THE ONLY HEALTHCARE BUSINESS NEWS WEEKLY | APRIL 27, 2020 | $5.

50

Pressing
pause
on M&A
COVID-19 pandemic is threatening
to postpone, derail or force a
restructuring of hospital deals
Page 22

Providers Medicare
remain Advantage
concerned plans gearing
that they could up for flood
be left out of of members
CARES Act with end-stage
funding / renal disease /
Page 8 Page 30
 Reliable Medical Waste
Service and Expertise,
during COVID-19
and Every Day

:LWKRXU\HDUV
RIH[SHULHQFHRYHU
PHGLFDOZDVWHWUXFNVDQG
WUHDWPHQWIDFLOLWLHVZHVWDQG
UHDG\WRVXSSRUW\RXUHIIRUWVLQ
ƓJKWLQJWKLVSDQGHPLFQDWLRQZLGH
:HōUHLQLWWRJHWKHU

ZZZ6WHULF\FOHFRP&RURQDYLUXV

k6WHULF\FOH,QF$OOULJKWVUHVHUYHG
 Opinions/Ideas

34 Editorial 35 Guest Expert

Home healthcare faces It’s time to retool the
another challenge: the post-COVID-19 curriculum
22 Cover story president’s continuing for clinicians to emphasize
attacks on immigration. the role of population health.
COVID-19 reshapes healthcare M&A
By Alex Kacik 36 Letters
Smaller hospitals are likely to seek mergers while larger health systems
Let’s not forget those on front lines of behavioral health amid
are positioned to better manage the pandemic and continue their deals as
the coronavirus pandemic.
planned, although they may face some delays.

6 Policy 38 Best
Practices
COVID-19 could accelerate Medicare’s march toward insolvency.
By Tara Bannow
8 Providers Hospitals are
HHS cutting $40B in CARES Act checks, but some providers may miss out. setting up small
grocery stores
9 Public health
in-house to help
Helping uninsured, distributing resources pose challenges in devising eliminate the need
national testing strategy. for their weary
10 Medicare/Medicaid staffers to go food
CMS lets independent, free-standing EDs bill Medicare, Medicaid. shopping.

40 Q&A
Dr. George Brandt, a psychiatrist
hospitalist and Army veteran who served
in Bosnia and Iraq, discusses the needs
of clinicians fighting COVID-19.

Data
39 Data Points
Patients, especially younger generations, are becoming more
comfortable rating their healthcare experiences online. And those
reviews may play a role in how consumers choose their providers.
Features
30 Kidney-care patients could be disadvantage for 42 By the Numbers
Medicare Advantage Hospital merger and acquisition activity in the first quarter of 2020.
By Shelby Livingston
Advantage plans are gearing up for a potential flood of new members with
end-stage renal disease who will be able to enroll in the alternative to
traditional Medicare starting in 2021. But they’ll face challenges.
Diversions
News 44 Outliers
2 Late News 12 Providers Hand-washing
SBA loans now available for HCA aims to “reboot” operations has become
community-owned rural hospitals. in second half of 2020. an especially
important ritual
4 Regional News 20 Executives today. But in
Beaumont Health data breach Healthy profits in 2019 led medieval times,
compromises information of to healthy pay bumps for there was quite
112,000 patients. insurer CEOs. an art to it.

MODERN HEALTHCARE (ISSN 0160-7480). Vol. 50 No. 17 is published weekly by Crain Communications Inc. (except for July 6, Nov. 23 and the last two issues in December.) 150 N. Michigan Ave.,
Chicago, Ill., 60601-7620. Periodicals postage is paid at Chicago, Ill., and additional mailing offices. U.S. subscription price: $189 per year, $258 for two years; foreign subscriptions: $218 per year.
Canadian subscriptions: $226 for one year (includes GST). Sales Agreement No. 0293547. GST #136760444. Printed in U.S.A. Title® at U.S. Patent Office. © Entire contents copyright 2020, by Crain
Communications Inc. Use of editorial content without permission is strictly prohibited. All rights reserved. POSTMASTER: Send address changes to MODERN HEALTHCARE, Circulation Department,
1155 Gratiot Ave., Detroit, Mich., 48207-2912.

April 27, 2020 | Modern Healthcare 1

SBA loans now available
for rural hospitals EDITORS
Aurora Aguilar
312-649-5218
Editor
aaguilar@modernhealthcare.com
Matthew Weinstock Managing Editor
The Small Business Administration April 24 said it will allow most community- 312-397-7585 mweinstock@modernhealthcare.com
owned rural hospitals to apply for forgivable small business loans as they deal Paul Barr Features Editor
with the continued financial fallout from the COVID-19 pandemic. 312-649-5418 pbarr@modernhealthcare.com
The guidance clarified that most community-owned rural hospitals will be Erica Teichert News Editor
212-210-0209 eteichert@modernhealthcare.com
eligible for the Paycheck Protection Program loans to help pay employees
David May Assistant Managing Editor
as long as the facilities receive less than half their funding from state or local 312-649-5451 dmay@modernhealthcare.com
government sources, exclusive of Medicaid.
CREATIVE SERVICES
President Donald Trump signed a more
Patricia Fanelli Creative Services Director
than $300 billion boost to the small business 312-649-5318 pfanelli@modernhealthcare.com
assistance program Friday afternoon. Rodolfo Jiménez Graphic Designer
“This is great news for community-owned 312-649-5338 Rodolfo.Jimenez@modernhealthcare.com
hospitals around the country, and I thank Paul Romejko Graphic Designer
SBA for their work to provide this clarity,” 312-649-5335 promejko@modernhealthcare.com
said House Energy & Commerce Committee DIGITAL
ranking Republican Greg Walden of Oregon. Saman Creel Digital Content Strategist
312-649-5225 screel@modernhealthcare.com
Community-owned rural hospitals had
Emily Olsen Web Producer
been excluded from the program, but advocates pushed for an exception 312-649-5482 eolsen@modernhealthcare.com
to be made. Rural hospitals were already financially vulnerable before
REPORTERS
the COVID-19 pandemic, which has decimated revenue from elective Tara Bannow Finance | Chicago
procedures. 312-649-5362 tbannow@modernhealthcare.com
The Colorado congressional delegation in partnership with the National Michael Brady Rules and Regulations | Washington
Rural Health Association wrote to SBA Administrator Jovita Carranza on 202-505-4789 mbrady@modernhealthcare.com
April 2 asking for the change. A bipartisan group of senators also wrote to Maria Castellucci Safety & Quality | Chicago
Congress a week later asking lawmakers to make a statutory exception, 312-397-5502 mcastellucci@modernhealthcare.com
though Congress didn’t change the eligibility standards in its most recent Jessica Kim Cohen Technology | Chicago
312-649-5314 jcohen@modernhealthcare.com
relief package. —Rachel Cohrs
Rachel Cohrs Politics and Policy | Washington
202-681-3353 Rachel.Cohrs@modernhealthcare.com
Steven Ross Johnson Population Health | Chicago
312-649-5230 sjohnson@modernhealthcare.com
Costs from COVID-19 the attack as low as possible and,
Alex Kacik Operations | Chicago
could hit $650 billion conversely, the potential cost of any 312-280-3149 akacik@modernhealthcare.com
‘herd immunity’ strategies that allow Shelby Livingston Insurance | Nashville
Researchers estimate that COVID-19 people to get infected,” a research 843-412-6857 slivingston@modernhealthcare.com
will result in $163 billion to $654 billion team from the City University of Merrill Goozner Columnist
in direct medical costs. New York and UCLA Medical Center mgoozner@modernhealthcare.com
If 80% of the U.S. population comes wrote in a Health Affairs study pub- RESEARCH AND DATA
Tim Broderick Data and Analytics Lead
down with COVID-19, it will create lished late last week. 312-649-5409 tbroderick@modernhealthcare.com
$654 billion in direct costs resulting The researchers found that an at-
Megan Caruso Data Specialist
from almost 45 million hospitalizations, tack rate of 50% would lead to nearly 312-649-5471 mcaruso@modernhealthcare.com
6.5 million ventilators in use and near- $410 billion in direct costs, and that COPY DESK
ly 250 million hospital bed days. But if treatment would cost more than Julie A. Johnson Copy Desk Chief
20% of the population gets sick, the virus $3,000 for each person showing 312-649-5236 jajohnson@modernhealthcare.com
would bring about $163 billion in direct symptoms of the virus. That’s about EDITORIAL SUPPORT
costs from just over 11 million hospital- four times the average cost of a symp- Rocio Villasenor Editorial Intern
312-280-3173 rocio.villasenor@modernhealthcare.com
izations, 1.6 million ventilators used and tomatic influenza case.
more than 62 million hospital bed days. Most of the additional costs result CUSTOMER SERVICE
877-812-1581 customerservice@modernhealthcare.com
“The significant difference in costs by from high rates of hospitalization
attack rate across the U.S. population and mortality compared with the Modern Healthcare editorial office: 150 N. Michigan Ave., Chicago, Ill.
shows the value of strategies that keep seasonal flu. —Michael Brady 60601-7620. Member of Business Publications Audit of Circulation.

2 Modern Healthcare | April 27, 2020

EXECUTIVE INSIGHT
COVID-19: Age-Friendly Health Systems Needed More than Ever
A Movement to Support Health Systems Caring for Most Vulnerable Patients During Pandemic
Terry Fulmer, PhD, RN, FAAN
President
The John A. Hartford Foundation
COVID-19 places an incredible strain
on our nation’s health systems. Through
the Age-Friendly Health Systems
movement, The John A. Hartford Foundation,
Institute for Healthcare Improvement, American Hospital
Association, and Catholic Health Association of the United
States support systems serving as the first line of defense.
Hospitals and health systems across the country share best
practices for treating older adults—the most vulnerable
population—in a safe and age-friendly way, without placing
unsustainable burdens on themselves.
What is the Age-Friendly Health Systems Movement?
TF: The Age-Friendly Health Systems movement is
improving care for older adults in the U.S. It is designed
around four essential, interrelated elements that guide
health care interactions with older patients. The first is
what matters to the patient. Especially during times of
crisis when so much care is focused on life preservation,
systems should know and align care with older patients’
health goals and care preferences. The next element is
mentation. Core to this is preventing, identifying, treating,
and managing dementia, depression, and delirium in older
patients. The third element is mobility, ensuring older adults
move safely every day. The last element is medication. If
medication is necessary, clinicians should prescribe age-
friendly medications that don’t interfere with what matters
to the patient, nor affect their mobility or mentation. Taken
together, we call these the “4Ms” and there is both a solid
evidence and business case behind them. Participating
systems receive expert technical support and share best
practices to ensure older adults receive age-friendly care.
Why is age-friendly care so important right now?
TF: Older adult patients already require special attention
and a unique approach to care by health systems and this
crisis emphasizes that need. According to the Centers for
Disease Control and Prevention, eight of every 10 deaths
associated with COVID-19 occur in patients over the
age of 65. Hospitals and health systems need support as
emergency and medical departments reach capacity with
patients experiencing COVID-19 symptoms, especially
older patients. The Age-Friendly Health Systems Initiative
provides that support and facilitates health systems
learning from each other to improve the care delivered to
older people.
Do the “4Ms” matter during a pandemic?
TF: If anything, the “4Ms” of age-friendly care—what matters,
mentation, mobility, and medication—are more important
now during this crisis. Older adults are more likely to be
affected by COVID-19 symptoms and measures to keep
the public safe, like social distancing, put older adults
at an increased risk of developing mentation issues like
depression or delirium. These social distancing measures
can negatively affect older adults’ mobility, with fewer
opportunities and places for safe exercise, leading to
declines in function. The pandemic could result in older
patients having a harder time managing their various
medications. Going to the pharmacy presents risks,
navigating the process of obtaining prescriptions by mail
may be challenging, or home care nurses or family members
may be unable to visit older adults to sort pills and ensure
they’re taking medications as scheduled. Finally, clinicians
are under stress, systems are at capacity, and older adults
are at higher risk for developing serious illness, including
ventilation, that could prevent them from expressing their
wishes for care. Understanding what matters to patients
is more critical than ever, given the high mortality of this
virus in older adults. Advance care plans and goals of care
are essential first steps in care planning; however, clinicians
must be cautious of the risk of potential misunderstandings.
As COVID-19 creates difficult triaging decisions, we must
carefully consider treatment and end-of-life care decisions,
based on what matters most to the person.
How are we helping during this crisis?
TF: We’re here to help hospitals and health systems,
especially during this crisis, deliver the care older patients
need, while they do everything in their power to slow the
spread of COVID-19. The more than 550 Age-Friendly
Health Systems clinical sites are discovering and sharing
best practices related to COVID-19 care for older adults—
including guides to telehealth and redesigned emergency
department care for older adults, forming collaborations
with public health and aging services organizations to
prevent social isolation, and collective advocacy for longer-
term policy change. Join the Age-Friendly Health Systems
movement, it’s free and all materials are open source.
This Executive Insight was
produced and brought to you by:
To learn more, visit,
ihi.org/agefriendly.

Michigan-based Beaumont Health has reported two data breaches this year.
Data breach at Beaumont
exposes information
of 112,000 patients
By Dustin Walsh
B
eaumont Health reported a data
breach that compromised the
personal and health information
of roughly 112,000 former or current
patients.
It’s the second data breach that
Michigan’s largest health system has
announced this year. In January,
Beaumont notified 1,182 patients
that an employee had unauthorized
access to patient information and
disseminated that information to an
employee of a personal injury law firm.
Beaumont discovered the newest
breach on March 29, finding that
“one or more of the email accounts
accessed between May 23, 2019 to
June 3, 2019 contained identifiable
personal and/or protected health
information,” the health system
said in a news release. Beaumont
4 Modern Healthcare | April 27, 2020
Email phishing
pivots to COVID-19
Even as the FBI recently warned
about an increase in business
email compromise (BEC) scams,
Barracuda Networks, an IT
security company, reported a
rise in all email phishing attempts
that are pandemic-related. They
reported the healthcare industry
is especially being targeted.
$2.1
billion
Losses caused by BEC
scams from January 2014
to October 2019
@BEAUMONTHEALTH VIA TWITTER
137
COVID-19-related phishing
attacks detected by Barracuda
in January
9,116
COVID-19-related phishing
attacks detected from March 1
to March 23
Types of attacks
Scams, including phony
cures, solicitation for
unearthed the breach at a time when investments or requests for
it was caring for more than 1,000 donations to fake charities
confirmed COVID-19 patients.
The emails contained patients’ 54%
names, birthdates, diagnosis,
diagnosis codes, procedures,
treatment locations, treatment types,
prescription information, Beaumont
patient account numbers and 34%
Beaumont medical record numbers. 11%
A “limited” number of Social Security BEC
scams: Emails
numbers and other information were
also included in the breach. 1% Blackmail impersonating
Beaumont could not determine attempts brands
whether the information was shared
with a third party, it said in a news (Through March 23)
release. l
Note: Phishing attacks are often used
to scam targets out of money, steal
Dustin Walsh is a reporter at Crain’s login credentials and install malware or
ransomware.
Detroit Business, a sister publication of
Modern Healthcare. Sources: blog.barracuda.com, FBI
 WEST
CDC confirms weeks-earlier
COVID-19 deaths in California
Health officials say two people died
with the coronavirus in California
weeks before the first confirmed
deaths from the disease. Santa Clara
County officials said the people died
at home Feb. 6 and Feb. 17. Before this,
the first U.S. deaths from the virus
were believed to have occurred
Feb. 26 in suburban Seattle.
The medical examiner’s office last
week received confirmation that
tissue samples sent to the Centers for
Disease Control and Prevention tested
positive for the virus, officials said.
As the state considered lifting
shelter-in-place restrictions last
week, Gov. Gavin Newsom said
California was testing an average of
14,500 people per day, up from just
2,000 tests per day at the beginning
of April. Still, in a state of nearly 40
million people, that’s not enough for
public health officials to know for sure
the reach of the highly contagious
virus that is still causing outbreaks
across the state in nursing homes and
homeless shelters.
Newsom said he wants the state to
test at least 25,000 people per day by
the end of April. California had nearly
38,000 confirmed coronavirus cases
and more than 1,400 deaths as of last
week, according to data compiled by
Johns Hopkins University.
NORTHEAST
Bloomberg to help develop N.Y.
testing and tracing program
Michael Bloomberg is stepping
in to help New York state fight
COVID-19. The billionaire and
former New York City mayor will
help develop and put into place the
state’s testing, tracing and isolation
program, Gov. Andrew Cuomo said.
He also will give more than $10
million to the effort, said Melissa
DeRosa, secretary to the governor.
“Michael Bloomberg will design
the program, design the training,”
Cuomo said.
As New York’s coronavirus
infection rate declines, the state
wants to ramp up a testing-and-
tracing program in order to avoid a
resurgence of COVID-19. Cuomo said
last week that the state would double
its daily testing capacity to 40,000
per day after securing federal supply
chain assistance in a meeting with
President Donald Trump.
Bloomberg will pitch in to aid the
effort to trace those who test positive
and their contacts with others, as
well as isolating positive cases, the
governor said. The former mayor is
expected to assist the approximately
225 tracers the state now has. That
workforce will need to expand into
the thousands, Cuomo said.
SOUTH
Atrium Health CEO donates
to COVID-19 employee fund
Atrium Health CEO Gene Woods
made a $1 million donation to a
fund set up to help employees who
need financial support during the
pandemic. The Charlotte, N.C.-based
system’s board matched the donation.
Atrium has touted several added
benefits to employees since the start
of the pandemic,
like enhanced
childcare and
help with food
and lodging.
But six nurses,
doctors and
medical staffers
told the Charlotte
Observer that
Gene Woods Atrium is
reducing work
hours for nurses and asking them to
work in units outside their specialty or
take paid-time off to keep full pay.
Atrium rebutted that claim, stating
that staffers were being asked to make
themselves available to work when
and where they are needed the most.
“At a time when thousands of
organizations and many health
systems across the country, and
even locally, are facing significant
financial hardships and laying off
workers, we are striving to ensure
our employees maintain meaningful
roles,” according to a statement
provided by a system spokesman.
MIDWEST
Illinois Senate president
seeks federal bailout
Illinois Senate President Don
Harmon has reached out to the state
congressional delegation seeking a
$40 billion federal bailout that would
in part help aid hospitals in the state.
GETTY IMAGES/MODERN HEALTHCARE ILLUSTRATION
Illinois and its municipalities are
getting more than $5 billion from the
$2.2 trillion federal stimulus bill that
passed Congress and was signed into
law by President Donald Trump last
month. But that money, as Gov. J.B.
Pritzker pointed out, is only to handle
out-of-pocket costs for the pandemic,
mostly medical expenses.
Pritzker and Democrats nationally
have asked for more money to
replace reduced state revenue that
plummeted after the stay-in-place
order was set in late March. The state
of Illinois, to date, has paid
$174 million for medicine and
protective equipment.
As of April 24, Illinois reported
nearly 1,800 residents had died of
complications related to COVID-19,
with more than 39,600 confirmed
cases of coronavirus since the
pandemic hit the state.
April 27, 2020 | Modern Healthcare 5
 Policy

