Younger, healthier patients are getting treated
An increased risk for vaccinated Americans too
‘Only way we’re going to stop this monster’
This post originally posted here CNN.com – RSS Channel – HP Hero
This post originally posted here CNN.com – RSS Channel – HP Hero
NHS Grampian said both Aberdeen Royal Infirmary and Dr Gray’s Hospital in Elgin, Moray have now been forced to postpone and cancel non-urgent elective operations due to a sharp rise in Covid patients. Both trusts have also seen a rise in staff members needing to self-isolate due to the virus. NHS Grampian medical director Professor Nick Fluck said: “This is a dynamic situation, subject to change throughout each day.
“I can confirm that both Aberdeen Royal Infirmary and Dr Gray’s Hospital have been at black status in recent days.
“Choosing to cancel procedures or appointments is never a decision we take lightly; however it is our only option if we are to relieve some of the pressure and allow staff to concentrate on the most urgent and emergency care.
“I know it is distressing for people to have procedures or appointments postponed, sometimes at very short notice. I apologise to anyone who has been affected by this.
“We will work to reschedule these, but we cannot offer any guarantees at present about when this might happen.
“If you are accessing any healthcare services, please be aware delays are likely.”
This comes as coronavirus cases, deaths and hospital admissions have begun to rise rapidly in Scotland.
According to the Scottish Government, 3,799 new cases were reported north of the border.
Since June 13, case levels have risen sharply and have exceeded 2,000 a day since June 21.
First Minister, Nicola Sturgeon has claimed the final easing of restrictions is not set in stone due to the rising case levels.
Scotland is due to proceed to level 0 on July 19 as England also lifts all restrictions.
She claimed lifting restrictions must be done in a reasonable and controlled manner due to the increasing case numbers.
Ms Sturgeon told the BBC: “We are looking at this very carefully.
“My biggest concern right now is that even though we are seeing a weakening of the link between cases and hospitalisations, if we have a high number of cases even a lower proportion of those cases ending up in hospital can put pressure on our NHS.”
This is a breaking news story, more to follow…
Author: Bill McLoughlin
Read more here >>> Daily Express :: UK Feed
SAN ANTONIO – For decades, the prices of procedures at most hospitals have been nearly impossible to find.
Now, hospitals in the U.S., including San Antonio, are posting the prices of their medical procedures online as a new federal rule and state law takes effect.
The mandates require hospitals to make public the costs of procedures, including those charged to insurance companies through negotiated rates and cash prices charged to uninsured patients.
A federal rule aimed at increasing transparency and helping people save money by comparing rates went into effect in January and was created by the Trump administration in 2019, according to a Kaiser Health News article.
The Texas Legislature followed that federal rule by passing a similar state law this year in Senate Bill 1137. Recently signed by Gov. Greg Abbott, the Texas Pricing Transparency Act takes effect Sept. 1.
Still, the price estimator tools are not front and center on most hospitals’ websites. KSAT has posted links to the local hospitals below.
If you are looking for prices from other hospitals, you can try using a search engine like Google and terms including the name of the hospital and “hospital prices” or “price estimator tools.”
According to an NPR article by Julie Appleby, it’s still an unanswered question whether the price transparency mandates will lead to lower prices for patients and it can be confusing for some.
Author: Raven Jordan
Read more here >>> Texas News
NEW DELHI — At 9:45 p.m., alarms blared across the intensive care unit of Jaipur Golden Hospital. Over two dozen patients on ventilators couldn’t breathe. Some flailed their arms and legs. Others cried for help, choking sounds coming from their throats as if they were being strangled.
Mechanics sprinted to the maintenance room to see what was wrong. Nurses grabbed small plastic pumps to fill the lungs of critically ill patients by hand.
It wasn’t enough. Jaipur Golden, a respected hospital in Delhi, had run out of medical oxygen. Over the next seven hours, 21 coronavirus patients died.
“Nobody can forget that night,” said Shaista Nigar, the hospital’s nursing superintendent. “It was a total breakdown.”
India is a major producer of compressed oxygen. But the Indian government moved too late to distribute supplies.
State governments feuded over oxygen and seized tankers, creating bottlenecks and delays.
Delhi city officials didn’t build systems to produce or store oxygen and struggled to allocate dwindling supplies. When tight supplies and government missteps led oxygen to run out at Jaipur Golden, some families said the hospital offered no warning.
Without a comprehensive coronavirus plan, Mr. Modi’s government has left much of the burden to states, cities, hospitals and even individuals. The oxygen crisis tragically revealed the limits of a do-it-yourself approach.
That approach will be tested again. Though infections have dropped, a vaccine shortage puts India at risk of a third wave. Without adequate preparations, the second wave’s tragedies could return.
“With an effective surge plan,” said Robert Matiru, a director at Unitaid, a health initiative affiliated with the World Health Organization, “this could have been averted.”
Anuradha Bansal had a 102-degree fever when she checked into Jaipur Golden on April 13. A veteran schoolteacher, Ms. Bansal had tested positive for Covid-19, along with her husband, Atul, and their two daughters.
