California Hospitals See Massive Surge In Homeless Patients (KHN)
By Phillip Reese, Kaiser Health News Homeless patients made about 100,000 visits to California hospitals in 2017, marking a 28% rise from two years earlier, according to the most recent state discharge data. More than a third of those visits involved a diagnosis of mental illness, according to the Office of Statewide Health Planning and Development. By contrast, 6% of all hospital discharges in California during that time involved a mental health diagnosis. Health officials and homeless advocates attribute the trend to the surging number of people living homeless in California in recent years. From 2015 to 2017, the state’s homeless population grew by about 16%, to 134,000, according to point-in-time reports compiled by the U.S. Department of Housing and Urban Development. Those figures cover only a single day, and homeless advocates argue far more Californians experience homelessness at some point over the course of a year. Many researchers say California’s skyrocketing housing costs have helped drive the overall spike in homelessness. Studies also indicate that more than a quarter of people living on the streets are dealing with mental illness. Besides mental illness, a disproportionate number of homeless were hospitalized for treatment of HIV infections, alcohol and drug addictions, skin disorders, burns, drug overdoses and traumatic injuries. “The folks who are living in the streets are sicker than the general public,” said Christie Gonzales, director of behavioral health operations for Wellspace Health. Wellspace Health provides respite care to homeless patients in the Sacramento region after they are discharged from the hospital. “We tend to see more of them with injuries and trauma, co- occurring with alcohol and drug problems,” Gonzales said. Los Angeles County saw the most discharges involving homeless patients in 2017, with 35,234, followed by San Diego, Sacramento, Orange and San Francisco counties. The number of homeless patients treated in L.A. County grew by about 7,500 from 2015 to 2017, the largest numerical increase in the state. (That is largely due to the county’s size; the percentage growth in L.A. County homeless discharges was similar to the state average.) Among places with at least 5,000 hospital discharges in 2017, the counties with the highest proportion of discharges involving homeless patients were San Francisco, Yolo, Santa Cruz and Humboldt. In all four counties, homeless discharges made up at least 4% of all hospital discharges. “There is no housing out here,” said Nicole Ring-Collins, who manages a winter shelter program for Mercy Coalition of West Sacramento in Yolo County. “It is so expensive.” Providers who work with homeless people say it is no surprise they end up hospitalized at disproportionate rates. Living in deep poverty can lead to health problems. Many homeless people are driven to the streets by health issues, particularly mental illness and drug addiction. Most of their inpatient health care is paid for through Medi-Cal, the state-federal insurance program for the poor, or Medicare, the government insurance program for seniors and people with disabilities. “When folks are forced to live outside with no shelter, the trauma they experience can result in more medical issues,” said Noel Kammermann, executive director of Loaves and Fishes, a homeless services agency in Sacramento. Often, people living homeless do not see the doctor until they have a serious problem, Kammermann said. That lack of preventive care can lead to hospital stays. And living on the streets makes it all the more challenging to follow post-discharge instructions for rehabilitation and recovery. “You heal better at home,” said Peggy Wheeler, a vice president at the California Hospital Association. Homeless patients struggle after discharge when they “have to go right back out to the street for a wound that needs to heal or medicine that needs to be taken on a regular schedule,” she added. Hospitals across the state are working to provide respite care to the homeless after discharge, similar to the collaborative program at Wellspace in the Sacramento region, Wheeler said. Hospitals design such programs to lower readmission rates. The homeless “are more vulnerable to other things because they don’t have a home to go to convalesce,” said Trina Gonzalez, director of community integration at UC Davis Health. “We want to make sure they are connected to the appropriate follow up care.” Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento. This KHN story first published on California Healthline, a service of the California Health Care Foundation. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Analysis: Can States Fix The Disaster Of American Healthcare? (KHN)
By Elisabeth Rosenthal, Kaiser Health News Last week, California’s new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state’s healthcare system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and healthcare for undocumented immigrants up to age 26. The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his campaign — a system in which the state government would pay all the bills and effectively control the rates paid for services. (Many California politicians before him had flirted with such an idea, before backing off when it was estimated that it could cost $400 billion a year.) But in firing off this opening salvo, Newsom has challenged the notion that states can’t meaningfully tackle healthcare on their own. And he’s not alone. A day later, Gov. Jay Inslee of Washington proposed that his state offer a public plan, with rates tied to those of Medicare, to compete with private offerings. New Mexico is considering a plan that would allow any resident to buy in to the state’s Medicaid program. And this month, Mayor Bill de