COVID-19 could accelerate Medicare’s

march toward insolvency
By Tara Bannow and Michael Brady ers to stop kicking the can and start
“It’s time for taking the finances of these programs
THE TEAM IN CHARGE of monitoring policymakers to stop seriously,” MacGuineas said. “Tens of
Medicare’s financial health last week kicking the can and start millions of seniors and disabled workers
projected that the Part A trust fund’s are counting on them to come together
taking the finances of
reserves will run out in 2026, a predic- on a bipartisan basis to save Social Secu-
tion unchanged from the trustees’ past these programs seriously.” rity and Medicare.”
two annual reports to Congress. Maya MacGuineas Medicare’s Hospital Insurance Trust
But the 2020 assessment has a major President, Committee Fund has had a projected shortfall since
caveat: It doesn’t factor in the effects of for a Responsible the program was created in 1966. Con-
Federal Budget
COVID-19 on Medicare spending. Se- gress has made a number of changes
nior administration officials acknowl- over the years to rein in spending to de-
edged the global pandemic will “no lay the fund’s insolvency date, includ-
question” have a negative effect on the which could drive up the program’s ex- ing revisions to Medicare’s inpatient
reserve funds of both Medicare and penses, said Dan Adcock, government prospective payment system and Medi-
Social Security. relations and policy director for the care Advantage payments.
The 2026 projection for the Medicare National Committee to Preserve Social In recent decades, slow wage growth
Hospital Insurance Trust Fund, which Security and Medicare. made it harder to fund Medicare be-
pays for Part A inpatient hospital ex- On the other hand, fewer Medicare cause of lower than expected revenue
penses, assumes intermediate spend- beneficiaries are going in for regular from the payroll taxes used to finance
ing. In a high-cost environment, that doctor visits or getting expensive hip or the program.
reserve would run out by 2023, a senior knee replacements, he said. Medicare spent $796 billion in 2019,
official said on a background call with “I guess it’s possible that all this could an increase of 7.5% over the prior year
reporters April 22. be a wash,” Adcock said. and representing 3.7% of gross domestic
“It is also possible that experience Administration officials said the re- product. Over the next decade, Medi-
could be even worse than that,” the of- port’s findings triggered a Medicare care spending is expected to grow at
ficial said. “So it truly is too early to say funding warning, which requires the 7.2% annually, compared with annual
exactly what the impacts are. But … they president to submit to Congress pro- GDP growth of 4.2%.
are generally going to be worse than posed legislation to respond to the Healthcare spending is growing
presented under the intermediate as- funding situation within 15 days of sub- faster than GDP throughout the health-
sumptions in this report.” mitting next year’s budget. care system—it’s not specific to Medi-
Reserves in the Hospital Insurance care, according to Paul Ginsburg,
Trust Fund declined by $6 billion to Once the trustees incorporate the director of the USC-Brookings Schaef-
$195 billion at the end of 2019, the re- effects of COVID-19 on payroll tax rev- fer Initiative for Health Policy and vice
port found. Even when the fund’s re- enue and other factors in next year’s chair of the Medicare Payment Adviso-
serves become depleted, the program’s report, “the situation will go from bad ry Commission.
income—mostly taxes—still covers 90% to worse,” Maya MacGuineas, president “We just pay more attention to it in
of scheduled benefits. The of the Committee for a Re- Medicare because of the presence of
same is true for Social Se- sponsible Federal Budget, the HI trust fund and the fact that Medi-
THE TAKEAWAY
curity’s trust funds. If those said in a statement. Medi- care in its entirety is almost all funded
reserves run out in 2035 Medicare trustees care’s Hospital Insurance by taxes,” he said.
as projected, taxes will still stuck with 2026 as and Social Security’s Dis- Of total Medicare spending, 47%
fund 79% of scheduled the projected year ability Insurance funds was on Part B, which covers doctor
benefits. Part A reserves may run out in just a few visits and other outpatient care. Part B
People covered under will run out, but years, with Social Securi- spending came in $2.4 billion higher
Medicare run a higher the coronavirus ty’s old age trust not far be- than projected in last year’s report, and
pandemic will likely
risk of requiring hospital- speed that up.
hind, she said. is expected to grow 8.1% annually over
ization from COVID-19, “It’s time for policymak- the next decade. 

6 Modern Healthcare | April 27, 2020

EXECUTIVE INSIGHT
Comprehensive Clinical Asset Management is Central to Battling COVID
For both the immediate crisis, and the recovery that follows, visibility and availability are key.
LeAnne Hester
Chief Marketing Officer
TRIMEDX
Helping health systems rapidly orient to
the location, utilization, and condition of
medical devices has never been more vital.
But enabling rapid and efficient reallocation of devices
across and within sites of care, allowing systems to navigate
the acute phase of the COVID crisis, will lay a foundation
to support long-term recovery.
COVID has brought attention to access and
maintenance of critical medical devices. How can
health systems ensure they are in the best possible
position?
LA: The first step is gaining visibility into medical devices
across all sites of care. Visibility is not just knowing the
number of devices a health system owns but also their
location, condition, manufacturer information, parts
availability, utilization data and when the next preventative
maintenance is scheduled to occur. This ensures that
devices get where they need to be and are functional, safe,
and running at peak performance.
Building on this foundation of visibility, there are several
strategic levers we would recommend any organization
consider:
Critical Equipment Dashboard. Our dashboard, which
is updated hourly and includes the data above, displays
all COVID-critical medical device. It marries this data with
predictive analytics during peak volume, allowing systems, in
real-time, to understand demand and to reallocate devices
to appropriate sites as needed.
Proactive PM Prep. Our supply chain team collaborates
with our health system partners to proactively order parts
and supplies based on COVID-critical device Preventative
Maintenance schedules, ensuring parts are on hand, thereby
minimizing risk of downtime.
Prioritized Response. To ensure COVID-critical devices
take priority in the event of a necessary repair, we flag
these devices with a critical response indicator. This allows
our clinical engineering team to prioritize work central to
COVID cases.
What are other challenges have you seen health
systems facing?
LA: The intensity of COVID care environments requires
that critical medical devices are available when and where
clinicians need them as providers are literally reconfiguring
hospitals overnight.
Our Mobile Medical Equipment (MME) program dedicates
resources to track MME location, use, cleanliness and
readiness for patient care. We have added COVID-critical
devices to our MME services, ensuring they are prioritized
for pick-up, proper cleaning and are ready where and when
clinicians need them. Second, our MME teams have worked
closely with our health system partners to ensure newly
converted units are well prepared to take on new patients. At
one particularly hard-hit site, our team has helped ensure the
availability of equipment for:
• Three new ICU units
• Six COVID surge units
• Deployment of additional IV and feeding pumps to key units
• Management of CAPR distribution
• PAR level adjustments on all floors
The best practice here is maintaining a clear inventory of
what equipment is needed, visibility into what a provider has
available for use and tracking its location along with a record
for where the equipment should be returned.
What are some challenges health systems may face
with their medical devices, post-COVID?
Health systems that embrace the importance of medical
device inventory management as a system-level asset,
versus an individual site of care asset, will be well positioned
for success. Through an IoMT (internet of medical things)
platform, device tracking software (RTLS) or a robust
MME program, health systems can also track availability
and utilization of devices to make better decisions around
reallocation of devices to different sites of care. This will
likely include the expansion of medical devices into “hospital
at home” environments or expansion into post-acute sites as
patients continue to recover
.
The larger lesson is the importance of health systems
employing objective data when deciding to replace, upgrade,
retire or reallocate medical devices. Two things are clear:
health systems can expect an economic hit and the impact of
managing COVID will have on-going consequences. The keys
to success from a medical device perspective are maintaining
true visibility and adopting processes that continuously
enable device availability. Health systems should prioritize the
development of an objective plan to ensure capital dollars are
deployed in the most efficient and effective manner. This will
be the heart of the medical device agenda in the next year.
This Executive Insight was
produced and brought to you by:
To learn more, please visit
www.trimedx.com
 Providers

HHS issuing $40B in CARES Act checks,

but some providers may still miss out
By Rachel Cohrs 2018 net patient revenue vs. operating expenses
Highest net patient revenue Highest operating expenses
HHS IS SENDING OUT more than
$40 billion in COVID-19 relief grants— New York-Presbyterian Hospital New York-Presbyterian Hospital
including carve-outs for providers in ru- New York $5.951 billion New York $5.889 billion
ral areas and coronavirus hot spots—but Cleveland Clinic Hospital Cleveland Clinic Hospital
there’s concern that the funds may run Cleveland $5.164 billion Cleveland $5.775 billion
out before some providers can submit Kaiser Foundation Hospital – NYU Langone Hospitals
important financial data. Fontana New York $4.358 billion
Of the $40 billion tranche of grants Fontana, Calif. $4.404 billion Vanderbilt University Medical Center
announced last week, $20 billion will be Stanford Health Care Nashville $4.032 billion
distributed to all healthcare providers Palo Alto, Calif. $4.132 billion Memorial Hospital for Cancer
based on net patient revenue in 2018 NYU Langone Hospitals and Allied Diseases
CMS cost reports. New York $4.101 billion New York $3.879 billion
But this round of deposits won’t be Source: 2018 cost reports
exactly proportional because HHS
is taking a prior, $30 billion round of
grants into account. Those payments for children’s hospitals.” operating expenses, they are allocat-
were based on Medicare fee-for-service Independent physician groups are ing the larger general provider funding
revenue. This new round of funding also worried about their share of the stream by net patient revenue.
aims to even out payments for provid- funds since they don’t file CMS cost That metric favors providers with
ers who got less than their share. reports. American Academy of Family more commercially insured patients,
A key challenge with HHS’ new meth- Physicians Senior Vice President Shawn which are largely better off anyway,
odology is that cost report data is in- Martin said he was concerned that ad- said Guidehouse healthcare partner
complete and some of the funds were ditional reporting and data analysis will Dave Moseley. But he noted that HHS
deposited before the department began create obstacles for practices. had to make hard choices to get the
collecting data from providers that don’t With data missing, McDermott+Con- grants out fast.
have information on file. Some are wor- sulting Vice President Mara McDermott HHS will use additional provider relief
ried that they’ll be left out as the rest of said it’s difficult to tell what total propor- funds to reimburse them for COVID-19
the money is sent out on a rolling basis. tion HHS is using to send out the first care for the uninsured. Registration for
The second round of funds aims to wave of direct deposit payments, and the Health Resources and Services Ad-
benefit providers that were largely ex- how much will be left over. ministration system begins this week,
cluded from the earlier tranche, such “It feels like a total black box to me. and claims submission begins May 6.
as children’s hospitals. But a Modern How do you rebalance the funds with For each claim, providers will have to
Healthcare analysis found that nearly less than you started with?” she said. submit patient eligibility information.
a quarter of the 82 children’s hospitals Of the $40.4 billion in grants an- Providers that choose to accept the
that filed full-year 2018 CMS cost re- nounced last week, $10 billion will uncompensated care reimbursement
ports failed to fill out the net patient rev- be sent to providers in COVID-19 hot cannot bill the uninsured patients for
enue field that will be used to calculate spots based on intensive-care capacity, additional cost-sharing.
the funds. COVID-19 admissions and Medicaid dis- HHS Secretary Alex Azar said future
Children’s Hospital Association proportionate-share hospital payments. funding will go to dentists, skilled-nurs-
Chief Operating Offi- Rural providers will get $10 ing facilities in COVID-19 hot spots and
cer Amy Knight said the THE TAKEAWAY billion; and Indian Health providers that only accept Medicaid.
new formula is an im- Service providers will re- The grants come from a $100 billion
provement, but a lack of HHS’ new formula for ceive $400 million. fund created in the CARES Act, which
centralized data will com- distributing CARES While HHS chose to dis- Congress replenished with another
plicate the effort, adding Act funds could leave tribute funds to rural hos- $75 billion last week. l
“That data is hard to come some providers out pitals and Indian Health
by, which is a challenge of the equation. Service providers based on Tim Broderick contributed to this report.

8 Modern Healthcare | April 27, 2020

 Public health

Helping uninsured, distributing resources pose

challenges in devising national testing strategy
By Steven Ross Johnson
PUBLIC HEALTH EXPERTS welcomed
Congress’ decision to allocate billions
for COVID-19 testing, but cautioned
that money alone won’t solve the chal-
lenges states and providers face in ex-
panding access.
“We remain concerned that hospitals
and small communities may be left be-
hind,” said Blair Holladay, CEO of the
American Society for Clinical Pathology.
states, will maximize public safety,” said
Highlights from Trish Riley, executive director for the Na-
Congress’ latest round tional Academy for State Health Policy.
of COVID-19 relief “When states reopen their economies,
they need enough testing and the ground
$75 billion to replenish
the CARES Act’s provider relief
troops to conduct contact tracing.”
Since early April, more than 100,000
coronavirus tests have been conducted
fund. Lawmakers didn’t add any daily in the U.S. for a total of more than
additional guardrails and left 4.5 million since the start of the outbreak,
it up to HHS to decide how to according to the COVID Tracking Proj-
distribute the money. ect, a volunteer organization launched

$25
“The money is there, but we will need in April by the Atlantic magazine.
to work tirelessly to ensure that these Projections indicate an average daily
resources are distributed adequately to billion to expand capacity of 500,000 to 1.5 million tests
testing capacity, including
the communities that need them.” will be necessary to begin reopening the
$11 billion to state and local
Lawmakers allocated $25 billion country, said John Auerbach, CEO of
governments. Governments at
to expand the country’s capacity for Trust for America’s Health.
the federal and local levels are
COVID-19 testing as part of a broader required to develop strategic
$484 billion emergency relief package plans for testing. Any national program should estab-
President Donald Trump signed April 24. lish a guidance committee that includes
Nearly half the funding—$11 billion—
will go toward helping states, municipali-
ties, tribes and employers purchase more
$370 billion to top
up small business assistance
input from state and local officials as
well as hospital leaders and represen-
tatives from laboratories to ensure the
coronavirus tests and scale up their ca- programs, which may be administration is getting insights from
pacity to analyze results, as well as identify available to small providers and all relevant voices, Auerbach added.
people who may have come in contact hospitals. Resources aside, Dr. James Cardon,
with someone who has been infected. chief clinical integration officer at the
More than $4 billion has been dedicat- Hartford (Conn.) HealthCare system,
ed to bolster testing capacity in harder-hit strategy prompted several states and said a national program must also ad-
areas; another $2 billion is set for state municipalities to develop their own dress testing for those who have lost
grants from the Public Health Emergency testing programs with varying stan- employer-based insurance as unem-
Preparedness program, which supports dards. Subsequently some states have ployment surges. The Families First
public health departments. formed regional alliances to procure Coronavirus Response Act, enacted
The biggest impact is likely to be a man- needed resources and to share data in March, dealt with some concerns
date giving the Trump administration and strategies for a more coordinated by letting state Medicaid plans cover
30 days to establish a national program COVID-19 response. COVID-19 testing with no out-of-pocket
detailing how it will boost production, Public health experts say a national costs for the uninsured.
training and availability of plan would help establish But COVID-19 treatment costs for the
COVID-19 tests, as well as a more unified set of met- uninsured aren’t covered by the law,
its plans to assist states and THE TAKEAWAY rics to measure progress in and the threat of large medical bills may
address testing disparities. the effort to expand testing, deter many low-income and uninsured
The latest stimulus
A national testing plan package includes
and address many of the individuals from being tested.
has long been supported by $25 billion to bolster problems that have led to “As we think about broad-based test-
public health experts and testing, but public shortages, quality issues re- ing, how do we ensure that we don’t
Democratic lawmakers, health experts say garding test accuracy, and put up any financial barriers for folks
but GOP legislators and the cost barriers as well delays in results. to test and ensure we are being totally
White House have pushed as states’ needs for “A national testing strate- inclusive regardless of access to in-
for states to take the lead. resources must be gy, if fully funded and devel- surance or whether you’re a citizen or
The lack of a national addressed. oped in collaboration with not,” Cardon said. l

