News & Updates

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  • 23 Jul 2021 9:20 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source | Comments Courtesy of Matt Zavadsky

    This is topic at many EMS agencies across the country.  Following the lead of other healthcare entities may provide some guidance.

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    American Hospital Association supports COVID-19 vaccine mandates

    ALEX KACIK 

    July 21, 2021

     

    The American Hospital Association supports hospitals and health systems that require their workers to get the COVID-19 vaccine, the group announced Wednesday.

     

    AHA, which represents nearly 5,000 hospitals and health systems, joins dozens of providers and several associations that have also backed vaccine mandates for healthcare workers.

     

    "The evidence is clear: COVID-19 vaccines are safe and effective in reducing both the risk of becoming infected and spreading the virus to others," AHA CEO Rick Pollack said in prepared remarks. "The AHA supports hospitals and health systems that choose, based on local factors, to mandate COVID-19 vaccines for their workforce. Doing so will help protect the health and well-being of healthcare personnel and the patients and communities they proudly serve."

     

    Low vaccination rates in nearly half of the country may prompt another wide-scale surge, healthcare providers warn, noting that some hospitals are already overrun. Arkansas, Louisiana and Missouri have been some of the hardest hit by COVID-19 variants, where only 35% to 41% of their residents are fully vaccinated, according to data from Johns Hopkins University School of Medicine's Coronavirus Tracking Center. The unvaccinated account for 97% of people hospitalized for severe COVID-19, said Rochelle Walensky, director of the Centers for Disease Control and Prevention.

     

    COVID-19 cases have increased in more than three dozen states, according to the seven-day trailing average from Johns Hopkins University School of Medicine's Coronavirus Tracking Center. The rate of new cases has more than doubled over a two-week span, the CDC reports.

     

    More hospitals and health systems are forcing their workers to get inoculated and hospital and medical professional associations are following suit. America's Essential Hospitals, which represents more than 300 hospitals and health systems, also supported vaccine decrees Wednesday, joining the Association of American Medical Colleges and the Association for Professionals in Infection Control and Epidemiology.

     

    "By requiring vaccination for all employees, essential hospitals can set the example we need to improve those numbers, turn back the pandemic's latest assault and build equity for all people," Dr. Bruce Siegel, CEO of America's Essential Hospitals, said in prepared remarks, adding that vaccines are safe and effective at preventing COVID-19 and reducing its spread. "We have lost too many of our caregivers to COVID-19. Vaccination can reduce the risk we lose more."



  • 13 Jul 2021 10:31 PM | AIMHI Admin (Administrator)

    HHS Source Article | Comments Courtesy of Matt Zavadsky

    Perhaps a good opportunity for local EMS agencies to communicate with their state EMS and Medicaid Offices to be included in potential applications?

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    CMS Addresses Substance Use, Mental Health Crisis Care for Those with Medicaid

    $15 Million Funding Opportunity for State Planning Grants to Bolster Mobile Crisis Intervention Services

    The Centers for Medicare & Medicaid Services (CMS) announced a funding opportunity made possible by the American Rescue Plan (ARP) to help states strengthen system capacity to provide community-based mobile crisis intervention services for those with Medicaid. The $15 million funding opportunity is available to state Medicaid agencies for planning grants to support developing these programs.

    This funding opportunity provides financial resources for state Medicaid agencies to assess community needs and develop programs to bring crisis intervention services directly to individuals experiencing a mental health or substance use related crisis outside a hospital or facility setting. These services may include screening and assessment, stabilization and de-escalation, and coordination of referrals after the initial treatment.

    "Investing in crisis intervention services ensures Americans experiencing a mental health or substance use disorder crisis get the care and treatment they need," said Secretary Becerra. "These grants will help states build these critical services to help communities send a responder who is trained and ready to assist people in crisis."

    "It is vital that we can meet people where they are, especially when those individuals are in crisis," said CMS Administrator Chiquita Brooks-LaSure. "This funding will help state Medicaid agencies plan innovative ways to provide and better mobilize these essential intervention services to their communities."

    The planning grants provide funding to develop, prepare for, and implement qualifying community-based mobile crisis intervention services under the Medicaid program. Grant funds can be used to support states' assessments of their current services, strengthen capacity and information systems, ensure that services can be accessed 24 hours a day/365 days a year, provide behavioral health care training for multi-disciplinary teams, or to seek technical assistance to develop State Plan Amendment (SPAs), demonstration applications, and waiver program requests under the Medicaid program.

    Letters of Intent to apply from states and territories are due July 23, 2021. Final applications must be submitted by August 13, 2021, 3:00 pm ET. The period of performance for this grant will be from September 30, 2021, through September 29, 2022. The Notice of Funding Opportunity (NOFO) provides additional details regarding eligibility and program requirements, as well as key deadline and application submission information.

    To view the NOFO, visit Grants.gov and search for the announcement by CFDA# 93.639.


  • 12 Jul 2021 10:39 AM | AIMHI Admin (Administrator)

    Atlantic Source Article | Comments Courtesy of Matt Zavadsky

    Fantastic article by The Atlantic! 

    EMS is facing a staffing crisis not seen in decades.  The EMS staffing crisis has been profiled by several national media outlets.  The latest, here in The Atlantic.

    Communities need to get serious about what life would look like if no one responded to EMS calls. 

    Among the two most notable quotes:

    That medicine treats emergency medics like disposable, low-wage workers instead of the health-care professionals they are isn’t just unfortunate for the workers themselves—it also leads to less than optimal care for the rest of us on the day we may need it most.”

    Emergency medics routinely struggle with high rates of burnout and job dissatisfaction, as well as PTSD and other mental illnesses. They are regularly bitten, punched, or otherwise assaulted by their patients, enduring a rate of occupational violence that is about 22 times higher than the average for all other U.S. workers. Altogether, the low pay, the absence of performance feedback, and the chronic mental and emotional toll “sends the message that no one cares about you and your work,” Crowe said.”

    The treatment of emergency medics as chauffeurs and not clinicians—as a profession of nonprofessionals—means that not enough Americans choose this career.”