Jaipur Golden had a good reputation. A four-story private hospital, it offered specialties like orthopedics and pediatric gastroenterology. Its motto was “We Care … With Care.”
But Ms. Bansal was shocked by the crowds filling Jaipur Golden and other hospitals in Delhi. Sick people packed the reception area, some leaning against the walls. In her Covid-19 ward, she said, extra beds had been squeezed in.
Her husband, Atul, a lawyer, was lying on his back in the I.C.U. down the hall, a plastic oxygen mask strapped to his face. He had been healthy for his 54 years, a strong swimmer who could hold his breath for minutes and ate a wholesome diet of beans, whole grain flour and yogurt.
Across northern India, medical oxygen was running short as Covid-19 caseloads soared. In one month, Delhi’s daily count had jumped to 13,468 from 419. Delhi’s 650 hospitals and nursing homes were so deluged that they were shutting their gates, leaving people to die at the curb or in their cars.
Though the tragic experiences of other places, like Egypt, showed what happens when oxygen runs out, India was still unprepared. It produces about 7,100 metric tons of liquid oxygen a day, mostly for industrial use. At the pandemic’s peak, India’s demand soared to 9,500 metric tons a day.
Worse, the oxygen was in the wrong place. Most was produced near steel plants in eastern India, hundreds of miles from hot spots like Delhi.
In November, a parliamentary committee urged leaders “to ensure that the oxygen inventory is in place.” A plan was unveiled to eventually build more than 160 plants that pull oxygen from the atmosphere for hospital use. Hospitals expanded their oxygen storage capacity by one-third, according to government figures.
As the second wave surged, it was clear that the efforts weren’t enough. Only about one-fifth of the oxygen plants had been built. The extra storage represented only a quarter of India’s emergency needs. Oxygen supplies were still concentrated in specific regions.
On April 15, the Modi government essentially nationalized India’s medical oxygen and dictated each state’s allotment. Air Force planes would airlift empty cryogenic tanker trucks to places like the Tata Steel plant in Odisha State, where they would be filled with liquid oxygen, put on special train cars and moved more than 1,000 miles to Delhi.
Still, much of the burden remained with the states. In an April 17 meeting, Dr. Harsh Vardhan, India’s health minister, urged 11 state health chiefs to “plan in advance” and increase medical infrastructure, including oxygenated beds, “to deal with any further surge in cases.”
Delhi officials warned that the central government wasn’t giving them enough. The Modi government allocated about 350 metric tons of oxygen a day to the capital. Delhi needed twice that and, in court proceedings, accused the government of basing the city’s allocation on prepandemic needs. The central government cited desperate needs in other places.
In the meantime, the crowds of sick people at the gates of Jaipur Golden and other hospitals were growing.
By April 20, Jaipur Golden was overstretched and undersupplied.
“My father was seething from inside,” said Rohit Gupta, a sales manager in Delhi whose father, Satish Kumar Gupta, had been admitted to the I.C.U. in early April. The younger Mr. Gupta said his father soiled the bed because nobody helped him go to the bathroom.
Mr. Gupta said his father cried out, “Take me away from here.” The hospital declined to comment.
As the national government doled out limited amounts of oxygen, officials in Delhi grew increasingly worried. Its hospitals had built only one small oxygen-generating plant because there had previously been little need, said Manish Sisodia, Delhi’s deputy chief minister. And Delhi could store only about one day’s worth of its pandemic needs at its hospitals and in a city-owned tank.
“The neighborhood supply has long been adequate,” Mr. Sisodia said. “The problem only came when the plants that were regularly supplying Delhi were asked to apportion some to other states.”
He appealed to the central government on Twitter, saying major hospitals had only enough for a few hours.
As supplies dwindled, Delhi’s oxygen was increasingly being confiscated by other states.
On April 21, officials in Haryana State stopped a Delhi-bound tanker. Officials in Uttar Pradesh did the same. In Rajasthan, officials briefly seized several.
The reason was simple: People in other states were also dying from a lack of oxygen. “If we have any left over,” Anil Vij, Haryana’s health minister, said to local media, “then we will give it.”
Delhi sent police officers to the Haryana border, and the tanker was allowed to proceed.
That day, Delhi received only 178 metric tons of liquid oxygen — half of what the central government had allocated and about a quarter of what the city needed.
A Delhi court ordered the central government to stop other states from interfering with oxygen shipments. Just to make sure, Delhi began sending police escorts with the oxygen tankers.
To fill the gaps, tankers were hastily imported from other countries, but some were incompatible with Indian oxygen tanks. Mr. Sisodia recalled his emergency response team Googling different solutions in one frenzied effort that went from 4 a.m. to 8 p.m.
On April 21, Mr. Sisodia called V.K. Bidhuri, a manager in Delhi’s oxygen distribution office.
“Sir,” Mr. Bidhuri asked him, “will we be able to save the people tonight?”
On April 23, the central government sent Delhi 308 metric tons of oxygen, less than half of its need.
