CVIndependent

Sat07042020

Last updateMon, 20 Apr 2020 1pm

When the novel coronavirus hit California, Jamille Cabacungan, a registered nurse at UCSF Medical Center, rushed to sign up as a volunteer to treat infected patients.

She hesitated to answer, however, when asked about her preparation for that job.

The hospital is providing the necessary gear, she said, and more heightened training for some nurses. But not for all—and much of her training is coming from videos forwarded to her by the hospital, as opposed to hands-on learning-by-doing. Her colleagues are depending on her—“we don’t want to put our pregnant co-workers or those who live with elderly people at risk,” she added—but the preparation is less intense than she expected, considering the risk involved.

As California’s coronavirus strategy has moved from containment to mitigation, the health-care workers on the first line of response to the epidemic are also finding themselves on the front line of potential infection. From internal conversations to calls for action from their unions, nurses, first responders and hospital staffers have sounded the alarm, raising questions about the safety protocols and spotlighting flaws and lags in response, both in California and nationally.

“Nurses are eager to take care of patients and make sure that our communities are safe, but we need the right staffing, equipment, supplies, communication and training to do this safely,” Deborah Burger, president of the National Nurses United, which represents about 150,000 nurses around the country, said during a public health roundtable earlier this week. 

“Put simply, if we are not protected, our patients are at risk,” Burger said. 

The union has asked the state to notify nurses when patients sickened by the virus are sent to their health-care facilities. They are also petitioning the state to release a full account of the protective gear in stock statewide, including respirators, and information about where these respirators are stored, citing concerns over a shortage of respirators and other personal protective equipment.

The nurses say that some of the workplace safety guidelines for states recommended by the Centers for Disease Control and Prevention are not rigorous enough to sufficiently protect health care workers and their patients.

Earlier this month, the union released a nationwide survey of 6,500 nurses in which only 29 percent said their hospitals had a plan in place to isolate potential coronavirus patients, and only 44 percent said they had gotten information from their employers about how to recognize and handle the virus.

As sick people turn up in emergency rooms, community clinics and school nurses’ offices, the workers who initially treat them run a high risk of infection. After a Vacaville hospital reported the first U.S. instance of community transmission, and the patient was transferred to UC Davis Medical Center in Sacramento, for example, healthcare workers’ unions reported 124 workers were placed under quarantine. (UC Davis Medical Center later said that number was inaccurate but did not provide an estimate.) Concerns have also been raised about health-care workers inadvertently spreading the virus.

Dr. Sonia Angell, director of the California Department of Public Health, said her department is collaborating with all groups involved in response and checking regularly with hospitals and health care facilities to learn where their needs are.

Gov. Gavin Newsom said Tuesday that the collaboration has extended to health-care workers’ unions.

“We certainly can strengthen those lines of communication, but they are open lines of communication, very directly with the governor himself,” Newsom said.

SEIU-United Healthcare Workers West, which represents nearly 150,000 workers across California, is also asking the state to help increase access to coronavirus testing for both workers and the general public. Spokesman Sean Wherley said the union also wants hospitals to make it easier to track workers sent home for possible exposure to the virus, and to provide clearer follow-up.

“They were sent home as a precaution, but not all of them were tested before they were sent home, so what about the risk posed to their families?” Wherley said.

In California and nationally, testing has been an ongoing issue. Though thousands of Californians are self-monitoring and self-quarantining, only 1,075 people have been tested in the state, with a backlog of about 200 tests, Newsom said Tuesday. Commercial labs are supposed to help relieve some of that load.

Workforce shortage is also a concern. “If each positive patient results in five to 10 workers being sent home, how many times can that happen before you have a staffing crisis?” Wherley said.

The California Hospital Association said healthcare staffing hasn’t become an issue at this point, “but it is certainly something everybody has to be cognizant of,” said Jan Emerson-Shea, a spokesperson for the group.

“The discussion has moved from containment to accepting the fact that this virus is here, so there is certainly some concern about how it will affect staff and the ability to continue operating,” she said.

Newsom’s emergency declaration earlier this month on coronavirus allows health-care workers to come from out of state to fill any gaps should California experience a crisis in staffing. Still, state lawmakers—the majority of whom, like Newsom, were elected with the support of organized labor—have been sensitive to health-care workplace concerns.

“Making sure we protect health care workers is extremely critical, because we depend on these very same health-care workers to take care of the patients who may end up in the hospital,” said Sen. Richard Pan, chair of the Senate Health Committee. “If there are any resources (state public-health officials) need, the Legislature would want to make sure they have those resources.”

CalMatters.orgis a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Local Issues

The federal government now requires hospitals to publish online its “charge description master”—a list of what the hospital charges for various services and items.

