container loads from manufacturers, although not all systems have the storage space.
Years of competition driving down to the lowest-cost options have narrowed supply chains. But that will change, said Jim Boyle, executive vice president of acute care sales at Medline, who expects the healthcare supply chain to slowly wean off Asian sources.
Medline has partnered with providers to produce more masks domestically and plans to increase critical supplies like PPE. Goods can expire in the traditional stockpiling system, which has in part led to a just-in-time inventory model. But within the right infrastructure, like a centralized hub-and-spoke model for specific supply categories, supply chains can gain resiliency and efficiency, Boyle said.
“All of us will have to look at the cost of ownership of these types of supplies as a cost of doing business,” he said during Modern Healthcare’s Leadership Symposium last month, emphasizing the need to diversify sources of finished products. “This isn’t now, this is a forever thing—we are going to have to adjust so we don’t get back in this position.”
About 30% of 200 healthcare supply chain experts said U.S. manufacturing capacity needs to grow, according to a new poll taken in September by Supplyframe.
More than 26% said PPE and medical devices will be harder to source, while 20% expect continued product shortages.
About a third estimate that it will take six to 12 months for the global supply chain to be back at full capacity, while about a fifth said it will take 12 months to two year.
“We find ourselves caught flat-footed in the U.S., which is why we are advocating for supply chain resiliency, transparency and redundancy,” Denning said. “It’s probably not feasible to move all production to the U.S., but we need to increase our domestic or nearshore footprint to ensure we are not in this position again.”
Source: Prices spike as exam glove supplies dwindle, GPO says
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The U.S. Department of Health and Human Services’ HHS Health Resources and Services Administration has announced nearly $500 million in awards to support, recruit and retain qualified health professionals and students through its National Health Service Corps, Nurse Corps and other workforce development loan repayment and scholarship programs.
About 17 million patients receive care from more than 16,000 NHSC members. An additional 1.8 million patients are cared for by more than 1,700 Nurse Corps clinicians. Through scholarship programs, over 1,500 NHSC and 600 Nurse Corps primary care students are in school or residency preparing for future service.
Two NHSC programs first introduced in 2019 have more than doubled the number of NHSC clinicians treating patients with opioid use disorders. The NHSC Substance Use Disorder Workforce Loan Repayment Program (SUD Workforce LRP) and NHSC Rural Community Loan Repayment Program are now supporting more than 2,800 providers. Overall, 1 in 3 or 31% of NHSC clinicians serve in rural communities.
Additionally, the NHSC has expanded efforts to recruit clinicians who are highly qualified to treat opioid addiction. This year saw a 63% increase in awardees, from 512 to 832, with DATA 2000 waivers — demonstrating that they are trained in a comprehensive approach that incorporates medication and behavioral health counseling.
In support of Indian Health/Tribal/Urban sites, the NHSC set aside $15.2 million of FY 2020 funding and provided 295 awards to clinicians at 195 tribal health centers to further increase access to care that’s critically needed in these communities.
WHAT’S THE IMPACT
These FY 2020 awards support a variety of HRSA programs.
The National Health Service Corps Loan Repayment Program ($224.1 million) provides 4,280 new awards and 2,355 one-year continuation awards to clinicians working in primary care medicine, dentistry, or as a nurse-midwife, physician assistant or nurse practitioner at an NHSC-approved site in exchange for serving in areas of greatest need.
The National Health Service Corps Substance Use Disorder Workforce Loan Repayment Program ($77.2 million) provides 1,206 new awards to clinicians directly involved in the treatment of substance use disorders and the recruitment and retention of health professionals needed in underserved areas to expand access to SUD treatment and prevent overdose deaths.
The National Health Service Corps Scholarship Program ($60.2 million) provides 251 new awards and 12 continuation awards to students pursuing primary care training leading to a degree in medicine or dentistry, or a degree as a nurse midwife, physician assistant or nurse practitioner, in exchange for providing primary health care services in areas of greatest need.
The National Health Service Corps Rural Community Loan Repayment Program ($40.1 million) provides 477 new awards in coordination with the Rural Communities Opioid Response Program from HRSA’s Federal Office of Rural Health Policy to provide evidence-based substance use treatment, assist in recovery and prevent overdose deaths in rural areas.
The National Health Service Corps Students to Service Loan Repayment Program ($17.3 million) provides 148 new awards. This program provides loan repayment assistance to medical and dental students in their last year of school in return for their choosing primary care as a practice focus and working in rural and urban areas of greatest need.
The Nurse Corps Loan Repayment Program ($51 million) provides 465 new awards and 291 one-year continuation awards to nurses in exchange for a commitment to serve at a health care facility with a critical shortage of nurses or serve as nurse faculty at an accredited school of nursing. Of these awards, the program provides 41 new awards and 27 continuation awards to nurse faculty who teach registered nurses or advanced practice nurses at eligible public or private schools of nursing.
The Nurse Corps Scholarship Program ($26.4 million) provides 244 new awards and 13 continuation awards to nursing students in exchange for a commitment to work at least two years in a facility with critical nursing shortages.
The Native Hawaiian Health Scholarship Program ($1.4 million) provides 9 new awards to Native Hawaiian health care professionals trained in those disciplines and specialties most needed to deliver quality, culturally competent, primary health services to Native Hawaiians in the State of Hawaii.
