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Black Tech Founders Want to Change the Culture of Health Care, One Click at a Time

When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 users — most of them Black — visited the platform in the first two weeks.

“It wasn’t the most fully functioning platform,” recalled Wisdom, 31. “It was not sexy.”

But the launch was successful. Now, more than a year later, Wisdom’s company, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

As more patients seek culturally competent care — the acknowledgment of a patient’s heritage, beliefs and values during treatment — a new wave of Black tech founders like Wisdom want to help. In the same way Uber Eats and Grubhub revolutionized food delivery, Black tech health startups across the United States want to change how people exercise, how they eat and how they communicate with doctors.

Inspired by their own experiences, plus those of their parents and grandparents, Black entrepreneurs are launching startups that aim to close the cultural gap in health care with technology — and create profitable businesses at the same time.

“One of the most exciting growth opportunities across health innovation is to back underrepresented founders building health companies focusing on underserved markets,” said Unity Stoakes, president and co-founder of StartUp Health, a company headquartered in San Francisco that has invested in a number of health companies led by people of color. He said those leaders have “an essential and powerful understanding of how to solve some of the biggest challenges in health care.”

Platforms created by Black founders for Black people and communities of color continue to blossom because those entrepreneurs often see problems and solutions others might miss. Without diverse voices, entire categories and products simply would not exist in critical areas like health care, business experts say.

“We’re really speaking to a need,” said Kevin Dedner, 45, founder of the mental health startup Hurdle. “Mission alone is not enough. You have to solve a problem.”

Dedner’s company, headquartered in Washington, D.C., pairs patients with therapists who “honor culture instead of ignoring it,” he said. He started the company three years ago, but more people turned to Hurdle after the killing of George Floyd.

In Memphis, Tennessee, Erica Plybeah, 33, is focused on providing transportation. Her company, MedHaul, works with providers and patients to secure low-cost rides to get people to and from their medical appointments. Caregivers, patients or providers fill out a form on MedHaul’s website, then Plybeah’s team helps them schedule a ride.

While MedHaul is for everyone, Plybeah knows people of color, anyone with a low income and residents of rural areas are more likely to face transportation hurdles. She founded the company in 2017 after years of watching her mother take care of her grandmother, who had lost two limbs to Type 2 diabetes. They lived in the Mississippi Delta, where transportation options were scarce.

“For years, my family struggled with our transportation because my mom was her primary transporter,” Plybeah said. “Trying to schedule all of her doctor’s appointments around her work schedule was just a nightmare.”

Plybeah’s company recently received funding from Citi, the banking giant.

“I’m more than proud of her,” said Plybeah’s mother, Annie Steele. “Every step amazes me. What she is doing is going to help people for many years to come.”

Mission alone is not enough. You have to solve a problem.
Kevin Dedner

Health in Her Hue launched in 2018 with just six doctors on the roster. Two years later, users can download the app at no cost and then scroll through roughly 1,000 providers.

“People are constantly talking about Black women’s poor health outcomes, and that’s where the conversation stops,” said Wisdom, who lives in New York City. “I didn’t see anyone building anything to empower us.”

As her business continues to grow, Wisdom draws inspiration from friends such as Nathan Pelzer, 37, another Black tech founder, who has launched a company in Chicago. Clinify Health works with community health centers and independent clinics in underserved communities. The company analyzes medical and social data to help doctors identify their most at-risk patients and those they haven’t seen in awhile. By focusing on getting those patients preventive care, the medical providers can help them improve their health and avoid trips to the emergency room.

“You can think of Clinify Health as a company that supports triage outside of the emergency room,” Pelzer said.

Pelzer said he started the company by printing out online slideshows he’d made and throwing them in the trunk of his car. “I was driving around the South Side of Chicago, knocking on doors, saying, ‘Hey, this is my idea,’” he said.

Wisdom got her app idea from being so stressed while working a job during grad school that she broke out in hives.

“It was really bad,” Wisdom recalled. “My hand would just swell up, and I couldn’t figure out what it was.”

The breakouts also baffled her allergist, a white woman, who told Wisdom to take two Allegra every day to manage the discomfort. “I remember thinking if she was a Black woman, I might have shared a bit more about what was going on in my life,” Wisdom said.

The moment inspired her to build an online community. Her idea started off small. She found health content in academic journals, searched for eye-catching photos that would complement the text and then posted the information on Instagram.

I didn’t see anyone building anything to empower us.
Ashlee Wisdom

Things took off from there. This fall, Health in Her Hue launched “care squads” for users who want to discuss their health with doctors or with other women interested in the same topics.

“The last thing you want to do when you go into the doctor’s office is feel like you have to put on an armor and feel like you have to fight the person or, like, you know, be at odds with the person who’s supposed to be helping you on your health journey,” Wisdom said. “And that’s oftentimes the position that Black people, and largely also Black women, are having to deal with as they’re navigating health care. And it just should not be the case.”

As Black tech founders, Wisdom, Dedner, Pelzer and Plybeah look for ways to support one another by trading advice, chatting about funding and looking for ways to come together. Pelzer and Wisdom met a few years ago as participants in a competition sponsored by Johnson & Johnson. They reconnected at a different event for Black founders of technology companies and decided to help each other.

“We’re each other’s therapists,” Pelzer said. “It can get lonely out here as a Black founder.”

In the future, Plybeah wants to offer transportation services and additional assistance to people caring for aging family members. She also hopes to expand the service to include dropping off customers for grocery and pharmacy runs, workouts at gyms and other basic errands.

Pelzer wants Clinify Health to make tracking health care more fun — possibly with incentives to keep users engaged. He is developing plans and wants to tap into the same competitive energy that fitness companies do.

Wisdom wants to support physicians who seek to improve their relationships with patients of color. The company plans to build a library of resources that professionals could use as a guide.

“We’re not the first people to try to solve these problems,” Dedner said. Yet he and the other three feel the pressure to succeed for more than just themselves and those who came before them.

“I feel like, if I fail, that’s potentially going to shut the door for other Black women who are trying to build in this space,” Wisdom said. “But I try not to think about that too much.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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from Health Industry – Kaiser Health News

Stranded by the Pandemic, He Had Only Travel Insurance. It Left Him With a $38,000 Bill.

Duy Hoa Tran, a retired Vietnamese schoolteacher, arrived in Los Angeles in February 2020 to visit his daughter and 2-month-old grandson. Two weeks later, the door closed behind him. To prevent the spread of covid-19, Vietnam shut its borders. No commercial flights would be allowed into the country for the next 18 months.

Tran’s daughter, An Tran, who has a doctorate in business administration and teaches marketing at the University of La Verne in California, did what she thought was necessary to ensure medical coverage for her then-65-year-old father during the pandemic. But the only option for a visitor on a tourist visa was travel insurance. In early March 2020, An Tran found and purchased a policy, for about $350 a month, from a company called Seven Corners.

She might as well not have bothered.

The elder Tran had been staying at An’s home in Diamond Bar, California, about a year when he told his daughter he was having trouble seeing out of his right eye. A visit to an ophthalmologist produced a solemn verdict: Tran had severe glaucoma and would quickly go blind unless he got surgery.

Seven Corners gave written preapproval for the procedures recommended by Dr. Brian Chen. To be safe, An Tran called the insurer “many times” to confirm it would cover the expense, but no one she spoke with would give her a definitive answer, she said. Chen, however, assured An that insurance companies typically covered the treatment, which was pretty routine.

On April 19, Tran underwent the first of three eye surgeries to resolve the glaucoma. The surgeries — the last was on July 19 — were successful. And then on Aug. 5, Seven Corners sent An Tran a denial of service letter.

The company’s policy excluded coverage for any “preexisting condition,” by which it meant any condition “whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed,” the letter said.

An Tran and her father were on the hook for nearly $38,000 in medical bills, although Seven Corners had preauthorized the surgery and she had paid around $6,000 for the insurance over the previous year and a half.

As for the bill, “my dad obviously can’t pay it,” Tran said. His $260 monthly pension from the Vietnamese government isn’t enough even for him to live on in Vietnam, she said.

The surgical procedures Duy Hoa Tran received are quite routine in the United States, said Dr. Davinder Grover, an ophthalmologist in the Dallas area and clinical spokesperson for the American Academy of Ophthalmology.

Medicare would generally pay about a quarter of the $37,896.83 Tran was billed for the surgeries, Grover said. If Tran’s daughter had known beforehand that insurance wouldn’t cover the procedures, the physician’s practice might have been willing to charge something like $12,000, he said.

The policy An Tran purchased had no deductible and offered coverage of up to $100,000 in medical bills, including covid care. But travel insurance generally covers only emergency or urgent medical expenses, according to the California state insurance commission, which regulates policies in the state.

Megan Moncrief, chief marketing officer for Squaremouth, which aggregates various companies’ travel insurance plans — including some from Seven Corners — and offers them through its website, said the policy language was not unusual for travel insurance. She noted the policy’s stipulation that it covered some acute conditions only if the patient sought treatment within 24 hours of the initial symptoms.

Moncrief said the fact that Tran did not seek treatment immediately may be the reason his surgeries weren’t covered. (Seven Corners refused all comment on the case.) She acknowledged it was hardly surprising he hadn’t dashed to the doctor at the first sign of discomfort: “I don’t know that I would have done that either, if I just had blurry vision.”

As for Seven Corners’ refusal to pay despite precertification, this is not uncommon, she said. By precertifying, the insurer verifies that a procedure is a covered benefit but doesn’t guarantee the insurer will cover it for that particular patient.