April 27, 2020 | Modern Healthcare 9

 Medicare/Medicaid

CMS lets independent free-standing

EDs bill Medicare, Medicaid
By Maria Castellucci Seema Verma said in a statement. “We decade and we’re thrilled to finally be
must leave no stone unturned as we able to provide them with timely access
THE CMS ISSUED GUIDANCE last seek to bolster the healthcare system to emergency medicine,” Brad Shields,
week allowing independently owned during this unprecedented crisis.” executive director of the National As-
free-standing emergency departments The guidance is specific to free-stand- sociation of Freestanding Emergency
to temporarily participate in Medicare ing EDs that aren’t affiliated with hos- Centers, said in a statement.
and Medicaid. pitals. Only four states—Colorado, While the guidance is temporary, the
The guidance is a way to expand ca- Delaware, Rhode Island and Texas— association said it will continue to push
pacity for hospital services as providers allow that type of free-standing EDs. for a “long-term solution.”
see an influx of patients with COVID-19, Health systems that own free-standing State regulations vary widely regard-
according to agency officials. EDs, which are called hospital outpa- ing what staffing and clinical services
“Expanding the num- tient departments, can a free-standing ED can offer, but it’s
ber of providers available already bill Medicare and usually imaging and lab services rather
THE TAKEAWAY
to Medicare and Medicaid Medicaid. There were than trauma care.
beneficiaries eases some Independently owned about 200 independently In order to accept Medicare and
of the burden shouldered free-standing EDs owned free-standing EDs Medicaid patients, the CMS said inde-
by traditional hospitals can temporarily in the U.S. in 2016. pendently owned free-standing EDs
and allows the health- bill Medicare and “The free-standing ER have three options: receive state ap-
care system to treat more Medicaid as part of community has advo- proval to operate as a hospital outpa-
patients at a time when an effort to expand cated to be able to serve tient department; enroll as a Medicaid
capacity for hospital
capacity is often limit- Medicare and Medicaid clinic; or be temporarily enrolled as a
services.
ed,” CMS Administrator patients for more than a hospital under Medicare. l

CMS approves first emergency Medicaid demonstration waiver

By Michael Brady of the COVID-19” public health emer- ton’s request to use Medicaid money to
gency, the agency said. create a disaster relief fund “to cover
WASHINGTON LAST WEEK became The state can now pay retainers for costs associated with treatment for un-
the first state to get a Medicaid Section personal care and rehabilitation pro- insured individuals with COVID-19,
1115 emergency waiver to help it deal viders, including occupational and housing, nutrition supports and oth-
with the coronavirus pandemic. physical therapists. Many providers er COVID related expenditures.” The
Under the waiver, health officials can have seen a massive decline in reve- agency believes that other resources
now target Medicaid services to areas nue since the pandemic began and re- are now available through the relief
hit hard by COVID-19 rather than deliv- tainer payments can help them stay in packages passed by Congress.
er services evenly across the state. The business. Washington can also loosen And the CMS didn’t approve the
state can also differentiate and target and expedite eligibility for long-term state’s requests to extend retainer
specific populations affected by the vi- care services and supports, among payments beyond 30 days or to allow
rus and “triage access to long-term ser- other changes. so-called “transportation brokers”
vices and supports based But the agency declined to provide non-emergency medical
on highest need,” the CMS THE TAKEAWAY to approve several of the transportation.
wrote in its approval letter. state’s requests to expand The CMS last month invited states
“CMS has determined Washington state coverage and other help, to apply for emergency waivers to help
that the Washington officials can now including opening up them prevent or address shortages
(waiver) is necessary to target Medicaid Medicaid to people with of healthcare supplies and services
assist the state in deliver- services to areas incomes at or below 200% caused by the coronavirus pandemic.
ing the most effective care hardest hit by the of the federal poverty line. All approved waivers will expire when
pandemic.
to its beneficiaries in light It also denied Washing- the public health emergency ends. l

10 Modern Healthcare | April 27, 2020

EXECUTIVE INSIGHT
Focusing resources on patients most at risk from COVID-19
COVID-19 specific models, analytics and services allow payers and providers to prepare for the virus
Michael Cousins, Ph.D.
Senior VP, Analytics & PHSO
Product Solutions
Lumeris
Michael Cousins is a seasoned analytics leader who uses
his experience to help guide healthcare organizations
along the analytics maturity curve—from reporting
and descriptive analytics capabilities to predictive and
“impactable” analytics capabilities. In this Q&A, Michael
discusses solutions for overcoming the operational and
clinical demands catalyzed by COVID-19, which are
overwhelming healthcare organizations that were already
struggling with acute margin pressures and resource
constraints.
What is the Virtual Care Access Package and how
can it help providers and payers during the COVID-19
crisis?
MC: We know that health systems and providers are facing
unprecedented challenges during this time. Our free Virtual
Care Access Package is designed to help organizations
identify, prioritize and manage patients at risk for COVID-19,
resulting in more efficient use of limited resources.
The solution enables organizations to analyze COVID-19
scenarios and effectively manage high-risk patients with
provider, caregiver and patient engagement tools that
integrate into existing workflows. In addition, it includes
capabilities for automating routine COVID-19 health checks
to increase office capacity to meet COVID-19 demands.
How should health systems be preparing to
understand the impact of COVID-19?
MC: The pandemic is clearly causing significant clinical,
operational and financial impacts to hospitals and provider
practices across the country. We determined that these
organizations will need support in understanding how
to manage their operations both during and after the
COVID-19 wave. Our solution provides enterprise-level
analysis and insights related to COVID-19 impacts, such
as disease surveillance, testing opportunity and patient
utilization. These reports will provide healthcare executives
with critical information to understand the impacts from the
pandemic specific to their organization, and what actions
they can take.
What can providers do now to help their high-risk
patients during the pandemic?
MC: One of the biggest challenges we are seeing is
that healthcare systems in certain regions are being
overwhelmed beyond their normal capacity and are facing
severely limited staffing. As a result, we wanted to find ways
to help providers identify high-risk patients that may be
able to be managed virtually, thus alleviating some of the
burden on their already constrained resources. Moreover,
if the peak has not hit a particular region yet, this solution
also provides a way for care teams to proactively engage
with their high-risk patients and help prevent unplanned
hospitalization.
To address this challenge, we have built a free Open Source
COVID-19 Hospitalization Index that identifies patients
at high risk of hospitalization due to existing conditions,
who are also at risk for severe disease and death due to
coronavirus infection. The Hospitalization Index can be used
within leading EHR patient registry platforms, including
those from Epic, Cerner, Athena and eClinical Works, and
can be easily implemented within 2 hours by non-technical
staff.
How can providers stay connected with their
patients and address their healthcare needs while
still following stay at home orders?
MC: The engagement driven by the Hospitalization Index can
be conducted via various channels including phone calls, text
messages, telehealth, or messages via the EHR’s patient portal.
It is expected that, through that engagement, staff can identify
challenges the person may be facing that, if addressed, can
reduce the likelihood of that person having an adverse event
such as hospitalization and increase the likelihood that the
person can remain at home sheltered-in-place.
Medical and/or non-medical staff — such as social workers — at
private and public health systems, provider offices and clinics
can reach out to these high-risk people proactively. There
is also ready-made workforce in those communities where
PCPs and clinic staff are being under-utilized or furloughed. In
addition, we can support them with our own staff or automated
outreach for routine COVID-19 health checks that can augment
their current capacity. For example, our no-cost Stay in Touch
program allows practices to stay connected with their high-risk
patients, monitoring their health status while keeping them safe
at home.
This proactive outreach won’t solve all the problems of the
pandemic on its own, but it can free up hospital bed capacity:
For example, given an organization whose proactive outreach
to the predicted highest risk tier (top 1% highest risk) can
reduce hospitalizations by 25%, every 100 people proactively
engaged could save 42 bed days/month.
This Executive Insight was
produced and brought to you by:
This Executive Insight was
produced and brought to you by:
To learn more, visit:
lumeris.com/covid-19-response-solution
Providers

HCA aims to ‘reboot’ operations

in second half of 2020
By Tara Bannow
THE STRANGLEHOLD COVID-19
put on HCA Healthcare’s volumes
starting March 15 has only worsened
in April, with outpatient surgeries
down 70% year over year so far.
Leaders with the Nashville-based
hospital chain said on an earnings
call last week that they view the
first quarter, which ended March
cific savings goal. The company hasn’t
HCA hits a rough patch tapped into a third phase.
The company has already received
Year-over-year comparisons for Q1 2020 most of an expected $4 billion in ac-
celerated Medicare payments under
Net income dropped Expenses rose the CARES Act, which the company
44%
to $581 million
9%
to $12 billion
will begin repaying in August, Ruth-
erford said. The company received
another roughly $700 million from
the Public Health and Social Ser-
Revenue EBITDA fell vices Emergency Fund, which does

2.7% 13.4%
31, in two distinct phases: pre- and inched up not need to be repaid.
post-COVID-19. All key volume in- As of last week, HCA had cared
dicators were on the upswing from for about 5,500 COVID-19 patients
to $2.2 billion
Jan. 1 through March 15. After that, to $12.9 billion
across its facilities, and Hazen said
all bets were off. in the quarter exposure to employees has been
Source: HCA Healthcare
“Everything was tracking great— limited. To date, the company hasn’t
they were absolutely killing it—and laid off or furloughed any employees,
then all of a sudden this thing hits,” but about 80,000 have had hours cut
said Frank Morgan, an analyst with RBC actual impact hasn’t been nearly as dire. because of the reduced volumes. Some
Capital Markets. “They were on pace to HCA may regain its ability to perform administrators, including Hazen, have
have probably another record quarter the same level of surgeries it could before taken voluntary pay cuts.
until this hit.” COVID-19, but whether demand will be
HCA announced it is pulling its 2020 there is another question, said Brian Tan- By comparison, Tenet announced
guidance, a move foreshadowed by its quilut, an analyst with Jefferies. it furloughed about 500 full-time posi-
peers Tenet Healthcare Corp. and Com- “But it’s encouraging to hear that as tions in early April.
munity Health Systems, and suspended we get out of the second quarter, we It’s hard to predict how the recov-
its quarterly dividend and share repur- would be closer to the recovery phase ery will look, because it’s unclear how
chase programs. Several analysts have of this whole situation,” he said. many patients will wind up uninsured,
lowered their 2020 performance fore- The real damage from COVID-19 is on Medicaid or other forms of coverage,
casts for investor-owned hospital chains. expected to hit companies in the sec- Hazen said. Getting elective surgeries
HCA is now focused on a reboot plan ond quarter, which began April 1 and restarted will involve coordination with
that the company’s CEO, Sam Hazen, ends June 30. So far in April, HCA’s ad- governors. HCA will need to reassure
said will be fully operational at the end missions are down about 30% year over patients it’s safe to return to medical fa-
of June. Leaders are looking ahead to year, and emergency department visits cilities, which involves having enough
restore capacity as governors in states are down 50%, Bill Rutherford, the com- personal protective equipment and
like Texas and Tennessee, pany’s chief financial offi- tests, he said.
where HCA does a lot of cer, said on the call. HCA’s doctors are split on their read-
THE TAKEAWAY
business, announce plans “Generally speaking, iness to return, with some eager to
to reopen economies. COVID-19 caused almost all volume sta- address their backlogs and others con-
“We believe the reboot HCA Healthcare’s tistics were adversely af- cerned about safety for their patients
phase will be accom- volumes to plummet fected,” he said. and themselves, Hazen said.
plished across most of the in the latter half of Analysts said HCA tends The stock market will largely view
company by the end of the March and into April. to be more resilient than its 2020 as a throwaway year, RBC’s Mor-
second quarter,” Hazen Now, the for-profit peers in the for-profit hos- gan said. The question then becomes
said on the earnings call. hospital chain is pital industry. HCA is in the whether companies have the financial
pushing its plan to
In many of HCA’s markets, restart services that
second phase of a cost-cut- wherewithal to ride out the rough patch.
he said initial forecasts have been disrupted. ting plan, although Hazen In his mind, HCA has the capital struc-
were “sobering,” but the declined to share the spe- ture and liquidity to do so. l

12 Modern Healthcare | April 27, 2020

The Healthcare Transformation
Summit is now a webinar series.

Due to the COVID-19 pandemic, we are taking the 2020 Healthcare

Transformation Summit online. Join industry leaders to learn what
will drive your business forward.

May 12-13, 2020

Webinars include:
• Leading Through Crisis: What COVID-19 is Teaching Us
• From Startup to Scale: Launching a Successful Healthcare Startup
• A Person-Centered Future for Healthcare, Moderated by Planned Parenthood
• How Innovation is Helping Battle COVID-19

To learn more and register, visit: ModernHealthcare.com/TSUMMIT

Connect. Learn. Advance your career.

Have a question about the webinar series? Contact Jodi Sniegocki, Education and Events Director
jsniegocki@modernhealthcare.com | 312.649.5459
Interested in sponsorship? Contact Ilana Klein, Advertising Director
iklein@modernhealthcare.com | 312.649.5311

The 2020 Healthcare Transformation Summit webinar series is sponsored by:

Supporting Additional
Sponsor Sponsor
Interoperability Reimagined.
EXPERIENCE THE POWER OF OPEN COLLABORATION
Industry attempts at interoperability have not fully delivered on the promise. Until now.

Holon Solutions and Lifeguard Health Networks have reimagined how the industry achieves the value of
interoperability through open network collaboration. We developed a way to get you there fast and then
went further. No more engaging disparate system vendors in a long, drawn out process. No more complicated
integrations. With Holon’s patented sensor and ribbon technology, you’ll be viewing relevant patient insights
in a matter of days. Combine that with Lifeguard’s mobile solution that connects care teams and tracks
patients between visits, and you have a platform proven to accelerate speed to value.

If you’re a technology provider interested in being an open network collaborator, contact us today at:
info@holonsolutions.com.

TO LEARN MORE, VISIT US AT

holonsolutions.com
lifeguardhealthnetworks.com
INTEROPERABILITY COALITIONS
The Next Wave of Interoperability: Coordinated Collaboration
As we navigate our way through COVID-19, the social distancing
and isolation affecting us all bears striking similarities to our
healthcare information: siloed, disconnected, and contextually
amiss. As healthcare professionals, we have become acutely
aware of this analogy. The pandemic has exposed massive gaps
in our system related to access, reliability, collaboration, and
our ability to mobilize resources in a meaningful way. Many of
us knew they were there; the pressure to change was not.
That has all changed now. Two innovative companies, Holon
Solutions and Lifeguard Health Networks, are collaborating
to shift the paradigm.
Single solutions aren’t enough to tackle the issues created
by the industry’s lack of effective cross-constituent
interoperability. In the spirit of true collaboration, Holon
and Lifeguard have come together to build a rapid response
knowledge, patient surveillance, and information platform
that enhances existing infrastructures while creating speed
to value for patients, healthcare workers, policymakers, and
other stakeholders. Powerful together, it’s only the beginning
of an open movement embracing all providers of healthcare
information.
Holon Solutions’ CollaborNet™ platform is a SaaS-based
knowledge delivery service that ensures contextually
relevant information is delivered to any provider’s workflow
at the time of need, regardless of the systems in place. A
“vendor-inclusive” solution, Holon’s patented sensor and
ribbon technology eliminates the need to integrate directly
inside EMR vendors – an enormous barrier facing many
healthcare organizations as they attempt to connect and
extract insights from disparate data sources in a way that
is meaningful to providers. CollaborNet functions with a
healthcare organization’s existing technology investments,
seamlessly gathering and presenting information when the
provider needs it most. It is currently deployed at scale to
help providers close gaps in care, knowledge, and coding.
Smart referral functionality carefully manages all the
communications and tracking of patients as they are referred
to specialists or community resources.
The LifeguardRx solution creates a digital bridge between
healthcare providers and their high-risk patients in the home,
eliminating the “information gap” that accumulates between
clinical visits. The mobile platform engages and activates a
patient’s circle of care (which includes credentialed health
professionals and trusted family caregivers), providing scale
and support when the healthcare provider is not present.
LifeguardRx also tracks meaningful patient reported
outcome measures (PROMs) in real-time, such as symptoms
and side effects, vital measures, and medication adherence,
and utilizes “exception-based” triggers to notify the medical
team when intervention is required.
Together, Holon and Lifeguard deliver an infrastructure that
powers a patient-centered, data-driven model enabling more
timely and informed clinical decisions at the point of care,
whether that is in the provider’s office or at home. Take, for
example, the lead crisis in Flint, Michigan. Holon was rapidly
deployed to help the community respond, making highly
INTEROPERABILITY SOLUTIONS GUIDE 2020
relevant patient information available to providers precisely
when they needed it, and facilitating the best possible
clinical response to those impacted. Likewise, in Australia,
Lifeguard quickly adapted requirements for patient-reported
monitoring in a population health program to track patients
suspected or confirmed to have COVID-19, supporting
respiratory clinics and practices in the region – and even
enabling quarantined clinical team members to manage
patients remotely. By combining their collective capabilities,
Holon and Lifeguard can accelerate and sustain the value
of knowledge and surveillance for better care delivery and
outcomes.
As collaborators on COVID-19, the Holon-Lifeguard
combination offers immense value. It is extremely fast to
implement and brings immediate benefits to providers
and patients. Just download, register, and use. The remote
monitoring capabilities of LifeguardRx give providers 24/7
access to vital information about their patients – especially
those who may have the coronavirus and/or are chronically
ill. The flexibility of the Holon CollaborNet platform ensures
those providers get important patient insights at the right
time, that would otherwise be unavailable or require them to
dig through multiple systems to find what they’re looking for
– whether that’s during an in-person or remote (telehealth)
visit. The combined power promises to help keep patients
healthier, at home, and out of our over-burdened hospitals.
As we emerge from the pandemic, this kind of open
collaboration will only become more significant. The more
constituents joining the collaboration, the better. Openness
and speed must be embraced. Healthcare will be forever
changed and our new normal will require expanded and
more rapid access to vital patient information and the
continued adoption of virtual solutions that support the
home as a growing place of service for care delivery. The
need for contextually relevant knowledge delivered at the
point of need, regardless of the system in place, will only
increase. Likewise, a platform that connects patients to their
caregivers and care professionals for real-time surveillance,
actions, and monitoring becomes more critical. Employing
existing, proven, collaborative technologies will be necessary
for healthcare organizations to survive and thrive.
Coordinated, relevant, actionable knowledge just-in-time,
at the point of need coordinated across all constituents in
any community is the right step forward. Never has the time
been more important to act wisely with a sense of urgency
and purpose to deliver results.
This Insight was written and brought to you by:
To learn more, please visit
www.holonsolutions.com
www.lifeguardhealthnetworks.com
BUILDING CONNECTIONS
FOR A HEALTHIER WORLD
Unlock the full potential of your data with the
industry’s leading interoperability provider,
Lyniate — the new home of Corepoint and Rhapsody.
Our products are used by thousands of customers
around the world to send hundreds of millions of
messages every day — using all health data
standards, including FHIR.