At Jaipur Golden, all 250 beds were full. Outside the emergency room, patients slumped in wheelchairs waited to be admitted.
Seema Awasthi, a school principal from north Delhi, was propped up on her I.C.U. bed, a ventilator feeding her lungs. At 8:45 a.m., she sent a text to her family: “I have to be fine soon. Trying to be strong.”
That same morning, Mr. Modi huddled with the chief ministers of India’s 10 hardest-hit states.
“We fear a big tragedy may happen due to the oxygen shortage and we will never be able to forgive ourselves,” Delhi’s chief minister, Arvind Kejriwal, told him on the video call.
Delhi had taken over the city’s oxygen distribution the day before, directing tankers according to need. Spreadsheets showed the supplies each hospital had left.
In desperate moments, officials could dispatch two city-owned trucks with stopgap supplies, answering anguished Twitter messages, texts or calls from a doctor or a patient’s relative. Though the system would eventually be computerized, Mr. Bidhuri, the oxygen distribution official, initially used a wire-bound notebook.
Jaipur Golden typically received its daily oxygen shipment by 5 p.m., said Dr. D.K. Baluja, its medical director. This time, though, the truck didn’t appear. At Inox, an oxygen supply company, nobody picked up the phone.
Contacted by The Times, Inox said it distributed oxygen “per government of Delhi’s instructions.” Delhi officials said they would supply records for April 23 but then did not.
At 7 p.m., Dr. Baluja called Delhi’s oxygen command center. Officials said they had none.
Jaipur Golden was nearly out. But employees and families said they had not been told. Some family members said they would have sought canisters on Delhi’s streets had they known.
Around 7 p.m., Ms. Bansal was summoned to the I.C.U. Her husband, Atul, had suffered a heart attack. The oxygen levels on his ventilator were fluctuating. He was writhing in his bed, gasping for air.
“I couldn’t bear to watch,” she said. She left.
At 9:45 p.m., ventilator alarms rang across the I.C.U. The oxygen was gone.
Dr. Baluja later said that Jaipur Golden had a backup system of 50 oxygen cylinders. That ran out, too, he said.
At 10:28 p.m., Ruchika Gupta telephoned from Amsterdam to check on her father, Satish Kumar Gupta. Right after the phone was answered, the receiver was put down.
“Hello? Hello?” Ms. Gupta asked.
In the background, she could hear the ding-ding of the ventilator alarms and someone muttering “Hari Om, Hari Om, Hari Om,” invoking God.
“My father was probably dying at that moment,” Ms. Gupta said.
Rohit Gupta, her brother, arrived at Jaipur Golden around 11:30 p.m. It was chaos, he said. People dashed in carrying oxygen cylinders. Distraught relatives threatened to kill doctors. One man paced around shouting: “I will not leave these doctors alone if something happens to my mother!”
Two tankers arrived close to midnight: a large one from Inox, seven hours late, and a smaller one from the Delhi government.
For 21 patients — Atul Bansal, Satish Kumar Gupta, Seema Awasthi, Atul Kapoor, Raj Kumar Gupta, Gurinder Singh, Parvinder Singh, Delphin Massey, Manohar Lal and 12 others — it was too late.
The next morning, Dr. Baluja appeared on television, weeping.
“They were my patients. They were my responsibility. They came on the faith of Dr. Baluja to Jaipur Golden Hospital,” he said. “And where did I put my faith? The government of India. Delhi government.”
The next week, a Delhi government committee formed to look into the deaths cited the “natural virulent course of the disease” and concluded that “shortage of oxygen as the cause of death could not be ascertained.”
Mr. Sisodia acknowledged that “we should have done better and we should have done more,” but said that his team had saved thousands of lives. Jaipur Golden, now facing a lawsuit from several families, declined to comment further.
Many of the families blame national, local and hospital officials for the deaths. Several are demanding a criminal investigation.
Ms. Bansal keeps a portrait of her husband by her bedside.
Every day she lights an incense stick by it.
“I miss him at every living moment,” she said. “They killed him.”
Author: Jeffrey Gettleman, Emily Schmall, Suhasini Raj and Hari Kumar
This post originally appeared on NYT > Top Stories
KATY, Texas — As hospitals nationwide face an ongoing nursing shortage, the deficit is top of mind for many Katy-area health care professionals and educators.
Hospitals across the United States reported higher rates of turnover and staff burnout as nurses faced heavier workloads and treated critically ill COVID-19 patients for more than a year, according to a February study from the U.S. Office of Inspector General.
Texas hospitals, however, have faced nursing shortages since long before the pandemic. The Texas Department of State Health Services projects the Gulf Coast region will have a deficit of 21,400 registered nurses by 2032 as the growing demand continues to outweigh supply.
“Health care workforce shortages existed before the pandemic. We didn’t have enough doctors; we didn’t have enough nurses; and the pandemic has definitely exacerbated that problem,” American Medical Association President Susan Bailey said.