Travel insurance typically offers little protection for any health problem linked to a preexisting condition, regardless of whether that condition has ever been diagnosed, says Susan Yates, general manager in the U.S. for Falck Global Assistance, an international insurer.

“For visitors to the U.S., especially those who are not permanent residents or citizens, it can be difficult to obtain health insurance,” she said. The Affordable Care Act doesn’t cover tourists, though some resident noncitizens can buy coverage.

“It’s usually better for a visitor to buy travel insurance from their country of origin, but in some countries (Vietnam being one), the insurance market is not developed,” Yates wrote in an email.

Tran had tried unsuccessfully for months to fly home to his town near Ho Chi Minh City, where his wife lives with another grandchild. On 14 occasions, An bought him tickets on regular commercial flights that were subsequently canceled. He was also unable to get a seat on charter flights arranged by the Vietnamese government; those tickets generally were available only through third parties charging up to $10,000.

The eye surgeon, Chen, offered to discuss the case with KHN, but his medical group’s counsel said it had a policy against discussing insurance issues with reporters, even with the patient’s consent.

After KHN approached him to discuss the issue, Chen told An Tran that he was waiving his $8,144 fee for the surgeries. The Acuity Eye Group, where he practices, would not immediately confirm Chen’s offer, but told An Tran they were seeking approvals to waive his fee and all other charges as well.

On Sept. 15, Duy Hoa Tran finally managed to get on a charter flight back to Vietnam. He’s happy to be home, An Tran said.

Under California’s filial responsibility laws, she could be liable for his remaining bills.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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from Health Industry – Kaiser Health News

Readers and Tweeters Find Disadvantages in Medicare Advantage

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

I'm a clinicianI have a PhD in policyNavigating this crazy maze for my mom annually leaves me feeling helpless/useless…Seems impossible for the average beneficiaryhttps://t.co/GJyvd1BmLo via @khnews
— Atul Grover (@AtulGroverMD) October 28, 2021

— Dr. Atul Grover, Baltimore

Reading the Fine Print on Medicare Advantage Plans

With Medicare Advantage open enrollment open until Dec. 7, millions of seniors will consider costs, benefits and networks when selecting a new plan (“Medicare Plans’ ‘Free’ Dental, Vision, Hearing Benefits Come at a Cost,” Oct. 27).

Many consumers may not be aware that some health plans have frustrating restrictions buried deep within that limit access to critical procedures. For example, Aetna recently began requiring prior authorization for cataract surgeries across all its health plans — including Medicare Advantage. Tens of thousands of Americans covered by Aetna have had their sight-restoring surgeries delayed or canceled, while insurance company representatives decide who gets to see better — and who must wait for their cataract to get worse before insurance will cover cataract surgery.

Congress is working to put guardrails around prior authorization abuse in Medicare Advantage through the Improving Seniors’ Timely Access to Care Act, which now has 239 co-sponsors in the House and was recently introduced in the Senate.

In the meantime, seniors should beware of prior authorization requirements in Medicare Advantage plans and press insurance representatives to be upfront about obstacles that can lead to care delays or denials.

— Dr. Tamara R. Fountain, president of the American Academy of Ophthalmology, Chicago

One of the selling points for #MedicareAdvantage is the extra benefits, but for some #Medicare beneficiaries it's all hat, no cattle. https://t.co/7UxWfI0xkv
— Julie Carter (@JulieCarterHAPF) October 27, 2021

— Julie Carter, Las Vegas

Your recent article on Medicare Advantage plans provided a good overview but omitted essential information.

Traditional Medicare coverage includes a well-defined set of benefits, rules and regulations with regards to coverage. Adverse coverage determinations can be appealed. The appeals process is well defined.

Medicare Advantage plans claim to cover services that traditional Medicare covers and “more.” The problem is that there is no means to ascertain the validity of such claims. Additionally, coverage under such plans is conditional and at the discretion of such plans. Denials of care have no standardized means of appeal. The appeal is to the plan itself. There is no means to override an adverse coverage decision and the plans tend to uphold their adverse decisions upon appeal as there is no external oversight mechanism that can be used to reverse the plans’ decisions.

Few individual providers have the resources to challenge adverse coverage decisions from the big health insurance companies running the Medicare Advantage plans. I am a provider. If a commercial health plan will not resolve a coverage dispute, I can contact the Texas Department of Insurance to resolve the issue. TDI has no jurisdiction over the Medicare Advantage Plans.

I have made numerous inquiries to determine who has jurisdiction over adverse coverage decisions by Medicare Advantage plans, including to the Centers for Medicare & Medicaid Services. No responses!

My warning to those turning 65 is “caveat emptor.” Unfortunately, the public is not provided with the comprehensive information they need to make informed choices.

— Dr. Ed Davis, San Antonio

The Barest of Necessities

My mother raised nine kids with cloth diapers and a washing machine (“‘Down to My Last Diaper’: The Anxiety of Parenting in Poverty,” Oct. 22). We were raised in poverty. My father worked two jobs and my mother even made soap in the basement for much of our early years. Jeans were patched, hand-me-downs might just as well have been a brand, and one pair of shoes a year … well, that was a good year. Yes, we grew up poor, but at the same time we were given a strong work ethic by example. All nine children are now successful, productive contributors to society.

It is impossible, therefore, that disposable diapers are an “essential.”

That leaves this article in the realm of political rhetoric rather than health news. Weakens your brand, don’t you think?

— Steve Meyer, Cincinnati

If you want to help your neighbors in need, one of the best, most effective ways is to donate money to your local diaper bank, which saw a doubling of demand during the pandemic. https://t.co/56bawk03D0
— Bradford Pearson (@BradfordPearson) October 22, 2021

— Bradford Pearson, Philadelphia

How Covid Had the Run of Hospitals

As a former registered nurse at a hospital in southwest Florida, I can attest positively to the facts presented in Christina Jewett’s article about hospital “safety” and how it relates to the retired pharmacist who died from covid-19 (“Patients Went Into the Hospital for Care. After Testing Positive There for Covid, Some Never Came Out,” Nov. 4). My observations and personal experiences in the hospital during the early days of this infection were just as she stated, with one additional caveat, which may be of interest. Our med-surg unit became an overflow unit for suspected and/or positive cases. What is not being told (yet is accurate) is that when our negative-pressure rooms were occupied (there were only two on our floor), patients were being put into regular rooms with the door closed.

Although on the surface this may sound like a “great” plan, I noticed a failure in management’s solution immediately: The room doors have a 1- to 2-inch gap underneath them. The patients in those rooms were not masked. This means, as is intuitively obvious, that the patients’ infected respirations were escaping from their rooms and into the hallways. Additionally, this “air” was then potentially capable of traveling into other patients’ rooms and thereby potentially infecting them with covid-19 as well. Needless to say, before too long, our floor had a couple of infected nurses.

My belief is that it is extremely possible and likely that many, many hospitals “reacted” this way during the earlier days of the pandemic. I wasn’t employed at this hospital far enough into the pandemic to observe where or how patients who were suspicious or positive for this virus were assigned rooms once researchers discovered that transmission was of the airborne variety rather than of the droplet variety, as initially thought.

Finally, as a nurse, I know of many other nurses here in Florida who absolutely refused to get vaccinated early, midway or late into this pandemic. I agree 100% that these nurses and various other “holdout” employees could very easily have “carried without knowledge” the virus to their patients, like the man spoken about in the article. There is no doubt in my mind that a “carrier” (likely unsymptomatic and unvaccinated) carried and infected the retired pharmacist. Great story, well-written.

— Janet M. Konikow, Fort Myers, Florida

This is just one reason ALL HEALTHCARE WORKERS need to be Covid vaccinated. If you’re working close to patients & you’re not vaccinated, you’re a weapon. Get out of the healthcare profession, you don’t belong there. https://t.co/e2gP5vRTlX
— OBX Jen 💙 (@OBXJEN) November 4, 2021

— Jen Weidinger, Loudonville, Ohio

‘Daily’ Pill vs. Flushing Out Covid Risks

With luck, molnupiravir may work as well as acyclovir for herpes “A Daily Pill to Treat Covid Could Be Just Months Away, Scientists Say” (Sept. 24). However, as the Centers for Disease Control and Prevention points out on its website: “These [antiviral] drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences.” At the same time, the CDC posts clear and unequivocal warnings about sharing a bathroom used by a covid-19 patient. Don’t.

Their unspoken message is covid could very well be an infectious enterovirus, with flush toilet micro-plume a vector. Cities are studying sewage for presence of the virus and the clinical trials for niclosamide are testing the participants’ stool on schedule for elimination of the pathogen. Why?

Merck’s trial makes no mention of fecal viral load or describes a goal of eliminating the presence of covid in a patient. Will this drug really be a “game changer”? It took over 30 years to recognize polio’s fecal mode of transmission; are we repeating a historical mistake?

— Tom Heusel, Eugene, Oregon

🤞🏼would be nice to have something cheap and available that works. https://t.co/zmoDV1JMuf
— Peter Zeihan (@PeterZeihan) September 24, 2021

— Peter Zeihan, Denver

Dental Health at the Root of U.S. Productivity

Dental care, like medical care, should be seen as a human right. The idea that support for dental care should be limited to older patients with major dental care issues is shortsighted. To this end, one estimate is that $45 billion of worker productivity is lost yearly because of tooth decay. This affects us all. Provision of good preventive dental care to all young people would increase productivity and thus benefit both the individuals at risk and society at large. (See: doi.org/10.1016/j.adaj.2020.09.019.)

