July 15, 2022

The Weekly Gist: The What Lies Beneath Edition

by Chas Roades and Lisa Bielamowicz MD

Parallel revelations from the art world caught our attention this week. In Israel, a painting by celebrated 20th century Italian Modernist Amedeo Modigliani, the 1908 “Nude With a Hat”, was discovered to have concealed under its surface three sketches by the artist that had never been seen before. Using the same X-ray technology, curators in Scotland discovered a previously unseen self-portrait by Vincent Van Gogh, beneath his “Head of a Peasant Woman”. In both cases, the artists thought better of their previous work, and started over with new paintings. Before one of our enterprising radiologist readers gets any bright ideas, we might as well come clean. If you run the Weekly Gist through an X-ray machine, you’ll discover a 533-page “gold book” under the surface, featuring 37 best practices for improving hospital coding and documentation. Just let it lie. We did.

THIS WEEK IN HEALTHCARE

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

1. Biden Administration says that all hospitals must provide abortion care in emergencies. This week, federal health officials sent hospitals clarification that the federal Emergency Medical Treatment and Labor Act (EMTALA) protects the provision of abortion care during medical emergencies, regardless of state laws. The guidance also offers EMTALA as a possible legal defense for providers against state enforcement of antiabortion laws. Texas Attorney General Ken Paxton has already sued the Department of Health and Human Services (HHS) to set aside the guidance, claiming the agency is exceeding its authority.

The Gist: This latest federal action follows President Biden’s recent executive order directing federal agencies to protect access to reproductive care, and HHS’s warning that pharmacists refusing to dispense medications used to induce abortions could be violating federal civil rights laws. The Federal Trade Commission and Justice Department have also announced that they will enforce data privacy rules and pursue legal action against states that look to restrict patients from traveling to obtain abortion care. These quick federal actions, while limited, are an attempt provide clarity for providers trying to deliver lifesaving care in a timely manner, without running afoul of state laws. Some Democrats, however, argue that they don’t go far enough, and are pushing for the President to declare a public health emergency on abortion, though it’s not clear that would provide much patient benefit. Meanwhile, reports from Texas and other states with restrictive abortion laws reveal physicians are already delaying care for ectopic pregnancies and other life-threatening conditions, setting up all-but-certain legal action when patients experience adverse outcomes.

2. Expanded national mental health crisis hotline launches July 16. Individuals in crisis can dial 988 to speak with mental health professionals, receive immediate medical assistance, or be directed to treatment. Established by a 2020 law, the hotline is an expanded version of the previous National Suicide Prevention Lifeline, intended to provide Americans with a single mental health emergency access point, akin to 911.

The Gist: While 988 has the potential to help more Americans, as well as reduce some burden on overstressed first responders and hospital emergency rooms, media outlets are reporting concerns from national, state, and local partners that they lack adequate staffing and funding to handle the expected level of demand. The nation is long overdue for creating accessible, coordinated mental health crisis care, and this is a step in the right direction. But with one in six calls to the current hotline system now going unanswered, the rollout needs to be coupled with funding for local infrastructure needs.

3. “Superbug” infections and deaths rose in 2020. While the world’s attention was focused on fighting COVID-19, antibiotic-resistant infections were spreading. A Centers for Disease Control and Prevention (CDC) report finds that hospital-acquired infections and deaths from antimicrobial-resistant pathogens increased 15 percent in 2020, compared to 2019. COVID overwhelmed healthcare settings, shifting the focus of infection control resources, resulting in sicker patients with longer catheter and ventilator use, which increased infection risks. Plus, clinicians initially unsure of how to treat the new disease prescribed COVID patients antibiotics at unusually high rates, setting the stage for growing drug resistance.

The Gist: This uptick reverses years of progress made on reducing the number of superbug infections in hospitals. Prior to the pandemic, hospitals were becoming markedly safer places, with fewer hospital-acquired infections, adverse drug reactions, and poor procedural outcomes. As health systems exit COVID crisis mode, hospitals must renew their focus on these longstanding goals of the infection control agenda.

Plus—what we’ve been reading.

 

4. Acknowledging the losses that come with a new strategy. Embarking on a new strategy requires myriad organizational changes—which will inevitably come with losses. Some parts of the business, people, roles, processes, and traditions will inevitably be deemphasized, or even eliminated from the organization. A recent article in the Harvard Business Review identifies how leaders launching new strategies typically spend a significant amount of time trying to plan for the unpredictable future, while overlooking one of the most predictable parts of any change in strategy: what will be lost when something else is gained.

