Mar
17

COVID quick update

Quick takes on stuff you need to know – and most of it is good news indeed.

Eli Lilly has what may be one of the more promising treatments, a cocktail of two unpronounceable drugs showed strong results in a recently-completed double-blind trial involving 769 patients.  The bamlanivimab-etesevimab duo cut the risk of hospitalization and death by 87% versus placebo.

Unlike the hydoxycholoroquine “research” touted by the former occupant of the White House, this is real science by reputable scientists which shows the drug has a positive impact.

Other research indicates the Pfizer vaccine works to stop the Brazilian variant; since I’m getting my first shot – and it’s the Pfizer version – Monday, that’s good news indeed. Pfizer also believes its vaccine will work against the South African variant as well.

These are all good news, as economists believe an economic recovery is highly dependent on stopping COVID.  One stated: “The vaccine is truly incredible…. It’s the best kind of stimulus we could want.” Excellent podcast for your morning walk or pm drive is here.

Terrific research out of CWCI last week; in their annual meeting, Alex Swedlow, Rena David and colleagues provided a lot of information on what’s happened with claim counts, costs, claim duration, and treatment timing. One very bright spot – February saw a huge drop in COVID workers’ comp claims. Rena also reported that “many workers with non-COVID claims got faster treatment than before the pandemic…” A big chunk was via telemedicine, which hit 25% of office visits in April and May, then dropped to about 18% in October. [thanks to WCC’s Mark Powell for his reporting]

I’m hoping to interview Alex and will provide more intel in a future post.

What does this mean for you?

Science, people. 


Feb
25

Worker comp payers – hold on to your purses and wallets

Two news items hit the virtual desk this morning; hospitals will lose more than $50 billion this year, and consolidation among hospitals and health systems is continuing, isn’t improving quality, and is increasing health systems’ leverage over payers.

The bad awful financial picture for hospitals comes after a pretty bad 2020, a year in which operating margins were slashed in half.

Of course financial problems are the main driver behind consolidation as health systems with stronger balance sheets take over struggling competitors. Physician practices hammered with revenue declines driven by far fewer patient visits, fewer elective surgeries, and more uninsured patients are also being acquired by health systems.

For payers – especially for workers’ comp payers – the balance of power has shifted to providers. With control over many hospitals and thousands of physicians, systems like Sutter Health in California can dictate terms to huge group health buyers.

I find it ironic indeed that the online ads next to the reporting on the consolidation problem in general and Sutter Health in specific include this one. Payers’ ability to control costs in consolidated health care markets is…challenging at best.

What does this mean for you?

If you operate in Alabama, Florida, Louisiana, Arkansas, Kansas and a bunch of other states, your facility costs are going up. 


Feb
16

COVID update #56

COVID is likely to become an endemic disease, one that is with us forever. It will morph, adapt, and change over time, evolving constantly as the virus does what all “living” things do – seek to survive and propagate.  Like all pandemics, our fortunes will wax and wane.  At times new variants will be more or less infectious, more or less deadly, more or less controllable.

We humans will develop immunity to a greater or lesser degree depending on multiple factors; what variant we’re exposed to, how old we are, our unique genetic makeup, other co-morbidities, whether or not we have decent, accessible healthcare, where we live and what we do and who we do it with.

credit Down to Earth

Most important will be whether we listen to science, exercise caution, and protect ourselves and others…or cross the stupid line.

The good news. 

The world’s focus on developing vaccines has been hugely successful; a year after the virus emerged about 150 million people have been vaccinated. That is a truly stunning accomplishment, all the more so because the most successful vaccines to date have relied on a never-before used model (mRNA).

Here in the US we just learned that the Biden Administration has secured enough doses of the Pfizer and Moderna vaccines to get every resident inoculated by mid-July. If J&J’s vaccine gets approved, the single-dose mechanism will significantly speed up the vaccination process.

The bad news is 100,000 of us died of COVID in January, and some of the new variants appear to be more infectious and others may be more deadly.

So, we are racing to develop herd immunity before the virus’ ability to adapt and change overcomes current vaccines’ ability to control it. 