Oral disease and systemic diseases such as cardiovascular disease, Type 2 diabetes and osteoporosis are linked. These conditions obviously are of enormous cost to society. Severe periodontal (gum) disease is associated with increased risk of cardiovascular disease. It is likely that gum disease actually causes cardiovascular disease. Substances produced either by germs infecting the teeth or by our bodies responding to the germs cause systemic disease. Mouth disease is clearly one cause of many systemic diseases. The cost to us of those diseases is obvious.

Including dental care in the health care package is a win for all. “Medicare for All” is the optimal solution.

— Dr. Marc H. Lavietes, board member for Physicians for a National Health Program, Bradley Beach, New Jersey

All this comes down to reimbursement rates. #Medicare benefits need to be universal and #Medicare payments need to be adequate. Teeth are essential to good health. Period. ⁦@NDA1913⁩ ⁦@AmerDentalAssn⁩ 🦷 https://t.co/JL8WblOszo
— Barbara DiPietro (@BarbaraDiPietro) November 1, 2021

— Barbara DiPietro, Baltimore

On Oral Health and a Dental Hygienist’s Scope

A recent article published by KHN spotlighted licensed Illinois dental hygienists who also hold public health dental hygienist (PHDH) certification (“Hygienists Brace for Pitched Battles With Dentists in Fights Over Practice Laws,” Oct. 19).

The Illinois Dental Hygienists’ Association (IDHA) has diligently initiated legislation to bring affordable direct preventive oral health services to those who live in skilled nursing facilities and other confined settings. Dave Marsh, lobbyist for the Illinois State Dental Society (ISDS), was quoted as saying, “I just don’t feel anybody with a two-year associate’s degree is medically qualified to correct your health.”

IDHA would like to inform ISDS that the entry-level degree of a registered nurse is also a two-year associate’s degree. Does this mean that registered nurses are also unqualified to care for the elderly? Of course not! This is just another clear example of how ISDS continues to battle licensed dental hygienists and suppress their ability to work to their highest scope.

Illinois dentists claim they cannot afford to provide care for citizens who have state-funded dental insurance, are uninsured or poor. Yet they do not want dental hygienists to care for them either. Why? As the article clearly points out, ISDS illustrates the power that lobbying groups have in shaping policies on where health professionals can practice and who keeps the profits. And who suffers? Illinois’ most vulnerable citizens.

The Illinois State Dental Society also claims that after the Illinois Dental Practice Act was modified to allow direct preventive services by a public health dental hygienist, it took the hygiene association years to develop the PHDH curriculum. Conveniently missing was that legislation was tied up in the administrative rules process from 2015 to 2019. Once this process was completed, the hygienists’ association developed, implemented and graduated the first class of PHDHs within nine months.

The article accurately states that Illinois trails many states. To be exact, 38 other states allow dental hygienists unsupervised contact with patients. The article also accurately states that, politically, the Illinois State Dental Society is rich and powerful. This allows them to donate generously to lawmakers.

The Illinois Dental Hygienists’ Association wishes to thank KHN for uncovering the fact that profits and control is what motivates the Illinois State Dental Society, not increasing access to care. Now lawmakers can see ISDS’ true motives for suppressing the scope of practice of Illinois dental hygienists and pass legislation so that all Illinois citizens can receive the oral health care they need, want and deserve.

— Sherri Foran, president of the Illinois Dental Hygienists’ Association, Chicago

Dentists against oral health. Cool. https://t.co/kpuLogwoMB
— Chris Lentil (@ChrisLentil) October 29, 2021

— Chris Lempa, Park Ridge, Illinois

Socially Constructed vs. Biologically Determined

The Oct. 20 morning briefing states “If You’re Pregnant, Your Baby’s Gender Influences Your Response To Covid.” “Gender” is not the accurate terminology here; “sex” is. Sex is a biological characteristic, whereas gender is a social construction. As the source article states “Sex of the fetus,” KHN’s usage of the word “gender” is not only inaccurate but also unnecessary. The distinction between gender and sex is small, but it is extremely important.

— Jade del Vecchio, Decatur, Georgia

Thanks to @philgalewitz and @KHNews for highlighting the shortage of home care aides – which is largely the result of low pay, low career mobility, & low respect. Home care aides are skilled, important, & the solution comes from investing in them. #LTC https://t.co/IKxx3dpMm0
— Joanne Spetz (@JoanneSpetz) July 1, 2021

— Joanne Spetz, San Francisco

A Shortage of Funds, Not Caregivers

I am wanting to comment on the article concerning caregiver shortages (“Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply,” June 30). It is a fact that there is a substantial shortage of caregivers in the industry. The problem will only increase in the foreseeable future. I’ve worked at a nurse registry in Florida for seven years. I believe the focus and terminology that is used in all national articles concerning this issue needs a redirection. You did a tremendous job covering this in your article. I find the layman interprets terms such as “caregiver shortage” in ways that could be misleading and overshadow the core problem.

For example, when I speak to a family member seeking care for a loved one and they hear “caregiver shortage,” they naturally think there are not enough caregivers. Technically speaking, that is true when taking the ratio of elderly to caregivers into account. But the true problem is not a shortage of caregivers. It’s a shortage of funds available, especially Medicaid funds, to pay caregivers what they are worth. Statistically speaking, for the company I work for, there are plenty of caregivers in the system open to work. So, we are not short on caregivers. There’s actually not enough work available for all of our caregivers matching their requested reimbursement rate.

I believe the main tone of this issue should not be “caregiver shortage” but “caregiver reimbursement increase.” Hearing the problem “caregiver shortage” automatically leads to seeking a solution to increasing the quantity of caregivers. Though the quantity of caregivers does need to increase, it will not solve this issue. Being able to utilize caregivers who are available and willing to assist, in my opinion, is the first step to solving this nationwide issue. I thank you for your time.

— Michael Asche, Stuart, Florida

This is one of the prime reasons why politicians need to rethink their definition of the word “infrastructure”—and their opposition to funding anything that doesn’t smell like asphalt. #NHPolitics https://t.co/kNamPpbe89
— David Meuse (@JdmMeuse) June 30, 2021

— Democratic state Rep. David Meuse, Portsmouth, New Hampshire

‘Dopesick’ Misses the Big Picture

I think it’s quite deplorable that you promote a program and its creators where no citations are made referencing our nation’s leading medical authorities. No mention of studies that do, indeed, support the <1% addiction rates. Dr. Scott Hadland, whose research was published in BMJ, shows rates well below 1%. These numbers can go higher depending on a patient’s prior risk factors. But Hadland’s study, with a cohort of over 3.2 million, was, I believe, opioid-naive patients ages 11-25 — understandably, a demographic of great concern.

There is no mention of National Institutes of Health Director Dr. Francis Collins’ views that dependence and addiction are different, with addiction being more severe but with lower rates of addiction present. [Collins said: “Physical dependence will develop in most individuals who take opioids chronically, resulting in withdrawal symptoms if the drug is taken away. Addiction is more severe and happens in only a small percentage of those who take opioids chronically.”] No mention of the views of National Institute on Drug Abuse Director Dr. Nora Volkow, who expressed great concern for the treatment of chronic pain patients. Both of those doctors said that while nobody is thrilled with the long-known downsides of opioids, there is currently nothing more effective.

There is no mention of the American Medical Association’s letter to the Centers for Disease Control and Prevention in June 2020 or the subsequent AMA statements since then, decrying the use of morphine milligram equivalents (MME).

No mention of the Department of Health and Human Services’ Pain Management Best Practices report of 2019 with its chapter on the 2016 guidelines, where it challenges some of the claims that are echoed in “Dopesick.”

Recently, in California, the California Department of Public Health issued a workgroup action notice regarding the closure of 29 Lags pain management clinics, setting adrift over 20,000 pain patients. Part of the state’s response was in the form of a video webinar on YouTube featuring San Francisco Public Health addiction physician Dr. Phillip Coffin. He was an original member of the core expert group that drafted the 2016 CDC guidelines. He again reiterated the plea of the CDC and many other medical authorities that the guidelines not be misinterpreted — that they are intended only for new patients and that if someone has been at 400 MME for 25 years, in general, just let them be.

Beth Macy herself wrote an endorsement for the cover of a new book by Ryan Hampton, a former White House staffer and presidential campaign official who became a heroin addict. Hampton’s new book, “Unsettled,” is about his experience on the committee that negotiated the Purdue/Sackler settlement. He is no fan of the Sacklers. But he reiterates that he has learned much in recent years and believes that chronic pain patients should be protected, that the interests of both pain and substance use disorder communities are aligned. He co-authored an article in the Los Angeles Times with Kate Nicholson, president and founder of National Pain Advocacy Center. Nicholson was an attorney for the Justice Department for 20 years, in the civil/disability rights division. She authored the current regs under the Americans with Disabilities Act and is a chronic pain patient, using opioids to relieve enough pain for her to do her job at DOJ. As the L.A. Times article quipped, “Our stories are two sides of the same pill. Serious pain and addiction are public health conditions that are widespread, stigmatized and misunderstood.”

— Tom Hayashi, Santa Rosa, California

Have you been watching #DopesickHulu? The dramatization of the #opioidcrisis is fascinating! Great conversation w/ journalists from @khn and @Kff, author @papergirlmacy, and show producer @DannyStrong on the very real facts behind the fiction.https://t.co/gjixULALgW
— Sema Sgaier, PhD (@SemaSgaier) October 23, 2021

— Sema Sgaier, Washington, D.C.

