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Saturday, January 8, 2022

Hospitals' labor expenses rose again just before omicron arrival: report

 

  • COVID-19 hospitalizations rose 25% in November, causing hospital margins to narrow as systems continued grappling with escalating expenses and nationwide labor shortages, according to Kaufman Hall’s latest national hospital flash report out Tuesday.
  • The highly contagious omicron variant hadn’t surged yet in the U.S. in November, though virus concerns drove volume declines month over month across most metrics, the report found.
  • Expense growth continues to outpace revenue growth, with labor expenses in particular continuing to climb. Labor expenses per adjusted discharge were up 2.7% month over month in November, and up 26.4% compared to pre-pandemic levels.


Labor strains continued driving operational and financial challenges for hospitals in November amid the "Great Resignation," as the U.S. job market faces significant churn amid COVID-19.

A record 4.5 million people quit their jobs in November. Healthcare and social assistance workers had the second highest quit rate across all industries at 6.4%, according to preliminary data from the Bureau of Labor Statistics.

"Hospitals are grappling with higher labor costs despite lower staffing levels, due to intense competition for qualified healthcare workers," Erik Swanson, a senior vice president of data and analytics with Kaufman Hall, said in a release on the report. "In addition, the highly contagious Omicron variant could put more pressure on hospitals in months to come."

That, coupled with supply chain issues, continue driving up expenses for hospitals, as per-patient expenses rose across all measures in Kaufman Hall’s report, which uses data from more than 900 hospitals.

And in another stressor, volumes fell slightly during the period despite systems reporting recent rebounds in some service lines, such as emergency departments.

Discharges, adjusted discharges and adjusted patient days decreased 4.8%, 3.9% and 2.4% month over month, respectively.

Higher acuity cases requiring longer stays led average length of stay to increase 0.8% month over month.

But overall, lower volumes drove a slight decrease in total hospital revenues in November, according to the report.

Compared to the month prior, gross operating revenue not including federal relief funding declined 0.6%, inpatient revenue dropped 2.6% and outpatient revenue dropped 0.7%.

However, year-to-date and year-over-year revenues remained elevated compared to both 2019 and 2020 levels for the ninth month in a row.

In a bright spot, hospital operating margins actually improved, up 8.1% from the month prior following two months of sequential declines, the report found.

Though operating margins improved for hospitals in November, it's still down significantly from pre-pandemic levels, with the median change in operating margin down 22.1% compared to November 2019 without including federal relief funding, according to the report.

https://www.healthcaredive.com/news/hospitals-labor-expenses-rose-again-just-before-omicron-arrival-report-fi/616651/

Shockwave upped to Overweight from Equal Weight by Wells Fargo

 Target $235

https://finviz.com/quote.ashx?t=SWAV&ty=c&ta=1&p=d

Nobel Laureate Kahneman Tells You How To Stop Making Bad Decisions

 Few people know how to make a decision better than Daniel Kahneman. He won the 2002 Nobel Memorial Prize in Economic Sciences mastering the art of making a good call.

And most people are pretty bad at it, said Kahneman, 87, whose bestselling book "Thinking, Fast And Slow" summarizes his lifelong findings on decision making. It boils down to this: Most people allow groupthink, poor processes and confusion to muddle their judgment. And poor decision making is all the more prevalent in business. One error repeats: People think they're better at making decisions than they are.

"People are overconfident in their judgments," Kahneman, the world's leading researcher on decision-making told Investor's Business Daily. "They make mistakes because they are generally overly optimistic when they make plans and absolutely believe those plans will come through. Overconfidence in business forecasting is systemic."

Learn Broader Lessons From Your Experiences

Kahneman, professor emeritus at Princeton University, didn't set out to be an expert in decision making. But he found the opportunity from an unlikely place.

He earned a psychology degree from Hebrew University. But after graduation, he started his compulsory military service in the Israeli Defense Force. Among his tasks: Evaluate officer school candidates. He'd watch a group of eight candidates undergo a tough physical exercise that required teamwork. And he'd try to predict who would become good leaders.

Over time, though, he learned he was getting it wrong. Feedback from the leaders' performance in the field showed little link between soldiers' performance in the test and their success. It was his first exposure to this disconnect. He coined the term, "the illusion of validity," to describe it.

