January 7, 2022

The Weekly Gist: The Commute From Hell Edition

by Chas Roades and Lisa Bielamowicz MD

For those frustrated by Omicron throwing a monkey wrench into return-to-work plans, take comfort that you don’t have to deal with even more challenging circumstances to get back to work. On Monday, Virginia Senator Tim Kaine, along with thousands of others, got stuck in a snowstorm on I-95 between Richmond, VA and Washington, DC that turned his usual two-hour commute into an epic odyssey. It’s a terrible stretch of interstate in the best of circumstances, but the storm left drivers stuck in their cars through the night, unable to move, shivering, with dwindling fuel and little to eat or drink. (Kaine sustained himself on orange slices and sips of Dr. Pepper, while tweeting to constituents about his thwarted journey.) Weary and cold, the Senator finally made it back to Capitol Hill 27 hours later. Talk about the commute from hell.

THIS WEEK IN HEALTHCARE

What happened in healthcare this week—and what we think about it.

  1. Omicron exacerbates existing staffing shortages. The incredibly contagious new coronavirus variant is sidelining healthcare workers with breakthrough infections and quarantines, as patients flood into hospitals across the country. While hospitals are reporting that most infected patients are less sick, the sheer number of patients is pushing an already stressed system into crisis.

The Gist: Given mounting evidence that Omicron is both causing less severe disease and evading vaccines, health systems will need to balance employee COVID testing and quarantine protocols against the constraints caused by mounting numbers of otherwise asymptomatic care workers out sick. As COVID becomes endemic, health systems must find a way to normalize operations even as they manage employee infections. It won’t be sustainable to continually revert to canceling non-emergent procedures (many of which carry clinical consequences to patients if they are delayed) and shifting to crisis standards of care.

  1. HCA Healthcare and Tenet Healthcare acquire more outpatient assets. HCA has purchased MD Now Urgent Care, Florida’s largest urgent care chain, adding 59 urgent care centers to its existing 170. Meanwhile Tenet’s $1.1B deal to buy SurgCenter Development cements its position as the nation’s largest ambulatory surgery center (ASC) operator, eclipsing Envision-owned AMSURG and Optum-owned Surgical Care Affiliates.

The Gist: Healthcare services are increasingly moving outpatient and even virtual—a trend only accelerated by the pandemic. With this latest acquisition, Tenet will now own or operate nearly seven times as many ASCs as hospitals. Such national, for-profit systems are looking to add more non-acute assets to their portfolios, to capitalize on a shift fueled by both consumer preference for greater convenience, and purchaser pressure to reduce care costs. 

  1. Vera Whole Health to acquire Castlight Health. The $370M deal will integrate Castlight’s digital healthcare navigation tools into Vera Whole Health’s subscription-based primary care services, in a bid to better compete in an increasingly crowded employer market.

The Gist: This deal closely follows last year’s merger of Doctor on Demand with Grand Rounds, and Accolade’s acquisition of two startups, second opinion service 2nd.MD and virtual care provider PlushCare. After years of record funding for digital health and primary care startups, we expect consolidation to pick up pace this year, as investors push startups to generate scale and profitability, and employers demand more integrated solutions.

  1. Elizabeth Holmes found guilty of defrauding investors. A San Jose jury convicted Theranos founder Elizabeth Holmes on four counts of fraud, deciding that she lied to investors while raising more than $700M in funds for the company. Holmes was found not guilty on four other counts relating to defrauding patients, though Theranos ended up voiding tens of thousands of erroneous test results. Each conviction carries a maximum twenty-year sentence, although Holmes is widely expected to appeal.

The Gist: It’s rare that tech executives are convicted of fraud. Investors, including many health systems, have been flooding healthcare startups with large sums of cash in hopes of big returns. But the Theranos debacle is a reminder that Silicon Valley’s “fake it till you make it culture” is not always the best fit for healthcare. Providers must continue to hold new medical technologies to high standards, regardless of how much promise they hold to “revolutionize” aspects of patient care.


GRAPHIC OF THE WEEK

A key insight or teaching point from our work with clients, illustrated in infographic form.