In-Network Care Can Help Curb Hospitalizations

I would quarrel with Loren Adler’s comment that once the law takes effect, “it’s completely irrelevant whether an emergency room doctor is in network or not” (“Surprise-Billing Rule ‘Puts a Thumb on the Scale’ to Keep Arbitrated Costs in Check,” Oct. 14). It matters to get those hospital-based physicians into global budget arrangements with insurers, like ACOs, so their incentives can be realigned to prevent return trips to the emergency department rather than to profit from them. Chronically ill patients attributed to such programs need all their providers pulling in the same direction to avoid unnecessary hospitalizations. The out-of-network business model has dangers to consumers beyond the fees, and it will be interesting and important to monitor utilization going forward to see if improved care coordination results.

— Jackson Williams, Lancaster, Pennsylvania

Patients will be protected from surprise medical bills starting Jan 1. The big ? is whether the law reduces health care costs as intended or shifts costs and⬆️premiums. The rule makes it more likely consumers see no surprise bills AND lower premiums.https://t.co/yzJXotp7KM
— Erica Socker (@EricaSocker) October 14, 2021

— Erica Socker, Alexandria, Virginia

To Top It Off, a Headline Can Steer Readers Wrong

I am really surprised to see this otherwise trustworthy site feeding false information about covid-19 vaccines. You published an article today with the outrageous headline “A Colorado Town Is About as Vaccinated as It Can Get. Covid Still Isn’t Over There” (Oct. 1), clearly suggesting that the story would contain information about the ineffectiveness of vaccinations. Since most people will only see this headline in one or another news aggregator or on social media, this is the message they will get. It turns out, when we read the story, that the individuals representing San Juan County’s serious covid-19 cases “all were believed to be unvaccinated” and the five hospitalized or dead people were all “summer residents.” The story should have been headlined something like “high vaccination rates protect residents of this Colorado county from unvaccinated visitors bringing covid to town.”

— Ira Abrams, Chicago

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from Health Industry – Kaiser Health News

KHN’s ‘What the Health?’: Why Health Care Is So Expensive, Chapter $22K

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Congress appears to be making progress on its huge social spending bill, but even if it passes the House as planned the week of Nov. 15, it’s unlikely it can get through the Senate before the Thanksgiving deadline that Democrats set for themselves.

Meanwhile, the cost of employer-provided health insurance continues to rise, even with so many people forgoing care during the pandemic. The annual KFF survey of employers reported that the average cost of a job-based family plan has risen to more than $22,000. To provide what their workers most need, however, this year many employers added additional coverage of mental health care and telehealth.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s episode:

Moderate Democrats who were worried about the price tag of the social spending bill said during negotiations last week that they wanted to see the full analysis of spending and costs from the Congressional Budget Office. But members of the House probably won’t get that score before voting on the bill. CBO instead is releasing its assessments piecemeal as analysts go through specific sections of the huge bill.
If the House passes the bill next week, which leadership is pledging, the legislation could still undergo major revisions in the Senate. Some provisions will be subject to the Byrd Rule, which says items in this type of bill must be related to the budget. Republicans are expected to challenge parts of the bill, and the parliamentarian will have to rule on whether their objections are valid.
Among the provisions that some moderate Democratic senators might object to are the paid family leave and the mechanism for lowering Medicare drug prices.
Congress is looking at a very busy end of the year, which could complicate passage of the social spending bill. Leaders already postponed a bill to raise the debt ceiling and the annual federal spending bills until early December.
A federal judge has blocked Texas Republican Gov. Greg Abbott’s order prohibiting mask mandates in schools. But a final resolution is likely some time away as the case is appealed. Disability rights groups, which had sued to stop the governor’s order, argued that the ban was keeping children with health problems who are at high risk from covid from coming to school.
Despite opposition from conservative leaders to vaccine mandates, the vast majority of workers have had their shots, either because they wanted them or their employer mandated it. Lawsuits brought against those workplace requirements may not signal a broad opposition among the population.
In its survey of employers’ health plans, KFF found that premiums are still increasing faster than wages as health costs continue to rise. Leaders of both political parties say they would like to reduce the cost of care, but no magic pill appears likely. Instead, lawmakers generally are more inclined to have the government pick up a bigger portion of the country’s health care costs when not finding a way to cut that spending.
One key challenge in addressing rising health care spending in Congress is the power of the health care industry. With the close political party margins on Capitol Hill, it is fairly easy for the industries to use their contributions to pick off a couple of members and keep major reform from passing.
The KFF survey also documented the wide expansion of telehealth coverage during the pandemic. Although employers and the government have been concerned that telehealth adds to spending because it duplicates services or allows doctors to charge for services they once performed over the phone without billing, it will be hard to put this genie back in the bottle. Consumers like the convenience. And some services, such as mental health therapy or medical consultations for rural residents, are much easier.

Also this week, Rovner interviews Rebecca Love, a nurse, academic and entrepreneur who has thought a lot about the future of the nursing profession and where it fits into the U.S. health care system

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Washington Monthly’s “The Doctor Will Not See You Now,” by Merrill Goozner.

Alice Miranda Ollstein: NPR’s “Despite Calls to Improve, Air Travel Is Still a Nightmare for Many With Disabilities,” by Joseph Shapiro and Allison Mollenkamp.

Rebecca Adams: KHN’s “Patients Went Into the Hospital for Care. After Testing Positive There for Covid, Some Never Came Out,” by Christina Jewett.

Anna Edney: Bloomberg News’ “All Those 23andMe Spit Tests Were Part of a Bigger Plan,” by Kristen V Brown.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

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Researcher: Medicare Advantage Plans Costing Billions More Than They Should

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, said his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.

Nearly $34 billion of that new spending came during 2018 and 2019, the latest payment period available, according to Kronick. The Centers for Medicare & Medicaid Services made the 2019 billing data public for the first time in late September.

“They are paying [Medicare Advantage plans] way more than they should,” said Kronick, who served as deputy assistant secretary for health policy in the Department of Health and Human Services during the Obama administration.

Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies. The health plans have enrolled nearly 27 million members, or about 45% of people eligible for Medicare, according to AHIP, an industry trade group formerly known as America’s Health Insurance Plans.

The industry argues that the plans generally offer extra benefits, such as eyeglasses and dental care, not available under original Medicare and that most seniors who join the health plans are happy they did so.

“Seniors and taxpayers alike have come to expect high-quality, high-value health coverage from MA [Medicare Advantage] plans,” said AHIP spokesperson David Allen.

Yet critics have argued for years that Medicare Advantage costs taxpayers too much. The industry also has been the target of multiple government investigations and Department of Justice lawsuits that allege widespread billing abuse by some plans.

The payment issue has been getting a closer look as some Democrats in Congress search for ways to finance the Biden administration’s social spending agenda. Medicare Advantage plans also are scrambling to attract new members by advertising widely during the fall open-enrollment period, which ends next month.

“It’s hard to miss the big red flag that Medicare is grossly overpaying these plans when you see that beneficiaries have more than 30 plans available in their area and are being bombarded daily by TV, magazine and billboard ads,” said Cristina Boccuti, director of health policy at West Health, a group that seeks to cut health care costs and has supported Kronick’s research.

Kronick called the growth in Medicare Advantage costs a “systemic problem across the industry,” which CMS has failed to rein in. He said some plans saw “eye-popping” revenue gains, while others had more modest increases. Giant insurer UnitedHealthcare, which in 2019 had about 6 million Medicare Advantage members, received excess payments of some $6 billion, according to Kronick. The company had no comment.

“This is not small change,” said Joshua Gordon, director of health policy for the Committee for a Responsible Federal Budget, a nonpartisan group. “The problem is just getting worse and worse.”

Responding to written questions, a CMS spokesperson said the agency “is committed to ensuring that payments to Medicare Advantage plans are appropriate. It is CMS’s responsibility to make sure that Medicare Advantage plans are living up to their role, and the agency will certainly hold the plans to the standards that they should meet.”

Making any cuts to Medicare Advantage payments faces stiff opposition, however.

On Oct. 15, 13 U.S. senators, including Sen. Kyrsten Sinema (D-Ariz.) sent a letter to CMS opposing any payment reductions, which they said “could lead to higher costs and premiums, reduce vital benefits, and undermine advances made to improve health outcomes and health equity” for people enrolled in the plans.

Much of the debate centers on the complex method used to pay the health plans.

In original Medicare, medical providers bill for each service they provide. By contrast, Medicare Advantage plans are paid using a coding formula called a “risk score” that pays higher rates for sicker patients and less for those in good health.

That means the more serious medical conditions the plans diagnose the more money they get — sometimes thousands of dollars more per patient over the course of a year with little monitoring by CMS to make sure the higher fees are justified.

Congress recognized the problem in 2005 and directed CMS to set an annual “coding intensity adjustment” to reduce Medicare Advantage risk scores and keep them more in line with original Medicare.

But since 2018, CMS has set the coding adjustment at 5.9%, the minimum amount required by law. Boccuti said that adjustment is “too low,” adding that health plans “are inventing new ways to increase their enrollees’ risk scores, which gain them higher monthly payments from Medicare.”

Some of these coding strategies have been the target of whistleblower lawsuits and government investigations that allege health plans illegally manipulated risk scores by making patients appear sicker than they were, or by billing for medical conditions patients did not have. In one recent case, the Justice Department accused Kaiser Permanente health plans of obtaining about $1 billion by inflating risk scores. In a statement, the insurer disputed the allegations. (KHN is not affiliated with Kaiser Permanente.)