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    Emergency Medicine’s Original Sin

    The misperception that paramedics are merely ambulance drivers is everyone’s problem.

    By Marion Renault

    July 12, 2021 

    Special Note: The Atlantic interviewed MedStar paramedic Jason Hernandez for their 2016 article “What It’s Like to be a Paramedic”.

    Lindsey Kaczmarek gets called an ambulance driver more often than she gets called a paramedic. “That’s absolutely not what I do,” she told me. What she does do is show up when someone needs medical help, figure out what’s wrong with them, and do whatever she can to help them survive the trip to the hospital—in her case, the Mayo Clinic in Rochester, Minnesota. The primary symptom for one in three 911 medical calls is simply “pain,” but during any given shift, Kaczmarek might attend to a heart attack, a stroke, a car crash, a labor and delivery gone wrong, a mental-health crisis, a shooting, or an elderly patient suffering from a severe urinary tract infection. “If they’re not breathing, I will breathe for them,” she said. “If their heart’s not beating, I will be the heartbeat for them.”

    The job of providing emergency medical services, or EMS, often resembles medical detective work, with limited clues, no specialists to consult, and very little, if any, of the sophisticated equipment available to doctors and nurses. But even though emergency medics—a catchall term used throughout this story for paramedics, emergency medical technicians, and emergency medical responders—handle tens of millions of calls in the United States each year and make life-altering decisions for their patients every day, they remain all but excluded from institutional medicine. “You’re basically like a glorified taxi,” says Sarayna McGuire, a Mayo Clinic emergency physician who has studied pre-hospital health care.

    The misconception that emergency medics provide transportation, not medicine, leaves them to cope with all sorts of indignities. “They’re used to being second-class citizens,” says Michael Levy, the president of the National Association of EMS Physicians. In one hour—during which they may respond to several 911 calls—the median paramedic or EMT makes a little more than $17. That’s half the hourly pay of registered nurses and less than one-fifth the pay of doctors—if they’re paid at all. During the pandemic, emergency medics were literally enclosed in rolling boxes with COVID-19 patients. But in some states, they were not prioritized alongside other essential health-care workers for the first round of vaccines. After delivering their precious cargo to a hospital, in many cases they don’t learn the final diagnosis, or whether their patient ever makes it back home.

    That medicine treats emergency medics like disposable, low-wage workers instead of the health-care professionals they are isn’t just unfortunate for the workers themselves—it also leads to less than optimal care for the rest of us on the day we may need it most.

    CONTINUE READING►


  • 2 Jul 2021 2:40 PM | AIMHI Admin (Administrator)

    Integrated Healthcare Executive Source | Comments by Matt Zavadsky

    Interesting pearls for EMS leaders here – Especially regarding the public’s desire for care in the home, patient navigation and telehealth.

    Historical note – “Integrated Healthcare Executive” was a newsletter founded by former EMS World/HMP leader, Scott Cravens and EMS leaders like Dr. Jeff Beeson, Dr. Brent Myers and others.

    In their “About Us”, they reference EMS as a component of IHE magazine:

    Founded in 2013, Integrated Healthcare Executive (formerly Integrated Healthcare Delivery) profiles leaders and chronicles innovations in the rapidly evolving field of integrated healthcare. It offers insights, analysis and actionable takeaways on key leadership concerns, including patient care, technology, business and regulatory compliance, with an emphasis on nonhospital provider organizations: skilled nursing, home health, hospice, assisted living, EMS, pharmacy, rehab, physical therapy, behavioral health and more. 

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    Patient Telehealth Preferences During and After the COVID-19 Pandemic

    Julie Gould

    Maria Asimopoulos

    06/16/2021

    https://www.hmpgloballearningnetwork.com/site/ihe/videos/patient-telehealth-preferences-during-and-after-covid-19-pandemic

     

    Benjamin Isgur, Health Research Institute (HRI) leader at PwC, discusses an HRI survey that analyzed telehealth trends during the pandemic, with an emphasis on what virtual services consumers want most and how the industry might adjust care models to patient preferences.

     

    Can you talk about PwC’s HRI survey? What did it examine and what was learned? Were any of the survey findings surprising?

    Consumer sentiment is really important to us. We have been looking at consumer sentiment for the past 15 years in the Health Research Institute. Because after all, for a long time, it seemed like the health system wasn't built around what consumers want and needs are.

     

    The pandemic has been a special case because it's accelerated a lot of trends, but then also brought up some pretty big gaps in the health system. One of the things that we saw from our latest survey is around consumers being bullish about receiving more of their care at home.

     

    This is something that's been talked about for a long time in the health system, that we actually need to provide care closer to where people live. We've seen that to a certain extent, but the pandemic has made it clear we also have to have the ability to bring services all the way into their homes.

     

    There was an incredible need for that, of course, because of the pandemic and many of our—especially if we go back a year ago, in the spring, many of our health organizations had to reduce capacity and utilization in order or to keep people safe from COVID. We saw a lot of movement toward virtual health, telehealth, and other sites of care.

     

    The home is no exception to that. In fact, 13% of consumers said that being able to receive care at their homes would make them feel most comfortable about rescheduling care they had put off during the pandemic.

     

    We asked like, "What would you be willing to do in terms of a doityourself care or care at your home?" Eighty-five percent of consumers said they'd be willing to have a DIY strep test, flu test, or remote monitoring. Testing is something really important for consumers to be able to do at home.

     

    Seventy-eight percent of consumers said that they would like to have their chronic care management visits in their home. Seventy-seven percent said a sick visit or some sort of a visit around an injury, they would like to have that at home.

     

    And 75% said that they would like a wellness visit or physical to be able to happen at home. A lot of very clear sentiment from consumers they want more of their care at home.

     

    What should health plans and providers do to increase care opportunities and deliver more cost-effective care?

    When we talk about the home, some of that would be in person, but a lot of that is virtual. I think if we talk about what can providers do to close those gaps for virtual.