As the illusion of validity shows, psychology is imperfect. Kahneman is a perfectionist, though. So his painstaking efforts to improve decisions led to provable breakthroughs. That's because he simply wouldn't publish anything until he knew he found concrete facts. For instance, after receiving his PhD in 1961, he conducted a number of "competent" studies. He believed the findings interesting.

But he never published some of them "because I set myself impossible standards," he once wrote. "In order not to pollute the literature, I wanted to report only findings that I had replicated in detail at least once."

Find Knowledge In Darkness Like Daniel Kahneman

Kahneman's successful career began in a dark place, though. He grew up in France during World War II. His Jewish family hid in various locations around the country until the war's end. And eventually, they emigrated to Palestine.

"I remember it was enormously exciting and exhilarating not to be hunted," Kahneman said. "One of the things I felt during the war is that we were like rabbits. And of course in Israel that changed."

But even in darkness, Kahneman found inspiration. He recounts a time he missed curfew. So he turned his sweater inside out to hide the mandated Jewish star he wore. He was on his way home when a German solder approached. Kahneman tried to avoid him, but couldn't. The soldier picked him up, hugged him, showed him a picture of a boy, presumably his son, and gave Kahneman money.

Kahneman learned right there "people were endlessly complicated and interesting," he said. The random event set Kahneman up for a career thinking outside the confines of psychology. Around the time he graduated from high school, "I was interested in the standard philosophical question, 'Does God exist?'" Kahneman said. But later, "I was more interested in why do people believe God exists, which is a psychological question."

Kahneman: Unlock Opportunities In Shortcomings

As Kahneman dug further into his research, some of his own limitations slowed him down. He learned partnerships with people with skills he lacked would improve his own decisions.

"My aspirations demanded more statistical power and therefore much larger samples than I was intuitively inclined to run," Kahneman said.

So, in the late 1960s, Kahneman began collaborating with a younger colleague, Amos Tversky, whom he described as the smartest person he knew. It was a true partnership. Tversky, who passed in 1996, pioneered research in risk.

"We avoided any explicit division of labor," Kahneman wrote. "Our principle was to discuss any disagreement until it had been resolved to mutual satisfaction." That included any decision, including who to list as the senior author of a published paper. They decided that the old fashioned way: With a coin flip.

Relish Disagreement To Make Better Decisions

"Intense" collaboration, or even disagreement, is not to be avoided, Kahneman says. It's key to solid decision-making.

Kahneman found bouncing opinions off someone else like Tversky stopped flawed thought from being published. The two worked together for more than a decade, most notably in prospect theory and decision making. Ultimately, they found a breakthrough in applying their ideas to business decisions.

This seminal work led to the creation of the field of behavioral economics. This work is cited in Kahneman's Nobel Prize: "For having integrated insights from psychological research into economic science, especially concerning human judgment and decision-making under uncertainty."

"It was a complete accident," Kahneman said of his move into the business realm. "We (Kahneman and Tversky) started collaborating on decision making and some people from the business school." Specifically, they worked with economist and future Nobel Laureate Richard Thaler.

The results are legendary. With the late Tversky and others, Kahneman revealed obstacles that block rational decision making. All sorts of decisions, from hiring to planning, and both individually and in groups are often flawed.

Conquer Bad Decisions In Business Like Daniel Kahneman

Business is rife with bad calls, Kahneman says.

Specifically, new facilities are often built larger than needed. Kahneman suggests "looking at similar plans and similar decisions made in the past to get a more realistic idea of the right direction and reducing the probability of error."

He recommends using statistical models. And he supports using artificial intelligence in some cases to eliminate bias and noise that surround many decisions.

"There is no easy way to correct this (bias)," Kahneman said. "There are better ways and worse ways of planning and making decision. It's always a matter of compromising between analysis and intuitive judgments that are often rash."

Hiring decisions are often flawed. First impressions, both positive and negative, drive who gets an offer. It's what Kahneman calls the halo effect. It's better, he says, to create objective benchmarks.

That is, first decide on the important skills needed by the job. And then create questions that will elicit responses for each desired trait. Finally, score the responses. If meeting deadlines is important, ask about deadlines in an applicant's past. If punctuality is important, ask about that.

It's important, he said, to ask the same questions in the same order to each candidate. And if there is more than one interviewer, Kahneman says, they shouldn't speak to each other. They should make their recommendations independently.

