Chartis Top Reads – Week of September 5 - September 11, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

20th Anniversary of 9/11

As many tragedies surround us—the continued fight against COVID-19, the aftermath of recent hurricanes as well as enduring fires in the western States— we pause on this 20th anniversary of the terror attacks on September 11, 2001, to remember the events of that day, honor the innocent people who perished, and pay tribute to the first responders and others who sacrificed their own lives in an effort to save others. We commend the medical workers who rushed to be of service only to, tragically, be met with very few patients. We also acknowledge the many who helped clean up and rebuild in the aftermath, and who have since passed away from or continue to suffer with medical complications from their exposure to toxins. We have selected a short list of articles in remembrance, including a piece from The New Yorker with reports from the days following the attacks, published on September 17, 2001. We will never forget. We will always honor.

The State of COVID-19

The Buzz This Week

Pfizer-BioNTech’s COVID-19 vaccine received full approval by the U.S. Food and Drug Administration (FDA) on August 23. Originally approved for emergency use authorization, the vaccine now has full approval for those 16 and older in the U.S. It is the first COVID vaccine to receive full approval and was the fastest vaccine approval in the FDA’s history at just under four months since Pfizer’s filing. Despite the expedited timeline, the process met all FDA standards. Pfizer is now marketing the vaccine under the brand Comirnaty, named for COVID-19 immunity and mRNA, and intended to evoke the “community.”

In the two-and-a-half weeks since the approval announcement, first doses in Americans have increased by 17 percent from just over 400,000 first doses per day to nearly 475,000. Vaccine hesitancy is now at an all-time low, according to one poll from Axios-Ipsos conducted just prior to full FDA approval. The results showed only 20 percent of respondents said they were still unlikely to get the COVID vaccine. In that same poll, more than 30 percent of the surveyed unvaccinated said they would get the vaccination if it received full FDA approval. A second poll, from Langer Research Associates, showed the proportion of participants responding that they are unlikely to get vaccinated at 17 percent. This marks a significant drop in unwillingness from a similar survey conducted in January, which showed more than 30 percent of people said they were unlikely to get vaccinated.

Why It Matters

The full FDA approval is a potential turning point in the fight against COVID-19 for numerous reasons. The COVID vaccine can now be treated exactly the same as any other approved vaccine, meaning it can be required for school and travel, and discussed regularly with providers. Full approval makes it easier for employers and government entities to mandate vaccination. In fact, immediately following the announcement of full approval, the Pentagon shared that it would be making the vaccine mandatory. Numerous companies followed suit, and President Biden encouraged public and private sector leaders to add vaccine requirements. Following full approval, providers are now able to prescribe third dose boosters for the immunocompromised, which may offer those who most need it better protection.

As we shared in August, there are numerous distinct reasons for choosing to wait to be vaccinated, all of which require different tactics to overcome hesitancy. The uptick in first doses is an encouraging sign, though much more work needs to be done to convince those who remain hesitant. Now that the Pfizer vaccine has full approval, the three reasons most cited for being unwilling to get the vaccine, according to polling from Kaiser Family Foundation, are:

Skepticism of COVID, vaccines, and the companies that produce vaccinations. 75 percent of those unwilling to get vaccinated fall into this bucket, and 90 percent of this group are not worried about getting sick and do not believe the vaccines work.

Fear of side effects. 36 percent fear significant side effects, and 31 percent feel the vaccine was moved too quickly through trials.

Belief that the vaccines do not prevent dying and severe disease from COVID. More than 20 percent of those polled believe the vaccines do nothing to prevent severe illness, compared to less than 2 percent of those who are vaccinated.

FDA approval was a vital step and is still needed for additional COVID vaccines, but it is not a replacement for continuing education and vaccine mandates for those who remain vaccine hesitant. While some were waiting for full approval, 82 percent of those who remain unvaccinated say that FDA approval makes no difference in their decision. With just over 50 percent of the country vaccinated, we must focus on addressing remaining concerns of the eligible adult population to limit the impact of a surge in the fall.

Health Ecosystem of the Future

The Buzz This Week

In early August, the United Nations’ Intergovernmental Panel on Climate Change (IPCC) published a devastating report on climate change, a summary of which is outlined in a recent New York Times piece. While the report looks ahead through the rest of this century and beyond, impacts on health are already being felt by the world’s population. Examples of climate-related impacts and related health consequences include but are not limited to:

Extreme heat: High temperatures are dubbed “America’s Deadliest Weather” by the National Weather Service, putting many at risk, particularly the old and frail and/or those who can’t access cooler environments. Farm workers are a population acutely affected by recent heat waves. In California, temperatures have risen over the past decade, with records set this August: 121 degrees in Thermal and 122 degrees in Palm Springs. Ambulances are more frequently being called to fields to treat workers who have heat stroke or other heat-related illnesses. John F. Kennedy Memorial Hospital in Indio, California, had treated 129 heat-related cases as of a Kaiser Health News (KHN) article published on August 23. That’s up from 85 in 2020 (a 52 percent increase) and 75 in 2019 (a 72 percent increase).

Farm workers are disproportionately Latino, and many do not speak English; they also rely on their jobs as the main source of income for their families. Because of this, despite the oppressive working conditions, they are less likely to file complaints. These farm workers received no federal assistance during the pandemic, and therefore, as a representative from United Farm Workers states in the KHN article, “they had no option; they had to keep showing up to work if they wanted to feed their family.”