Blasio of New York announced a plan to expand healthcare access to uninsured, low-income residents of the city, including undocumented immigrants. For over a decade, we’ve been waiting for Washington to solve our healthcare woes, with endless political wrangling and mixed results. Around 70 percent of Americans have said that healthcare is “in a state of crisis” or has “major problems.” Now, with Washington in total dysfunction, state and local politicians are taking up the baton. The legalization of gay marriage began in a few states and quickly became national policy. Marijuana legalization seems to be headed in the same direction. Could reforming healthcare follow the same trajectory? States have always cared about healthcare costs, but mostly insofar as they related to Medicaid, since that comes from state budgets. “The interesting new frontier is how states can use state power to change the healthcare system,” said Joshua Sharfstein, a vice dean at Johns Hopkins Bloomberg School of Public Health and a former secretary of the Maryland Department of Health and Mental Hygiene. He added that the new proposals “open the conversation about using the power of the state to leverage lower prices in healthcare generally.” Already states have proved to be a good crucible for experimentation. Massachusetts introduced “Romneycare,” a system credited as the model for the Affordable Care Act, in 2006. It now has the lowest uninsured rate in the nation, under 4 percent. Maryland has successfully regulated hospital prices based on an “all payer” system. It remains to be seen how far the West Coast governors can take their proposals. Businesses — pharmaceutical companies, hospitals, doctors’ groups — are likely to fight every step of the way to protect their financial interests. These are powerful constituents, with lobbyists and cash to throw around. The California Hospital Association came out in full support of Newsom’s proposals to expand insurance (after all, this would be good for hospitals’ bottom lines). It offered a slightly less enthusiastic endorsement for the drug negotiation program (which is less certain to help their budgets), calling it a “welcome” development. It’s notable that his proposals didn’t directly take on hospital pricing, even though many of the state’s medical centers are notoriously expensive. Giving the state power to negotiate drug prices for the more than 13 million patients either covered by Medicaid or employed by the state is likely to yield better prices for some. But pharma is an agile adversary and may well respond by charging those with private insurance more. The governor’s plan will eventually allow some employers to join in the negotiating bloc. But how that might happen remains unclear. The proposal by Washington Gov. Inslee to tie payment under the public option plans to Medicare’s rates drew “deep concern” from the Washington State Medical Association, which called those rates “artificially low, arbitrary and subject to the political whims of Washington, D.C.” On the bright side, if Newsom or Inslee succeeds in making healthcare more affordable and accessible for all with a new model, it will probably be replicated one by one in other states. That’s why I’m hopeful. In 2004, the Canadian Broadcasting Corp. conducted an exhaustive nationwide poll to select the greatest Canadian of all time. The top-10 list included Wayne Gretzky, Alexander Graham Bell and Pierre Trudeau. No. 1 is someone most Americans have never heard of: Tommy Douglas. Douglas, a Baptist minister and left-wing politician, was premier of Saskatchewan from 1944 to 1961. Considered the father of Canada’s health system, he arduously built up the components of universal healthcare in that province, even in the face of an infamous 23-day doctors’ strike. In 1962, the province implemented a single-payer program of universal, publicly funded health insurance. Within a decade, all of Canada had adopted it. The United States will presumably, sooner or later, find a model for healthcare that suits its values and its needs. But 2019 may be a time to look to the states for ideas rather than to the nation’s capital. Whichever state official pioneers such a system will certainly be regarded as a great American. This story originally appeared on Kaiser Health News, and also ran in the New York Times. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Multiple Hospitals Evacuate As California Wildfires Spread
Multiple hospitals evacuated patients this week as the Camp Fire continued to spread across California, according to the state’s Department of Public Health. More than 300 patients across three general acute care hospitals, three skilled nursing facilities and six intermediate care facilities have evacuated since Nov. 10. Some facilities, like Los Robos Regional Medical Center in Thousand Oaks, have started repopulating their hospitals with evacuee patients, but most of the facilities remain non-operational, according to the Department of Public Health. The blaze forced Adventist Health Feather River Hospital to evacuate on Nov. 8, and damaged the lower level of the hospital, the chiller and utility area and most of the other outbuildings, according to the hospital’s website. Full damage from the fire is still being assessed, but in the meantime evacuated patients are staying at Enloe Hospital in Chico and Oroville Hospital in Oroville. A majority of Adventist Health’s staff have lost their homes, a representative for the hospital told Bloomberg News. The Camp Fire, which started on Thursday, Nov. 8 near Camp Creek Road in Butte County, has been recorded as the deadliest and most destructive wildfire in California history. The fire has killed 63 people and destroyed thousands of homes and commercial structures, according to the most recent Butte County Camp Fire Incident Update on Nov. 16 Camp Fire Incident Update 11.16.18 AM#CampFire #ButteCounty @ButteSheriff @CountyofButte @townofparadise @chicofd @chicopolice @CHP_Valley @CHP_Oroville @CHP_Chico #ButteCounty @CAL_FIRE pic.twitter.com/5DL7vSd6gZ — CAL FIRE Butte Unit/Butte County Fire Department (@CALFIRE_ButteCo) November 16, 2018 View the current status of active California wildfires on the map below:
