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The Latest on Viruses

National Institute for Health Care Management (NIHCM)

As COVID-19 hospitalizations are declining, many hospitals are updating the traditional hospital design model to better accommodate the next pandemic. Some familiar viruses, such as influenza, have returned in unexpected ways while other viruses, including monkeypox and enterovirus, have become more prevalent. 

  • Influenza: With COVID-19 precautions continuing to weaken and fewer individuals immunized against influenza, health officials are warning that this fall and winter may be an exceptionally severe flu season and that cases may begin to rise earlier than usual. The projected rise in flu and COVID-19 cases this winter could result in the long-feared "twindemic."
  • Monkeypox Cases: The US reported almost two-fifths of the world’s monkeypox cases. While new cases and serious complications are still occurring, transmission in the US appears to be slowing down. The CDC recommends that the monkeypox antiviral be reserved only for people at high risk for severe disease.
  • Perception of Monkeypox: Awareness of monkeypox surged over the summer in the US and public health experts continue to warn about stigmatizing monkeypox messaging as was the case during the HIV/AIDS epidemic. Increased awareness of monkeypox has also been accompanied by increased scrutiny for many individuals with skin conditions. For those that have contracted the lesion-causing virus, it continues to impact both physical and mental health.
  • EV-D68 in Children: In September, the CDC issued a health advisory about the nationwide increase in pediatric hospitalizations with severe respiratory illness who also tested positive for rhinovirus or enterovirus EV-D68. In rare cases, this virus can cause polio-like symptoms in children.
 

One in 4 Clinicians Want to Leave Healthcare, Citing Burnout. Here's What Providers Can Do to Stem the Tide

Fierce Healthcare | By Heather Landi
 
About one out of four clinicians in the U.S. are considering leaving healthcare, primarily due to unrelenting burnout.
 
Even among doctors and nurses who want to stay in healthcare, about a third are considering switching employers, according to a Bain and Company survey. Research shows that around half of clinicians surveyed report their mental health has declined since the start of the pandemic.
 
Of those considering leaving the field entirely, 89% cite burnout as the main cause, the consultancy firm's survey of nearly 600 clinicians found. Additionally, around 40% of all clinicians surveyed say they don’t have the resources they need to operate at full potential. They report a lack of effective processes and workflows, supplies and equipment. And 59% don’t believe their teams are adequately staffed.
 
Clinicians' dissatisfaction is also illustrated by drastically dropping Net Promoter Scores (NPS), a measure of their likelihood to recommend their employer. U.S. physicians’ NPS dropped 17 points from 36 points in 2020 to 19 points and this year, nurses weighed in with a dissatisfied NPS of 11 points, according to the company.
 
These challenges, including turnover and potential departure from the industry, come as the healthcare industry is already facing a tight labor market that is on track to be short 38,000 to 124,000 physicians by 2034, according to data from the Association of American Medical Colleges.
 
Aligned with the low NPS scores, hospital-based staff has the highest turnover rate, which increased 6.4 percentage points in the past year alone, according to NSI’s National Health Care Retention & RN Staffing Report. The staff RN turnover rate has reached 27%, exceeding the turnover rate for hospital staff overall (26%) for the first time…

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‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

The New York Times | By Reed Abelson and Margot Sanger-Katz

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan.

But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice.

In statements, most of the insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health.

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Open Enrollment Began 10/15. Are You Ready for Open Enrollment? Prepare by Previewing 2023 Health and Drug Plans Now.

Medicare Open Enrollment runs from October 15 to December 7, 2022. During this time, people eligible for Medicare can compare 2023 coverage options on Medicare.gov. Medicare.gov provides clear, easy-to-use information, as well as an updated Medicare Plan Finder, to allow people to compare options for health and drug coverage, which may change from year to year.

Medicare Plan Finder was updated with the 2023 Medicare health and prescription drug plan information on Saturday, October 1, 2022 to allow people to begin previewing health and drug plans before the enrollment period opens on October 15. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.

To view options for health and drug coverage, please visit the Medicare Plan Finder on Medicare.gov.

 

CMS Seeking to Create National Directory of Health Care Providers, Services

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released a request for information regarding the creation of a “national directory of health care providers and services.”
 
The effort – a major undertaking – could eventually lead to a new database that better connects home health agencies to patients, payers and other stakeholders. 
Specifically, the agency is seeking public input on what a directory of this kind would do for providers and patients. In essence, CMS sees it as a centralized system of provider and patient information that would facilitate care coordination, health information exchange and data reporting efforts.
 
In theory, it sounds like exactly what health care experts – both in and outside of home-based care – have been pining for over recent years. Data, reporting and health care information at large remains fragmented, which has resulted in “interoperability” becoming a buzz word. 
CMS believes the directory would be of help in its efforts to improve access to care, reduce clinician burden and support that interoperability throughout health care. 
 
“Easy access to accurate and useful provider directory information is critical for patients trying to find health care that best meets their individualized needs and preferences,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “CMS is seeking comment on how a National Directory of Health Care Providers and Services could better serve patients and reduce unnecessary burden placed on providers to maintain dozens of separate directories.”
The request-for-information period will be open until Dec. 6, 2022. 
 
“CMS is specifically requesting public feedback on the [directory] concept and potential benefits, provider types, entities and data elements that could be included to create value for the health care industry, the technical framework for a [directory], priorities for a possible phased implementation, and prerequisites and actions CMS should consider taking to address potential challenges and risks,” the CMS release read. 
 
CMS would obviously lead the directory. The agency also says the directory would utilize a “modern interoperable” technology that would allow payers to update their own directories from a single directory through an application programming interface (API).
 
Part of what the agency touted in its description of the directory is the enhancements it could make in the provider-payer relationship. 
 
As managed care gets more involved in both home health and home care – and agencies look to get into value-based care through risk-sharing with these plans – data sharing has become a major topic of conversation. 

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