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
Healthcare Tops Guns, Economy As Voters’ Top Issue
By Phil Galewitz, Kaiser Health News Healthcare has emerged as the top issue for voters headed into the midterm elections, but fewer than half of them say they are hearing a lot from candidates on the issue, according to a new poll released Thursday. Seven in 10 people list healthcare as “very important” as they make their voting choices, eclipsing the economy and jobs (64 percent), gun policy (60 percent), immigration (55 percent), tax cuts (53 percent) and foreign policy (51 percent). When asked to choose just one issue, nearly a third picked health care, according to the survey by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) Still, midterm elections are traditionally a referendum on the president and his party, and that holds true this year as two-thirds of voters say a candidate’s support or opposition to President Donald Trump will be a major factor in their voting decision, the poll found. Health care was also the top issue chosen overall by voters living in areas identified in the survey as political battlegrounds, although the results varied when pollsters drilled down to political parties. Nearly 4 in 10 Democratic battleground voters and 3 in 10 independents chose health care as their most important issue in voting for Congress. Among Republican voters, immigration was their top issue, garnering 25 percent compared with 17 percent for health care. The poll results in two battleground states — Florida and Nevada — also underscored voters’ interest for keeping the Affordable Care Act’s protections for people with preexisting conditions, one of the most popular provisions in the law. Democrats have made that a key part of their campaign, pointing to Republicans’ votes to repeal the entire law and trying to drive home the message that the GOP’s efforts would strip that guarantee. Nonetheless, Republicans have recently sought to fight back on that issue, promising on the stump and in campaign ads that they understand the need to keep the protections and would work to do that. Nearly 7 in 10 Florida voters said they are more likely to vote for a candidate who wants to maintain the protections for people with preexisting conditions, while 9 percent said they are more likely to vote for a candidate who wants to eliminate these protections. In Nevada, nearly 70 percent of voters also said they wanted the ACA preexisting protections guaranteed. In Florida, where the deadliest mass school shooting in American history took place last February, health care also was the top issue among voters. Twenty-six percent of Florida voters listed health as their top issue. The economy and gun policy tied for the second-biggest issue at 19 percent. The shooting at Marjory Stoneman Douglas High School in Parkland, Fla., left 17 students and staff members dead, spurred massive marches around the country and stirred national debate on gun policy. Florida is traditionally a key battleground state but more so this year with close races for the U.S. Senate and governor’s race hanging in the balance. Nearly half of Florida voters said they are more likely to vote for a candidate who wants to expand Medicaid. Florida is one of 17 states that has chosen not to expand Medicaid under the health law, leaving tens of thousands of its adult residents without health insurance. The Republican-controlled legislature has refused to accept millions of dollars in federal funding to extend the coverage. Two in 10 Democratic voters in Florida said support for a candidate supporting a national health plan, or “Medicare-for-all,” is the most important healthcare position for a candidate to take. Andrew Gillum, the Florida Democratic gubernatorial nominee, has said he would support a national health plan. In Nevada, which also has a key Senate battle, the poll found nearly a quarter of voters said health care was the top issue in their decisions this year, but immigration and the economy were very close behind. Nearly a third of Democrats in Nevada said they are looking for a candidate who supports a single-payer health plan. Just under a third of Republicans in Florida and Nevada said that a candidate’s support of repealing the ACA is the most important health issue when they vote. The poll of 1,201 adults was conducted Sept. 19-Oct. 2. The national survey has a margin of error of +/-3 percentage points. This article originally appeared on Kaiser Health News 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.