Lyniate adapts to the needs of any sized organization, including

large health systems, specialty clinics, payers and health plans, and
health IT vendors. Our products integrate all your health data simply,
securely, and seamlessly. At Lyniate, we believe a well-connected
healthcare ecosystem is just the beginning.

Visit www.lyniate.com for details.

INTEROPERABILITY PLATFORMS
Interoperability Platforms: Their Role in COVID-19 and Beyond
Lyniate CEO Erkan Akyuz explains how interoperability platforms
free up data exchange for patient care.
By themselves, the final Interoperability
Rules from the ONC and CMS are
landmark mandates for the healthcare
industry. Their timing has coincided
with a crippling pandemic, the likes
of which haven’t occurred in recent
memory. Together, these two game-
changing events will force healthcare
organizations to adopt technology and
policies that allow providers, public health agencies, and
epidemiological organizations to share data across the care
continuum. Lyniate’s products enable this level of seamless
data sharing.
What is an interoperability platform?
EA: Interoperability platforms like Lyniate’s Corepoint and
Rhapsody allow players in the healthcare ecosystem to
exchange data by creating interfaces between disparate
systems. These interfaces could be between a health
system’s EHR and its laboratory, billing, and radiology
systems; a remote medical device and a provider’s EHR; or a
provider and a public health system.
As patients increasingly demand access to their health data
and serve as conduits for sharing it, our platforms will enable
this type of data exchange as well.
What role do your platforms play in the COVID-19
pandemic?
EA: First, they allow providers and public health agencies
to share, exchange, and report clinical data. Which patients
have been tested? How are patients’ outcomes being
monitored and tracked? Which providers have access to
that data to ensure continuity of patient care? How is that
data being reported to state and regional public health
agencies, and, where appropriate, to the CDC?
Now we’re seeing a need to track inventory data — available
beds, ventilators, and personal protective equipment. It’s
important to collect this data in a central location so it can
be allocated where there’s the greatest need.
With the increased stress on our health systems, inventory
decisions must be made on a basis that optimizes their
deployment. Currently, this data isn’t uniformly collected
in a central place. The COVID-19 pandemic will change this,
and platforms like ours will be a vital layer in health systems’
IT infrastructure to enable efficient sharing of clinical and
inventory data where ad hoc, stopgap measures are in place
right now.
Why isn’t the healthcare system already
interoperable?
EA: In the U.S., healthcare organizations have never
been incentivized to share data. Leaders of healthcare
organizations haven’t wanted to share what they deem to be
proprietary information with competitors who could use it
to target high-value patients or gain insights into clinical or
business practices.
INTEROPERABILITY SOLUTIONS GUIDE 2020
Another barrier is the number of different healthcare
standards out there. While we’ve seen incredible innovation
among health IT vendors in recent years, the products and
software they’re developing often use proprietary data
formats that aren’t interoperable with other systems.
Lyniate’s platforms address both barriers by unlocking data
and normalizing it in a way that is incredibly powerful for
clinicians, patients, payers, and public health agencies.
One unique aspect of the ONC rule is that it specifies a
healthcare standard called Fast Healthcare Interoperability
Resources, or FHIR. It’s rare for a rule from the Health and
Human Services to mandate a particular technology like
they’ve done here.
A FHIR application programming interface defines the layer
on top of an EHR that allows other applications to interact
with its data. The growing use of this standard will lead the
healthcare industry to what the ONC calls the “health app
economy,” where patients have access to their healthcare
data in much the same way they access their financial
information. Both of Lyniate’s platforms allow developers to
create workflows using FHIR.
How will different segments of the healthcare
market adjust their business models to enable
interoperability?
EA: Business models will have to include the infrastructure
to enable healthcare data exchange — not only because the
government is now mandating it, but because we must be
better prepared for the next public health crisis.
As these business models change, organizations that are
best at enabling data portability — in a way that is efficient,
accurate, secure, and shareable with any destination system
— will have a competitive advantage in terms of patient
experience.
How do your products help healthcare leaders adapt
to new business models?
EA: Lyniate enables these business models by creating
adaptable interoperability solutions for all healthcare
organizations — from specialty clinics to large networks, from
payers to vendors, and everything in between. Our products
are used to send hundreds of millions of messages every day,
moving data where it needs to be. During a time when so
much is uncertain, it takes data that is easily shareable and
actionable to help us make the right decisions and create a
health system that is better equipped to care for patients in
times of calm and in times of crisis.
This Insight was written and brought to you by:
To learn more, please visit
www.Lyniate.com
Executives
Healthy profits in 2019
led to healthy pay bumps
for insurer CEOs
By Shelby Livingston Insurance company
CEO compensation
THE CEOs OF THE LARGEST publicly Total compensation for the seven CEOs
traded health insurers received more in increased 15.7% to $151 million in 2019
total compensation in 2019 than they did over 2018
the year before as nearly all of their com- 2018 Total compensation
panies grew profits and revenue. 2019 CEO ($ in millions)
David Wichmann, CEO of the most *Larry Merlo, $21.9
profitable health insurer, UnitedHealth CVS Health
Group, made $18.9 million in total pay Michael Neidorff, $26.1
Centene Corp. $26.4
last year, a 4.3% increase over the pre-
David Cordani, $18.9
vious year, according to the company’s Cigna Corp. $19.3
annual proxy statement filed with the David Wichmann, $18.1
Securities and Exchange Commission. UnitedHealth Group $18.9
Anthem CEO Gail Boudreaux made Joseph Zubretsky, $15.2
$15.5 million, an increase of 9.1% over Molina Healthcare $18
2018, and Molina Healthcare CEO Joseph Bruce Broussard, $16.3
Zubretsky made $18 million, up 18.4%. Humana $16.7
Compensation is primarily based Gail Boudreaux, $14.2
Anthem $15.5
on company financial results and the
CEO’s individual performance, accord- $0 $10 $20
ing to company proxy statements. To a * 2019 total includes long-term stock awards
and other one-time incentives.
lesser extent, some insurers also con-
sider success in meeting certain qual- Source: Insurance company SEC filings
ity metrics, like improving members’
health outcomes and customer service. Merlo’s reported pay is misleading be-
cause CVS changed how it reports com-
WE B E XCLUSIVE pensation, resulting in some of Merlo’s
Front-line providers and primary-care long-term incentive awards being
physicians expect pay cuts as COVID-19 counted twice.
strains their organizations. Read more at Further, CVS gave Merlo long-term
ModernHealthcare.com/webexclusives. stock awards earlier than planned to re-
flect the company’s Aetna acquisition
“More than 90% of the overall com- and initiatives to transform care, such as
pensation for the CEO is impacted by opening its HealthHUB expanded clin-
company performance, including per- ics inside some CVS drugstores. Absent
formance relative to company goals those factors, Merlo’s compensation was
and financial metrics, and changes in closer to $19.6 million.
the company’s stock price,” an Anthem “We’re creating a higher-quality, sim-
spokeswoman said in an email. pler and more affordable healthcare ex-
Larry Merlo, CEO of CVS Health, perience for the millions of Americans
which bought insurer we interact with every
Aetna in 2018, made $36.5 THE TAKEAWAY day, in normal circum-
million, a 66.1% increase stances and in times
over 2018, according to As profits soared, of need. That progress
the company proxy. But a so did compensation was reflected in our 2019
spokesman explained that for insurer CEOs. executive compensation,
20 Modern Healthcare | April 27, 2020
the vast majority of which was perfor-
mance-based,” the spokesman said in an
emailed comment.
As reported last month, Michael Nei-
dorff, CEO of Centene Corp., received
$26.4 million in total compensation last
year, a 1.2% increase over 2018. Cigna
Corp. CEO David Cordani made $19.3
million, up about 2% over the year be-
fore, and Humana chief Bruce Broussard
made $16.7 million, an increase of 2.5%.
A Humana spokesman said the insurer
pays its executives to reflect financial per-
formance and health outcomes.
Compensation for the seven CEOs
ballooned as their companies have be-
come much more than health insurers.
Many of the firms have acquired or been
$36.5 acquired by companies not in the insur-
ance business, such as pharmacy chains
and pharmacy benefit managers. Sever-
al have branched into healthcare deliv-
ery, buying up primary-care clinics and
home health agencies.
Beyond CVS’ merger with Aetna, in
recent years Cigna bought pharmacy
benefit manager Express Scripts, while
Centene acquired rival insurer WellCare
Health Plans. Humana purchased stakes
in home health and hospice companies
$30 while building out primary-care clinics,
and Anthem developed its own in-house
PBM called IngenioRx. UnitedHealth’s
Optum business has continued to grow
its army of physicians.
Collectively, the seven companies
analyzed reported $35.6 billion in prof-
it on revenue of $913.1 billion in 2019.
That’s a significant increase from 2018,
when they reported combined profits of
$21.5 billion on revenue of $697.5 billion.
Executive compensation typically
is composed of salary, cash incentive
payments, equity awards and other
compensation, such as company con-
tributions toward a retirement plan or
insurance policy. An executive’s pay for a
year doesn’t necessarily reflect what that
person took home, as equity awards may
not become available for several years.
Sometimes, what a CEO actually
brought home differs greatly from the
reported total compensation. In Wich-
mann’s case, for example, his “realized”
pay—factoring in stock awards vested
and option awards exercised during
2019—totaled $52.1 million. l
EXECUTIVE INSIGHT
Early Mobility for High Volumes of Respiratory Illness
How to Incorporate Early Mobility Into a Care Plan
Todd Brockway
division vice president
Medline
In the last few months, hospitals have
handled an influx of ICU patients due to
COVID-19 and it has put a strain on bedside
nurses. When patients in critical conditions are ventilated,
the risk of ventilator-associated events increases. Early
mobility and safe patient handling are mission-critical
for helping patients return to their baseline level of
health. Todd Brockway, division vice president at Medline
who oversees business priority, strategy and product
development, highlights how to make early mobility a part
of a hospital’s protocol when caring for ICU patients.
Why is early mobility especially important for patients
with a respiratory illness?
TB: It is important to get patients with respiratory illnesses
moving to help lung expansion and keep secretions
moving. As patients are mechanically ventilated, prolonged
immobility often leads to delirium and generalized weakness.
Early mobility can play a significant role in reducing delirium
and prevent prolonged time on mechanical ventilation by
improving strength and endurance.1
What are important steps to think about when
implementing early mobility?
TB: The first step is to assess the patient’s mobility level.
Even if a patient is in the ICU and in the acute phase
of illness, there are special assessment tools bedside
caregivers can use to determine mobility level. In addition,
nurses need to determine if the patient is hemodynamically
stable to tolerate early mobility. This will help determine
the activity the patient can tolerate. Their mobility level
will determine the type of equipment needed to assist the
patient back to their baseline mobility status. As part of the
care plan, it is critical to assess the patient’s strength daily
to determine appropriate mobility exercises.
Additionally, care teams should have ample equipment
available to keep patients and staff safe. Some of the
essential items include a patient lift, repositioning sling,
slide sheet, arm cradle, bolsters and head positioner.
Utilizing the proper equipment can help reduce the
number of staff needed and reduce the risk of injury.
What is prone positioning and why is there a seemingly
sudden focus on it?
TB: Proning, turning the patient on their stomach, helps to
increase the amount of oxygen that gets into the patient’s
lungs. We are hearing from healthcare providers that they
are seeing improvement in oxygenation in COVID patients
when practicing prolonged proning.2 Medline is dedicated
to partnering with healthcare systems to create solutions
that improve patient care. This has led to the introduction of
proning product bundles to help make early mobility more
intuitive for bedside caregivers.
Are there ways to make prone positioning—which is
typically arduous—any easier for caregivers?
TB: Lifts and friction-reducing devices help reduce the
amount of physical exertion required by staff to perform the
task. Many ICUs have lifts, but they often are underutilized
because bedside nurses worry about dislodging tubes
or IV lines. However, a lift should be a nurse’s best friend
because when used properly, it is safer for the nurse and the
patient than moving them manually. When using a lift, it is
recommended to have two to three caregivers available to
assist.
How can busy facilities find time to make early
mobility part of their care plan?
TB: Early mobility should be treated like any other part of
the patient’s care plan. It is another form of medicine for
the patient that can help improve their health. For health
systems to be successful, it is important to move away from
the mindset that there is too much else to do. Supporting
clinicians with easy accessibility to equipment and training
empowers them to make mobility a part of their practice.
Having a program and providing guidelines for everyone to
follow will help ensure that mobility is achieved appropriately
and timely to increase patient safety and improve outcomes.
1. Knight J., Nugam Y., & Jones A. (2018) Effects of bedrest series.
Nursing Times
2. N Engl J Med 2013 (2013) Prone Positioning in Severe Acute
Respiratory Distress Syndrome https://www.nejm.org/doi/full/10.1056/
NEJMoa1214103
This Executive Insight was
produced and brought to you by:
To learn more, please visit
www.medline.com
COVID-19 reshapes
healthcare M&A
By Alex Kacik

HE COVID-19 PANDEMIC is threatening to post-

T pone, derail or force a restructuring of hospital

deals in the works, but an unusual four-hospital,
two-system deal is still intact.
Advocate Aurora Health’s Advocate Trinity Hospital, Trin-
ity Health’s Mercy Hospital & Medical Center, South Shore
Hospital and St. Bernard Hospital would join forces to down-
size aging, underutilized facilities and create a new hospital
and several community centers. It would require a $1.1 bil-
lion infusion of capital from the hospitals and their parent
companies, private donations and the government.
Hospital executives say the merger is still on track, but de-
clined to elaborate if or how COVID-19 has changed timing South Shore Hospital GOOGLE EARTH
or strategy.
Initial plans didn’t call for any facilities to close until new OW NERSH IP S TAT US: Independent
ones were opened, but the COVID-19 pandemic may accel-
BEDS O P ER AT I N G R E V EN U E
erate that, said Michael Buchanio, a principal in West Mon-
roe Partners’ healthcare practice. 137BEDS $40.2 million
“This may expedite closures, especially of hos- F T E190
s (down 3% from
pitals that relied on outpatient elective proce- $41.3 million in 2017)
dures,” he said, adding that could dent revenue by
See By the
Numbers for a
388
40% to 60%. “The CARES Act and short-term relief list of hospital DAYS C A SH ON H A ND 9
would likely not be enough to offset that.” M&A activity in
Q1 2020, p. 42 Sources: HMP Metrics and annual earnings
Prior to the onslaught of an unprecedented pan-
reports, 2018
demic that spiked labor and supply costs, the deal
was already complicated. It calls for Advocate Trin-
ity and Mercy Hospital to be divested by their respective par-
ent companies and St. Bernard to separate from its sponsor,
Catholic Health International, as the institutions look to blend the parent company’s infrastructure as the new entity gets
cultures, reposition, revamp decades-old facilities and turn its footing.
around years of operating losses. The hospitals’ average inpatient occupancy levels are
The four not-for-profit South Side Chicago 45%, and none are leading their respective
hospitals are within a 20-minute drive of each THE TAKEAWAY service areas in market share, according to
other, predominantly serving Medicaid benefi- HMP Metrics data compiled from Medicare
ciaries, many of whom are battling chronic ill- COVID-19 will cost reports.
nesses. They recorded a collective $84.3 million likely force smaller “If a larger system’s smaller hospitals don’t
operating loss in 2018 as they have struggled to hospitals to seek support its referral network and fit well, they
mergers while larger
maintain hospitals that are too old and too big, are taking a more critical look at them,” said
health systems
executives said. are poised to Gregory Eli, shareholder at consultancy LBMC.
“Developing a transition plan to carve out better manage the “I don’t know how you sustain the number of
three hospitals from their parents and sponsors pandemic hospitals and beds in this country at these cen-
is complex and requires significant time and re- and continue their sus levels.”
sources,” Buchanio said. deals as planned, Oftentimes, the emotion and optics of main-
Typically, these divestitures include tempo- albeit with possible taining a small community hospital can trump
rary service agreements, which grant access to delays. business and financial aspects, he added.