Legal or not, the rise in Medicare Advantage coding means taxpayers pay much more for similar patients who join the health plans than for those in original Medicare, according to Kronick. He said there is “little evidence” that higher payments to Medicare Advantage are justified because their enrollees are sicker than the average senior.

Kronick, who has studied the coding issue for years, both inside government and out, said that risk scores in 2019 were 19% higher across Medicare Advantage plans than in original Medicare. The Medicare Advantage scores rose by 4 percentage points between 2017 and 2019, faster than the average in past years, he said.

Kronick said that if CMS keeps the current coding adjustment in place, spending on Medicare Advantage will increase by $600 billion from 2023 through 2031. While some of that money would provide patients with extra health benefits, Kronick estimates that as much as two-thirds of it could be going toward profits for insurance companies.

AHIP, the industry trade group, did not respond to questions about the coding controversy. But a report prepared for AHIP warned in September that payments tied to risk scores are a “key component” in how health plans calculate benefits they provide and that even a slight increase in the coding adjustment would prompt plans to cut benefits or charge patients more.

That threat sounds alarms for many lawmakers, according to Kronick. “Under pressure from Congress, CMS is not doing the job it should do,” he said. “If they do what the law tells them to do, they will get yelled at loudly, and not too many people will applaud.”

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from Health Industry – Kaiser Health News

Fueron al hospital para recibir atención. Allí, contrajeron covid… y algunos nunca salieron

Ingresaron a hospitales con infartos, insuficiencia renal o por crisis psiquiátricas.

Se fueron con covid-19, si es que se fueron.

Más de 10,000 pacientes fueron diagnosticados con covid en hospitales de los Estados Unidos el año pasado, después de ser admitidos por otra causa, según registros federales y estatales analizados exclusivamente para KHN.

Pero, de hecho, el número es un recuento insuficiente, ya que incluye principalmente a pacientes de 65 años o más, además de pacientes de California y Florida de todas las edades.

Sin embargo, entre los posibles escenarios que pueden salir mal en un hospital, es una cifra catastrófica: alrededor del 21% de los pacientes que contrajeron covid en el hospital de abril a septiembre del año pasado murieron, según muestran los datos. En contraste, casi el 8% de otros pacientes de Medicare murieron en el hospital en ese mismo tiempo.

Steven Johnson, de 66 años, esperaba que lo liberaran de una infección que tenía su cadera a carne viva en el Blake Medical Center, en Bradenton, Florida, en noviembre pasado. El farmacéutico jubilado había sobrevivido al cáncer de colon y fue meticuloso para evitar contraer covid.

No podía haber sabido que, de abril a septiembre, el 8% de los pacientes con covid de Medicare de ese hospital fueron diagnosticados con el virus después de ser admitidos por otra necesidad médica.

Johnson había dado negativo para la prueba de covid dos días antes de ser admitido. Su esposa, Cindy Johnson, también farmacéutica retirada, contó que, después de 13 días en el hospital, dio positivo.

En pocas horas, estaba luchando por eliminar una flema parecida a pegamento de sus pulmones. Un equipo médico apenas pudo controlar su dolor. Le pidieron a Cindy que expresara sus últimos deseos. Ella le preguntó: “Cariño, ¿quieres que te intuben?”. Él respondió con un enfático “no”. Murió tres días después.

Después de que su esposo dio positivo, Cindy Johnson, entrenada en rastreo de contactos, rápidamente se hizo la prueba para covid. Dio negativo. Pero no paraba de pensar en la gran cantidad de personal del hospital que entraba y salía de la habitación de su esposo, los que, a menudo, le sacaban la máscara, y sospechó que un miembro del personal lo había infectado.

Que el hospital, parte de la cadena HCA Healthcare, todavía no haya hecho mandatoria las vacunas es “espantoso”, opinó.

“Estoy furiosa”, agregó.

“¿Cómo pueden decir en su sitio web que ‘las precauciones de seguridad que hemos implementado hacen que nuestras instalaciones estén entre los lugares más seguros posibles para recibir atención médica en este momento’?”, se preguntó.

Lisa Kirkland, vocera del Blake Medical Center, dijo que el hospital “está alentando firmemente la vacunación” y señaló que sigue las pautas federales de los Centros para el Control y la Prevención de Enfermedades (CDC) y las normas estatales para proteger a los pacientes. El presidente Joe Biden ha pedido que todos los empleados de hospitales estén vacunados, pero el requisito podría enfrentar resistencia en una docena de estados, incluida Florida, que han prohibido los mandatos de vacunación.

En general, la tasa de propagación intrahospitalaria entre Medicare y otros pacientes fue más baja que en otros países, incluido el Reino Unido, que hace públicos esos datos y los discute abiertamente.

En promedio, alrededor del 1,7% de los pacientes con covid internados en hospitales de los Estados Unidos fueron diagnosticados con el virus en estas instalaciones, según un análisis de los registros de Medicare del 1 de abril al 30 de septiembre de 2020, proporcionado por el doctor James Kennedy, fundador de CDIMD, una empresa de consultoría y análisis de datos con sede en Nashville.

Sin embargo, la tasa de infección fue mucho más alta en 38 hospitales donde el 5% o más de los casos de covid de Medicare se documentaron como adquiridos en el hospital. Los datos provienen de un período de tiempo desafiante del año pasado cuando los equipos de protección escaseaban, y las pruebas eran escasas o lentas para producir resultados. Los datos de Medicare para el cuarto trimestre de 2020 y este año aún no están disponibles, y los datos estatales reflejan del 1 de abril al 31 de diciembre de 2020.

Una revisión de KHN de los registros de seguridad en el trabajo, la literatura médica y entrevistas con el personal de los hospitales de alta propagación indica por qué se afianzó el virus: los líderes de los hospitales tardaron en admitir que se transmitía por vía aérea, lo que hizo que los pacientes que tosían fueran peligrosos para los compañeros de habitación y los miembros del personal, que a menudo usaban máscaras quirúrgicas menos protectoras en lugar de N95.

Los hospitales no pudieron realizar pruebas a todos los pacientes admitidos, gracias a la guía de los CDC que dejaba tales pruebas a “discreción de la instalación“. La gerencia a menudo no informaba a los trabajadores cuando habían estado expuestos a covid y, por lo tanto, estaban en riesgo de propagarlo ellos mismos.

La propagación entre los pacientes y el personal parecían ir de la mano. En Beaumont Hospital, Taylor, en Michigan, se registraron 139 infecciones por covid en empleados entre el 6 de abril y el 20 de octubre del año pasado, según muestra un informe de inspección del hospital. Casi el 7% de los pacientes de Medicare con covid dieron positivo después de ser admitidos en ese hospital por otra causa, según muestran los datos federales.

Un vocero del hospital dijo que las pruebas no estaban disponibles para evaluar a todos los pacientes el año pasado, lo que resultó en algunos diagnósticos tardíos. Dijo que, ahora, todos los pacientes que ingresan son evaluados.

El seguimiento de covid dentro de las instalaciones de salud no es una tarea nueva para los funcionarios federales, quienes informan públicamente cada semana sobre nuevos casos en empleados y residentes en cada hogar de adultos mayores a lo largo del país. Sin embargo, el Departamento de Salud y Servicios Humanos informa datos sobre la propagación de covid en los hospitales solo a nivel estatal, por lo que los pacientes no saben qué instalaciones presentan casos.

KHN encargó un análisis de los registros de facturación de los hospitales, que también se utilizan de manera más amplia para detectar diversas infecciones adquiridas en el hospital. Para covid, los datos tienen limitaciones. Puede detectar algunos casos adquiridos en la comunidad que tardaron en aparecer, ya que pueden pasar de dos a 14 días desde la exposición al virus para que aparezcan los síntomas, con un promedio de cuatro a cinco días. Los registros no tienen en cuenta los casos recogidos en una sala de emergencias o diagnosticados después del alta de un paciente del hospital.

Linda Moore, de 71 años, dio positivo al menos 15 días después de una estadía en el hospital para una cirugía de columna, según contó su hija Trisha Tavolazzi. Su madre estaba en el Centro Médico Regional Havasu en Lake Havasu City, Arizona, que no tuvo una tasa de propagación interna superior al promedio el verano pasado.

El hospital implementó "protocolos rigurosos de salud y seguridad para proteger a todos nuestros pacientes" durante la pandemia, dijo Corey Santoriello, vocero del hospital, quien no quiso comentar sobre el caso de Moore, citando normas de privacidad.

Moore fue trasladada en avión a otro hospital, donde su condición solo empeoró más, dijo su hija. Después de que le quitaron el ventilador, se aferró a la vida de manera irregular durante cinco horas y media, mientras su hija oraba para que su madre encontrara el camino al cielo.

“Le pregunté a su mamá, a su papá y a su familia y oré a Dios: 'Por favor, ven a mostrarle el camino'”, dijo Tavolazzi. "Vuelvo a vivir ese momento todos los días".

Cuando Tavolazzi buscó respuestas en el hospital sobre dónde contrajo el virus su madre, dijo que no obtuvo ninguna: "Nadie me devolvió la llamada".