     

    First of all, we saw a huge increase in the amount of virtual care in the early stages of the pandemic. Some of that is leveling off now that people can go back to in person and going forward, we'll see a hybrid model.

     

    We'll see a certain amount of care that makes sense to be in person, that'll stay in person. Then a lot of care that can be moved virtually will continue to be virtual or maybe increase. There's some great examples of that, like mental and behavioral health visits, those being done remotely. They make a lot of sense because consumers want it and like it.

     

    In fact, clinicians and health leaders tell us that they're seeing lower no show rates for mental health appointments when they're being done virtually. That's just one example, but what does that mean for health leaders thinking about their virtual health offerings?

     

    There's definitely some gaps in the system. Not everyone has great technology at home. In fact, some of our previous consumer surveys have shown that there are technical challenges around it. More than half of consumers said that they had some issue with a telehealth or virtual health visit. Some of it was technical, like I mentioned.

     

    Some of it, though, is just care navigation. They don't know where to go after the virtual visit. How can they get connected to those ancillary services they may need, such as getting an MRI, or an Xray, or getting lab tests? I think there is a danger as we move to more virtual that we don't create silos and we don't forget that we need good handoffs.

     

    For health leaders, that means that's something they're going to need to invest in. Not just a virtual health platform and keeping their customers and market in the loop, but they also have to invest in that care navigation and the warm handoffs between a virtual service and the times we need an inperson service.

     

    Overall, what can professionals take away from this survey? How will the findings help improve the future of care?

     

    One thing that professionals can take away from the survey is that it's very obvious that the way care is going to be delivered is changing. We're moving into an incredible hybrid model. There's more ways than ever, there's more front doors than there ever have been, to receive care, for consumers.

     

    Let me give you just a couple of examples of that, what we're seeing in terms of our consumer survey. Virtual visits, as I mentioned before, a lot of growth, 97% growth, over the last year in terms of virtual visits. Urgent care visits, almost 20% growth over the last year. Retail clinic visits, over 40% growth over the last year.

     

    What that mean is we've created our many front doors to health care. There's a lot of places for consumers to go. If you're a health care leader, you have to make sure that you're providing the best experience, that you're providing good handoffs, that you're providing great navigation, that people are going to the appropriate place.

     

    That's a big issue that's not often thought about. You could frustrate consumers if they think they can get something done virtually that actually should never have been done virtually, it needs to be done in person. That's something to consider. When you've got a lot of front doors, how are you communicating to patients and consumers about which front door they should use in which case?

     

    When they get there and they're using those services, how do you communicate to them where they need to go next so they feel like they've got great care management? A lot of work to be done there.

     

    The other thing I would bring up is we have to be careful that we don't leave people behind in terms of all of this technology. Not everyone has great bandwidth, or not everyone has great smart devices at their fingertips. In fact we've seen some companies invest in the social determinants of health and really helping people in underserved communities get this technology.

     

    We've seen examples of payers who are providing smart tablets for some of their members so that they have access, have oneclick access, to telehealth services. Thinking outside the box in terms of what people need, it's going to be important so that we don't leave people behind.

     

    Do you think care has forever changed following the pandemic, or do you see certain aspects going back to the way it was?

     

    That's a really good question. The answer is yes. Not everything is going to be made for telehealth, or virtual health, or at home visits, or these distributed visits in different parts of the health system. There will be a giant sifting and sorting that will happen over the next year of figuring out where people get the best care.

     

    Let me give you an example of that. As part of our research, we did some field interviews with providers. One of the providers I spoke to runs a large physical therapy clinic. When the pandemic was shutting things down, about a year ago, they attempted to move to virtual visits.

     

    I know that seems tough, right? A physical therapy visit, how do you do that virtually? They set up a system where they can have a physical therapist in one location, with cameras, and then the patient in their home with a camera and smartphone so they can go through the evaluation and the exercises and the range of motion and do that together, but virtually.

     

    What they found was that's pretty difficult. Not impossible, but it is pretty difficult. The other thing they found is for physical therapy and rehabilitation, a lot of people like to do that in a group setting. They need the camaraderie.

     

    For some physical therapy, it's fine to do those exercises at home and alone or at least with some instruction, but for other types of physical therapy, the journey actually requires camaraderie, and it requires having other people in the room and helping people to achieve that.

     

    It's just one tiny example of, there will not be a one size fits all. That we actually need to go through each of the care modalities and figure out what which makes sense for which type of visit.

     

    Also, even dig a little bit deeper because we may find somewhere consumers are split. Certain consumers may want a virtual visit while others want to do it in person because that's just their personal preference.

     

    Is there anything else you want to add to the conversation?

    The other thing that I would just add because it's on people's minds right now is about the vaccinations, because that's a big part of the pandemic. The vaccinations are going on right now, and I think it does bring up this concept of consumer preference.

     

    One of the things that we looked at is, where do people want to get vaccinated? There's a split. We saw a split in terms of age between people preferring to get vaccinated at a retail clinic, or urgent care center, or retail pharmacy versus a doctor's office. As we got to the older age cohorts, the preference leaned more towards the doctor's office and those other alternative sites of care.

     

    We saw some other differences based on race. Without diving into all of it, I would just say even with the vaccine distribution, if we want to get to higher percentages of Americans vaccinated, we're going to have to look at the modality.

     

    Where do people want to get those vaccines, and we need to meet consumers where they are. Again, another example right here, a very important one, of how consumer preference is going to drive that way the health system is being set up.

     

     

    Reference:

    PwC Health Research Institute. Consumer health behavior and the COVID-19 pandemic: What we've learned. PwC; 2021. Accessed June 16, 2021. https://www.pwc.com/us/en/industries/health-industries/library/assets/hri-2021-consumer-survey-Insight-chartpack.pdf


  • 1 Jul 2021 7:44 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source | Comments by Matt Zavadsky

    So many potential messages here for our EMS leaders. 

     

    The healthcare labor market being impacted by wages for retail and fast-food workers, certainly applies to what we are seeing in EMS.