What’s worse is this did not have to happen. Between eliminating the budget of a key government entity tasked with early identification of infectious diseases, promoting useless and dangerous COVID treatments, refusing to encourage people to wear masks and politicizing public health, we can clearly see what happens when we elect incompetent politicians.

Trump et al failed us miserably, but they aren’t the only ones at fault. The conduct of a Governor whose administration failed to report nursing home deaths and another Governor (of a state with death rates among the highest in the nation) that actively lied about COVID is reprehensible. In Cuomo’s case, blaming the coverup on fears the Trump Administration would use the death count as a political cudgel is no excuse.

What does this mean for you?

We all need to accept that COVID is never going away.


Feb
10

Hospitals got hammered in 2020

2020 was a really awful year for hospitals.

The median operating margin dropped 16.6% –  and the median facility just barely broke even.

And that was AFTER the billions hospitals received from you and me courtesy of the CARES Act.

Without our largesse, hospital margins dropped…wait for it…55.6%.

Another key datapoint is the use of operating rooms. Usage was down by over 10%; as that’s where hospitals make their money, it’s not surprising that margins dropped even more than operating room usage did.

What does this mean for you?

Nothing good.


Feb
9

We have a very long way to go.

The first step to recovery is admitting you have a problem. Well, America, we have a problem. That problem is our healthcare delivery and payment system/industry.

Our healthcare system is a mess.

It is unfathomably complicated, far too expensive, and delivers results that are generally good for wealthier White people and not so good for poorer and non-White people.

This is just the high level stuff…

But wait, Medicare is simple…right??

Then there’s our crappy results.

Americans’ life expectancy has dropped while people in every other developed country are living longer.

Oh, and it’s stupid expensive…Americans spend twice as much on healthcare as the average developed country.

But our healthcare is great…right??

Not for Black babies.

But all of us get far fewer doctor visits…

From far fewer doctors…

While Purdue and the rest of the opioid industry make tens of billions of dollars killing our relatives and friends

The result  – we pay waaaay more than other people and die sooner.

What does this mean for you?

Demand better. And do something about it.


Dec
18

Opioid deaths up…Perdue family completely blameless

Two members of the Perdue family, the folks who made tens of billions of dollars addicting patients to dangerous drugs, testified before Congress yesterday.  Both averred there was nothing they could have done to avoid/prevent the damage their company did.

Yesterday the CDC reported 81,230 drug overdose deaths occurred in the United States in the 12-months ending in May 2020.

Quoting the CDC:

This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded.

The Perdue family’s complicity in this national disaster is obvious and damning to everyone but the billionaires who’ve parked more than $10 billion of their profits from drug dealing offshore, safe from recovery efforts by American law enforcement and Perdue’s victims.

This from Kathe Perdue:

“I have tried to figure out, was there anything that I could have done differently? Knowing what I knew then — not what I know now?” said Dr. Sackler, who served on the board from 1990 to 2018. “There’s nothing that I can find that I would have done differently based on what I believed and understood then.”

Perdue on the Board through 2018, many years after Perdue Pharma’s criminal sales practices had been prosecuted, fines paid, settlements authorized. She was on the Board in 2007 when it authorized a $600 million settlement to resolve just one set of charges.

Oh, that represented 1/50th of the family’s net worth.

Two conclusions are possible – and only two.

Either Ms Perdue really couldn’t think of anything she could have “done differently” to stop her company’s ongoing, continuous and highly effective efforts to addict people, or she’s a bald-faced liar.

In the first instance, she’s a psychopath.

In the second, she lied to Congress.

What does this mean for you?

When are you going to sue these bastards for what they’ve done to your customers, employees, members, and organization?

Thanks to Steve Feinberg MD for the heads up on the CDC data.


Nov
12

COVID facts and implications

This is getting real.

I woke this morning to the news that COVID has infected well over 10 million of us and killed almost a quarter million of our mothers, fathers, daughters, siblings, and grandparents.

Worse, the infection rate in the Midwest and Great Plains is exploding

As is the overall US infection rate…

If anything, the trend line is worse than it appears, as it is an average of the last 7 days. With daily new case counts rising rapidly (Wednesday’s count was 142,755), this third wave is looking more like a tsunami.