De dos pruebas negativas para covid a ser el “paciente cero”

Cuando la segunda ola de covid disminuyó en septiembre pasado, los médicos del prestigioso Brigham and Women’s Hospital publicaron un estudio tranquilizador: con un control cuidadoso de la infección, solo dos de 697 pacientes con covid adquirieron el virus en el hospital de Boston. Eso es aproximadamente el 0.3% de los pacientes, aproximadamente seis veces más bajo que la tasa general de Medicare.

Brigham evaluó a todos los pacientes que admitió, superando las recomendaciones de los CDC. Fue transparente y abierto sobre las preocupaciones de seguridad.

Pero el estudio, publicado en la revista JAMA Network Open, transmitió un mensaje equivocado, según el doctor Manoj Jain, médico de enfermedades infecciosas y profesor adjunto de la Escuela de Salud Pública Rollins de la Universidad Emory. Covid se estaba extendiendo en los hospitales, dijo, y el estudio enterró "el problema debajo de la alfombra".

Poco después de la publicación, el virus comenzó una racha sigilosa a través del hospital de élite. Entró con un paciente que dio negativo dos veces, pero resultó ser positivo. Fue la "paciente cero" en un brote que afectó a 38 empleados y 14 pacientes, según un estudio en Annals of Internal Medicine publicado inicialmente el 9 de febrero.

Los autores de ese estudio secuenciaron el genoma del virus para confirmar qué casos estaban relacionados y exactamente cómo se diseminó por el hospital.

A medida que los pacientes fueron trasladados de una habitación a otra en los primeros días del brote, covid se propagó entre los compañeros de habitación 8 de cada 9 veces, probablemente a través de la transmisión por aerosol, según el estudio. Una encuesta a los miembros del personal reveló que quienes cuidaban a los pacientes que tosían tenían más probabilidades de enfermarse.

El virus también pareció haber traspasado el equipo de protección apoyado por los CDC. Dos miembros del personal que tuvieron contactos cercanos con pacientes mientras usaban una máscara quirúrgica y un protector facial también se infectaron. Los hallazgos sugirieron que los respiradores N95, más seguros, podrían ayudar a proteger al personal.

Ahora, Brigham and Women's hace la prueba a todos los pacientes al momento de la admisión, y nuevamente poco después. Se anima a las enfermeras a que vuelvan a realizar la prueba si ven un signo sutil de covid, dijo la doctora Erica Shenoy, jefa asociada de la Unidad de Control de Infecciones del Hospital General de Massachusetts, quien ayudó a elaborar las normas en Brigham.

Shenoy dijo que las enfermeras y los trabajadores de los servicios ambientales están sentados a la mesa para la formulación de políticas: "Yo personalmente me aseguro de decir: 'Dime lo que estás pensando'", dijo Shenoy. "'No habrá consecuencias porque necesitamos saber'".

Las pautas de los CDC, sin embargo, dejaron un amplio margen en el equipo de protección y las pruebas. Hasta el día de hoy, dijo Shenoy, los hospitales emplean una amplia gama de políticas.

Los CDC dijeron en un comunicado que sus pautas "proporcionan un enfoque integral y en capas para prevenir la transmisión del SARS-CoV-2 en entornos de atención médica" e incluyen la prueba de pacientes que tienen "incluso síntomas leves" o exposición reciente a alguien con covid.

Las políticas de control de infecciones rara vez son evidentes para los pacientes o visitantes, más allá de si se les pide que usen una máscara. Pero las revisiones de los registros públicos y las entrevistas con más de una docena de personas muestran que en los hospitales con altas tasas de propagación de covid, los miembros del personal a menudo se alarmaban por la falta de prácticas de seguridad.

Enfermeras hacen sonar la alarma sobre la propagación de covid

Cuando covid llegó a Florida en la primavera de 2020, la enfermera Victoria Holland se enfrentó a los gerentes del Blake Medical Center en Bradenton, donde murió Steven Johnson.

Dijo que la suspendieron temprano en la pandemia después de participar en una protesta y "tener un ataque de enojo" cuando se le negó un nuevo respirador N95 antes de un procedimiento que involucaraba la generación de partículas aéreas. Los CDC advierten que estos procedimientos pueden propagar el virus por el aire. Antes de la pandemia, se capacitó a las enfermeras para desechar una N95 después de cada encuentro con un paciente.

Cuando terminó la suspensión, dijo Holland, sintió inseguridad. “No nos dijeron nada”, dijo. “Todo fue un rumor entre los médicos. Si tenías potenciales pacientes con covid obtendrías una pequeña máscara quirúrgica porque [ellos no] querían desperdiciar una N95 a menos que supieran que el paciente era positivo”.

Holland dijo que renunció a mediados de abril. Sus colegas de enfermería presentaron una queja ante la Administración de Salud y Seguridad Ocupacional (OSHA) a fines de junio alegando que al personal que “trabajaba en torno a posibles casos positivos de Covid-19” se le había negado el EPP. Los miembros del personal protestaron frente al hospital en julio y presentaron otra queja de OSHA que decía que el hospital estaba permitiendo que los empleados expuestos a covid siguieran trabajando.

Kirkland, el vocero de Blake, dijo que el hospital respondió a OSHA y "no se identificaron deficiencias".

El análisis de Medicare muestra que 22 de 273 pacientes con covid, o el 8%, fueron diagnosticados con el virus después de ser admitidos en Blake. Eso es aproximadamente cinco veces más alto que el promedio nacional.

Kirkland dijo que "no existe una forma estándar para medir las transmisiones de covid-19 asociadas al hospital" y que "no hay evidencia que sugiera que el riesgo de transmisión en el Blake Medical Center sea diferente al que se encontraría en otros hospitales".

En Washington, D.C., 34 pacientes de Medicare con covid contrajeron el virus en el MedStar Washington Hospital Center, o casi el 6% de su total, muestra el análisis.

Insatisfechos con las prácticas de seguridad, que incluían la esterilización con gas y la reutilización de las N95, miembros de National Nurses United protestaron en el jardín del hospital en julio de 2020. En la protesta, la enfermera Zoe Bendixen dijo que una enfermera había muerto a causa del virus y 50 se habían enfermado: " [Las enfermeras] pueden convertirse en una fuente de transmisión de la enfermedad a otros pacientes, compañeros de trabajo y familiares".

La enfermera Yuhana Gidey dijo que contrajo covid después de tratar a un paciente que resultó estar infectado. Otra enfermera, no el personal que realiza el rastreo de contactos, le dijo que había estado expuesta, dijo.

La enfermera Kimberly Walsh contó en una entrevista que en septiembre de 2020 hubo un brote en una unidad geriátrica donde trabajaba. Dijo que la gerencia culpó a las enfermeras por llevar el virus a la unidad. Pero Walsh señaló otro problema: el hospital no estaba sometiendo a pruebas para covid a pacientes que venían de hogares de adultos mayores, donde la propagación fue desenfrenada el año pasado.

MedStar rechazó una solicitud de entrevista sobre sus prácticas de control de infecciones y no respondió a preguntas específicas.

Si bien los hospitales deben rastrear e informar públicamente las tasas de infecciones persistentes como C. diff, estafilococos resistentes a los antibióticos e infecciones del sitio quirúrgico, no se informan sobre tasas similares de covid adquiridas en el hospital.

KHN examinó una fuente diferente de datos que el Congreso requirió que los hospitales documentaran sobre las "afecciones adquiridas en el hospital". Los datos de Medicare, que indican si cada caso de covid estaba "presente en la admisión" o no, están disponibles meses después de una hospitalización en archivos oscuros que requieren un acuerdo de uso de datos que generalmente se otorga a los investigadores. KHN contó los casos, como lo hacen los funcionarios federales, en algunos casos en los que la documentación se considera insuficiente para categorizar un caso.

Para estos datos, considerar un caso de covid adquirido en el hospital recae en codificadores médicos que revisan las notas de los médicos y los resúmenes de alta y les hacen preguntas a los médicos si el estado no está claro, dijo Sue Bowman, directora senior de política de codificación y cumplimiento de la American Health Information Management Association.

Dijo que los codificadores médicos son conscientes de que los datos se utilizan para medidas de calidad hospitalaria y tendrían cuidado de revisar el rastreo de contactos u otra información en el registro médico.

Si un caso estaba en los datos que utilizó KHN, "eso significaría que fue adquirido durante la estadía en el hospital, ya sea de un trabajador de la salud u otro paciente o tal vez si un hospital permitiera visitas, de un visitante", dijo Bowman. "Esa sería una interpretación justa de los datos".

La alta tasa de muerte para los diagnosticados con covid durante una estadía en el hospital, alrededor del 21%, refleja la tasa de muerte de otros pacientes con covid de Medicare el año pasado, cuando los médicos tenían pocos métodos probados para ayudar a los pacientes.

También destaca el peligro que representa el personal no vacunado para los pacientes, dijo Jain, el médico de enfermedades infecciosas. La Asociación Estadounidense de Hospitales estima que alrededor del 42% de los hospitales de del país han exigido que todos los miembros del personal estén vacunados.

"No necesitamos que [el personal no vacunado] sea una amenaza para los pacientes", dijo Jain. "La administración [del hospital] tiene demasiado miedo de presionar al personal de enfermería, y el público en general no tiene ni idea de la amenaza que representa una persona no vacunada para una población vulnerable".

Cindy Johnson dijo que el hospital donde cree que su esposo contrajo covid enfrentó un escrutinio mínimo en una inspección estatal, incluso después de ella misma informará que su esposo había contraído covid en la instalación. Johnson exploró la posibilidad de demandar, pero un abogado le dijo que sería casi imposible ganar un caso así. Una ley estatal de 2021 requiere que la prueba de "al menos negligencia grave" prevalezca en la corte.