22 Modern Healthcare | April 27, 2020

 St. Bernard Hospital
Sponsored by
OW NERSH IP S TAT US:

Catholic Health International

BEDS
O P ER AT I N G R E V EN U E
190 $91.5 million
BEDS
FTEs (up 3% from
190
758 $88.5 million in 2017)

DAYS C A SH ON H A ND 35
Sources: HMP Metrics and annual earnings
reports, 2018

ST. BERNARD HOSPITAL

New approach
Tentatively, a new 500-bed hospital or two 250-bed hospi-
tals are planned to take the place of the four hospitals’ nearly
800 combined beds. They had planned to sign a definitive
agreement and announce a CEO and leadership team by
midyear.
The hospitals could aggregate their data to identify future
care sites and service lines, like violence recovery, executives
said. The community centers would offer urgent care, am-
bulatory surgery, infusion therapy, mental health services,
diagnostics and imaging as well as specialty care.
Similar moves are being made throughout the country,
Buchanio said, noting that Chicago’s South Side has changed
a lot since the 1950s.
“It’s hard to adapt unless hospitals merge and attack re-
gional patient demographics in a different way,” he said.
Changes to reimbursement, including efforts to spur new
models of care, are leading to consol-
idation and specialization, said Mark
Armstrong, a shareholder at LBMC. Mercy Hospital
“Smaller markets have been en-
couraged to be more general, but & Medical Center
then they have to adapt when they
OW NERSH IP S TAT US: Owned by
realize they shouldn’t be all things to
all people,” he said. Trinity Health
Illinois officials are seemingly BEDS
supporting this deal because of the
treatment barriers that low-income 258
communities face, said Jennifer FTEs
Perry, managing principal at con-
sultancy FMG Leading.
1,839
The hospitals predominantly serve DAYS C A SH ON H A ND 19
a South Side community that has sig- Sources: HMP Metrics and annual earnings
nificantly lower life expectancy than reports, 2018
downtown Chicago, the result of food
deserts, violence and substandard
housing, among other issues.
“Competition isn’t serving all of them or the com-
munity that well,” said Perry, adding that several of
the hospitals’ faith-based missions may have led to a
partnership. “They may have tried to be involved in
other transactions that may have not been attractive
because of their performance.”
COSTAR GROUP
While the new entity will not be a Catholic system, dis-
cussions about the church’s Ethical and Religious Directives
that ban abortions, gender reassignment surgeries and other
procedures are ongoing, executives said.
Catholic and secular hospitals will often set up separate
subsidiaries to ensure patients have access to all treat-
ments, but they aren’t performed through the faith-based
division, Perry said.
Meanwhile, it’s uncertain whether the funding commit-
ment from local and state agencies and philanthropists was
guaranteed. “The money may be going toward more imme-
diate needs,” Buchanio said. If that’s the case, it may push
back a lot of that funding, he said.
Thus, it’s imperative hospital leaders make a compelling
case, experts said. The executives must clearly explain the ra-
tionale of closures and operations adjustments to the com-
munity, Buchanio said.
“An inability to do so erodes trust and
can negate or dampen the momentum
behind the investment,” he said.
“Given the complexity of the deal, they
have to spend time upfront clarifying
their shared purpose and manage ex-
pectations,” Perry said.
Many hospital deals lead to aggre-
gation rather than integration, warned
O P ER AT I N G R E V EN U E
$238.4 million
(up 1% from
$237.1 million in 2017)

April 27, 2020 | Modern Healthcare 23

Gay Casey, a managing director at Berkeley Research Group. MERGERS AND ACQUISITIONS REPORT
Economists have pointed to a number of studies that have
shown prices typically rise after hospitals merge while ex- M&A slowdown
pected savings often fall short. Broader merger and acquisition activity was down in 2019
“They cannot afford to have duplication of administration relative to the previous year, with not-for-profit buyers pulling
function,” she said. “They have to optimize resources and back by about 30%.
sites of service and figure out how to best deliver care for
Top five deals of 2019
people in those communities. If they try to continue oper-
By revenue of acquisition target ($ in millions)
ations status quo, then I would venture to say the outlook is
not great.” TARGET
Casey remembers one deal where a health system divest- GraniteOne Health, Dartmouth-Hitchcock
ed a hospital, and they had to set up everything from scratch. Revenue: $2,700* Beds: 797 States: N.H., Vt.
“It took a small army and relentless focus to get that Merged: Dartmouth-Hitchcock Health GraniteOne
done,” she said. TARGET
Wake Forest Baptist
A losing record Revenue: $2,010 Beds: 1,423 State: N.C.
Each of the four of the hospitals is operating in the red, with Acquirer: Atrium Health
2018 net losses ranging from $1.3 million at South Shore to TARGET
nearly $70 million at Mercy Hospital, according to HMP Met- Summa Health System
rics data. Revenue: $1,375 Beds: 1,372 State: Ohio
“Working individually, our hospitals will not be able to pro- Acquirer: Beaumont Health System (deal delayed)
vide sustained, quality care on the South Side,” Charles Hol- TARGET
land, CEO of St. Bernard Hospital, said in prepared remarks. Four California hospitals (Verity Health)
Mercy Hospital amassed more than $250 million in oper- Revenue: $1,239 Beds: 1,229 State: Calif.
ating losses from 2014 through 2018. Advocate Trinity Hos- Acquirer: KPC Group (deal did not close)
pital recorded around $30 million in operating losses over
TARGET
that span, much like St. Bernard’s results. Ten LifePoint Health hospitals
While its finances have been improving, South Shore Revenue: $859 Beds: 1,449 States: Multiple
racked up nearly $7 million in operating losses from 2014 to
Acquirer: Medical Properties Trust
2018, HMP data show.
“The financial implications may have forced their hand, * Revenue is for resulting joint operating company
creating an opportunity to form a unique approach,” Perry
said. “Otherwise, the community faces a loss of income and All announced
transactions For-profit Not-for-profit
access to care.”
They can position themselves as a growth opportunity TARGETS ACQUIRERS
centering around a new hospital and community clinics 120
39 20
with a shared purpose, Perry said.
“It is good news for the South Side of Chicago, but there is 100
a lot of work in human capital let alone structural and gover- 97
nance issues to make this deal happen,” she said. 80 17 18
Some of the hospitals involved only have a week or two of 78
cash on hand, Casey said. 60
69 68
“If they are putting in new revenue-cycle processes and
IT systems, it could have a major impact on cash flow,” she
said. “If they are starting to build new facilities, it is a very 40
scary time.”
20
Bad timing
Many health systems are laying off primary-care physi- 0
cians and other staff members deemed “nonessential” to 2018 2019 2018 2019
the COVID-19 response. Cash flow issues are paramount,
said Christopher Kerns, vice president of executive insights Average number Total revenue
at Advisory Board. of beds ($ in billions)
If overall cash levels drop significantly, that can trigger a $38.9
344.3
material adverse change clause. Bondholders can rescind a
227.6
bond or increase borrowing rates, Kerns said. $18.8
“A lot of those bonds are backed by a union fund and uni-
versity endowments,” he said. “If they get skittish about cash 2018 2019 2018 2019
flow, that can trigger material adverse changes resulting in a Source: Ponder & Co.

24 Modern Healthcare | April 27, 2020


Advocate Trinity Hospital
ADVOCATE TRINITY
OW NERSH IP S TAT US: Owned by Advocate
Aurora Health
BEDS O P ER AT I N G R E V EN U E
201 $145 million
(up less than 1% from
FTEs
$144.5 million in 2017)
810
DAYS C A SH ON H A ND N/A
Sources: HMP Metrics and annual earnings
reports, 2018
technical default or rate increases.”
The federal stimulus packages have largely been aimed at
supporting cash flow and helping hospitals make payroll.
If hospitals lay off or furlough more than 10% of their
workforce, they would have to pay back more of their Small
Business Administration loans. There are also limits to exec-
utive compensation.
“Before hospitals make big moves like furloughing or fir-
ing employees, they should question how those decisions
will affect funding,” Buchanio said.
Distressed markets typically create a lot of M&A activity
and we are starting to see the beginning of it, he added.
“This is forcing companies to get creative, and they have
to look at all their options,” he said. “I don’t think that we will
see a downturn in activity. We may see an uptick because of
companies that need additional funding or to expand their
service offerings so they are not siloed in one market.”
and then pause, he said.
“We believe the stronger the strategic rationale
there was to pursue the transaction, the more likely
these will continue—understanding the reality that
COVID-19 will influence pace and process,” Singh
said. “Larger systems with broader and deeper teams
often have additional human capital and resources to
continue certain strategic initiatives, such as transac-
tions and partnerships—particularly as compared to
smaller-scaled service providers where fewer total re-
sources are available.”
The delay of elective surgeries could dent revenue
by 40% to 60%, analysts said.
“I believe these pressures will accelerate the need
for vulnerable hospitals to merge or be acquired to
stay afloat, and fully expect that new models of care
will emerge that will likely impact future growth
plans, resource allocation and strategic relationships
for all hospitals,” Perry said.
Many of the deals that hinged on ambulatory services cer-
tainly halted, Casey said.
“For the organization being acquired, it can change the
entire structure of the deal and make the acquiring organi-
zation rethink what they are actually purchasing,” she said.
“With hospitals, it’s a little less clear, but the activity around
the deals has come to a halt just due to resources being im-
mersed in caring for the patients or preparing to care for
you.”
The priority for all hospitals right now is understanding
how much support they will get from the stimulus bills,
Casey said.
“They need to figure out what to track, how to qualify and
what they are applying for,” she said. 
Crain’s Chicago Business’ Stephanie Goldberg contributed to
this report.
2018 operating loss ($ in millions)
$0
-1.3 -6.5 -8.4
-$10
-$20
-$30

M&A outlook -$40

COVID-19 has had a varied impact on hospital transac-
tions, M&A experts said. -$50
No transaction in the first quarter involved a seller with
more than $1 billion in annual revenue, according to -$60
-64.7
Kaufman Hall data.
Deals that offer a broader solution to combat the pandemic South St. Bernard Mercy Advocate
Shore Hospital Hospital & Trinity
will likely expedite some transactions in the works. Financial
Hospital Medical Hospital
headwinds will also force some administrators’ hands, said Center
Anu Singh, head of the M&A practice at Kaufman Hall. Other
hospitals and health systems will aim to get to a key milestone Source: HMP Metrics and annual earnings reports, 2018

April 27, 2020 | Modern Healthcare 25

 SPONSORED CONTENT
EXECUTIVE SPECIAL ADVERTISING SECTION
CONVERSATIONS
A Virtual Response to the Virus
How the COVID-19 crisis is shaping the
future of telehealth
Kathy Ford
President and Chief Product Officer
Rhinogram
Healthcare operations have been dramatically
impacted by the COVID-19 crisis, as hospitals have
been transformed to maximize capacity and safeguard
patients. Hospitals are being repurposed to best
mitigate the impact of the pandemic, and entire service
lines have either been put on pause or transferred to a
virtual setting.
Telehealth adoption has already been on the rise in
recent years, and the pandemic has caused demand
to surge at an unforeseen rate. Though telehealth
has historically been positioned as an option of
convenience, the COVID-19 pandemic is pushing this
modality to the forefront of the healthcare dialogue as a
critical, must-have tool for healthcare organizations.
In a discussion with Modern Healthcare Custom Media
two industry leaders offered best practices around
telehealth and discussed how it can be used not just as
a differentiator but an essential asset.
Kathy Ford is president and chief product officer of
Rhinogram. She is a healthcare industry veteran with 25
years of experience as an innovator and leader at GE
Medical Systems, McKesson, Siemens Medical,
Carestream Dental and NantHealth.
Dr. Jason Hallock is chief medical officer at SOC Telemed,
where he leads clinical and administrative strategy. He is
a clinical and operational leader with over twenty years of
experience in some of the nation’s most highly developed
clinically integrated networks.
Jason Hallock, MD
Chief Medical Officer
SOC Telemed
The COVID-19 pandemic has forced a rapid, massive
shift to virtual care, with the alternative being
closure of clinics. How can healthcare organizations
transition services quickly and efficiently?
KF: Conducting virtual visits is crucial for business
continuity during this crisis, especially when faced with
disrupted operations and staff furloughs. Communication
platforms that deliver telehealth capabilities and can engage
patients in their preferred manner—such as secure text
messaging or social media—allow providers to reduce
phone call bottlenecks and reach patients more quickly,
while securing the foundation for smoother workflows and
better patient care.
JH: No one was prepared to virtualize this quickly.
Virtualizing scheduled visits is fairly straightforward. Many
outpatient clinics are using point-to-point solutions like
Zoom. The more difficult piece revolves around triaging
patients in real-time and managing surge. How do you
efficiently deploy available clinicians to where they are
needed in real-time? The real “magic” in telemedicine is in
the virtual workflows.
How should providers use telehealth to optimize the
operation of costly service lines?
KF: Providers must stay connected with low-acuity and
chronic patients, even as facilities close and postpone
elective procedures. This is where telehealth can be
leveraged to triage patients’ physical and emotional
 SPONSORED CONTENT
Fighting COVID-19
“Providers must ensure telehealth aligns
with technological capabilities of the
patient population.”
Kathy Ford
health, through four key actions: condition identification,
remote monitoring, limiting exposure and extending care to
those with limited access. Telehealth offers customizable
templates, smart routing and text-to-pay, further optimizing
staff time.
JH: Telemedicine increases provider efficiency. Windshield
time, idle time, geographic boundaries and even the time
it takes a physician to walk down the hall are eliminated.
Instead of covering a single facility across the course of
a shift, virtual specialists can be deployed to any
geographic location experiencing an acute need.
Real-time, centralized visibility into clinician
availability optimizes every minute of time.
Hard-pressed rural providers are looking
for new revenue opportunities, while health
plans are looking to ensure cost-effective
access. How should telehealth factor into
their rural health strategies?
KF: Telehealth extends care to those in rural
settings, but there are limitations. For instance,
video tele-consults and logging into an EHR
portal might not be an option for those without
reliable internet access. But cell phones are
nearly ubiquitous. Providers must ensure telehealth
implementations align with the technological capabilities
of the patient population, as well as any integration
requirements for existing EHR and billing systems.
JH: Telemedicine is already impacting rural health strategy.
In the U.S., 48% of hospitals are “rural,” serving 84%
of land but only 18% of the population. One challenge
for many rural facilities is a lack of access to specialists
which creates critical gaps in care. Telehealth can deliver
specialists wherever they are needed allowing rural
hospitals to continue providing critical care, stroke care and
emergency psychiatry services around the clock.
As patients look to national telehealth providers for
episodic care, how can leaders reduce the risk of
care fragmentation among those who may not have a
consistent clinician?
KF: National telehealth providers are useful for patient
overflow and after-hours care but are transactional in
nature. For patients, it comes down to convenience which
is why more physicians must leverage telehealth advances
as a source for immediate care. Implementing a text and
video communication platform means patients can stay
connected to their physician rather than seek care from a
national network with whom they have no prior relationship.
JH: The healthcare delivery model is changing faster than
many physician practices can keep up. Patients want on-
demand access to a doctor. They want care to fit into their
regular lifestyle. And they don’t want to wait. Widespread
adoption of telemedicine will further accelerate this evolution.
Primary care should take note.
How widespread is telehealth access for vulnerable
Americans, like older adults or the poor? What can be
done to improve access?
KF: Telehealth protects high-risk populations and allows them
to keep up with care plans. To ensure widespread access,
providers must support virtual care with the lowest technology
 SPONSORED CONTENT

ability to mirror the communication patterns

Fighting COVID-19
“Adoption is skyrocketing due to the
COVID-19 pandemic, but we are barely
scratching the surface.”
Jason Hallock, MD
barriers possible: cellular service. The ACA made flip phones
with unlimited texting available to any Medicaid patient.
Further government support and full reimbursement for
asynchronous communications (texting) will continue to drive
adoption of this type of care.
JH: Connectivity is still an issue in many parts of the country.
The poorest in our communities may have no connectivity
at all. Today most older adults seem comfortable using
smartphones, but they may not be as comfortable accessing
telehealth programs or communicating with providers in this
capacity. But, with facilitated care, family members, social
workers, visiting nurses and caregivers can support telehealth
access for vulnerable citizens
of the user—be it traditional text, Facebook
messenger, WhatsApp, Instagram or whatever
follows. Healthcare must make faster strides to
keep up with today’s generation of consumers.
JH: Telehealth offers the ability to tear down the
four walls of the hospital and the physician’s
office all at once. Of late, the speed of adoption
has skyrocketed due to the COVID-19
pandemic, but we are still barely scratching
the surface. Prior to COVID-19, telehealth
accounted for just 1% of hospital care. As care
continues to fragment toward the paths of least
resistance, in the near future telehealth could
account for more than 25% of care.
For more information about Rhinogram,
visit www.rhinogram.com.
For more information about SOC Telemed,
visit www.soctelemed.com.