The median turnover rate for registered nurses in the Gulf Coast region was 17.5% in hospitals and 50% in long-term care facilities in 2019. Since the pandemic began, many nurses have considered leaving the profession due to the anxiety over bringing COVID-19 home to their families and the reality of losing at least 4,000 health care workers to the virus nationally, Bailey said.
On the other hand, health care workers have been dubbed pandemic heroes, and many have decided to enter the field as they learn more about what the role entails, said Dr. Renae Schumann, the former dean of Houston Baptist University’s School of Nursing and Allied Health, who now serves as District 9 president of the Texas Nurses Association.
“There’s the part of nursing where people are tired; they’re burned out; and they’re having a hard time staying in it. But there’s another part where people are looking at nursing and go, ‘I really want to be a part of that,'” Schumann said.
Local educators, including Kathryn Tart, dean of the University of Houston’s College of Nursing, said the nursing field does not come without its challenges. Still, she said, educators are searching for ways to encourage students to pursue the career path because of the incontestable need.
“It’s very meaningful work, but you have to find the right people to do that work who can overcome a lot of obstacles,” Tart said.
While the pandemic amplified Texas’ nursing shortage, experts said it has been a concern for years.
“There’s been a shortage of nurses for the past several decades-since long before I’ve been a nurse,” said Vicki Brownewell, vice president and chief nursing officer at Houston Methodist West Hospital. “Many people even date the shortage back to World War II.”
In the last decade, the region’s supply of registered nurses has grown by 45%, according to the DSHS, but it is not enough to keep up with the growing population, experts said.
According to the DSHS, about 24% of the region’s nursing workforce in 2019 was older than 55.
And as the nursing workforce ages, so does Texas’ general population, Tart said. New, younger nurses are needed to keep up with the “silver tsunami,” she said, referring to a metaphor used to describe the population aging since older residents require more care.
Nurses today can choose from a more diverse range of career paths than ever before, Brownewell said. Those different options often come without the demands of working in a hospital or clinical setting and offer more regular schedules, she said. For example, many nurses want to work in specialty areas of the hospital, and some have goals to move on to more advanced practices.
With facilities throughout the Houston area, including several Katy locations, Next Level Urgent Care representatives said their practice-which employs nurse practitioners instead of registered nurses-has not been affected by the shortage.
Nurse practitioners typically obtain a master’s or doctoral degree in nursing and often serve as primary health care providers, according to Texas Nurse Practitioners.
Houston Methodist works to retain nurses by giving them a voice in the processes and standards of practice, Brownewell said, as well as providing opportunities for nurses to grow and develop.
“We hire nurses who are going to be a good fit who can integrate well with us, do a good job and want to stay here for the long haul,” she said
Jennifer Mizell, who graduated from the UH College of Nursing in December, said she feels lucky working at a hospital now opposed to one year ago when the pandemic hit. But even when nurses are not grappling with a global health crisis, it is clear why they get burned out, Mizell said.
“It’s constant stress. It’s hard to be on edge everyday, and as a nurse, you are,” she said.
Brownewell said the pandemic has caused some nurses to turn away from the profession over the risks and sacrifices, while others have found a renewed enthusiasm for the difference they can make.
“We have seen a bit of an increase in terms of turnover because of the pandemic but, thankfully, nowhere as high as some other hospitals in other parts of the country,” she said. “On the other hand, we’ve also seen more people who want to be nurses now after living through this.”
Schumann said COVID-19 has led to more registered nurses retiring earlier than usual. Others have transitioned to travel nursing or part-time work to alleviate stress, she said.
“When you are in a full-time position, most of the hospitals will have 12-hour shifts, which sounds great if you’re thinking, ‘Oh, well that means I get to work fewer days,'” Schumann said. “Well, that’s true, but if you’re so tired that you’re sleeping through all your days off, then that’s not very helpful. COVID has been very difficult for nurses and health care workers.”
Though that exhaustion has led some nurses away from the profession, others have chosen to persevere, Brownewell said.
“Some people have moved out of hospital nursing at least temporarily but others, thankfully, want to continue to be nurses,” Brownewell said.
Bailey said applications to both medical and nursing schools are at an all-time high. However, due to a limited number of seats available, the DSHS reported 54% of qualified applicants were not granted admission to one of the region’s 27 prelicensure registered nurse education programs in 2019.
The Texas Legislature approved the creation of the Nursing Shortage Reduction Program in 2001, allowing the Texas Higher Education Coordinating Board to provide funds to nursing programs that increase the number of nursing graduates.
Still, a shortage of qualified nursing faculty and a scarcity of clinical settings also contribute to the nursing shortage, officials with the Texas Board of Nursing said.
But some nursing education programs have found creative ways to offer clinicals and keep students progressing toward graduation even during the pandemic, board officials said.
At the UH College of Nursing, students were able to get paid while meeting clinical requirements this past year thanks to an opportunity through the National Council of State Boards of Nursing. They were able to get experience assisting health care workers swamped with patients, Tart said.
“It helped our nurses; it helped our students; and most importantly, it helped the patients,” Tart said.