     

    • The impact of higher education and stricter licensing requirements on the availability of the workforce. 
      • Potential workers are ‘opting out’ of healthcare (EMS) for similarly paying jobs with lower educational and licensure requirements. 
      • This speaks to the underlying economic issues for EMS. 
      • Reduced reimbursement for the services we provide, making it hard to pay an adequate wage for EMS workers, unless the systems as heavily subsidized, like other public health/safety systems.

     

    • The need to fundamentally redesign how healthcare (EMS) is delivered and financed in this country to reduce the pressures created by a diminishing workforce and upside-down economics. 
      • Imagine the number of ambulances and first response units that would not be necessary if 10, 15, 20% of our 911 EMS requests could be mitigated in the 911 center, without having to send a response with 2, 3, 4 or 6 people to the ‘scene’ of a call (like many other countries with a different funding model for healthcare (EMS), one that is not based on fee-for-service reimbursement).

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    Rising pay in other industries blows holes in healthcare's workforce

    Dustin Walsh

    June 30, 2021

     

    Beaumont Health has more than 2,600 open positions across its eight hospitals and more than 165 outpatient centers. Roughly 20% of those positions fall under one job — medical assistant.

     

    A medical assistant performs relatively routine tasks, such as filling out insurance forms, scheduling laboratory appointments or preparing patients for treatment. But, increasingly, the job is becoming more clinical and their responsibilities expanding to where medical assistants are functionally bedside nurses.

     

    And as one of the lowest paid clinical jobs in healthcare — the median wage in the U.S. is $17.23 per hour and $16.75 per hour in Michigan with an entry-level wage of $13.63 — the roles are increasingly more difficult to fill as workers seek employment in other industries that require less training and offer better benefits and bigger pay than healthcare.

     

    "Medical assistants earn wages no better than those with no required training or skills," said Anne Scott, health center operations manager for the Michigan Primary Care Association. "Some fast food chains pay $15 an hour, so why would you go into a healthcare position that also requires an expensive training certificate? Many people can't just shell out $6,000 for a certificate program, go into debt and then make $14 an hour."

     

    If you're not first, you're last

    The same issue is playing out across other industries long known for good pay and consistent work, like manufacturing.

     

    Michigan and the Midwest were built on the backs of factory employment, which historically paid significantly more than other jobs in the region, particularly for workers with limited to no secondary education or training.

     

    But times, they are a-changing.

     

    Hourly factory workers made an average of 56% more than restaurant and fast food workers in April, according to U.S. Department of Labor data analyzed by the Wall Street Journal. But that's down from 83 percent more in 2011.

     

    In 2020, medical assistants made only 11% more than retail workers' average wage of $15.03 per hour and 39% more than fast food cooks.

     

    But McDonald's announced in May it would raise the minimum wage for all restaurant employees to $15 an hour and upward of $17 per hour for some entry-level employees. Target and Walmart have already raised minimum wages to $15 an hour across their thousands of U.S. locations.

     

    And many fast food chains have been offering large signing bonuses, including a recent $400 signing bonus at the Wendy's on Wixom Road in Wixom. Most chain retail and restaurant companies also offering tuition reimbursement toward an associate's or bachelor's degree.

     

    Ash Shehata, principal and U.S. leader for the healthcare and life sciences practice at advisory firm KPMG, said the healthcare industry has spent 20 years instituting stricter licensing requirements on the workforce in an attempt to improve patient care but that has also made it harder to find workers in the tight labor market.

     

    "Healthcare was ahead of the curve with pay for a long time and were using that pay to improve workers and patient flow," Shehata said. "That was fine two years ago. Now they are running into competition from all these other industries and those additional requirements and licensure have put overall market pressure on the base rate (of pay)."

     

    Scott said the result is not only a draining of medical assistant candidates but also increased turnover at health centers, which typically pay less than larger health systems.

     

    "Health centers are increasingly asking them to work at the top of their skill and training but as cheaply as possible," Scott said. "That kind of economics is just not panning out as workers can just walk out and make more at health system down the street or even a fast food restaurant or retail store."

     

    A record 4 million people quit their jobs in April alone, according to the Labor Department.

     

    "We haven't seen anything quite like the situation we have today," Daniel Zhao, a labor economist with the jobs site Glassdoor, told NPR last week.

     

    Gianna Ferrarotti, vice president of talent management and organizational effectiveness at Beaumont, confirmed worker turnover is a problem in the system.

     

    "We've seen about a 20% increase in openings since the onset of the pandemic," Ferrarotti said. "It's a really competitive market."

     

    Gathering carrots

    Beaumont instituted a $15 minimum hourly wage at the end of last year and is offering signing, retention and referral bonuses as a way to combat the problem, Ferrarotti said.

     

    The health system is also increasingly relying on temporary workers from agencies.

     

    Bob Riney, president of hospital operations and COO for Henry Ford Health System, said shortages are not only impacting medical assistants but also in housekeeping, labs, pharmacy and surgery technicians and even registered nurses. Between June 2020 and May 2021, open positions were up 19% at Henry Ford.

     

    "We believe there will be a two or three year period where supply and demand will not be evenly matched for us," Riney said. "There's no question we're facing a challenge. We are looking for individuals that are drawn the mission of health care. The good news is that while the pandemic did increase and accelerate early retirement of individuals that were quite frankly people who were exhausted, but we feel the supply chain will be filled up again because people have realized the importance of health care during the pandemic."

     

    In the meantime, Henry Ford is reevaluating its wages and working to create more flexibility in roles to appease current and potential workers, Riney said.

     

    Henry Ford increased its minimum wage to $15 per hour last October, immediately affecting 3,000 employees.

     

    Mercy Health and Saint Joseph Mercy Health System, which together comprise the Michigan region of Trinity Health, also raised its minimum wage to $15 per hour in 2020.

     

    The health system is also using recruiting firms to find lower-skilled workers anywhere in the U.S., an expenditure Henry Ford typically reserved for finding physicians and nursing specialists.