How do you foresee pending federal interoperability Life-Saving

Telemedicine
requirements impacting the telehealth industry?

KF: For interoperability, it should never be about who

owns the data; but who needs the data to deliver the best Virtually deploying clinicians where
possible care. Today, EHRs serve as the Fort Knox of patient they are needed most.
information. And while that data needs to be secured, it also
needs to be shared. The more we can interweave social
determinants, patient histories and clinical episodes, while Intensivists
making that information accessible across platforms, the Hospitalists
faster we’ll diagnose, prescribe and heal.
tele
JH: It is really patients who will benefit most from the Emergency Medicine
elimination of data silos and the safe transfer of information Triage
between providers. Having access to a robust medical
history provides additional context for providers, improving Neurologists

their interactions with patients, eliminating the need for Psychiatrists

duplicative testing and preventing medication errors. In sum,
Urgent Care
interoperability supports better longitudinal care.

Adoption of telehealth services has increased

dramatically over the last decade. Where do you see
room for continued growth?
To learn more about SOC’s 72-hour rapid deployment and
KF: While some telehealth advances—like video—can be
COVID-19 response, please visit www.soctelemed.com
limiting due to the expense and access reasons discussed
in my prior answer, there’s still plenty of room for growth.
But adoption will increase only in relation to telehealth’s
 The
Appreciation Issue
Is Coming

May 11, 2020

Celebrate Hospital Week by sharing your story and
supporting the healthcare workers on the front line of the
COVID-19 pandemic.

Submit your story on social media using #MHAppreciation

To advertise in the issue

contact Ilana Klein
iklein@modernhealthcare.com
312.649.5311

Thank you for your dedication and service.

 DAVITA KIDNEY CARE
A DaVita Kidney Care clinician tends to a dialysis patient. Medicare spending on kidney disease totaled more than $114 billion in 2016.

Medicare Advantage
insurers to be tested
by flood of patients with
permanent kidney failure
By Shelby Livingston

CORNER OF THE HEALTH INSUR- renal disease, who will be able to enroll in the

A ANCE INDUSTRY that has enjoyed

years of rapid growth and lucrative
returns will soon face a challenge that
threatens to upend that success.
Medicare Advantage insurers are gearing
up to receive a potential flood of new members
with permanent kidney failure, or end-stage
private alternative to traditional Medicare for
the first time in 2021. Tens of thousands of these
very sick, costly patients are expected to take
advantage of the option.
While many Advantage insurers currently
cover a few hundred end-stage renal disease,
or ESRD, patients who developed the condi-

30 Modern Healthcare | April 27, 2020

 Medicare spending on
If you are a smaller health end-stage renal disease by source
plan, a regional plan with less Medicare Advantage 2016 total: $49.1 billion
than 50,000 members, if you get spending experienced
Fee-for-service $35.4 billion
more than your fair share (of ESRD the biggest percentage
Patient obligation $3.8 billion
increase from 2004
patients), I think it would be very to 2016 Medicare Advantage $10.0 billion
hard financially for these health
$50
plans to survive.” ($ in billions)
$45
Jill Selby
Corporate vice president at California-based $40
SCAN Health Plan
$35
$30

$25
tion while already enrolled, the prospect of adding hun- $20
dreds or thousands more to their rosters will put care and 2004 total: $22.7 billion
cost-management skills to the test. $15
Fee-for-service $18.5 billion
Insurers who successfully manage the patients, who $10 Patient obligation $2.8 billion
are in the final stage of chronic kidney disease, could do $5 Medicare Advantage $1.4 billion
well financially; others could be squeezed and forced
to hike premiums or cut benefits. “Health plans are go- $0

9
5

07

13

15

17
11
0

0
ing to have to change operationally in many ways,” said
20

20

20

20

20

20

20
Jane Scott, a senior clinical consultant at Gorman Health
Note: 2017 values for patient obligation and Medicare Advantage
Group, which advises Advantage plans. were not available, but total spending from 2016 to 2017 reportedly
New York-based insurer Emblem Health is prepar- rose 1.3%
ing for new kidney disease members by striking up Source: U.S. Renal Data System 2018 annual report,
2019 summary report
value-based care arrangements to drive better health
outcomes. Michigan-based Priority Health is training
its care managers to be able to better serve patients with
ESRD. Humana is expanding its ability to facilitate dialy- striction beginning next year, and patient advocates and
sis at home instead of in a clinic, and for more than a year, dialysis providers cheered the change for allowing ESRD
CVS Health has been working on a clinical trial for a home patients more choice in where they access coverage.
hemodialysis device. The change comes amid a broader push by the Trump
All insurers and dialysis providers are calling for high- administration to improve care and reduce costs for
er payment rates from the federal government, but their patients with kidney disease, which affects 37 million
pleas have so far landed on deaf ears. people. It aims to reduce the number of Americans who
“If you are a smaller health plan, a regional plan with less develop ESRD, promote dialysis at home and expand
than 50,000 members, if you get more than your fair share access to kidney transplants. About 750,000 Americans
(of ESRD patients), I think it would be very hard financially have ESRD, and 530,000 have Medicare benefits. It’s un-
for these health plans to survive,” said Jill Selby, a corpo- clear if COVID-19 infections will increase the number
rate vice president at California-based SCAN Health Plan, of kidney failure patients, because kidney damage has
which has offered a Medicare Advantage special needs been reported as a consequence of the coronavirus.
plan for ESRD patients since 2006. The CMS said it expects 83,000 ESRD patients to switch
People with permanent kidney failure, in- to Medicare Advantage due to the Cures Act
cluding those under age 65, have long been provision, with half of those enrolling in 2021
eligible to enroll in the traditional Medicare THE TAKEAWAY alone. Advantage plans have more limited net-
program, which covers dialysis treatments, Medicare Advantage works than traditional Medicare, but they also
kidney transplants and other services. Dialysis insurers are limit how much members must pay out of pock-
removes waste and fluid from the blood when gearing up for a et. Traditional Medicare, which requires ESRD
the kidneys are no longer working. potential flood of patients to shoulder 20% of the cost of dialysis
new members with services, has no such limit, and some states
ESRD patients previously barred end-stage renal make it difficult for people younger than 65 to
ESRD patients are the only patient group disease who will be purchase a supplemental policy that would pick
barred from enrolling in Medicare Advan- able to enroll in a up out-of-pocket costs.
private alternative to
tage, except in limited circumstances. The 21st “For people with ESRD, this could really fi-
traditional Medicare
Century Cures Act signed into law by former starting in 2021. nancially help many of them, simply because
President Barack Obama in 2016 lifted that re- Advantage plans have an out-of-pocket limit,”

April 27, 2020 | Modern Healthcare 31

said Gretchen Jacobson, vice president of the Medicare actively planning for an influx of new ESRD patients. In
program at the Commonwealth Fund. addition to investing in training for care managers, For-
Some patients may be better off with traditional shee said the insurer will ramp up its use of artificial intel-
Medicare and supplemental insurance, however. ligence and advanced analytics to pinpoint opportunities
Richard Knight, president of the American Association for better care. Care managers will assess patients in their
of Kidney Patients and a former hemodialysis patient, homes to address any barriers, such as a lack of transpor-
said his organization has been helping several health tation to the dialysis clinic.
insurers conduct focus groups to get a sense of the ben- “We’ve spent a significant amount of time understand-
efits and coverage that kidney disease patients need and ing what interventions we can help with, what social de-
want. Those could include benefits like transportation, terminants we can help with, and we’ll do more of that
home-delivered meals, home dialysis and a good phar- with this new population,” he said.
macy plan, because kidney patient drugs are expensive, Humana Chief Financial Officer Brian Kane told in-
he explained. dustry analysts in February that the insurer
Knight said the jury’s still out on whether is modeling how many new members with
In 2016,
Medicare Advantage will be the best option end-stage kidney disease it might enroll next
for patients. That will depend on the bene-
fits that plans ultimately offer, the premi-
ums and the restrictions on which doctors
$67,116
was spent per ESRD
year, standing up clinical teams to manage
them, and working with dialysis provid-
ers “to come up with creative risk-sharing
patients can visit. beneficiary mechanisms to help drive outcomes.”
“We are staunch defenders of patient versus Kane said Humana is also considering
choice and being able to choose the option
that’s going to make the most sense for the
patient,” he said. “The question we have is
$10,182 bringing additional capabilities to the di-
alysis marketplace to boost competition
through home dialysis, “micro-clinics” or
per senior beneficiary
will they design plans that complement the other alternative care sites. “We understand
president’s executive order?” Source: MedPAC June 2019 report why it makes sense to bring ESRD into this
population,” Kane said. “We just need to
Cost of care Total Medicare manage the short-term transition.”
Health insurers are worried they won’t fee-for-service spending
be paid enough by the federal government in the general Medicare Prevention efforts
to cover the cost of the expensive services population increased Some insurers have turned their focus to
and care management that ESRD patients
require. Beyond kidney failure, patients of-
ten have multiple other chronic conditions,
3.1%
in 2016 to $490.1 billion
identifying kidney disease early and pre-
venting it from progressing to permanent
kidney failure. CVS Health last year began
such as diabetes, heart disease or lung dis- rolling out its new chronic kidney-care
ease. Many are older, frail and face socio- Medicare fee-for-service management program to Aetna members
economic barriers to medical care. spending and pharmacy benefit manager clients, CVS
for patients with end-stage renal
While ESRD patients made up just 1% of disease rose by CEO Larry Merlo said at the J.P. Morgan
Medicare enrollment, they accounted for Healthcare Conference in January.
7%, or $35 billion, of the program’s costs
in 2016, according to the U.S. Renal Data
System. Together, Medicare spending on
4.6%
to $35.4 billion in 2016,
CVS and Aetna are combing data to pin-
point patients at risk for chronic kidney
disease to then prevent or slow the onset of
chronic kidney disease and ESRD totaled accounting for the disease and the need for dialysis. Mean-
more than $114 billion, or about 23% of fee- while, CVS’ home hemodialysis device, now
for-service spending.
Advantage plans, which cover a total of
7.2%
of Medicare claims.
in clinical trials, could be in the market by
the second half of 2021, Merlo said.
24.7 million people, are familiar with ESRD Likewise, not-for-profit insurer Emblem-
patients—131,000 were covered by the plans Source: U.S. Renal Data System Health said it tries to catch kidney disease
for various reasons in 2019, according to the early and design clinical interventions to
CMS. The question is whether insurers have scaled the pro- improve outcomes and quality of life while reducing costs.
grams they need to care for them, said Sean Creighton, a Members with Stage 4 or Stage 5 kidney disease are as-
managing director at consultancy Avalere Health and for- signed a renal nurse to provide one-on-one support and
mer CMS official. care management, said Dr. Richard Dal Col, chief medical
“This is about more than payment,” Creighton said. In- officer. The insurer is also expanding its strategy to imple-
surers “have to look at building networks of nephrologists; ment value-based arrangements with clinicians to support
they have to look at contracting with dialysis centers; and chronic kidney disease patients.
putting in place care management for ESRD patients.” While Dal Col said he is confident in EmblemHealth’s
Dr. James Forshee, chief medical officer at Michi- care-management skills, he—like most insurance execu-
gan-based Priority Health, said the insurer has been tives—is concerned about receiving adequate reimburse-

32 Modern Healthcare | April 27, 2020

ment from the CMS. Insurers have commissioned reports Top 10 Medicare Advantage insurers
from actuarial and consulting firms to show why they By number of enrollees, March 2020
think ESRD payment rates fall short and will cause them to Insurer Enrollment
raise premiums or cut benefits for all Advantage members. UnitedHealth
“Our internal analysis has found that the cost to man- Group 6,361,671
age the ESRD population is notably greater than the CMS Humana 4,449,202
revenue we receive,” Kaiser Permanente officials wrote in
CVS Health
a March comment to the agency. (acquired Aetna) 2,595,608
Insurers have also argued that they can’t negotiate
Kaiser Foundation
high enough reimbursement rates for dialysis because Health Plan 1,681,202
just two companies dominate that market. Those com-
Anthem 1,326,206
panies—DaVita Kidney Care and Fresenius Medical
Care—both support the change allowing kidney failure Centene Corp.
(acquired WellCare) 879,564
patients to enroll in Medicare Advantage. They typically
can command higher payments from Advantage plans Blue Cross and Blue
Shield of Michigan 591,631
than fee-for-service Medicare.
“We actually see this change as an opportunity to fur- Cigna Corp. 508,814

ther expand and demonstrate the effectiveness of our co- InnovaCare 263,348
ordinated-care models, which ultimately reduce overall Highmark Health 238,125
spending and improve outcomes,” said David Pollack, Source: CMS.gov
president of the integrated-care group at Fresenius.

Payment differs for ESRD patients when it published its final rate notice in
Medicare Advantage plans are paid differently for early April, though it acknowledged the complaints and
ESRD patients than they are for other members. Plans said it would continue analyzing the issue. Tim Courtney,
receive risk-adjusted benchmark payments for ESRD pa- a Wakely actuary and author of the firm’s report on ESRD,
tients that are calculated by the CMS at the state level us- said the agency may not have the authority to change the
ing data from the traditional Medicare program. payment calculation.
One reason these payments are inadequate, accord- The agency did, however, seek to mitigate ESRD costs
ing to an insurer-commissioned report by actuarial firm by allowing insurers to shift more costs to patients. It
Wakely, is because traditional Medicare does not impose increased the maximum out-of-pocket level by 13% to
a maximum out-of-pocket limit on members and Medi- $7,550 for all Advantage members and increased the total
care Advantage does. The current rates paid beneficiary cost threshold by $3, which al-
to Advantage plans don’t account for lows plans to put slightly more out-of-pocket
that difference. cost burden on members, Courtney said.
Wakely’s report, which was spon- We actually see The CMS has also proposed loosening
sored by Humana, concluded that this change as Advantage insurers’ network adequacy re-
at current payment rates, if all ESRD an opportunity to quirements related to dialysis. And it said
patients enrolled in Medicare Ad- further expand and the agency would continue to shoulder the
vantage, plan profits would decrease by demonstrate the costs for organ acquisitions for kidney trans-
almost 2%. Plans would have to increase effectiveness of our plants instead of having Medicare Advan-
monthly premiums by $16 across all Ad- coordinated-care tage plans do so.
vantage members and pare back benefits to But organ acquisition is not where the
maintain profit levels.
models, which costs are, said SCAN’s Selby. “The true ex-
Another report, by Avalere, concluded ultimately reduce pense is in the dialysis, and that’s continuing
that ESRD payments to Medicare Ad- overall spending until they get the transplant,” she said. “But
vantage plans fell below costs in 10 of 15 and improve the transplant and professional fees and all
metropolitan areas with the most ESRD outcomes.” the things that go into making sure a trans-
patients enrolled in traditional Medicare. plant isn’t rejected is also a huge expense.”
David Pollack
Payments to Advantage plans were higher President of the In the end, a lot will be determined by
than fee-for-service costs in the other five, integrated-care group the number of ESRD patients who switch to
however. One issue, according to Avalere, at Fresenius Medical Care Medicare Advantage.
is that payment rates are set at the state “You could do extremely well financially
level instead of county level, so they don’t with ESRD patients, but it’s kind of one of
consider cost variation within a state. The those unknowns,” said Jeff Fox, president
report was commissioned by the Better Medicare Alli- of Gorman Health Group. “If you have a couple today it’s
ance, a group that advocates for Medicare Advantage. easy to manage; if you have a couple hundred, how easy is
CMS did not change the way it pays Advantage plans it going to be to manage?” l