2018 Election: Healthcare Issues Travelers Should Watch
One of the benefits of being a travel healthcare professional can be the opportunity to avoid hospital politics, but national politics are much harder to ignore. Many hot-button healthcare issues decided at the polls can have a direct impact on the travel healthcare job market, both positive and negative, and the 2018 midterm election on November 6 is no exception. Below, we’ve provided brief summaries on ballot initiatives across the country that could have tangible effects on the travel healthcare market. For those who need more information on when, where and how to vote in the midterms, check out our 2018 midterm election voting FAQ. 2018 Election Healthcare Issues California Prop 4, Children’s Hospital Bond Initiative Proposition 4, also known as the Children’s Hospital Bond Act Fund, would authorize $1.5 billion in bonds that would be used to award grants to children’s hospitals for construction, expansion, renovation, and equipment projects. With interest over 35 years, the bond’s total cost would be $2.9 billion. The bonds would be repaid over a period of time from the state’s General Fund, according to the state website. According to Ballotpedia, the $1.5 billion would be distributed as follows: 72 percent ($1.08 billion) to eight nonprofit hospitals providing comprehensive services to high volumes of children eligible for governmental programs and children with special health needs eligible for California Children’s Services. 18 percent ($270 million) to five University of California general acute hospitals, including the University of California, Davis Children’s Hospital; Mattel Children’s Hospital at University of California, Los Angeles; University Children’s Hospital at University of California, Irvine; University of California, San Francisco Children’s Hospital; and University of California, San Diego Children’s Hospital. 10 percent ($150 million) to public and private hospitals that provide pediatric services to children eligible for California Children’s Services Why this is important for travelers If approved by Californa voters, the massive cashflow could provide many positive benefits for both children’s facilities and travelers. Hospitals would be able to update, renovate or construct new units, which could improve quality of care for patients, improve the working environment for healthcare professionals and potentially provide staffing opportunities for travelers. Idaho Proposition 2, Medicaid Expansion Initiative Idaho Medicaid expansion advocates successfully petitioned and gathered 75,314 verified signatures to add a Medicaid expansion measure to the ballot. The petition met both state requirements to qualify the ballot measure, gathering at least 56,192 verified signatures that represented at least 18 of Idaho’s 35 legislative districts. An expansion would allow Idaho residents under 65 and earning incomes at 138 percent of the national poverty level to apply for Medicaid insurance. About 62,000 Idahoans would qualify for this coverage. Expansion would also bring in $105 million in costs to the state over 10 years and $200 million in savings, according to an independent analysis by The Milliman consulting firm. Why this is important for travelers Studies have shown that hospitals in Medicaid expansion states have not only saved tremendously on uncompensated care costs, but they also have also seen more newly-insured patients coming in for healthcare services. The increased patient needs and loosened revenue streams could result in more opportunities for healthcare travelers. You can read more about this issue in our Medicaid expansion guide. Massachusetts Question 1, Nurse-Patient Assignment Limits Initiative Approval of Question 1 in Massachusetts would establish a set nurse-to-patient ratio across all state hospitals, except during a public health emergency. This measure would also require the limits to be met without a reduction in staff, and would allow the Massachusetts Health Policy Commission to regulate and enforce the initiative, which could result in $25,000 per incident for hospitals that violate the mandated ratios. If approved, Massachusetts would become the second state with mandated nurse-to-patient ratios—currently, California is the only state that has them. According to an independent study by the Massachusetts Health Policy Commission, implementing the mandate would cost from $676 million to $949 million per year. They also estimated possible savings of $34 million to $47 million from reduced hospital length of stay and potential for improved patient care with increased nurse staffing. State hospitals would also need to increase staffing by 2,286 to 3,101 additional full-time equivalent nurses to comply with the mandated ratios, according to the study. Medical-surgical and psychiatric nurses would present the greatest needs for increased staffing. Why this is important for travelers Of all the healthcare initiatives voters will decide on at the polls this fall, Question 1 could have the biggest and most direct impact on travel nurses. Mandated ratios mean more nurse hiring, which also means significantly more opportunities for travel nurses. You can find more information additional details on the impact of this change by checking out our recent coverage of the ballot issue. Utah Utah Proposition 3, Medicaid Expansion Initiative Utah Gov. Gary Herbert signed a bill on March 27, 2018, for