Johnson sí le pidió a un médico que atiende pacientes en el hospital: por favor, quite el gran letrero que dice “ABIERTO Y SEGURO”.

En cuestión de días, el cartel desapareció.

La corresponsal de KHN del Medio Oeste Lauren Weber, contribuyó con este informe.

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As Constituents Clamor for Ivermectin, Republican Politicians Embrace the Cause

When state senators in South Carolina held two hearings in September about covid-19 treatments, they got an earful on the benefits of ivermectin — which many of the lawmakers echoed, sharing experiences of their own loved ones.

The demands for access to the drug were loud and insistent, despite federal regulators’ recent warning against using the drug to treat covid.

Ivermectin is a generic drug that has been used for decades to treat river blindness, scabies and even head lice. Veterinarians also use it, in different formulations and dosages, to treat animals for parasites like worms.

At one of the South Carolina hearings, Pressley Stutts III reminded the panel that his father, a prominent GOP leader in the state, had died of covid a month earlier. He believed ivermectin could have helped him. But doctors at the hospital wouldn’t discuss it.

“I went every bit as far as I could without getting myself thrown in jail trying to save my father’s life,” he told the panel, as lawmakers offered condolences.

“What is going on here?” he asked, with the passion in his voice growing. “My dad’s dead!”

The pleas to public officials have been building. And now politicians are beginning to act, largely to satisfy their conservative constituents.

After the pandemic began, scientists launched clinical trials to see if ivermectin could help as a treatment for covid. Some are still ongoing. But providers in mainstream medicine have rejected it as a covid treatment, citing the poor quality of the studies to date, and two notorious “preprint” studies that were circulated before they were peer-reviewed, and later taken off the internet because of inaccurate and flawed data.

On Aug. 26, the Centers for Disease Control and Prevention advised clinicians not to use ivermectin, citing insufficient evidence of benefit and pointing out that unauthorized use had led to accidental poisonings. Vaccination, the CDC reiterated, is still the best way to avoid serious illness and death from the coronavirus.

But many Americans remain convinced ivermectin could be beneficial, and some politicians appear to be listening to them.

“If we have medications out here that are working — or seem to be working — I think it’s absolutely horrible that we’re not trying them,” said Republican state Sen. Tom Corbin in South Carolina. He questioned doctors who had come to the Statehouse to counter efforts to move ivermectin into mainstream use.

The doctors challenged the implied insult that they weren’t following best practices: “Any implication that any of us would do anything to withhold effective treatments from our patients is really insulting to our profession,” said Dr. Annie Andrews, a professor at the Medical University of South Carolina who has cared for covid patients throughout the pandemic.

Instead of listening to the medical consensus, some politicians in states like South Carolina seem to be taking cues from doctors on the fringe. During one September hearing, state senators patched in a call from Dr. Pierre Kory.

Last year, Kory started a nonprofit called the Front Line COVID-19 Critical Care Alliance, which promotes ivermectin. He said he’s not making money by prescribing the drug, though the nonprofit does solicit donations and has not yet filed required financial documents with the IRS.

Kory acknowledged his medical opinions have landed him on “an island.”

He first testified about ivermectin to a U.S. Senate committee in December. That video went viral. Although it was taken down by YouTube, his Senate testimony prompted patients across the country to ask for ivermectin when they fell ill.

By late August, outpatient prescriptions had jumped 24-fold. Calls to poison control hotlines had tripled, mostly related to people taking ivermectin formulations meant for livestock.

Kory said he has effectively lost two jobs over his views on ivermectin. At his current hospital in Wisconsin, where he runs the intensive care unit two weeks a month, managers called him to a meeting in September, where he was informed he could no longer prescribe ivermectin. He’d been giving it to “every patient with covid,” he said.

“After the pharma-geddon that was unleashed, yeah, they shut it down,” he told the South Carolina lawmakers. “And I will tell you that many hospitals across the country had already shut it down months ago.”

Framing the ivermectin fight as a battle against faceless federal agencies and big pharmaceutical corporations appealed to Americans already suspicious of the science behind the pandemic and the approved covid vaccines.

Kory suggests success stories with covid treatments in other parts of the world have been suppressed to instead promote the vaccines.

In an interview with NPR, Kory said he regrets the flashpoint he helped ignite.

“I feel really bad for the patients, and I feel really bad for the doctors,” he told NPR. “Both of them — both the patients and doctors — are trapped.”

Patients are still demanding the treatment, but doctors sympathetic to their wishes are being told by their health systems not to try it.

Now conservatives in elected office are sensing political payoff if they step in to help patients get the drug. State legislatures, including those in Tennessee and Alaska, are debating various ways to increase access to ivermectin — with proposals such as shielding doctors from repercussions for prescribing it, or forcing pharmacists to fill questionable prescriptions.

The Montana State News Bureau reported that the state’s Republican attorney general dispatched a state trooper to a hospital in Helena where a politically connected patient was dying of covid. Her family was asking for ivermectin.

In a statement, St. Peter’s Hospital said doctors and nurses were “harassed and threatened by three public officials.”

“These officials have no medical training or experience, yet they were insisting our providers give treatments for covid-19 that are not authorized, clinically approved, or within the guidelines established by the FDA and the CDC,” the statement added.

On Oct. 14, the Republican attorney general in Nebraska addressed the controversy, issuing a nearly 50-page legal opinion arguing that doctors who consider the “off-label” use of ivermectin and hydroxychloroquine for covid are acting within the parameters of their state medical licenses, as long as the physician obtains appropriate informed consent from a patient.

Some patients have filed lawsuits to obtain ivermectin, with mixed success. A patient in Illinois was denied. But other hospitals, including one in Ohio, have been forced to administer the drug against the objections of their physicians.

Even as they gain powerful political supporters, some ivermectin fans say they’re now avoiding the health care system — because they’ve lost faith in it.

Lesa Berry, of Richmond, Virginia, had a friend who died earlier this year of covid. The doctors refused to use ivermectin, despite requests from Berry and the patient’s daughter.

They know better now, she said.

“My first attempt would have been to keep her out of the hospital,” Berry said. “Because right now when you go to the hospital, they only give you what’s on the CDC protocol.”

Berry and her husband have purchased their own supply of ivermectin, which they keep at home.

This story is from a partnership that includes NPR, Nashville Public Radio and KHN.

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Few Acute Care Hospitals Escaped Readmissions Penalties

Preventable rehospitalization of the nation’s older adults has proved a persistent health and financial challenge for the U.S., costing Medicare hundreds of millions of dollars each year.

Various analyses have found many readmissions within a month of discharge might have been avoided through better care and more attention paid to the patients after they left the hospital. The federal government’s campaign to reduce the frequency of so-called boomerang patients by applying financial disincentives has entered its 10th year with Medicare’s decision to lower payments to 2,499 hospitals throughout the current fiscal year, which began last month and runs through September 2022.

The Hospital Readmissions Reductions Program (HRRP), created as part of the Affordable Care Act, punishes general acute-care hospitals when more Medicare patients return for a new admission within 30 days of discharge than the government decides is appropriate. The average penalty this fiscal year is 0.64%, with 39 hospitals losing the maximum of 3% of reimbursements.

Over the lifetime of the program, 2,920 hospitals have been penalized at least once. That’s 93% of the 3,139 general acute hospitals subject to HRRP evaluation, and 55% of all hospitals. Moreover, 1,288 have been punished in all 10 years. Only 219 eligible hospitals have avoided any payment reductions since the program’s start in 2013, though more than 2,000 hospitals are automatically exempt from penalties because they have specialized functions: those that focus on children, psychiatric patients, veterans, rehabilitation and long-term care or those that serve as the only hospital in an area.

Hospital readmissions have become less frequent since before the ACA was enacted, and most experts attribute that partly to the financial threat of the penalties, though other factors likely contributed to the improvements. Less debatable is that the penalties have saved the government billions of dollars since their inception. The Centers for Medicare & Medicaid Services estimates that because of the HRRP, Medicare will keep an extra $521 million this fiscal year. You can look up individual hospital penalties using KHN’s interactive tool.

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Laboratorios sin técnicos: por qué los expertos en salud pública están renunciando

Hubo días, noches y fines de semana en los primeros meses de la pandemia en los que Denise Von Bargen era la única persona que realizaba pruebas de covid en el laboratorio de salud pública del condado de Ventura, en California. Supo tener ocho o nueve empleados que la ayudaban. Pero, uno tras otro, todos se retiraron o cambiaron de empleo.

Al igual que otros laboratorios de salud pública en California encargados de las pruebas y la vigilancia de enfermedades a gran escala, el laboratorio de Ventura recibió dinero federal y estatal para nuevos equipos y contrataciones a corto plazo para reforzar su respuesta ante covid-19. Pero el financiamiento fue temporal y Von Bargen, la directora, no pudo usarlo para aumentar los salarios de sus empleados, quienes podían ganar más dinero en el sector privado, con menos trabajo.

Las operaciones se deterioraron aún más en octubre, después que el laboratorio perdiera su licencia para realizar pruebas de rutina que verifican el agua del océano del condado en busca de bacterias mortales. Parece haber sido un error administrativo: el papeleo de la licencia cambió y el personal normalmente responsable de presentar la solicitud había renunciado.

“La mayor amenaza para [los laboratorios de salud pública] en este momento no es el próximo patógeno emergente”, dijo Donna Ferguson, directora del laboratorio de salud pública en el condado de Monterey, “sino que los laboratorios cierren por la falta de personal”.