April 27, 2020 | Modern Healthcare 33

 Protecting the unsung
healthcare heroes
AURORA AGUILAR Editor
T
elehealth has stolen the spotlight as the new way
to deliver patient care following the overnight
disruption of COVID-19.
While the CMS and providers have
encouraged broader use of telehealth
tools to maintain regular visits and
contain spread of the virus, many bene-
ficiaries use another favorite handoff in
the continuum of care—home health.
Providers have sent COVID-19 pa-
tients home when they don’t need inten-
sive care. Remote monitoring and other
innovations allow healthcare workers to
minimize exposure and to potentially
lower the cost of treatment. This option
precedes the pandemic. Providers and
insurers for years have been searching
for ways to avoid costly settings.
Home healthcare has faced a chal-
lenge though: inadequate staffing.
Low wages and unforgiving work have
dissuaded new workers from entering
an occupation that faces increased
demand because of a booming elderly
population.
Now the backbone of the sector faces
another challenge: President Donald
Trump’s assault on those who make up
a significant portion of the workforce.
Last week, Trump announced he would
ban immigration into the U.S. and sus-
pend green-card applications. Over the
course of several days, that threat was
walked back to a 60-day suspension,
and ultimately he said it wouldn’t ap-
ply to the healthcare workforce. Still
visa and green-card applications have
34 Modern Healthcare | April 27, 2020
slowed in recent years.
Politico reported that from Oct. 1,
2018 and July 29, 2019, the State De-
partment issued 12,179 visa rejections.
That’s up from 1,033 rejections in fiscal
2016, the last year under former Presi-
dent Barack Obama.
Almost 9% of those home healthcare
workers are not citizens. These work-
ers don’t have glamorous jobs, and it’s
unlikely they’ll be labeled as heroes by
anyone other than those they care for.
Their clients depend on them to bathe,
get dressed, eat, keep up with their
medications and clean their homes.
During the pandemic, many of those
have also put themselves at extreme
risk. The Kaiser Family Foundation last
week reported that 53% of all long-term
care workers are personal-care workers
who come in close contact with patients.
It shouldn’t come as a surprise that
there will be 8.2 million job openings in
home care through 2028. These work-
ers are paid, on average, $10 an hour.
First-year turnover can exceed 80%.
And if the economic burden of car-
ing for our elderly loved ones on low
pay isn’t enough, many of these home
health aides face another insidious
burden: xenophobia.
Of the 4.5 million direct-care work-
ers employed in the U.S. in 2018, about
1 in 4 was an immigrant. Almost 9% of
those home healthcare workers are not
citizens. Those people have faced in-
creased uncertainty about living in the
U.S. during the Trump administration.
Last week’s executive order was
just the latest missive in Trump’s fight
against immigration. The Supreme
Court has yet to rule on the lawfulness
of Trump’s decision last year to end the
Deferred Action for Childhood Arriv-
als program, which previously allowed
undocumented immigrants who came
to the U.S. as children to legally avoid
deportation.
The impact of that move elicited an
op-ed early during the COVID-19 out-
break from several general counsels
in large health systems. They plead-
ed for the estimated 29,000 front-line
medical workers at risk of being de-
ported while working to save lives in
COVID-19 hot spots.
The impact of Trump pausing im-
migration could affect more than the
permanent residents and noncitizens
in the home health space.
It doesn’t matter that immigration to
the U.S. is ostensibly shut down while
the globe cowers amid the ferocity of
this modern plague. What matters is
the message being sent during a time of
immense fear and division.
Those healthcare workers may see
this as an added reason to bail on this
occupation. And who will lose out? The
providers that had been depending on
them as linchpins in caring for the pa-
tient as a whole. l
We need a retooled post-COVID-19 curriculum
to emphasize the role of population health
By Dr. David Nash
T
he eminent scholar, educator and advocate for
continuous improvement W. Edwards Deming once
said, “Every system is perfectly designed to achieve
the results it gets.”
The U.S. spends more on healthcare
than any other country. Yet among
wealthy nations, we have the lowest
life expectancy. Maybe no healthcare
system could have been prepared for
a pandemic, but we were not nearly
as prepared as places like South Ko-
rea and Taiwan, which spend far less.
As COVID-19 metastasized, America’s
healthcare system, designed to deliver
episodic, acute care but not health care,
was nearly crippled. The negative ef-
fects, on the professionals and the bot-
tom line, could last for years.
Our healthcare system gives little
thought or resources to improving pop-
ulation health by preventing and man-
aging disease. We spend our treasure on
health services, not on social services,
which is upside down and backward.
Maybe it takes a pandemic to get peo-
ple to realize, holy mackerel! Population
health! I guess that’s kind of important.
It’s too late to do more than scramble
and do the best we can with what we’ve
got, but education is about the future.
What can we do in our healthcare curric-
ula today to make sure we don’t find our-
selves in this predicament tomorrow?
Healthcare reform is about adopting
the tenets of population health, which
align perfectly with the Quadruple Aim:
enhancing patient experience, improv-
ing the health of communities, reducing
costs, and reducing caregiver burnout.
Clinicians of the future won’t be ready to
lead this kind of system redesign unless
they have the tools to do it.
I’d like to share some key components
of a curriculum designed to do just that:
Dr. David Nash
is founding dean
emeritus and
professor of health
policy at the
Jefferson College of
Population Health
in Philadelphia.
Public health. The U.S. was unpre-
pared for COVID-19, despite the fact
that national leaders had been briefed
about the likelihood of a pandemic.
The basic tenets of public health are
in our graduate-school curricula right
now: monitor and diagnose community
health, mobilize partnerships, develop
policies and plans, evaluate effective-
ness, and research innovative solutions.
We need to double down here.
Leadership education. More than
ever, we need physicians who can envi-
sion and adapt to change, and lead or-
ganizational responses. MBA programs
excel at teaching the skills and strategies
that effective leaders need. Medical and
nursing schools can learn from these
leadership programs, the sooner the
better, and incorporate leadership train-
ing, the earlier the better.
Population health intelligence.
Artificial intelligence, big data and pre-
dictive analytics are indispensable tools
that assess information in a way no
single clinician could. If we mine and
analyze large data sets, we can distill in-
formation for making better-informed
decisions about patient care. These
tools also help us identify fraud, waste
and abuse. Let’s insist that clinicians
can create, interpret and extrapolate
from patient registries and that they are
grounded in probability theory too.
Performance improvement. The
tools have been around for 30 years:
performance and quality improvement,
waste or error reduction, and realloca-
tion of wasted resources. Based on the
evidence, one-quarter to one-third of
healthcare spending, roughly $1 trillion,
is of no value. Imagine if we had been
able to reallocate those resources for
masks, gowns and ventilators. The statis-
tical process control tools of quality im-
provement, including run charts, and the
like, must be taught starting on day one.
Social determinants of health.
Good health and ill health are more
than biomedical conditions: they’re the
outcomes of social inequality. Research
shows that the principal predictors of
health are poverty, housing and access to
good food. To improve health, we have to
improve social services. Let’s insist that
all trainees have community-based ser-
vice experience, to understand how we
can work together to reduce disparities.
These are not electives or nice cur-
ricular add-ons. Like anatomy and tak-
ing a personal history, they encompass
the core knowledge and essential skills
future healers must have to become
leaders who can see beyond the status
quo. Neglecting them in a curriculum
meant to train future caregivers is like
marching into a pandemic with too few
ventilators and not enough personal
protective equipment. Let’s rethink and
reform the curricula for all healthcare
professionals today so we don’t get the
same results tomorrow. l
April 27, 2020 | Modern Healthcare 35
 Battling on the front lines organizations to provide behavioral our provider organizations are using
of behavioral health during healthcare for Floridians who are innovative ways to continue to serve,
indigent, uninsured or underinsured. including telehealth. Our network of
COVID-19 crisis
The services are provided at crisis care is burgeoning and our providers
The media continues to laud our stabilization units, detox and inpatient continue to answer the call.
hospitals’ physicians and nurses substance abuse treatment facilities, Christine Cauffield
who valiantly put their lives at risk mobile response units, homeless CEO
while treating those diagnosed with shelters, psychiatric hospital units LSF Health Systems
coronavirus. They most certainly and medication-assisted treatment Jacksonville, Fla.
deserve our praise and admiration. But facilities, just to name a few.
there is another group of healthcare These brave and caring
professionals who deserve this same professionals are also on the front An army of health workers
recognition—the physicians, nurses, lines, providing treatment for those could help with
social workers, psychiatric technicians with depression, anxiety, bipolar
tracing activities
and other caring workers who are disorder, schizophrenia, alcoholism,
treating the homeless, those who live opioid addiction and other behavioral The article “Reopening could
with mental illness and those who health disorders. COVID-19 has require thousands more public health
suffer from addiction. escalated symptoms, increased the workers” (ModernHealthcare.com,
At LSF Health Systems, the rate of relapse as well as incidences April 16) noted, “As federal officials
managing entity that serves northeast of domestic violence, child abuse weigh how and when to reopen the
and north central Florida, I have the and suicide. Our providers also face country, experts say the U.S. does not
privilege of leading a not-for-profit challenges with the dearth of personal have enough public health workers to
social service network of 56 behavioral protective equipment such as masks, suppress another outbreak, especially
health provider organizations gloves, gowns, sanitizers and other those qualified to do contact tracing,
serving 23 counties—a third of supply needs. the critically important effort to find
the state. LSF contracts with these With the current increased demand, people who may have been exposed to
the virus.”
The story overlooks a very pragmatic
solution to support tracing: There are
tens of thousands of staff and volunteers
Submit nominations from community-based organizations
for Top 25 Innovators on the streets delivering social services
recognition support every day. Agencies on aging,
centers for independent living and
Modern Healthcare is accepting nominations for the Top 25 Innovators family-services organizations are
recognition program for 2020. responding to citizens’ nonclinical
For the healthcare industry to truly transform, innovation must take hold at needs such as food deliveries, post-
all levels and in all sectors. Never has this been more urgent and imperative hospitalization care-transition support,
as the industry—and the nation—confront the coronavirus pandemic and transportation, in-home assistance,
face the uncertainties of its aftermath. etc. Their ranks include social workers,
Nominations are open to those who hold titles of director or above in a nutritionists, nurses, and community
provider organization (e.g., hospital, health system, clinic, physician group) or
health workers.
These professionals could easily be
insurer. Researchers and public policy officials are eligible, but nominations
incorporated into COVID-19 tracing
must reflect the real-world impact of their work. This year’s program is also
activities and help support a more
open to healthcare supplier/vendor nominations.
integrated approach to clinical care for
Entries will be accepted in four categories: consumerism, cost
all high-risk patients.
reduction, population health, and quality and safety—and can be made in Sharon R. Williams
more than one category. Key criteria include measurable results and sustained Grosse Pointe, Mich.
gains/improvements as a result of the nominee’s work and leadership.
The nomination deadline is June 1. The 25 honorees will be recognized in
the Aug. 17 issue of Modern Healthcare and in a special online presentation.
Letters welcome
For more information on criteria, required documents, fee and to submit Write us with your comments.
nominations, please visit ModernHealthcare.com/Top25Innovators. To submit a letter electronically,
send an email to dmay@modernhealthcare.com

36 Modern Healthcare | April 27, 2020

Who’s on the move?
Be in the know about the latest
industry moves with our
People on the Move newsletter.

ModernHealthcare.com/POTM

People on the
MOVE
Hospitals install small
grocery stores to help
overwhelmed workers
By Tara Bannow
AS THE COVID-19 PANDEMIC hit
Phoenix in late March, doctors, nurses
and other caregivers working long
hours ran into a new problem: the dif-
ficulty of getting groceries.
“My staff was having a hard time be-
cause at the end of their shift, grocery
stores were closed,” said Zoe Coleman,
clinical nurse manager of St. Joseph’s
Hospital & Medical Center’s nursery
intensive-care unit. “You can’t bring
perishables to work and stock them
here. Same thing with the night shift.
It wouldn’t be appropriate to go to the
grocery store in scrubs after work.”
St. Joseph’s became the first Com-
monSpirit Health hospital to add a
makeshift grocery store to the facility
last month. As front-line caregivers
across the country struggle to treat a
growing wave of coronavirus patients,
hospitals are increasingly adding
grocery stores with little or no price
markups so employees can grab the es-
sentials on their way out.
STRATEGIES
Carry staples like milk, bread,
cheese, meats, fresh produce,
pasta and rice.
Determine whether you can sell
without a markup to cover the cost
of repackaging and cleaning the
products.
Inform staff working long
hours of their options for feeding
themselves and their families.
38 Modern Healthcare | April 27, 2020
“They didn’t even know that there
could be a solution to this other than
make it work on their own until it was
provided to them,” Coleman said. The
state of Arizona’s total cases were more
than 5,000 as of April 21 with more than
200 deaths.
Not-for-profit systems like Chica-
go-based CommonSpirit, St. Luke’s
Health System and St. Alphonsus
Health System have added the stores
to their hospitals.
Boise, Idaho-based St. Luke’s
launched five grocery stores in its hos-
pitals in late March. St. Luke’s launched
them after an “overwhelming” re-
sponse to its pilot that opened in Merid-
ian, Idaho. They carry staples like milk,
bread, cheese, meats, fresh produce,
pasta and rice. Everything is priced
with a 10% markup to cover the cost
of repackaging and cleaning the prod-
ucts, said Bart Zillner, operations man-
ager for food and nutrition services at
St. Luke’s Boise. “We’re not in the busi-
ness of making money,” he said. “We
just need to cover our overhead.”
Others said the food is priced
with no markup. That’s the case at St.
Alphonsus, also based in Boise, which
opened stores in its two Idaho hospi-
tals. “This is not a profit center,” spokes-
man Mark Snider said.
The cafeteria staff at St. Luke’s Boise
cook family-size meals hospital em-
ployees can buy refrigerated and reheat
at home, Zillner said.
The idea came from the recogni-
tion that St. Luke’s employees are now
working shifts that last 12 hours or
longer on the floor or 10 hours or lon-
ger caring for patients in tents. The last
ST. LUKE’S HEALTH SYSTEM
thing they want to do when they’re
done is go to the grocery store and
potentially risk exposure to the virus,
Zillner said. “We probably overheard
conversations of, ‘Oh, I have to go to
the store and I just don’t have time,’ ”
he said. “Just having those quick little
items has made things easier.”
At St. Joseph’s Hospital & Med-
ical Center in Phoenix, the idea
came from the facility’s food and
nutrition services director, Cole-
man said. “He was aware of the long
hours we were working and also
aware that the first thing we wanted
to do when we were not working is go
home to our families,” she said.
CommonSpirit has made a big push
to open the stores across its system. Its
Tacoma, Wash., hospital opened a gro-
cery store a few days after the Phoenix
hospital. The health system has also
opened stores in its hospitals in Chan-
dler and Gilbert, Ariz., as well as its Cal-
ifornia hospitals in Bakersfield, Merced
and Redding.
CommonSpirit has or will open
stores in its hospitals in the San Fran-
cisco Bay Area, Southern California,
Sacramento, Calif., and 12 hospitals in
Nebraska.
St. Alphonsus has also opened gro-
cery stores in its two Oregon hospitals.
They carry a long list of staples, as well
as take-and-bake meals—all sourced
through the health system’s regular
food vendors.
“At the end of a long shift, they don’t
want to face going to an empty gro-
cery store,” Snider said. “Colleague
resiliency is a major emphasis for us
now as people are working long and
stressful hours.” l
 Airing grievances online
Patients, especially those in younger generations, are becoming more comfortable rating
their healthcare experiences online. And those reviews may be having an impact in how
consumers choose their providers.

