Healthcare Round Up: Stand-Alone ER's, Mandatory Healthcare Worker Bonuses, Canadian Drug Imports & More

CO Seeking to Shut Down Stand-Alone ERs:

A decade ago free-standing emergency rooms began cropping up around the country with the promise of providing emergency care in areas where there were no hospitals or where hospital ERs were overcrowded. But instead, the stand-alone ERs - which now number in the hundreds across more than 20 states - tend to be located in affluent suburbs and treat patients who don’t actually need ER care at pricey ER rates.

Colorado has 44 such facilities, mostly owned by hospitals, which use them to attract patients to their main facilities, as well as to take patients away from competing providers. But the state has launched an initiative requiring hospitals to choose from among a set of goals for improving their quality of care - one of which is converting their stand-alone ERs to other purposes, such as providing primary care - in order to qualify for millions of dollars in Medicaid funding. The aim is to lower Medicaid costs by reducing the use of stand-alone ERs for treating common illnesses and injuries.

“We don’t want hospitals to have stand-alone ERs, so we are willing to pay to shut them down,” said Kim Bimestefer, executive director of the state’s Department of Health Care Policy & Financing.

“Money talks,” she said. (KAISER HEALTH NEWS)

FL OB-GYN Protection Law Goes Awry:

In 1988, in an effort to reduce the cost of malpractice insurance for doctors in the state, Florida passed a law barring lawsuits for birth-related injuries resulting in serious physical or cognitive disabilities and creating a no-fault fund to cover the healthcare costs for those who suffer such injuries instead. The Birth-Related Neurological Injury Compensation Association (NICA) fund was subsidized by fees of $5,000 a year for obstetricians, $250 a year for other doctors and $50 per live birth for hospitals.

NICA reportedly proceeded to amass $1.5 billion in assets by investing the doctors’ and hospitals’ fees in the markets and by refusing to pay for anything until care had been sought through Medicaid or private insurance.

According to Sara Rosenbaum, a professor of health law at George Washington University, federal law makes Medicaid the “payer of last resort, meaning that it covers only what other “third parties” don’t, unless one of those third parties has received an exemption, which NICA has not.

“I’m not understanding why [Medicaid] has not come down on them like a load of bricks,” Rosenbaum said. “There’s something upside down about this whole arrangement.”

After a series of investigative reports by the Miami Herald and ProPublica, state lawmakers approved legislation (SB 1786) significantly reforming the NICA program. The measure is yet to be signed by Gov. Ron DeSantis (R).

A federal lawsuit is also pending that alleges NICA encouraged parents of injured children to commit fraud by telling them to file claims with Medicaid before seeking payment from NICA. (MIAMI HERALD, STATE NET)

Pandemic Gives Boost to Hospital-at-Home Care:

Hospital-at-home programs for the treatment of low-level health conditions have been around for a while. But since the start of the coronavirus pandemic, more health systems, including Kaiser Permanente and the Mayo Clinic, have been offering hospital-at-home care for acute illnesses.

“Heart failure, pneumonia, skin infections — those are all patient populations we can safely care for in the home,” said Dr. Margaret Paulson, who heads up a new home-based care program offered by the Mayo Clinic in rural Wisconsin.

Some studies indicate at-home care delivers better patient outcomes at a lower cost than traditional in-patient healthcare.

“This is actually a higher level of touch from physicians and advanced practitioners,” said Dr. Kavita Patel, a health policy fellow at the Brookings Institution.

Hospital-at-home care involves regular video conferencing and 24/7 monitoring, augmented by in-person visits from nurses and other healthcare workers for basic care that can’t be provided virtually, like the administration of antibiotics.

“This isn’t just sending Mom or Dad to the bedroom,” said Patel.

Hospital-at-home care isn’t a good fit for some patients, such as those who are too far from emergency care, lack high-speed internet or are just too sick.

“This can’t be something where it’s so complicated that you are monitoring a patient, worried that they could crash and need to be in the ICU within minutes,” said Patel.

But for the treatment of moderate covid and many other conditions, acute hospital at-home care could become more prevalent. (KAISER HEALTH NEWS)

Federal Lawmakers, Cities Seek to Shift Mental Health Crises Response Away from Police:

Bipartisan legislation introduced in the U.S. Senate last week would provide funding for local governments to expand mental health services, including for the uninsured. The bill, sponsored by Sen. Catherine Cortez Masto (D-Nevada) and Sen. John Cornyn (R-Texas), would also set nationwide standards for crisis hotlines, urgent care centers and other facilities that deal with mental health emergencies.

“The coronavirus pandemic has exacerbated the mental health challenges so many Americans are facing, and we need to act with urgency to protect vulnerable people experiencing behavioral health crises and provide them with the treatment and services they need to get healthy,” Cortez Masto said in a statement. “I’ve heard from both law enforcement and civil rights leaders that we can’t rely on the same old system.”

The federal measure is part of a larger effort to shift responsibility for mental health emergencies away from law enforcement and potentially reduce the likelihood of those crises escalating into deadly conflicts. Several cities, including Denver, Los Angeles and New York City, are piloting programs that send emergency medical and mental health care workers to mental health emergencies instead of police officers.

The programs are patterned after one that’s been in place in Eugene, Oregon since 1989. In 2019 that program, called Crisis Assistance Helping Out in The Streets, or CAHOOTS, handled 24,000 calls, fewer than 1 percent of which required the involvement of law enforcement. (BLOOMBERG CITYLAB)

Health in Brief

CA Ponders Mandatory Healthcare Worker Bonuses:

Legislation introduced in California (AB 650) would require hospitals and other healthcare facilities to provide their workers “hazard pay retention bonuses” of up to $10,000, spread out into four installments over the next year to persuade those workers not to leave their jobs. Hospitals estimate the additional pay would cost them $3.8 billion statewide, according to an analysis of the bill by the Assembly Appropriations Committee. (LOS ANGELES TIMES, STATE NET)

CO Drug Overdose Deaths Surge:

Fatal drug overdoses increased by 59 percent last year in Colorado, to 1,313 from an average of about 824 the preceding five years. The pandemic is likely responsible for some of that increase, but there’s also been a surge of fentanyl use in the state. (DENVER POST)

Abortions up in KS:

The number of abortions performed in Kansas in 2020 was up by 9.1 percent from the year before, 7,542 versus 6,916, and out-of-state patients also outnumbered in-state patients for the first time in nearly 50 years. The increase was likely due to efforts by the governors of Oklahoma and Texas to ban most abortions during the pandemic, spurring women from those two states to make the trip to Kansas to have the procedure done. (ASSOCIATED PRESS)

MA ‘Surprise Billing’ Settlement:

South Shore Anesthesia Associates, based in Weymouth, Massachusetts, agreed to pay the state $260,000 to settle allegations it employed “surprise billing” practices with patients at South Shore Hospital, according to the state attorney general’s office. That sum includes a $185,000 civil penalty. (BOSTON GLOBE)

Biden Sides with States on Canadian Drug Imports:

The Biden administration filed a legal brief last week asking a federal court to dismiss a lawsuit that could prevent states from allowing the importation of prescription drugs from Canada. The brief makes the case that the suit, filed on behalf of U.S. drug makers, is premature because the federal government hasn’t approved any importation programs yet. (INSURANCE JOURNAL)

-- Compiled by KOREY CLARK