The Faculty Loan Repayment Program ($1.1 million) provides 20 new awards to health professions educators from economically and environmentally disadvantaged backgrounds in exchange for serving as a faculty member in an accredited and eligible health professions school. The program also encourages participants to promote careers in their respective health care fields.
ON THE RECORD
“National Health Service and Nurse Corps clinicians have been heroic frontline providers in high-need rural, urban and tribal communities for decades, and their service has proven only more essential during the COVID-19 pandemic,” said HHS Secretary Alex Azar. “This year’s nearly half a billion dollars in awards will help Corps clinicians continue their work as part of HHS’s efforts to address health disparities, tackle substance abuse, and expand access to care for vulnerable Americans.”
“During the COVID-19 pandemic, the efforts of our NHSC and Nurse Corps clinicians have been tremendous,” said HRSA Administrator Tom Engels. “HRSA has provided flexibilities that ensure that these clinicians are able to do the work they’re called to do – care for and serve the patients in their communities where they may be the only health care provider for miles.”
Source: HHS awards nearly $500 million to support primary healthcare workforce
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Atrium Health, Wake Forest Baptist Health and Wake Forest School of Medicine completed their merger, the North Carolina-based not-for-profit organizations announced Friday.
The combined entity is comprised of 70,000 employees, 42 hospitals and around 1,500 care locations that generate more than $11 billion in annual operating revenue. Executives aim to bolster their pipeline of medical professionals with a second Wake Forest School of Medicine campus in Charlotte as well as expand their population health efforts, among other goals.
“As the healthcare field goes through the most transformative period in our lifetime, in addition to a new medical school, our vision is to build a ‘Silicon Valley’ for healthcare innovation spanning from Winston-Salem to Charlotte,” Eugene Woods, president and CEO of Atrium Health, said in prepared remarks. “We are creating a nationally-leading environment for clinicians, scientists, investors and visionaries to collaborate on breakthrough technologies and cures. Everything we do will be focused on life changing care, for all, in urban and rural communities alike. And we will create jobs that provide inclusive opportunities to enhance the economic vitality of our entire region.”
Dr. Julie Ann Freischlag, CEO of Wake Forest Baptist Health and dean of Wake Forest School of Medicine, has been named the chief academic officer of Atrium Health. Edward Brown, the current board chair of the Charlotte Mecklenburg Hospital Authority, will lead the 16-member board appointed by the CMHA and Wake Forest University Baptist Medical Center, which will oversee the newly formed not-for-profit corporation, Atrium Health, Inc.
“Through our combined, nationally recognized clinical centers of excellence in multiple specialties, we will be able to expand our research in signature areas, such as cancer, cardiovascular, regenerative medicine and aging, and target bringing research breakthroughs to the community in less than half the time of the national average,” Freischlag said in prepared remarks.
The combined institution plans to build a new eye institute and construct a new critical care, emergency department and surgery tower at Wake Forest Baptist Medical Center.
Atrium will also expand its virtual care and behavioral health capacity and grow its research related to Alzheimer’s disease, high blood pressure, diabetes, obesity, hypertension and vascular disease.
Through the first half of the 2020 fiscal year, Atrium reported a $225 million operating loss on $2.96 billion of operating revenue, although that was offset by nearly $232 million in federal COVID-19 relief grants, according to Modern Healthcare’s financial database. That compared to a $168.3 million operating income on $3.21 billion of operating revenue in the same prior period.
Atrium reported $386.4 million of operating income on $7.48 billion of revenue in the 2019 fiscal year.
Through the fiscal year ended June 30, Wake Forest Baptist reported $40.6 million of operating income on $3.61 billion of operating revenue, up from a $1.84 million loss on $3.38 billion of operating revenue the prior year.
Source: Atrium Health and Wake Forest Baptist Health complete merger
The Trump administration has no plans to delay implementation of its hospital price transparency rule on Jan. 1, a White House official said.
Hospitals have implored the Trump administration to delay the January 2021 implementation of hospital price transparency requirements, but the White House does not appear to be backing down.
A White House official said that the administration already delayed implementation when HHS published the final rule and pushed the deadline to Jan. 1.
“As of right now we have no plans to delay implementation further,” the official said.
Hospital groups including the American Hospital Association, Federation of American Hospitals, Association of American Medical Colleges and Children’s Hospital Association in June wrote to HHS Secretary Alex Azar arguing the rule would be burdensome for hospitals to adhere to amid the COVID-19 pandemic and asked HHS to delay implementation until after the rule’s legality is settled by the courts.
“Even attempting to comply with the rule will require a significant diversion of financial resources and staff time that hospitals and health systems cannot afford to spare as they prepare to or care for patients with COVID-19,” the hospital groups wrote.
Oral arguments before the U.S. Court of Appeals for the District of Columbia Circuit are set for Oct. 15. A District Court judge upheld the rule in June.
Instead of acceding to hospitals’ demands for a delay, President Donald Trump signed an executive order that requires CMS to make data on compliance with the price transparency rule publicly available in March.
“At this point hospitals have shown they want to fight us tooth and nail in court and we think the statutory grounding is sound,” the White House official said.
Source: White House sticks to Jan. 1 hospital price transparency deadline
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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