Panama City Hospitals Closed, Evacuating Patients After Hurricane Michael
Panama City’s largest healthcare facilities have mostly shut down in the wake of Hurricane Michael’s impact on Wednesday and began evacuating patients Thursday morning. Gulf Coast Regional Medical Center said the hospital’s ER will remain open, but main hospital services have been suspended. Bay Medical Center Sacred Heart (BMSH) began evacuations at 3 a.m. Thursday morning and moved patients to Sacred Heart Hospital in Pensacola, Florida, Providence Hospital in Mobile, Alabama and St. Vincent Healthcare in Jacksonville, Florida, according to a Twitter post. About 200 patients, including 39 intensive care patients, will be evacuated over a 48-hour period. The hospital said no patients were injured during the storm. “All patients, family members, and staff are safe and patient care will continue until the last patient is transferred,” BMSH CEO Scott Campbell said in a press release. “If patients do not have a family member or other support persons with them at the hospital, we are reaching out to their emergency contacts.” 1 of the County Hospitals (Sacred Heart) aka Bay Medical Center on MLK … Gulf Coast Regional has suffered damage as well. Waiting to hear back from them regarding where my Grandmother is being transported. #hurricanemichael #panamacity pic.twitter.com/m6Rg0bJLOV — L Miller (@ohlizalizaliza) October 11, 2018 The hospital sustained significant structural and water damage, including a section of roof that collapsed in the hospital’s materials management building which damaged items needed for long-term care. The hospital plans to keep the ER open as the generator still has power. “Our staff and physicians have demonstrated extraordinary dedication throughout this crisis, providing exemplary care for our patients,” Campbell said. “This has been a truly noble effort and we are deeply grateful for their sacrifice.”
Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model
By Sandra G. Boodman, Kaiser Health News Calvin Brown doesn’t have a primary care doctor — and the peripatetic 23-year-old doesn’t want one. Since his graduation last year from the University of San Diego, Brown has held a series of jobs that have taken him to several California cities. “As a young person in a nomadic state,” Brown said, he prefers finding a walk-in clinic on the rare occasions when he’s sick. “The whole ‘going to the doctor’ phenomenon is something that’s fading away from our generation,” said Brown, who now lives in Daly City outside San Francisco. “It means getting in a car [and] going to a waiting room.” In his view, urgent care, which costs him about $40 per visit, is more convenient — “like speed dating. Services are rendered in a quick manner.” Brown’s views appear to be shared by many millennials, the 83 million Americans born between 1981 and 1996 who constitute the nation’s biggest generation. Their preferences — for convenience, fast service, connectivity and price transparency — are upending the time-honored model of office-based primary care. Many young adults are turning to a fast-growing constellation of alternatives: retail clinics carved out of drugstores or big-box retail outlets, free-standing urgent care centers that tout evening and weekend hours, and online telemedicine sites that offer virtual visits without having to leave home. Unlike doctors’ offices, where charges are often opaque and disclosed only after services are rendered, many clinics and telemedicine sites post their prices. A national poll of 1,200 randomly selected adults conducted in July by the Kaiser Family Foundation for this story found that 26 percent said they did not have a primary care provider. There was a pronounced difference among age groups: 45 percent of 18- to 29-year-olds had no primary care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50 to 64 and 12 percent age 65 and older. (Kaiser Health News is an editorially independent program of the foundation.) A 2017 survey by the Employee Benefit Research Institute, a Washington think tank, and Greenwald and Associates yielded similar results: 33 percent of millennials did not have a regular doctor, compared with 15 percent of those age 50 to 64. “There is a generational shift,” said Dr. Ateev Mehrotra, an internist and associate professor in the Department of Health Care Policy at Harvard Medical School. “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives,” from shopping to online banking. So is speed. Younger patients, Mehrotra noted, are unwilling to wait a few days to see a doctor for an acute problem, a situation that used to be routine. “Now,” Mehrotra said, “people say, ‘That’s crazy, why would I wait that long?’” Until recently, the after-hours alternative to a doctor’s office for treatment of a strep throat or other acute problem was a hospital emergency room, which usually meant a long wait and a big bill. Luring Millennials For decades, primary care physicians have been the doctors with whom patients had the closest relationship, a bond that can last years. An internist, family physician, geriatrician or general practitioner traditionally served as a trusted adviser who coordinated care, ordered tests, helped sort out treatment options and made referrals to specialists. But some experts warn that moving away from a one-on-one relationship may be driving up costs and worsening the problem