partial Medicaid expansion, directing the state to seek federal approval to expand Medicaid to 100% of the federal poverty level. The bill stipulated using the ACA enhanced federal match rate and adding a work requirement for the expansion population. The Center for Medicare and Medicaid Services (CMS) has not approved waivers to access the match rate until Utah approves a full expansion. In the meantime, Utah expansion advocates garnered enough petition signatures to add a competing bill to November ballots that would approve a full expansion. An expansion would provide an estimated 150,000 Utah residents with Medicaid coverage. Why this is important for travelers Studies have shown that hospitals in Medicaid expansion states have not only saved tremendously on uncompensated care costs, but they also have also seen more newly-insured patients coming in for healthcare services. The increased patient needs and loosened revenue streams could result in more opportunities for healthcare travelers. You can read more about this issue in our Medicaid expansion guide. Nebraska Nebraska Initiative 427, Medicaid Expansion Similar to Idaho and Utah, Nebraska advocates have submitted a petition to add a Medicaid expansion initiative to the midterm election ballot. Supporters filed more than 133,000 signatures on July 5 and a large enough majority
Kaiser proposes change to national labor partnership amid nursing union fractures, continued protests
Negotiations between healthcare company Kaiser Permanente and members of the Coalition of Kaiser Permanente Unions (CKPU) remain tense as nurses across the state continue the third and final week of planned protests at Kaiser-owned California facilities. Members of both parties met on May 7 to discuss details of the Coalition’s Labor Management Partnership, which was established between Kaiser and CKPU in 1997. Kaiser presented their new potential blueprints for this partnership, which would focus on individual bargaining with local union contracts expiring in 2018 or those who are entitled to wage reopeners, according to a company press release. The company plans to maintain provisions of existing agreements while bargaining new contracts, according to the release. “We asked union leadership to review our proposed improvements to the partnership agreement and provide feedback,” the company said in the press release. “The next step is to work in partnership with labor to have a final version of a new partnership agreement in the coming weeks.” CKPU fired back against the new bargaining format, saying the proposal represents a “top-down, unilateral” move that limits the coalition’s ability to negotiate under unified terms. “The unions of the Coalition are completely committed to Partnership and the great work we’ve done together, but any changes to the Partnership need to be discussed in national bargaining,” said Walter Allen, executive director of Office and Professional Employees International Union Local 30 in a press release. Healthcare workers at Kaiser Antelope Valley say, “Get your priorities straight, Kaiser! You made a 22% increase in profits from 2016-2017 — but you’re still trying to outsource jobs and lower wage scales.” #HealthcareJustice @BernardJTyson @RamonfBaez @DrRichardIsaacs pic.twitter.com/nAtauqza5D — SEIU-UHW (@seiu_uhw) May 10, 2018 In the meantime, California Kaiser workers will continue to picket healthcare facilities regarding claims of job outsourcing and layoffs until the end of the week. “I am confident our members will take unified action to say enough is enough,” said Ron Ruggiero, president of SEIU Local 105 in a release. “We deserve a great new contract and any partnership worth its name must be on equal terms. Our union, and our Coalition, are clear that this is what we are fighting for.” Union disputes delay contract negotiations The longstanding terms of the partnership, as well as the original dates for the National Bargaining, were thrown into disarray in March after more than half of the local nursing unions split from the CKPU one day before negotiations were scheduled to occur. Twenty one local unions with about 45,000 members split from CKPU, forming a new union called the Alliance of Health Care Unions (AHCU), according to a report from nwLaborPress. The remaining 13 unions in the CKPU still retain more than 80,000 members, most of which are based out of California. During a union meeting in 2017, SEIU United Healthcare Workers West (SEIU-UHW), the largest union in CKPU, pushed for more influence over CKPU decisions making. Additionally, SEIU-UHW made aggressive moves against Kaiser without overall CKPU approval, negotiating in private meetings and threatening to push contract issues to voters with a ballot initiative. Members of the newly formed AHCU said they had good partnerships with Kaiser and wanted to continue those relationships while still maintaining a unified voice–outside of the influence of unions still a part of the CKPU. The new union’s executive director Peter diCicco, founder and executive director of the original CKPU from 1997 to 2006, said joining AHCU feels like coming home. “But we’ve got our work cut out for us,” diCicco said in a press release. “We’re working to establish a new structure that builds on what worked best with the prior coalition, while addressing internal coalition issues that became obvious in recent years and ultimately drove the creation of this new Alliance.” The AHCU has not announced their plans for negotiating with Kaiser, but the potential is there for a compromise that satisfies both parties. The California Nurses Association, a union with National Nurses United that’s separate from the CKPU, successfully negotiated a tentative contract with Kaiser in April with provisions targeting staffing enhancements, wage increases and employee benefits.