"The way people can fail here is not properly deciding what the correct criteria for a job are," he said.

Stop Groupthink In Meetings

Kahneman also found business meetings to be flawed. Why? The first person to speak at a meeting usually steers the outcome.

To avoid what he calls the "wisdom of the crowd," Kahneman recommends participants "form an opinion in advance." They should then convey that to the chairperson prior to the meeting. Then have the group discuss what everyone said before reaching a final decision.

"This is a way for people to motivate people to form an opinion independent of others. The idea is to get people to reach conclusions in a more disciplined way," he said.

Olivier Sibony, co-author of Kahneman's most recent book, "Noise: A Flaw in Human Judgement," said: "When you look at some of the work Danny did 40 or 50 years ago, it has stood the test of time. That is probably because he was as demanding of himself then as he is now."

Kahneman doesn't get attached to ideas, until he proves them.

"Danny produces brilliant ideas, then he destroys them ... the idea is now better for surviving his scrutiny," Sibony said. "He actually enjoys that process of iteration. It seems there is nothing he likes more than finding a flaw in his own thinking."

Daniel Kahneman's Keys

Connecticut asks nursing homes to accept hospital transfers with COVID-19

 Connecticut is asking nursing homes to accept COVID-19-positive patients discharged from hospitals as the state looks to alleviate the burden on the healthcare system during the latest wave of the pandemic.

New guidance from the Connecticut Department of Public Health says post-acute care facilities, a category which includes nursing homes, should take in patients discharged from a hospital 'regardless of COVID-19 status,' according to a memo dated Jan. 6.

This comes as more than 80 percent of nursing homes in Connecticut are reporting positive cases of COVID-19 among residents or staff, according to The Connecticut Mirror. And while Connecticut has fully vaccinated more than 92 percent of residents aged 65 to 74 and 86.9 percent of those 75 or older, according to data from the state health department, early studies have shown that the mutated omicron variant evades the immunity granted by vaccines more than past strains of the virus.

The new guidance should still give the state's 209 nursing homes enough wiggle room to refuse patients if they can't care for them, said Matthew Barrett, the president and CEO of the Connecticut Association of Health Care Facilities.

“The guidance that came out today, we don’t interpret it initially as in any way undermining a nursing home’s very appropriate authority and ability to refuse a hospital admission, if the nursing home believes it is unable to meet the care needs of the resident due to staffing issues," he told the Mirror. "And staffing issues are present all across the state and especially in Connecticut nursing homes."

A spokesperson for Connecticut Gov. Ned Lamont said if a nursing home refuses a patient, the hospital is responsible for finding another place for the person, according to the CT Mirror.

Guidance from the Centers for Disease Control and Prevention (CDC) recommends that states considering "relief healthcare" facilities must ensure that transferring patients won't compromise those facilities' ability to combat the spread of the virus internally.

Additionally, the facilities must have an "adequate number of trained healthcare professionals, sufficient space to accommodate additional patients, appropriate PPE, and other equipment and supplies to care for these patients," according to the CDC guidance.

The news comes as 82 percent of Connecticut's inpatient hospital beds, including 81 percent of its intensive care unit beds, were occupied as of last week, per data from Johns Hopkins University.

https://thehill.com/homenews/state-watch/588900-connecticut-asks-nursing-homes-to-take-in-hospital-transfers-who-test

Bharat-Ocugen Booster Dose Study Demonstrates Robust Immune Responses and Long-Term Safety

 Ocugen, Inc. (NASDAQ: OCGN), a biopharmaceutical company focused on discovering, developing, and commercializing novel therapeutics and vaccines, announced that its partner, Bharat Biotech, posted positive results from a Phase 2 analysis of the vaccine candidate, COVAXIN™ (BBV152), in participants ages 12-64, receiving a booster dose six months following a second dose on the pre-print server, medRxiv. The analysis found that participants receiving a booster dose saw a significant increase in neutralizing titers, an important predictor of vaccine efficacy.

“As the COVID-19 virus continues to evolve, so does our understanding of the efficacy of vaccines and the critical role they play in protecting people from serious disease, hospitalization and death,” said Dr. Shankar Musunuri, Chairman, CEO and Co-Founder, Ocugen, Inc. “These booster data provide critical information about how COVAXIN™ can be used in the ongoing battle against COVID-19. We are encouraged by these results which continue to suggest that COVAXIN™ remains an important, broad-spectrum vaccine candidate with durability.”