     

    "We're casting a wider net," Riney said. "There's no reason for roles like these we can't attract individuals from other communities and other states. People look to relocate for a lot of reasons, so we want to find those people. Historically we have reserved that for higher level roles, but we're now expanding that to medical assistants and other classifications."

     

    Shehata agrees this is likely a short-term problem for the industry and other industries. While they are raising rates and paying more in labor today, most health systems will look to streamline operations and invest in technology to reduce those labor costs.

     

    "We're going to see heavy digitization," Shehata said. "The idea that health care has to leverage automation to improve patient experience and improve the workflow is sort of a third rail that's as much about this labor shortage issue."

     

    The Economic Alliance of Michigan, which represents employers, including General Motors Co., Ford Motor Co., Lear Corp. and others to advocate for higher quality and controlled pricing in health care, is also urging the industry to streamline operations instead of increasing hiring.

     

    "Healthcare costs continue to rise and the industry never sees a contraction," said Bret Jackson, president of the nonprofit whose members provide health insurance to 900,000 Michiganders. "As the rest of the state's industries shrink, health care keeps growing. We just keep pumping money into an inefficient system and more workers won't solve that. Without a new way of doing business, the industry is headed for a bubble and all these workers they are hiring will be laid off."


  • 24 Jun 2021 11:27 AM | AIMHI Admin (Administrator)

    San Francisco Chronicle Source | Comments by Matt Zavadsky

    Interesting!

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    San Francisco to Require City Workers to get Vaccinated

    San Francisco previously announced that it will require employees to be vaccinated in high-risk settings, including hospitals, nursing homes and jails, regardless of whether they work for the city.

    June 24, 2021

    https://www.sfchronicle.com/health/article/S-F-will-require-all-city-workers-to-be-16269840.php.

     

    San Francisco will require all 35,000 city employees to be vaccinated against the coronavirus once a vaccine receives full approval from the Food and Drug Administration, city officials said Wednesday.

    The new policy makes San Francisco the first city or county in California — and probably the U.S. — to mandate COVID vaccinations for all government employees.

    San Francisco previously announced that it will require employees to be vaccinated in high-risk settings, including hospitals, nursing homes and jails, regardless of whether they work for the city. The new policy will mandate vaccinations for all city employees, from police and firefighters to Muni operators and City Hall clerks and custodians. It does not cover teachers, who are school district employees.

     

    City workers who refuse to be vaccinated and don't get a medical or religious exemption could be fired.

    Employees will have 10 weeks after a vaccine is approved by the FDA to get their shots. The three vaccines used in the United States currently are under emergency authorization by the FDA, but they are expected to be fully approved within a few months.

    Starting Monday, employees will have 30 days to report to the city their current vaccination status, including showing proof of vaccination. As of Wednesday, about 55% of city employees have said they are at least partially vaccinated, according to the Department of Human Resources . About 5% of employees have said they are not vaccinated. The vaccination status of the remaining 40% is not known.

     

    "It's really a decision for the health and safety of our employees and our public that we serve," said Carol Isen , San Francisco director of human resources. "It's about protecting the city as an employer from what we deem to be unacceptable risk."

    Employees will report their vaccination status through the city's payroll system, Isen said. They must provide proof by uploading a photo of their vaccination card or the QR code generated by the state's digital verification system.

    Mawuli Tugbenyoh, chief of policy for the Department of Human Resources , said that "repercussions (for refusing vaccination) go all the way up to termination. But we're focused on the education and outreach part of it now."

    San Francisco has among the highest vaccination rates in the state, with about 80% of residents 12 and older who are eligible for vaccines having received at least one dose. But about 60% of city employees live elsewhere in the Bay Area, where vaccination rates may be lower, Tugbenyoh said.

    The city is the second-largest employer in San Francisco after UCSF. Although San Francisco appears to be the first city or county in the U.S. to mandate vaccinations for its employees, institutions like hospitals, universities and nursing homes have announced similar policies. Most, like San Francisco , are requiring vaccination only after the vaccines are formally approved.

    A health care system in Texas caused an uproar among its staff in April when it required all workers to be vaccinated ahead of FDA approval. This week, about 150 staff members were fired or quit after refusing to be vaccinated.

    Tugbenyoh said he was aware of the fallout in Texas and expected some San Francisco employees to have reservations about a mandate.

    "But we're saying only after the FDA approves it," he said.

    He noted that San Francisco would allow exemptions for medical or religious reasons.

    Officials with several San Francisco city workers unions said Wednesday that they had only just heard of the vaccine mandate and did not yet have a comment. But Tracy McCray , vice president of the San Francisco Police Officers Association , said that "we appreciate that the city's mandate goes into effect after full FDA approval and that they have provided the appropriate medical and religious exemptions for those city employees who need them."

    Isen said she hoped to work with unions to encourage employees to get vaccinated ahead of the mandate.

    "We want to do everything we can to help our employees get over whatever hurdles, physical or emotional or psychological, that they're having to getting vaccinated," she said.

    Vaccine mandates are important for protecting public health, especially for people who work in high-risk settings, said Arthur Caplan , a bioethicist at New York University's Grossman School of Medicine.  For example, flu vaccine mandates are common among health care workers and nursing home staffers, even those who don't work directly with residents.

    Mandates may also be key for keeping critical workforces — like police and firefighters — healthy and intact. In some parts of the country, vaccine uptake has been notably low among emergency workers. That puts the people they come into contact with at risk and could be devastating if an outbreak meant many workers were too sick to do their jobs, Caplan said.

    Dr. Grant Colfax , director of the San Francisco Department of Public Health , said protecting the workforce was especially important with the highly infectious delta variant gaining traction across the United States . Although he's pleased that 80% of San Francisco residents are at least partially vaccinated, "the fact is there are still thousands who are not vaccinated," he said.

    "Given that the delta variant is here and likely to increase in terms of its prevalence across the city, we need to do everything we can to protect our city workforce and the public we serve, especially as the city reopens," Colfax said. "The last thing we want to do is have to slow or curtail city services because of an increase in cases."