Forest fires:
Climate change has caused earlier snow melt and higher temperatures in the spring and summer, contributing to drier conditions and increasing the likelihood that a wildfire will spread farther, burn longer, and be more intense. Aside from the direct mortal danger that firefighters face, wildfires and the smoke and particulate matter they produce can cause or exacerbate lung conditions. They can be especially dangerous for those with heart disease, asthma, chronic obstructive pulmonary disease, or other lung conditions, according to the American Lung Association. A study published in August in Science Advances estimated that nearly 20,000 COVID-19 cases were attributable to the effects of increased particulate matter from 2020 wildfires in Washington, Oregon, and California.

Hurricanes:
Aside from the direct loss of life and property caused by the storm itself, the aftermath of the wind force and floods brings increased air pollution and water pollution, causing exposure to toxins and increasing mortality as well as introducing long-term health complications. Loss of air conditioning can lead to heat stress, discussed above, and improper use of generators to restart power and air conditioning can lead to carbon monoxide poisoning.

Why It Matters

For healthcare providers, treating these distressed populations is difficult in itself. Doing so with limited power, structural damage, flooding, reduced staff, supply chain delays, medication shortages, transportation limitations, and insurance restrictions becomes an almost impossible task. In 2016, the Centers for Medicare and Medicaid Services (CMS) put forth a new regulation, The Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule, revised in 2019, aimed at better preparing hospitals for future disasters, including those related to climate change. Insurers have typically relaxed certain restrictions and requirements after a weather-related disaster, such as waiving prior authorization and referral requirements as well as early medication refill restrictions, which government insurers and UnitedHealth Group, Aetna, and Humana did after the recent Hurricane Ida. Still, many hospitals in that storm’s wake struggled to take care of patients as they lost power and experienced flooding, as was described in a recent Modern Healthcare piece. They now wonder whether they will get paid for patients they had to transfer to “non-approved settings” and how their patient payor mix might shift in the future if insurers raise premiums in the long term to manage risk against increasing climate change impact.

Even if healthcare providers are superbly prepared for the medical needs brought on by climate change, some are suggesting that hospitals and health systems should look beyond perfecting their ability to respond. In addition, they should be proactive, taking on responsibility for their contributions to the source of the problem, namely carbon emissions, for which the healthcare system is responsible for 8.5 percent in the United States. Recently, the Department of Health and Human Services (HHS) launched the Office of Climate Change and Health Equity, which will tackle the health impacts of climate change and its effects, including extreme weather and the impact on health. Per a recent article in Fierce Healthcare, the Office “aims to roll out new requirements for hospitals and health systems to cut greenhouse gas emissions and could potentially levy penalties to facilities for failing to do so.”

Some health systems have already started down the path of carbon emission reduction. Kaiser Permanente declared itself the nation’s first “carbon neutral” health system in 2020, achieved through improving energy efficiency in its buildings, installing solar power systems, and investing in carbon offsets. The last category is a way to compensate for emissions rather than eliminating them, which is commendable and realistic with our current technology, though a longer-term goal would be to achieve carbon neutrality primarily through green, renewable, or energy efficient measures, with minimal offsets.

Several experts at Yale University have introduced the concept of “Net Zero Healthcare,” different from carbon neutrality. “The idea [is] that we minimize all of the greenhouse gas emissions resulting from our organization’s activities to essentially zero when accounting for sources and sinks that we influence” Dr. Todd Cort, Faculty Co-Director for the Yale Center for Business and the Environment and the Yale Initiative on Sustainable Finance, explained in a recent Yale Sustainability article. “It is the idea of netting out the positives and the negatives in our emissions so you walk away with, essentially, no impact.” This requires impacting direct emissions from the health system’s operations (“Scope 1”), indirect emissions from utilities paid by the health system (“Scope 2”), and all other emissions (“Scope 3”), including those from manufacturers and transporters in the supply chain and transportation of health professionals and patients—the last of which would be incredibly hard to do effectively and comprehensively.

While the IPCC’s report stresses that there is no time to lose on combating climate change, some efforts on the part of hospitals and health systems may need to wait until COVID-19 is under control. For example, special air purification systems required under new regulatory standards due to the pandemic have increased energy use and emit more carbon—but without a carbon-neutral air purification technology, this increase in emissions is difficult to avoid. Michelle Hood, Executive Vice President and Chief Operating Officer of the American Hospital Association contextualized the situation as follows: “Hospitals and health systems already are undertaking efforts to improve environmental sustainability, although, understandably, their primary focus since January 2020 has been on responding to the public health emergency caused by COVID-19 … Financial penalties would not address the root cause of these issues.” Ms. Hood suggests that an alternate approach would be to convene hospital leaders, regulators, scientists, and subject matter experts to identify effective strategies that would minimize the impact on the environment while also enabling health systems to continue to provide high-quality, safe healthcare.

Regardless of the timing or approach, climate change is certainly going to increase the world’s medical and healthcare needs, and health systems can work to better address those needs as well as help mitigate the contributing factors to climate change.


Contributors

Roger A Ray, MD
Chief Physician Executive
[email protected]

Alexandra Schumm
Principal, Vice President of Research
[email protected]

Abigail Arnold
Senior Research Manager
[email protected]


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Chartis Top Reads - Week of September 5 -… | The Chartis Group