 

The Gist: It is critical to identify, acknowledge, and plan for these losses in adopting any new strategy, as the unexpressed fear of loss is a key driver of organizational inertia and resistance to change. With health systems deep in strategy development for the post-COVID marketleaders must take into account the wide range of challenges their organizations will face when it comes to reconfiguring investment, growth, competencies, and people, in addition to focusing on new areas of opportunity revealed by the pandemic. Failing to confront these tradeoffs head-on may sacrifice any strategic gains resulting from new initiatives.


GRAPHIC OF THE WEEK

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

 

Current state of President Biden’s healthcare policy agenda

With a closely divided Congress, President Biden has leaned heavily on regulatory actions to advance his healthcare priorities. With the midterm elections fast approaching, the graphic below assesses the impact of those actions, and outlines which legislative components Democrats may still try to pass before November. From the start, the administration has signaled the importance of promoting competition in healthcare markets, and has devoted more scrutiny to hospital mergers—while leaving most attempts at vertical integration unchallenged. Through Medicaid waivers, it has worked to expand insurance coverage, rolling back Trump-era work requirements, expanding postpartum coverage, and encouraging states to experiment with public option plans on the Affordable Care Act (ACA) exchanges. The Centers for Medicare and Medicaid Services (CMS) has continued the steady march toward value programs, revising the Direct Contracting model to factor in health equity. Despite these incremental moves, Medicare Advantage (MA) remains the focus of long-term efforts to control Medicare spending, and MA programs have seen payments boosts year-over-year. Meanwhile, the fate of President Biden’s signature healthcare campaign promises remains in the hands of an intransigent Congress. Senate Democrats are currently trying to negotiate a deal on a bill allowing Medicare drug negotiations and extending ACA subsidies, an important provision to protect millions from receiving premium hike notices just weeks before Election Day.


INTERMISSION

A recommendation from our weekly diet of music, movies, TV, and other good stuff.

Fear Fear by Working Men’s Club—Checking in from the synthpop quadrant of the post-punk revival (let’s call it the “joy” division), this West Yorkshire quartet’s second LP is full of danceable darkwave delights. Catch those Factory feels all over again—the Haçienda sound is alive and well.


THIS WEEK AT GIST—ON THE ROAD

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

COVID is not done with us, part six (…seven? eight?)

The rise of ubiquitous self-testing and the paucity of accurate, timely data from the CDC on COVID numbers has left us feeling our way in the dark in terms of the current state of the pandemic. Clearly there’s a new surge underway, driven by the BA.5 variant. What we can report from our experiences on the road over the past few weeks is that the wave is significant. We’re hearing from our health system members that inpatient COVID volumes and COVID-related ED visits are significantly up again—often double or more what they were just two months agoalthough still well below levels of past surges. Length of stay for COVID inpatients is shorter, with fewer ICU visits than during the Delta surge—about the same intensity, proportionally, as during Omicron. But COVID-related staffing shortages are once again having a real impact on hospitals’ ability to deliver care—clinical and non-clinical staff callouts are at high levels again, as during Omicron. One piece of good news: masking is back in vogue among many health system executive teams, likely in response to a number of “superspreader” events: gatherings of hospital staff over the past few weeks that resulted in clusters of cases. One system described an all-hands session for anesthesiologists that resulted in more than a dozen cases across the next week—forcing the hospital to cancel procedures. We’re worried that this BA.5 surge is just getting started, and with booster uptake stagnating and masking all but nonexistent in the general population, the late summer and early autumn situation could be significantly worse. Be careful out there.


THIS WEEK AT GIST—ON THE PODCAST

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

Coming up this Monday, we’ll hear from Will Schpero, Ph.D., a health economist and assistant professor at Weill Cornell Medical College. He’ll discuss how the new requirement for Medicaid programs to cover the routine costs of clinical trials presents an opportunity to greatly improve diverse patient representation in cutting-edge clinical research.

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


That’s all for now. Hope you’re finding a way to dodge the sweltering heat, and your summer plans include refreshing swims and cool beverages. Thanks for taking time to read the Weekly Gist! Don’t forget to let your friends and colleagues know about us—we’d love for them to subscribe, and check out our awesome podcast.

As ever, please don’t hesitate to reach out if we can 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