From an education perspective, addressing the shortage long term will require creating a pipeline in which students are encouraged to pursue the field and current nurses plan to transition into nursing education to train the younger generation, Tart said.”It’s the will of our educators and our nurses to say, ‘I want to be the educators for the future of our profession,'” Tart said. “It’s the will of our … legislators to say we are going to support nursing and nursing education because we know that this is a wonderful way to provide access to care.”
The video above is from a previous story.
This content was provided by our partners at Community Impact Newspaper.
Author: Community Impact Newspaper
This post originally appeared on ABC13 RSS Feed
The University of California’s governing board has adopted a new policy that tightens the rules on affiliations with hospitals that impose religious restrictions on health care.
The new policy follows criticism the UC system has faced for contracts with religious hospitals that refuse to provide services such as abortions, sterilizations or transgender surgery. The UC is fighting legislation by Sen. Scott Wiener, a Democrat from San Francisco, that would require it to end contracts with religious health facilities unless the hospitals changed their policies or did not apply them to UC physicians and students working there.
The vote Wednesday by the UC Board of Regents moved in that direction, but did not require termination of any of the contracts the university says it has with 77 hospitals and other health facilities in California, the San Francisco Chronicle reported. UC officials say the contracts with large chains like Dignity Health, formerly Catholic Healthcare West, allow its medical staff to provide care for 35,000 patients, many of them low-income Californians with little access to hospitals.
“We should have greater ability to serve more patients, but in a way that is in compliance with the policy we adopt today. We’re against discrimination,” said regents Chair John Pérez, author of the resolution the board approved by a 22-0 vote.
The policy allows new contracts only with health care providers that offer their services to all patients, without discrimination, Pérez said.
It would not require a sectarian hospital’s own staff to perform all medical procedures, but it would allow UC personnel at the facilities to do so. And if a patient needed a procedure, such as a hysterectomy or delivery of an ectopic pregnancy, and could not be safely transferred, UC staff would be allowed to perform it at the hospital.
An initial recommended proposal, sent to the regents by UC President Michael Drake’s office, did not create a clear pathway for the UC to phase out hospitals that choose not to comply with the changes.
An amended policy, proposed by Pérez, gives UC-affiliated hospitals with policy-based restrictions until the end of 2023 to comply with the policy, or the affiliation agreement must be canceled.
Drake and Sen. Wiener endorsed Pérez’s amendments.
“It has the potential to significantly expand access to reproductive and gender-affirming care and to ensure UC physicians can exercise their own professional judgment in providing care,” Wiener said in a statement.
This post originally appeared on Medscape Medical News Headlines
Across the street from the Buckingham Palace Garden and an ocean away from its Ohio headquarters, Cleveland Clinic is making a nearly $ 1 billion bet that Europeans will embrace a hospital run by one of America’s marquee health systems.
Cleveland Clinic London, scheduled to open for outpatient visits later this year and for overnight stays in 2022, will primarily offer elective surgeries and other profitable treatments for the heart, brain, joints and digestive system. The London strategy attempts to attract a well-off, privately insured population: American expatriates, Europeans drawn by the clinic’s reputation, and Britons impatient with the waits at their country’s National Health Service facilities. The hospital won’t offer less financially rewarding business lines, like emergency services.
“There are very few people out there in the world who would not choose to have Cleveland Clinic as their health care provider,” said chief executive Dr. Tomislav Mihaljevic.
Facing the prospect of stagnant or declining revenues at home, around three dozen of America’s elite hospitals and health systems are searching with a missionary zeal for patients and insurers able to pay high prices that will preserve their financial successes.
For years, a handful of hospitals have partnered with foreign companies or offered consulting services in places like Dubai, where Western-style health care was rare and money plentiful. Now a few, like the clinic, are taking on a bigger risk — and a potentially larger financial reward.
These foreign forays prompt questions about why American nonprofit health systems, which pay little or no taxes in their hometowns, are indulging in such nakedly commercial ventures overseas. The majority of U.S. hospitals are exempt from taxes because they provide charity care and other benefits to their communities. Nonprofit hospitals routinely tout these contributions, though studies have found they often amount to less than the tax breaks.
Despite their tax designation, nonprofit hospitals are as aggressive as commercial hospitals in seeking to dominate their health care markets and extract prices as high as possible from private insurers. Though they do not pay dividends, some nonprofits amass large surpluses most years even as more and more patients are covered by Medicare and Medicaid, the U.S. government’s insurance programs for the elderly, disabled and poor, which pay less than commercial insurance. Cleveland Clinic, one of the wealthiest, ran an 11% margin in the first three months of this year and paid Mihaljevic $ 3.3 million in 2019, the most recent salary disclosed.
The advantages of international expansion for their local communities are tenuous. Venturing overseas does not provide Americans with the direct or trickle-down benefits that investing locally does, such as construction work and health care jobs. Even when hospitals abroad add to the bottom line, the profits funneled home are minimal, according to the few financial documents and tax returns that disclose details of the operations.