of fragmented or unnecessary care, including the misuse of antibiotics. A recent report in JAMA Internal Medicine found that nearly half of patients who sought treatment at an urgent care clinic for a cold, the flu or a similar respiratory ailment left with an unnecessary and potentially harmful prescription for antibiotics, compared with 17 percent of those seen in a doctor’s office. Antibiotics are useless against viruses and may expose patients to severe side effects with just a single dose. “I’ve seen many people who go to five different places to be treated for a UTI [urinary tract infection] who don’t have a UTI,” said Dr. Janis Orlowski, a nephrologist who is chief health care officer at the Association of American Medical Colleges, or AAMC. “That’s where I see the problem of not having some kind of continuous care.” “We all need care that is coordinated and longitudinal,” said Dr. Michael Munger, president of the American Academy of Family Physicians, who practices in Overland Park, Kan. “Regardless of how healthy you are, you need someone who knows you.” The best time to find that person, Munger and others say, is before a health crisis, not during one. And that may mean waiting weeks. A 2017 survey by physician search firm Merritt Hawkins found that the average wait time for a new-patient appointment with a primary care doctor in 15 large metropolitan areas is 24 days, up from 18.5 days in 2014. While wait times for new patients may reflect a shortage of primary care physicians — in the view of the AAMC — or a maldistribution of doctors, as other experts argue, there is no dispute that primary care alternatives have exploded. There are now more than 2,700 retail clinics in the United States, most in the South and Midwest, according to Rand Corp. researchers. Connecting With Care To attract and retain patients, especially young adults, primary care practices are embracing new ways of doing business. Many are hiring additional physicians and nurse practitioners to see patients more quickly. They have rolled out patient portals and other digital tools that enable people to communicate with their doctors and make appointments via their smartphones. Some are exploring the use of video visits. Mott Blair, a family physician in Wallace, N.C., a rural community 35 miles north of Wilmington, said he and his partners have made changes to accommodate millennials, who make up a third of their practice. “We do far more messaging and interaction through electronic interface,” he said. “I think millennials expect
High-Deductible Health Plans Fall From Grace In Employer-Based Coverage
Jay Hancock, Kaiser Health News With workers harder to find and Obamacare’s tax on generous coverage postponed, employers are hitting pause on a feature of job-based medical insurance much hated by employees: the high-deductible health plan. Companies have slowed enrollment in such coverage and, in some cases, reinstated more traditional plans as a strong job market gives workers bargaining power over pay and benefits, according to research from three organizations. This year, 39 percent of large, corporate employers surveyed by the National Business Group on Health (NBGH) offer high-deductible plans, also called “consumer-directed” coverage, as workers’ only choice. For next year, that figure is set to drop to 30 percent. “That was a surprise, that we saw that big of a retraction,” said Brian Marcotte, the group’s CEO. “We had a lot of companies add choice back in.” Few if any employers will return to the much more generous coverage of a decade or more ago, benefits experts said. But they’re reassessing how much pain workers can take and whether high-deductible plans control costs as advertised. “It got to the point where employers were worried about the affordability of health care for their employees, especially their lower-paid people,” said Beth Umland, director of research for health and benefits at Mercer, a benefits consultancy that also conducted a survey. The portion of workers in high-deductible, job-based plans peaked at 29 percent two years ago and was unchanged this year, according to new data from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) Deductibles — what consumers pay for health care before insurance kicks in — have increased far faster than wages, even as paycheck deductions for premiums have also soared. One in 4 covered employees now have a single-person deductible of $2,000 or more, KFF found. Employers and consultants once claimed patients would become smarter medical consumers if they bore greater expense at the point of care. Those arguments aren’t heard much anymore. Because lots of medical treatment is unplanned, hospitals and doctors proved to be much less “shoppable” than experts predicted. Workers found price-comparison tools hard to use. High-deductible plans “didn’t really do what employers hoped they would do, which is create more sophisticated consumers of health care,” Marcotte said. “The health care system is just way too complex.” At the same time, companies have less incentive to pare coverage as Congress has repeatedly postponed the Affordable Care Act’s “Cadillac tax” on higher-value plans. Although deductibles are treading water, total spending on job-based health plans continues to rise much faster than the overall cost of living. That eats into workers’ pay in other ways by boosting what they