    Once the FDA approves the vaccines, Caplan said, "You're going to see more hospitals, nursing homes, home care programs move to mandate. Followed pretty quickly by the military, then some private employers and people with big overseas sales forces. And then maybe some local governments.

    "But I don't think county or city governments are going to be first in line, even if San Francisco was the first to do it," he added.

    Colfax said he hoped that other cities or counties would join San Francisco .

    "It's not the first time in the pandemic that ( San Francisco ) has continued to push ahead, push things forward," he said. "We think from the broader public health lens that this is absolutely important and the right thing to do."

    Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday


  • 24 Jun 2021 8:42 AM | AIMHI Admin (Administrator)

    Modern Healthcare source | Comments by Matt Zavadsky

    An option that may help keep rural hospitals open, at least for emergency care, and prevent rural EMS agencies from transporting some patients great distances.

    ---------------------

    New law offers rural hospitals new payment model—if they scrap inpatient beds

    Jessie Hellman

    June 23, 2021


    Rural hospitals facing closure will soon have another option: a payment model that allows them to convert to standalone emergency departments while ending inpatient services.

     

    Starting in 2023, CMS will offer a new "Rural Emergency Hospital" designation to facilities that agree to wind down inpatient care and build up outpatient services.

     

    The program, authorized by a spending bill President Donald Trump signed last December, aims to help facilities become more financially stable by scaling back their operations while maintaining some critical services for patients.

     

    This option won't be enough to halt the ongoing spate of rural hospital closures, which have reached 180 since 2005, including 20 last year alone, according to data from the University of North Carolina. But it could enable rural hospitals that see very few inpatients to avoid shuttering entirely.

     

    "This new model is really targeted at communities which, for whatever reason, are not able to sustain an inpatient hospital. This is seen as an alternative to having a closure," said George Pink, a professor at the University of North Carolina at Chapel Hill's Department of Health Policy and Management.

     

    The Rural Emergency Hospital model is the first new hospital designation Congress has created in decades. In 1997, lawmakers established the "Critical Access Hospital" model that boosted Medicare reimbursements in an attempt to stop rural hospital closures, but it has had limited success. Most of the nation's rural hospitals are CAHs. And these facilities must maintain at least 25 inpatient beds in order to retain that designation and the special payments that come with it. The new policy is intended for small rural hospitals with very low inpatient volumes, as few as one or day a day.

     

    Bottom of Form

    For some rural hospitals, the high fixed costs of maintaining inpatient services for shrinking local populations and declining patient volumes has become an albatross around their necks, with a growing number eventually closing under financial pressure.

     

    The ability to dump those inpatient services while still getting higher reimbursements from CMS through the Rural Emergency Hospital designation could be a lifeline for some, said John Hawkins, senior vice president of government relations at the Austin-based Texas Hospital Association.

     

    "I think there's a considerable number of hospitals that will take advantage of this," he said. Twenty-four rural hospitals have closed in Texas since 2005, the most of any state during that time period, the UNC database shows.

     

    "They basically have kept their inpatient status so they can access the 101% cost-based reimbursement," Hawkins said.

    "We ought to let them redesignate themselves in a way that meets the needs of the community but still give them enhanced federal funding."

     

    Under the new policy, current Critical Access Hospitals and rural Prospective Payment System hospitals with fewer than 50 beds can convert to the new Rural Emergency Hospital (REH) status.

     

    Using this designation, they can furnish outpatient services, including around-the-clock emergency care, observation, nursing facility services and ambulances—but not inpatient services. Because they're getting rid of inpatient care, REHs must have transfer agreements with regional Level 1 or Level 2 trauma centers.

     

    In exchange, hospitals adopting the REH model will receive a Medicare outpatient rate that is 5% higher than what full-service hospitals receive, and will get monthly facility payments, although the size of those payments remains undetermined. The program begins Jan. 1, 2023.

     

    The Medicare Payment Advisory Committee (MedPAC) called for a voluntary payment model geared toward standalone emergency departments in rural areas that can't support inpatient services in a 2018 report, a recommendation reflected in the new statute.

     

    MedPAC raised concerns about the impact on access to emergency care in rural communities when hospitals close their doors. Helping a facility maintain outpatient services while eliminating costly inpatient care that can be provided elsewhere—albeit at a location further away—can help these rural facilities remain in business, the panel concluded.

     

    "They want to continue to be that access point of care in their communities, but staying open as an acute care facility may not be the most feasible option—both financially, and it's just not what the community ultimately needs," said Carrie Cochran-McClain, the chief policy officer at the Overland Park, Kansas-based National Rural Health Association (NRHA).

     

    "It's scary to give up inpatient services but that might be a better alternative than losing a hospital altogether," she said.

     

    The NRHA estimates between 50 and 100 hospitals will be eligible to become REHs. There are more than 1,800 rural hospitals in the U.S., and one-fourth of them are vulnerable to closure based on financial performance, according to the Chartis Center for Rural Health. Even more could become at risk of closure in the post-pandemic landscape, according to the center.

     

    A MedPAC report released earlier this month analyzed 40 rural hospitals that closed between 2015 and 2019: In all cases, they experienced large declines in all-payer inpatient admissions in the years before closure, largely due to patients going elsewhere for care. From 2005 to 2014, these hospitals averaged a 54% drop in inpatient admissions.

     

    "I think the model holds promise to be an alternative, innovative new way of meeting healthcare needs in rural communities where inpatient hospitals might close," said UNC's Pink. "The uptake will depend on the outcome of the rulemaking process CMS is going through. There has to be a financial case for hospitals to take it up."

     

    Still, the program is voluntary. Hospitals should go through multiple levels of analysis to determine whether changing designations is advisable, said Martie Ross, office managing principal for PYA, a healthcare consulting and accounting firm headquartered in Kansas. The fact that CMS has yet to issue regulations is a significant obstacle to hospitals' decision making in the meantime.

     

    Facilities will have to consider factors such as the need for inpatient services in their communities, their capacity for EMS services and their relationships with other regional hospitals.