“It’s a distraction from the local mission at a minimum,” said Paul Levy, a former chief executive at Boston’s Beth Israel Deaconess Medical Centerand now a consultant. “People get into them at the beginning, thinking this is easy money. The investment bankers get involved because they get the financing, and the senior faculty get on board and say, ‘This is great; it means I can go to Italy for two years’ — and there’s not a real business plan.”
There are financial hazards. For instance, Cleveland Clinic has warned bondholders that its performance could suffer if its London project does not launch as planned. There are also risks to a system’s reputation if a foreign venture goes awry.
Finance experts temper expectations that operations of overseas hospitals will have a major bearing on a system’s balance sheet. “Even though they do well, they’re small hospitals — they’re never part of the overall picture,” said Olga Beck, a senior director at Fitch Ratings. “It does help [the U.S. operations] because it gives a global name and presence in other markets.”
Hospital executives say their foreign ventures provide an additional source of revenue, thus adding stability, and benefit the care of their hometown patients.
“As we go to different areas around the world, we learn and we continuously improve for all our patients,” said Dr. Brian Donley, CEO of Cleveland Clinic London. He said the clinic has learned from U.K. practices more efficient ways to sterilize surgical instruments and perform X-rays.
For decades, wealthy foreigners — who are willing to pay the list prices for specialized surgeries and cancer care that domestic insurers bargain down — have been appealing targets for U.S. hospitals. Hospitals like MedStar Health’s Georgetown University Hospital in Washington, D.C., assist foreign patients with special offices staffed by people with job titles such as “international services coordinator” and “international services finance administrator.”
Between July 2019 and June 2020, U.S. hospitals treated more than 53,000 foreign patients, charging them more than $ 2.8 billion, according to a survey of members by the Chicago-based U.S. Cooperative for International Patient Programs. In addition, instead of just importing patients, 37 of 51 health systems in the survey said they offer international advisory or consulting services abroad.
“‘Send us your patients’ is pretty much a dying approach,” said Steven Thompson, a consultant who has spearheaded international programs for Baltimore’s Johns Hopkins Medicine and Boston’s Brigham and Women’s Hospital. “People see it on both sides for what it is: a one-way relationship.”
One of the oldest foreign ventures is the organ transplant program the Pittsburgh-based nonprofit system UPMC has run in Palermo, Italy, since 1997, when Sicily’s government and Italian insurers realized it would be cheaper to perform those procedures there than continue to send patients to the U.S. Since then, UPMC’s Palermo facility has performed more than 2,300 transplants.
In this initial expansion, the U.S. hospital was providing a highly specialized type of surgery — one that UPMC is renowned for — that was not available locally. But UPMC, one of the most entrepreneurial U.S. health systems, didn’t stop there. In Ireland, UPMC owns a cancer center and provides care for concussions through sports medicine clinics. Since 2018, the system has acquired hospitals in Waterford, Clane and Kilkenny. They are staffed mostly by independent Irish physicians, but UPMC regularly sends over its leading U.S. specialists to lend expertise, according to Wendy Zellner, a UPMC spokesperson.
UPMC has company in Ireland: in 2019, Bon Secours Mercy Health, a Roman Catholic system with hospitals in Eastern states, merged with a five-hospital Catholic system there.
Over the past two decades, UPMC did advisory and consulting work in 15 countries but ultimately decided to narrow its involvement to four: Italy, Ireland, China and Kazakhstan, where UPMC is helping a university develop a medical teaching hospital. Charles Bogosta, president of UPMC International, said UPMC wanted to focus its efforts where it was confident it could improve the quality of care, bolster UPMC’s reputation and earn profit margins greater than its U.S. hospitals do.
UPMC officials said the economics are favorable abroad because labor is cheaper and the mix of patients is heavily tilted toward those with commercial insurance, which pays better than government programs.
“What we’ve been doing overseas has been really helpful in addressing what everyone in the U.S. is trying to do, which is come up with diversified revenue sources,” Bogosta said.
Even so, that extra revenue remains a small part of UPMC’s earnings. The health system’s foreign hospital business generated gross revenues of $ 96 million, or 1% of UPMC’s $ 9.3 billion total hospital revenues in 2019, according to a KHN analysis of a UPMC financial disclosure. Since that figure is before accounting for the costs of running the hospitals, taxes and other expenses, the actual profits the foreign hospitals might send back to Pittsburgh are much smaller. In Ireland, where corporations are required to disclose audited financial statements, UPMC Investments Ltd., an umbrella group that owns the Waterford hospital operation and property, reported net profits of about a half-million dollars in 2019 on more than $ 47 million in gross revenues.
In an email, Zellner said the Ireland statements “do not give you the totality of the picture in Ireland or International, where our results are far better than these documents would suggest.” UPMC declined to provide more detailed financial data.
Like other systems, UPMC has expanding ambitions in China. In 2019 it signed an agreement with the multinational corporation Wanda Group to help manage several “world-class” hospitals, starting with one opening in Chengdu next year.
But foreign ventures can misfire. “These partnerships can turn into nightmares, as Hopkins has learned,” Thompson wrote in a 2012 article for the Harvard Business Review that described his observations as the founder and first CEO of Johns Hopkins Medicine International, a for-profit venture jointly owned by Johns Hopkins Medicine and Johns Hopkins University.