Consumer confidence unshaken by Omicron—at least so far

While Omicron’s rapid spread is causing COVID hospitalizations to surge once again, the impact on consumer confidence may be different this time around. Drawing on the most recent data from analytics firm Strata Decision Technology, the graphic below shows how hospital volumes have fluctuated throughout the pandemic. Hospital volumes mostly returned to pre-COVID levels early last summer, until the Delta surge caused patients to begin avoiding care across all settings once again. It remains to be seen if the forty percent of consumers who said they were less likely to seek non-emergency care during the Delta surge feel similarly about the Omicron spike. So far, consumer sentiment seems to be holding steady at last summer’s levels, though we’re still a few weeks away from Omicron’s expected peak. As the pandemic enters its third year, it’s also likely that consumers who have been delaying care will simply be unwilling or unable to hold off any longer. But even if Omicron doesn’t dissuade consumers from seeking non-COVID care, health systems will be hard pressed to accommodate both COVID and non-COVID care amid worrisome staffing shortages.


THIS WEEK AT GIST—ON THE ROAD

What we learned this week from our work in the real world.

“We’re losing the nursing brain trust” 

Every hospital in America has been affected by the growing shortage of nursing talent as the pandemic persists. This week a health system chief operating officer shared her greatest concern about the future of the nursing workforce: “We’re under immense pressure to find any nurses we can to keep units and operating rooms open. But if I think about the long-term impact, what I am most worried about is losing our most experienced nurses en masse.” The average age of a nurse is 52, and 19 percent of nurses are over 65. Health systems have been facing a wave of retirements of Baby Boomer nurses, and the stresses of the pandemic, both in the workplace and at home, have dramatically accelerated the rate of tenured nurses leaving the profession, taking their well-honed clinical acumen with them. “We’re looking at ways to increase the nursing pipeline, but you can’t replace a nurse with decades of experience one-to-one with someone just out of school, and expect the same level of clinical management, particularly for complex patients,” our COO colleague shared.

In the near term, her system is looking at two sets of strategies to maintain the nursing “brain trust”. First, they hope to retain tenured nurses with job flexibility: “We’re not just losing nurses to retirement, we’re losing them to Siemens and Aetna—not because they are excited about that work, but because they don’t want to work a 12-hour shift. We have to be better about creating part-time, flexible schedules.” Second, they are piloting telenursing and decision-support solutions to provide guidance and a second set of eyes for new nurses. These tools have also helped in new nurse recruitment. We’d predict the workforce crisis will persist far beyond the pandemic, and require rethinking of training, process automation, and the boundaries of practice license. But in the near-term, retaining and upskilling the talent we have is essential to maintaining access and quality.


THIS WEEK AT GIST—ON THE PODCAST

All the headlines in healthcare policy, business, and more, in ten minutes or less every weekday morning.

In our last interview episode, we heard how UMass Memorial Health’s Hospital at Home Program doubled capacity in just a few months. Hospital at home is allowing providers to address social needs and medication adherence, Medical Director Dr. Taki Michaelidis said, and low-income patients are benefiting most from the program.

Coming up next Monday, Janelle Lee, VP of Talent Services at St. Joseph, MO-based Mosaic Life Care, discusses strategies to bolster nurse retention during the COVID crisis. In addition to financial incentives, Mosaic is allowing shift flexibility and increasing training and support for first-year nurses.

[Subscribe on Apple, Spotify, Google, or wherever fine podcasts are available.]


That’s all for this week, a modest start to the new year. We really appreciate your readership, and a special “thank you” to all who participated in our recent survey—we’re busy sorting through the results and will continue to make tweaks to the newsletter over the coming weeks to reflect your feedback. (For the handful of die-hard music fans out there, don’t worry…the record reviews will be back soon!)

In the meantime, we hope you’ll share the Weekly Gist with your friends and colleagues, and encourage them to subscribe, and to listen to our daily podcast. It’s going to be a crazy year in healthcare, and we’re excited to watch it unfold with our readers and listeners.

As ever, please let us know if there’s anything we can do to be of assistance in your work. You’re making healthcare better—we want to help!

Best regards,

Chas Roades
Co-Founder and CEO
chas@gisthealthcare.com

Lisa Bielamowicz, MD
Co-Founder and President
lisa@gisthealthcare.com