En todo California, los departamentos de salud pública están perdiendo personal experimentado debido a los retiros, el agotamiento, la política partidista y los trabajos mejor pagos. Incluso antes de que la pandemia de coronavirus drenara los departamentos, la cantidad de personal se había reducido con los presupuestos del condado.

Pero la disminución se ha acelerado durante el último año y medio, incluso cuando se han recibido millones de dólares en dinero federal.

Enfermeras de salud pública, microbiólogos, epidemiólogos, funcionarios de salud y otros miembros del personal que defienden a la población contra enfermedades infecciosas como la tuberculosis y el VIH, inspeccionan los restaurantes y el trabajo para mantener la salud de las comunidades están abandonando el campo.

Es un problema que los aumentos temporales de financiación no pueden solucionar.

La fuga de cerebros está socavando la supervisión de la salud comunitaria a todo nivel, grande y pequeño. Las personas que trabajan en los laboratorios de salud pública, por ejemplo, realizan pruebas complejas para detectar enfermedades mortales que requieren capacitación especializada de la que carecen la mayoría de los laboratorios comerciales.

Si bien su trabajo es en gran parte invisible para el público, afectan a casi todos los aspectos de la sociedad. Los laboratorios de salud pública toman muestras de los mariscos para asegurarse de que sean seguros para comer. Supervisan el agua potable y desarrollan pruebas para detectar amenazas emergentes para la salud, como virus resistentes a los antibióticos. También realizan pruebas para detectar enfermedades graves, como el sarampión y covid. Y, por lo general, lo hacen a una fracción del costo de los laboratorios comerciales, y más rápido.

Los directores de laboratorios públicos generalmente deben tener un doctorado y deben tener las credenciales adecuadas para que sus laboratorios estén certificados.

Ferguson dijo que se siente como si hubiera una puerta giratoria en su laboratorio, ya que los recién graduados universitarios se unen durante unos meses para ganar experiencia, con un salario inicial de $19 la hora, y luego pasan a trabajos mejor pagados en hospitales. Es casi imposible contratar personal calificado para puestos de medio tiempo, como los creados con ráfagas temporales de fondos, debido a la capacitación requerida. En California, muchos puestos de laboratorio requieren un certificado de microbiólogo experto en salud pública del Departamento de Salud Pública.

California tiene 29 laboratorios de salud pública, en comparación con casi 40 antes de la recesión de 2008. Un laboratorio en Merced ha estado sin director durante meses y podría cerrar pronto.

Si bien no hay un recuento oficial de cuánto se ha reducido el campo, casi todos los laboratorios carecen de miembros clave entre su personal, dijo Godfred Masinde, presidente de la Asociación de Directores de Laboratorios de Salud Pública de California, director del laboratorio de San Francisco y director interino del laboratorio del condado de Fresno. Docenas de puestos de microbiólogos de salud pública están vacantes en todo el estado.

“Ahora tenemos financiación; tenemos equipo”, dijo Masinde. “Pero no tenemos el personal para operarlo”.

Su laboratorio de San Francisco generalmente realiza 100,000 pruebas para gonorrea y clamidia cada año, y entre 150 y 200 pruebas para sífilis todos los días, dijo Masinde. Si bien California también tiene laboratorios estatales, señaló, simplemente no tienen la capacidad para relevar a los laboratorios cerrados del condado.

Los condados también están luchando para contratar y retener personal para otros puestos. Una encuesta informal realizada por los directores de enfermería de salud pública de California encontró que al menos 84 enfermeras de salud pública han dejado sus trabajos desde marzo de 2020. Muchas se jubilaron, parte de una fuerza laboral canosa que enfrenta el desafío de reclutar enfermeras en un campo gris que requiere una acreditación especial.

Las enfermeras de salud pública están capacitadas en enfermería y salud comunitaria y, a menudo, trabajan con familias o grupos comunitarios, no solo con clientes individuales.

Realizan visitas domiciliarias después del parto, trabajan en el desarrollo de la primera infancia y ayudan a responder a los brotes de enfermedades infecciosas. “Por lo tanto, brindan un enfoque más holístico y también abordan los determinantes sociales de la salud”, dijo Michelle Curioso, directora de enfermería de salud pública del condado de Kern y presidenta de los directores de enfermería de salud pública de California. Al igual que el personal de laboratorio, las enfermeras de salud pública deben estar especialmente certificadas para trabajar en departamentos de salud pública.

En California, el salario anual promedio de una enfermera registrada es de más de $120,000, según la Oficina de Trabajo y Estadísticas, mientras que los puestos de trabajo de enfermera de salud pública en varios condados ofrecen salarios a partir de $65,000.

La escasez de enfermeras ha sido particularmente grave en las zonas rurales de California. En el condado de Butte, varias enfermeras de salud pública se jubilaron antes de lo esperado, dijo Monica Soderstrom, directora de enfermería de salud pública de Butte. Y dos enfermeras jóvenes que se tomaron una licencia por embarazo decidieron no regresar después de encontrar trabajos con salarios más altos. “Ha sido difícil cubrir nuestros puestos vacantes”, afirmó Soderstrom, “ya que competimos con hospitales y clínicas que pagan bonificaciones de inicio debido a las necesidades de personal por covid”.

La pérdida de los principales líderes de salud del condado (directores de departamentos y funcionarios de salud encargados de liderar la respuesta a la pandemia en las comunidades locales) ha sido particularmente grave, reflejando una tendencia nacional.

Diecisiete de los 58 condados de California han perdido a su oficial de salud desde marzo de 2020, y al menos 27 han perdido a un director o subdirector. El director y el subdirector del Departamento de Salud Pública estatal también renunciaron.

La experiencia colectiva perdida con esas salidas es difícil de exagerar.

Tomemos, por ejemplo, al doctor Robert Bernstein, quien se mudó a California en 2018 para convertirse en oficial de salud del condado rural de Tuolumne después de más de dos décadas trabajando en salud pública para los Centros para el Control y la Prevención de Enfermedades (CDC), la Organización Mundial de la Salud (OMS) y el Departamento de Salud de Florida.

En California, los funcionarios de salud deben ser médicos y están encargados de hacer cumplir los estatutos estatales y locales, y de proteger al público de los peligros para la salud.

En marzo de 2020, justo cuando la pandemia estaba haciendo su primer aumento en todo el estado, la junta de supervisores del condado le pidió a Bernstein que renunciara. Según Bernstein, los supervisores estaban molestos porque había ordenado vacunas contra la rabia para dos niños mordidos por murciélagos, incluido un murciélago que dio positivo por rabia, en contra de los deseos de sus padres. El condado se negó a comentar sobre el asunto, diciendo que está legalmente prohibido discutir asuntos de personal.

Bernstein se mudó al condado de Butte y se convirtió en funcionario de salud después de que su predecesor renunciara en mayo de 2020. Observó cómo sus colegas en los condados vecinos, comenzaban a renunciar uno tras otro, luego de enfrentar amenazas públicas por haber emitido órdenes relacionadas con covid.

En algunas comunidades, los funcionarios de salud pública también enfrentaron un rechazo humillante por parte de los funcionarios electos locales, incluso cuando los líderes policiales se negaban abiertamente a cumplir sus directivas de salud.

“Podrías, como funcionario de salud pública, tener la autoridad y la responsabilidad de recomendar o incluso ordenar ciertas acciones de salud pública”, dijo Bernstein, “pero necesitas una asociación con los que tienen la autoridad para llevarlas a cabo”.

En septiembre de este año, Bernstein estaba desilusionado con la dinámica y la idea de que su familia podría verse atrapada en el rencor de por covid. “Acabo de decidir que, como padre de trillizos de 16 años, no necesito que ni yo ni los niños sean amenazados de ninguna manera, y puedo hacer un buen trabajo de salud pública a nivel estatal, federal o incluso internacional”, dijo Bernstein.

Michelle Gibbons, directora ejecutiva de la Asociación de Ejecutivos de Salud de los Condados de California, dijo que los departamentos locales están viendo los efectos en cascada de esas deserciones de alto nivel, y los gerentes de nivel medio dudan en pasar a puestos de alto nivel, a pesar de que los altos funcionarios pueden obtener salarios de más de $200,000 .

El presupuesto estatal de este año incluyó $3 millones para una evaluación de la infraestructura de salud pública de California, y los líderes de salud pública creen que mostrará que la dotación de personal y la capacitación son problemas importantes.

Aún así, el presupuesto no incluyó fondos adicionales a largo plazo para los departamentos de salud. En medio de titulares negativos y un bombardeo de cabildeo, el gobernador Gavin Newsom finalmente acordó agregar $300 millones al año para la salud pública, un acuerdo de apretón de manos que no está programado para comenzar hasta julio.

Los defensores advierten que el momento es importante: muchos trabajadores de salud pública están esperando a que sus comunidades superen la pandemia y se irán una vez que mejore. “Veremos una gran ola de jubilaciones cuando esto termine”, dijo Kat DeBurgh, directora ejecutiva de la Asociación de Oficiales de Salud de California.

En el condado de Ventura, Von Bargen, agotado por la pandemia, ha estado tratando de jubilarse durante un año. No quería abandonar el laboratorio por el que luchó tanto por mantener abierto, y le tomó tanto tiempo encontrar un reemplazo. Su sucesor comenzará a principios del próximo año, momento en el que Von Bargen también se unirá a las filas de ex empleados de salud pública.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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