Anadolu Medical Center, which Hopkins helped establish in Istanbul in 2005, was “plagued by quality problems,” including overbooked operating rooms and physicians who refused to follow evidence-based procedures and quality protocols, he wrote. Thompson attributed the problem to the Turkish mandate that the hospital be run by a Turkish citizen and wrote that the problems did not dissipate until Hopkins was allowed to install its own manager in the second-highest position and dissolve the top position to get around the citizenship requirement “while remaining in technical compliance with the law.”
While “the project is now thriving,” he warned that “lending the Hopkins name to a hospital that delivers unimpressive care could significantly damage our 135-year-old brand — and that’s a real danger in developing areas, especially in a project’s early days.”
Hopkins has remained skittish about outright ownership or even management responsibilities. Instead, it has affiliations with hospitals and health systems in 13 countries, including Vietnam, China, Turkey, Lebanon, Brazil and Saudi Arabia. Hopkins does not run any of the hospitals but helps develop hospital master plans and clinical programs, trains doctors, and advises on patient safety and infection control.
Even so, in 2014 it created a joint venture with the oil and gas company Saudi Aramco to provide health care to 255,000 employees and their dependents and retirees. Hopkins, which owns a fifth of the venture, said all foreign net revenue is returned to the system’s parent organizations to fund research, expansion of care and scholarships. But its public records report meager income from its foreign subsidiary, just $ 7 million in 2018 — a tenth of a percent of the health system’s $ 7 billion revenues.
Charles Wiener, the current president of Johns Hopkins Medicine International, focused on other benefits. “If we can put in robust quality and safety at one of our affiliates, their patients do better,” he said. “If we can export our education and training models, we believe that allows our people to benefit from learning from other cultures, and some of their people come here to train.”
Cleveland Clinic London is unusual in that U.S. health systems rarely build a hospital abroad from scratch without a local partner. The clinic chose that more cautious approach with Cleveland Clinic Abu Dhabi, a 364-bed hospital owned by the Mubadala Investment Co. that the clinic manages. It also has a consulting practice that is helping a Singapore health care company build a hospital in Shanghai.
Foreign enterprises appeal to the clinic because it has limited growth opportunities in Ohio, where the population is growing slowly and aging, meaning more patients are leaving high-paying commercial insurers for lower-paying Medicare. The clinic has expanded in Florida, acquiring five hospitals to take advantage of population increases and wealthier patients there.
The London project will have 184 beds and eight operating rooms. Donley said it will be staffed primarily by U.K. physicians, including ones who also work for the National Health Service.
“The clinic has a long track record of being able to execute on its strategies,” said Lisa Martin, an analyst at the bond rating agency Moody’s Investors Service. “The London project is obviously the biggest venture and the biggest financial risk that they’ve made abroad.”
This post originally appeared on Medscape Medical News Headlines
Released today, the 2021–2022 rankings, which acknowledge 50 US centers for delivering exceptional care in several specialties, also give the Massachusetts hospital the top spot in 4 of 10 pediatric specialties assessed: nephrology, neurology and neurosurgery, pulmonology and lung surgery, and urology.
Children’s Hospital of Philadelphia (CHOP) retains second spot in the annually updated list, and Texas Children’s Hospital, in Houston, moves up a rung to third place, bumping Cincinnati Children’s Hospital Medical Center from third to fourth place. Children’s Hospital Los Angeles comes in at no. 5.
The remaining top 10 placements, in descending order, are as follows:
Children’s Hospital Colorado, in Aurora; Children’s National Hospital, in Washington, DC; Nationwide Children’s Hospital, in Columbus, Ohio; UPMS Children’s Hospital, of Pittsburgh, Pennsylvania; and Lucile Packard Children’s Hospital Stanford, in California.
This year’s edition of offers something new, adding rankings within states and multiple-state rankings within seven regions to facilitate choice. “The Best Children’s Hospitals rankings have always highlighted hospitals that excel in specialized care,” said Ben Harder, chief of health analysis and managing editor at US News, in a press release. “Now, this year’s new state and regional rankings can help families identify conveniently located hospitals capable of meeting their child’s needs. As the pandemic continues to affect travel, finding high-quality care close to home has never been more important.”
Across the seven regions, the top-ranked institutions are as follows:
Mid-Atlantic ― CHOP
Midwest ― Cincinnati Children’s Hospital Medical Center
New England ― Boston Children’s Hospital
Pacific ― Children’s Hospital Los Angeles
Rocky Mountains ― Children’s Hospital Colorado
Southeast ― Children’s Hospital of Atlanta and Monroe Carell Jr. Children’s Hospital of Vanderbilt, in Nashville, Tennessee
Southwest ― Texas Children’s Hospital
Boston Children’s not only topped the overall list but also led in four specialties. For the other six specialties that were ranked, the top hospitals on the honor roll are as follows:
Cancer ― CHOP
Cardiology and heart surgery ― Texas Children’s Hospital
Diabetes and endocrinology ― CHOP
Gastroenterology and gastrointestinal surgery ― Children’s Hospital Colorado
Neonatology ― Children’s National Hospital
Orthopedics ― CHOP
For the past 15 years, the objective of the rankings has been to offer a starting point for parents in making decisions about the best place to take very sick children for high-quality care. The editors of the rankings acknowledge that considerations of travel costs and insurance coverage are other factors to consider.