46% 60% 70%

of people say online
ratings and reviews
of consumers
check reviews
of millennials surveyed
in 2018 shared their
were the most even when referred experience with physicians
important factor in to a provider or hospitals online
choosing a provider

Primary source of information for choosing a provider

Most common
complaints
in negative
reviews on
commercial or
health system
sites:

54% 48% 45% 42% 29% 1

Clinician’s
Google Hospital Facebook Healthgrades Instagram communication
or clinic or interpersonal
website skills
Where patients share their reviews
2
Facility or office
experience
and staff
characteristics

3
57% 49% 40% 30% Technical skills

Facebook Google Healthgrades/ Instagram 4

health system
Patient-care
site (tie)
experience

Where the review is

posted may matter 5

35.5%
General negative
comments

Sources: “2019 Healthcare

Consumer Insight & Digital
of reviews on commercial Engagement” survey from
binaryfountain.com; “Reporting
rating sites had an of Patient Experience Data on
overall negative theme, Health Systems’ Websites and
Commercial Physician-Rating
compared with 12.8% Websites,” Journal of Medical
on health system sites Internet Research, March 2019

April 27, 2020 | Modern Healthcare 39

‘Make sure that they
see you and know
that you’re concerned’
Having served in the Army in Bosnia and in Iraq after the 9/11 attacks, Dr. George Brandt about every coffeepot they
has seen his share of people experiencing combat stress. There are parallels, he says, for could in the building. You
healthcare staff grappling with stress and anxiety as they work through the coronavirus would deploy your support
pandemic. A psychiatrist hospitalist at Porter Adventist Hospital, part of Colorado-based staff to those places (in
Centura Health, Brandt says it is critical that leaders support the mental well-being of that situation). I would
their entire workforce. Brandt spoke with Modern Healthcare Managing Editor Matthew want chaplains checking
Weinstock. The following is an edited transcript. in at every coffeepot in
the hospital and making
sure people are supported.
MH: You’ve drawn a parallel MH: What kind of tactics length, just to protect Go where the people are
between the situation today and strategies are you everyone in the home. and make sure that they
and what you’ve seen from recommending leadership see you and know that
your time in the military. start to deploy as they talk to MH: What can leaders do you’re concerned and
front-line staff and manage for staffers who have to have a presence and an
Brandt: I did about 15,000 their anxiety? remain an arm’s length away ear for them and are able
miles of convoy operations from their personal support to respond to any of their
and flights throughout Brandt: It starts with systems? concerns.
south central Iraq—going listening to safety
out to see the soldiers (announcements) and Brandt: Make sure basic MH: Thinking back to 9/11,
where they were, their doing your job. Another needs are being taken care were those check-ins
forward operating bases thing is, we’re in a bit of of. Make sure that they planned, or did they happen
and taking care of my a marathon more than a get breaks. Make sure that more organically?
troops who were in the sprint, so I want to make the overall fatigue isn’t too
same areas. You would sure that people have a great. Make sure they get Brandt: It’s a bit of both.
have preparation and good sustainment strategy, fed. Make sure that they’re The military gets very
a briefing before every that they’re getting plenty getting information at regimented … every group
convoy, every operation of rest, they’re getting the beginning and end of of soldiers, firefighters and
about what to do and plenty of sleep. shifts and be transparent other support staff who
how to plan and how you Many people working about what’s going on. If went in the building would
were going to manage in intensive-care settings someone develops a fever have an opportunity for
your safety. are not spending as much or symptoms, it’s time to a debriefing as they left.
(What’s happening now time with their families. stay home and get tested. We would sit down and I
is) like going off the base— They’re socially distancing And make sure that testing would ask, “What did you
what’s your strategy for within their own homes to is available for people. see today? What did you
managing risk? I’m going protect their family from I was active duty during do today?” That check-in
to be wearing masks, using a potential exposure. So 9/11 and in the recovery time and having regular
gloves, being very smart there’s a bit of a challenge phase afterwards. The support seemed to help
about where I go and what with not having their psychiatrists stationed people do well.
I do and try to not bring support system … or their at the Pentagon didn’t
anything home to hurt support system needs to set up as many formal MH: Equipment shortages
my family. be a bit more than at arm’s debriefings, but they found have been a challenge across

40 Modern Healthcare | April 27, 2020


“Doctors are some of the most resilient people (because of their)
education and training. Sometimes I worry more about the
clerk on the unit who may not have seen people die before.”
the industry, and we’re
seeing a lot of stress from
front-line staff talking about
it. Are there ways just to deal
with that from an emotional,
psychological aspect?
Brandt: Part of it is trying
to make sure there’s really
good communication
from command about
what the supplies are,
what’s coming in and
when it’s coming in and
how (leadership) plans to
protect (staff).
Giving good
information (helps) allay
some of those fears.
MH: You also think using
humor can help during these
times. How?
Brandt: There are those
moments every day; they
just happen. The ability to
laugh and share a laugh is
very preserving; it relieves
tension. It’s a little refresh
for people as well.
MH: Stress was a factor
for clinicians before the
pandemic started. What do
industry leaders need to think
about now since those stress
levels are only going up?
Brandt: Pay attention to
your inbox and how many
things are still coming in
related (to the pandemic).
It’s not over the day the
last patient is discharged.
It goes on for a while.
(Look at) how you assess
people’s needs. That’s
when I’d really look at
the coffeepot follow-up,
where you’re physically
present in the building
and collecting people’s
stories. “What did you do?
Where were you?”
Collecting stories,
getting multiple
perspectives about events,
getting good information
to people, those will
be very helpful in
helping them digest this
experience.
I’ve been in medicine
34 years and I haven’t
had days—other than
some combat days—
where I’d had multiple
deaths. That’s something
people haven’t seen for
a while. Being able to
talk about that will be
important.
MH: Managers and executives
are dealing with their own
form of stress, too. Are there
self-care tips you recommend
for them?
Brandt: They need to get
good information, get it to
people, but then they also
need to have times where
they shut down. There
are only so many hours
of news I would want one
to consume. Make sure
that they’re talking about
processes and executing
their leadership tasks
… but also making sure
that they take care of
themselves with some
downtime.
You have to have some
days you turn off the
phone and try to get a
good night’s sleep and
let somebody else take
the hospital call that
night.
MH: That’s hard to do for a lot
of people though.
Brandt: You’ve got me
thinking back to Bosnia
in the 1990s and there
was a particular place
where there were just
great sunsets and then
stopping and reflecting for
a moment.
I love the personal
reflections that our
CEO at Porter Adventist
Hospital (is doing).
Today’s was about the
polio epidemic in the
1950s and how that
rippled through families
and the changes that
came from it. This
reflective capability about
where we are today and in
the historical context can
be helpful.
Doctors are some
of the most resilient
people (because of their)
education and training.
Sometimes I worry more
about the clerk on the unit
who may not have seen
people die before and that
person might be the most
vulnerable person in the
organization from a lack
of training and experience
standpoint.
MH: How do you help those
people?
Brandt: That’s the person
I want talking to folks
before they go home.
I’m thinkng about a
young woman in Bosnia
with one of our fatalities
there. It was quite the
shock for her. She was a
medical record specialist,
April 27, 2020 | Modern Healthcare
so not having a great
deal of medical training
but being right there,
gathering information
in the middle of a very
traumatic event was
quite an exposure for her.
(But) helping (her and
her team) understand
what we were doing and
why they were doing
it and thanking them
for their presence and
(understanding that the)
paperwork being done
right was important.
MH: On a different front,
what’s been the impact on
your patients and practice?
Brandt: I am busy with
telepsych.
MH: Do you see continuing
with telepsych when we
return to more normal
operations?
Brandt: It is a very useful
way to do business.
It does impact the
emotional distance with
people and the emotional
intensity. I find it more
fatiguing than having
patients in the office,
but it’s reaching people
where they are.
MH: Why is it more fatiguing?
Brandt: You can see the
whole person in your
office. You get a sense of
their presence by reading
the body language.
(With telehealth you
are) moving through
multiple programs. I use
one program to get my
staff to check the client
in. I use another program
to do the clinical
encounter. We use
Zoom, as well. And then
sometimes my phone in
addition to that. l
41
Hospital merger and acquisition activity, Q1 2020
Ranked by total revenue of hospitals in a given deal ($ in millions)
TARGET DATE ACQUIRER TARGET TOTAL
RANK TARGET (PARENT) LOCATION STATUS ANNOUNCED ACQUIRER STATUS BEDS REVENUE

1 AtlantiCare1 Atlantic City, N.J. NFP March 31 AtlantiCare NFP 806 $826.5
(Geisinger Health)
Three hospitals
2 South Carolina FP March 5 Prisma Health NFP 377 329.5
(LifePoint Health)
East Jefferson
3 Metarie, La. NFP Feb. 27 LCMC Healthcare NFP 371 303.2
General Hospital
St. Francis Hospital Emory Healthcare-
4 Columbus, Ga. FP Jan. 8 FP 325 270.9
(LifePoint Health) LifePoint Health JV
Two hospitals
5 California NFP March 29 AHMC Healthcare FP 275 217.5
(Verity Health)
Two hospitals
6 Illinois NFP Jan. 9 Carle Foundation NFP 194 192.8
(Advocate Aurora Health)

7 St. Mary’s Healthcare1 Amsterdam, N.Y. NFP March 25

St. Mary’s
NFP 149 160.5
(Ascension Health) Healthcare
Union Hospital of ChristianaCare
8 Elkton, Md. NFP Jan. 1 NFP 166 158.2
Cecil County Health System
Bayonne Medical Center
9 Bayonne, N.J. FP March 25 BMC Hospital FP 254 157.3
(CarePoint Health)

10 Two hospitals2 Wisconsin NFP Feb. 20

Marshfield Clinic
NFP 101 126.7
(JV with Ascension) Health System
Easton Hospital St. Luke’s University
11 Easton, Pa. FP Feb. 12 NFP 222 125.7
(Steward Health Care) Health Network
Deaconess Health
12 Methodist Health3 Henderson, Ky. NFP Feb. 11
System
NFP 230 123.1

13 Divine Savior Healthcare Portage, Wis. NFP Feb. 3 Aspirus NFP 73 100.3

Central Texas Medical Center

14 San Marcos, Texas NFP Feb. 4 Christus Health NFP 170 81.7
(AdventHealth)
Riverside Tappahannock
15 Tappahannock, Va. NFP March 10 VCU Health System NFP 67 53.1
Hospital
Unity Medical and Surgical Three physician
16 Hospital (Medical Facilities Mishawaka, Ind. FP Feb. 27 groups FP 29 40.6
Corp.) (majority interest)
Two hospitals
17 Florida FP Jan. 30 HCA Healthcare FP 74 31.4
(Community Health Systems)
Henderson County
18 Community Hospital Lexington, Tenn. FP March 25 Braden Health FP 45 11.8
(Quorum Health Corp.)
19 Prague Community Hospital Prague, Okla. NFP Jan. 20 TULSA NFP 25 5.9
1
is separating from its parent organization to operate independently. 2Marshfield Clinic is buying out Ascension’s stake in their joint venture.
Target
3
Methodist Health has been financially affiliated with Deaconess since 2018 and is now joining the system.

For more information on the data used to compile this chart, contact Ponder & Co.,10 Cadillac Drive, Suite 120, Brentwood, TN 37027; (615) 613-0215; ponderco.com
Source: Ponder & Co.
Information in this chart may be subsequently revised at the discretion of the editor.
For more information on our research, contact Megan Caruso at 312-649-5471 or mcaruso@modernhealthcare.com.
FOR MORE charts, lists, rankings and surveys, please visit modernhealthcare.com/data.

42 Modern Healthcare | April 27, 2020

 Healthcare Construction
and Design Directory
Reach your future clients through the
Construction and Design Directory. Issue Close
Date Date
Don’t miss your opportunity to show
and tell prospective clients how your May 18 May 7
firm can meet construction and design
needs.

To reserve you space, please contact:

Ilana Klein | iklein@modernhealthcare.com | 312.649.5311

PUBLISHER AUDIENCE DEVELOPMENT

Fawn Lopez Vice President/ 312-649-5491 flopez@modernhealthcare.com Lauren Melesio Reprint sales 212-210-0707 lmelesio@modernhealthcare.com
Publisher
MODERN HEALTHCARE METRICS sales@modernhealthcaremetrics.com
OPERATIONS
Jennifer McCullough Director of 312-649-5353 jmccullough@modernhealthcare.com EDUCATION AND EVENTS
Operations Jodi Sniegocki Education and Events 312-649-5459 jsniegocki@modernhealthcare.com
Director
ADVERTISING AND SPONSORSHIP
Steve Eck Event Content Strategist 312-649-5346 seck@modernhealthcare.com
Ilana Klein National Advertising 312-649-5311 iklein@modernhealthcare.com
Sales Director Adam Rubenfire Custom Content Strategist 312-649-5229 arubenfire@modernhealthcare.com
Michelle Paras Sales Coordinator 312-649-5350 mparas@modernhealthcare.com Jenny Winistorfer Event Specialist 312-649-5340 jwinistorfer@modernhealthcare.com
David Baker South 615-371-6618 dbaker@modernhealthcare.com Sally Zimmerman Custom Content Analyst 312-649-5499 szimmerman@modernhealthcare.com
Cheryl DeSimone Northeast 212-210-0193 cdesimone@modernhealthcare.com Emily Basara Associate Content Strategist 312-649-5374 ebasara@modernhealthcare.com
Brian Lonergan West 312-649-5379 blonergan@modernhealthcare.com Casey Bogin Event Ticket and 312-649-5228 cbogin@modernhealthcare.com
Daniel Wright Conferences 312-280-3116 dwright@modernhealthcare.com Subscription Sales
and Events
CUSTOMER SERVICE SUBSCRIPTION 877-812-1581
To place an advertisement: Call 312-649-5311 or send a fax to 312-397-5510
To place a classified advertisement: Call 312-649-5311 or send a fax to 312-397-5510 877-812-1581 www.modernhealthcare/subscriptions
customerservice@modernhealthcare.com Subscription fax 847-291-4816
PRODUCTION
Robert Hedrick Media Services 312-649-7836 bhedrick@crain.com
Manager CRAIN COMMUNICATIONS INC
MARKETING Keith E. Crain Mary Kay Crain KC Crain Chris Crain
Katie Driscoll Integrated Brand 312-649-7849 kdriscoll@modernhealthcare.com Chairman Vice Chairman President Senior Executive
Development Director *** *** Vice President
Nadiia Dibrova Email Operations 312-280-3163 ndibrova@modernhealthcare.com Lexie Crain Armstrong Robert Recchia
Specialist Secretary Chief Financial Officer
Colleen Dluzynski Senior Marketing 312-280-3155 cdluzynski@modernhealthcare.com *** ***
G.D. Crain Jr. Mrs. G.D. Crain Jr.
Coordinator Founder (1885-1973) Chairman (1911-1996)
CREATIVE SERVICES
Patricia Fanelli Creative Services 312-649-5318 pfanelli@modernhealthcare.com WHO WE ARE AND HOW TO REACH US - Modern Healthcare is the only weekly business news
Director magazine for hospital and healthcare executives. You can learn more about the publication and view
our daily news updates on our website at ModernHealthcare.com. Modern Healthcare welcomes
Rodolfo Jiménez Graphic Designer 312-649-5338 Rodolfo.Jimenez@modernhealthcare.com letters to the editor. They may be sent by mail to Modern Healthcare, 150 N. Michigan Ave., Chicago
Paul Romejko Graphic Designer 312-649-5335 promejko@modernhealthcare.com IL 60601-7620; e-mail, mhletters@modernhealthcare.com or fax, 312-280-3183. All letters to the
editor must be signed with job titles and telephone numbers.
Grayson Layshock Graphic Design Intern 312-649-5391 glayshock@modernhealthcare.com

April 27, 2020 | Modern Healthcare 43

Museum delves into
the artful aspects
of hand-washing
t a time when hand-
A washing has become
a crucial health concern, the
Cleveland Museum of Art puts
a new perspective on the issue—a
medieval one.
A post on the CMA Thinker blog, “The Art
of Handwashing,” takes a look through the
museum’s holdings and those of other institutions
to explore the role of elegant hand-washing
accessories in the Middle Ages.
Like today, it was the custom then to wash one’s hands
before eating. But the accoutrements for doing so could
be ornate and valuable.
“Handwashing was not only a sign of good manners
but an opportunity to display desirable possessions
including basins, ewers, aquamanilia, and jugs. Medieval
wills and treasury accounts often list them when they
were made of fine materials,” writes Amanda Mikolic,
curatorial assistant for the medieval art department.
An aquamanile was a type of ewer originally used to
pour water over priests’ hands during Mass, but they
44 Modern Healthcare | April 27, 2020
were eventually adopted in
households for washing
hands before meals.
Mikolic describes them
as “small-scale functional
sculptures,” with ones
shaped like animals, real
or imagined, quite popular
for centuries. The ones
featured in the blog post stand
about 8 to 9 inches tall.
Lavabos, a bit larger, were basins
also used in both churches and homes
for hand-washing. The blog post features one in the
museum’s collection, as well as depictions in artwork. 
Clockwise from top: A panel of the “Annunciation Triptych” at the
Metropolitan Museum of Art shows a lavabo in the background
just above the angel’s head. A detail from the “Romance of Tristan,”
a manuscript in the Bibliothèque Nationale de France, shows
people using basins and ewers to wash their hands before a meal.
A 13th century German aquamanile, part of the Cleveland Museum
of Art’s collection, depicts a lion, with its mouth as the spout. Also
in its collection is a 15th century lavabo from the Netherlands.
To ensure women’s health is prioritized,
care delivery models need to change.
Join our panel of esteemed clinical experts to learn how to move from traditional
models to those that provide comprehensive services for women.

Featured Session | Is the US Healthcare System Meeting the Clinical

Needs of Women?

Panelists

Anne Klibanski, MD Sharmila Makhija, MD Laurie Zephyrin, MD

President and Professor and Chair Vice President, Delivery
Chief Executive Officer Department of OB/GYN and Women’s Health System Reform
Partners HealthCare Albert Einstein College of Medicine The Commonwealth Fund
Montefiore Health System

August 13-14, 2020 | Chicago, IL

ModernHealthcare.com/WLH

An important message about the COVID-19 outbreak and our event.

We are closely monitoring the COVID-19 pandemic and following recommended precautionary
measures, protocols and guidelines. Your safety and wellbeing are top priorities for us.

Women Leaders in Healthcare Conference is sponsored by:

Lead Sponsor Supporting Sponsors WiFi Sponsor

Welcome Reception Sponsor Book Exchange Sponsor Water Bottle Sponsor Tote Bag Sponsor
 :HVWDQGZLWK\RX
$QGZHVWDQG
LQDZHRI\RX
2XUGHHSHVWWKDQNVWRDOORI
WKHKHURHVRXWWKHUHZKRULVN
VRPXFKWRWDNHRQWKLV
JOREDOSDQGHPLF
<RXUFRXUDJHGHWHUPLQDWLRQ
LQJHQXLW\DQGVHOƮHVVQHVVZLOO
QHYHUEHIRUJRWWHQ
…9L]LHQW,QF$OOULJKWVUHVHUYHG
)URPWKHIURQWOLQHVWRWKHVXSSO\
OLQHVRXUKHDOWKFDUHV\VWHPLV
EHLQJWHVWHGOLNHQHYHUEHIRUH
:HDUHFRPPLWWHGWRVWDQGLQJ
EHVLGH\RXDQGGRLQJHYHU\WKLQJ
WKDWZHFDQWRKHOS\RXWRGD\DQG
HYHU\GD\
7RVHHRXUODWHVWXSGDWHV
LQIRUPDWLRQDQGUHVRXUFHVJRWR
YL]LHQWLQFFRPFRYLG