Additional data from the analysis found that more than 75 percent of all participants had a detectible neutralizing antibody response six months post their second dose of COVAXIN™. After receiving the booster, participants also saw an increase in antibody titers (at day 28) that were higher than those achieved after the two-dose primary series. Wild-type neutralizing antibodies (PRNT50) GMTs at one month after a booster dose against Alpha, Beta, Delta and Delta plus variants were increased 10·9, 161·0, 264·7, and 174·2 fold from baseline at six months post second dose, respectively.

“Although protection against severe disease remains high six months following the second dose, a decline in efficacy against symptomatic disease over time and the continued emergence of variants are expected and consistent with what we are seeing with other vaccines. Based on emerging data, a third dose may be beneficial to maintain the highest levels of protection,” said Huma Qamar, MD, MPH, CMI, Associate Vice President, Clinical Development, Ocugen, Inc.

The booster dose analysis also found no serious adverse events, including hospitalization or death, were reported.

About COVAXIN™ (BBV152) COVAXIN™ (BBV152) is an investigational vaccine candidate product in the U.S. It was developed by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR) - National Institute of Virology (NIV). COVAXIN™ (BBV152) is a highly purified and inactivated vaccine that is manufactured using a vero cell manufacturing platform.

https://www.kulr8.com/news/money/covaxin-bbv152-booster-dose-study-demonstrates-robust-immune-responses-and-long-term-safety/article_2fb74a3f-fa5b-5348-8719-e85e9444d686.html

How China is keeping to its strict 'zero COVID' strategy

 The distressing case of a pregnant Chinese woman miscarrying after a strict lockdown delayed her access to medical treatment has reignited debate over the limits of China's zero-tolerance approach to COVID-19.

The country where the coronavirus was first detected in 2019 is now among the last places still hewing to "zero COVID", placing millions under quarantine even as Beijing prepares to host next month's Winter Olympics.

How is China maintaining 'zero COVID'?

China has a formula it calls "dynamic zero" for curbing outbreaks: strict lockdowns and immediate mass testing.

Unlike softer lockdowns elsewhere, people in China can be banned from leaving their buildings or forced to remain inside hotel rooms if they are considered high-risk contacts.

The historic city of Xi'an, home to the famed Terracotta Warriors, was locked down in December, forcing its 13 million residents indoors after around 150 cases were detected.

The similarly sized city of Zhengzhou tested every resident after just 11 cases.

International flights are a fraction of pre-pandemic levels with arrivals undergoing strict weeks-long quarantine.

Mandatory track-and-trace apps mean close contacts are usually detected and quarantined quickly.

Does it work?

China's official tally since the start of the pandemic—just over 100,000—is a fraction of the record one million cases logged by the US in a single day earlier this month.

The official death toll has stayed under 5,000.

Although cases from the chaotic initial outbreak in Wuhan in early 2020 are widely believed to have been under-reported, life since then has largely returned to normal.

"There is still no ability to stop single local cases from appearing, but we have the ability and confidence to quickly extinguish the outbreak when a local case is found," National Health Commission official Liang Wannian told reporters last month.

Who pays the price?

"Zero COVID" comes at a cost.

Border areas, especially near Myanmar, have endured almost constant lockdowns and seen an exodus of businesses.

Locked-down communities have complained of poor access to food, supplies and .

Meanwhile, migrant workers have been left stranded from families for months due to onerous travel rules and restrictions.

Heavy-handed enforcement has sometimes sparked outrage, such as when health workers beat a corgi to death after the owners were sent to quarantine.

Analysts say repeated shutdowns of factories and businesses have contributed to the country's slowdown, despite China being the only major economy to expand in 2020.

Will China ever reopen?

"China certainly has shown it is feasible to continue the zero COVID strategy almost indefinitely," Ben Cowling, an epidemiologist at Hong Kong University, told AFP.

The country effectively cut itself off from the world in March 2020 and virtually banned foreigners from entering.

Since then,  have eased slightly.

But international tourism is non-existent and the government has said it will not renew expiring Chinese passports unless the holder has a good reason for travel.

The country will not reopen until at least after the upcoming Winter Olympics and Paralympics in Beijing, with the government anxiously guarding the capital and tightening restrictions ahead of the Games.

Those who question "zero COVID" have faced a nationalistic backlash.