The rankings are helpful for families, according to Joe W. St. Geme, III, MD, CHOP’s physician-in-chief and chair of its Department of Pediatrics. “Some parents, especially those coming from outside an area, find them useful when deciding on care away from home,” he told Medscape Medical News. “Most types of pediatric care are available in the community, but sometimes a child has an unusual disease or complex disease for which local care is not available.”
St. Geme said the new regional rankings may be useful in helping parents decide where to bring a child for care that is closer to where they live.
A top ranking from U.S. News is just one indication of a hospital’s overall performance, according to Angel Lorts, MD, MBA, director of the Ventricular Assist Device Program, at Cincinnati Children’s Hospital Medical Center.
“Parents seeking care for their child should use the data to ask questions and understand the limitations,” she told Medscape Medical News. “Rankings are only based on a small subset of the children we care for. Many of the metrics may not pertain to their child and may not reflect the care they will receive.”
In her view, ranking will not give parents all the information they need about medical care and outcomes for specific conditions.
Hospitals can use the rankings to target improvements, says St Geme. “These rankings can provide an opportunity for some benchmarking, to see what other institutions are doing and how they’re able to deliver care. They can serve as a source of ideas and can influence planning,” he said.
He cautioned that the data are not as complete as they could be. “A number of services are not included, and we try to keep that in mind,” he said.
Rankings may also affect recruitment, St. Geme added, because higher-ranked institutions may find it easier to attract sought-after clinicians and investigators in needed areas.
Another sphere of influence is philanthropy and fund raising. “People are much more likely to consider making both small and large donations to a high-ranked institution,” said J. Howard Smart, MD, chief of pediatrics at Sharp Mary Birch Hospital for Women and Newborns, in San Diego, California.
St. Geme agrees. “Philanthropists are interested in making investments where they feel they’re a sure bet, and rankings may indicate a sure bet. But their impact on government funding and grant support is probably less.”
Ultimately, however, some families may not have lot of choice in where to go when their children are sick, Smart said. “And people probably don’t choose a location to live in based on nearby children’s hospitals the way they do for schools,” he said.
What about hospitals that continue to rank much lower on the 50-institution list ― excellent though they must be to make it onto the honor roll. “To be on the list but not to have risen in rank in recent years might be a disappointment,” said Sr. Geme. “But it might also motivate a hospital to think about making internal investments in order to strengthen a particular service. And it may motivate nonranked hospitals to improve care in order to break into the list.”
Lorts points out that the annual survey process requires hospitals to track the clinical outcomes of a subset of patients, which may lead to improvement in these areas. It also requires data collection on structure and process, which drives needs assessments of select hospital areas. “But ideally, all hospitals would be tracking important outcomes, benchmarking to peer hospitals, and improving where needed without the U.S. News incentive,” she said.
This year’s data, compiled by research and consulting firm RTI International, derive from feedback on more than 1200 questions provided by 118 responding institutions. Details on each hospital on the list and the methodology used in the analysis are available on U.S. News & World Report’s website.
Diana Swift is medical journalist based in Toronto. [email protected]
This post originally appeared on Medscape Medical News Headlines
The man, in his 60s, had worked in the economic sector under Kim Jong Il, the father of the present leader.
The North Korean dictator reportedly expressed sadness over losing such a “talented official”, according to the Seoul based media outlet Daily NK.
At the same time, he ordered scientists to stop their test trials of Chinese Covid vaccines and to concentrate on producing a domestic one instead.
This is not the first time that the North Korean leader has acted unilaterally to ban things.
Western-style clothing such as ripped or skinny jeans, sloganed T-shirts and nose and lip piercings have also been forbidden.
Meanwhile, officials continue to crack down down on pop music following the success of South Korean K-pop bands such as BTS and Blackpink.
This post originally appeared on Daily Express :: World Feed
AUSTIN (Texas Tribune) — Texas state officials, including those in Gov. Greg Abbott’s office, knew for months that foster children were being illegally housed in an emergency shelter cited hundreds of times for dangerous conditions — but failed to report the violation to court-appointed watchdogs tasked with monitoring the state’s foster care system, according to court records.
The Whataburger Center, a shelter for foster children in San Antonio named after the restaurant chain because of a one-time donation, was cited 239 times for not meeting state minimum standards between 2016 and 2020. Some of the reports identified abuse or neglect. In September, the shelter was put on probation by the Texas Health and Human Services Commission and placed on an admissions hold — blocking children from being housed there — after the department said it found “a continued pattern of deficiencies in the area of supervision, medication, and reports/record keeping.”
Author: Billy Gates
This post originally appeared on KXAN Austin