contribute in premiums. Employer-sponsored group health plans, which insure 150 million Americans — nearly half the country — tend to get less attention than politically charged coverage created by the ACA. For these employer plans, the cost of family coverage went up 5 percent this year and is expected to rise by a similar amount next year, the research shows. Insuring one family in a job-based plan now costs on average $19,616 in total premiums, the KFF data show. The American worker pays $5,547 of that in a country where the median household income is more than $61,000. The KFF survey was published Tuesday; the NBGH data, in August. Mercer has released preliminary results showing similar trends. The recent cost upticks, driven by specialty drug costs and expensive treatment for diseases such as cancer and kidney failure, are an improvement over the early 2000s, when family-coverage costs were rising by an average 7 percent a year. But they’re still nearly double recent rates of inflation and increases in worker pay. Such growth “is unsustainable for the companies I have been working with,” said Brian Ford, a benefits consultant with Lockton Companies, echoing comments made over the decades by experts as health spending has vacuumed up more and more economic resources. For now at least, many large employers can well afford rising health costs. Earnings for corporations in the S&P 500 have increased by double-digit percentages, driven by federal tax cuts and economic growth. Profit margins are near all-time highs. But for workers and many smaller businesses, health costs are a heavier burden. Premiums for family plans have gone up 55 percent in the past decade, twice as fast as worker pay, according to KFF. Employers’ latest cost-control efforts include managing expenses for the most expensive diseases; getting workers to use nurse video-chat services and other types of “telemedicine”; and paying for primary care clinics at work or nearby. At the “top of the list” for many companies are attempts to manage the most expensive medical claims — cases of hemophilia, terrible accidents, prematurely born infants and other diseases — that increasingly cost as much as $1 million each, Umland said. Employers point such patients to the highest-quality doctors and hospitals and furnish guides to steer them through the system. Such steps promise to improve results, reduce complications and save money, she said. On-site clinics cut absenteeism by eliminating the need for employees to drive across town and sit in a waiting room for two hours to get a rash or a sniffle checked or get a vaccine, consultants say. Almost all large employers offer telemedicine, but hardly any workers use it. Thirty-nine percent of the larger companies covering telemedicine now make it comparatively less expensive for workers to consult doctors and nurses virtually, the KFF survey shows. This story originally appeared on Kaiser Health News. 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.
U.S. News Releases 2018-19 Best Hospitals List
U.S. News & World Report released their 2018-19 Best Hospitals rankings on Tuesday, which annually compiles evaluations on more than 5,000 medical facilities nationwide, according to their site. Mayo Clinic in Rochester, Minnesota, Cleveland Clinic and John Hopkins Hospital in Baltimore, Maryland took the top three spots for another year. This marks the third consecutive year Mayo Clinic was recognized as the No. 1 hospital in the publication’s “Best Hospitals Honor Roll.” “We are humbled and honored to be recognized by U.S. News & World Report,” said John Noseworthy, M.D., president and CEO of Mayo Clinic in a press release. “This ranking recognizes Mayo Clinic as a destination medical center for patients with complex and serious illnesses, our staff’s total commitment to patient care, and the extraordinary depth and breadth of our medical practice.” Hospitals are ranked using a points system that evaluates performance in 16 areas of specialty care and for “bellwether procedures and conditions such as heart bypass, hip and knee replacement, heart failure and lung cancer surgery.” Facilities were also awarded additional points if they ranked in one of 16 specialty areas, like cancer, cardiology or neurology. Below are the top 20 facilities that made the U.S. News & World Report Best Hospitals Honor Roll. You can read more information about their selection process here. You can also find the full list of top hospitals by specialty and state, as well as the top children’s hospitals by clicking here. 2018-19 Best Hospitals Honor Roll Mayo Clinic, Rochester, Minnesota Cleveland Clinic Johns Hopkins Hospital, Baltimore Massachusetts General Hospital, Boston University of Michigan Hospitals-Michigan Medicine, Ann Arbor UCSF Medical Center, San Francisco UCLA Medical Center, Los Angeles Cedars-Sinai Medical Center, Los Angeles Stanford Health Care-Stanford Hospital, Stanford, California New York-Presbyterian Hospital, New York (Tie) Barnes-Jewish Hospital, St. Louis (Tie) Mayo Clinic Phoenix Northwestern Memorial Hospital, Chicago Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia (Tie) NYU Langone Hospitals, New York (Tie) UPMC Presbyterian Shadyside, Pittsburgh Vanderbilt University Medical Center, Nashville, Tennessee Mount Sinai Hospital, New York Duke University Hospital, Durham, North Carolina Brigham and Women’s Hospital, Boston