When this new policy, which took effect Jan. 1, was announced last year, it was heralded as an overdue move to promote fairness and transparency within our country’s expensive and often-confusing health-care system.

Unfortunately … that’s not how things have turned out.

The Independent decided to see how this new policy is working at the three Coachella Valley hospitals. I dove into my research enthusiastically, easily locating and downloading the charge masters, as these lists are called, from the Eisenhower Medical Center (EMC) and Desert Care Network (DCN) websites.

Then … well, I opened the charge masters. Just as I thought I was gaining useful information, I discovered the downloaded documents, practically speaking, are useless to any layperson who lacks a knowledge of oft-unintelligible medical terminology. It’s also nearly impossible to compare between hospitals, since each uses its own terms and formats.

Download the Eisenhower Medical Center Chargemaster here.

Download the Desert Regional Medical Center Chargemaster here.

Download the JFK Memorial Chargemaster here.

Oh, one more thing: If you have insurance, you and your insurance company aren’t paying the amounts listed on the chargemaster, anyway.

According to the Association of American Medical Colleges: “The hospital charge description master … represents 100 percent of services used by patients in a hospital setting. The use of charge masters began in the early 1950s with the advent of indemnity insurance products; in this environment, hospital rates were set based on billed charges for individual services. As the health insurance industry matured, hospitals moved to payments based on negotiated rates, and the billed charges expressed in the charge master remained largely as a rate schedule for those patients who were private pay or uninsured. … The process for updating the charge master is not intended to ensure that it is a comprehensive document for tracking relative prices. Instead, hospitals focus on adding new services and calibrating highly competitive services rather than updating rates for older services.”

Still … I wanted to ask why the charge masters from our local hospitals were so unwieldly, poorly organized and confusing.

I received no reply from Eisenhower, but I did speak briefly with Todd Burke, California director of communications for Tenet Healthcare, which runs the two valley hospitals within the Desert Care Network: Desert Regional Medical Center in Palm Springs, and JFK Memorial Hospital in Indio. He provided a corporate statement which read: “The hospitals of the Desert Care Network focus on providing high-quality, cost-effective care to all patients we serve. We understand that the costs of health care can be confusing. When looking at the charges posted to our website, it is important to know that the charges posted are a reference price and not the amount that patients or insurers actually pay. When inquiring about actual costs of care, we strongly encourage patients to speak with their insurance provider, or if uninsured or those patients who have Medicare or Medicaid, to speak with the hospital’s financial services department.”

Burke also suggested that I reach out to Jan Emerson-Shea, the vice president for external affairs at the California Hospital Association. So I did.

“You know, people often like to say, ‘Well, I shop for shoes, and I shop for cars, so why shouldn’t I be able to shop for health care, and look at prices ahead of time?’” Emerson-Shea said. “We understand the desire for that level of price transparency, and hospitals are always willing to do the best they can to provide that information. But it’s important for people to understand that these things are different, because you’re talking about a person’s individual health-care needs. So if I happen to have diabetes, and you don’t, we might be having the same health-care procedure, but mine might be more complicated and more expensive due to my pre-existing health condition. People have to understand that everything with health-care pricing is dependent on what your actual needs are as a person, and then it’s also dictated by what your insurance coverage is—and if you are uninsured, California has a decade-old law that limits how much you can be liable for in terms of your hospital care. Depending on your income level, this state law says that hospitals are required to give you either free or discounted care based on a sliding scale. So, really, no patient ever winds up paying the dollar-cost amounts that are shown on any charge master list.”

In other words … all the hospitals in the United States are complying with this requirement to post their charge masters because they’re required to do so, yet everybody involved knows that the charge masters are of no use to anyone in the patient population?

“Yes. That’s exactly right,” she replied.

Where does this leave the discussion about cost transparency within the health-care industry?

“Legally, we are complying with what the laws and regulations require,” Emerson-Shea said. “Is it fair to say that hospitals understand that this information is not very useful, and that we’re looking for ways to make it more useful? Yes. This is not an easy discussion, but I can certainly say that our association is working with our member hospitals to figure out what other options there may be. There are some hospitals in the state that have looked at new technologies to see if there’s a way to put a price estimator on their website that allows patients to go in pre-surgery and enter their information. I think it’s certainly fair to say that there’s a live conversation going on.”

She them summed up the puzzle facing all parties involved.

“If you’re faced with having a procedure done at a hospital, you’ll be going to the hospital where your doctor practices, or you’re being taken to one by an ambulance. … Are you really going to shop around for prices in that situation? I know the California Health Care Foundation has done some research on this question, and they found that, for the most part, consumers are not shopping for health care in that way. … It is not similar to shopping for any other type of a consumer product. Still, I think it’s fair to say that hospitals are looking at how to make this information more useful for patients.”

Published in Features