     

    While some rural hospitals could save money and improve their margins by closing inpatient services, it's not clear if the new model will provide enough revenue to cover operating costs. That could prove a tough sell.

     

    "Where I think this makes sense, or where I think it's likely the math will work, are smaller hospitals that are part of health systems," Ross said.

     

    For many rural hospitals, the decision undoubtedly will come down to money over other considerations. PYA's state-based analysis of the REH payment model found that it would cover between 80% to 87% of rural hospitals' costs.

     

    That analysis doesn't take into account the monthly facility payment REHs would receive under the program, but CMS hasn't revealed what that will be. Based on the formula laid out in the law, each REH could get about $1 million per year in facility payments, Ross estimated. Hospital industry groups maintain that the law allows CMS to boost these payments so REH's come out ahead financially.

     

    Other obstacles to transitioning to an REH include state licensing requirements and community objections to losing local access to inpatient services.

     

    "The law is basically saying: We want to help you by giving you money, but the only way we'll give you money is if you give up a service that might be critically important to your community," said Harold Miller, president and CEO for the Center for Healthcare Quality and Payment Reform in Pittsburgh. "If a hospital closes more services, it's going to be easier for it to close altogether and transfer all the outpatient services to a larger system."

     

    Whether the REH designation would benefit specific hospitals might be "random," Miller said. The formula laid out in law for the facility payment—which could be key to the program succeeding for rural hospitals—doesn't take into account each hospital's specific characteristics, such as their patient population and finances. Instead, each participating facility would receive the same amount of money.

     

    While an REH designation might be beneficial to some hospitals, particularly those that are already looking to scrap inpatient services, "there's no solution for the others in this situation," Miller said.

     

     


     


  • 8 Jun 2021 11:35 PM | AIMHI Admin (Administrator)

    Modern Healthcare | Comments courtesy of Matt Zavadsky

    Yes, it’s 1% of their workforce, but a bold move that seems to be backed by the recent decision on this issue by the EEOC.  99% of the staff have been vaccinated.

    And, the EUA may be ending soon, which no longer provides the ‘experimental’ argument.

    ----------------------

    Houston Methodist suspends 178 workers for two weeks for failing to get vaccinated

    June 08, 2021

    https://www.modernhealthcare.com/hospitals/houston-methodist-suspends-178-workers-two-weeks-failing-get-vaccinated

    Houston Methodist suspended 178 workers for failing to get fully vaccinated by the deadline set by the health system, the CEO said Tuesday.

    In a letter to all employees and physicians, CEO Marc Boom said the 178 workers will be suspended without pay for two weeks, giving them another chance to either get the second dose of the Pfizer or Moderna vaccine or a single-shot Johnson & Johnson vaccine. In April, Boom told employees that COVID-19 vaccines would be mandatory, and those who did not comply would face termination.

    "The small percentage of employees who did not comply with the policy are now suspended without pay for the next 14 days," Boom said. "I wish the number could be zero, but unfortunately, a small number of individuals have decided not to put their patients first."

    As of Tuesday, 24,947 Houston Methodist employees — nearly 100% — had been fully vaccinated, Boom said. Of the 178 suspended, 27 had received one dose of the vaccine. Another 285 received a medical or religious exemption, and 332 were granted deferrals for pregnancy and other reasons, Boom told employees. Some of the affected employees protested the system's mandate Monday, the deadline set for workers to have become fully vaccinated, the New York Times reported.

    "While we celebrate this remarkable accomplishment, I know that today may be difficult for some who are sad about losing a colleague who's decided to not get vaccinated. We only wish them well and thank them for their past service to our community, and we must respect the decision they made," Boom said. "Since I announced this mandate in April, Houston Methodist has been challenged by the media, some outspoken employees and even sued. As the first hospital system to mandate COVID-19 vaccines we were prepared for this. The criticism is sometimes the price we pay for leading medicine."

    The health system was sued in late May by 117 employees over the vaccine mandate. In the complaint, employees alleged that "Methodist Hospital is forcing its employees to be human 'guinea pigs' as a condition for continued employment" and is violating the Nuremberg Code, which prohibits human experimentation without consent. At that time, Boom said 99% of the hospital's 26,000 employees already had been vaccinated.

    The complaint which was filed in the District Court of Montgomery County in Texas, alleged that employers can't mandate vaccines that haven't yet received FDA approval, calling the vaccines "experimental." The COVID-19 vaccines only have received emergency use authorization.

    On May 28, the federal Equal Employment Opportunity Commission updated its COVID-19 guidance to clarify that an employer can require employees to be vaccinated for COVID-19 to enter a physical workplace, as long as accommodations are made for those who can't get vaccinated for medical or religious reasons.

    Houston Methodist is one of a small number of healthcare providers that are mandating the COVID-19 vaccine for workers. In mid-May, the University of Pennsylvania Health System announced that all employees and clinical staff would be required to be vaccinated against COVID-19 by Sept. 1. Starting July 1, Penn Medicine also will require all new hires to be vaccinated before starting work.


  • 7 Jun 2021 9:33 AM | AIMHI Admin (Administrator)

    New study just released today on the use of ketamine in the out-of-hospital setting.

    ----------------

    Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality

    Antonio R. Fernandez, PhD, NRP*; Scott S. Bourn, PhD, RN; Remle P. Crowe, PhD, NREMT; E. Stein Bronsky, MD; Kenneth A. Scheppke, MD; Peter Antevy, MD; J. Brent Myers, MD, MPH

     

    June 7, 2021

     

    Shape Description automatically generated with medium confidence

    https://www.sciencedirect.com/science/article/pii/S0196064421001529?dgcid=coauthor

     

    Study objective:

    To describe out-of-hospital ketamine use, patient outcomes, and the potential contribution of ketamine to patient death.

     

    Methods:

    We retrospectively evaluated consecutive occurrences of out-of-hospital ketamine administration from January 1, 2019to December 31, 2019 reported to the national ESO Data Collaborative (Austin, TX), a consortium of 1,322 emergency medical service agencies distributed throughout the United States. We descriptively assessed indications for ketamine administration, dosing, route, transport disposition, hypoxia, hypercapnia, and mortality. We reviewed cases involving patient death to determine whether ketamine could be excluded as a potential contributing factor.

