By George W. Chapman
NYS has already mandated all NYS healthcare workers must be vaccinated by early this past December 2021.
While many workers chose to quit rather than get the vaccine, most NYS healthcare facilities and physician offices report compliance rates in the 90% to 95% range.
Not all states issued a vaccine mandate. So, the federal government issued its own mandate ordering all healthcare workers in all states to be vaccinated by Jan. 4. Rather than comply, 14 states chose to sue. In December, a federal court in Louisiana granted them a temporary hold on the federal mandate. As the delta variant once again surges and the omicron variant begins to spread, more and more people are getting vaccinated. Ninety-nine percent of patients who end up hospitalized, and possibly in the ICU on vents, are unvaccinated. Consequently, 99% of deaths are among the unvaccinated. Meanwhile, surveys of non-healthcare employers reveal 60% have mandates or are about to implement one. The major healthcare organizations, (AHA, AMA, ANA, etc.) remain fully supportive of vaccine mandates to protect both their members and their patients. The administration is going to require health insurers to fully cover COVID-19 testing at your physician’s office and at home.
Women as Health System CEOs
Forty percent of practicing physicians are women. This has been steadily increasing over the past two decades as there are now more females (52%) than males in medical school. Ninety percent of nurses are women. But according to a survey of more than 250 healthcare systems and national insurers, reported in the AMA Journal, in an industry dominated by women, only 15% of respondents had a female CEO. Female representation was slightly better in other senior suite positions like COO, CFO, etc. Maybe as a consequence, only 25% of the respondents had a female chair of the board. By comparison, various surveys of top US corporations reveal only 5% to 10% are headed by a woman.
Really Bad Timing
Hospitals, nursing facilities, clinics and physician offices are the veritable front lines in the pandemic war. They are saddled with labor shortages, skyrocketing labor and supply costs and a workforce that is overworked, overwhelmed, underappreciated and demoralized.
To make matters worse, in the middle of the war, Medicare was about to impose salt- in- the- wound- thanks- for- your- service cuts to their reimbursement effective Jan. 1. This is tantamount to cutting a soldiers pay and supplies in the middle of a war. The overall cut would be 10% while medical inflation is currently running around 10%. So it’s a 20% slash.
Physicians were to be cut 4% and clinical labs, performing all kinds of pandemic-related testing in addition to routine testing would be cut 23%. Hospitals and nursing facilities were to be chopped as well. And to top it all off, the cuts come at a time when physician visits and hospital procedure declined. Granted, most of the cuts were planned pre-pandemic. But why did it take a last ditch effort by Congress to postpone (not cancel) the cuts? Didn’t anyone see this coming? The very least we can do to support our “troops” and win the war is to get vaccinated and be patient and appreciative when we seek care. Sadly, the cuts to reimbursement was passed by Congress.
Death Rate Increased
The overall death rate in the US increased 17% from 2019 to 2020. NYS ranked No. 1 with a 29% increase. Much of the national overall rate is due to preventable COVID-19 and overdose-related deaths. COVID-19 disproportionately impacted minorities, including American Indians, Blacks, Hispanics and Pacific Islanders. COVID-19 was the No. 3 leading cause of death.
Again, most of those deaths were preventable. Out of the 38 countries studied, the US ranked low (No. 33 for infant mortality) in most metrics. Once again the US claimed No. 1 for most spending per capita. In sort of good news, the number of us with three or more chronic conditions decreased and the per capita spending on public health was up 33% to $116 per capita. Unfortunately, most of the public health spending increase was to put out fires like COVID-19.
Overshadowed by the COVID-19 pandemic, more than 100,000 people died of a drug overdose the year between March 2020 and April 2021, and 75% of all drug overdoses were caused by opioids.
Drug overdoses killed more of us than car crashes and guns combined. Fentanyl-laced opioid pills (more kick) helped fuel the continuing epidemic. COVID-19 exacerbates the situation by causing relapses in addicts suffering from anxiety, depression and isolation. More must be done to battle this ongoing epidemic which impacts mostly rural teens and young adults. Naloxone reverses opioid overdoses. We need to expand the supply of, access to and affordability of Naloxone. Use telemedicine to reach isolated and rural areas where the epidemic is at its worst. MAT (medically assisted treatment), which combines medication management and counseling, works well virtually.
To get a dramatic glimpse into the opioid problem, I suggest watching “Dopesick” starring Michael Keaton on Hulu. It focuses on the notorious Sackler family which developed and marketed OxyContin via their company, Purdue Pharma. Having been sued by dozens of state attorneys general, the Sacklers agreed to a one-time settlement of $4.5 billion to be released over nine years.
The average victim would be compensated between $3,500 and $48,000 which seems paltry. The Sackers never admitted guilt nor expressed remorse. All future profits from Purdue Pharma will be diverted to addiction centers. The Sacklers remain one of the wealthiest families in the world.
Open enrollment in the Affordable Care Act programs began Nov. 1, 2020, for new participants. As of early December, 4.6 million people had enrolled though either federal or state exchanges. Ninety-five percent of the new enrollees are eligible for tax credits which subsidize their monthly premiums. These enrollees are just above the poverty line and make too much money to qualify for Medicaid. Consequently, they can purchase commercial insurance on-line at a graduated discount based on income. The ACA now covers 32 million people, or one in ten citizens.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.