Prominent Chinese medical expert Zhang Wenhong wrote in July that countries must eventually "learn to coexist with the virus"—prompting attacks from online trolls.

What will happen if China opens up?

Peking University researchers have warned China could suffer a "colossal outbreak" that would overwhelm its medical system if it relaxed restrictions to a similar level as Europe and the US.

But Ivan Hung, an infectious diseases expert at Hong Kong University, said second generation vaccines targeting the Delta and Omicron variants—as well as close to 100 percent vaccination rates—could ward off a disaster.

In this scenario, "it's likely that COVID will turn out to be similar to influenza," Hung said.

But letting the virus in could be risky for President Xi Jinping as he seeks a third term in October after billing himself as a leader that will always keep China safe.

"When it does come, the transition may not be easy because Chinese society has gotten quite used to a low level of transmission," University of Oxford's Thomas Hale told AFP.

https://medicalxpress.com/news/2022-01-china-strict-covid-strategy.html

Virus testing shortages and delays help fuel surge

 The difficulty finding coronavirus test kits in many parts of California and delays in getting results are causing increasing frustration and contributing to the surge of infections that in just two weeks more than doubled the number of people in hospitals with COVID-19.

Negative  results can be a necessity for any number of activities, from going to work to boarding an airplane or attending a sporting event. Delays in getting results—or inability to find a —can mean people with very mild or no symptoms may presume they are not infected and go about their usual routines.

"If you are tested and you're positive then you know you need to isolate," said Abraar Karan, an infectious diseases doctor at Stanford University. "If you can't get tested, and you don't have the luxury to just quarantine without knowing, sure, you may have people going out and infecting others."

The surge of cases in California has led to a soaring demand for tests that in many places simply can't be found. Some county mail-in testing programs have been halted due to exploding demand. In places where tests are available, people sometimes have to wait in line for several hours.

Kirsten Bibbins-Domingo, an epidemiology professor at University of California, San Francisco's , said she heard one lab was taking nine days to return results—longer than someone exposed to COVID-19 may have to quarantine.

"If you are trying to do the right thing, and you decided to wait in line to get a test, having a long time to get actionable information is not helpful," she said. "It's sort of absurd."

Some people have resorted to paying $100 or more for a rapid result—something many can't afford.

Shane Hirschman, a 36-year-old from San Clemente, said he ordered a mail-in test kit from the Orange County health agency last week but never received one. When he started feeling sick this week, he said he couldn't find an at-home kit in stores and testing appointments at nearby pharmacies were booked. He wound up paying nearly $100 for a rapid test to confirm he didn't have the variant.

"They've had a year and a half to sort this out and it shouldn't be like this," he said. "I don't feel like I can pay 100 bucks every day."

In Los Angeles County, where a quarter of the state's nearly 40 million people live, overwhelming demand prompted a temporary halt to a program that allowed people to test at home and mail back their sample. Public health director Barbara Ferrer said she hopes the testing crunch will ease in coming days. In the meantime, she urged restraint.

"Please don't decide that because you didn't get tested, you don't have COVID and you don't have to stay home if you've got symptoms," she said. "We do ask while we're trying to increase testing capacity and make it much easier for everyone who need to test to get a test that you please stay home while you're symptomatic."

California, like the rest of the country, has been overtaken by the omicron variant, which spreads more easily than other coronavirus strains. It also more easily infects those who have been vaccinated or had previously been infected by prior versions of the virus, though it appears less likely to cause severe illness.

Since Christmas, more than 5,000 people in California have been admitted to hospitals with COVID. In many cases, they went in for something else and only learned they were infected upon testing.

State models used to forecast the impact of the virus show that within a month California could have a record 23,000 people in hospitals with COVID.

Orange County, the state's third most populous with more than 3 million residents, is among a growing number of places where hospitals are becoming strained by the flood of COVID patients coupled with a high number of nurses and other workers who are not on the job because they are infected or quarantined due to exposure to the virus.

Dr. Regina Chinsio-Kwong, the county's deputy health officer, said many hospitals have resorted to using tents to triage patients, something not seen since a year ago when the state was in the throes of its deadliest surge. Ambulances are waiting nearly an hour to drop off patients.

"It is a dire situation right now," she said.

https://medicalxpress.com/news/2022-01-virus-shortages-fuel-surge.html