     

    Results:

    Indications for out-of-hospital ketamine administrations in our 11,291 patients were trauma/pain (49%; n=5,575), altered mental status/behavioral indications (34%; n=3,795), cardiovascular/pulmonary indications (13%; n=1,454), seizure (2%; n=248), and other (2%; n¼219). The highest median dose was for altered mental status/behavioral indications at 3.7 mg/kg (interquartile range, 2.2 to 4.4 mg/kg). Over 99% of patients (n=11,274) were transported to a hospital. Following ketamine administration, hypoxia and hypercapnia were documented in 8.4% (n=897) and 17.2% (n=1,311) of patients, respectively. Eight on-scene and 120 in-hospital deaths were reviewed. Ketamine could not be excluded as a contributing factor in 2 on-scene deaths, representing 0.02% (95% confidence interval 0.00% to 0.07%) of those who received out-of-hospital ketamine. Among those with in-hospital data, ketamine could not be excluded as a contributing factor in 6 deaths (0.3%; 95% confidence interval 0.1% to 0.7%).

     

    Conclusion:

    In this large sample, out-of-hospital ketamine was administered for a variety of indications. Patient mortality was rare. Ketamine could not be ruled out as a contributing factor in 8 deaths, representing 0.07% of those who received ketamine.


  • 27 May 2021 7:39 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

    EMS providers have theorized that decreased 911 calls, and increased patient transport declination rates for patients experiencing cardiac-related symptoms may have led to increases in out-of-hospital-cardiac arrest (OHCA) cases and deaths.

    A study just released in Health Affairs seems to support this theory.

    Previously released data from the Academy of International Mobile Healthcare Integration (AIMHI) revealed concerning trends reported by member agencies from:

    • Fort Worth, TX: Metropolitan Area EMS Authority (MedStar)
    • Richmond, VA:   Richmond Ambulance Authority
    • Fort Wayne, IN: Three Rivers Ambulance Authority
    • Solano, CA:         Medic Ambulance Service
    • Davenport, IA:   Medic EMS

     

    EMS providers and other healthcare experts continue to encourage people to not delay seeking medical care for potentially serious medical complaints.

     

    Excerpts from the study and full study link:

    -----------------

    Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care

    Christopher Sun, Sophia Dyer, James Salvia, Laura Segal, and Retsef Levi

    PUBLISHED: MAY 26, 2021

     

    Conclusion

    The indirect effects of COVID-19 pose substantial immediate and long-term public health challenges. During the pandemic, patient avoidance and reluctance in seeking emergency care via EMS significantly increased compared with historical baselines. The avoidance of care and resulting possible treatment postponement likely played a critical role in the excess out-of-hospital cardiac arrests observed during the same time. The sustained changes in patients’ care-seeking behaviors and excess OHCA deaths after the initial COVID-19 wave may foreshadow the harmful long-term indirect effects of COVID-19 on health care systems. Ensuring that patients seek timely care during and after the pandemic is essential, to reduce potentially avoidable excess cardiovascular disease deaths.

     

    Abstract

    Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic.

     

    In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients’ reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (−27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (−17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston’s fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.

     

    Change In Characteristics And Outcomes:

    Beyond increased OHCA incidence, worse OHCA outcomes may also demonstrate the repercussions of patient reluctance and COVID-19. While assessing these relationships, OHCA patient and response characteristics with confounding effects on OHCA outcomes must also be examined. Accordingly, both the changes in OHCA outcomes and cofounding patient and response characteristics were assessed during and after the initial COVID-19 wave, relative to the historical baselines.

     

    Discussion

    This study supports the hypothesis that treatment delays resulting from increased patient reluctance to obtain urgent care contributed to the increased absolute and relative volume of non–nursing home out-of-hospital cardiac arrest incidence and death during the COVID-19 pandemic. Specifically, the substantial decrease in cardiac calls and increase in hospital transportation refusals during the pandemic supports the hypothesis of increased patient reluctance to seek EMS and in-hospital care.

     

    As positive cardiac outcomes are dependent on timely treatment after symptom onset,1214 these prolonged delays could explain the significantly increased rates of OHCA incidence and poor outcomes. In fact, these treatment delays may play a larger role in increasing OHCA incidence compared with the direct impact of COVID-19 infection.5,26 

     

    The Poisson regression analysis indicated that OHCA incidence was strongly associated with increased reluctance to call EMS and the initial COVID-19 wave period, during which barriers of obtaining care were abundant (for example, infection fears, financial instability, and stay-at-home advisories), but not with neighborhood-level COVID-19 infection rates.

     

    Importantly, patients’ reluctance to seek emergency care and OHCA incidence remained elevated despite the low COVID-19 infection rates and relaxed public health advisories after the initial COVID-19 wave. This not only suggests the greater impact of patient reluctance on excess OHCA incidence compared with COVID-19 infections but also raises concerns regarding the potential long-term indirect effects of COVID-19. Lasting changes in patients’ care-seeking behaviors that worsen the underuse of EMS could result in increased mortality rates for acute conditions.912

     

    The increased EMS avoidance and hospital transportation refusals during the pandemic were likely driven by patients’ reluctance to obtain care as opposed to unneeded medical attention. The decreased cardiac call volume and higher proportion of OHCAs among all cardiac calls suggests that at least some of the patients were only calling EMS during extreme emergencies. There is also evidence that some patients acted against explicit medical advice and refused transportation to a hospital after calling EMSAt least some of these patients experienced OHCA less than seven days after their initial EMS call, indicating that these refusals occurred despite worsening conditions. Moreover, historically, transportation refusals represent a reluctance to obtain necessary care, as approximately one in five patients refusing transportation received subsequent care at an emergency department within forty-eight hours after their refusal.27,28 Increases in refusal rates during the pandemic may similarly indicate higher patient reluctance to obtain care.


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