Latest research

The CDC is finally putting on its big boy pants…

CDC recommends community use of masks, specifically non-valved multi-layer cloth masks, to prevent transmission of SARS-CoV-2.

Wow…who would’ve thunk it??

Research determined that wearing masks protects the wearer as well as those around them. From CDC:

An investigation of a high-exposure event, in which 2 symptomatically ill hair stylists interacted for an average of 15 minutes with each of 139 clients during an 8-day period, found that none of the 67 clients who subsequently consented to an interview and testing developed infection. The stylists and all clients universally wore masks in the salon as required by local ordinance and company policy at the time.

Make sure your masks:

  • have multiple cloth layers and/or
  • are made of silk or
  • polypropylene.

Vaccine progress

The NYTimes’ excellent – and constantly updated – vaccine progress tracker reports there are:

  • no vaccines currently approved for wide use;
  • 6 vaccines approved for early or limited use; and
  • 11 more in large scale efficacy (does it work?) testing.

Pfizer’s vaccine shows a lot of promise, with early results from a large study indicating it was 90%+ effective in “preventing the disease in individuals with no prior history of the disease.”

The vaccine has some significant logistical challenges which will make distribution tricky indeed; it:

Notably, Pfizer did not take any taxpayer money to fund its research, and its executives specifically stated the company is not participating in “Operation Warp Speed.”

Hospitals in ten high-infection states are at or beyond capacity.  From the Atlantic;

According to local news reports, hospitals are already on the brink of being overwhelmed in IowaKansasMinnesotaMissouriMontanaNorth DakotaTexasUtah, and Wisconsin,

Implications

Expect a return to limited availability of facility-based medical services. Hospitals are going to have to cut back on elective services to maintain capacity.

More states will mandate restrictions on group gatherings and business operations. New York has already done so, along with North Dakota and I’m sure several others.

There will be significant economic effects.

What does this mean for you?

If everything goes well, by spring 2021 – that’s late March – there may be enough of us vaccinated to slow the virus’ spread.

Be responsible. Wear a mask.

 

 

 

 


Oct
30

It’s not a good time to be a hospital.

Lots happening this week, much of which was lost in the pre-election madness.

From Becker’s, a list of the 16 rural hospitals that shut their doors this year; over the last decade 133 have closed.  Most are in the South.

States that didn’t expand Medicaid figure prominently, accounting for 12 of the 16 closures. More than two dozen hospitals in Kentucky are at risk; the state’s decision to expand Medicaid took effect in June of this year, but the years of financial hardship will prove to be too much of a burden for some.

Expect more closures in the coming months.

One small contributor; now that PPE manufacturing is moving stateside, facilities’ costs will increase. That adds another straw to the camel’s back.

What does this mean for you?

Longer drives to get care if you live in a rural area, and hospitals looking everywhere for revenue to make up for losses.


Oct
27

More hospital consolidation = higher prices

The only demonstrable impact of facility consolidation is higher prices.

There’s also solid evidence that more concentrated health care markets are associated with lower health care quality.

While the number of deals dropped by about 21% in the first half of this year as everyone’s attention focused on COVID and the impact thereof, a number of transactions still took place.  Conversely, several deals in process totaling around $23 billion were abandoned, victims of a variety of challenges.

Consolidation may actually accelerate as facilities hammered by the financial impact of COVID19 seek safe harbors.

The latest consolidation is in the north-central part of the nation, with 2 not for profit systems working on an a deal driven in large part of a desire to help the systems expand their footprint.

I’d expect more, although the increasing number of facility closures may well put a damper on deals as some run out of time.

This is particularly damaging in rural areas, where over a hundred hospitals have shut their doors over the last decade.

From Bob Shepard, UAB

What does this mean for you?

There will be fewer hospitals tomorrow than today, which likely means higher prices.


Oct
22

COVID update – where we are today v2

Had a posting issue yesterday; email notifications did not go out to all subscribers – reposting this  – apologies if you already received this.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.